1. A 26 year old pregnant woman is under treatment at an in-patient hospital.
After a continuous attack of vomiting she was found to have reduced volume of circulating
blood. What kind of change in general blood volume is the case?
A. Polycythemic hypovolemia
B. Simple hypovolemia
C. Oligocythemic hypovolemia
D. Polycythemic hypervolemia
E. Oligocythemic hypervolemia
2. A blood drop has been put into a test tube with 0,3% solution of NaCl.
What will happen to erythrocytes?
A. Osmotic haemolysis
B. Shrinkage
C. Mechanical haemolysis
D. Any changes will be observed
E. Biological haemolysis
3. In a dysentery patient undergoing treatment in the contagious isolation ward, a
significant increase in packed cell volume has been observed (60%).
What other value will be affected by this change?
A. Increasing blood viscosity
B. Increasing volume of blood circulation
C. Leukopenia
D. Thrombocytopenia
E. Increasing erythrocyte sedimentation rate (ESR)
4. During postembryonal haemopoiesis in the red bone marrow the cells of one of the
cellular differons demonstrate a gradual decrease in cytoplasmic basophilia as well as an
increase in oxyphilia, the nucleus is being forced out. Such morphological changes are
typical for the following haemopoiesis type:
A. Erythropoiesis
B. Lymphopoiesis
C. Neutrophil cytopoiesis
D. Eosinophil cytopoiesis
E. Basophil cytopoiesis
5. In a car accident a man got injured and lost a lot of blood. What changes in peripheral
blood are most likely to occur on the 2nd day after the injury?
A. Erythropenia
B. Hypochromia
C. Anisocytosis
D. Microplania
E. Significant reticulocytosis
6. Examination of a 52-year-old female patient has revealed a decrease in the amount of
red blood cells and an increase in free hemoglobin in the blood plasma
(hemoglobinemia).Color index is 0,85. What type of anemia is being observed in the
patient?
A. Acquired hemolytic
B. Hereditary hemolytic
C. Acute hemorrhagic
D. Chronic hemorrhagic
E. Anemia due to diminished erythropoiesis
7. A 37-year-old female patient complains of headache, vertigo, troubled sleep, numbness
of limbs. For the last 6 years she has been working at the gas-discharge lamp-producing
factory in the lead-processing shop.
Blood test findings: low hemoglobin and RBC level, serum iron concentration exceeds the
norm by several times.Specify the type of anemia:
A. Iron refractory anemia
B. Iron-deficiency anemia
C. Minkowsky-Shauffard disease
D. Hypoplastic anemia
E. Metaplastic anemia
8. A patient is diagnosed with irondeficiency sideroachrestic anemia, progression of which
is characterized by skin hyperpigmentation, pigmentary cirrhosis, heart and pancreas
affection. Iron level in the blood serum is increased. What disorder of iron metabolism
causes this disease?
A. Failure to assimilate iron leading to iron accumulation in tissues
B. Excessive iron intake with food
C. Disorder of iron absorption in bowels
D. Increased iron assimilation by body
E. 9. Degenerative changes in posterior and lateral columns of spinal cord (funicular
myelosis) caused by methylmalonic acid accumulation occur in patients with B12deficiency anemia. This results in synthesis disruption of the following substance:
A. Myelin
B. Acetylcholine
C. Norepinephrine
D. Dopamine
E. Serotonin
10. Blood test of a patient suffering from atrophic gastritis gave the following results: RBCs
- 2, 0 • 1012 /l, Hb- 87 g/l, colour index - 1,3, WBCs - 4, 0 • 109/l, thrombocytes - 180 •
109/l. Anaemia migh have been caused by the following substance deficiency:
A. Vitamin B12
B. Vitamin A
C. Vitamin K
D. Iron
E. Zinc
11. A patient suffering from chronic myeloleukemia has got the following symptoms of
anemia: decreased number of erythrocytes and low haemoglobin concentration, oxyphilic
and polychromatophilic normocytes, microcytes. What is the leading pathogenetic
mechanism of anemia development?
A. Substitution of haemoblast
B. Intravascular hemolysis of erythrocytes
C. Deficiency of vitamin B12
D. Reduced synthesis of erythropoietin
E. Chronic haemorrhage
12. On the fifth day after the acute blood loss a patient has been diagnosed with
hypochromic anemia. What is the main mechanism of hypochromia development?
A. Release of immature red blood cells from the bone marrow
B. Impaired iron absorption in the intestines
C. Increased destruction of red blood cells in the spleen
D. Impaired globin synthesis
E. Increased excretion of body iron
13. A 19-year-old female patient has had low haemoglobin rate of 90-95 g/l since
childhood. Blood count results obtained after hospitalisation are as follows:erythrocytes 3, 2 • 1012/l, Hb- 85 g/l, colour index - 0,78; leukocytes - 5, 6 • 109/l,
platelets - 210 • 109/l. Smear examination revealed anisocytosis, poikilocytosis and target
cells. Reticulocyte rate is 6%. Iron therapy was ineffective. What blood
pathology corresponds with the described
clinical presentations?
A. Thalassemia
B. Enzymopathy
C. Membranopathy
D. Sickle-cell anemia
E. Favism
14. Along with normal hemoglobin types there can be pathological ones in the organism of
an adult. Name one of them:
A. HbS
B. HbF
C. HbA1
D. HbA2
E. HbO2
Hemostasis disorder.
14. A patient is diagnosed with hereditary coagulopathy that is characterized by factor VIII
deficiency. Specify the phase of blood clotting during which coagulation will be disrupted in
the given case:
A. Thromboplastin formation
B. Thrombin formation
C. Fibrin formation
D. Clot retraction
E. 15. After a tourniquet application a patient was found to have petechial haemorrhages.
The reason for it is the dysfunction of the following cells:
A. Platelets
B. Eosinophils
C. Monocytes
D. Lymphocytes
E. Neutrophils
16. After implantation of a cardiac valve a young man constantly takes indirect
anticoagulants. His state was complicated by hemorrhage. What substance content has
decreased in blood?
A. Prothrombin
B. Haptoglobin
C. Heparin
D. Creatin
E. Ceruloplasmin
17. A 3-year-old boy with pronounced hemorrhagic syndrome doesn’t have antihemophilic
globulin A (factor VIII) in the blood plasma. Hemostasis has been impaired at the following
stage:
A. Internal mechanism of prothrombinase activation
B. External mechanism of prothrombinase activation
C. Conversion of prothrombin to thrombin
D. Conversion of fibrinogen to fibrin
E. Blood clot retraction
18. A 12-year-old patient has been admitted to a hospital for hemarthrosis of the knee
joint. From early childhood he suffers from frequent bleedings. Diagnose the boy’s
disease:
A. Hemophilia
B. Hemorrhagic vasculitis
C. Hemolytic anemia
D. B12 (folic acid)-deficiency anemia
E. Thrombocytopenic purpura
19. After pancreatic surgery the patient developed hemorrhagic syndrome with disturbed
3rd stage of blood clotting. What will be the most likely mechanism of the hemostatic
disorder?
A. Fibrinolysis activation
B. Decrease of prothrombin synthesis
C. Decrease of fibrinogen synthesis
D. Qualitative abnormalities of fibrinogenesis
E. Fibrin-stabilizing factor deficiency
Leukocytosis and leukemia.
1. A 3-year-old child had eaten some strawberries. Soon he developed a rash and itching.
What was found in the child’s leukogram?
A. Eosinophilia
B. Hypolymphemia
C. Neutrophilic leukocytosis
D. Monocytosis
E. Lymphocytosis
2. After an attack of bronchial asthma a patient had his peripheral blood tested.
What changes can be expected?
A. Eosinophilia
B. Leukopenia
C. Lymphocytosis
D. Thrombocytopenia
E. Erythrocytosis
3. As a result of a road accident a 26- year-old man is in the torpid phase of shock. Blood
count: leukocytes - 3, 2 • 109/l. What is the leading mechanism of leukopenia
development?
A. Leukocyte redistribution in the bloodstream
B. Leukopoiesis inhibition
C. Faulty release of mature leukocytes from the bone marrow into the blood
D. Leukocyte destruction in the hematopietic organs
E. Increased excretion of the leukocytes from the organism
4. A 26-year-old man is in the torpid shock phase as a result of a car accident.
In blood: 3, 2 • 109/l. What is the leading mechanism of leukopenia development?
A. Redistribution of leukocytes in bloodstream
B. Leikopoiesis inhibition
C. Disturbed going out of mature leukocytes from the marrow into the blood
D. Lysis of leukocytes in the blood-forming organs
E. Intensified elimination of leukocytes from the organism
5. A 59-year-old woman has been hospialized in a surgical ward due to exacerbation of
chronic osteomyelitis of the left shin. Blood test: leukocytes - 15, 0 • 109/l. Leukogram:
myelocytes - 0%, metamyelocytes - 8%, stab neutrophils - 28%, segmented neutrophils 32%, lymphocytes - 29%, monocytes - 3%. Such blood count would be called:
A. Regenerative left shift
B. Right shift
C. Hyperregenerative left shift
D. Degenerative left shift
E. Regenerative-degenerative left shift
Pathophysiology of the systemic blood circulation
Cardiac insufficiency.
20. A patient suffering from stenocardia was taking nitroglycerine which caused restoration
of blood supply of myocardium and relieved pain in the cardiac area. What intracellular
mechanism provides restoration of energy supply of insulted cells?
A. Intensification of ATP resynthesis
B. Reduction of ATP resynthesis
C. Increased permeability of membranes
D. Intensification of oxygen transporting into the cell
E. Intensification of RNA generation
21. Experimental stimulation of the sympathetic nerve branches that innervate the heart
caused an increase in force of heart contractions because the membrane of typical
cardiomyocytes permitted an increase in:
A. Calcium ion entry
B. Calcium ion exit
C. Potassium ion exit
D. Potassium ion entry
E. Calcium and potassium ion exit
22. For biochemical diagnostics of myocardial infarction it is necessary to measure activity
of a number of enzymes and their isoenzymes. What enzymatic test is considered to be
the best to prove or disprove the diagnosis of infarction in the early period after the chest
pain is detected?
A. Creatine kinase isoenzyme CK-MB
B. Creatine kinase isoenzyme CK-MM
C. LDH1 lactate dehydrogenase isoenzyme
D. LDH2 lactate dehydrogenase isoenzyme
E. Aspartate aminotransferase cytoplasmic isoenzyme
23. A 50 year old patient suffers from essential hypertension. After a physical stress he
experienced muscle weakness, breathlessness, cyanosis of lips, skin and face.
Respiration was accompanied by distinctly heard bubbling rales. What mechanism
underlies the development of this syndrome?
A. Acute left-ventricular failure
B. Chronic right-ventricular failure
C. Chronic left-ventricular failure
D. Collapse
E. Cardiac tamponade
24. After a serious psychoemotional stress a 48 year old patient suddenly developed acute
heart ache irradiating to the left arm. Nitroglycerine relieved pain after 10minutes. What is
the leading pathogenetic mechanism of this process development?
A. Spasm of coronary arteries
B. Dilatation of peripheral vessels
C. Obstruction of coronary vessels
D. Compression of coronary vessels
E. Increase in myocardial oxygen consumption
25. The patient with acute myocardial infarction was given intravenously different solutions
during 8 hours with medical dropper 1500 ml and oxygen intranasally. He died because of
pulmonary edema. What caused the pulmonary edema?
A. Volume overload of the left ventricular
B. Decreased oncotic pressure due to hemodilution
C. Allergic reaction
D. Neurogenic reaction
E. Inhalation of the oxygen
26. A 35-year-old male developed acute heart failure while running for a long time.
What changes in the ionic composition can be observed in the cardiac muscle?
A. Accumulation of Na+ and Ca2+ ions in the myocardium cells
B. Accumulation of K+ and Mg2+ ions in the myocardium cells
C. Reduction of Na+ and Ca2+ ions in the myocardium cells
D. Reduction of K+ and Mg2+ ions in the extracellular space
E. Reduction of Na+ and Ca2+ ions in the extracellular space
27. A patient with extensive myocardial infarction has developed heart failure.
What pathogenetic mechanism contributed to the development of heart failure in the
patient?
A. Reduction in the mass of functioning myocardiocytes
B. Pressure overload
C. Volume overload
D. Acute cardiac tamponade
E. Myocardial reperfusion injury
28. ECG of a 44-year-old patient shows of hypertrophy of both ventricles and the right
atrium. The patient was diagnosed with the tricuspid valve insufficiency.
What pathogenetic variant of cardiac dysfunction is usually observed in case of such
insufficiency?
A. Heart overload by volume
B. Heart overload by resistance
C. Primary myocardial insufficiency
D. Coronary insufficiency
E. Cardiac tamponade
29. A patient who had been continuously taking drugs blocking the production of
angiotensin II developed bradycardia and arrhythmia. A likely cause of these disorders is:
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
E. Hypercalcemia
30. An isolated cell of human heart automatically generates excitement impulses with
frequency of 60 times per minute. This cell was taken from the following heart structure:
A. Sinoatrial node
B. Atrium
C. Ventricle
D. Atrioventricular node
E. His’ bundle
31. Heart rate of a 30-year-old man under emotional stress reached 112 bpm. The reason
for the heart rate increase is the altered condition of the following conducting system of
heart:
A. Sinoatrial node
B. Purkinje’s fibers
C. His’ bundle branches
D. Atrioventricular node
E. His’ bundle
32. Since a patient has had myocardial infarction, his atria and ventricles contract
independently from each other with a frequency of 60-70 and 35-40 per minute. Specify
the type of heart block in this case:
A. Complete atrioventricular
B. Partial atrioventricular
C. Sino-atrial
D. Intra-atrial
E. Intraventricular
33. A patient complains of palpitation after stress. The pulse is 104 bpm, P-Q=0,12
seconds, there are no changes of QRS complex. What type of arrhythmia does the patient
have?
A. Sinus tachycardia
B. Sinus bradycardia
C. Sinus arrhythmia
D. Ciliary arrhythmia
E. Extrasystole
34. A 67 year old patient complains of periodic heart ache, dyspnea during light physical
activities. ECG reveals extraordinary contractions of heart ventricles. Such arrhythmia is
called:
A. Extrasystole
B. Bradycardia
C. Tachycardia
D. Flutter
E. Fibrillation
35. A 45-year-old patient was admitted to the cardiological department. ECG data:
negative P wave overlaps QRS complex, diastolic interval is prolonged after
extrasystole. What type of extrasystole is it?
A. Atrioventricular
B. Sinus
C. Atrial
D. Ventricular
E. Bundle-branch
36. Analysis of the ECG revealed the missing of several PQRST cycles. The remaining
waves and complexes are not changed. Specify the type of arrhythmia:
A. Sinoatrial block
B. Atrial fibrillation
C. Atrioventricular block
D. Atrial premature beat
E. Intra-atrial block
37. ECG of a patient displays an abnormally long R wave (up to 0,18s). This is caused by
a decrease in the conduction velocity of the following heart structures:
A. Ventricles
B. Atria
C. Atrio-ventricular node
D. Right ventricle
E. Left ventricle
38. During ventricular systole, the cardiac muscle does not respond to additional
stimulation because it is in the phase of:
A. Absolute refractoriness
B. Relational refractoriness
C. Hyperexcitability
D. Subnormal excitability
E. There is no correct answer
39. A patient complaining of pain in the left shoulder-blade region has been diagnosed with
miocardial infarction. What kind of pain does the patient have?
A. Radiating
B. Visceral
C. Phantom
D. Protopathic
E. Epicritic
39/. A woman, who has been suffering from marked hypertension for 15 years, has lately
developed dyspnea, palpitations, slightly decreased systolic pressure, while diastolic
pressure remains the same What is the main mechanism of heart failure development in
this case?
A. Cardiac overload due to increased vascular resistance
B. Cardiac overload due to increased blood volume
C. Damage to the myocardium
D. Disorder of impulse conduction in the myocardium
E. Dysregulation of cardiac function
Pathophysiology of vessels.
1. As a result of a home injury, a patient suffered a significant blood loss, which led
to a fall in blood pressure. Rapid blood pressure recovery after the blood loss is
provided by the following hormones:
A. Adrenaline, vasopressin
B. Cortisol
C. Sex hormones
D. Oxytocin
E. Aldosterone
2. A patient with constant headaches, pain in the occipital region, tinnitus, dizziness has
been admitted to the cardiology department. Objectively:AP- 180/110mm
Hg, heart rate - 95/min. Radiographically, there is a stenosis of one of the renal arteries.
Hypertensive condition in this patient has been caused by the activation of the following
system:
A. Renin-angiotensin
B. Hemostatic
C. Sympathoadrenal
D. Kinin
E. Immune
3. A 43-year-old-patient has arterial hypertension caused by an increase in cardiac output
and general peripheral resistance. Specify the variant of hemodynamic development of
arterial hypertension in the given case:
A. Eukinetic
B. Hyperkinetic
C. Hypokinetic
D. Combined
E. 4. A 16-year-old female patient has fainted after quickly changing her body position from
horizontal to vertical one. Which process from the ones listed below has caused the loss of
consciousness in the first place?
A. Decreasing venous return
B. Increasing venous return
C. Increasing central venous pressure
D. Decreasing oncotic pressure of blood plasma
E. Increasing arterial pressure
5. A patient has insufficient blood supply to the kidneys, which has caused the
development of pressor effect due to the constriction of arterial resistance vessels. This is
the result of the vessels being greately affected by the following substance:
A. Angiotensin II
B. Angiotensinogen
C. Renin
D. Catecholamines
E. Norepinephrine
6. A month after surgical constriction of rabbit’s renal artery the considerable increase of
systematic arterial pressure was observed. What of the following regulation mechanisms
caused the animal’s pressure change?
A. Angiotensin-II
B. Vasopressin
C. Adrenaline
D. Noradrenaline
E. Serotonin
Pathophysiology of the respiratory system.
1. A 23-year-old patient has been admitted to a hospital with a craniocerebral injury. The
patient is in a grave condition.Respiration is characterized by prolonged convulsive
inspiration followed by a short expiration. What kind of respiration is it typical for?
A. Apneustic
B. Gasping breath
C. Kussmaul’s
D. Cheyne-Stokes
E. Biot’s
2. A patient has increased thickness of alveolar-capillary membrane caused by a
pathologic process. The direct consequence will be reduction of the following value:
A. Diffusing lung capacity
B. Oxygen capacity of blood
C. Respiratory minute volume
D. Alveolar ventilation of lungs
E. Expiratory reserve volume
3. A patient has a traumatic injury of sternocleidomastoid muscle. This has resulted in a
decrease in the following value:
A. Inspiratory reserve volume
B. Expiratory reserve volume
C. Respiratory volume
D. Residual volume
E. Functional residual lung capacity
4. When studying the signs of pulmonary ventilation, reduction of forced expiratory volume
has been detected.What is the likely cause of this phenomenon?
A. Obstructive pulmonary disease
B. Increase of respiratory volume
C. Increase of inspiratory reserve volume
D. Increase of pulmonary residual volume
E. Increase of functional residual lung capacity
5. A patient with bronchial asthma has developed acute respiratory failure. What kind of
respiratory failure occurs in this case?
A. Obstructive disturbance of alveolar ventilation
B. Restrictive ventilatory defect
C. Perfusion
D. Diffusion
E. Dysregulation of alveolar ventilation
6. Analysis of the experimental spirogram of a 55-year-old person revealed a decrease in
tidal volume and respiratory amplitude compared to the situation of ten years ago. The
change in these indicators is caused by:
A. Decreased force of respiratory muscle contraction
B. Gas composition of the air
C. Physical build of a person
D. Height of a person
E. Body mass of a person
7. A female patient, having visited the factory premises with lots of dust in the air for the
first time, has got cough and burning pain in the throat. What respiratory receptors, when
irritated, cause this kind of reaction?
A. Irritant receptors
B. Juxtacapillary (J) receptors
C. Stretch receptors of lungs
D. Proprioceptors of respiratory muscles
E. Thermoreceptors
8. A patient under test was subjected to a moderate physical stress. His minute blood
volume amounted 10 l/min. What blood volume was pumped through his lung vessels
every minute?
A. 10 l/min
B. 5 l/min
C. 4 l/min
D. 6 l/min
E. 7 l/min
9. To assess the effectiveness of breathing in patients, the indicator of functional residual
capacity is used. It includes the following volumes:
A. Expiratory reserve volume and residual volume
B. Inspiratory reserve volume and residual volume
C. Inspiratory reserve volume, tidal volume, residual volume
D. Expiratory reserve volume and tidal volume
E. Inspiratory reserve volume and tidal volume
10. 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?
A. Respiratory volume
B. Vital capacity of lungs
C. Inspiratory reserve volume
D. Expiratory reserve volume
E. Total lung capacity
11. A patient demonstrates sharp decrease of pulmonary surfactant activity. This condition
can result in:
A. Alveolar tendency to recede
B. Decreased airways resistance
C. Decresed work of expiratory muscles
D. Increased pulmonary ventilation
E. Hyperoxemia
Pathophysiology of the liver and digestive system.
1. A patient has a critical impairment of protein, fat and hydrocarbon digestion.
Most likely it has been caused by low secretion of the following digestive juice:
A. Pancreatic juice
B. Saliva
C. Gastric juice
D. Bile
E. Intestinal juice
2. A 42 year old patient complains of pain in the epigastral area, vomiting; vomit masses
have the colour of "coffee-grounds", the patient has also melena. Anamnesis records
gastric ulcer. Blood formula: erythrocytes - 2, 8 • 1012/l, leukocytes - 8 • 109/l, Hb- 90 g/l.
What complication is it?
A. Haemorrhage
B. Penetration
C. Perforation
D. Canceration
E. Pyloric stenosis
3. A patient takes cholagogues. What other process besides biliary excretion will be
stimulated?
A. Intestinal motility
B. Gastric juice secretion
C. Pancreatic juice secretion
D. Gastric motor activity
E. Water absorption
4. A 49-year-old male patient with acute pancreatitis was likely to develop pancreatic
necrosis, while active pancreatic proteases were absorbed into the blood stream and
tissue proteins broke up. What protective factors of the body can inhibit these processes?
A. α2-macroglobulin, α1-antitrypsin
B. Immunoglobulin
C. Cryoglobulin, interferon
D. Ceruloplasmin, transferrin
E. Hemoplexin, haptoglobin
5. A 30 year old woman has subnormalconcentration of enzymes in the pancreatic juice.
This might be caused by the hyposecretion of the following gastrointestinal hormone:
A. Cholecystokinin-pancreozymin
B. Somatostatin
C. Secretin
D. Gastro-inhibiting peptide
E. Vaso-intestinal peptide
6. A 60 year old patient was found to have a dysfunction of main digestive enzyme of
saliva. This causes the disturbance of primary hydrolysis of:
A. Carbohydrates
B. Fats
C. Proteins
D. Cellulose
E. Lactose
7. A 30-year-old male patient with acute pancreatitis has been found to have a disorder of
cavitary protein digestion. The reason for such condition can be the hyposynthesis and
hyposecretion of the following enzyme:
A. Tripsin
B. Pepsin
C. Lipase
D. Dipeptidase
E. Amylase
8. 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?
A. Liver
B. Pancreas
C. Thymus
D. Spleen
E. Thyroid
9. A 53-year-old male patient complains of acute pain in the right hypochondrium.
Objective examination revealed scleral icterus. Laboratory tests revealed increased ALT
activity, and stercobilin was not detected in the stool. What disease is characterized by
these symptoms?
A. Cholelithiasis
B. Hemolytic jaundice
C. Hepatitis
D. Chronic colitis
E. Chronic gastritis
10. A patient has normally coloured stool including a large amount of free fatty acids.
The reason for this is a disturbance of the following process:
A. Fat absorption
B. Fat hydrolysis
C. Biliary excretion
D. Choleresis
E. Lipase secretion
11. A patient has been admitted to the contagious isolation ward with signs of jaundice
caused by hepatitis virus. Which of the symptoms given below is strictly specific for
hepatocellular jaundice?
A. Increase of ALT, AST level
B. Hyperbilirubinemia
C. Bilirubinuria
D. Cholemia
E. Urobilinuria
12. An infectious disease unit admitted a patient with signs of jaundice caused by
hepatitis virus. Select an indicator that is specific only for parenchymatous jaundice:
A. Increase in ALT and AST rate
B. Hyperbilirubinemia
C. Bilirubinuria
D. Cholaemia
E. Urobilinuria
13. A tooth extraction in a patient with chronic persistent hepatitis was complicated with
prolonged hemorrhage. What is the reason for the haemorrhagic syndrome?
A. Decrease in thrombin production
B. Increase in thromboplastin production
C. Decrease in fibrin production
D. Increase in fibrinogen synthesis
E. Fibrinolysis intensification
14. After severe viral hepatitis a 4 year-old boy presents with vommiting, occasional loss of
consciousness, convulsions. Blood test revealed hyperammoniemia. Such condition is
caused by a disorder of the following biochemical hepatic process:
A. Disorder of ammonia neutralization
B. Disorder of biogenic amines neutralization
C. Protein synthesis inhibition
D. Activation of amino acid decarboxylation
E. Inhibition of transamination enzymes
15. Blood analysis of a patient with jaundice reveals conjugated bilirubinemia, increased
concentration of bile acids. There is no stercobilinogen in urine.
What type of jaundice is it?
A. Obstructive jaundice
B. Hepatocellular jaundice
C. Parenchymatous jaundice
D. Hemolytic jaundice
E. Cythemolytic jaundice
16. A patient with jaundice has high total bilirubin that is mainly indirect (unconjugated),
high concentration of stercobilin in the stool and urine. The level of direct (conjugated)
bilirubin in the blood plasma is normal. What kind of jaundice can you think of?
A. Hemolytic
B. Parenchymal (hepatic)
C. Mechanical
D. Neonatal jaundice
E. Gilbert’s disease
17. A patient presents with icteritiousness of skin, scleras and mucous membranes. Blood
plasma the total bilirubin is increased, stercobilin is increased in feces, urobilin is
increased in urine. What type of jaundice is it?
A. Haemolytic
B. Gilbert’s disease
C. Parenchymatous
D. Obturational
E. Cholestatic
18. Enzymatic jaundices are accompanied by abnormal activity of UDPglucuronyl
transferase. What compound is accumulated in blood serum in case of these pathologies?
A. Unconjugated bilirubin
B. Conjugated bilrubin
C. Dehydrobilirubin
D. Hydrobilirubin
E. Choleglobin
19. 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:
A. Gastrin
B. Histamine
C. Secretin
D. Cholecystokinin
E. Neurotensin
20. A patient presents with steatorrhea. This disorder can be linked to disturbed supply of
the intestine with the following substances:
A. Bile acids
B. Carbohydrates
C. Tripsin
D. Chymotrypsin
E. Amylase
Pathophysiology of the kidneys
1. Urine analysis has shown high levels of protein and erythrocytes in urine. This can be
caused by the following:
A. Renal filter permeability
B. Effective filter pressure
C. Hydrostatic blood pressure in glomerular capillaries
D. Hydrostatic primary urine pressure in capsule
E. Oncotic pressure of blood plasma
2. Diabetic nephropathy with uremia has developed in a patient with pancreatic diabetes.
The velocity of glomerular filtration is 9 ml/min. What mechanism of a decrease in
glomerular filtration velocity and chronic renal failure development is most likely in the case
of this patient?
A. Reduction of active nephron mass
B. Decrease in systemic arterial pressure
C. Obstruction of nephron tubules with hyaline casts
D. Tissue acidosis
E. Arteriolar spasm
3. According to the results of glucose tolerance test, the patient has no disorder of
carbohydrate tolerance. Despite that, glucose is detected in the patients’ urine (5 mmol/l).
The patient has been diagnosed with renal diabetes. What renal changes cause glucosuria
in this case?
A. Decreased activity of glucose reabsorption enzymes
B. Increased activity of glucose reabsorption enzymes
C. Exceeded glucose reabsorption threshold
D. Increased glucose secretion
E. Increased glucose filtration
4. Due to the use of poor quality measles vaccine for preventive vaccination, a 1-year-old
child has developed an autoimmune renal injury. The urine was found to contain
macromolecular proteins. What process of urine formation has been disturbed?
A. Filtration
B. Reabsorption
C. Secretion
D. Reabsorption and secretion
E. Secretion and filtration
5. A child has an acute renal failure. What biochemical factor found in saliva can confirm
this diagnosis?
A. Increase in urea concentration
B. Increase in glucose concentration
C. Decrease in glucose concentration
D. Increase in concentration of higher fatty acids
E. Decrease in nucleic acid concentration
6. A patient with a history of chronic glomerulonephritis presents with azotemia, oliguria,
hypo- and isosthenuria, proteinuria. What is the leading factor in the pathogenesis of these
symptoms development under chronic renal failure?
A. Mass decrease of active nephrons
B. Intensification of glomerular filtration
C. Tubular hyposecretion
D. Disturbed permeability of glomerular membranes
E. Intensification of sodium reabsorption
7. A histological specimen of kidney shows a structure consisting of a glomerulus of
fenestrated capillaries and a bilayer epithelial capsule. Specify this structure:
A. Renal corpuscle
B. Proximal tubule
C. Distal tubule
D. Henle’s loop
E. Receiving tube
8. 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. Impaired synthesis of calcitriol
B. Increased excretion of calcium
C. Hyperfunction of parathyroid glands
D. Hypofunction of parathyroid glands
E. Lack of calcium in food
9. 14 days after quinsy a 15-year-old child presented with morning facial swelling, high
blood pressure, "meat slops"urine. Immunohistological study of a renal biopsy sample
revealed deposition of immune complexes on the basement membranes of the capillaries
and in the glomerular mesangium. What disease developed in the patient?
A. Acute glomerulonephritis
B. Acute interstitial nephritis
C. Lipoid nephrosis
D. Acute pyelonephritis
E. Necrotizing nephrosis
10. A patient with massive burns developed acute renal insufficiency characterized by a
significant and rapid deceleration of glomerular filtration.What is the mechanism of its
development?
A. Reduction of renal blood flow
B. Damage of glomerular filter
C. Reduction of functioning nephron number
D. Rise of pressure of tubular fluid
E. Renal artery embolism
11. A male patient has been diagnosed with acute post-streptococcal glomerulonephritis. It
is most likely that the lesion of the basement membrane of renal corpuscles was caused
by the following allergic reaction:
A. Immune complex
B. Anaphylactic
C. Cytotoxic
D. Delayed
E. Stimulating
12. As a result of continuous starvation the glomerular filtration rate has increased by 20%.
The most probable cause of the glomerular filtration alteration under the mentioned
conditions is:
A. Decrease in the oncotic pressure of blood plasma
B. Increase in the systemic arterial pressure
C. Increase in the permeability of the renal filter
D. Increase of the filtartion quotient
E. Increase of the renal blood flow
13. A 12-year-old child developed nephritic syndrome (proteinuria, hematuria, cylindruria)
2 weeks after a 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?
A. Immune complex
B. Granulomatous
C. Antibody-mediated
D. Reaginic
E. Cytotoxic
15. Poisoning caused by mercury (II) chloride (corrosive sublimate) occurred in the result
of safety rules violation. In 2 days the patient’s diurnal diuresis was 620 ml. The patient
developed headache, vomiting, convulsions, dyspnea; moist crackles were observed in the
lungs. Name this pathology:
A. Acute renal failure
B. Chronic renal failure
C. Uremic coma
D. Glomerulonephritis
E. Pyelonephritis
16. A man presents with glomerular fi- ltration rate of 180 ml/min., while norm is 125±25
ml/min. The likely cause of it is the decreased:
A. Plasma oncotic pressure
B. Effective filtration pressure
C. Hydrostatic blood pressure in the glomerular capillaries
D. Renal blood flow
E. Permeability of the renal filter
Pathophysiology of the endocrine system
1. Parodontitis is treated with calcium preparations and a hormone that stimulates tooth
mineralization and inhibits tissue resorption. What hormone is it?
A. Calcitonin
B. Parathormone
C. Adrenalin
D. Aldosterone
E. Thyroxine
2. A 41-year-old male patient has a history of recurrent attacks of heartbeats (paroxysms),
profuse sweating, and headaches. Examination revealed hypertension, hyperglycemia,
increased basal metabolic rate, and tachycardia. These clinical presentations are typical
for the following adrenal pathology:
A. Hyperfunction of the medulla
B. Hypofunction of the medulla
C. Hyperfunction of the adrenal cortex
D. Hypofunction of the adrenal cortex
E. Primary aldosteronism
3. In the course of an experiment adenohypophysis of an animal has been removed. The
resulting atrophy of thyroid gland and adrenal cortex has been caused by deficiency of the
following hormone:
A. Tropic hormones
B. Thyroid hormones
C. Somatotropin
D. Cortisol
E. Thyroxin
4. A patient with signs of osteoporosis and urolithiasis has been admitted to the
endocrinology department. Blood test has revealed hypercalcemia and
hypophosphatemia. These changes are associated with abnormal synthesis of the
following hormone:
A. Parathyroid hormone
B. Calcitonin
C. Cortisol
D. Aldosterone
E. Calcitriol
5. A child has abnormal formation of tooth enamel and dentin as a result of low
concentration of calcium ions in blood. Such abnormalities might be caused by deficiency
of the following hormone:
A. Parathormone
B. Thyrocalcitonin
C. Thyroxin
D. Somatotropic hormone
E. Triiodothyronine
6. 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:
A. Natriuretic hormone
B. Aldosterone
C. Renin
D. Angiotensin
E. Vasopressin
7. A 44 year old woman complains of general weakness, heart pain, significant increase of
body weight. Objectively: moon face, hirsutism, AP is 165/100 mm Hg, height - 164 cm,
weight - 103 kg; the fat is mostly accumulated on her neck, thoracic girdle, belly. What is
the main pathogenetic mechanism of obesity?
A. Increased production of glucocorticoids
B. Reduced production of thyroid hormones
C. Increased insulin production
D. Reduced glucagon production
E. Increased mineralocorticoid production
8. Examination of a 42 year old patient revealed a tumour of adenohypophysis.
Objectively: the patient’s weight is 117 kg, he has moon-like hyperemic face, redblue 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?
A. Cushing’s disease
B. Cushing’s syndrome
C. Conn’s disease
D. Diabetes mellitus
E. Essential hypertension
9. A 38-year-old female patient complains of general weakness, cardiac pain, increased
appetite, no menstruation. Objectively: the height is 166 cm, weight 108 kg, the patient has
moon-shaped face, subcutaneous fat is deposited mainly in the upper body, torso and
hips. There are also blood-red streaks. Ps- 62/min, AP-160/105 mm Hg. Which of the
following diseases is the described pattern of obesity most typical for?
A. Cushing pituitary basophilism
B. Alimentary obesity
C. Myxedema
D. Insulinoma
E. Babinski-Frohlich syndrome
10. A 19-year-old male was found to have an elevated level of potassium in the secondary
urine. These changes might have been caused by the increase in the following hormone
level:
A. Aldosterone
B. Oxytocin
C. Adrenaline
D. Glucagon
E. Testosterone
11. The patient with complaints of permanent thirst applied to the doctor.
Hyperglycemia, polyuria and increased concentration of 17-ketosteroids in the urine were
revealed. What disease is the most likely?
A. Steroid diabetes
B. Insulin-dependent diabetes mellitus
C. Myxoedema
D. Type I glycogenosis
E. Addison’s disease
12. A 20 year old patient complains of morbid thirst and huperdiuresis (up to 10 l daily).
Glucose concentration in blood is normal but it is absent in urine. The patient has been
diagnosed with diabetes insipidus. What hormonal drug is the most appropriate for
management of this disorder?
A. Vasopressin
B. Cortisol
C. Thyroxin
D. Oxytocin
E. Insulin
13. A 30-year-old female exhibits signs of virilism (growth of body hair, balding temples,
menstrual disorders). This condition can be caused by the overproduction of the following
hormone:
A. Testosterone
B. Oestriol
C. Relaxin
D. Oxytocin
E. Prolactin
14. A 46-year-old patient suffering from the diffuse toxic goiter underwent resection of the
thyroid gland. After the surgery the patient presents with appetite loss, dyspepsia,
increased neuromuscular excitement. The body weight remained unchanged. Body
temperature is normal. Which of the following has caused such a condition in this patient?
A. Reduced production of parathormone
B. Increased production of thyroxin
C. Increased production of calcitonin
D. Increased production of thyroliberin
E. Reduced production of thyroxin
15. The secretion of which hypophysial hormones will be inhibited after taking the oral
contraceptives containing sex hormones?
A. Gonadotropic hormone
B. Vasopressin
C. Thyrotrophic hormone
D. Somatotropic hormone
E. Ocytocin
16. A female patient with bronchial asthma had taken prednisolone tablets (1 tablet 3 times
a day) for 2 months. Due to a significant improvement of her condition the patient suddenly
stopped taking it. What complication is likely to develop in this case?
A. Withdrawal syndrome
B. Cushing’s syndrome
C. Gastrorrhagia
D. Upper body obesity
E. Hypotension
17. A patient complains of polyuria (7 liters per day) and polydipsia. Examination reveals
no disorders of carbohydrate metabolism. These abnormalities might be caused by the
dysfunction of the following endocrine gland:
F. Neurohypophysis
G. Adenohypophysis
H. Islets of Langerhans (pancreatic islets)
I. Adrenal cortex
J. Adrenal medulla
18. 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 perspiratory glands:
A. Aldosterone
B. Vasopressin
C. Cortisol
D. Tgyroxin
E. Natriuretic
19. On examination the patient presents with hirsutism, moon-shaped face, stretch marks
on the abdomen. BP is 190/100 mm Hg, blood glucose is 17,6 mmol/l. What pathology is
such clinical presentation characteristic of?
A. Adrenocortical Hyperfunction
B. Hyperthyroidism
C. Hypothyroidism
D. Gonadal hypofunction
E. Hyperfunction of the insular apparatus
20. On examination the patient is found to have low production of adrenocorticotropic
hormone. How would this affect production of the other hormones?
A. Decrease adrenocorticotropic hormones synthesis
B. Decrease hormone synthesis in the adrenal medulla
C. Decrease insulin synthesis
D. Increase sex hormones synthesis
E. Increase thyroid hormones synthesis
Pathophysiology of the nervous system
1. A patient complains that at the bare mention of the tragic events that once occurred in
his life he experiences tachycardia, dyspnea and an abrupt rise in blood pressure. What
structures of the CNS are responsible for these cardiorespiratory reactions in this patient?
A. Cerebral cortex
B. Cerebellum
C. Lateral hypothalamic nuclei
D. Specific thalamic nuclei
E. Quadrigemina of mesencephalon
2. 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:
A. Tractus rubrospinalis
B. Tractus corticospinalis
C. Tractus corticonuclearis
D. Tractus spinothalamicus
E. Tractus tectospinalis
3. A patient complaining of pain in the left shoulder-blade region has been diagnosed with
miocardial infarction. What kind of pain does the patient have?
A. Radiating
B. Visceral
C. Phantom
D. Protopathic
E. Epicritic
4. After the traumatic tooth extraction a patient is complaining of acute, dull, poorlylocalized pain in gingiva, body temperature rise up to 37, 5oC. The patient has been
diagnosed with alveolitis. Specify the kind of pain in this patient:
A. Protopathic
B. Epicritic
C. Visceral
D. Heterotopic
E. Phantom
5. A patient got a gunshot wound of hip which damaged the sciatic nerve. Any impact on
the affected limb causes severe, excruciating pain. What mechanism of pain is most likely
in this case?
A. Causalgic
B. Reflex
C. Phantom
D. Endorphin hypofunction
E. Enkephalin hypofunction
6. An animal has an increased tonus of extensor muscles. This is the result of enhanced
information transmission to the motoneurons of the spinal cord through the following
descending pathways:
A. Vestibulospinal
B. Medial corticospinal
C. Reticulospinal
D. Rubrospinal
E. Lateral corticospinal
7. During an animal experiment, surgical damage of certain brain structures has caused
deep prolonged sleep. What structure is most likely to cause such condition, if damaged?
A. Reticular formation
B. Basal ganglion
C. Red nuclei
D. Hippocampus
E. Cerebral cortex
8. In a cat with decerebrate rigidity themuscle tone is to be decreased. This can be
achieved by:
A. Destruction of the vestibular nuclei of Deiters
B. Stimulation of the otolithic vestibular receptors
C. Stimulation of the vestibular nuclei of Deiters
D. Stimulation of the vestibulocochlear nerve
E. Stimulation of the ampullar vestibular receptors
9. As a result of an injury, the integrity of the anterior spinal cord root was broken. Specify
the neurons and their processes that had been damaged:
A. Axons of motor neurons
B. Motor neuron dendrites
C. Axons of sensory neurons
D. Dendrites of sensory neurons
E. Dendrites of association neurons
10. A patient got an injury of spinal marrow in a road accident that caused loss of tactile
sensation, posture sense, vibration sense. What conduction tracts are damaged?
A. Fascicle of Goll and cuneate fascicle
B. Anterior spinocerebellar tract
C. Rubrospinal tract
D. Reticulospinal tract
E. Tectospinal tract
11. A patient presents with the following motor activity disturbances: tremor, ataxia and
asynergia movements, dysarthria. The disturbances are most likely to be localized in:
A. Cerebellum
B. Basal ganglions
C. Limbic system
D. Brainstem
E. Medulla oblongata
12. A male with a lesion of one of the CNS parts has asthenia, muscular dystonia, balance
disorder. Which CNS part has been affected?
A. Cerebellum
B. Black substance
C. Reticular formation
D. Red nuclei
E. Vestibular nuclei
13. Vegetative abnormalities in the sleep, heat regulation, all kinds of metabolism,
diabetes insipidus are developing in the patient due to grouth of the tumour in the III
ventricle of brain. Irritation of the nucleus of what part of the brain can cause these
symptoms?
A. Hypothalamus
B. Cerebral peduncles (cruces cerebri)
C. Mesencephalic tegmentum
D. Pons cerebelli
E. Medulla
14. A 5-month-old boy was hospitalized for tonic convulsions. He has a lifetime 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:
A. Hypoparathyroidism
B. Hyperparathyroidism
C. Hyperaldosteronism
D. Hypoaldosteronism
E. Hypothyroidism
15. A 49-year old female patient has limitation of left limbs arbitrary movements.
Muscular tonus of left hand and leg is overstrained and spasmodic, local tendon reflexes
are strong, pathological reflexes are presented. What is the most likely development
mechanism of hypertension and hyperreflexia?
A. Reduction of descending inhibitory
B. Motoneuron activation induced by stroke
C. Activation of excitatory influence from the focus of stroke
D. Activation of synaptic transmission
E. Inhibition of cerebral cortex motoneurons
16. A patient underwent an extraction of a part of a CNS structures by medical indications.
As a result of the extraction the patient developed atony, astasia, intention tremor, ataxy
and adiadochokinesis. Which part of CNS structure had been extracted?
A. Cerebellum
B. Amygdaloid corpus
C. Hippocamp
D. Basal ganglions
E. Limbic system
17. A patient with hypertension has developed headache, tinnitus, vomiting, high BP up to
220/160 mm Hg. On examination: facial asymmetry on the right, volitional mobility is
absent, increased tendon reflexes and muscle tone of extremities on the right. What motor
disorder of nervous system occurred in this case?
A. Hemiplegia
B. Paraplegia
C.Tetraplegia
D. Hyperkinesis
E. Monoplegia
18. Parkinson’s disease is caused by disturbance of dopamine synthesis. What brain
structure synthesizes this neurotransmitter?
A. Substantia nigra
B. Globus pallidus
C. Corpora quadrigemina
D. Red nuclei
E. Hypothalamus
Pathophysiology of extreme situation.
40. 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?
A. Erectile
B. Terminal
C. Torpid
D. Preshock (compensation stage)
E. Agony
41. As a result of a trauma a patient has developed traumatic shock that led to the
following disorders: AP is 140/90 mm Hg, Ps is 120 bpm. The patient is fussy, talkative,
pale. Such state relates to the following shock phase:
A. Erectile
B. Latent period
C. Terminal
D. Torpid
E. 42. A man has a considerable decrease in diuresis as a result of 1,5 l blood loss.
The primary cause of such diuresis disorder is the hypersecretion of the following
hormone:
A. Vasopressin
B. Corticotropin
C. Natriuretic
D. Cortisol
E. Parathormone
43. A 63 year old patient with collapse presentations was delivered to the emergency
hospital. A physician has chosen noradrenalin against hypotension. What is its mechanism
of action?
A. Activation of α1-adrenoreceptors
B. Activation of serotonin receptors
C. Activation of β-adrenoreceptors
D. Activation of dopamine receptors
E. Block of M-cholinoreceptors
44. A nurse accidentally injected a nearly double dose of insulin to a patient with diabetes
mellitus. The patient lapsed into a hypoglycemic coma. What drug should be injected in
order to help him out of coma?
A. Glucose
B. Lidase
C. Insulin
D. Somatotropin
E. Noradrenaline
45. A comatose patient was taken to the hospital. He has a history of diabetes mellitus.
Objectively: Kussmaul breathing, low blood pressure, acetone odor of breath. After the
emergency treatment the patient’s condition improved. What drug had been administered
to the patient?
A. Insulin
B. Adrenaline
C. Isadrinum
D. Glibenclamide
E. Furosemide
46. An unconscious patient was taken by ambulance to the hospital. On objective
examination the patient was found to have 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 the accumulation of the following
metabolite:
A. Ammonia
B. Urea
C. Glutamine
D. Bilirubin
E. Histamine
47. A patient has been diagnosed with influenza. His condition became drastically worse
after taking antipyretic drugs. His consciousness is confused, AP is 80/50 mm Hg, Ps is
140/m, body temperature droped down to 35, 8oC.What complication developed in this
patient?
A. Collapse
B. Hyperthermia
C. Hypovolemia
D. Acidosis
E. Alkalosis
48. An adult man presents with systemic arterial pressure drop from 120/70 to 90/50 mm
Hg. This resulted in reflex vasoconstriction. Vasoconstriction will be minimal in the
following organ:
A. Heart
B. Skin
C. Bowels
D. Skeletal muscles
E. Liver