Krok 1

A 58-year-old female has undergone surgery for necrotic bowel. Despite having been treated with antibiotics, on postoperative day 5, she develops symptoms (fever, hypotension, tachycardia, declining urine output, and confusion) consistent with septic shock. What hemodynamic support would be helpful?

As a result of prophylactic medical examination a 7 year old boy was diagnosed with Lesch-Nyhan syndrome (only boys fall ill with it). The boy's parents are healthy but his grandfather by his mother's side suffers from the same disease. What type of disease inheritance is it?

.Hartnup disease is caused by point mutation of only one gene which results in disturbance of tryptophane absorption in the bowels and its resorption in the renal tubules. It is the reason for disorder of both digestive and urination systems. What genetic phenomenon is observed in this case?

A boy has I (I^0I^0) blood group and his sister has IV (I^AI^B) blood group. What blood groups do their parents have?

A man has worked in an African country for 3 years. A month after his return to Ukraine he consulted an ophthalmologist and complained about eye ache, eyelid edema, lacrimation and temporary visual impairment. Underneath the eye conjunctiva the doctor revealed helminths 30-50 mm long with elongated filiform body. What diagnosis might be suspected?

A patient working at a pig farm complains about paroxysmal abdominal pain, liquid feces with admixtures of mucus and blood, headache, weakness, fever. Examination of large intestine revealed ulcers from 1 mm up to several cm large, feces contained oval unicellular organisms with cilia. What disease should be suspected?

A 39-year-old woman has madescence in the region of mammilla, a small ulcer with inflammatory hyperemia and cutaneous edema. Histologic examination of tissue sampling from this area revealed in the malpighian layer of thickened epidermis atypical cells with light and optically empty cytoplasm, with no intracellular bridges. Such cells were also found in the orifice of big mammal gland ducts. What is the most probable diagnosis?

The guide of the scientific expedition in India was native who always was with his dog. What invasive diseases can be transmitted by the dog if it is the source of invasion?

The cell of the laboratory animal was overdosed with Roentgen rays. As a result albuminous fragments formed in the cytoplasm. What cell organoid will take part at their utilization?

In some regions of South Africa there is a spread sickle-shaped cell anemia, in which erythrocytes have shape of a sickle as a result of substitution of glutamin by valine in the hemoglobin molecule. What is the cause of this disease?

A female patient consulted a physician about digestive disorder, extended abdominal pain. Examination revealed drastic decrease in hemoglobin concentration. It is known from the anamnesis that while living in the Far East the patient used to eat freshly-salted caviar. Some relatives living with her had the similar condition. What is the most likely diagnosis?

A 26-year-old female consulted a doctor about having stool with white flat moving organisms resembling noodles. Laboratory analysis revealed proglottids with the following characteristics: long, narrow, with a longitudinal channel of the uterus with 17-35 lateral branches on each side. What kind of intestinal parasite was found?

A teenager was irradiated with high radiation dose that resulted in serious damages of lymphoid system, lysis of many lymphocytes. Restoration of normal hemogram is possible due to the functioning of the following gland:

It was revealed that T-lymphocytes were affected by HIV. Virus enzyme - reverse transcriptase (RNA-dependent DNA polymerase) - catalyzes the synthesis of:

Patient has symptoms of inflammation of urogenital tracts. Examination of a vaginal smear revealed big monocellular, pear-shaped organisms with the pointed spike at the posterior end of body, big nucleus and undulating membrane. What protozoa were found in the smear?

Tuberculosis can be treated by means of combined chemotherapy that includes substances withdifferent mechanisms of action. What antituberculous medication inhibits transcription of RNA into DNA in mycobacteria?

25.Larvae were detected occasionally on the microscopic examination of the sputum of the patient with pneumonia. Eosinophiles were detected on the blood examination. What helminthiasis can be diagnosed?

A patient consulted a urologist about pain during urination. Analysis of his urine taken in the daytime revealed eggs with a characteristic sharp point. It is known from the anamnesis that the patient has recently returned from Australia. What is the most likely diagnosis?

According to the phenotypic diagnosis a female patient has been provisionally diagnosed with X-chromosome polysomia. This diagnosis can be confirmed by a cytogenetic method. What karyotype will allow to confirm the diagnosis?

Examination of cell culture got from a patient with lysosomal pathology revealed accumulation of great quantity of lipids in the lysosomes. What of the following diseases is this disturbance typical for?

Golgi complex exports substances from a cell due to the fusion of the membrane saccule with the cell membrane. The saccule con

.An 18-year-old male has been diagnosed with Marfan syndrome. Examination revealed a developmental disorder of connective tissue and eye lens structure, abnormalities of the cardiovascular system, arachnodactylia. What genetic phenomenon has caused the development of this disease?

Woman applied to the medico-genetic consulting centre for information about the risk of haemophilia in her son. Her husband has been suffering from this disease since birth. Woman and her parents are healthy (don't have haemophilia). Is the boy likely to have the disease in this family?

Electrocardiogram of a 45-year-old man showed absence of P-wave in all the leads. What part of the conducting system is blocked?

When a patient with traumatic impairment of the brain was examined, it was discovered that he had stopped to distinguish displacement of an object on the skin. What part of the brain was damaged?

The patient with diabetes mellitus has been delivered in hospital in the state of unconsciousness. Arterial pressure is low. The patient has acidosis. Point substances, which accumulation in the blood results in these manifestations:

Patient 54 year-old, 5th day after surgical operation. Blood count: Erythrocytes 3,6*1012/l, Hemoglobin 95 g/l, Erythrocyte’s hemoglobin content (color index) 0,78; Leukocytes 16*109/l, Platelets 450*10 9/l Blood picture: anizocytosis, poikilocytosis, reticulocytes-3,8%. What anemia does this patient have?

A 16 year-old patient got numerous traumas in automobile accident. Now the patient is haning a shock. АP - 80/60 mm Hg. Daily urine volume 60-80 ml. What pathogenic mechanism leads to kidneys function violation?

46 year-old patient has complained of headache, fatigue, thirst, pains in the spine and joints for the last 2 years. Clinically observed disproportional enlargement of hands, feet, nose, superciliary arches. He notes that he needed to buy bigger shoes three times. What is the main reason of such disproportional enlargement of different parts of the body?

A 55-year-old patient with continuing ventricular arrhythmias was admitted to the hospital. The patient is taking timolol drops for glaucoma, daily insulin injections for diabetes mellitus, and an ACE inhibitor for hypertension. You have decided to use phenytoin instead of procainamide. What is the reason?

A 25-year-old woman with red and itchy eczematoid dermatitis visits your office. She had a dental procedure one day earlier with administration of a local anesthetic. There were no other findings, although she indicated that she had a history of allergic reactions. Which of the following drugs is most likely involved?

Highly injured person gradually died. Please choose the indicator of biological death:

Ultrasonic examination of a patient revealed aneurism in the area of aortic arch that caused alteration of vocal function of larynx. What nerve was constricted?

In course of a small pelvis operation it became necessary to ligate an ovarian artery. What formation may be accidentally ligated together with it?

A patient was diagnosed with bartholinitis (inflammation of greater vulvovaginal glands). In which organ of urogenital system are these glands localized?

A patient was admitted to the surgical department with inguinal hernia. During the operation the surgeon performs plastic surgery on posterior wall of inguinal canal. What structure forms this wall?

While performing an operation in the area of axillary crease a surgeon has to define an arterial vessel surrounded by fascicles of brachial plexus. What artery is it?

After a craniocerebral trauma a patient lost the ability to execute learned purposeful movements (apraxia). The injury is most likely localized in the following region of the cerebral cortex:

In case of a penetrating wound of the anterior abdominal wall the wound tract went above the lesser curvature of stomach. What peritoneum formation is most likely to be injured?

A patient got a craniocerebral trauma that resulted in right-side convergent strabismus. Damage of which craniocerebral nerve caused such consequences?

Preventive examination of a patient revealed an enlarged lymph node of metastatic origin on the medial wall of the left axillary crease. Specify the most likely localization of the primary tumour:

A patient with cholelithiasis fell ill with mechanic jaundice. Examination revealed that the stone was in the common bile duct. What bile-excreting ducts make up the obturated duct?

.A patient's knee joint doesn't extend, there is no knee-jerk reflex, skin sensitivity of the anterior femoral surface is disturbed. What nerve structures are damaged?

A 40-year-old patient complains of intensive heartbeats, sweating, nausea, visual impairment, arm tremor, hypertension. From his anamnesis: 2 years ago he was diagnosed with pheochromocytoma. Hyperproduction of what hormones causes the given pathology?

A 38-year-old patient came to a traumatology centre and complained about an injury of his right hand. Objectively: the patient has a cut wound in the region of the thenar eminence on the right hand; distal phalanx of the I finger cannot be flexed. What muscle was injured?

A 35 year old man with a trauma of his left hand was admitted to the traumatology department. Objectively: cut wound of palmar surface of left hand; middle phalanxes of II–V fingers don't bend. What muscles are damaged?

Ovarian tumour was diagnozed in the woman. Surgery was indicated. What ligament should be cut by the surgeon to disconnect the ovary and the uterus?

.A man with internal abdominal right side injury and suspicion of liver rupture was admitted to the traumatological department. In what peritonial structure will blood accumulate?

.Obturative jaundice developed in a 60-year-old patient because of malignant tumour of the big papillary of the duodenal. Lumen of what anatomical structure is squeezed with tumour?

A patient has tissue ischemia below the knee joint accompanied with intermittent claudication. What artery occlusion should be suspected?

After a trauma of soft tissues in the region of the posterior sorface of medial condyle of humerus a patient has got a skin prickle of medial forearm surface. Which of the listed nerves is located in the affected region?

.Examination of a 2-year-old child revealed physical developmental lag, the child often has pneumonias. The child was diagnosed with nonclosure of ductus arteriosus. Haemodynamics disorder was caused by the intercommunication of the following vessels:

A female patient with a tumour of pancreas has developed mechanic jaundice resulting from compression of a bile-excreting duct. Which duct is compressed?

Patient operated on complicated appendicitis has the following changes of blood count: erythrocytes - 4,0*1012/l, Нb - 120 g/l, color index - 0,9, leukocytes – 18*109/l, basophils - 0, eosinophils - 0, myelocytes - 0, juvenile - 0, stab neutrophils - 20, segmentonuclear neutrophils - 53, lymphocytes - 21, monocytes - 5. How is such nuclear shift of leukocytic formula called?

A patient complains about edemata of legs, skin cyanosis, small ulcers on one side of the lateral condyle. Examination revealed a swelling, enlarged veins, formation of nodes. The pathological process has started in the following vein:

A woman underwent an operation on account of extrauterine (tubal) pregnancy. In course of the operation the surgeon should ligate the branches of the following arteries:

7-year-old girl has signs of anemia. Laboratory examination revealed pyruvate kinase deficiency in erythrocytes. What process disturbance plays the main role in anemia development?

A comminuted fracture of infraglenoid tubercle caused by shoulder joint injury has been detected during X-ray examination of a patient. What muscle tendon attached at this site has been damaged?

An injured man has bleeding from branches of carotid artery. For a temporary arrest of bleeding it is necessary to press the carotid artery to the tubercle of cervical vertebra. Which vertebra is it?

.An 18-year-old man was delivered to the hospital after a road accident. Examination at the traumatological department revealed multiple injuries of soft tissues of face in the region of the medial eye angle. The injuries caused massive haemorrhage. What arterial anastomosis might have been damaged in this region?

.As a result of a continuous chronic encephalopathy, a patient has developed spontaneous motions and a disorder of torso muscle tone. These are the symptoms of the disorder of the following conduction tract:

35-year-old patient applied to a doctor with complaints about having intense rhinitis and loss of sense of smell for a week. Objectively: nasal cavity contains a lot of mucus that covers mucous membrane and blocks olfactory receptors. In what part of nasal cavity are these receptors situated?

While examining the oral cavity a stomatologist revealed inflammation of papillae on the border of the median and posterior third of the back of tongue. What papillae are inflamed?

After consumption of rich food a patient has nausea and heartburn, steatorrhea. This condition might be caused by:

Characteristic sign of glycogenosis is muscle pain during physical work. Blood examination reveals usually hypoglycemia. This pathology is caused by congenital deficiency of the following enzyme:

A 46-year-old female patient has a continuous history of progressive muscular (Duchenne's) dystrophy. Which blood enzyme changes will be of diagnostic value in this case?

In case of enterobiasis acrihine - the structural analogue of vitamin B2 - is administered. The synthesis disorder of which enzymes does this medicine cause in microorganisms?

.Researchers isolated 5 isoenzymic forms of lactate dehydrogenase from the human blood serum and studied their properties. What property indicates that the isoenzymic forms were isolated from the same enzyme?

Tere is observed inhibited fibrillation in the patients with bile ducts obstruction, bleeding due to low level of absorbtion of some vitamin. What vitamin is in deficit?

.While examining the child the doctor revealed symmetric cheeks roughness, diarrhea, disfunction of the nervous system. Lack of what food components caused it?

.Increased breaking of vessels, enamel and dentine destruction in scurvy patients are caused by disorder of collagen maturing. What stage of modification of procollagen is disordered in this avitaminosis?

Untrained people often have muscle pain after sprints as a result of lactate accumulation. This might be caused by intensification of the following biochemical process:

.The concentration of albumins in human blood sample is lower than normal. This leads to edema of tissues. What blood function is damaged?

.A 20 year old patient complains of general weakness, dizziness, quick fatigability. Blood analysis results: Hb- 80 g/l. Microscopical examination results: erythrocytes are of modified form. This condition might be caused

A patient has pellagra. Interrogation revealed that he had lived mostly on maize for a long time and eaten little meat. This disease had been caused by the deficit of the following substance in the maize:

A 46 year old patient applied to a doctor complaining about joint pain that becomes stronger the day before weather changes. Blood examination revealed strengthened concentration of uric acid. The most probable cause of the disease is the intensified disintegration of the following substance:

Donor skin transplantation was performed to a patient with extensive burns. On the 8-th day the graft became swollen and changed colour; on the 11-th day graft rejection started. What cells take part in this process?

A newborn child has convulsions that have been observed after prescription of vitamin B6. This most probable cause of this effect is that vitamin B6 is a componet of the following enzyme:

Concentration of pyruvate is increased in the patient's blood, the most of which is excreted with urine. What avitaminosis is observed in the patient?

.A 1,5-year-old child presents with both mental and physical lag, decolorizing of skin and hair, decrease in catecholamine concentration in blood. When a few drops of 5% solution of trichloroacetic iron had been added to the child’s urine it turned olive green. Such alteration are typical for the following pathology of the amino acid metabolism:

.The greater amount of nitrogen is excreted from the organism in form of urea. Inhibition of urea synthesis and accumulation of ammonia in blood and tissues are induced by the decreased activity of the following liver

44-year-old woman complains of common weakness, heart pain, considerable increase of body weigt. Objectively: moon-like face, hirsutism, AP- 165/100 mm Hg, height - 164 cm, weight - 103 kg; fat is mostly accumulated in the region of neck, upper shoulder girdle, stomach. What is the main pathogenetic mechanism of obesity?

A 36-year-old female patient has a history of collagen disease. Urine analysis is likely to reveal an increased concentration of the following metabolite:

An infant has apparent diarrhea resulting from improper feeding. One of the main diarrhea effects is plentiful excretion of sodium bicarbonate. What form of acid-base balance disorder is the case?

A 4 y.o. Child with signs of durative proteinic starvation was admitted to the hospital. The signs were as follows: growth inhibition, anemia, edemata, mental deficiency. Choose a cause of edemata development:

According to clinical indications a patient was administered pyridoxal phosphate. What processes is this medication intended to correct?

Desulfiram is widely used in medical practice to prevent alcocholism. It inhibits aldehyde dehydrogenase. Increased level of what metabolite causes aversion to alcochol?

Objective examination of a patient revealed: slender figure, big skull, highly developed frontal region of face, short extremities. What constitutional type is it characteristic for?

Osteolaterism is charcterized by a decrease in collagen strength caused by much less intensiveformation of cross-links in collagen fibrils. This phenomenon is caused by the low activity of the following enzyme:

A 5-month-old boy was hospitalized for tonic convulsions. He has a life-time history of this disease. Examination revealed coarse hair, thinned and fragile nails, pale and dry skin. In blood: calcium - 1,5 millimole/l, phosphor - 1,9 millimole/l. These changes are associated with:

Cytogenetic examination of a patient with dysfunction of the reproductive system revealed normal karyotype 46, ХУ in some cells, but most cells have Klinefelter's syndrome karyotype - 47, ХХУ. Such phenomenon of cell inhomogeneity is called:

A sportsman needs to improve his sporting results. He was recommended to take a preparation that contains carnitine. What process is activated the most by this compound?

Laboratory examination of a child revealed increased concentration of leucine, valine, isoleucine and their ketoderivatives in blood and urine. Urine smelt of maple syrup. This disease is characterized by the deficit of the following enzyme:

Examination of a patient revealed II grade obesity. It is known that he consumes a lot of sweets and rich food, has sedentary way of life. That's why anabolic metabolism has the priority in his organism. Which of the following pathways is amphibolic?

A 4-year-old child with hereditary renal lesion has signs of rickets, vitamin D concentration in blood is normal. What is the most probable cause of rickets development?

A 6-year-old child was delivered to a hospital. Examination revealed that the child couldn't fix his eyes, didn't keep his eyes on toys, eye ground had the cherry-red spot sign. Laboratory analyses showed that brain, liver and spleen had high rate of ganglioside glycometide. What congenital disease is the child ill with?

In clinical practice tuberculosis is treated with izoniazid preparation - that is an antivitamin able to penetrate into the tuberculosis bacillus. Tuberculostatic effect is induced by the interference with replication processes and oxidation-reduction reactions due to the buildup of pseudo-coenzyme:

A 49-year-old driver complains about unbearable constricting pain behind the breastbone irradiating to the neck. The pain arose 2 hours ago. Objectively: the patient’s condition is grave, he is pale, heart tones are decreased. Laboratory studies revealed high activity of creatine kinase and LDH1 . What disease are these symptoms typical for?

A 67-year-old male patient consumes eggs, pork fat, butter, milk and meat. Blood test results: cholesterol - 12,3 mmol/l, total lipids - 8,2 g/l, increased low-density lipoprotein fraction (LDL). What type of hyperlipoproteinemia is observed in the patient?

A patient visited a dentist with complaints of redness and edema of his mouth mucous membrane in a month after dental prosthesis. The patient was diagnosed with allergic stomatitis. What type of allergic reaction by Gell and Cumbs underlies this disease?

Decreased blood supply to the organs causes hypoxia that activates fibroblasts function. Volume of what elements is increased in this case?

A 22-year-old patient was admitted to the hospital with complaints of heavy nasal breathing. During the examination of her nasal cavity the doctors found thickened mucous membrane, a lot of mucus and nodular infiltrates without erosions in the nose. The nasal rhinoscleroma was diagnosed. The biopsy was taken. What typical morphological changes may be found?

During histological examination of the stomach it was found out that glands contain very small amount of pariental cells or they are totally absent. Mucose membrane of what part of the stomach was studied?

13-year-old girl with history of asthma complained of cough, dyspnea and wheezing. Her symptoms became so severe that her parents brought her to the emergency room. Physical examination revealed diaphoresis, dyspnea, tachycardia and tachypnea. Her respiratory rate was 42/min, pulse rate was 110 beats per minute, and blood pressure was 130/70 mm Hg. Choose from the following list the most appropriate drug to reverse the bronchoconstriction rapidly:

In the blood of a 26-year-old man it was revealed 18% of erythrocytes of the spherical, ball-shaped, flat and thorn-like shape. Other eritrocytes were in the form of the concavo-concave disks. How is such phenomenon called?

On autopsy a 35-year-old man the focus of carnification 5 cm in diametre enclosed in a thin capsule was revealed in the second segment of the right lung . The focus consists of a tough dry friable tissue with a dim surface. For what disease are these morphological changes typical?

M-r S presents all signs of the hepatic coma: loss of consciousness, absence of reflexes, cramps, convulsion, disorder of heart activity, recurrent (periodical) respiration. What are cerebrotoxical substances which accumulate in blood under hepar insufficiency?

The low specific gravity of the secondary urine (1002) was found out in the sick person. Wat is the most distant part of nephron where concentration of secondary urine takes place?

Examination of a 43 y.o. Patient revealed that his stomach has difficulties with digestion of protein food. Gastric juice analysis revealed low acidity. Function of which gastric cells is disturbed in this case?

.A histological specimen shows a blood vessel. Its inner coat is composed by endothelium, subendothelium and internal elastic membrane. The middle coat is enriched with smooth myocytes. Such morphological characteristics are typical for the following vessel:

Kidneys of a man under examination show increased resorbtion of calcium ions and decreased resorbtion of phosphate ions. What hormone causes this phenomenon?

.During pubescence the cells of male sexual glands begin to produce male sex hormon testosterone that calls forth secondary sexual characters. What cells of male sexual glands produce this hormone?

Ultramicroscopical examination of "dark" hepatocyte population in the cell cytoplasm detected a developed granular endoplasmic reticulum. What function has this organella in these cells?

Study of fingerprints (dactylography) is used by criminalists for personal identification as well as for diagnostics of genetic abnormalities, particularly Dawn's disease. What layer of skin determines individuality of fingerprints?

An endocrinal gland with parenchyma consisting of epithelium and neural tissue is under morphological examination. Epithelial trabecules have two types of cells: chromophilic and chromophobic. Identify this organ:

.One of sections of central nervous system has layerwise arrangement of neurocytes. Among them there are cells of the following forms: stellate, fusiform, horizontal, pyramidal. What section of central nervous system is this structure typical for?

Patient with hypersecretion of the gastric juices was recomended to exclude from the diet concentrated bouillons and vegetable decoctions because of their stimulation of gastric secretion. What is dominating mechanism of stimulation of secretion in this case?

Person felt thirsty after staying in heat for a long time. Signals of what receptors caused it first of all?

There is only one hormone among the neurohormones which refers to the derivatives of amino acids according to classification. Point it out:

Blood analysis of a patient showed signs of HIV infection (human immunodeficiency virus). Which cells does HIV-virus primarily affect?

Respiratory coefficient was studied in the patient who strictly kept certain diet for 10 days. It was determined that it is 1. What diet does the patient follow?

29.The person has decreased diuresis, hypernatremia, hypokalemia. Hypersecretion of what hormon can cause such changes?

.ECG study showed that the T-waves were positive in the standard extremity leads, their amplitude and duration were normal. The right conclusion would be that the following process runs normally in the heart ventricles:

In course of an experiment a skeletal muscle is being stimulated by a series of electric impulses. What type of muscle contraction will arise, if every subsequent impulse comes in the period of shortening of the previous single muscle contraction?

.Due to activation of ion channels of external membrane of excitable cell it's rest potential has significantly increased. What channels were activated?

Due to cranial trauma, the patient developed the symptoms: intention tremor, dysmetry, adiadochokinesis, dysarthria. What structure of the brain is injured?

A man is being measured power inputs on an empty stomach, in the lying position, under conditions of physical and psychic rest at a comfortable temperature. Power inputs will reach the maximum at:

A patient has a disturbed absorbtion of fat hydrolysates. It might have been caused by a deficit in the small intestine cavity:

A man has normal sensitivity of his finger skin, however he doesn’t sense his wedding ring around the finger. What process induced by wearing of the ring has caused this phenomenon?

.Intrapleural pressure is being measured in a person. In what phase has a person hold his breath if the pressure is - 25 cm H2O?

.What heat transfer mechanism is the most effective while the man being at 80% of air moisture and the temperature +350С?

Parents of a 10 y.o. Boy consulted a doctor about extension of hair-covering, growth of beard and moustache, low voice. Intensified secretion of which hormone must be assumed?

.Lung ventilation in a person is increased as a result of physical activity. Which of the following indices of the external respiration is much higher than in a state of rest?

.Atria of an experimental animal were superdistended by blood that resulted in decreased reabsorption of Na+ and water in renal tubules. This can be explained by the influence of the following factor upon kidneys:

60-year-old man after cerebral hemorrhage felt asleep for a long time. Damage of what structure caused this state?

.As a result of destruction of certain brainstem structures an animal has lost its orientative reflexes in response to strong photic stimuli. What structures were destroyed?

A hypertensive glucose solution was introduced to a patient. It will intensify water movement:

.A patient is 44 years old. Laboratory examination of his blood revealed that content of proteins in plasma was 40 g/l. What influence will be exerted on the transcapillary water exchange?

From the nasopharynx of a 5-year-old child it was excreted amicroorganism which is identical to Corynebacterium diphtheriae dose according to morphological and biochemical signs.Microorganism does not produce exotoxin. As a result of what process can this microorganism become toxigenic?

While examining a patient an otolaryngologist noticed hyperaemia and significantly edematous tonsils with a grayish film upon them. Microscopical examination of this film revealed some gram-positive bacilli placed at an angle with each other. What disease might be suspected?

In a patient with clinical signs of immunodeficiency the number and functional activity of T and B lymphocytes are not changed. Defect with dysfunction of antigen-presentation to the immunocompetent cells was found during investigation on the molecule level. Defect of what cells is the most probable?

Patient who came to the doctor because of his infertility was administered to make tests for toxoplasmosis and chronic gonorrhoea. Which reaction should be performed to reveal latent toxoplasmosis and chronic gonorrhoea of the patient?

While registering the child to the school Mantu's test was made to define whether revaccination was needed test result is negative. What does this result of the test mean?

.Patient with diarrhoea was admitted to the infection unit. Gramnegative curved rod-like bacteria were founded on bacterioscopic examination of faecal masses. What is the most likely disease in this patient?

Examination of a patient with pustular skin lesions allowed to isolate a causative agent that forms in the blood agar roundish yellow middle-sized colonies surrounded by haemolysis zone. Smears from the colonies contain irregular-shaped clusters of gram-positive cocci. The culture is oxidase- and catalase-positive, ferments mannitol and synthesizes plasmocoagulase. What causative agent was isolated?

A 50-year-old man has felt vague abdominal discomfort within past 4 months. Physical examination revealed no lymphadenopathy, and no abdominal masses or organomegaly at palpation. Bowel sounds are heard. An abdominal CT scan shows a 20 cm retroperitoneal soft tissue mass obscuring the left psoas muscle. A stool specimen tested for occult blood is negative. Which of the following neoplasms is this man most likely to have?

Extensive thromboembolic infarction of the left cerebral hemispheres, large septic spleen, immunocomplex glomerulonephritis, ulcers on the edges of the aortic valves, covered with polypous thrombus with colonies of staphylococcus were revealed on autopsy of the young man who died in coma. What disease caused cerebral thromboemboly?

During surgery in a 17-year-old patient it was revealed the tumour of 4,5х5,0х3,5 sm in size on the lower surface of the liver with subserose localization, of dark-red color. On the section tumour has cavities with marked amount of blood. What is preliminary diagnosis?

On autopsy it is revealed: soft arachnoid membrane of the upper parts of cerebral hemisphere is plethoric, it is of yellowish-green color, soaked with purulent and fibrose exudate, it lookes like cap. For what disease is it characteristical picture

Patient died under conditions of cardiovascular insufficiency. Autopsy results: postinfarction cardiosclerosis, myocardium hypertrophy and dilatation of its cavities, especially of its right ventricle. Liver is enlarged, its surface is smooth, incision revealed that it was plethoric, with dark-red specks against the background of brownish tissue. Histologically: plethora of central parts of lobules; peritheral parts around portal tracts contain hepatocytes in a state of adipose degeneration. How are these liver changes called?

An 8-year-old child was admitted to the infectious department with fever (up to 38oC) and punctuate bright-red skin rash. The child was diagnosed as having scarlet fever. Objectively: mucous membrane of pharynx is apparently hyperaemic and edematic, the tonsils are enlarged and have dull yellowish- grey foci with some black areas. What inflammation is the reason for the pharynx alterations?

.On autopsy it was revealed: large (1-2 cm) brownish-red, easy crumbling formations covering ulcerative defects on the external surface of the aortic valve. What is the most likely diagnosis?

A 22 year old patient from the West Ukraine complains of laboured nasal breathing. Morphological examination of biopsy material of nasal mucous membrane revealed lymphoid, epithelioid, plasma cells as well as Mikulicz's cells. What is the most probable diagnosis?

A 70-year-old patient suffers from atherosclerosis complicated by the lower limb thrombosis that has caused gangrene on his left toes. What is the most likely cause of the thrombosis origin?

.Inflamation is characterised by increasing penetration of vessels of microcirculation stream, increasing of their fluid dynamic blood pressure. Increasing of the osmotic concentration and dispersity of protein structures present in the intercellular fluid. What kind of edema will appear in this case?

In a 45-year-old patient on ECG it was revealed: sinus rhythm, the number of auricular complexesexceeds number of ventricular complexes; progressing extension of the P-Q interval from complex to complex; fallout of some ventricular complexes; Р waves and QRST complexes are without changes. Name the type of heart rhythm disfunction.

.A patient with the symptoms of acute alcoholic poisoning was brought to the hospital. What carbohydrates metabolism changes are typical for this condition?

Examination of a patient admitted to the surgical department with symptoms of acute appendicitis revealed the following changes in the white blood cells: the total count of leukocytes is 16*109/l. Leukocyte formula: basophils - 0, eosinophils - 2%, juvenile forms - 2%, stabnuclear - 8%, segmentonuclear - 59%, lymphocytes - 25%, monocytes-4%. The described changes can be classified as:

Proserin increases skeletal muscle tone when given systematically. Halothane induces relaxation of skeletal muscles and reduces proserin effects. What is the nature of proserin and halothane interaction?

The patient was treated medically for psychosis for 2 weeks. Patient's condition improved but rigidity, tremor, hypokinesia developed. Which of the drugs can cause such complications?

Gonorrhoea was revealed in the patient on bacterioscopy of the smear from urethra. Taking into account that medecines for gonorrhoea are fluorquinolones, patient should be prescribed:

.Patient was admitted to the infection unit with diagnosis of bacterial dysentery. On laboratory studies it was revealed that causative element is sensative to the many antimicrobial medicines, but patient has anemia. What medicine is contra-indicated to the patient?

Anapriline therapy caused positive effect in the dynamic of the disease of a 44-year-old woman suffering from stenocardia. What is the main mechanism of the effect of this medicine?

Patient taking clonidine for essential hypertension treatment was using alcohol that caused intense inhibition of central nervous system. What may it be connected with?

A doctor administered a patient with allergic dermatitis a H1 - histamine blocker as a part of complex treatment. Name this medication:

Patient suffering from coronary artery disease had taken a certain drug many times a day in order to arrest stenocardia attacks. Overdose of this drug finally caused intoxication. Objectively: cyanotic skin and mucous membranes, dramatic fall in the arterial pressure, tachycardia, respiration inhibition. Blood has increased concentration of methemoglobin. The drug the patient had taken relates to the following group:

Patient with chronic cardiac insufficiency has been treated with cardiotonic drugs and a thiazide diuretic, but in spite of it there are still edemata and risk of ascites. What medication should be prescribed to amplify diuretic effect of the applied drugs?

An ophthalmologist used a 1% mesaton solution for the diagnostic purpose (pupil dilation for eye-ground examination). What is the cause of mydriasis induced by the drug?

A patient with chronic cardiac insufficiency has been treated with cardiotonic drugs and a thiazide diuretic, but in spite of it there are still edemata and risk of ascites. What medication should be prescribed to amplify diuretic effect of the applied drugs?

66 year old female patient got intravenous injection of magnesium sulfate solution for the purpose of elimination of hypertensive crisis. But arterial pressure didn't go down and after repeated introduction of the same preparation there appered sluggishness, slow response, inhibition of consciousness and respiration. What preparation is antagonist of magnesium sulfate and can eliminate symptoms of its overdose?

A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for the past month. On further questioning, she admits having lost 3 kilograms in the last 2weeks. On physical examination, she is a tired- appearing thin woman. Hyperpigmentation is present over many areas of her body, most prominently over the face, neck and back of hands(areas exposed to light). Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient

A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period.However, she is otherwise a healthy girl with no significant medical problems since birth.On physical examination, her vital signs are stable. She does not have pubic hair and her breast is slightly elevated with areola remaining in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?

A 43-year-oldmanseeksevaluationatan emergencydepartmentwithcomplaintsof fever withchills,malaise,diffuseabdominal painforoveraweek,diarrheaandlossof appetite.Hesaysthathissymptomsare progressivelygettingworse.Herecallsthat thefeverbeganslowlyandclimbeditsway up stepwisetothecurrent39.8oC. Hisblood pressureis110/70mmHg.Aphysicalexam revealsacoatedtongue,enlargedspleenand rosespotsontheabdomen.Serologicstudy showstheagglutininOtitreof1:200bythe Widaltest.Whichofthefollowingisthemost likelycausativeorganismforthispatient’s condition?

A 6-year-old boy is brought to the pediatrician by his mother, who complains of low-grade fever, chronic cough and night sweats in her child. She describes the cough as productive, producing white sputum that is sometimes streaked with blood.S heal so says that her son has lost some weight in the last month.His vital signs include blood pressure of 115/75mmHg, heart rate of 110/min., respiratory rate of 18/min.and temperature of 36.6oC. On physical examination, the patient is ill looking. Pulmonary auscultation reveals some fine crackles in the right upper lobe. The pediatrician suspects an active infection and performs Mantoux test. Intradermal injection of which of the following substances has been most likely used by pediatrician for screening test in this clinical case?

A 14-year old girl presents to the emergency department for evaluation of an ”infected leg”. She states there is no history of trauma but mentions she had a history of sickle cell disease. On physical examination, her upper part of right shin is very painful, red,swollen and hot. Her temperature is 39.2oC. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia. Increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?

A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?

A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c) - 8.0%, Fasting Blood Glucose - 12 mmol/L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug’s action?

A group of researchers aimed to study cardiac physiology found that overstretching of atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause of physiologic effects discovered by researchers?

An 11-year-old girl is brought to the doctor’s office by her mother who states her daughter has been weak with swollen face for 3 days. The mother states her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria and microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?

A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse - 91/min., temperature - 36.8oC and respiratory rate - 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypercholesterolemia, hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE’s complication in this patient?

A 40-year-old woman dies of intracerebral hemorrhage after the hypertensive emergency. During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini populated by a homogenous cluster of deeply basophilic cells. Which of the following was the most likely underlying disease?

An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The organ can be subdivided into two regions: a cortex with lymphoid nodules and medulla with medullary cords populated by plasma cells, B-cells and T-cells. Which of the following structures is most likely the origin of this surgical specimen?

A 46-year-old man presents with fatigue and joint pain in his fingers and wrists for the last 2 months. The pain is present in both hands and the wrists are swollen. Furthermore, he describes morning stiffness in his joints lasting about 2 hours, which improves with use. His past medical history reveals he has been successfully treated for H. Pylori related ulcers last year. He denies smoking and stopped drinking when his gastric symptoms started. Which of the following drugs is the best choice for his joints’ pain management?

A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient’s death?

A team of medical students is performing research on phases of cell cycle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely takes place in the cell?

A mother of a 4-month-old male infant brought him to pediatrician with complaints of food rejection and weight loss. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomegaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he continues to reject food. Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick disease is suspected. Which of the following is the most likely deficient enzyme in this patient?

After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?

A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for ”many years”, but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is afebrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination. There is a ”pillrolling” resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by fingernose testing. When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug

A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision. Her doctor reveals loss of vision in the lateral halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?

A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination reveals the organ encased by thin connective tissue capsule that enters the substance of the lobes to further subdivide the organ into irregular lobular units. Each lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity of the follicle. Which of the following organs does this tissue most likely belong to?

A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wife reports he became more irritable and forgetful in the past year. In addition, she notes that he became a vegan a year ago, and currently, his diet consists of starchy foods like potatoes, corn, and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczema-like lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a ”gloves and socks” distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?

A 37-year old female presents to the clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or take ibuprofen but now the pain is much worse and wakes her up at night. She works as a typist and her pain mostly increases after typing all day. Her right wrist and fingers are fine. Nerve conduction studies reveal nerve compression. Which of the following nerves is most likely compressed in this patient?

A 68-year-old man comes to his physician with complaints of severe fatigue and altered sensations in his extremities. Past medical history is remarkable for chronic gastritis. He drinks alcohol almost every day. His blood pressure is 130/80 mm Hg, heart rate is 95/min., respiratory rate - 14/min. And temperature of 37.1oC. His heart has a regular rate and rhythm, his lungs are clear to auscultation bilaterally. Neurologic examination reveals loss of touch and vibration sense in both upper and lower limbs. Laboratory investigation results include a hemoglobin of 80 g/L, Mean Corpuscular Volume (MCV) of 115 fL (the reference range is 80-100 fL) and White Blood Cells (WBC) of 3.0 · 109/L. Which of the following is the most likely diagnosis?

A 34-year-old man visits his dentist complaining of toothache. After a dental procedure that involved extraction of several teeth, he develops severe bleeding lasting more than 15 minutes. He has a history of chronic hepatitis C. Which of the following is the most likely cause of prolonged bleeding in this patient?

A 23-year-old woman presents to the emergency department complaining of bloody diarrhea, fatigue and confusion. A few days earlier, she went to a fast food restaurant for a birthday party. Her friends are experiencing similar symptoms. Laboratory studies show anemia. Which of the following would you most likely obtain for microbiologic testing?

An 18-year-old girl comes to her physician with concern about her health because she has not achieved menarche. She denies any significant weight loss, changes in mood, or changes in her appetite. She mentions that her mother told her about mild birth defects, but she cannot recall the specifics. Past medical history and family history are benign. On physical examination, the patient is short in stature, has a short and webbed neck and wide chest. Staining of buccal smear reveals absence of Barr bodies in the nucleus of epithelial cells. A urine pregnancy test is negative. Which of the following genetic disorders is the most likely cause of this patient’s condition?