2019 Krok 2 Booklet Qs 1-50 Highlights and Explanation

A complete compilation of Questions 1-50 from the 2019 krok 2 Booklet with answers, with explanations and highlight to help with studying.


You can navigate to any of the other 2019 Krok Booklet Parts/sections/questions via the bellow links:


Answers contain an “*” on the answer.


1. Human body receives from atmosphere a number of chemicals. What type the of action results in the combined effect that is less than the sum of isolated effects of these chemicals on the body?

A. Synergistic action
B. Complex action
C. Isolated action
D. *Antagonism
E. Potentiation


2. A 30-year-old woman came to the gynecological department. She complains of sharp pain in her lower abdomen and temperature of 38.8°C. She has a history of extramarital sexual activity and 2 artificial abortions. On gynecological examination the uterus is unchanged. The appendages are bilaterally enlarged and painful. Profuse purulent discharge is being produced from the vagina. What examination needs to be conducted to clarify the diagnosis?

A. *Bacteriological and bacterioscopic analysis
B. Laparoscopy
C. Colposcopy
D. Hysteroscopy
E. Curettage of the uterine cavity

3. A 16-year-old patient has made an appointment with an otolaryngologist. He complains of elevated body temperature and sore throat. Disease onset was 2 days ago after the patient ate two portions of ice-cream. Pharyngoscopy shows hyperemic mucosa of the palatine tonsils, with purulent exudate in the lacunae. Make the provisional diagnosis

A. Pseudomembranous (Vincent’s) tonsillitis
B. Acute pharyngitis
C. Diphtheria → NO gray unremovable  exudate
D. *Lacunar tonsillitis → Membranous Tonsillitis
E. Follicular tonsillitis



Image result for Lacunar tonsillitis or follicular


4. At the railroad crossing a passenger train collided with a bus. In this collision 26 bus passengers died, another 18 passengers received mechanical injuries of varying severity. Where will be professional medical aid provided for the victims of this accident? Who will provide this aid?

A. At the site of the accident; specialized second-response emergency teams → First aid 
B. In medico-prophylactic institutions; specialized second-response emergency teams → First aid 
C. *In medico-prophylactic institutions general physicians and surgeons → Prof
D. At the site of the accident; first-response emergency teams → First aid 
E. In medical institutions: all listed types of healthcare workers → First aid 


5. A 35-year-old man complains of rapidly increasing fatigue, palpitations, “visual snow and dizziness. He has a history of peptic ulcer of the stomach. Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic murmur is detected over the cardiac apex, heart rate is 100/min., BP is 100/70 mm Hg. The epigastrium is slightly tender on palpation. Blood test: erythrocytes .3.2.1017/L, Hb. 100 g/L, color index – 0.95 What type of anemia is the most likely present in this case?

A. Hemolytic anemia
B. Sideroblastic anemia
C. Hypoplastic anemia
D. *Posthemorrhagic anemia
E. Chronic iron-deficiency anemia


6. A 63-year-old man complains of unmotivated weakness and pressing and bursting sensation in the left subcostal area. According to him, these signs have been present for a year already. Previously he was healthy. He took part in containment measures during the accident at the Chornobyl Nuclear Power Plant. Objectively the skin is pale, peripheral lymph nodes are not enlarged, the liver is +3 cm, the spleen is +10 cm. Complete blood count: erythrocytes – 3.1 . 109/L, Hb- 100 g/L, leukocytes. 46. 10°/L, blasts -2%. promyelocytes – 10% myelocytes – 18%, band neutrophils – 27% segmented neutrophils – 10%, lymphocytes – 12%, eosinophils – 6%, basocytes – 3%, monocytes – 2%, erythrocyte sedimentation rate – 20 mm/hour. What is the most likely diagnosis?


A. Hepatic cirrhosis
B. Chronic lymphatic leukemia
C. Acute leukemia
D. *Chronic myeloleukemia
E. Hemolytic anemia



myelocyte is a young cell of the granulocytic series, occurring normally in bone marrow (can be found in circulating blood when caused by certain diseases).

Chronic myelogenous leukemia (CML) is an uncommon type of cancer of the bone marrow — the spongy tissue inside bones where blood cells are made. CML causes an increased number of white blood cells in the blood.

The term “chronic” in chronic myelogenous leukemia indicates that this cancer tends to progress more slowly than acute forms of leukemia. The term “myelogenous” (my-uh-LOHJ-uh-nus) in chronic myelogenous leukemia refers to the type of cells affected by this cancer.

Chronic myelogenous leukemia can also be called chronic myeloid leukemia and chronic granulocytic leukemia. It typically affects older adults and rarely occurs in children, though it can occur at any age.


7. A 57-year-old patient complains of dyspnea at rest. The patient presents with orthopnea. acrocyanosis, bulging cervical veins. On percussion: dull sound over the lower lung segments. On auscultation: no respiratory sounds. Heart rate is 92/min. Right-sided cardiac dilatation is observed. The liver is +7 cm. Shins are swollen. Pleural effusion is suspected. What indicator would confirm the presence of transudate in this case?

A. *Total protein content in the pleural fluid below 25 g/L
B. Positive Rivalta’s test
C. Specific gravity exceeding 1015
D. Total protein content in the pleural fluid exceeding 30 g/L
E. Presence of atypical cells



Image result for transudate and exudate

Transudates are also associated with hypoalbuminemia, nephritic syndrome, and peritoneal dialysis. Transudates are characterized by pleural fluid/serum total protein ratio of 0.5 or less and a pleural fluid/serum LDH ratio of 0.67 or less


8. To assess the effectiveness of medical technologies and determine the power and direction of their effect on the public health indicators, the research was conducted to study the immunization rate of children and measles incidence rate by district. What method of statistical analysis should be applied in this case?

A. Calculation of matching factor
B. Calculation of standardized ratio
C Calculation of morbidity Index among the nonvaccinated
D. Calculation of statistical significance of the difference between two estimates
E *Calculation of correlation coefficient


9. A 59-year-old woman was brought into the rheumatology unit. Extremely severe case of scleroderma is suspected. Objectively she presents with malnourishment, mask-like lace, and acro-osteolysis. Blood: erythrocytes 22. 10°, erythrocyte sedimentation rate 40 mm/hour. Urine: elevated levels of free Oxyproline. Name one of the most likely pathogenetic links in this case:


A. Formation of antibodies to native DNA
B, *Formation of antibodies to collagen
C. Formation of antibodies to transversal striated muscles
D. Formation of antibodies to vessel wall
E. Formation of antibodies to blood corpus



Oxyproline is one of the major collagen amino acids, which enables it to be regarded as a marker that reflects the catabolism of this protein. The purpose of this investigation was to ascertain the diagnostic value of free oxyproline in patients with hereditary and acquired collagenoses.


10.A 10-year-old boy was brought to the hospital with complaints of expiratory dyspnea, respirations are 30/min. He explains his state by a change in the weather conditions For the last 4 years the boy has been registered for regular check-ups due to his diagnosis of third degree persistent bronchial asthma. To provide emergency aid for this child, first he needs to be given:

A. *Salbutamol or short-acting B2-agonists →  short-acting and our question asks for first aid
B. Claritin (Loratadine)  →  Anti Allergic & long acting
C. Dexamethasone
D. Adrenaline →  not indicated
E. Euphylline (Aminophylline) →  long acting bronchodilator


11. A newborn has Apgar score of 9. When should this infant be put to the breast?

A. *In the delivery room
B. On the 3rd day
C. On the 2nd day
D. After 2 hours
E. After 12 hours


12. A 55-year-old woman complains of pain and popping sounds in her left knee joint, which occur when she climbs the stairs. Occasionally during movements her joint becomes “stuck” 5 years ago she suffered a trauma of her left knee. Complete blood count and biochemical blood analysis show normal results. X-ray shows marked osteosclerosis and osteophytes. The joint space is narrowed. Make the provisional diagnosis:

A. Reactive arthritis
B. Psoriatic arthritis
C. *Osteoarthritis
D. Gouty arthritis
E. Rheumatoid arthritis


Osteoarthritis is Degenerative(after injury), unilateral, and her age

Image result for ra vs oa

Image result for ra vs oa


13. A 40-year-old man. a welder, uses manganese electrodes in his line of (18 years of experience). He complains of gait abnormalities, problems with speech and hand tremors. Objectively the following is observed in the patient hypomimia Increased muscle tone of plastic type, and quiet monotonous speech, tremor of the tongue, pill-rolling tremor of the fingers, and retropulsion. What syndrome developed in this patient due to manganese poisoning?

A. Vestibular syndrome → is acute and our case took 18 yrs
B. Polyneuritic syndrome
C. Hypothalamic syndrome → No weight changes with endocrine disorders
D. Meningism → No meningial Sign
E. *Parkinsonism



Vestibular disease refers to a sudden, non-progressive disturbance of balance.” Vestibular disease refers to a sudden, non-progressive disturbance of balance. It is more common in older dogs. It is also referred to as old dog vestibular syndrome and canine idiopathic vestibular syndrome.


signs/symptoms of polyneuropathy

Parkinson’s signs and symptoms may include:
  • Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. …
  • Slowed movement (bradykinesia). …
  • Rigid muscles. …
  • Impaired posture and balance. …
  • Loss of automatic movements. …
  • Speech changes. …
  • Writing changes.


14. A 45-year-old man developed constricting retrosternal pain that occurs during walks at the distance of 200 m. Objectively, heart rate is 80/min., BP is 160/90 mm Hg During cardiopulmonary exercise test at 50 W there is a depression of S-T segment by 3 mm below the isoline in V3-V4. What is the provisional diagnosis?

A. Exertional angina pectoris, functional class IV
B. *Exertional angina pectoris, functional class III
C. Alcoholic myocardiodystrophy → Not indicated
D. Exertional angina pectoris, functional class II
E. Somatoform autonomic dysfunction, hypertension type → Not indicated


15. A 13-year-old girl for the last two weeks has been complaining of dyspnea and shin and foot edemas that appear after a physical exertion. In the morning the edemas significantly decrease. Clinical examination revealed enlarged liver and coarse systolic murmur over the heart area. Blood tests and urinalysis are without changes. What is the most likely cause of edemas in this child?

A. Angioneurotic edema
B. Hepatic cirrhosis
C. *Heart failure → Right sided heart failure hepatomegally(ascites) and peripheral Edema.
D. Acute pyelonephritis → No fever no leucocyteuria
E. Nephrotic syndrome → Edema with albuminUria (urinalysis changes), dyslipidemia and protein uria > 3



Image result for renal vs cardiac edema

Image result for renal vs cardiac edema


16. A 14-year-old girl came to the general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after the previous delay of 2 months. Objectively: the skin is pale, heart rate is 90/min., BP is 110/70 mm Hg. Hb is 88 g/L. Rectal examination the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?

A. *Posthemorrhagic anemia
B. Dysmenorrhea → Painful menstruation (cramps)
C. Somatoform autonomic dysfunction of hypotonic type
D. Migraine
E. Gastritis


17. Heart X-ray of a 31-year-old man has revealed the following with tightly field opacified esophagus there is a marginal filling defect in its middle third on the posterior wall; the defect is 1.8×1.3 cm in size with clear oval border. Mucosal folds are retained and envelop the defect; wall peristalsis and elasticity are not affected. There are no complaints regarding the condition of the patient’s alimentary canal. Make the provisional diagnosis

A. Barrett esophagus → Caused by GERD
B. Diverticulum → poutch and comes with fever
C. Esophageal burns
D. *Esophageal tumor
E. Achalasia cardiae → Narrowing of lower part of esophagus (bird beak sign or rat tail sign)


Barrett’s esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from normal stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine, and large


18. For three years a 31-year-old woman has been complaining of pain and swelling of her radiocarpal and metacarpophalangeal articulations and their reduced mobility in the morning, which persisted up to 1.5 hours Two weeks ago she developed pain, swelling, and reddening of her knee joints, her body temperature increased up to 375°C. “The treatment was untimely. Examination of the internal organs revealed no pathologic alterations. Diagnosis of rheumatoid arthritis was made. What changes are most likely to be visible on the arthrogram?

A. Joint space narrowing. subchondral osteosclerosis
B. Numerous marginal osteophytes
C. *Joint space narrowing, usuration
D. Cysts in the subchondral bone
E. Epiphyseal osteolysis


An arthrogram is an X-ray image or picture of the inside of a joint (e.g. shoulder, knee, wrist, ankle) after a contrast medium (sometimes referred to as a contrast agent or “dye”) is injected into the joint.


19. A 58-year-old man complains of weakness and tumor-like formations that appeared on the anterior surface of his neck and in the inguinal region. Palpation detects soft painless mobile cervical and inguinal lymph nodes up to 2 cm in diameter. The liver protrudes by 2 cm from the edge of the costal margin, the lower splenic pole is at the umbilical level. In blood: erythrocytes – 3.5 – 10/1, Hb-88 L leukocytes – 86. 10/L, band neutrophils – 1% segmented neutrophils – 10%, lymphocytes – 85%, eosinophils – 2%, basocytes – 0%, monocytes – 2%, erythrocyte sedimentation rate – 15 mm/hour, Gumprecht shadows. What is the most likely diagnosis?

A. Lymphogranulomatosis
B. Lymphocytic leukemoid reaction
C. *Chronic lymphocytic leukemia
D. Acute leukemia
E. Chronic myeloid leukemia


Smudge cells (Gumprecht shadows) are chronic lymphocytic leukaemic cells ruptured during peripheral blood smear


20. A 20-year-old man, a calibrator of dosimetry equipment committed gross violation of safety regulations when he put two ampoules with cobalt-60, each with the Radioactivity of 7 MCi In the pockets of his trousers and jacket. He has been keeping the ampoules in his pockets for hours. The tissues at the distance of 0.5 cm from the Source received the done of 30 Gy (3000 R). while the tissues at the distance of 20 cm 2R Did this man develop radiation sickness

A. Yes, he developed a moderate form of acute radiation syndrome
B. *No, he did not
C. Yes, he developed chronic syndrome radiation
D. Yes, he developed a severe form of acute radiation syndrome
E. Yes, he developed a mild form of acute radiation syndrome


21. A 46-year-old woman has diarrhea with abdominal distension, loss of body mass, and large amounts of porridge-like foul smelling stool without blood streaks or tenesmus. Objective examination detects moderate tenderness in the mesogastrium and left-abdominal flank. Feces analysis detects steatorrhea with neutral fat and creatorrhea. What prescription would be the most advisable in this case?

A. Antacids and antispasmodics
B. Cholinergic antagonists and antibacterial agents
C. Cholinergic antagonists
D. *Multi-enzyme preparations
E. Metronidazole and loperamide



steatorrhea with neutral fat and creatorrhea indicate lack of enzymes to digest fat.


22. After overexposure to cold a 45-year old woman developed acute pain in her suprapubic and lumbar areas during urination sharp pains at the end of urination, false urges to urinate. Urine is turbid with blood streaks. The doctor suspects urinary tract infection. What results of laboratory analysis would be the most indicative of such infection?

A. Daily proteinuria under 3.0
B. Increased blood creatinine and blood urea
C. Daily proteinuria over 3.0
D. *Leukocyturia, gross hematuria
E. Gross hematuria


23. A 32-year-old woman complains of body weight loss despite her increased appetite, nervousness, and tremor of the extremities. Objectively: the skin is moist: the thyroid gland is diffusely enlarged, painless, soft, and mobile. Blood test: increased level of T3, T4, and thyroid-stimulating hormone (THS). What is the most likely diagnosis?

A. *Diffuse toxic goiter
B. Autoimmune (Hashimoto’s) thyroiditis →  period of hyper followed by hypothyroidism
C. Diffuse nontoxic goiter → No hyperthyroid function just an enlarged gland
D. Thyroid carcinoma
E. Thyroid adenoma


24. A 48-year-old woman has been hospitalized due to the development of tachysystolic atrial fibrillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?

A. Autoimmune thyroiditis
B. Chronic thyroiditis
C. Nontoxic nodular goiter
D. *Toxic nodular goiter
E. Aterosclerotic cardiosclerosis


25. A 19-year-old young man complains of cough with expectoration of purulent sputum in the amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37.8°C, general weakness, weight loss. The patient’s condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition. pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, numerous various moist crackles in the lower pulmonary segments on the left can be observed. In blood: erythrocytes – 3.2 . 1012/L, leukocytes – 8.4. 10°/L, ESR-56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?

A. Chronic abscess of the left lung
B. *Multiple bronchiectasis of the left lung
C. Left-sided pulmonary cystic dysplasia
D. Chronic left-sided pneumonia
E. Suppuration of the cyst in the left lung


26. A 30-year-old man came to the family physician. 2 months ago he underwent surgery for an open fracture of the humerus. On examination the patient’s condition is satisfactory, in the area of the postoperative wound there is a fistula that discharges a small amount of pus; the area itself is red: fluctuation is detected. X-ray shows destruction of the humerus with sequestra. What complication did the patient develop during the postoperative period?

A. Wound suppuration
B. Suture sinus
C. Posttraumatic phlegmon → Inflamed tissue and superficial
D. Hematogenous osteomyelitis
E. *Posttraumatic osteomyelitis → Deeper than tissue


Osteomyelitis is an infection of the bone, a rare but serious condition. Bones can become infected in a number of ways: Infection in one part of the body may spread through the bloodstream into the bone, or an open fracture or surgery may expose the bone to infection.


27. After eating shrimps, a 25-year-old man suddenly developed skin itching, some areas of his skin became hyperemic or erupted into vesicles. Make the diagnosis:

A. Psoriasis → No relevant history & not sudden
B. Urticaria pigmentosa
C. *Acute urticaria → Sudden
D. Scabies → Itching in palms & not sudden
E. Hemorrhagic vasculitis (Henoch-Schonlein purpura) → not sudden


Urticaria pigmentosa (also known as generalized eruption of cutaneous mastocytosis (childhood type) ) is the most common form of cutaneous mastocytosis. It is a rare disease caused by excessive numbers of mast cells in the skin that produce hives or lesions on the skin when irritated.

28. A woman came to the doctor with complaints of increased body temperature up to 378°C and moderately sore throat for the last 3 days. Objectively: mandibular lymph nodes are enlarged up to 3 cm. Palatine tonsils are hypertrophied and covered with gray coating that spreads to the uvula and anterior pillars of the fauces. What is the most likely diagnosis?

A. Agranulocytosis
B. Infectious mononucleosis
C. Oropharyngeal candidiasis
D. Pseudomembranous (Vincent’s) tonsillitis
E. *Oropharyngeal diphtheria


29. Indicators of work of inpatient departments in the city hospitals for the past year were analyzed. After that the meeting was held at the central city hospital and, based on the results of the analysis, a decision was made to decrease the number of beds in the inpatient departments, and instead open daycare units with partial hospitalization in the city polyclinics. What is the main goal of this decision?

A. *Rational use of the bed fund
B. Decrease of the length of inpatient stay
C. Optimization of the average bed occupancy rate per year
D. Intensification of the bed fund usage
E. Decreased mortality during inpatient treatment


30. A 30-year-old woman made an appointment with the family doctor for a scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?

A. Tertiary healthcare
B. *Primary healthcare
C. Secondary healthcare
D. Emergency aid
E. Palliative care

Image result for primary secondary and tertiary healthcare

Image result for primary secondary and tertiary healthcare


31. A 2-year-old child with persistent cough and subfebrile body temperature after a case of URTI developed dyspnea, cyanosis of the nasolabial triangle, percussion dullness and weakened respiration in the lower lobe of the right lung, and a slight mediastinal displacement to the left. What pulmonary pathology is likely to cause this clinical presentation?

A. Emphysema
B. Atelectasis
C. *Pleurisy
D. Bronchitis
E. Pneumonia → needs presence rales or crackles


32. A 30-year-old multigravida has been in labour for 18 hours. 2 hours ago the pushing stage began. Fetal heart rate is clear, rhythmic, 136/min. Vaginal examination reveals complete cervical dilatation, the fetal head in the pelvic outlet plane. Sagittal suture is in line with obstetric conjugate, the occipital fontanel is near the pubís. The patient has been diagnosed with primary uterine inertia. What are the further tactics of labor management?

A. Cesarean section
B. Labour stimulation
C. *Outlet forceps
D. Vacuum extraction of the fetus
E. Skin-head Ivanov’s forceps


Fetal heart rate is clear, rhythmic, 136/min indicates fetus is not indestress


33. A 40-year-old man with Bekhterev disease (ankylosing spondylitis) complains of elevated body temperature up to 37.8°C, back pain and stiffness, especially observed during the second half of the night. This condition has been lasting for 2 years. Objectively: reduced spinal mobility, painful sacroiliac joint, erythrocyte sedimentation rate – 45 mm/hour. X-ray shows narrowing of the intervertebral disc space and of the sacroiliac joint. What eye pathology is often associated with this type of disease progression?

A. Cataract
B. *Iridocyclitis
C. Blepharitis
D. Retinal detachment
E. Optic nerve atrophy


Iridocyclitis is an inflammation of the iris (the colored part of the eye) and of the ciliary body (muscles and tissue involved in focusing the eye). This condition is also called “anterior uvetitis” and “iritis”.


34. In the air of the feed kitchen at the poultry factory at the area where formula feed is being mixed, the dust concentration reaches 200 mg/m”. Air microflora is represented predominantly by Aspergillus and Mucor fungi. What effect determines pathogenic properties of the dust?

A. *Allergenic
B. Mutagenic
C. Toxic
D. Teratogenic
E. Fibrogenic


Aspergillus and Mucor fungi molds causing allergy


35. A 25-year-old woman was brought into the gynecological department with profuse bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the last 3 days she was experiencing pains in her lower abdomen that eventually started resembling cramps, she developed bleeding. Her skin is pale, pulse 88/min., blood pressure – 100/60 mm Hg, body temperature – 36.8°C. Vaginal examination: the uterus size corresponds with 11 weeks of pregnancy, the cervical canal allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is bloody and profuse. What is the most likely diagnosis?

A. *12-week pregnancy, spontaneous abortion in progress
B. Full-term pregnancy, term labor
C. 12-week pregnancy, threatened spontaneous abortion
D. Disturbed menstrual cycle, amenorrhea
E. Disturbed menstrual cycle, hyperpolymenorrhea


36. A 7-year-old boy has severe pulmonary mucoviscidosis (cystic fibrosis). He complains of dyspnea and blood expectoration. Objectively he presents with lagging physical development, acrocyanosis, hepatomegaly, drumstick fingers, and nail plates resembling a “clock face Provisional diagnosis of chronic pulmonary heart disease is made. What examination would be the most informative for diagnosis confirmation?

A. Chest X-ray
B. *Doppler echocardiography
C. Rheography of the pulmonary artery
D. Ultrasound of the liver
E. Electrocardiography


37. In the factory cafeteria there was an outbreak of food poisoning. Clinical presentation indicates staphylococcal etiology of this disease. 15 people are sick. To confirm the diagnosis of food poisoning, samples need to be sent to the laboratory. What samples should be obtained for analysis?

A. Blood for hemoculture
B. Urine
C. *Vomit masses
D. Saliva
E. Blood (complete blood count)


38. A 47-year-old man developed the signs of decompensated laryngeal stenosis against the background of acute phlegmonous laryngitis. He presents with inspiratory dyspnea at rest, forced position, cyanotic skin covered in cold sweat, tachycardia, deficient pulse, and low blood pressure. What urgent treatment tactics should be chosen?

A. Oxygen therapy
B. *Tracheostomy
C. Intravenous administration of dehydrating agents
D. Administration of glucocorticoid hormones
E. Oral administration of hyposensitization substances and broncholytics


Oxygen therapy would have been the best option had there not been the Decompensated laryngeal stenosis

Decompensated laryngeal stenosis indicates that the larynx is closed so we need to provide the airway.


39. A woman with the pregnancy term of 8 weeks complains of elevated temperature up to 37.6°C, skin rash that can be characterized as macular exanthema, enlargement of posterior cervical and occipital lymph nodes, small amount of bloody discharge from the genital tracts. She was examined by the infectious diseases specialist and diagnosed with rubella. What tactics should the obstetrician-gynecologist choose?

A. Prescription of antibacterial therapy
B. Treatment of incipient abortion
C. Prescription of hemostatic therapy
D. *Abortion
E. Prescription of antiviral therapy


40. A 20-year-old man was hospitalized on the 9th day of the disease. He attributes his disease to eating insufficiently thermally processed pork. At its onset this condition manifested as periorbital edema and fever. Objectively his body temperature is 38.5°C. The face is puffy and the eyelids are markedly swollen. Palpation of gastrocnemius muscles is sharply painful. Blood test shows hypereosinophilia. What is the etiology of this disease?

A. *Trichinella
B. Echinococci → Playing with dog or sheep
C. Leptospira → Fish
D. Ascarididae → Peianal itching in the night
E. Trichuris


41. A 34-year-old man complains of pale edema of the face, feet, shins, and lumbar area. elevated blood pressure up to 160/100 mm Hg. and general weakness. He has a clinical history of nonspecific ulcerative colitis. Objectively: pulse – 84/min., rhythmic, blood pressure – 165/100 mm Hg: edemas all over the body: the skin is pale and dry with low turgor. The kidneys cannot be palpated, on an attempt to palpate them they are painless. Blood test: erythrocytes – 3.0 – 1012/L, Hb- 100 L erythrocyte sedimentation rate – 50 mm/hour. Urinalysis: proteins – 3.5 L, erythrocytes – 7-10 in the vision field, leukocytes – 5-6 in the vision field. Daily proteinuria – 6 grams. What analysis should be conducted additionally to verify the diagnosis?

A. *Gingival biopsy for the diagnosis of amyloid disease
B. Renal ultrasound
C. Urinalysis for Bence-Jones protein
D. Radioisotopic examination of kidneys
E. Survey and excretory urography


Amyloidosis is any of a group of disparate conditions characterized by extracellular deposition of insoluble fibrils composed of misaggregated proteins. These proteins may accumulate locally, causing relatively few symptoms, or widely, involving multiple organs and causing severe multiorgan failure. Amyloidosis can occur de novo or be secondary to various infectious, inflammatory, or malignant conditions. Diagnosis is by biopsy of affected tissue; the amyloidogenic protein is typed using a variety of immunohistologic and biochemical techniques. Treatment varies with the type of amyloidosis.


42. A 26-year-old woman is suspected to suffer from systemic lupus erythematosus due to systemic lesions of skin, vessels, joints, serous tunics, and heart that developed after photosensitization. The following is detected: LE cells, antibodies to native DNA, isolated anti-centromere antibodies, rheumatoid factor is 1:100, Wassermann reaction is positive, the circulating immune complex is 120 units. What immunological indicators are considered to be specific to this disease?

A. Immunoglobulin A → Mucous membrane immune function
B. *DNA antibodies → Or ANA(antinuclear antibody)
C. Rheumatoid factor → Rheumatoid Arthritis
D. Increased circulating immune complex
E. Anti-centromere antibodies → in systemic scleroderma (formerly called CREST syndrome), and occasionally in the diffuse form of scleroderma.


43. A patient is being treated in the tuberculosis clinic. Throughout the last 3 weeks he has been suffering from headaches of increasing intensity. Neurological examination detects nuchal rigidity without focal signs. Make the provisional diagnosis:

A. Chorea minor
B. Brain tumor
C. Myelitis
D. *Tuberculous meningitis
E. Convexital arachnoiditis


44. A 13-year-old girl has 30% of excessive body mass, she started to gain weight at the age of 3. She has a family history of obesity, Her height and sexual development are normal for her age. The appetite is excessive. She complains of periodical headaches. Blood pressure – 120/80 mm Hg. Subcutaneous fat is evenly distributed, she has no stretch marks. There is juvenile acne on her face. What type of obesity is it?

A. Hypothalamic obesity → irrespective of diet
B. *Alimentary constitutive obesity
C. Adrenal obesity → irrespective of diet & she has no stretch marks
D. Hypothalamic syndrome of puberty → irrespective of diet
E. Hypothyroid obesity → Will need to have low blood pressure


45. A 45-year-old man, a farmer, presents with acute onset of a disease. He complains of headache, high temperature, pain in the gastrocnemius muscles, icteric face, and dark urine. Objectively: body temperature – 38°C. blood pressure – 100/70 mm Hg, conjunctival hemorrhages, hepatosplenomegaly, and oliguria. What is the most likely provisional diagnosis?

A. Viral hepatitis
B. Brucellosis
C. Pseudotuberculosis
D. Trichinosis
E. *Leptospirosis


46. During analysis of morbidity in the city, it was determined that age structure of population is different in each district. What statistical method allows to exclude this factor, so that it would not skew the morbidity data?

A. *Standardization
B. Dynamic time series analysis
C. Wilcoxon signed-rank test
D. Correlation-regression analysis
E. Analysis of average values


47. A 52-year-old woman has been suffering for 2 years from dull, occasionally exacerbating pain in her right subcostal area, occurring after eating high-fat foods, bitter taste in her mouth in the morning. constipations, and flatulence. Objectively she has excess weight, her body temperature is 36.9°C; there is a coating on the root of her tongue; the abdomen is moderately distended and painful in the area of gallbladder projection. What examination would be the most helpful for diagnosis-making?

A. Cholecystography
B. Duodenal intubation
C. Liver scanning
D. Duodenoscopy
E. *Ultrasound


In order to diagnose biliary dyskinesia, the patient should have right upper quadrant pains similar to biliary colic but have a normal ultrasound examination of the gallbladder (no stones, sludge, microlithiasis, gallbladder wall thickening or CBD dilation).


48. A 50-year-old patient was brought to a hospital with complaints of blood in urine. Urination is painless and undisturbed. Macrohematuria had been observed for 3 days. Objectively: kidneys cannot be palpated. The suprapubic area is without alterations, external genitalia are non-pathologic. On rectal investigation: prostate is not enlarged, painless, has normal structure. Cystoscopy revealed no changes. What is the most likely

A. Necrotic papillitis
B. *Renal carcinoma
C Dystopic kidney
D. Bladder tuberculosis
E. Varicocele


Hematuria without any other signs is Renal carcinoma


49. During examination a 4-month-old child with meningococcemia presents with acrocyanosis, cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg. anuria, and sopor. What clinical syndrome is it?

A. *Toxic shock syndrome
B. Encephalic syndrome
C. Exicosis
D. Acute renal failure
E. Neurotoxicosis


50. A district doctor has diagnosed one of his patients with dysentery. What accounting document reflects this type of morbidity?

A. Certificate of temporary disability
B. *Urgent report
C. Report on a major non-epidemic disease
D. Control card of a patient registered for regular check-ups
E. Statistical report


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    1. It’s because I’ve not yet made the explanations for the next questions. But i have provided links to the questions if you’d like to see them without the explanation.

      1. when are you planning to make explanations for rest of 2019 paper. it will be very helpfull if you do that sooner.

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