KROK 1 2015, ANSWERS EXPLAINED
This material aims to explain answers and sometimes, point out why the other options are not the correct ones. We encourage the student preparing for Krok 1 to avoid memorizing answers and instead set out to understand questions and the concepts behind them. It would also help a great deal to seek out topics that occur repeatedly, and study them thoroughly so one is ready for those questions in whatever form.
Note: All answers are A
- Characteristic sign of glycogenosis is muscle pain during physical work. Blood examination usually reveals hypoglycemia. This pathology is caused by congenital deficiency of the following enzyme:
- Glycogen phosphorylase
- Glucose 6-phosphate dehydrogenase
- Lysosomal glycosidase
EXP: Mcardle’s Disease is a congenital disease caused by a deficiency in glycogen phosphorylase in skeletal tissues. This phenomenon leads to muscle cramping during exertion. This deficiency causes hypoglycemia since glycogen cannot be converted back to glucose.
- Histologic specimen of a kidney demonstrates cells closely adjoined to the renal corpuscle in the distal convoluted tubule. Their basement membrane is extremely thin and has no folds. These cells sense the changes in sodium content of urine and influence renin secretion occurring in juxtaglomerular cells. Name these cells:
- Macula densa cells
- Juxtaglomerular cells
- Mesangial cells
- Glomerular capillary endothelial cells
EXP: These peculiarities are typical for Macula Densa cells; closely packed cells which are part of the juxtaglomerular apparatus.
- A 46-year-old female patient has continuous history of progressive muscular (Duchenne’s) dystrophy. Which blood enzyme changes will be of diagnostic value in this case?
- Creatine phosphokinase
- Lactate dehydrogenase
- Pyruvate dehydrogenase
- Glutamate dehydrogenase
- Adenylate cyclase
EXP: Creatine phosphokinase is a specific enzyme found in the skeletal muscles, heart muscles and brain tissue. On destruction of any of these tissues, there is release of this specific marker.
- A laboratory experiment on a dog was used to study central parts of auditory system. One of the mesencephalon structures was destroyed. The dog has lost the orienting response to auditory signals. What structure was destroyed?
- Inferior colliculi of corpora quadrigemina
- Superior colliculi of corpora quadrigemina
- Substantia nigra
- Reticular formation nuclei
- Red nucleus
EXP: Inferior colliculi of corpora quadrigemina contains the auditory nucleus and several auditory pathways. Note that the Superior Colliculi has to do with vision.
- A patient has decreased concentration of magnesium ions that are required for ribosomes connection to granular endoplasmic reticulum. This condition is known to disrupt the process of protein biosynthesis. Disruption occurs at the following stage:
- Amino acids activation
EXP: Translation occurs when the ribosome connects to the granular endoplasmic reticulum which leads to protein biosynthesis, disruption of this process leads to disruption in translation.
- A 6-year-old child with suspected active tuberculous process has undergone diagnostic Mantoux test. What immunobiological preparation was injected?
- BCG vaccine
- DTP vaccine
- Td vaccine
EXP: Mantoux test is a test done to diagnose TB and tuberculin is a purified protein derivative essential for the test. BCG is the vaccine for TB.
- During postembryonal haemopoiesis in red bone marrow the cells of one of the cellular differons demonstrate gradual decrease in cytoplasmic basophilia as well as increase in oxyphilia, the nucleus is being forced out. Such morphological changes are typical for the following haemopoiesis type:
- Neutrophil cytopoiesis
- Eosinophil cytopoiesis
- Basophil cytopoiesis
EXP: Erythropiesis is the formation of red blood cells. The reticulocytes (young red blood cells) do contain a nucleus but after they mature the nucleus is forced out and they gain more affinity for oxygen(oxyphilia).
- When taking exams students often have dry mouth. The mechanism that causes this state results from the following reflexes:
- Conditioned sympathetic
- Unconditioned parasympathetic
- Conditioned parasympathetic
- Unconditioned sympathetic
- Unconditioned peripheral
EXP: Conditioned sympathetic reflex consists of dryness of mouth, increased heart rate, urinary retention. Please note that it is conditioned because the cause (exams) is not a naturally occurring i.e the students had to learn it.
- A 67-year-old patient with clinical diagnosis of chronic bronchitis, pneumosclerosis, and cardiopulmonary decompensation has the biopsy material taken from the suspicious area in his right bronchus mucosa. Cellular and tissue atypism along with Pearlybodies can be histologically detected. What pathologic process is characterized by the described histological changes?
- Squamous cell carcinoma of bronchus with keratinization
- Polypoid chronic bronchitis
- Acute bronchitis
- Squamous cell metaplasia of bronchial mucosa
EXP: Cellular and tissues atypsim is a sign of malignzation and Pearly bodies are formed due to keratinization. Also, squamous epithelium lines the walls of the bronchus.
- A microspecimen of heart shows rectangular cells from 50 to 120 micrometers large with central position of nucleus and developed myofibrils. The cells are connected by intercalated discs. These cells are responsible for the following function:
- Function of heart contractions
- Function of impulse conduction
EXP: Heart muscles are composed of tubular cells called myocytes, and a myofibril is the basic unit of the myocyte. Notice the size of the cells and the intercalated discs (smooth muscles).
- Untrained people often have muscle pain after sprints as a result of lactate accumulation. This can be caused by the intensification of the following biochemical process:
- Pentose phosphate pathway
EXP: Anaerobic glycolysis leads to production of lactate and this tends to accumulate in muscle tissue and causes pain and cramps.
- Poisoning caused by botulinum toxinthat prevents calcium ions from entering axon nerve endings of motor neurons is life-threatening because it can lead to:
- Respiratory arrest
- Cardiac arrest
- Vasotonic disorder
EXP: When there is prevention of calcium ions from entering the axon nerve endings of motorneurons, there is prevention of the exocytosis of acetylcholine into the synaptic cleft. This leads to paralysis of major respiratory muscles eg. diaphragm, intercostal muscles.
- Increased HDL levels decrease the risk of atherosclerosis. What is the mechanism of HDL anti-atherogenic action?
- They remove cholesterol from tissues
- 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 HDL has the ability to remove cholesterol from tissues.
EXP: 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.
- 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?
- Pyruvate dehydrogenase complex
- Microsomal oxidation
- Methemoglobin reductase
- Glutathione peroxidase
- Glutathione reductase
EXP: Sodium arsenate binds to the sullfhydryl groups in dihydrolipoic acid leading to an impairement of the pyruvate dehydrogenase complex.
- 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.
- A 35-year-old man with peptic ulcer disease has undergone antrectomy. After the surgery secretion of the following gastrointestinal hormone will be disrupted the most:
EXP: Postoperative pancreatitis occurs after the antrectomy leading to a disruption of insulin.
- Atretic bodies and developed yellow body can be observed along with follicles of various orders in an ovary specimen. What stage of ovarian and menstrual cycle is characterized by the described ovary condition?
- Follicle growth
EXP: Premenstrual stage is the stage between menstrual cycles when the uterus is preparing for menstruation (growing follicles). It is characterized by the presence of atretic bodies and developed yellow body.
- A 16-year-old adolescent is diagnosed with hereditary UDP (uridine diphosphate) glucuronyltransferase deficiency. Laboratory tests revealed hyperbilirubinemia caused mostly by increased blood content of the following substance:
- Unconjugated bilirubin
- Conjugated bilirubin
EXP: UDP glucuronyltransferase deficiency leads to an increase in unconjugated bilirubin since the enzyme converts unconjugated bilirubin to conjugated bilirubin.
- Prior to glucose utilization in cells it is transported inside cells from extracellular space through plasmatic membrane. This process is stimulated by the following hormone:
EXP: Insulin helps in the transportation and utilization of glucose in various tissues.
- After implantation of a cardiac valve a young man systematically takes indirectanticoagulants. His state was complicatedby hemorrhage. What substance content has decreased in blood?
EXP: Indirect Anticoagulants (e.g warfarin) act by inhibiting Prothrombin in blood leading to decreased clotting of blood and increased bleeding time. Note that direct anticoagulants (e.g heparin) inhibit thrombin.
- A 12-year-old patient has white non-pigmented spots on the skin. The spots appeared after the patient became 10 years old, and they constantly grow. This spots appeared due to the lack of the following skin cells:
EXP: Melanocytes are responsible for the pigmentation of skin and a lack of it leads to depigmentation.
- A group of Ukrainian tourists returning from Samarqand was bringing with them gerbils. During examination in customs office, ulcers were detected on the skin of the animals. What protozoais the most likely to cause the disease in the animals, if mosquitos are the carriers?
- Leishmania tropica major
- Balantidium coli
- Plasmodium falciparum
- Trypanosoma cruzi
- Toxoplasma gondii
EXP: Leishmania tropica major causes leishmaniasis, a disease that causes ulcers in the skin of its host and is transmitted by the mosquito.
- A 5-year-old child has been diagnosed with acute right distal pneumonia. Sputum innoculation revealed that the causative agent is resistant to penicillin and sensitive to macrolides. What drug should be prescribed?
EXP: Azithromycin is a macrolide that is broad spectrum and used to treat diseases and infections that do not respond to penicillin medication. Note that most macrolides (antibiotics) have the –ycin ending.
- To an emergency ward a 7-year-old child was delivered in the condition of allergic shock caused by a bee sting. High concentration of histamine is observed in blood. Production of this amine is the result of the following reaction:
EXP: Production of Histamine leads to decarboxylation which is the removal of the carboxyl group and release of carbon dioxide leading to respiratory insufficiency.
- A 65-year-old man suffering from gout complains of pain in his kidneys. Ultrasonic examination revealed kidney stones. A certain substance in increased concentration can cause kidney stones formation. Name this substance:
- Uric acid
EXP: High quantities of uric acid cause it to crystallize, and accumulate to form stones. It crystallizes easily due to very low solubility.
- Sex chromatinwas detected during examination of a man’s buccal epithelium. It is characteristic of the following chromosome disease:
- Klinefelter’s syndrome
- Down’s disease
- Turner’s syndrome
- Triple X syndrome
- Hypophosphatemic rickets
EXP: Sex chromatin is dna material only found in nuclei of female cells (esp as Barr body) and believed to represent the X chromosome. Finding it in a man indicates Klinefelter’s syndrome with karyotype is XXY.
- Pure culture of microorganisms was obtained from pharynx of a child with suspected diphtheria. Morphologic, tinctorial, cultural, and biochemical properties of the microorganisms were studied and revealed to be characteristic of diphtheria agents. What investigation should be additionally performed to make a conclusion, that these microorganisms are pathogenic diphtheria bacilli?
- Determine toxigenic properties
- Determine proteolytic properties
- Determine urease activity
- Determine cystinase activity
- Determine amylolytic activity
EXP: Diphtheria bacilli undergoes phage conversion and becomes toxigenic. The action of toxins is the pathophysiology of disease so determining toxigenic properties is a sure way to confirm diagnosis of diphtheria.
- Autopsy of a man who had tuberculosis revealed a 3×2 cm large cavity in the superior lobeof the right lung. The cavity was interconnected with a bronchus, its wall was dense and consisted of three layers: the internal layer was pyogenic, the middle layer was made of tuberculous granulation tissue and the external one was made of connective tissue. What is the most likely diagnosis?
- Fibrous cavernous tuberculosis
- Fibrous focal tuberculosis
- Acute focal tuberculosis
- Acute cavernous tuberculosis
EXP: Fibrous cavernous tuberculosis is normally found in the superior lobe of lungs, fibrous meaning there is formation of connective tissue, Cavernous meaning there is formation of a cavity and of tuberculous origin.
- A 7-year-old child has acute onset of disease: temperature rise up to 38oC, rhinitis, cough, lacrimation, and large-spot rash on the skin. Pharyngeal mucosa is edematous, hyperemic, with whitish spots in the buccal area. What kind of inflammation causes the changes in the buccal mucosa?
- Catarrhal inflammation
- Suppurative inflammation
- Fibrinous inflammation
- Hemorrhagic inflammation
- Serous inflammation
EXP: Catarrhal inflammation normally occurs in respiratory tracts accompanied by edema, increased production of mucous and inflammation of the mucosa. Also there is no purulent discharge (suppurative), connective tissue (fibrinous) or blood (hemorrhagic).
- Analysis of sputum taken from a patient with suspected pneumonia revealed slightly elongated gram-positive diplococci with pointed opposite ends. What microorganisms were revealed in the sputum?
- Streptococcus pneumoniae
- Staphylococcus aureus
- Klebsiella pneumoniae
- Neisseria meningitidis
- Neisseria gonorrhoeae
EXP: Gram positive diplococci with pointed ends is characteristic of Streptococcus pneumoniae.
- Serological diagnostics of infectious diseases is based upon specific interaction withantigens. Specify the serological reaction that underlies adhesionof microorganisms when they are affected by specific antibodies in presence of an electrolyte:
- Agglutination reaction
- Precipitation reaction
- Complement-binding reaction
- Hemadsorption reaction
- Neutralization reaction
EXP: The options are all antibody-antigen reactions. But Agglutination is characterized by the adhesion or clumping together of the antigens (microorganisms) after reacting with specific antibodies in presence of electrolyte.
- A 4-year-old child was admitted to an orthopaedic department with displaced shin fracture. Bone fragments reposition requires analgesia. What drug should be chosen?
- Morphine hydrochloride
EXP: All the drugs have analgesic effect. However… Panadol is a mild analgesic and can’t be used alone in this case, Analgin (also Metamizole) can cause serious blood-related toxicity and is rarely used nowadays, Morphine also has a lot of side-effects.
Promedol (also Trimeperidine), is a very potent analgesic with sedative effect and is the best choice in this case.
- Doctors make mostly radial incisions during mammary gland surgery. What particulars of anatomical organization make such surgical technique preferable?
- Lobe apexes converge towards nipples
- Lobe bases radiate from nipples
- Transversal position of gland lobes
- Vertical position of gland lobes
EXP: The female adult breast contains 14–18 irregular lactiferous lobes that converge at the nipple. The apex of the lobes converge.
- A 41-year-old man has a history of recurrent attacks of heartbeats (paroxysms), profuse sweating, headaches. Examination revealed hypertension, hyperglycemia, increased basal metabolic rate, and tachycardia. These clinical presentations are typical 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: Hyperfunction of the medulla leads to an increase in secretion of corticosteroids leading to hyperfunction of the sympathetic nervous system (tachycardia, increased BMR, sweating etc).
- A 12-year-old child has developed nephritic syndrome (proteinuria, hematuria, cylindruria) 2 weeks after the case of tonsillitis, which is a sign of affected glomerular basement membrane in the kidneys. What mechanism is the most likely to cause the basement membrane damage?
- Immune complex
EXP: Post streptococcal glomerulonepritis is characterized by the accumulation of immune complex (antibody-antigen) in the basement membrane leading to its damage.
- Several minutesafter a dentist administered novocaine for local anaesthesia ofa patient’s tooth, the following symptoms sharply developed in the patient: fatigue, skin itching. Objectively the following can be observed: skin hyperemia, tachycardia, BP dropped down to 70/40 mm Hg. What kind of allergic reaction is this pathology?
- Cell-mediated immune reaction
- Immune complex
EXP: The patient is allergic to novocaine and this leads to anaphylaxis which is characterized by skin itching, skin hyperemia, tachycardia and drop in blood pressure. Note that it took only a few minutes to develop.
- A patient with probable liver abscess was delivered to a surgical department. The patient for a long time had been on an assignment in an African country and had recurrent cases of acute gastrointestinal disturbance. What protozoan disease can it be?
EXP: Amoebiasis leads to the formation of liver abscesses and this leads to acute gastro-intestinal disturbances.
- Work in a mine is known to cause inhalation of large amounts of coal dust. Inhaled coal dust can be detected in the following pulmonary cells:
- Alveolar macrophages
- Respiratory epithelial cells
- Secretory epithelial cells
- Capillary endothelial cells
- Pericapillary cells
EXP: Alveolar macrophages ingest foreign materials in the lungs.
- Electrical activity of neurons is being measured. They fire prior to, and at the beginning of inhalation. Where are these neurons situated?
- Medulla oblongata
- Spinal cord
- Cerebral cortex
EXP: Medulla Oblangata contains the respiration center, therefore controls breathing mechanism.
- Electrocardiogramanalysis demonstrates that cardiac cycle of a human equals 1 second. It means that heart rate per minute equals:
EXP: In a second the heart beats once, meaning in one minute the heart beats 60 times.
- Glomerular filtration of a person, who has been starving for a long time, has increased by 20%. The most likely cause of filtration changes in the given conditions is:
- Decrease of blood plasma oncotic pressure
- Increase of systemic blood pressure
- Increase of renal filter permeability
- Increase of filtration factor
- Increase of renal plasma flow
EXP: Starvation leads to a use up of carbohydrates, fats and proteins. Protein deficiency leads to reduction of substances like albumin(heavy molecules) that are responsible of keeping blood plasma oncotic pressure normal, and lack of these heavy molecules will make filtration faster.
- Cells of healthy liver actively synthesize glycogen and proteins. What organelles are the most developed in them?
- Granular and agranular endoplasmic reticulum
- Cell center
EXP: Granular and agranular endoplasmic reticulum are the cell organelles responsible for the synthesis of glycogen and proteins.
- Atria of an experimental animal were super distended with blood, which resulted in decreased reabsorption of Na+ and water in renal tubules. This can be explained by the influence of the following factor on kidneys:
- Natriuretic hormone
EXP: Natriuretic hormone is hormone released from the heart muscles when there is high blood pressure, its release leads to increased release of sodium and water to reduce the high blood pressure.
N.b: Natriuretic: Causing natriuresis, the excretion of an excessively large amount of sodium in the urine.
A hybrid of the Latin natrium = sodium and the Greek ouresis = a making water.
- A patient with hypertensive crisis has increased content of angiotensin II in blood. Angiotensin pressor effect is based on:
- Contraction of arteriole muscles
- Activation of biogenic amine synthesis
- Prostaglandin hyper-production
- Vasopressin production stimulation
- Activation of kinin–kallikrein system
EXP: ‘Pressor effect’ means to raise blood pressure usually by vasoconstriction. Angiotensin II is a vasoconstricting agent which is found in the blood, its pressor effect is characterized by the contraction of the arteriole muscles.
- A 43-year-old-patient has arterial hypertension caused by increase in cardiac output and general peripheral resistance. Specify the variant of hemodynamic development of arterial hypertension in the given case:
EXP: The hemodynamic devt. of arterial hypertension may be Hypokinetic, Hyperkinetic or Eukinetic.
Hyperkinetic type usually is accompanied by increasing of heart outflow with increased heart index more than 4.5 l per min in m² and normal general peripheral resistance.
Hypokinetic type is accompanied by decreasing of heart outflow with decreased heart index to 2.8 l per min in m² and high general peripheral resistance.
Eukinetic type is accompanied by normal or slightly increased heart outflow and slightly increased general peripheral resistance.
- A patient has been hospitalised with provisional diagnosis of virus B hepatitis. Serological reaction based on complementation of antigen with antibody chemically bound to peroxidase or alkaline phosphatasehas been used for disease diagnostics. Name this serological reaction:
- Immune-enzyme analysis
- Radioimmunoassay technique
- Immunofluorescence test
- Bordet-Gengou test
- Antigen-binding assay
EXP: Note the enzymes used. ELISA (enzyme-linked immune-sorbent assay) or immune-enzyme analysis is the only test here that uses enzymes.
- A surgeon has to find the common hepatic duct during operative intervention for treatment of concrements in the gall ducts. The common hepatic duct is located between the leaves of:
- Hepatoduodenal ligament
- Hepatogastric ligament
- Hepatorenal ligament
- Round ligament of liver
- Venous ligament
EXP: Common hepatic duct is found between the leaves of the hepatoduodenal ligament.
- It is known that the gene responsible for development of blood groups according to AB0 system has three allele variants. Existence of the IV blood group can be explained by the following variability form:
EXP: The fourth (IV) group known as AB blood group includes the combination of both A and B therefore variability form is combinative.
- When measuring power inputs of a person by the method of indirect calorimetry the following results were obtained: oxygen consumption is 1000 ml and carbon dioxide production is 800 ml per minute. The person under examination has the following respiratory coefficient:
EXP: The respiratory coefficient or quotient (RQ) is the ratio of CO2 produced to O2 consumed while food is being metabolized: RQ = CO2 eliminated/O2 consumed i.e 800/1000 = 0.8
- On examination of a newborn boy’s external genitalia a fissure in the urethra opening on the inferiorsurface of his penis is detected. What maldevelopment is it?
EXP: Hypospadias is when the urethral fissure opens on the inferior surface of the penis. Epispadiais when it opens on the superior surface.
- Poisoning caused by mercury (II) chloride (corrosive sublimate) occurred in the result of safety rules violation. In 2 days the patient’s diurnal diuresis became 620 ml. The patient developed headache, vomiting, convulsions, dyspnea; moist crackles are observed in the lungs. Name this pathology:
- Acute renal failure
- Chronic renal failure
- Uremic coma
EXP: Poisoning with mercury leads to renal failure(but because it occurs within 2 days it is acute)as there is damage to the kidneys causing a reduction in diurnal diuresis.
- For people adapted to high external temperatures profuse sweating is not accompanied by loss of large volumes of sodium chloride. This is caused by the effect the following hormone has on the perspiratory glands:
EXP: Aldosterone increases the reabsorption of sodium and water from sweat glands.
- Along with normal hemoglobin types there can be pathological ones in the organism of an adult. Name one of them:
EXP: Hemoglobin S is a type of hemoglobin inherited from one’s parents and is known to have the sickle cell trait. HbF is fetal hemoglobin, HbO2 oxygenated hemoglobin, while Hb A1 and A2 are hemoglobin proteins.
- Emotional stress causes activation of hormone-sensitive triglyceride lipase in the adipocytes. What secondary mediator takes part in this process?
- Cyclic adenosine monophosphate
- Cyclic guanosine monophosphate
- Adenosine monophosphate
- Ions of __2+
EXP: Cyclic adenosine monophosphate cAMP is an important secondary messenger, and it takes part in activation of hormone-sensitive triglyceride lipase and other processes.
- A patient has been diagnosed with Alkaptonuria. Choose an enzyme that can cause this pathology when deficient:
- Homogentisic acid oxidase
- Phenylalanine hydroxylase
- Glutamate dehydrogenase
- Pyruvate dehydrogenase
- Dioxyphenylalanine decarboxylase
EXP: Alkaptonuria is caused by inherited deficiency of the liver enzyme homogentisic acid deoxygenase. This leads to accumulation of homogentisic acid, which is rapidly cleared in the kidney and excreted.
- As a result of a continuous chronic encephalopathy a patient has developed spontaneous motions and disorder of torso muscle tone. These are the symptoms of the disorder of the following conduction tract:
- Tractus rubrospinalis
- Tractus corticospinalis
- Tractus corticonuclearis
- Tractus spinothalamicus
- Tractus tectospinalis
EXP: The tractus rubospinalis is an extrapyramidal motor tract that runs from the motor Red Nucleus to the spinal cord, mainly responsible for movement in upper extremities, this includes the torso.
Rudimentary knowledge of Latin will help you a lot when it comes to the nervous system. Finding out the literal English translations of the structures is a very good idea.
- A child is 10 years old. The following presentations have developed: sharp pain during swallowing, swollen neck, body temperature rise up to 39.0oC, bright-red finely papular rashall over the body. Pharynx and tonsils are sharply hyperemic (“flaming pharynx”), “crimson tongue”.On the tonsils surface there are isolated greyish necrosis focuses. What disease it might be?
- Scarlet fever
- Meningococcal nasopharyngitis
EXP: Apart from the ‘crimson tongue’ and ‘flaming pharynx’ which are pathognomonic for Scarlet fever, the presence of papular rash all over the body, with high-temperature confirms diagnosis.
- A patient suffers from intermittent fevers and normalizations of body temperature that occur during the day. The temperature rise is observed regularly every fourth day. Specify the type of temperature curve:
- Febris intermittens
- Febris continua
- Febris reccurens
- Febris hectica
- Febris remitens
EXP: Febris intermittens temperature curve is characterized by rising periods of temperature (paroxysms) that alternate with the periods of normal temperature (apirrhexions).
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.
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).
- A woman with the III (В), Rh- blood group gave birth to a child with the II (А) blood group. The child is diagnosed with hemolytic disease of newborn caused by rhesus incompatibility. What blood group and Rh can the father have?
- II (А), Rh+
- I (0), Rh+
- III (B), Rh+
- I (0), Rh−
- II (A), Rh−
EXP: The child has hemolytic disease caused by Rhesus incompatibility. This means the child is Rh(+) since the mother is Rh(-.) Rh is an inherited trait, so the father has to be Blood group II(A) with Rh(+).
- A patient is diagnosed with hereditary coagulopathy that is characterised by factor VIII deficiency. Specify the phase of blood clotting during which coagulation will be disrupted in the given case:
- Thromboplastin formation
- Thrombin formation
- Fibrin formation
- Clot retraction
EXP: The deficiency of factor VIII( haemophilia A) makes it impossible for the body to produce thromboplastin.
- Angiocardiography of a 60-year-old man revealed constriction of the vessel located in the left coronary sulcus of his heart. Name this pathological vessel:
- Ramus circumflexus
- Ramus interventricularis posterior
- A. coronaria dextra
- V. cordis parva
- Ramus interventricularis anterior
EXP: The Circumflex Artery is a ‘ramus’ or branch of the Left Coronary Artery that branches off to loop around the heart via the left coronary sulcus (the coronary sulci are circular grooves that delimit the atria and ventricles).
- A patient complains of pain in the right lateral abdomen. Palpation revealed a dense, immobile, tumor-like formation. The tumor is likely to be found in the following part of the digestive tube:
- Colon ascendens
- Colon transversum
- Colon descendens
- Colon sigmoideum
EXP: The ascending colon is located at the right lateral part of the abdomen.
- During regular check-up a child is detected with interrupted mineralization of the bones. What vitamin deficiency can be the cause?
- Folic acid
EXP: Calciferol is a derivative of Vitamin D which helps in development and strengthening of children bones.
- During histological analysis of the lymph node situated in the posterior neck triangle of an 18-year-old patient a morphologist detected a cluster of cells including the following: isolated multinucleate Reed-Sternberg cells, large and small Hodgkin’s cells and numerous lymphocytes, isolated plasma cells, eosinophils. What disease has developed in the patient?
- Nodular lymphoma
- Burkitt’s lymphoma
- Lymphocytic lymphoma
- Chronic lymphocytic leukemia
EXP: Reed-Sternberg cells are typical for Hodgkin’s lymphoma. This is a cancer of the lymphatic system aka Lymphogranulomatosis.
- An infant has pylorospasm, weakness, hypodynamia, convulsions as a result of frequent vomiting. What kind of acid-base disbalance is it?
- Excretory alkalosis
- Excretory acidosis
- Metabolic acidosis
- Exogenous nongaseous acidosis
- Gaseous alkalosis
EXP: In metabolic or excretory alkalosis, the main sign is vomiting (or other forms of excretion like sweating/dehydration), which leads to loss in hydrogen ions which further leads to weakness, pylorospasm, hopodynamia etc….
- A 39-year-old man who had been operated for the stomach ulcer died 7 days after the surgery. Autopsy revealed that peritoneal leaves were dull, plethoric, covered with massive yellow-greenish films. The peritoneal cavity contained about 300ml of thick yellow-greenish liquid. What pathologic process was revealed in the peritoneal cavity?
- Fibrinous suppurative peritonitis
- Serous peritonitis
- Fibrinous serous peritonitis
- Peritoneal commissures
- Fibrinous haemorrhagic peritonitis
EXP: Fibrinous suppurative peritonitis is a secondary peritonitis mainly caused by perforation of (e.g. peptic ulcer, diverticular disease, Crohn’s disease, appendix or gall bladder), infection (e.g. appendix abscess, pyosalpinx), it is characterized by yellow-greenish films and liquids.
- Monoamine oxidase inhibitors are widely used as psycho-pharmacological drugs. They change the level of nearly all neurotransmitters in synapses, with the following neurotransmitter being the exception:
EXP: This is because all enzymes here can be broken down in the body by both MAO-A and MAO-B (Monoamine oxidase A&B) except acetylcholine.
- A patient with urolithiasis has developed severe pain attacks. For pain shock prevention he was administered an antispasmodic narcotic analgesic along with atropine. Name this drug:
- Ethylmorphine hydrochloride
- Morphine hydrochloride
EXP: Promedol with both analgesic and spasmolytic effect is used either in adults, or in children older than 2 years old on moderate and intensive pains, mainly of traumatic origin, before, during and after surgery.
The preparation is effective on a pain syndrome related to the smooth muscle spasm in the inner organs (ureter in this case) in combination with atropine-like and spasmolytic preparations).
- A patient with acute myocardial infarction has been administered heparin as a part of complex therapy. Sometime after heparin injection the patient developed hematuria. What heparin antagonist should be injected to remove the complication?
- Protamine sulfate
- Aminocaproic acid
EXP: Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it.
- A 37-year-old woman complains of headache, vertigo, troubled sleep, numbness of limbs. For the last 6 years she has been working at a gas-discharge lamp-producing factory in a 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:
- Iron refractory anemia
- Iron-deficiency anemia
- Minkowsky-Shauffard disease
- Hypoplastic anemia
- Metaplastic anemia
EXP: The underlined symptoms are neurological effects of Lead poisoning. Lead poisoning also causes anemia by causing hemolysis of red blood cells… hence the increased iron content in blood.
- Despite the administration of cardiotonics and thiazide diuretic a patient with chronic heart failure has persistent edemas and the risk of ascites arose. What medication should be administered to enhance the diuretic effect of the administered drugs?
EXP: Thiazide diuretics are Potassium wasting diuretics. Spironolactone (Triamterene) is a Potassium-sparing diuretic that also relieves pulmonary and systemic edema. It reduces blood pressure and pre-load helping the heart failure.
- Acute renal impairment caused death of a patient with hemorrhage. Autopsy revealed enlarged kidneys with broad pale-pink cortical layer expressively demarcated from dark-red renal pyramids. Macroscopic examination revealed lack of epithelial nuclei of convoluted tubules, tubulorrhexis, phlebostasis. The cell nuclei of choroid glomus and straight tubules were present. What pathology is it?
EXP: In Necronephrosis (also called Acute Tubular Necrosis), there is usually tubulorrhexis, that is, localized necrosis of the epithelial lining in renal tubules, with focal rupture or loss of basement membrane.
- 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 large cells containing crescent-shaped peripheral nuclei situated between them. Specify the type of meningitis in the child:
EXP: This occurs most commonly shortly after a primary infection in childhood or as part of miliary tuberculosis. The usual local source of infection is a caseous focus in the meninges or brain substance adjacent to the CSF pathway.
The brain is covered by a greenish, gelatinous exudate, especially around the base, and numerous scattered tubercles are found on the meninges.
- A 66-year-old woman had intravenous injection of magnesium sulfate solution to stop hypertensive crisis. However her arterial pressure did not decrease and after repeated introduction of the same preparation she developed sluggishness, slow response to stimuli; the patient is unconsciousness and her respiration is inhibited. What preparation is antagonist of magnesium sulfate and can remove the symptoms of its overdose?
- Calcium chloride
- Potassium chloride
- Sodium chloride
- Activated carbon
- Potassium permanganate
EXP: Calcium chroride IV can be used to treat magnesium intoxication.
- A patient working at a pig farmcomplains of paroxysmal abdominal pain, liquid feces with mucus and blood, headache, weakness, fever. Examination of large intestine revealed ulcers from 1 mm up to several cm in diameter, feces contained oval unicellular organisms with cilia. What disease can be suspected?
EXP: Balantidium coli are oval unicellular organisms with cilia around them. It is acquired by humans via the feco-oral route from the normal host, the pig.
- An unconscious patient was delivered by ambulance to the hospital. On objective examination the patient was found to present no reflexes, periodical convulsions, irregular breathing. After laboratory examination the patient was diagnosed with hepatic coma. Disorders of the central nervous system develop due to accumulation of the following metabolite:
EXP: The ammonia accumulates in the brain tissues, some of which is converted to glutamine, by way of the glutamine synthetase pathways, leading to localized swelling of astrocytes (brain cells). This ammonia-induced glutamine accumulation may cause dysfunction of astrocytes that leads to impairment of vascular reactivity.
- When playing a child received a hit to the presternum region. As a result of this trauma an organ located behind the presternum was damaged. Name this organ:
- Thyroid gland
EXP: Presternal region is the region of the thorax overlying the sternum, the thymus is located here.
p.s Do you know what the Thymus is named after?
- A child suffers from dry cough. What non-narcotic antitussive drug will relieve the patient’s condition?
- Glaucine hydrochloride
- Codeine phosphate
- Morphine hydrochloride
- Potassium iodide
- Althaea officinalis root extract
EXP: Glaucine hydrochloride is the only non-narcotic anti-tussive here. Potassium iodide and Extract of Althaea are not even anti-tussives.
- A patient complains of acute pain attacks in the right lumbar region. During examination a nephrolithic obturation of the right ureter in the region between its abdominal and pelvic segments has been detected. What anatomical boundary exists between those two segments?
- Linea terminalis
- Linea semilunaris
- Linea arcuata
- Linea transversa
- Linea inguinalis
EXP: The linea teminalis is an imaginary anatomical boundary line that is between the abdominal and lumbar regions.
- A patient has insufficient blood supply to the kidneys, which has caused the development of pressor effect due to constriction of arterial resistance vessels. This condition results from the vessels being strongly affected by the following substance:
- Angiotensin II
EXP When renal blood flow is reduced; juxtaglomerular cells in the kidneys convert the Prorenin already present in the blood to Renin. Plasma Renin then converts Angiotensinogen, released by the liver, to Angiotensin I.
Angiotensin I is subsequently converted to Angiotensin II by the enzyme angiotensin-converting enzyme (ACE) found in the lungs. Angiotensin II is a potent vaso-active peptide that causes blood vessels to constrict, resulting in increased blood pressure.
- In a village a case of anthrax has been registered. Medical services began epidemiologically indicated specific prophylaxis of population against anthrax. What preparation was used for this purpose?
- Live vaccine
- Inactivated vaccine
- Chemical vaccine
- Genetically engineered vaccine
EXP: Specific Prophylaxis means a vaccine. Anthrax vaccine is always live vaccine i.e. the weakened (attenuated) form of the virus.
- Experimental stimulation of the sympathetic nerve branches that innervate the heart caused an increase in the force of heart contractions because the membrane of typical Cardiomyocytes permitted an increase in:
- Calcium ion entry
- Calcium ion exit
- Potassium ion exit
- Potassium ion entry
- Calcium and potassium ion exit
EXP: Sympathetic nervous system causes an increase in Inotropic effect (heart contraction) by increasing the rate of calcium entry into the cardiomyocytes.
- According to the results of glucose tolerance test a patient has no disorder of carbohydrate tolerance. Despite that glucose is detected in the patient’s urine (5mmol/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
EXP: On the decrease activity of glucose reabsorption enzymes on kidney, it makes it difficult for the kidney to reabsorb glucose back into the blood after filtration, leading to glucosuria.
- Alveolar space of acinus was invaded by bacteria that interacted with the surfactant. This led to the activation of the cells that are localized in the alveolar walls and on the surface. Name these cells:
- Alveolar macrophages
- Alveolocytes type I
- Endothelial cells
- Clara cells
- Alveolocytes type II
EXP: Alveolar macrophages are localized on the alveolar wall. Alveolar macrophages are phagocytes that play a critical role in homeostasis, host defence, and response to foreign substances.
- Parents of a 5-year-old boy report him to have frequent colds that develop into pneumonias, presence of purulent rashes on the skin. Laboratory tests have revealed the following: absence of immunoglobulins of any type, 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: This question is about immune deficiencies and how to differentiate them.
The answer is Bruton’s Type Hypo-/Agammaglobuinemia, which is the reduction or complete absence of immunoglobulins (IgA, IgD, IgE, IgM, IgG) due to a disorder of the B cells that produce them. It affects humoral immunity and we can see the patient has recurrent infections.
DiGeorge Syndrome will have absence of only T Cells (cellular immunity) and hypocalcemia due to development disorder of the Thymus and Parathyroid glands respectively.
Swiss Type Agammaglobulinaemia will have absence of both T Cells and B Cells/Immunoglobulins.
Louis–Bar syndrome also called Ataxia telangiectasia (A-T) is a rare, neurodegenerative, autosomal recessive disease causing severe disability. Ataxia refers to poor coordination and telangiectasia to small dilated blood vessels.
In Agranulocytosis, the concentration of granulocytes (neutrophils, basophils, & eosinophils)is low or absent, Hypoplastic Anemia is well… Hypoplastic Anemia.
- Examination of a 42-year-old patient revealed a tumour of adenohypophysis. Objectively: the patient’s weight is 117kg; he has moon-like hyperemic face, red-blue striae of skin distension on his belly. Osteoporosis and muscle dystrophy are present. AP is 210/140 mm Hg. What is the most probable diagnosis?
- Cushing’s disease
- Cushing’s syndrome
- Conn’s disease
- Diabetes mellitus
- Essential hypertension
EXP: Moon –like hyperemic face, skin distension on belly, osteoporosis, muscle dystrophy and high arterial blood pressure are key signs of Cushing’s.
The difference between Cushing Disease and Syndrome is that, Cushing’s syndrome occurs when the body produces too much cortisol while Cushing’s disease occurs when a tumor on the pituitary gland causes the gland to produce too much ACTH, the hormone responsible for cortisol production.
- 2 days after labour a woman developed shock along with DIC syndrome that caused her death. Autopsy revealed purulent endomyometritis, regional purulent lymphangitis, lymphadenitis and purulent thrombophlebitis. There were also dystrophic alterations and interstitial inflammation of parenchymal organs. What is the most likely diagnosis?
- Tuberculosis of genital organs
- Chorioadenoma destruens
- Hydatid mole
EXP: Purulent inflammation of heart, blood vessels, lymph nodes, and even parenchymal organs, this shows generalized inflammation all over the body mostly due to septicaemia (sepsis in blood).
- In case of alkaptonuria, homogentisic acid is excreted in urine in large amounts. The development of this disease is associated with metabolic disorder of the following amino acid:
EXP: Alkaptonuria, also called Black Urine/Black Bone Disease is caused by build-up of Homogentisic Acid due to lack of the enzyme Homogentisic Acid 1, 2, Dioxygenase to convert it.
Phenylalanine———————–> Tyrosine—————> Homogentisic Acid——————->MalylAcetoacetate
- When blood circulation in the damaged tissue is restored, lactate accumulation stops and glucose consumption decelerates. These metabolic changes are caused by activation of the following process:
- Aerobic glycolysis
- Anaerobic glycolysis
- Glycogen biosynthesis
EXP: When the blood supply comes back to damaged tissue, oxygen returns back which in turn instead of lactate accumulation (because of anaerobic glycolysis) glucose is converted to pyruvate (aerobic glycolysis).
- A doctor examined a patient, studied the blood analyses, and reached a conclusion, that peripheral immunogenesis organs are affected. What organs are the most likely to be affected?
- Red bone marrow
- Yellow bone marrow
EXP: The peripheral immunogenetic organs are the tonsils while the central immunogenesis organs are the red bone marrow, thymus, lymph nodes and spleen.
- A doctor asked a patient to make a deep exhalationafter a normal inhalation. What muscles contract during such exhalation?
- Abdominal muscles
- External intercostal muscles
- Trapezius muscles
- Pectoral muscles
EXP: Deep or forced exhalation is achieved by the abdominal and the internal intercostal muscles. During this process air is forced or exhaled out. The Diaphragm and External Intercostal muscles contract for inhalation.
- A 4-year-old child with hereditary renal lesionhas signs of rickets; vitamin D concentration in blood is normal. What is the most probable cause of rickets development?
- Impaired synthesis of calcitriol
- Increased excretion of calcium
- Hyperfunction of parathyroid glands
- Hypofunction of parathyroid glands
- Lack of calcium in food
EXP: In this child, Vitamin D is normal in blood.
Calcitriol (dihydroxycholecalciferol) is produced in the kidneys, and it increases blood calcium level… the renal lesion leading to reduced calcitriol and reduced blood calcium is the primary cause of this rickets.
- In a cat with decerebrate rigidity the muscle tone is to be decreased. This can be achieved by:
- Destruction of the vestibular nuclei of Deiters
- Stimulation of the otolithic vestibular receptors
- Stimulation of the vestibular nuclei of Deiters
- Stimulation of the vestibulocochlear nerve
- Stimulation of the ampullar vestibular Receptors
EXP: The lateral vestibular nucleus (Deiter’s nucleus) is responsible for muscle tone.
- Autopsy of a 5-year-old child revealed in the area of vermis of cerebellum a soft greyish-pink node 2 cm in diameter with blurred margins and areas of haemorrhage. Histologically this tumour consisted of atypical monomorphous small round cells with large polymorphous nuclei. What tumour is it?
EXP: Medulloblastoma is a pediatric malignant primary brain tumor (cancer), histologically it is seen
atypical monomorphous small round cells with large polymorphous nuclei.
- Surface with an intact toad on it was inclined to the right. Tone of extensor muscles became reflectory higher due to the activation of the following receptors:
- Vestibuloreceptors of utricle and saccule
- Vestibuloreceptors of semicircular ducts
- Mechanoreceptors of foot skin
- Photoreceptors of retina
EXP: Vestibuloreceptors of utricle and saccule are responsible for tone of extensor muscles in the toad.
- A patient with high-titerantinuclear antibodiesdied from progressing renal impairment. Autopsy revealed mesangioproliferative glomerulonephritis and abacterial polypous endocarditis. Periarterial bulbar sclerosis was detected in spleen and productive proliferative vasculitis in skin. What is the most likely diagnosis?
- Systemic lupus erythematosus
- Nephrotic syndrome
- Periarteritis nodosa
EXP: Systemic lupus erythematous (SLE) is a chronic autoimmune disease that can affect almost any organ system. It is characterized by butterfly rash, it can affect the kidneys, heart, vessels etc. on biochemical blood examination it presents with high-titre antinuclear antibodies.
- When studying the signs of pulmonary ventilation, reduction of forced expiratory volume has been detected. What is the likely cause of this phenomenon?
- Obstructive pulmonary disease
- Increase of respiratory volume
- Increase of inspiratory reserve volume
- Increase of pulmonary residual volume
- Increase of functional residual lung capacity
EXP: The reduction of FEV1 (forced expiratory volume in one second) is typical for obstructive pulmonary diseases. Think about it, there is an ‘obstruction’ to exhaled/outgoing air.
- A specimen of a parenchymal organ shows poorly delineated hexagonal lobules surrounding a central vein, and the interlobular connective tissue contains embedded triads (an artery, a vein and an excretory duct).What organ is it?
EXP: Histologically the Liver is divided into lobules. The center of the lobule is the central vein. At the peripheries of the lobule are portal triads (an artery, a vein and an excretory duct).
- A patient had a trauma that caused dysfunction of motor centres regulating activity of head muscles. In what parts of cerebral cortex can the respective centre normally be located?
- Inferior part of Precentral gyrus
- Superior part of precentral gyrus
- Supramarginal gyrus
- Superior parietal lobule
- Angular gyrus
EXP: The Precentral gyrus controls motor activities. The superior part is for the lower limbs, the middle part for the trunk and arms, and the inferior part for the head.
- During intravenous saline transfusion a patient’s condition deteriorated drastically, and the patient died from asphyxiation. Autopsy revealed acute venous congestion of internal organs with sharp right heart dilatation. When the right ventricle was punctured underwater, the bubblesescaped. What pathological process occurred in the patient?
- Air embolism
- Gaseous embolism
- Adipose embolism
- Tissue embolism
EXP: An air embolism, also called a gas embolism, occurs when one or more air bubbles enter a vein or artery and block it. This air was caused by intravenous saline transfusion which had air (bubbles) in it. The air caused the dilation of right side of the heart.
- Diseases of respiratory system and circulatory disorders impair the transport of oxygen, thus causing hypoxia. Under these conditions the energy metabolism is carried out by anaerobic glycolysis. As a result, the following substance is generated and accumulated in blood:
- Lactic acid*
- Pyruvic acid
- Glutamic acid
- Citric acid
- Fumaric acid
EXP: In absence of oxygen, pyruvate is converted to Lactate by influence of Lactate dehydrogenase enzyme. In prolonged oxygen deprivation, Lactic acid accumulates in blood.
- Examination of a 6-month-old child revealed a delay in closure of the occipital Fontanelle. When should it normally close?
- Before 3 months*
- Before the child is born
- Before 6 months
- Before the end of the first year of life
- Before the end of the second year of life
EXP: Occipital fontanelle closes within first 2 to 3 months of life.
- Sex chromosomes of a woman didn’t separate and move to the opposite poles of a cell during gametogenesis (meiosis). The ovum was impregnated with a normal spermatozoon. Which chromosomal disease can be found in her child?
- Turner’s syndrome*
- Down’s syndrome
- Patau’s syndrome
- Edwards’ syndrome
- Cat cry syndrome
EXP: Failure of X chromosome separation leads to the presence of only 1 X chromosome in a female child XO, thus; Turner Syndrome.
- A patient was prescribed Loratadine to treat allergic cheilitis. What is the mechanism of action of this drug?
- Blockade of H1-histamine receptors*
- Blockade of adrenergic receptors
- Increases activty of monoamine oxidase
- Suppresses activity of Na+/K+-ATPase
- Suppresses activity of choline esterase
EXP: Loratadine is an Anti-histamine drug which blocks H1 histamine receptors. Note that most anti-histamines have the ‘-ine’ ending (Acrivastine, Clemastine, Cetirizine, Cimetidine, Famotidine)
- During introduction of local anaesthesia a patient has gone into anaphylactic shock. What drug must be administered to the patient?
- Epinephrine hydrochloride*
- Atropine sulfate
EXP: In Anaphylactic shock, The Internal Organs enter into a shut-down phase. As a result, Epinephrine/Adrenaline hydrochloride, a non-selective adrenomimetic vigorously acts on all adrenergic receptors preventing and reversing the Shut- down phase.
- A patient has been diagnosed with influenza. His condition drastically worsened after taking antipyretic drugs. He is unconscious, AP is 80/50 mm Hg, Ps is 140/m, body temperature dropped down to 35,8oC. What complication developed in this patient?
EXP: In Influenza, administration of Antipyretics leads to appearance of a complication called Collapse (note the sharply reduced blood pressure and temperature, increased pulse, and unconsciousness).
- An alcoholic has alcoholic psychosiswith evident psychomotor agitation. What neuroleptic drug should be administered for emergency aid?
- Sodium bromide
EXP: Aminazine is a Neuroleptic; psychotropic drug from the group PHENOTHIAZINES used in psychosis treatment.
- During blood transfusiona 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: In blood transfusion, intravascular erythrocyte hemolysis belongs to Type II antibody dependent hypersensitivity and it occurs in transfusion of Incompatible Blood Groups.
- In the course of an experiment thalamocortical tracts of an animal were cut. What type of sensory perception remained intact?
EXP: The Olfactory tract is the only tract among these that does not pass through Thalamus or have Collateral connections with thalamus.
- A 4-year-old child presents with general weakness, sore throat and deglutitive problem. After his examination a doctor suspected diphtheriaand sent the material to a bacteriological laboratory. To determine the diphtheria causative agent the material should be inoculated into the following differential diagnostic medium:
- Blood tellurite agar*
- Endo’s agar
- Ploskyrev’s agar
- Sabouraud’s agar
- Levenshtein-Yessen agar
EXP: Diagnostic culture media for diphtheria is blood tellurite agar.
- When treating a patient with chronic cardiac failure a doctor detected bradycardia and deterioration of the patient’s general state. Such condition is caused by cumulative effect of a drug. Which drug of those listed below has cumulative action?
- Diphenhydramine (Dimedrol)
- Retinol acetate
EXP: Cardiac glycosides; e.g Digoxin have an accumulated toxic effect. Thus, deterioration of the patient’s state.
- A doctor was addressed by a 30 year-old man. There is a probability of the patient being HIV-positive. To clarify the diagnosis the doctor proposed to perform polymerase chain reaction. The basic process in this kind of investigation is:
- Gene amplification*
- Genetic recombination
- Genomic mutation
- Chromosome mutation
EXP: P.C.R is an enzymatic method for repeated copying of two strands of DNA of a gene sequence. It amplifies minute/small quantities of Biologic material for laboratory studies.
- Due to the use of poor-quality measles vaccine for preventive vaccination, a 1- year-old child developed an autoimmune renal injury. The urine was found to contain macromolecular proteins. What process of urine formation was disturbed?
- Reabsorption and secretion
- Secretion and filtration
EXP: Auto-Immune renal injuries mainly affect Glomerulus of the kidney distorting its permeability. Thus, there is disorder of filtration that is bigger molecules can pass through the membrane.
- 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 the only antibiotic among the options provided.
- A 65-year-old man suddenly lost vision in one eye due to the retinal detachment. The patient underwent enucleation. Histological examination of the removed eye retina and choroid revealed clusters of atypical cells with marked polymorphism of cells and nuclei, with a moderate number of mitoses including the pathological ones. The cell cytoplasm and intercellular medium contained brown pigmentresulting in positive DOPA reaction. Perls’ reaction was negative. What is the most likely diagnosis?
- Pigmented mole
- Wilson’s disease
EXP: Enucleation is the removal of entire structure of eyeball without rupture usually occurring in the presence of Tumours. In this case; Melanoma (note the presence of brown pigment).
- During determining the blood group according to the AB0 system with salt solutions of monoclonal antibodies agglutination did not occur with any of the solutions. What blood group is it?
- 0 (I)*
- А (II)
- C. В (III)
- D. АВ (IV)
EXP: Group I(O) or group zero is called the Universal donor because it has neither anti-A nor anti-B antibodies and is compatible with all other groups.
- One of the factors that cause obesity is inhibition of fatty acids oxidation due to:
- Low level of carnitine*
- Impaired phospholipid synthesis
- Excessive consumption of fatty foods
- Choline deficiency
- Lack of carbohydrates in the diet
EXP: Fatty acids’ Beta oxidation is impaired in Carnitene (a transport protein) deficiency as fatty acids can’t be transported into inner mitochondrial membrane.
- During ventricular systole the cardiac muscle does not respond to additional stimulation because it is in the phase of:
- Absolute refractoriness*
- Relational refractoriness
- Subnormal excitability
- There is no correct answer
EXP: In absolute refractory period, Excitability is depressed and as a result, action potentials of threshold intensity cannot stimulate heart any further.
- A patient is diagnosed with acute morphine hydrochloride intoxication. Prescribe the oxidizingagent for gastric lavage:
- Potassium permanganate*
- Sulfocamphocainum (Procaine + Sulfocamphoric acid)
- Chlorhexidine (bi)gluconate
EXP: Potassium permanganate (purple crystals) is a strong oxidising agent used for gastric lavage.
- During cell division DNA replication occurs after a signal is received from the cytoplasm, then a certain portion of the DNA helix unwindsand splits into two individual strains. What enzyme facilitates this process?
- RNA polymerase
- DNA polymerase
EXP: Unwinding of DNA helix is facilitated by the enzyme Helicase
- A patient has been given atropine sulfate for rapid relief of spastic colon symptoms. The use of this drug is contraindicated during the followng disease:
- Bronchial asthma
- Gastric ulcer
EXP: Atropine sulfate increases intraocular pressure, as a result is contraindicated in Glaucoma patients.
- As an example of specific human parasites one can name Plasmodium falciparum, human pinworm and some others. The source of parasite invasion in these cases is always a human. Such specific human parasites cause the diseases that are called:
- Multifactorial diseases
EXP: Diseases caused by human parasites are called ANTHRO-PONOSES. By animals is Zoo-noses
- In the course of an experiment there has been increase in nerve conduction velocity. This may be caused by increase in concentration of the following ions that are present in the solution around the cell:
- K+ and Cl−
- K+ and Na+
- Ca2+ and Cl−
EXP: Cells are bags of potassium ions surrounded by sodium ions. Nerve conduction occurs when sodium enters and potassium leaves.
- An HIV-positive patient’s cause of death is acute pulmonary insufficiency resulting from pneumonia. Patho-histological investigation of lungs has revealed interstitial Pneumonia, alveolocyte desquamation and methamorphoses: alveolocyte Enlargement, large intranuclear inclusions surrounded by lightly-coloured areas. Transformed cells resemble owl’s eye. Name the causative agent of pneumonia:
- Influenza virus
- Candida fungi
EXP: Cytomegalovirus is synonymous with pneumonia in H.I.V with Owl’s eye cells.
- The organisms to be identified have a nucleus surrounded by a nuclear membrane. Genetic material is concentrated predominantly in the chromosomes that consist of DNA strands and protein molecules. These cells divide mitotically. Identify these organisms:
EXP: Prokaryotes have their DNA scattered in the cell. The nucleus and mitosis indicate eukaryotes
- A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes may be the cause of this disease?
- Trisomy 21*
- Trisomy 13
- Trisomy X
- Trisomy 18
- Monosomy X
EXP: No comment 😛
- 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: Victim is in a stage of Erectile shock or agitation as the Vital signs are increased.
- As a result of a mechanical injury an over 10 cm long portion of a peripheral nerve was damaged. This caused an impairment of the upper limb activity. The patient was offered nerve transplantation. What glial cells will participate in regeneration and provide the trophism of the injured limb?
- Schwann cells*
- Fibrous cells
- Protoplasmic cells
- Ependymal cells
EXP: Glial cells are support cells with different functions. Schwann cells provide help with trophism and regeneration.
- A 47-year-old man developed intestinal colic against the background of essential hypertension. In this situation it would be most efficient to arrest the colic by administering drugs of the following group:
- Myotropic antispasmodics* B. Anticholinesterase agents
- Sympathomimetics D. M-cholinomimetics
EXP: Intestinal Colics are best treated using spasmolytics such as no-spa. Thus; Myotropic Antispasmodics
- Microscopy of a female patient’s swabs made from vaginal secretion revealed gram-negative bean-shaped diplococci. What provisional diagnosis can be made?
EXP: Description above matches that of gram negative Neisseria Gonorrhoea.
- A 54-year-old woman was brought to a casualty department after a car accident. A traumatologist diagnosed her with multiple fractures of the lower extremities. What kind of embolism is most likely to develop in this case?
EXP: In Multiple fractures, subcutaneous fat is dislodged into vessels leading to obstruction of blood flow called Adipose Embolism.
- A therapeutist has an appointment with a 40-year-old patient complaining of recurrent pain attacks in his hallux joints and their swelling. Urine analysis revealed its marked acidity and pink colour. What substances can cause such changes in the urine?
- Uric acid salt*
- Ammonium salts
- Calcium phosphate
- Magnesium sulfate
EXP: Acidic, pink fluid causing swelling of joints of fingers and toes is seen in Gout. Identified as Uric Acid Salts
- A 30-year-old man with diabetes mellitus type I was hospitalised. The patient is comatose. Laboratory tests revealed hyperglycemia and ketonemia. What metabolic disorder can be detected in this patient?
- Metabolic acidosis*
- Metabolic alkalosis
- Respiratory acidosis
- Respiratory alkalosis
- Normal acid-base balance
EXP: Ketoacidosis is the most likely complication that will develop in Diabetes mellitus manifested as Metabolic acidosis.
- A 15-year-old patient has fasting plasma glucose level 4,8 mmol/l, one hour after glucose challenge it becomes 9,0 mmol/l, in 2 hours it is 7,0 mmol/l, in 3 hours it is 4,8 mmol/l. Such parameters are characteristic of:
- Subclinical diabetes mellitus*
- Diabetes mellitus type 1
- Diabetes mellitus type 2
- Healthy person
- Cushing’s disease
EXP: The fasting glucose is normal before and after. However, in healthy persons, it goes back to normal 2 hours after the glucose challenge not 3. This suboptimal glucose control is typical for Subclinical Diabetes Mellitus.
- A patient has undergone 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 murky thick yellowish-green fluid with an unpleasant odor. Microscopically the fluid consisted mainly of polymorphonuclear leukocytes. What pathological process are these morphological changes typical for?
- Chronic abscess*
- Acute abscess
EXP: In Chronic Abscess of the Liver, yellowish fluid progresses to yellowish green fluid and Odourless fluid becomes very unpleasant.
- A patient consulted a physician about chest pain, cough, and fever. Roentgenography of lungs revealed eosinophilic infiltrateswhich were found to contain the larvae. What kind of helminthiasis are these presentations typical for?
EXP: Helminth with Larvae and Eosinophilic infiltrate is typical for Ascaris
- During appendectomy a patient had the a. appendicularis ligated. This vessel branches from the following artery:
- A. Ileocolica*
- A. colica dextra
- A. colica media
- A. sigmoidea
- A. mesenterica inferior
EXP: Appendicular artery is a branch of Ileocolic artery. It descends posterior to the terminal Ileum and supplies Appendix.
- A 28-year-old patient undergoing treatment in a pulmonological departmenthas been diagnosed with pulmonary emphysema caused by splitting of alveolarseptum by tissular tripsin. The disease is caused by the congenital deficiency of the following protein:
- α1-proteinase inhibitor*
EXP: Trypsin is a Proteinase, an enzyme which helps to hydrolyse proteins. Disease here is a congenital deficiency of Alpha 1 Proteinase inhibitor leading to no suppression/inhibition of tissular trypsin.
- A patient, who has been suffering for a long time from intestine dysbacteriosis, has increased hemorrhaging caused by disruption of posttranslational modification of blood-coagulation factors II, VII, IХ, and Х in the liver. What vitamin deficiency is the cause of this condition?
EXP: Vitamin K aids blood clotting and its deficiency leads to increased haemorrhage.
- During a surgery for femoral hernia a surgeon operates within the boundaries of femoral trigone. What structure makes up its upper margin?
- Lig. Inguinale*
- Arcus iliopectineus
- Lig. lacunare
- Lig. pectinale
- Fascia lata
EXP: Femoral Triangle is formed with the inguinal ligament superiorly and the adductor longus and Sartorius muscle forming the 2 sides.
- An obstetrician-gynecologist measures pelvis size of a pregnant woman. A caliper was used to measure the distance between the two iliac crests. What measurement of large pelvis was made?
- Distantia cristarum*
- Distantia throchanterica
- Distantia spinarum
- Conjugata vera
- Conjugata anatomica
EXP: Cristaric Distance/ Distance between iliac crests is the Ideal measurement for the large pelvis in a pregnant woman.
- A patient has arterial hypertension. What long-acting drug from the group of calcium channel blockers should be prescribed?
EXP: Although they are all used to treat hypertension, Amlodipine is the only Ca+ channel blocker here; Atenolol is a beta blocker, Reserpine and Octadine are adrenergic inhibitors.
- A patient has been diagnosed with URTI. Blood serum contains immunoglobulin M. What stage of infection is it?
EXP: IgM is the 1st antibody released in infection. In blood serum this confirms acute stage in Upper respiratory tract infection.
- A 43-year-old patient suffers from acute pancreatitis with disrupted common bile duct patency. What condition can develop in this case?
- Mechanical jaundice*
- Hemolytic jaundice
- Hepatocellular jaundice
- Hepatic coma
- Portal hypertension
EXP: Common bile duct is oriented medially to Pancreatic duct. In acute pancreatitis, edema of pancreatic duct leads to compression of Common bile duct and thus; Mechanical Jaundice.
- A patient has a tumor of the eye socket tissues behind the eyeball. Disruption of accomodation and pupil constriction is observed. What anatomical structure is damaged?
- Ganglion ciliare
- N. nasociliaris
- N. lacrimalis
- N. opticus
- N. trochlearis
EXP: Ciliary Ganglion receives parasympathetic fibers from the Edinger Westphal nucleus of Oculomotor nerve which in turn supplies Sphincter pupillae and Ciliaris muscles. Thus; disruption of accommodation and pupil constriction.
- Lymphocytes and other cells of our body synthesize universal antiviral agents as a response to viral invasion. Name these protein factors:
- Interleukin – 2
- Interleukin – 4
- Tumor necrosis factor
EXP: Lymphocytes synthesise Interferons as a response to Viral Infection.
- A patient consulted a dentist about restricted mouth opening (trismus). Anamnesis states a stab wound of the lower extremity. What infection may cause these symptoms?
- Whooping cough
D.Wound anaerobic infection
EXP: Trismus is a symptom of progressing Tetanus Infection.
- A patient has damaged spinal cord white matter in the middle area of the posterior white column, disrupted proprioceptive sensibility of the lower limb joints and muscles. What fibres are affected?
- Fasciculus gracilis*
- Tr. spinothalamicus lateralis
- Tr. spinocerebellaris anterior
- Tr. spinocerebellaris posterior
- Fasciculus cuneatus=
EXP: Posterior white Column of spinal cord contains Dorsal column tract of spinal cord responsible for Deep sensations, Propriception and Fine touch. Medial Affect is present in Fasciculus Gracilis.
- In an elderly person the change in heart force and vessels physical properties were detected; they can be clearly observed on graphic recording of carotid pulse waves. What method was applied?
EXP: Sphygmography is the use of a sphygmomanometer to measure force of heart and blood pressure generally.
- A patient has developed paroxysmal ventricular tachycardia against the background of cardiac infarction. What antiarrhythmic drug should be chosen to avoid lowering cardiac output?
- Lidocaine hydrochloride*
- Potassium chloride
EXP: Lidocaine hydrochloride is the antiarrhythmic drug capable of preserving cardiac output.
- Electrocardiogram of a young man reveals deviation of his electrical axis of heart to the left. This phenomenon can be caused by:
- Hypersthenic body type*
- Asthenic body type
- Dilation of the right atrium
- Dilation of the right ventricle
- Dilation of the left atrium
EXP: Hypersthenic/Excessively built body type has highest predisposition to ECG deviation to the left.
- A 6-year-old child suffers from delayed growth, disrupted ossification processes, decalcification of the teeth. What can be the cause?
- Vitamin D deficiency*
- Decreased glucagon production
- Insulin deficiency
- Vitamin C deficiency
EXP: Vitamin D is responsible for Bone ossification, prevention of rickets in children.
- A 30-year-old patient’s blood test revealed the following: erythrocyte count is 6 · 1012/l, hemoglobin is 10,55ммоль/l. Vaquez’s disease was diagnosed. Name the leading part of pathogenesis:
- Neoplastic erythroid hyperplasia*
EXP: Vaquez’ disease is a chronic form of polycythemia usually characterised by Bone marrow hyperplasia, RBC increase.
- A 25-year-old patient complains of increasing pain in his leg muscles occurring during walking and forcing him to make frequent stops. Objectively: skin of legs is pale, no hair-covering, toenails are with trophic changes, no pulsation of pedal arteries. The most probable cause of these changes is:
- Venous hyperemia
- Arterial hyperemia
EXP: These features are typical for hypoxia, oxygen deficiency leading to Tissue Ischemia.
- This year influenza epidemic is characterised by patients’ body temperature varying from 36.9oC to 37,9oC. Such fever is called:
EXP: Subfebrile fever is characterised by temperature 36.9 – 37.9oC
- A woman complains of visual impairment. Examination revealed obesity in the patient and her fasting plasma glucose level is hyperglycemic. What diabetes complication can cause visual impairment/blindness?
EXP: Vessels of the Retina are very small. Therefore, angiopathy of small vessels occur called Microangiopathy.
- Prolonged treatment of hypothyroidism has caused general dystrophy, dental caries, tachycardia, tremor of extremities. What drug is the cause of these side effects?
- Humulin (Human insulin)
EXP: L-Thyroxin is used to treat hypothyroidism and it presents these side effects in prolonged treatment.
- A 3-year-old child has eaten some strawberries. Soon he developed a rash and itching. What was found in the child’s leukogram?
- Neutrophilic leukocytosis
EXP: Child has allergy to strawberries, in allergic reaction, Eosinophilia is seen in Leukogram
- A patient has been found to have a marked dilatation of the saphenous veins in the region of anterior abdominal wall around the navel. This is symptomatic of pressure increase in the following vessel:
- V. portae hepatis*
- V. cava superior
- V. cava inferior
- V. mesenterica inferior
- V. mesenterica superior
EXP: Patient has symptoms of Portal Hypertension; hepatic portal vein is affected.
- Cholesterol content in blood serum of a 12-year-old boy is 25 mmol/l. Anamnesis states hereditary familial hypercholesterolemia caused by synthesis disruption of receptor-related proteins for:
- Low-density lipoproteins*
- High-density lipoproteins
- Very low-density lipoproteins
- Middle-density lipoproteins
EXP: Low density lipoproteins take cholesterol from the Liver to target organs e.g Adrenal gland for steroid hormone synthesis. In deficiency of LDL, hypercholesteremia occurs.
- Obesity is a common disease. The aim of its treatment is to lower content of neutral fats in the body. What hormone sensitive enzyme is the most important for intracellular lipolysis?
- Triacylglycerol lipase*
- Protein kinase
- Adenylate kinase
- Diacylglycerol lipase
- Monoacylglycerol lipase
EXP: T.A.G lipase helps to break down Triacylglycerol into free fatty acids for beta oxidation.
- A 40-year-old woman was diagnosed with glomerulonephritis based on her clinical symptoms and the results of urine analysis. Anamnesis states chronic tonsillitis. What microorganisms are the most likely cause for her kidney damage?
EXP: Streptococci have highest possibility to cause glomerulonephritis after previous throat infection.
- A man is suffering from diarrhea. In summer he spent his vacation in the south at the sea coast. Bacteria with the following properties were detected in his feces: gram negative curved mobile monotrichous bacillithat do not produce spores or capsules. They are undemanding to nutrient medium but require alkaline reaction (рН 8,5-09,5). Described are the agents of the following enteric infection:
- Typhoid fever
EXP: Vibrio is the one with curve. Chronic diarrhoea with such epidemiology and clinical picture is typical for Cholera.
- A patient is diagnosed with chronic atrophic gastritis attended by deficiency of Castle’s intrinsic factor. What type of anemia does the patient have?
- B12-deficiency anemia*
- Iron refractory anemia
- Hemolytic anemia
- Iron-deficiency anemia
- Protein-deficiency anemia
EXP: Intrinsic factor of stomach helps absorb Vitamin B-12. Its deficiency leads to B-12 deficiency anemia.
- A pregnant woman was detected with IgM to rubella virus. An obstetrician/gynecologist recommended therapeutic abortion due to the high risk of teratogenic affection of the fetus. Detection of IgM was of great importance as it is these specific immunoglobulins that:
- Indicate recent infection*
- Penetrate placental barrier
- Have the largest molecular weight
- Are associated with anaphylactic reactions
- Are the main factor of antiviral protection
EXP: Ig M indicates recent infection, Memory antibodies in Rubella.
- A patient is diagnosed with cardiac infarction. Blood test for cardiospecific enzymes activity was performed. Which of the enzymes has three isoforms?
- Creatine kinase*
- Lactate dehydrogenase
- Aspartate transaminase
- Alanine transaminase
- Pyruvate kinase
EXP: Creatine Kinase has 3 Isoforms; CK1, CK2, CK3.
- A 50-year-old man, who has been suffering from chronic hepatic failure for several years, has developed ascites. What is the main mechanism of this disorder development?
- Increased pressure in portal vein system*
- Decrease of albumin and globulin synthesis in liver
- Increased content of low-density and very low-density lipoproteins in blood
- Neurotoxins appearing in blood
- Increase of blood oncotic pressure
EXP: Ascites in Chronic hepatitis develops from venous congestion, increased pressure in Portal vein system.
- A 30-year-old man has sustained an injury to his thorax in a traffic incident, which caused disruption of his external respiration. What type of ventilatory difficulty can be observed in the given case?
- Restrictive extrapulmonary ventilator impairment*
- Restrictive pulmonary ventilatory impairment
- Obstructive ventilatory impairment
- Impaired ventilation regulation dysfunction
- Cardiovascular collapse
EXP: It is restrictive extra pulmonary ventilator impairment because it concerns external respiration (exhalation) and it doesn’t affect the lungs (extrapulmonary).
- A 53-year-old man suffering from diabetes mellitus has developed a painful conical induration, bluish-red with yellow center, on the skin of his neck. Such changes are characteristic of:
EXP: Symptom above is typical for a furuncle in Diabetes mellitus.
- Biochemical analysis of an infant’s erythrocytes revealed evident glutathione peroxidase deficiency and low concentration of reduced glutathione. What pathological condition can develop in this infant?
- Hemolytic anemia*
- Pernicious anemia
- Megaloblastic anemia
- Iron-deficiency anemia
EXP: Glutathione peroxidase deficiency results in build-up of glutathione which causes hemolysis with oxidative distress. It is a tripeptide of Glycine, Cysteine and Glutamate.
- In winter a 3-year-old child has sharp rise of body temperature up to 40oC. Hemorrhagic rash is observed on the skin and mucosa. Bean-shaped gramnegativemicroorganisms situated in pairsare detected in the blood. What provisional diagnosis can be made?
- Scarlet fever
EXP: Paired bean shaped gram negative organism is typical for Neisseria Meningitidis causing Meningococcosis.
- Microelectrode analysis of nerve fiber biolectrical activity revealed, that its membrane potential equals 90 mV. Its initial rest potential was 85 mV. What process occurs in this case?
EXP: An increase in polarisation of membranes past the resting potential is called Hyperpolarisation.
- Parkinson’s disease is caused by disruption of dopamine synthesis. What brain structure synthesizes this neurotransmitter?
- Substantia nigra*
- Globus pallidus
- Corpora quadrigemina
- Red nucleus
EXP: Dopamine is primarily synthesised in Substantia Nigra of the brain.
- Determining a patient’s blood group with monoclonal test-reagents revealed positive agglutination reaction to anti-A and anti-B reagents, and negative reaction to anti-D. What blood group does this patient have?
- A. IV(АВ) Rh−*
- B. II(А) Rh+
- C. III(В) Rh−
- D. IV(АВ) Rh+
- I (0) Rh+
EXP: Group I(0) has no antigens so there is no agglutination with either anti-A [group III(B)], or anti-B [group II(A)] antibodies.
Group II (A) with A antigens will only agglutinate with anti-A antibodies (in group B blood)
Group III(B) with B antigens will only agglutinate with anti-B antibodies (in group A blood)
Group AB has both A & B antigens, so it will react with both anti-A and anti-B antibodies.
Anti-D reaction is positive for Rh+ and negative for Rh–
- A patient visited a dentist to extract a tooth. After the tooth had been extracted, bleeding from the tooth socket continued for 15 minutes. Anamnesis states that the patient suffers from active chronic hepatitis. What phenomenon can extend the time of hemorrhage?
- Decrease of fibrinogen content in blood*
- Increased activity of anticoagulation system
- Decrease of albumine content in blood
EXP: Thrombocytes and calcium aid clotting so…no. Albumin has nothing to do with it.
The key is the chronic hepatitis. The liver which synthesizes proteins (including fibrinogen in option A & the anticoagulating agents in option D) is damaged. This causes decrease in its synthesis of proteins.
- Name the halogen-containing antiseptic with fungicidal properties, which is used to treat dermatomycosis:
- Iodine solution*
- Formalin solution
- Methylene blue
- Brilliant green
- Boric acid solution
EXP: Iodine solution is the ONLY halogen compound here.
- Due to severe pain syndrome a patient was prescribed a narcotic analgesic. Name this drug:
- Metamizole (Analgin)
- Dimethyl sulfoxide
EXP: Morphine is a Narcotic analgesic used for very severe pain.Metamizole, Nimesulide and Indomethacin are NSAIDs. DiMethy Sulfoxide is also a non-narcotic drug with anti-inflammatory, analgesic and anti-oxidant effects.
- During pathomorphological kidney investigation of a patient, who for a long time had been suffering from osteomyelitis and died from progressing renal failure, the following was revealed: deposits of homogeneous eosinophilic masses in glomerular mesangium, arterial and arteriolar walls, and stroma, which became red when stained with Congo red. What pathological process is this?
- Mucoid swelling
- Carbohydrate degeneration
EXP: Description is typical for pathological protein called Amyloid seen in degenerative processes. Condition is called Amyloidosis. Stained by Congo red.
- A microslide presents a tissue with spherical cells, each of them containing a large fat drop covered with thin cytoplasm layer in its center. Nucleus is compressed and situated at the cell periphery. What tissue is it?
A.White adipose tissue *
- Brown adipose tissue
- Mucous tissue
- Pigmented tissue
- Reticular tissue
EXP: We know it is adipose, now let us differentiate.
In white adipose tissue, the cells accumulate fat in the cytoplasm, small “droplets” of fat grow into a single large droplet. This pushes the remaining cytoplasm and the nucleus to one corner of the cell. During preparation of H & E slides the fat is dissolved and the cell appears empty, with a very thin rim of cytoplasm and the nucleus along the edge. This appearance is described as “signet ring” appearance. (If you have a historical or biblical movie you may have seen how the ring of a king carries his seal which can be “impressed” on writing material by punching it!)
Brown fat cells, on the other hand, contain multiple droplets of fat which do not push the nucleus to one side. The nucleus remains in the centre and the multiple droplets give an appearance of tiny soap bubbles or sponge within the cell.
- To treat rheumatoid arthritis a 65-year-old woman was prescribed an immunosuppressive hormonal drug as a part of her complex therapy. Name this drug:
- Thymus cytomedins (Thymalin)
- Chloropyramine (Suprastin)
EXP: Glucocorticoids (prednisolone) have Immunosuppressive, anti-inflammatory; anti-shock effects and are hormonal preparations.
- An experiment was aimed at testing flexor reflex in a spinal frog, which was initiated by simultaneous stimulation with isolatedpre-threshold electrical impulses. The frequencyof those impulses was such that the reflex occurred. What process in the nerve centers can be observed during this experiment?
- Temporal summation*
- Spatial summation
- Presynaptic summation
- Postsynaptic summation
- Threshold summation
EXP: Single pre-threshold impulses cannot stimulate flow of action potentials but when transmitted from multiple sources or at high frequencies, they add up to produce a Threshold Impulse capable of producing action potentials in a phenomenon called Summation.
There are 2 types of Summation, Spatial (with multiple sources) and Temporal (single or isolated source, repeatedly at a high frequency). Note the words we have made bold.
- A patient diagnosed with acute dysentery has been treated for 3 days in an infectious diseases hospital. On admission there were complaints of high temperature, stomach ache and fluid excrements with mucus as often as 8-10 times a day. What sample should be taken for analysis?
EXP: In acute dysentery, fecal analysis is the most reliable source of diagnosis.
- An 18-year-old woman has body disproportion; wing-like folds on the skin of her neck, underdeveloped ovaries, nuclei of her buccal epithelium cells have no Barr bodies. Dermatoglyphics method revealed that her adt angle is 66o. What provisional diagnosis can be made in this case?
- Turner’s syndrome*
- Cri du chat (cat cry) syndrome
- Kleinfelter’s syndrome
- Patau’s syndrome
- Edwards’ syndrome
EXP: In healthy females, there is usually 1 Barr body. This is due to underdevelopment of 1 of the 2 XX chromosomes. In Turner’s syndrome the karyotype is 45, X0. Note the underdevelopment of sex organs.
- A 27-year-old patient with injury to the neck has lost approximately 30% of the blood volume. The patient’s condition is severe: blood pressure is 60/40 mmHg, heart rate is 140/min., and respiratory rate is 30/min.,conscious. Characterize the condition of the patient’s circulatory system:
- Hypovolemic shock*
- Cardiogenic shock
- Arterial hypertension
EXP: Due to massive loss of blood, Blood volume and pressure have drastically decreased causing Hypovolemic Shock.
Check out Question 106 with similar parameters and the answer there is Collapse. The difference is no loss of blood and unconsciousness.
- A soldier with explosion-caused trauma was delivered to a hospital. Examination revealed his tympanic membrane to be intact. What defense reflex prevented the tympanic membrane from rupturing?
- Contraction of m. tensor tympani
- Relaxation of m. tensor tympani
- Contraction of m. auricularis arterior
- Relaxation of m. auricularis arterior
- Relaxation of m. stapedins
EXP: Tensor veli tympani muscle provides contraction defence reflex for tympanic membrane.
- A person with the fourth blood group (genotype IAIB) has in erythrocytes both antigen A controlled by allele IA and antigen B controlled by allele IB. This phenomenon is an example of the following gene interaction:
EXP: An equal degree of dominance of both genes is seen here. That is; genes A and B are Co-dominant.
- During narcosis a patient developed a risk of cerebral edema. What drug should be administered in this case?
- Sodium bromide
EXP: Diuretics are used to treat and prevent edema and Furosemide is a strong loop diuretic.
- During surgery performed in abdominal cavity a surgeon located ligament of liver stretching from anterior abdominal wall (navel) to inferior surface of liver. What ligament is it?
- Round ligament of the liver*
- Falciform ligament of the liver
- Coronary ligament of the liver
- Venous ligament of the liver
- Triangular ligament of the liver
EXP: Round ligament of the liver ‘ligament teres’ extends from the navel to the inferior surface of the liver.
- A 9-year-old boy has acute onset of disease: sore throat, body temperature rise up to 39,5oC; on the second day diffuse skin rash was detected all over his skin except for nasolabial triangle. On examination of oral cavity: crimson tongue, “flaming pharynx”, and necrotic tonsillitis. What diagnosis is the most likely?
- Scarlet fever*
EXP: Flaming pharynx, crimson tongue are pathognomonic for Scarlet fever. Remember that Scarlet fever is caused by Streptococci (note the sore throat and fever).
- A 49-year-old man complains of pain in his metatarsophalangeal joints and joint deformation. In blood hyperuricemiacan be observed. X-ray has revealed metatarsophalangeal joint space narrowing, erosion, periarticular calcification of the both joints, osteoporosis. Microscopy has revealed inflammatory granulomatous reaction surrounding necrotizing masses in the area of the first metatarsophalangeal joint. Choose the most likely diagnosis:
- Gout (podagra)*
- Pyrophosphate arthropathy
- Rheumatoid arthritis
EXP: Hyperuricemia is typical for Gout. Also, the granulomatous inflammation of the 1st Metatarso-Phalangeal joint is very specific for gout (the patients usually have swollen feet).
- Granulomas containing lymphocytes and macrophages were detected during analysis of skin biopsy material. Among macrophages there are large cells with fat inclusions, which contain microorganisms in spherical packages (Virchow’s cells). The following disease is based on the described type of hypersensitivity:
- Epidemic typhus
EXP: Virchow cells are pathognomonic for Leprosy.
- A patient with suspected necrosis of the upper abdominal cavity organs was delivered to a surgical department. This condition is associated with acute circulatory disturbance of the following vessel:
- Truncus coeliacus*
- A. mesenterica inferior
- A. mesenterica superior
- A. iliaca communis
- A. renalis
EXP: The Common Iliac Artery and Renal Artery supply the lower limbs and kidney respectively.
The superior mesenteric artery supplies the midgut, i.e., from the second part of the duodenum to the left part of the transverse colon. The inferior mesenteric artery supplies the hindgut, i.e., from the left part of the transverse colon to the rectum.
Coeliac trunk supplies upper abdominal cavity organs (liver, spleen, stomach, gall bladder, pancreas). In its violation, Ischemia and Necrosis occur.
- Name the drug that inhibits excretory function of pancreas during treatment of acute pancreatitis:
- Contrykal (Aprotinin)*
- Pancreatin (Mezym forte)
EXP: Contrycal inhibits excretory function of pancreas, used in acute pancreatitis. Pancreatin (also called Panzynorm and Festal) is used in chronic pancreatitis.
Allochol is a cholagogue, used for chronic hepatitis, cholangitis and cholecystitis.
- An 18-year-old patient has developed candidiasis after the case of pneumonia treated with β-lactam antibiotic. What antimycotic agent should be prescribed?
- Trimethoprim/sulfamethoxazole (Biseptol)
EXP: Candidiasis usually occurs due to dysbacteriosis as Normal flora have been killed by antibiotics leading to increased amount of opportunistic flora such as candida. Fluconazole is the only antifungal drug here, used in its treatment. The other drugs are antibiotics/anti-bacterial.
- During autopsy of a 9-month-old girl’s body, who died due to severe pneumonia complicated with sepsis, lack of thymusis observed. In the lymph nodes the lymphoid follicles and cortical substance are absent; follicles of spleen are reduced in size with no light zones and plasma cells. What is the cause of such structural changes?
- Thymus agenesis*
- Accidental involution of thymus
- Thymus hypoplasia
- Thymus atrophy
- Thymus aplasia
EXP: Well, lack of thymus is observed and ‘agenesis’ means total congenital absence.
- A patient with femoral neck fracture, who for a long time had to remain in bed in a forced (supine) position, has developed dark-brown lesions along the backbone; soft tissues are swollen, in the areas of maceration there is a foul-smelling liquid. Name the clinic-pathologic type of necrosis:
- Coagulation necrosis
- Dry gangrene
EXP: Remaining in bed for a prolonged period of time leads to development of Bed-Sores due to reduced circulation to the affected area.
- A woman poisoned with unknown substance was hospitalised in a toxicological department. What group of drugs can be administered to decrease absorption and introduction of the poison to her body?
- Organic nitrates
- Cholinesterase inhibitors
EXP: Effects of Poisons are best neutralised, decreased using Adsorbents such as activated charcoal.
- A patient after disrupted cerebral circulation has developed paralysis. Choose the anticholinesterasedrug to be prescribed in this case:
- Hexamethonium (Benzohexonium)
EXP: Proserin is the Anticholinesterase drug among these.
Cordiamnin is a CNS stimulant
Aceclidine is a choline-mimetic
Methacin is an NSAID
Benzohexonium is a non-depolarizing ganglionic blocker
- A 50-year-old woman is being treated for shingles in a neurology unit. What reactivated virus causes this disease?
- Varicella zoster virus (chickenpox virus)
- Herpes simplex virus type 1
- Herpes simplex virus type 2
- Measles virus
EXP: Varicella Zoster virus causes Shingles. It is interesting to note that Varicella and Cytomegalovirus are in the Herpes family.
- During examination of a patient a doctor should use anatomical division of anterior abdominal wall into regions for more precise diagnostics. How many such regions can the abdomen be divided into?
EXP: 3 upper, 3 middle, and 3 lower. In total 9 regions based on projection of internal organs on abdominal wall.