Module № 1
1. The 5-year old boy suffers from deficiency of body weight been constant moist cough. In the
history several times pneumonia occurs with symptoms of obstruction. Objectively inflated
chest, lungs shortening of percussion sound in the lower divisions, auscultation - a large number
of different-sized wet wheezing. Sweat chloride level of 98 mg/dL. Which is the previous
diagnosis?
*Cystic fibrosis
Idiopathic fibrosing alveolitis
Asthma
Recurrent bronchitis
Bronchiectasis
2. The boy of 3 years in the history of pneumonia has three times with obstructive syndrome.
The examination revealed acrocyanosis, fingers as drumsticks, lung auscultation - wet wheezing
and wheezing. What possible criteria may indicate the possibility of cystic fibrosis?
*Increasing concentration of sweat chloride
Identification of bronchiectasis the X-ray of lungs
The presence fingers as drumsticks
A positive family history for cystic fibrosis
Sustainability of physical changes in the lungs
3. 4 month old infant suffering from acute segmental pneumonia has respiration rate - 80 per
minute, paradoxical breathing, tachycardia, and total cyanosis. Respiration and pulse - ratio is
1:2. The heart dullness are the under normal size. Such signs are characterize:
*Respiratory failure of III degree
Respiratory failure of I degree
Respiratory failure of II degree
Myocarditis
Congenital heart malformation
4. Early morning infant is suffering from acute pneumonia which was complicated by
cardiovascular insufficiency and respiratory failure of II degree. The accompanied diagnosis is
malnutrition of II degree. Choose the best variant of therapy:
*Ampiox and Amicacin
Macropen and Penicillin
Ampiox and Penicillin
Macropen and Gentamycin
Ampiox and Polymixin
5. A 2-year-old child was taken to a hospital on the 3-th day of the disease. The disease began
acutely with temperature 38.9°C, weakness, cough, breathlessness. He is pale, cyanotic, has had
febrile temperature for over 3 days. There are crepitative fine bubbling rales on auscultation.
Percussion sound is shortened in the right infrascapular region. X-ray picture shows nonhomogeneous segment infiltration 8-10 mm on the right, the intensification of lung pattern. Your
diagnosis:
*Segmental pneumonia
Interstitial pneumonia
Bronchitis
Bronchiolitis
Flu
6. The condition of the 10 years child is complicated, flabby, pale, perioral cyanosis.
Expiratory dyspnea. In the act of breathing ancillary muscles are involved. Percussion of the
lungs has box sound. Breathing sharply weakened, dry whistling wheezing. BH- 42 per minute.
The boundaries of cardiac dullness is not extended. Heart sounds are muffled. HR 124 per min.
Blood pressure 110/65 mm.hg, liver + 1cm. Diuresis under age. What is the reason of the
condition?
*Respiratory failure
Vascular insufficiency
Liver failure
Heart failure
Renal failure
7. The boy of 8 years suffers from bilateral pneumonia increased dyspnea, increased body
temperature to 39.3°С. Objective: the right half of the chest behind in breathing, intercostal
spaces smoothed. Percussion tympanitis on the right, auscultation breath over this section is
absent. Borders of the heart are shifted to the left. The blood leucocyte total amount is 24.5 g/l.
What is the most likely complication?
*Pleuraempyema
Atelectasis
Hydrothorax
Pneumothorax
Bronchiectasis
8. A 10-month-old child presents with fever, cough, and dyspnea. The symptoms appeared 4
days ago after a contact with a person having acute respiratory viral infection. Objectively: the
child is in grave condition. Temperature of 38.4ºC, cyanosis of nasolabial triangle is present. RR52/min, nasal flaring are present while breathing. There was percussion dullness on the right
below the scapula angle, and tympanic sound over the rest of lungs. Auscultation revealed
bilateral fine moist rales predominating on the right. What is the most likely diagnosis?
*Acute pneumonia
Acute bronchiolitis
Acute laryngotracheitis
Acute bronchitis
Acute respiratory viral infection
9. A child of 1 year suffers from constant cough since the first weeks of life. Sputum separates
hard. The physical development is not according to the age. Cyanosis nasolabial triangle. During
the examination - neutrophilic leukocytosis, electrolytes - sodium 128 mmol/L, chlorine - 92
mmol/L, sweat electrolytes - chlorine 82 mg/dL. What is the proper diagnosis?
*Cystic fibrosis
Syndrome Kartahenera
Idiopathic fibrosing alveolitis
Bronchiolitis
Deficiency of alpha-1-antitrypsin
10. A child of 6 years suffers from recurrent bronchitis. Otorhinolaryngologist identified
adenoid vegetation. What type of examination with a high degree of probability will let out the
presence of pulmonary form of cystic fibrosis?
*Determining the level of electrolytes in sweat
Bronchography
The study of family history
Research stool to neutral fat
Adenoid biopsy and cytological examination
11. A child of two years was hospitalized with complaints on non-productive cough with
purulent sputum release, asthma, retarded physical development, polyexcrements, increased
sweat chloride 148 mEq/L of disease from 3 months of age. The diagnosis: cystic fibrosis.
Choose the best therapy.
*Pancreatic enzyme + antibiotic
Adaptogen + bile drug
Antihistamine drug + hepatoprotector
Probiotic + antibiotics
Vitamin therapy + mucolytic
12. The child is 1 year. From the first weeks of life - constant cough, sputum stands hard.
Physical development is not according to the age. Cyanosis nasolabial triangle. Over lungs
mosaic sound is heard, plenty of wet and dry wheezing. During the examination - neutrophilic
leukocytosis, serum electrolytes - natriy116 mmol/L chlorine - 86 mmol/L, sweat electrolytes chlorine 84 mg/dL. What is the proper diagnosis?
*Cystic fibrosis
Syndrome Kartahenera
Idiopathic fibrosing alveolitis
Bronchiolitis
Acute obstructive bronchitis
13. A mother of a 2 month child appealed to the district pediatrician with complains of cough,
dyspnea, lag in physical development of the child. From history: the second child of full-term
pregnancy, which ran with the threat of interruption (first child died at the age of 4 months from
the pathology of the lungs, according to the mother). Weight at birth 2400 g. From the first days
of life there cough, treated twice for bronchitis. According to the complicated condition of the
child, the doctor prescribed hospitalization. What is the proper diagnosis?
*Cystic fibrosis
Acute obstructive bronchitis
Tuberculosis
Pertussis
Acute pneumonia with obstructive syndrome
14. Most common etiologies of bronchiectasis are the severe pneumonia, B cell abnormalities,
recurrent aspiration or aspiration of a foreign body and ciliary dyskinesia. A focused history,
laboratory investigation, and instrumental methods are suggested in the evaluation of these
children. The most informative method of radiation diagnosis of bronchiectasis is:
*Bronchography
Tomography lungs
Computed tomography
Plain radiography of the chest
Magnetic resonance imaging
15. A 1.5-year old child has symptoms of cystic fibrosis, recurrent pneumonia, release of large
amounts of purulent sputum green, choking, polyexcrements, retarded physical development,
increased sweat chloride 126 mEq/L. Choose the most accurate method of diagnosis.
*The direct detection of gene by polymerase chain reaction
Determining the sex chromatin
Karyotyping
Analysis ancestral history
Enzymatic analysis
16. The girl 8 year has complains on headache, weakness, fever 39.8ºС, vomiting, expressed
dyspnea, pale skin with flush on right cheek, lag of right hemithorax respiratory movement,
dullness on percussion over low lobe of right lung, weakness of vesicular respiration in this zone.
The abdomen is painless and soft at palpation. Which disease lead to these symptoms and signs?
*Pneumonia croupousa
Flu
Acute appendicitis
Intestinal infection
Acute cholecystitis
17. A child of 3 years suffers from frequent, prolonged respiratory disease and pancreatic form
of malabsorption. Cystic fibrosis was suspected. What research should be done to confirm this
diagnosis?
*The content of chloride in sweat
Karyotyping
Bronchoscopy
Sputum examination
Research mukociliar clearance
18. The child of 8 months suffers from recurrent bronchopulmonary pathology observed with
obstructive syndrome. The physical development is not according to the child. The taste of the
skin is salty. What is your preliminary diagnosis?
*Cystic fibrosis
Obstructive bronchitis
Bronchiolitis
Respiratory allergies
Acute pneumonia
19. A boy of 4 months has diarrhea and malnutrition. He was born with a mass of 3250g of 2
months transferred to artificial feeding cow's milk. Dry skin, decreased muscle tone, liquid stool,
greenish, fetid. In coprogram there is neutral fat, 70 mmol/L sweat chloride/liter. What is the
proper disease?
*Cystic fibrosis
Celiac disease
Galactosemia
Intestinal infection
Fruktozemiya
20. A patient of more than 15 complains of cough with purulent sputum separation, pain in the
lower part of the left part of the chest, periodic fever. What will be the most informative
examination for diagnosis?
*Bronchoscopy
Puncture of the pleural cavity
Bronchography
Plain radiograph of the lungs
Bacteriological study of sputum
21. A boy of 6 years since the first months of life, suffers from recurrent pneumonia and release
with features of obstructive episodes and viscous sputum, retarded body weight and height,
deformation phalanges - "drum sticks", hepatomegaly, rectal prolapse. Hemoglobin 91 g/L,
erythrocyte 2.9x1012/L, color index of 0.7, total serum protein 56 g/L. A large amount of
excrement is sparkling with a lot of fat in. What is the proper diagnosis?
*Cystic fibrosis
Celiac disease
Obstructive bronchitis
Chronic bronchitis
Deficiency intestines disaccharidases
22. A patient of 11 years has cough with purulent sputum, usually in the morning, shortness of
breath, wheezing wet rack below the left shoulder blade. Fingers as drumsticks. Sputum - threelayered. Hemography: leukocytosis, left shift, accelerated ESR. The content of chloride in sweat
39 mmol/L. Bronhohramma - expanding of end sections of lower lobe bronchus on the left. What
is the proper diagnosis?
*Bronchiectasis
Syndrome Kartahenera
Cystic fibrosis
Chronic bronchitis
Idiopathic fibrosing alveolitis
23. A boy of 10 years complains of constant cough with greenish sputum, dyspnea on exertion.
First became ill at the age of 2 year of bilateral pneumonia which had a protracted course.
Further observed disease recurrence 4-5 times a year in remission consistently kept moist cough.
The results of which survey will be the most important for proper diagnosis?
*Bronchography
Microbiological specimens
Bronchoscopy
Radiography of the chest
Spirography
24. An 8 week old child is admitted because of tachypnea. Birth had been uneventful, although
conjunctivitis developed on the third day of life and lasted for about 10 days. Physical
examination reveals tachypnea, bilateral inspiratory crackles and single expiratory wheezing.
Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no history of fever.
White blood cell count is 18x109/l, with 22% of eosinophils. The most likely cause of this child's
symptoms is:
*Clamydia trachomanis
Mycoplasma pneumonia
Pneumocystis carinii
Visceral larva migrans
Varicella
25. A boy of 4 months suffers from a runny nose, shortness of breath, dry cough. She has been
sick for 2 days. Objectively: pale skin, acrocyanosis, shallow breathing, Ps- 80/min. Over the
entire surface of the lungs box sound, plenty of bubbling (moist) rales. What is the proper
diagnosis?
*Bronchiolitis
Cystic fibrosis
Acute bronchitis
Pneumonia
Foreign body airway
26. The doctor was called to the child at the age of 1.5 year. The child suddenly turned blue and
began to choke. Doctor saw the child sitting among the small child objects (buttons, beans, etc.).
The child's condition was a bit different from the usual, the chilled continued to play. No signs of
respiratory failure. What should the doctor do?
*To conduct auscultation and percussion of the chest cavity and deliver in a hospital
Supervision of parents
Knock back, encourage and stimulate cough
Examine the baby mouth, despite his resistance
Reassure the mother and say that the child is not in danger
27. The child is 7 months. Mother complains of severe cough, dyspnea, and cyanosis. The child
has been sick for 5 days. The general condition is complicated. Above the lungs box percussion
sound is heard, breathing hard, a large number of different-sized wet and dry wheezing on both
sides. Cardiac weakened. HR 176/min. In the blood: E – 4.3 x 1012/L, Hb-119 g/L, L – 13.2 x
109/L, E-3%, N - 79%, Lim. - 12%, M - 6% ESR - 23 mm/h. On X-ray increased vascular
pattern, increased transparency peripheral regions of the lungs. What is the proper diagnosis?
*Acute bronchiolitis
Return focal pneumonia
Acute obstructive bronchitis
Polysegmental pneumonia
Acute bronchitis
28. The child of 2 years has been sick for the last 2 days .The body temperature – 37.4°C,
restless, "barking" hard cough, hoarseness of voice, noisy breathing, complicated breath, pale
skin, during inspiration retraction intercostal spaces and jugular fossa. What kind of disease is it?
*Laryngitis
Asthma
Pneumonia
Bronchiolitis
Aspiration of foreign body
29. The child of 3 months suffers from expiratory dyspnea, dry cough, temperature of 37.7°C,
BH - 80/min., cyanosis skin, muscles support in breathing. Above the lungs ─ boxed lung
sounds, relaxed breathing with prolonged exhalation wheezing bubbling crepitation on both
sides. What is the preliminary diagnosis?
*Bronchiolitis
Acute bronchitis
Pneumonia
Cystic fibrosis
Tracheitis
30. The child is 3 years. She got seriously ill, temperature 39.2°C, painful unproductive cough,
restless, expressed conjunctivitis, mucous discharge from the nose, congestion pharynx, his voice
is hoarse. Breathing in complicated, with the involvement of the intercostal spaces. Percussiontympanitis, auscultation – difficult to hear wheezing with hard breathing. What is your proper
diagnosis?
*Croup complicated of streptococcus infection
Acute bronchitis
Pneumonia
Bronchiolitis
Asthma attack
31. The child is 3 years. He is ill for the first time. He has been sick for two days: t – 37.5°C,
dry cough, BH - 30/min. above the lungs clear percussion sound. Auscultation - breathing hard,
scattered dry wheezing. On radiographs increased pulmonary pattern. What is the proper
diagnosis?
*Obstructive bronchitis
Bronchiolitis
Asthma
Congenital stridor
Pneumonia
32. The girl of 2 year has been ill for 2 days suffers from illness, temperature 37.6 °C, runny
nose, joined by frequent dry cough, expiratory dyspnea. During the objective examination boxed
shade percussion sound is observed on the top of the lungs, during auscultation - a large number
of dry whistling and bubbling rales. What is the proper diagnosis?
*Acute obstructive bronchitis
Asthma
Pneumonia
Bronchiolitis
Laryngotracheitis
33. A 11 month baby suffers from fever, cough, shortness of breath. He is ill for 6 days after
contact with patients with cold. The child's condition is hard. The temperature of 38.6°C,
cyanosis of nasolabial triangle. Respiration rate – 56/min, fanning wings, nose breathing.
Percussion of the lungs shortening sound right lower corner of the scapula, over other areas tympanic shade sound. Auscultation: a large number of bubbling moist rales on both sides, more
on the right. What is the proper diagnosis?
*Pneumonia
Acute respiratory viral infection
Laryngotracheitis
Acute bronchitis
Bronchiolitis
34. A child of 4 months acutely ill with fever to 38°С, coughing. On the third day, increased
cough, dyspnea joined. Percussion of the lungs tympanic sound auscultation on both sides of a
large number bubbling moist rales and crepitation in expiration. What is the proper diagnosis?
*Bronchiolitis
Pneumonia
Bronchitis
Rhinopharyngitis
Focal pneumonia
35. Last winter you diagnosed respiratory syncytial virus bronchiolitis in a 10-month-old girl.
She had wheezing and required hospitalization for supportive care. Now his mother asks what
she chances are of wheezing this coming winter. Of the following, her chances of wheezing
again are closest to
*25%
40%
50%
65%
80%
36. A boy of 2 years complaints of prolonged moist tympanitis ough, frequent inflammatory
disease of the respiratory tract. A slight asymmetry of the chest, numerous stigma disembriog
tympanitis enesis. Breathing in the relevant area is not performed. Radiological findings:
reducing of volume of the chest cavity, poor differentiation of dome tympanitis diaphragm and
homogeneous darkening in the projection of the right lower lobe. About what disease it is
necessary to think?
*Hypoplasia right lower lobe
Foreign body airway
Asthma
Dextral pleurisy
Acute obstructive bronchitis
37. A girl of 5 years complains of a cough that lasts more than a month, recurrent episodes of
breathlessness. From history we know that a month before her during meals choked and it caused
cough. Percussion - blunting in the basal parts of the lung on the right. Breathing in the relevant
area is not performed. On radiographs, in the right lower lobe is visualized homogeneous
darkening in the form of a triangle. What is the causal therapy?
*Sanation bronchoscopy
Spirography
Prescribe antibiotics
Prescribe mucolytics
Prescribe bronchodilators
38. A girl of 12 years was in soporose state, with remote whistling wheezing, cyanosis of the
face. From history: two years of suffering from asthma. This aggravation for two days. Ventolin
enjoyed 12 times a day, the effect is temporary. Objectively: leather with cyanotic tinge,
paradoxical thoraco-abdominal breathing. Percussion: the vesiculotympanitic (bandbox, wooden)
resonance of the lungs sound. Auscultation: breathing does not listen. Cardiac sharply weakened.
What should be assigned first of all?
*Oxygen therapy
Enter aminophylline intravenously
Budesonide through a nebulizer
Salbutamol through a nebulizer
Ipratropium bromide through a nebulizer
39. A 8-year-old girl with intermittent asthma attacks that are repeated 2-3 times a year and
disappear in a few minutes. The child was at an early artificial feeding, there have been periodic
manifestations of atopic dermatitis, an allergic reaction to penicillin. Dry cough, occasionally expiratory dyspnea, RR - 32/min. Auscultation: breathing hard, dry whistling wheezing on both
sides. Cardiac moderately muffled, rhythmic, PS 110/min. In other systems the deviations were
found. In the physical development of the child is not far behind. What is the most likely
diagnosis?
*Asthma
Congenital heart defect
Obstructive bronchitis
Bronchiolitis
Cystic fibrosis
40. A 4 month baby got ill with increase of body temperature to 38.2°C, cough, shortness of
breath, and loss of appetite. Objective: marked expiratory dyspnea BH - 49/min, frequent
unproductive cough, wheezing. Above the lungs box percussion sound in low-back departments
of moderately weakened breathing, wheezing, a large number of bubbling moist rales. What is
the diagnosis?
*Acute obstructive bronchitis
Acute bronchiolitis
Pneumonia
Acute bronchitis
Laryngotracheitis
41. A 4 year old boy with a cough and runny nose. Two other family members had the same
symptoms. On the third day cough increased, became dry, intrusive; increased body temperature
to 37,7°C. Objective: breathing with the participation of auxiliary muscles percussion on both
sides – lung sounds with tympanychnym shade, breathing hard, prolonged exhalation, dry
whistling and sometimes medium-bubble wet wheezing. What is the diagnosis?
*Acute obstructive bronchitis
Pneumonia
Constrictive laryngotracheitis
Asthma
Acute bronchiolitis
42. A girl of 7 years is ill, increased body temperature to febrile numbers, appeared catarrhal
symptoms. Treated as outpatients, panadol, expectorant drugs. During 6 days condition
deteriorated. Increased cough, dyspnea expiratory character appeared, BH - 44/min. Over the
entire surface of the lungs the box shade percussion sound. Auscultation: breathing hard on the
background of scattered dry whistling and wheezing mixed wet. What is the disease according to
the clinical symptoms?
*Acute obstructive bronchitis
Pneumonia
Acute bronchiolitis
Asthma
Laryngotracheitis
43. A child of 10 complained about dry cough, shortness of breath. He suffers from intermittent
asthma for one year. Objective: baby restless, pale skin, cyanosis nasolabial triangle, dyspnea
expiratory type, BH - 42/min. Above the lungs percussion sound with a box shade, auscultation,
breathing weakened, dry whistling wheezing on both sides. Volume of forced expiratory - 78%
of the norm. Which drugs are the most appropriate?
*Salbutamol
Diphenhydramine
Prednisolone
Eufillin
Lasix
44. A Child of 3 year was examined by a district pediatrician. He suffers from paroxysmal
cough to 15-20 attacks per day. Sick for 2.5 weeks. Initially worried mostly dry cough at night.
Symptomatic treatment effect is not allowed. At the end of the second week coughing became
cramping in nature. Checked puffiness of the face, pinpoint hemorrhages in the conjunctiva. In
the lungs breathing hard, solitary wheezing scattered throughout the lungs. Review of
oropharynx provokes coughing fit. What is the proper diagnosis in this case?
*Рertussis
Obstructive bronchitis
Foreign body in the respiratory tract
Asthma
Сonstrictive laryngotracheitis
45. A child of 6 years is suffering from asthma for 3 years, asthma attacks occur mostly in
spring and summer. According to the results of allergy tests: hypersensitivity to poplar fluff,
field grasses. What is the proper prescription?
*Holding specific hyposensitization
Holding physiotherapy
Holding spa treatment
Holding herbal medicine
Holding acupuncture
46. A 11 month baby suffers from fever, cough, shortness of breath. He is ill for 6 days after
contact with patients with cold. The child's condition is hard. The temperature of 38.6°C,
cyanosis of nasolabial triangle. Respiration rate – 56/min, fanning wings, nose breathing.
Percussion of the lungs shortening sound right lower corner of the scapula, over other areas tympanic shade sound. Auscultation: a large number of bubbling moist rales on both sides, more
on the right. What is the proper diagnosis?
*Pneumonia
Acute respiratory viral infection
Laryngotracheitis
Acute bronchitis
Bronchiolitis
47. A girl of 7 years complained of constant cough with greenish sputum, dyspnea on exertion.
First became ill at the age of 1 year of bilateral pneumonia, which had a protracted course.
Further observed disease recurrence 4-5 times a year in remission consistently kept moist cough.
Which results of the survey will be the most important in establishing a clinical diagnosis?
*Bronchography
X-ray of the chest
Microscopy of sputum
Computed tomography
Spirography
48. A child of 4 months acutely ill with fever to 38°С, coughing. On the third day, increased
cough, dyspnea joined. Percussion of the lungs tympanic sound auscultation on both sides of a
large number bubbling moist rales and crepitation in expiration. What is the proper diagnosis?
*Bronchiolitis
Pneumonia
Bronchitis
Rhinopharyngitis
Focal pneumonia
49. The child of 1.5 years on the background of acute viral respiratory infection appeared hoarse
voice and noisy breath. During crying sticking supraclavicular and subclavicular pits and
increase inspiratornori dyspnea are observed which disappear when the child is calm. What
disease can you suspect in child?
*Acute constrictive laryngotracheitis
Foreign body in the respiratory tract
Pneumonia
Asthma
Congenital heart defect
50. A boy of 12 was taken to hospital after being bitten by bees, appeared swollen lips, face,
neck, feeling the heat and lack of air. Breathing is labored, noisy, frothy discharge from the
mouth, coughing. The skin is pale, cold. Bradypnoe. Cardiac deaf, arrhythmic. Pulse thready.
What is the proper diagnosis?
*Anaphylaxis
Angioneurotic edema
Asthma
Acute cardiovascular failure
Panic attack
51. The child of 1.5 years on the background of acute viral respiratory infection appeared hoarse
voice and noisy breath. During crying sticking supraclavicular and subclavicular pits and
increase inspiratornori dyspnea are observed which disappear when the child is calm. What
disease can you suspect in child?
*Acute constrictive laryngotracheitis
Foreign body to the respiratory tract
Pneumonia
Asthma
Congenital heart defect
52. The child of 4 months suffers from restlessness, frequent shallow breathing, and cough.
Objective: t body – 38.6°S, cyanosis nasolabial triangle involving shallow breathing muscles
subsidiary, HR-58 for 1 min. Over the lungs you can hear moist rales, heart rate - 172 in 1 min.,
tons heart muted. Blood: white blood cells - 14.5 g/l; ESR - 26 mm/h. X-ray of the lungs, focal
shadow on the both lungs on the background of intensified bronchopulmonary figure, the roots
are infiltrated. Your diagnosis?
*Bilateral focal pneumonia
Broncho-obstructive syndrome
RVI, adenoviral infection
Foreign body of the airway
Congenital disease of the bronchopulmonary system
53. A boy of 13 complains of cough with purulent sputum, shortness of breath. Within 2.5 years
of suffering recurrent pneumonia. Objectively: pale skin, sunken chest, fingers as “drumsticks”,
BR-25 for 1 min. Percussion over lungs sound with box shade, auscultation scattered dry and wet
variegated wheezing. Lung X-ray: bilateral patchy darkening of area around the root of the lung,
increased bronchopulmonary picture. What examination for further diagnosis should be done?
*Bronchography
Thoracentesis
Spirography
Pikfluometry
Estimate oxygen saturation
54. A girl 7 years old fell ill acutely. Complaints of dry cough, discharge from the tympanitis
nose, sore throat. Two months ago postviruses acute myocarditis was diagnosed, a week ago she
stopped receiving digoxin at a dose of 10 mg/kg per day. When examined t 37,4°C, BR 33 per
min. Heart rate to 126 per min. Cardiac song is loud, liver +1 cm. What will indicate digoxin
renovation to be used again?
*Tachypnea, wheezing in the lungs, liver enlargement
Prolonged fever
Bold streptococci from throat
Ventricular paroxysmal tachycardia
Sore throat
55. A 10 year old child more 8 months periodic fever appears to 38-38.4°C, cough, dyspnea,
hemoptysis once. Her grandfather suffers from chronic bronchitis. In the lungs scattered mixed
wet and dry wheezing. Radiological findings: of the same type, equal, into small particles
infiltration of the lungs, in the upper fate of thin-walled cavern with moderate perifocal
infiltration. What is the proper disease?
*Pulmonary tuberculosis
Pneumonia
Alveolitis
Asthma
Haman-Rich syndrome
56. A boy of 2 years complaints of prolonged moist tympanitis ough, frequent inflammatory
disease of the respiratory tract. A slight asymmetry of the chest, numerous stigma disembriog
tympanitis enesis. Breathing in the relevant area is not performed. Radiological findings:
reducing of volume of the chest cavity, poor differentiation of dome tympanitis diaphragm and
homogeneous darkening in the projection of the right lower lobe. About what disease it is
necessary to think?
*Hypoplasia right lower lobe
Foreign body airway
Asthma
Dextral pleurisy
Acute obstructive bronchitis
57. A girl of 5 years. She complains of a cough that lasts more than a month, recurrent episodes
of breathlessness. From history we know that a month before she during meals choked and it
caused cough. Percussion - blunting in the basal parts of the lung on the right. Breathing in the
relevant area is not performed. On radiographs, in the right lower lobe homogeneous darkening
in the form of a triangle. What is the causal therapy?
*Sanation bronchoscopy
Spirography
Prescribe antibiotics
Prescribe mucolytics
Prescribe bronchodilators
58. The state boy 10 years is heavy, flabby, pale, perioral cyanosis, expiratory dyspnea. In the
act of breathing ancillary muscles are involved. Percussion above the lungs box sound, breathing
sharply weakened. Dry whistling wheezing. BR-40 per minute. The boundaries of cardiac
dullness are not extended. Heart sounds are muffled. PR 120 per min., blood pressure 105/65
mm. Hg. Liver + 1cm. Diuresis according to the age. What are the reasons?
*Respiratory failure
Vascular insufficiency
Heart insufficiency
Hepatic failure
Pneumothorax
59. The girl 9 years with exacerbation of moderate asthma, examined by doctor. To relieve
attacks bronchodilator therapy by nebulizer was prescribed. During the day, the child's condition
has stabilized. What method of study is the best for further monitoring of respiratory function of
the patient?
*Peakflowmetry
Spirometry
Holding bronchodilatation test
Pneumotahometry
Holter monitoring
60. A 9 year-old boy is being treated in the cardiology department with acute non-rheumatic
carditis. On the second day in the hospital her condition got worse: increase shortness of breath,
there was cyanosis nasolabial triangle, joined wet nonproductive cough, skin covered with cold
sweat, there is a motor agitation, breathing rate - 40 in 1 min, pulse 80 in 1 minute, arrhythmic,
weak filling and stress; limits hearts dilated left much weakened tone, accent II tone of the
pulmonary artery of the lungs breathing weakened, a large number bubbling rales, blood pressure
90/45 mm What are the carditis complications
*Acute leftventricle heart failure
Acute right ventricle heart failure
Total acute heart failure
Acute pneumonia
Asthmatic condition
61. Child 3 years, suffering from polysegmental pneumonia suddenly increased cough, which
has become intrusive, exhausting. Lips blue. In the lungs breathing weakened. Diffuse crackling.
Tachycardia. Heart tones deaf. BR - 57 per 1 min., pulse - 220 in 1 minute, pO 2 - 44%, pCO 2 72%. Diurez reduced. What is the preliminary diagnosis?
*Acute heart failure (left ventricular on type) II degree
Pneumothorax
Acute heart failure (total) II degree
Bronchial obstruction syndrome
Acute heart failure (on right ventricular type) II degree
62. While playing in kindergarten in a child of 2 years got dyspnea, attack of dry intrusive
cough. Face cyanotic, with tears in his eyes. There have been repeated vomiting, the right half of
the entire chest weakened breathing. What is the preliminary diagnosis?
*Foreign body
Acute laryngotracheitis
Obstructive bronchitis
Asthma
Hysteric attack
63. Girl 5 years hospitalized with complaints of constant cough with purulent sputum, shortness
of breath. She was ill since birth. Objectively: pale skin, sunken chest, fingers as drumsticks.
What method of diagnosis should be used for diagnosis?
*Bronchoscopy
Radiophotography
Spirography
Thoracentesis
Pneumotachometry
64. A boy of 6 years was hospitalized with attack of breathlessness. From history - atopic
dermatitis, frequent obstructive bronchitis. Objectively: pale skin, cyanosis of the lips, over the
entire surface of the lungs dry whistling wheezing during expiration can be heard. In a blood test:
hemoglobin - 120 g/l, leukocytes - 5.4x109, ESR - 12 mm/h. What method of diagnosis should
be carried out to establish the diagnosis?
*Peakflowmetry
X-ray of the lungs
Contrast bronchography
Computed tomography
Angiopulmonography
65. At night by ambulance a girl of 3 years was delivered to Children's Hospital, on the second
day of acute respiratory viral infection appeared noisy breathing, inspiratory dyspnea, trapping
intercostal spaces, fanning wings, nose and barking cough. What is the most likely diagnosis?
*Virus croup
Asthma
Diphtheria croup
Foreign body airway
Epiglottis
66. A boy of 8 years on the second day of the disease acute respiratory viral infection got a wet
cough. For percussion - normal lung sound, auscultation - dry wheezes over the entire surface of
the lungs. What is the proper diagnosis?
*Simple acute bronchitis
Recurrent bronchitis
Obstructive bronchitis
Asthma
Pneumonia
67. A boy of 15 years old suffers from pulsing headache attack and excitement, t is 39,5°C
chills, vomiting. Upper limb numbness, dry mouth. PR by 40 minutes. Breath - vesicular. Heart
rate of 120 per minute. AT 155/100mm / Hg. Heart is not enlarged. Cardiac sounding clean.
Abdomen soft, painless. The preliminary diagnosis.
*Sympathoadrenal crisis
Vagoinsulyarnyh crisis
Asthma status
Meningeal syndrome
Coma
68. On the third day of hospitalization a 3 month child with acute respiratory disease got
choking of mixed nature for central cyanosis type. During examination wheezing was
determined and over the lungs tympanic percussion sound, tapped scattered crackles. Using of βagonist did not affect. Cyanosis disappears during breathing with oxygen. Your diagnosis?
*Bronchiolitis
Viral croup
Pneumonia
Epiglottis
Asthma
69. Doctor evaluated a 2-year-old girl who is new to your practice. His mother states that she is
allergic to the following foods: eggs, peanuts, fish sticks, pancakes, cake, tuna fish salad,
macaroni salad, and ice cream from an ice cream store. She can eat spaghetti, macaroni and
cheese, and chocolate ice cream from a carton. When she reacts, she immediately breaks out in
hives, vomits, and sometimes wheezes. She has injectable epinephrine, but has not used it
because her symptoms do not seem bad enough. The mother has brought him to you because she
feels she needs more guidance with his food allergies. Of the following, your best advice is that
*It is unlikely he is allergic to all those foods and further evaluation is needed
Should be started daily oral antihistamine to prevent anaphylaxis
He is not really allergic to macaroni because he can eat spaghetti
Should be started immediately allergy immunotherapy with his food allergies
The treatment of choice for anaphylactic reactions is an oral antihistamine
70. Doctor received a call from the mother of 9-year-old girl who has asthma and is ill. She has
no fever, but the mother says she looks unwell. She does not hear wheezing now, but she was
wheezing last night. She is receiving beta agonist nebulizer treatments every 3-4 hours with only
minimal relief. His peak expiratory flow rate, which normally is 450 L/min, is 150 L/min after a
treatment. Of the following, the best advice for the nurse to give the mother is to
*Go to the emergency department for treatment
Continue present therapy and call back if the child’s condition worsens
Bring the child to the office later this afternoon
Increase the beta agonist treatments to every 2 hours
Start an inhaled corticosteroid at a high dose
71. A 7-year-old child with recurrent episodes of wheezing, breathlessness, chest tightness, and
coughing, particularly at night or in the early morning that are repeated 2-3 times a month and
disappear in a few minutes examined by a doctor. The child was at an early artificial feeding,
there have been periodic manifestations of atopic dermatitis. Auscultation: breathing hard, dry
whistling wheezing on both sides. In other systems the deviations not found. In the physical
development of the child is not far behind. What is the most likely diagnosis?
*Asthma
Cystic fibrosis
Foreign body in the lung
Pneumonia
Acute bronchiolitis
72. A 6-year-old girl, who had an upper respiratory tract infection for two days without fever or
change in level of activity, awakens with temperature of 38,7C°, lassitude, and anorexia. He soon
struggles to breathe and his parents bring him to the emergency room. On physical examination
her vital signs include a pulse of 146 beats per minute and respirations of 34 per minute. The
child is holding his arms around the back of a chair and exerting a greet a fort to breath. He has a
mucoid rhinorrhea auscultation reveals high-pithched breathe sounds heard in all lung fields
during expiration. The most appropriate diagnosis is
*Asthma
Pneumonia
Epiglottis
Bronchitis
Laryngitis
73. A 7-month-old infant is brought to the emergency with fever, intermittent inspiratory stridor.
Retraction of the intercostals mucles, and flaring of the nostrils. The mother states that the child
has had an upper respiratory infection for the last 1 or 2 days. What is the most likely diagnosis?
*Laringotraheobronchitis (croup)
Whooping couth
Acute epiglottitis
Bronchiolitis
Bronchial asthma
74. A 6-year-old child with severe asthma is being treated with an intravenous drip of
theophylline in the emergency room. The child is slowly becoming sleepy and less wheezing
than on admission. Which action is the most appropriate in the care of this patient?
*Order arterial blood gas studies immediately
Send the child home with the mother
Order a chest x-ray
Measure the theophylline level
Conduct spirometry
75. A 2-year-old boy has a low grade fever “raspy” coughs and clear rhinorrhea for 3 days. She
is brought to the emergency room when she does not improve and begins to develop difficult
breathing. On physical examination her vital signs a temperature of 38.4 C°, a pulse of 156 beats
per minute, and respiration of 35 per minute. Auscultation reveals bilateral rhonchi, wheezing,
and some mild stridor. The most appropriate diagnosis is
*Laryngotracheobronchitis
Asthma
Tonsillitis
Epiglottitis
Pneumonia
76. A 1.5-year-old boy is brought to the emergency room because he is having trouble
breathing. The mother states that he has had a cough since he born, did not includes that the boy
defecate for quite some time after delivery. You chart his growth and find that he is in less than
the fifth percentile. Whiz this information, what additional test are you going to order?
*Sweet test
HIV test
Immunoglobulin A,M,G
Urinalysis
Rectal biopsy
77. A 7-year-old boy is brought to the emergency room by her camp counselor. The patient,
who had previously been completely healthy in appearance, suddenly developed a cough and
noise breathing while playing a late-night game of hide-and-seek. Her best friend says that she
usually takes, some kind of medicine, but has not since arriving at camp. You not that she is in
respiratory distress and actively using accessory muscles. Her respiration is harsh with wheezing
in both phases. The expiratory phase is prolonged, and there is tachypnea and tachycardia you
diagnose the patient as having
*Asthma
Panic attack
Foreign body obstruction
Chronic bronchitis
Epilepsy
78. A 6-hour-old girl had been doing fine until nurses attempted to challenge-feed the newborn.
She became cyanotic during the attempt but got better and cried when discontinued. The most
likely diagnosis is
*Choanal atresia
Hyaline membrane disease
Tracheobronchomalacia
Meconium aspiration syndrome
Tracheoesophageal fistula
79. Laboratory assessments and studies may be used to exclude other diagnoses. Arterial blood
gases are valuable for assessing severity of exacerbations and following response to treatment.
Early in an attack of asthma, which of the following sets of arterial blood values is most likely?
*Low PO 2 and low PCO 2
Normal PO 2 and normal PCO 2
Normal PO 2 and low PCO 2
Normal PO 2 and elevated PCO 2
Low PO 2 and elevated PCO 2
80. An 8-year-old child is brought to the office because of chronic nasal obstruction.
Examination reveals bilateral clear, serous discharge from the nose but is otherwise
unremarkable. During 5 years he suffers of atopic dermatitis. The most likely diagnosis is
*Allergic rhinitis
Defect in the cribriform plate
Atresia choan
Cystic fibrosis
Postnasal-drip syndrome
81. A 6-month-old child develops a cold and cough. The cough fails to clear and, over a ten
days period, worsens to the point of severe paroxysms associated with cyanosis. The paroxysms
occasionally end with vomiting. The child is afebrile, and physical examination is within normal
limits. The most appropriate method to try to culture the responsible organism from this child
would be:
*Bronchoscopy
Throat swab
Lung puncture
Nasopharyngeal swab
Blood culture
82. Doctor examining a 12 years old asthmatic boy who on twice a day receives an inhalation
corticosteroid as a basis treatment for the last 2 years. This morning, the child woke up with an
acute attack. You would prescribe:
*Salbutamol puffs
Beclomethasone puffs
Theophylline
Cromoglycate
Parenteral introduction of dexamethasone
83. A newborn infant has excessive drooling along with coughing and choking with feeding.
Cyanosis is present and is unrelieved by crying. Bilateral pulmonary rales are present. There are
is abdominal distention with tympany of percussion. The most likely diagnosis is:
*Tracheoesophageal fistula
Epiglottitis
Pylorospasm
Choanal atresia
Respiratory distress syndrome
84. Infant 7 months has had a runny nose and has been sneezing and coughing for two days.
Four hours ago his cough became much worse. On physical examination he is in moderate
respiratory distress with nasal flaring, hyperexpantion of the chest, and easily audible wheezing
without rales. The most likely diagnosis is:
*Bronchiolitis
Viral croup
Asthma
Epiglottitis
Diphtheria
85. Reasonable explanations for the feeding of a chloride concentration of 120 meg/L in the
sweat of a 3-year-old boy with recurrent pneumonias include each of the following except:
*This is the upper limit of normal
He has cystic fibrosis
He has untreated adrenal insufficiency
Before the collection of sweat the skin was not washed properly to remove residual salt
This was a laboratory error and the test must be repeated
86. You are awakened in the night by your 3-year-old daughter, who has developed noisy
breathing on inspiration, marked retraction, of the chest wall, flaring of the nostrils, and a
barking cough. He has a mild upper respiratory infection for 1 day. The most likely diagnosis is:
*Viral croup
Asthma
Epiglottitis
Foreign body in the right mainstem bronchium
Postnasal-drip syndrome
87. Croup is a common, primarily pediatric viral respiratory tract illness. However, morbidity is
secondary to narrowing of the larynx and trachea below the level of the glottis (subglottic
region), causing the characteristic audible inspiratory stridor. A child with viral croup can be
expected to have all the following except:
*Hyperinflation on chest x-ray
A low-grade fever
Inspiratory stridor
Infection with parainfluenza virus
Age between 6 months and 3 years
88. The child of 9 years in the country side in August got asthma attack, expiratory dyspnea,
cough. Over 3 years in this period was marked conjunctivitis, cough. A sister suffers from atopic
dermatitis. Which is the proper diagnosis?
*Asthma
Acute bronchitis
Allergic rhinitis
Acute obstructive bronchitis
Pneumonia
89. A girl of 2 years old, suffering from food allergies, acute ill, complaining of dry paroxysmal
cough, whistling wheezing, shortness of breath (BR 60 for 1 min) with difficulty exhaling,
auxiliary muscles involved in breathing. Above the lungs box sound, the mass of dry whistling
and wheezing mixed wet on both sides. Select which drugs should be given intravenously to the
child.
*Prednisolone
Penicillin
Epinephrine
Lazolvan
Calcium gluconate
90. A 5-year-old girl was taking to the emergency department with a 1-month history of fever,
cough, and weight loss. Her parents are Nigerians, although he was born in the United States.
After talking with parent doctor learn that relatives from Nigeria recently visited the family. Of
the following, the diagnostic test most likely to yield the cause of this child's illness is a:
*Nasopharyngeal swab for viral culture
Blood culture
Chlamydia serology on serum
Skin test with purified protein derivative
Sweat chloride test
91. The parent of a girl who has a history of asthma and sinusitis calls doctor in the middle of
the night because the boy is coughing incessantly. She states that once previously you had
prescribed a very effective cough suppressant, and she would like another prescription now. You
explain to her that the proper use of a cough suppressant in her child is to treat cough due to
*An asthma exacerbation
Postnasal drip syndrome
Psychogenic cough
A viral disease
Bacterial pneumonia
92. You are preparing a presentation for schoolchildren. You have to explain that even a simple
bodily function, such as coughing, is important, stressing that the cough reflex protects the
airway and allows for expulsion of foreign material. Of the following, which disease is
associated with an impaired ability to cough?
*Spastic diplegia cerebral palsy
Spina bifida
Pectus excavatum
Allergic rhinitis
Becker type muscular dystrophy
93. A 2-year-old child is brought to the emergency department because of stridor that developed
over 20 hours and is associated with fever (39.6°C) and dysphagia. Physical examination reveals
a child who is sitting up, drooling, and exhibiting inspiratory stridor. Her immunization status is
unknown. Of the following, the most likely finding to support the correct diagnosis is:
*Anteroposterior neck radiography showing subglottic narrowing
Lateral neck radiography showing supraglottic edema
Airway fluoroscopy showing midtracheal expiratory collapse
Chest radiography showing irregular tracheal debris
Barium swallow showing a midthoracic indentation
94. Doctor is evaluating an 8-year-old boy for his fifths episode of right middle lobe pneumonia,
as demonstrated by chest radiography. He has a chronic cough and occasionally hemoptysis.
Upon reviewing the chart, you note that he has had poor weight gain since these episodes began
1.5 years ago. Of the following, the best test to evaluate this problem is:
*Bronchography
Arterial blood gas measurement
Spirometry (pulmonary function testing)
Sweat chloride test
Computed tomography with high-resolution
95. Doctor is reviewing results of the pulmonary function tests of a new patient who was
recently hospitalized for respiratory problems. You note that the child has a restrictive pattern on
testing. Because the cause of a restrictive pattern for most children is poor technique, you review
his other pulmonary function tests, which reveal that the pattern is reproducible. Of the
following, the most likely disease for this child is:
*Asthma
Chronic bronchitis
Allergic rhinitis
Muscular dystrophy
Dysplasia
96. An 8-year-old boy has been admitted to the pediatric intensive care unit after a neardrowning incident. He received immediate cardiopulmonary resuscitation at the scene and was
intubated by the paramedics. In the hospital, she requires 80% inspired oxygen and peak endexpiratory pressures of 12 cm H 2 O to keep her oxygen saturations above 95%. Chest
radiography shows diffuse bilateral pulmonary infiltrates. Of the following, the most likely late
sequela of her condition is:
*Bronchiectasis
Asthma
Emphysema
Pulmonary embolus
Plevritis
97. During the health supervision visit of a 10-month-old boy, you note mild wheezing. The
mother states he has been playful, afebrile, and eating well. However, this is his third episode of
wheezing. Review of past medical history reveals treatment for one episode of suspected
pneumonia 1 month ago. His mother had no prenatal care, and he remained in the newborn
nursery for an additional day due to rapid breathing. The only previous intervention for his
respiratory symptoms has been the prescription of a home nebulizer for wheezing at 4 months of
age. Of the following, the best next course of action is to
*Refer the infant for allergy testing
Prescribe an elimination diet
Conduct a chest radiograph
Prescribe a 1-week course of albuterol and prednisone
Prescribe only prednisone for the next 3 weeks
98. A 14-year-old girl who has myasthenia gravis presents with a cough that is productive of
green sputum. He had Pseudomonas aeruginosa pneumonia 2 months ago. On physical
examination, she has a temperature of 39.5°C, respiratory rate of 32 breaths/min, and weight of
56 kg. She has left basilar rales. Pulseoximetry shows oxygen saturation of 92%. Forced vital
capacity is 500 ml. Of the following, the most appropriate initial management for this patient is:
*Administration of intravenous antibiotic
Determination arterial blood gas
Chest physical therapy
Emergent tracheostomy
Endotracheal intubation and mechanical ventilation
99. A girl of 10 years was in soporose state, with remote whistling wheezing, cyanosis of the
face. From history: two years of suffering from asthma. This aggravation for two days. Ventolin
enjoyed 13 times a day, the effect is temporary. Objectively: leather with cyanotic tinge,
paradoxical thoraco-abdominal breathing. Percussion: the vesiculotympanitic resonance of the
lungs sound. Auscultation: breathing does not listen. Cardiac sharply weakened. What should be
assigned first of all?
*Oxygen therapy
Enter aminophylline intravenously
Inhaled nebulized budesonide
Inhaled salbutamol nebulized
Inhaled nebulized ipratropium bromide
100.A 5 year old child with a cough and runny nose. Two other family members had the same
symptoms. On the third day cough increased, became dry, intrusive; increased body temperature
to 37.6°C. Objective: breathing with the participation of auxiliary muscles percussion on both
sides – lung sounds with tympanychnym shade, breathing hard, prolonged exhalation, dry
whistling and sometimes medium-bubble wet wheezing. What is the diagnosis?
*Acute obstructive bronchitis
Asthma
Larynhotraheitis
Pneumonia
Acute bronchiolitis
101.A child of 3 year was examined by a pediatrician. He suffers from paroxysmal cough to 25
attacks per day. Sick for 2 weeks. Initially worried mostly dry cough at night. Symptomatic
treatment effect is not allowed. At the end of the second week coughing became cramping in
nature. Checked puffiness of the face, pinpoint hemorrhages in the conjunctiva. In the lungs
breathing hard, solitary wheezing scattered throughout the lungs. Review of oropharynx
provokes coughing fit. What is the proper diagnosis in this case?
*Рertussis
Obstructive bronchitis
Foreign body of bronchus
Asthma
Сonstrictive laryngotracheitis
102.The child of 4 months suffers from restlessness, frequent shallow breathing, and cough.
Objective: t body – 38.6°S, cyanosis nasolabial triangle involving shallow breathing muscles
subsidiary, HR-58 for 1 min. Over the lungs you can hear moist rales, heart rate - 172 in 1 min.,
tons heart muted. Blood: white blood cells - 14.5 g/l; ESR - 26 mm/h. X-ray of the lungs, focal
shadow on the both lungs on the background of intensified bronchopulmonary figure, the roots
are infiltrated. Your diagnosis?
*Bilateral focal pneumonia
Broncho-obstructive syndrome
RVI, adenoviral infection
Foreign body of the airway
Congenital disease of the bronchopulmonary system
103.A boy of 13 complains of cough with purulent sputum, shortness of breath. Within 2.5 years
of suffering recurrent pneumonia. Objectively: pale skin, sunken chest, fingers as “drumsticks”,
BR-25 for 1 min. Percussion over lungs sound with box shade, auscultation scattered dry and wet
variegated wheezing. Lung X-ray: bilateral patchy darkening of area around the root of the lung,
increased bronchopulmonary picture. What examination for further diagnosis should be done?
*Bronchography
Thoracentesis
Spirography
Pikfluometry
Estimate oxygen saturation
104.A girl 7 years old fell ill acutely. Complaints of dry cough, discharge from the tympanitis
nose, sore throat. Two months ago postviruses acute myocarditis was diagnosed, a week ago she
stopped receiving digoxin at a dose of 10 mg/kg per day. When examined t 37,4°C, BR 33 per
min. Heart rate to 126 per min. Cardiac song is loud, liver +1 cm. What will indicate digoxin
renovation to be used again?
*Tachypnea, wheezing in the lungs, liver enlargement
Prolonged fever
Bold streptococci from throat
Ventricular paroxysmal tachycardia
Sore throat
105.A 10 year old child more 8 months periodic fever appears to 38-38.4°C, cough, dyspnea,
hemoptysis once. Her grandfather suffers from chronic bronchitis. In the lungs scattered mixed
wet and dry wheezing. Radiological findings: of the same type, equal, into small particles
infiltration of the lungs, in the upper fate of thin-walled cavern with moderate perifocal
infiltration. What is the proper disease?
*Pulmonary tuberculosis
Pneumonia
Alveolitis
Asthma
Haman-Rich syndrome
Module № 2
1
This ECG rhythm is called:
A.
B.
C.
D.
E.
Atrial flutter with variable ventricular response
Sinus rhythm with PACs
Atrial fibrillation with fast ventricular response
Sinus arrhythmia
Ventricular tachycardia
2 A 14-year-old patient presented with body temperature rise up to 38, 5C, pain in the small articulations of hands;
face edemata and erythema. In blood: RBCs - 2,6 · 1012/l; Hb- 98 г/л; WBCs - 2 · 109/l; ESR - 58 mm/h. In the urine:
protein - 3,1 g/l; RBCs - 10-15 in the vision field. What disease can be suspected in this case?
A. Systemic lupus erythematosus
B. Sepsis
C. Systemic scleroderma
D. Periarteritis nodosa
E. Acute glomerulonephritis
3 18-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially
at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease.
Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
A. Iridocyclitis
B. Iritis
C. Keratitis
D. Choroiditis
E. Acute attack of glaucoma
4 As a result of prolonged exposure to the sun a 17-year-old patient has developed low-grade fever, pain and
swelling in the knee and ankle joints, erythema on her face and nose bridge, leukopenia and accelerated ESR. She has
been provisionally diagnosed with systemic lupus erythematosus. What pathognomonic laboratory data may confirm
this diagnosis?
A. Antinuclear factor
B. Accelerated ESR
C. C-reactive protein
D. Anaemia
E. Lymphocytosis
5 An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a skin lesion over the
extensor surfaces of joints with atrophic cicatrices, depigmentation, symmetrical affection of skeletal muscles
(weakness, edema, hypotrophy). What disease are these changes most typical for?
A. Dermatomyositis
B. Systemic scleroderma
C. Nodular periarteritis
D. Systemic lupus erythematosus
E. Reiter’s disease
6 A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic
fever, active phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for
prevention of rheumatism recurrence?
A. Bicillinum-5
B. Bicillinum-1
C. Erythromycin
D. Ampicillin
1
E. Oxacillin
7 A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the
symptoms of chronic tonsillitis, mitral insufficiency, carious teeth. What is the optimal method of secondary
prophylaxis?
A. Year-round bicillin prophylaxis till the age of 25
B. Course of cardiotrophic drugs twice a year
C. Year-round bicillin prophylaxis for 3 years
D. Tonsillectomy
E. Oral cavity sanitation
8
A.
B.
C.
D.
E.
Treatment of rheumatic fever may include all of the following, except:
sulfadiazine
bed rest
bicillinum
vitamins
prednisone
9 A 20-month-old child is brought to the emergency department because of fever and irritability and refusal to
move his right knee that resist passive motion. The most important test to confirm the impression of septic arthritis
is:
A. examination of joint fluid
B. x-ray of the knee
C. erythrocyte sedimentation rate ( ESR )
D. complete blood count (CBC) and differential
E. blood culture
10 A 4-year-old boy with a history of seizures and mental retardation comes to the physician for follow-up. His
history is also significant for infantile spasms during the first year of life with abnormal EEG. An MRI of the brain is
performed and the patient is noted to have multiple hamartomas in the cortical structures of the brain. A
periventricular mass is also noted. Physical examination of the patient reveals hypomelanotic, elliptic macules
distributed throughout the trunk and angiofibromas on malar regions of the face (adenoma sebaceum). This patient is
most at risk for which of the following conditions?
A. Cardiac rhabdomyomas
B. Cerebellar hemangioblastoma
C. Leptomeningeal angiomatosis
D. Nevus flammeus
E. Retinal hemangioblastoma
11 For a 12-years-old girl with an oligoanuria stage of acute kidney insufficiency waves of different form, widths,
heights are educed on ECG, with a chaotic rhythm and frequency more than 320 /min. What complication did arise
up?
A. Ventricular fibriilation.
B. Ciliary arrhythmia.
C. Sinoatrial blockade.
D. Atrioventricular blockade.
E. Atrial fibrillation.
12 In a maternity hospital the newborn was diagnosed of congenital heart disease (defect of intraventricular partition).
The shortness of breath appeared in 2-monthly age - to 60/min, tachycardia - to 170/min, increase of liver a to 3 cm
below than edge of costal arc. What preparations must be appointed to the child first of all?
A Cardiac glycosides
B Nonsteroid’s antiinflammatory
C Preparations of potassium
D β-adrenoblockers
E Glucocorticoids
13 The mother of 3-years-old child noticed for him the attacks of frequent palpitation, shortness of breath, which arise
up suddenly and duration about 3 hours. Objectively: skin pale, perioral cyanosis, pulsation of neck veins. Above
2
lungs there is the vesicular breathing. Borders of heart are in a norm, heart sounds is muffled, Ps - 180/min, arterial
blood pressure - 80/55 mmHg. On ECG paroxysmal tachycardia is registered with the aberrational complexes of QRS.
What preparation is contraindicated for treatment of attack for this patient?
A. Digoxinum
B. Obsidanum
C. Lidocainum
D. Amiodaronum
E. Isoptinum
14 For a 10-years-old child on ECG was discovered ventricular fibrillation. What is primary in the first aid to the
child?
A. Electric defibrillation.
B. Introduction of adrenalin
C. Introduction of calcium chloride
D. Introduction of glucocorticoids
E. Introduction of cardiac glycosides
15 A child entered into the hospital with acute infectiously-allergic myocarditis. On the 2nd day the attack of
paroxysmal tachycardia developed for the child. What drug is preparation of choice for the removal of attack?
A. Finoptinum
B. Noradrenalinum
C. Cardiac glycosides
D. Morphinum
E. Quinidine
16 17 y.o. patient complains of acute pain in the knee joint and t- 38C. He was ill with angina 3 weeks ago.
Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain
in the joints. Which diagnose is the most correct?
A. Rheumatism, polyarthritis
B. Systemic lupus erythematodes
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E. Rheumatoid arthritis
17 A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is accompanied by body
temperature rise, indisposition, pain in joints and along the legs muscles. Objectively: violet-bluish erythema around
eyes and over knee joints. HR- 120/min, heart sounds are weak. Blood count: leukocytes - 12 ∗ 109/L, ESR- 40
mm/h. What is the most probable diagnosis?
A. Dermatomyositis
B. Systemic lupus erythematosus
C. Rheumathoid arthritis
D. Atopic dermatitis
E. Reactive polyarthritis
18 A 17 y.o. patient complains of acute pain in the knee joint and t– 38C. He was ill with angina 3 weeks ago.
Objectively: deformation and swelling of the knee joints with skin hyperemia. Small movement causes an acute pain
in the joints. Which diagnose is the most correct?
A. Rheumatism, polyarthritis
B. Systemic lupus eritematodes
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E. Rheumarthritis
19 A 6-year-old boy is brought to the office because he has had pain in his right knee for the past two days. The
patient walks with a mild limp because of the pain. He has no history of trauma to the knee. He had cold symptoms
one week ago but is otherwise healthy. Vital signs are within normal limits. Physical examination shows full range of
motion of the right knee with limited internal rotation of the right hip. On laboratory studies, erythrocyte
sedimentation rate is slightly elevated and white blood cell count is within normal limits. Anteroposterior and frog-leg
3
x-ray studies of the right hip and knee show no abnormalities. Which of the following is the most likely cause of the
pain in this patient's knee?
A. Transient synovitis
B. Developmental dysplasia of the hip
C. Legg-Calvé-Perthes disease
D. Septic joint
E. Slipped capital femoral epiphysis
20 A 13-year-old girl presents with joint pain lasting for 2-months. She admits to joint stiffness in the morning that
resolves with movement. Her mother says she has been eating less, fatigues easier, and is irritable. Physical exam
reveals a rash and limited range of motion in the affected joints. Which of the following is most likely?
A. Juvenile rheumatoid arthritis (JRA)
B. Systemic lupus erythematosus (SLE)
C. Polyarteritis nodosa (PAN)
D. Kawasaki disease
E. DiGeorge syndrome
21 A late adolescent presents with a malar facial rash, photosensitivity, and painless oral ulcerations. Testing reveals
anemia, positive ANA, and signs of a type III hypersensitivity reaction. What is the treatment of choice?
A. Corticosteroid (e.g. prednisone)
B. Sedating H 1 blockers (e.g. diphenhydramine)
C. Non-sedating H1 blockers (e.g. fexofenadine)
D. H2 blocker (e.g. famotidine)
E. Antibiotic (e.g. amoxicillin)
22 PAN usually presents with waxing and waning symptoms of painful erythematous skin nodules, purpura,
hypertension, hematuria, and systemic complaints. Henoch-Schönlein purpura is an IgA-mediated vasculitis that peaks
in winter months, is usually preceded by a group A streptococcal upper respiratory infection, and causes nonthrombocytopenic palpable purura. What is the treatment of choice for both of these?
A. Corticosteroid (e.g. prednisone)
B. Sedating H 1 blockers (e.g. diphenhydramine)
C. Non-sedating H 1 blockers (e.g. fexofenadine)
D. H2 blocker (e.g. famotidine)
E. Antibiotic (e.g. amoxicillin)
23 Fever of unknown origin (FUO) implies a fever greater than 38.3C degrees (101F) for equal to or greater than how
many days?
A. 14 days
B. 3 days
C. 5 days
D. 7 days
E. 21 days
24 A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea,
cardialgia. There are dense, edema on the lower extremities and sacrum. Ps - 120/min. The cardiac borders are
extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the xiphoid
process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein is - 58.6 g/l. In urine: protein - 0,025
g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the field of vision. What is the main mechanism of edema
syndrome development:
A. Venous congestion of greater circulation
B. Venous congestion of lesser circulation
C. Peripheral circulation disorder
D. Secondary nephropathy development
E. Hypoproteinemia
25 A girl which for a year is ill rheumatism carried an angina a week ago. She entered in hospital with complaints
about a general weakness and the cardiodynia. Suddenly the pallor of skin covers increased for the child. Shortness of
breath, tachicardia, swelling of veins of head, anxiety, feeling of fear was developed. Pulse threadlike, blood pressure 60/20 mm Hg. Central venous pressure enhanceabled, oliguria. What complication did develop for the patient?
4
A.
B.
C.
D.
E.
Cardiogenic shock
Infectious shock
Hypovolemic shock
Acute pulmonary heart
Acute kidney insufficiency
26 For a 10-years-old child with acute bleeding suddenly falling of blood pressure, expressed dormancy, thirst. Skin
covers pale, covered by sticky cold sweet; pulse threadlike, 132 /min; breathing superficial, tachypnea. This state is the
basis of:
A. Hypovolemia.
B. Hypoxia.
C. Hyperkalemia.
D. Acidosis.
E. Hypothermia.
27 A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability. His anamnesis registers
frequent respiratory diseases. On percussion: heart borders are dilatated to the left and upwards. On auscultation:
amplification of the SII above pulmonary artery, a harsh systolodyastolic "machine" murmur is auscultated between
the II and the III rib to the left of breast bone, this murmur is conducted to all other points including back. AP is
100/20 mm Hg. What is the most probable diagnosis?
A. Opened arterial duct
B. Interventricular septal defect
C. Isolated stenosis of pulmonary arterial orifice
D. Interatrial septal defect
E. Valvar aortic stenosis
28 A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth, hyperthelorismus) has
systolic murmur in the second intercostal to the right of the sternum. The murmur passes to the neck and along the
sternum left edge. The pulse on the left brachial arteryis weakened. BP on the right arm is 110/60 mm Hg, on the left 100/60 mm Hg. ECG results: the hypertrophy of the right ventricle. What defect is the most probable?
A. Aortic stenosis
B. Defect of interventricular septum
C. Defect of interatrial septum
D. Coarctation of the aorta
E. Open aortic duct
29Which of the following should be given to an unstable infant with suspectedcongenital heart disease?
A. Prostaglandin E1 (alprostadil)
B. Prostaglandin E2 (dinoprostone)
C. Phosphodiesterase 3 inhibitor (milrinone)
D. Phosphodiesterase 4 inhibitor (mesembrine)
E. Phosphodiesterase 5 inhibitor (sildenafil)
30During a routine cardiac examination of an infant, a murmur is heard. Further examination reveals a fixed split S2,
regardless of inspiration or expiration. An ECGshows mild right ventricular hypertrophy (RVH). Which of the
following is most likely?
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus
D. Tetrology of Fallot
E. Coarctation of the aorta
31 Which of the following presents with a holosystolic murmur and is the most commoncongenital heart defect?
A. Ventricular septal defectf
B. Patent ductus
C. Atrial septal defect
D. Tetrology of Fallot
E. Coarctation of the aortae
5
32 A young child presents with cyanosis. The mother says the child has periodicepisodic cyanosis, which is
accompanied by agitation and rapid, deep breathing. Thechild turns blue for a couple minutes then normal color
returns. Chest x-ray shows a“boot shaped” heart and ECG shows right-axis deviation. Which of the following would
NOT be seen in this child?
A. Atrial septal defect
B. Over-riding aorta
C. Right ventricular hypertrophy
D. Pulmonary stenosis
E. Transposition of the great arteries
33 A newborn is found to have Turner syndrome. Blood pressure measurements show adifference between upper and
lower extremities. Which of the following is most likely?
A. Coarctation of the aortae
B. Patent ductus
C. Atrial septal defect
D. Tetrology of Fallot
E. Ventricular septal defect
34 A newborn boy presents to the Emergency Room with cyanosis. A chest x-ray showsan egg-on-a-string (eggshaped) heart. Which of the following is most likely?
A. Transposition of the great arteries
B. Patent ductus
C. Atrial septal defect
D. Tetrology of Fallot
E. Coarctation of the aorta
35 Conotruncal anomalies (e.g. truncus arteriosus, tetralogy of Fallot, VSD) areassociated with what chromosomal
micro-deletion?
A. 22q11
B. 11p22
C. 11q22
D. 22p11
E. 21q11
36
A.
B.
C.
D.
E.
What is the most common cardiac lesion found in rheumatic heart disease?
Mitral regurgitation
Hypoplastic left heart syndrome
Coronary artery aneurysms
Aortic stenosis
Ventricular septal defect
37 A young child is found to have pericarditis, myocarditis, and transient rhythm disturbances. If Kawasaki disease is
suspected, which of the following may develop?
A. Coronary artery aneurysms
B. Hypoplastic left heart syndrome
C. Aortic stenosis
D. Mitral regurgitation
E. Ventricular septal defect
38 Endocarditis is seen in adult IV drug abusers and with prosthetic replacement valvesafter dental procedures. In
children, it is seen with congenitally abnormal valves. What isthe most common causative agent?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Haemophilus influenza (HACEK)
D. Staphylococcus epidermidis
E. Coxsackie B virus
39 A child presents with fever, dyspnea, tachycardia, and mild ST-and T-wave changeson ECG. Physical exam
reveals S3 ventricular gallop. If myocarditis is suspected, whichof the following is most likely?
6
A.
B.
C.
D.
E.
Coxsackie B virus
Streptococcus viridans
Haemophilus influenza
Staphylococcus epidermidis
Staphylococcus aureus
40 Dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), pulsus alternans, andneuromuscular disease etiology
(e.g. Duchenne Muscular Dystrophy) is seen in which of the following?
A. Dilated cardiomyopathy
B. Hypertrophic cardiomyopathy
C. Endocarditis
D. Myocarditis
E. Myocardial infarction
41
A.
B.
C.
D.
E.
A young high school basketball player suddenly collapses during a game. Which of the following is most likely?
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
Endocarditis
Myocarditis
Myocardial infarction
42 A 6-year-old boy presents with a newly appreciated heart murmur. He is asymptomatic, with normal growth and
development and normal exercise tolerance. On examination S1 and S2 are normal; a II/VI low-frequency midsystolic
murmur is heard at the left lower sternal border. His pulses are normal. The most likely diagnosis is:
A. Bicuspid aortic valve
B. Still's murmur
C. Ventricular septal defect
D. Atrial septal defect
E. Coarctation of the aorta
43 The natural course of events in ventricular septal defacts not corrected surgically may include any of the following
EXCEPT:
A. Bacterial endocarditis
B. A normal life
C. Development of pulmonary valvular obstruction
D. Spontaneous closure of the defect
E. Increasing pulmonary vascular resistance
44
A.
B.
C.
D.
E.
Which one of the following is NOT a clinical feature or recognized complication of tetralogy of Fallot?
Cyanosis
Brain abscess
Congestive heart failure
Anoxic spells
Poor growth
45 Which one of the following is NOT one of the four cardinal structural or pathophysiologic features of tetralogy of
Fallot?
A. Atrial septal defect
B. Dextroposition of the aorta
C. Right ventricular hypertrophy
D. Right ventricular outflow tract obstruction
E. Ventricular septal defect
46 After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What
complementary instrumental method of examination should be applied for the diagnosis confirmation?
A. Echocardiography
B. Roentgenography of chest
C. Phonocardiography
D. ECG
7
E. Veloergometry
47 Examination of an 11-year-old boy revealed frequent nosebleeds, fatigue when walking, underdevelopment of the
lower half of the body, increased blood pressure in the upper extremities and decreased pressure in the lower ones,
extension of the left heart border, blowing systolic murmur in the interscapular region. ECG shows the horizontal axis
of heart. Radiography reveals left cardiomegaly, costal usuration. What is the most likely diagnosis?
A. Aortarctia
B. Aortic stenosis
C. Patent ductus arteriosus
D. Ventricular septal defect
E. Atrial septal defect
48 A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the
symptoms of chronic tonsillitis, mitral insufficiency, and carious teeth. What is the optimal method of secondary
prophylaxis?
A. Year-round bicillin prophylaxis till the age of 25
B. Course of cardiotrophic drugs twice a year
C. Year-round bicillin prophylaxis for 3 years
D. Tonsillectomy
E. Oral cavity sanitation
49 What is the most common etiology of pediatric cardiac arrest?
A. Respiratory
B. Cardiacc
C. CNS
D. Metabolic
E. Renal
50 When assessing a pediatric patient in cardiorespiratory arrest, the primary surveyinvolves ABCDE (airway,
breathing, circulation, disability, and exposure). Which of thefollowing components of the primary survey is
contraindicated in children?
A. Blind finger sweepd
B. Head-tilt chin-lift
C. Jaw-thrust maneuver
D. Using heart rate to assess intravascular volume status
E. Using capillary refill to assess adequate circulation
51 Newborn cyanosis is most likely due to cardiac, pulmonary, neurologic, or hematologic disorders. It is clinically
evident when absolute concentrations of deoxygenated hemoglobin rise above:
A. 3g/dL
B. 1g/dL
C. 2g/dL
D. 4g/dL
E. 5g/Dl
52 A 13-year-old girl presents with joint pain lasting for 2-months. She admits to jointstiffness in the morning that
resolves with movement. Her mother says she has beeneating less, fatigues easier, and is irritable. Physical exam
reveals a rash and limited rangeof motion in the affected joints. Which of the following is most likely?
A. Juvenile rheumatoid arthritis (JRA)
B. Polyarteritis nodosa (PAN)
C. Kawasaki disease
D. Systemic lupus erythematosus (SLE)
E. DiGeorge syndrome
53 PAN usually presents with waxing and waning symptoms of painful erythematousskin nodules, purpura,
hypertension, hematuria, and systemic complaints. Henoch-Schönlein purpura is an IgA-mediated vasculitis that peaks
in winter months, is usually preceded by a group A streptococcal upper respiratory infection, and causes nonthrombocytopenic palpable purura. What is the treatment of choice for both of these?
A. Corticosteroid (e.g. prednisone)
B. Non-sedating H1 blockers (e.g. fexofenadine)
8
C. H2 blocker (e.g. famotidine)
D. Sedating H1 blockers (e.g. diphenhydramine)
E. Antibiotic (e.g. amoxicillin)
54 An infant presents with high fever, lymphadenopathy, and mucocutaneous lesions.Physical exam reveals bilateral
conjunctivitis, dry fissured lips, strawberry tongue,indurative edema of the feet, and truncal polymorphous rash.
Kawasaki disease issuspected. What is the treatment of choice for the convalescent phase?
A. Aspirin
B. Acetaminophen
C. Indomethacin
D. Ibuprofen
E. Hydrocortizonum
55 A 5-year-old boy presents with a waddling limp and has had a stiff right hip for the last 2 months. He has minimal
complaints of pain. The most likely diagnosis is:
A. Juvenile idiopathic arthritis
B. Legg-Calve-Perthes disease
C. Slipped capital femoral epiphysis
D. Toddler's fractured
E. Septic arthritis
56A 17-year-old young girl on oral contraceptive therapy for regulation of her menstrual periods presents with a 1week history of left leg pain and swelling. Evaluation with a Doppler ultrasound reveals absence of flow in the left
femoral and popliteal veins. The clot extends proximally to the left external iliac vein. The most important potential
complication that one should be cautious about in this girl is:
A. Venous insufficiency
B. Limb overgrowth
C. Pulmonary embolism
D. Edema
E. Gangrene
57 A 14-year-old girl presents with several weeks of profound fatigue, intermittent low-grade fevers, a facial rash, and
joint pain. The rash recently worsened markedly after sun exposure. On physical examination, she has a malar rash
extending over the bridge of the nose, but sparing the nasolabial folds, painless oral ulcers, and painful limitation of
movement in her wrists and finger joints. On laboratory testing, her WBC is 3,500/mm3,Hgb 9.5 g/dL, platelet count
120,000/mm3. A urinalysis shows 15 to 19 RBC/hpf and an elevated protein of 100 mg/dL. Which of the following
tests will most likely be positive?
A. Antinuclear (ANA) antibody
B. Rheumatoid factor (RF)
C. Anti-double-stranded DNA (dsDNA) antibody
D. Anti-Smith (Sm) antibody
E. Anti-Ro (SS-A) antibody
58 5-year-old boy presents with painful swelling of the hand and feet since the day before. Since earlier today, he has
palpable purpura on the lower extremities, and also developed intermittent, colicky midabdominal pain. Prior to these
events, he had a cold for 1 week. He did not have fevers, and overall is well appearing. On physical examination, he
has normal vital signs. He has palpable purpura on the lower extremities and buttocks. He has scrotal swelling. His
hand and feet are puffy, and he has pain with movement of the ankle joints. His abdominal examination is
unremarkable. A complete blood count shows normal results with a platelet count of 350,000/mm3. Which of the
following laboratory tests is most often abnormal in this disease process?
A. Urinalysise
B. Antinuclear antibody (ANA)
C. Antineutrophil cytoplasmic antibody (ANCA)
D. Complement C3 and C4 levels
E. Serum creatinine
59 The most reliable method of prevention of recurrent episodes of acute rheumatic fever is:
A. An intramuscular injection of benzathine penicillin every 4 weeks
B. Prompt treatment with oral or intramuscular penicillin for 10 days for any signs or symptoms of pharyngitis
9
C. Prompt treatment with oral or intramuscular penicillin for 10 days for any febrile illness
D. Prophylactic penicillin for all dental and surgical procedures as well as for trauma and febrile illnesses
E. Prompt administration of penicillin and corticosteroids for 14 days for any documented infection with group A betahemolytic streptococci
60 Treatment of rheumatic fever may include all of the following except
A. Sulfadiazine
B. Salicylates
C. Bed rest
D. Prednisone
E. ***************
61 A 8-year-old boy has suffered from tonsilitis. In 2 weeks he started complaining of migratory joint pain, edema of
joints, restriction of movements, fever. On examination it was revealed an acute rheumatic heart disease, activity of the
III-rd degree, primary rheumocarditis, polyarthritis; acute course of disease, cardiovascular failure IIA. What
medication is to be prescribed?
A Prednisone
B Cefazolin
C Delagil
D Diprazinum
E Erythromycin
62 A 14-year-old boy has rheumatism. Over the last 2 years he has had 3 rheumatic attacks. What course of
rheumatism does the patient have?
A Prolonged
B Acute
C Subacute
D Latent
E Persistent-reccurent
63 The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure does the child have?
A. Aortal insufficiency
B. Mitral stenosis
C. Aortal stenosis
D. Mitral insufficiency
E. Rheumatism
64 A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea,
cardialgia. There are dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac
borders are extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the
xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein is - 58.6 g/l. In urine: protein 0,025 g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the field of vision. What is the main mechanism of edema
syndrome development:
A Venous congestion of greater circulation
B Venous congestion of lesser circulation
C Peripheral circulation disorder
D Secondary nephropathy development
E Hypoproteinemia
65 An 11-year-old boy complains of general weakness, fever up to 38,2oC, pain and swelling of the knee joints,
feeling of irregular heartbeat. 3 weeks ago, the child had quinsy. Knee joints are swollen, the overlying skin and skin
of the knee region is reddened, local temperature is increased, and movements are limited. Heart sounds are muffled,
extrasystole is present, and auscultation reveals apical systolic murmur that is not conducted to the left inguinal region.
ESR is 38 mm/h. CRP is 2+, antistreptolysin O titre - 400. What is the most likely diagnosis?
A Acute rheumatic fever
B Vegetative dysfunction
C Non-rheumatic carditis
D Juvenile rheumatoid arthritis
E Reactive arthritis
10
66 A 13-year-old boy with hypertrophic cardiomyopathy complains of dyspnea on minimal exertion. EhoCG reveals
asymmetric left ventricular hypertrophy, signs of pulmonary hypertension, dilatation of the left atrium. EF is 64%. The
revealed alterations are indicative of:
A Diastolic heart failure
B Systolic heart failure
C Primary pulmonary hypertension
D Primary arterial hypertension
E Symptomatic arterial hypertension
67 An 8-year-old boy was brought to the admission department by his parents. Parents report that he has had pain in
the right knee for the last 9 months, recently mother has noticed some limitation of motion in his right leg, and
morning stiffness that doesn't last till the evening. What is the most likely diagnosis?
A Juvenile rheumatoid arthritis
B Rheumatism
C Osteomyelitis of the knee joint
D Reactive arthritis
E Traumatic arthritis
68 A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the
symptoms of chronic tonsillitis, mitral insufficiency, and carious teeth. What is the optimal method of secondary
prophylaxis?
A Year-round bicillin prophylaxis till the age of 25
B Course of cardiotrophic drugs twice a year
C Year-round bicillin prophylaxis for 3 years
D Tonsillectomy
E Oral cavity sanitation
69 The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents
with anxiety, acrocyanosis, peripheral edema, and dyspnea. Auscultation of lungs reveals fine moist rales on both sides
mainly in the lower parts. AP- is 65/40 mm Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole).
Liver is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of
examination is most informative for assessing the child's status dynamics?
A Echocardiography
B ECG
C Diuresis monitoring
D Monitoring of K+, Na+ concentration in blood
E 24-hour monitoring of heart rhythm
70 Six months ago, a 5-year-old child was operated for CHD. For the last 3 weeks he has complained of fever, heart
pain, aching muscles and bones. Examination results: "white-coffee" skin color, auscultation revealed systolic murmur
in the region of heart along with a noise in the III-IV intercostal space. Examination of fingertips revealed Janeway
lesions. What is your provisional diagnosis?
A Infectious endocarditis
B Sepsis
C Nonrheumatic carditis
D Acute rheumatic fever
E Typhoid fever
71 A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two
weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
A Streptococcus
B Staphylococcus
C Pneumococcus
D Klebsiella
E Proteus
72 Adenosine triphosphate may be expected to convert which of the following arrhythmias to sinus rhythm?
A. Paroxysmal supraventricular tachycardia
11
B.
C.
D.
E.
Paroxysmal ventricular tachycardia
Atrial fibrillation
Atrial flutter
Ventricular fibrillation
73 A 7-year old boy has periods of loss of attention that last 10-15 seconds and occur several times a day. During
these periods he stands still in one position, doesn’t answer the questions or react when he is called by his name.
Neurological examination revealed no changes. What diagnostic method should be applied to specify his diagnosis?
A. Electroencephalography
B. Skull roentgenogram
C. Computer tomogram
D. Echoencephalography
E. Examination of evoked potentials
74 A 18 y.o. man has a stab knife wound in the left half of thorax close to nipple. AP is 90/60 mm Hg, Ps- 130/min,
BR- 32/min. During inspiration there is increase of pulse wave in the region of jugular vein, decrease of peripheral
arterial pulse and reduction of AP. Respiratory murmurs are unchanged. X-ray pattern of thorax organs has no
pecularities. After introduction of 2 l of isotonic solution the AP stayed low, CVP raised up to 32 cm of water column.
The first step in further treatment of the patient will be:
A. Echocardiogram
B. Catheterization of left pleural cavity while the outer end of catheter is submerged in water
C. Continued parenteral introduction of fliud in order to raise AP
D. Introduction of peripheral vasodilatators in order to reduce CVP
E. Introduction of loop diuretics in order to reduce CVP
75 A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the
treatment tactics in this case?
A. Increased potassium concentration in blood
B. Increased sodium conсentration in blood
C. Reduced magnesium concentration in blood
D. Increased calcium level in blood
E. –
76 A 14 y.o. girl got a bad mark at the lesson of math as well as teacher’s reprimand that made her cry for a long
time. At the end of the lesson she suddenly lost consciousness and fell down. Objectively: skin is of pale pink colour,
Ps- 100 bpm, satisfactory, AP- 110/70 mm Hg. Eyelids are closed and don’t give away to the tries of their opening.
There are no evident injuries. What is the provisional diagnosis?
A. Hysteric syncope
B. Epilepsy
C. Vagotonic syncope
D. Long QT syndrome
E. Sympathicotonic collapse
77 A 15 y.o. patient complains of palpitation, dizziness, noise in ears, feeling of shortage of air. Objectively: pale,
damp skin. Vesicular respiration, respiratory rate- 22 per min, pulse- 200 bpm, AP-100/70 mm Hg. On ECG: heart
rate- 200 bmp, ventricular complexes are widened deformed, location of segments ST and of wave T is discordant.
The wave Р is not changed, superimposes QRST, natural conformity between Р and QRS is not present. What kind of
arrhythmia is present?
A. Paroxismal ventricular tachycardia
B. Sinus tachycardia
C. Atrial flutter
D. Ventricular extrasystole
E. Atrial tachycardia
78 A 14 y.o. child suffers from of vegetovascular dystonia of pubertal period. He has developed sympathoadrenal
crisis. What medicine should be used for crisis reduction?
A. Obsidan
B. No-shpa
C. Amisyl
12
D. Euphyline
E. Corglicone
79 A 10-year-old boy underwent treatment in cardiological department for rheumatism, I acute attack of rheumatic
fever, active phase, II degree. The patient was discharged in satisfactory condition. Which drug should be chosen for
prevention of rheumatism recurrence?
A Bicillinum-5
B Bicillinum-1
C Erythromycin
D Ampicillin
E Oxacillin
80 A child has the sudden stopping of breathing, cyanosis of skin covers, disappearance of pulse on general vessels
and narrowing of pupils. What most optimal primary measures?
A Artificial ventilation of lungs, closed massage of heart
B Intravenous introduction of aminophillinum
C Washing of stomach
D Oxygen
E Intracardiac introduction of adrenalin
81 For a child with a chronic carditis, insufficiency of blood circulation ІІА, which was treatment by digoxin,
increasing of bradicardia, nausea, vomiting, dizziness and violation of sleep was appeared. On ECG: extrasystolia, PQ
- 0,22. What most credible reason of this state?
A Overdose of cardiac glycosides
B pulmonary edema
C hyperkaliemia
D Acute intestinal infection
E hypokaliemia
82 You are called to the delivery room for a routine birth. The infant cries when the cordis cut. You examine the child
under the warmer and notice that when he stops crying, his chest heaves, and he turns blue. You are unable to pass the
NG tube through the nose for suctioning. Which condition is most likely causing this infant's respiratory distress?
A Choanal atresia or stenosis
B Vocal cord paralysis
C Subglottic stenosis
D Recurrent laryngeal nerve damage
E Laryngeal web
83 A 3-month-old infant presents with cyanosis and an echocardiogram reveals that the child has tetralogy of Fallot.
What four associated lesions describe tetralogy of Fallot?
A Ventricular septal defect, over-riding aorta, pulmonary stenosis, right ventricular hypertrophy
B Ventricular septal defect, atrial septal defect, pulmonary stenosis, right ventricular hypertrophy
C Ventricular septal defect, atrial septal defect, aortic stenosis, right ventricular hypertrophy
D Ventricular septal defect, coarctation of the aorta, aortic stenosis, right ventricular hypertrophy
E Ventricular septal defect, mitral valve prolapse, pulmonary stenosis, left ventricular hypertrophy
84 While staying in a stuffy room a 18-year-old emotionally labile girl developed severe weakness, dizziness,
blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is
pale, extremities are cold. AP - 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon
reflexes are present. There are no pathological signs. What is the most likely diagnosis?
A. Syncope
B. Vegetovascular paroxysm
C. Epileptic attack
D. Hysterical neurosis
E. Transient ischemic attack
85 А 14-year-old boy with a history of chronic tonsillitis and sinusitis has developed a feeling of heart irregularities
and additional pulse. HR- 83/min. ECG results: regular impulses with no visible P wave that occur every two sinus
13
contractions, QRS complex is dramatically deformed and prolonged to over 0,11 s, T wave is discordant followed by a
complete compensatory pause. Specify the arrhythmia type:
A. Trigeminal extrasystole
B. Bigeminal extrasystole
C. Partial AV-blockade
D. Complete AV-block
E. Left bundle branch block
86 A 13-year-old girl complains of periodic prickly pain in the heart region. Percussion revealed no changes of
cardiac borders. Auscultation revealed arrhythmic enhanced heart sounds, extrasystole at the 20-25 cardiac impulse.
ECG showed the sinus rhythm, impaired repolarization, single supraventricular extrasystoles at rest. What is the most
likely diagnosis?
A. Somatoform autonomic dysfunction
B. Rheumatism
C. Nonrheumatic carditis
D. Myocardial degeneration
E. Intoxication syndrome
87 An 8-year-old girl was diagnosed with signs of Morgagni-Adams-Stokes disease that developed against the
background of the III degree atrioventricular heart block. What drug should be introduced intravenously for
emergency aid?
A. Atropine
B. Prednisolone
C. Dobutamine
D. Digoxin
E. Potassium chloride
88 ECG revealed the following in a 10-year-old child: sharp acceleration of the heart rate - 240/min., P wave overlaps
with T wave and deforms it, moderate lengthening of PQ interval, QRS complex is without changes. What pathology
does this child have?
A. Paroxysmal atrial tachycardia
B. Atrial hypertrophy
C. Ventricular hypertrophy
D. WPW syndrome
E. Extrasystole
89 A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and cardiomegaly.
Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child most likely has congestive
heart failure caused by:
A. Paroxysmal atrial tachycardia
B. A ventricular septal defect and transposition of the great vessels
C. Atrial flutter and partial atrioventricular block
D. Hypoplastic left heart syndrome
E. A large atrial septal defect and valvular pulmonary stenosis
90 An 8-year-old girl periodically has sudden short-term heart pains, sensation of chest compression, epigastric pain,
dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min., jugular pulse is present. Ps- 185/min.,
of poor volume. BP- 75/40 mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed.
At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
A. Paroxysmal atrial tachycardia
B. Sinus tachycardia
C. Paroxysmal ventricular tachycardia
D. Complete AV-block
E. Atrial fibrillation
91 A previously well 6-month-old infant is brought to the emergency room because of signs of an upper respiratory
infection and because “his heart is beating fast”. Examination reveals an uncomfortable appearing infant with
tachycardia. Temperature is 38,3 C. An ECG shows a very regular heart rate of 280 beats per minute. It is not clear
whether or not P waves are present; the QRS complexes are normal. The infant most likely has:
14
A.
B.
C.
D.
E.
supraventricular tachycardia secondary to congenital structural heart disease
sinus tachycardia secondary to a URI and fever
sinus tachycardia secondary to congenital structural heart disease
Wolff-Parcinson-white syndrome
supraventricular tachycardia secondary to Wolff-Parcinson-white syndrome
92 An ill-appearing 2-week-old girl is brought to the emergency room. She is pale and dyspneic with a respiratory
rate of 80 breath per minute. Heart rate is 195 beats per minute, sounds are distant, and there is a suggestion of a
gallop. There is cardiomegaly by x-ray. An echocardiogram demonstrates poor ventricular function, dilated
ventricular, and dilatation of the left atrium. An electrocardiogram shows ventricular depolarization complexes that
have low voltage. The diagnosis suggested by this clinical picture is:
A. myocarditis
B. endocardial fibroelastosis
C. pericarditis
D. aberrant left coronary artery arising from pulmonary artery
E. glycogen storage disease of the heart
93 A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG: tachycardia
with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication is
to be prescribed to provide first aid?
A. Lydocain
B. Isoptin
C. Seduxen
D. Novocainamides
E. Strophantin
94 An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain,
dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min, jugular pulse is present. Ps- 185 bpm, of
poor volume. AP- 75/40 mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed. At
the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
A. Paroxysmal atrial tachycardia
B. Sinus tachycardia
C. Paroxysmal ventricular tachycardia
D. Complete AV-block
E. Atrial fibrillation
95 You are called to the delivery room to evaluate a newborn. The pregnancy was complicated by maternal lupus.
The infant is pink, vigorous, and in no distress. He has clear breath sounds and is well perfused. His heart rate is 50
beats/min. You obtain an electrocardiogram. Of the following, the MOST likely diagnosis for this infant is
A. third-degree (complete) heart block
B. first-degree heart block
C. second-degree (Wenckebach) heart block
D. atrial fibrillation
E. Wolff-Parkinson-White syndrome
96 Which of the following is a primary treatment option for a pediatric patient in pulseless ventricular tachycardia
or ventricular fibrillation?
A. Defibrillation
B. Cardioversion
C. Amiodarone or procainamide
D. Vagal maneuvers and adenosine
E. Atropine and epinephrine
97 A child presents with a cardiac arrhythmia. The Emergency Department physician putsa bag of ice-cold water on
the child’s face to induce the mammalian diving reflex (vagal maneuver). Which of the following did the patient likely
have?
A. Hemodynamically stable supraventricular tachycardia
B. Hemodynamically stable ventricular tachycardia
C. Hemodynamically unstable ventricular tachycardia or supraventricular tachycardia
15
D. Pulseless ventricular tachycardia or ventricular fibrillation
E. Bradycardia or asystole
98 Which of the following drugs would be useful for multiple ventricular ectopy (PVCs)as well as for refractory
VT/VF to improve the susceptibility for cardioversion?
A. Lidocaine
B. Atropine
C. Bicarbonate
D. Calcium and magnesium
E. Epinephrine
99 A 2-year-old female child presents with VT, severe ventricular dysfunction, hypotension, and metabolic acidosis.
The patient is cardioverted into ventricular fibrillation, which degenerates into asystole. What is the most appropriate
indication for using intravenous epinephrine in this patient?
A. Asystole
B. Ventricular ectopy
C. Severe refractory metabolic acidosis and/or hyperkalemia
D. Bradycardia
E. Supraventricular tachycardia
100 A 2-month-old infant presents to your emergency department with a heart rate of 220 beats/minute, pulses, and
adequate perfusion. After giving the infant oxygen, you note abnormal P waves and a narrow QRS (0.08 sec) on the
cardiac monitor. Which of the following is the best course of action?
A. Administer IV adenosine by rapid bolus
B. Administer IV/IO epinephrine
C. Administer IV calcium chloride
D. Administer IV atropine by rapid bolus
E. Administer IV sodium bicarbonate
101 What is the duration of a normal PR-interval?
A. 0.12 - 0.2 sec
B. 0.04 - 0.08 sec
C. 0.08 -0.12 sec
D. 0.04 - 0.12 sec
E. 0.21-0.4 sec
102 The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents
with anxiety, acrocyanosis, peripheral edemata, dyspnea. Auscultation of lungs reveals fine moist rales on both sides
mainly in the lower parts. AP- 65/40 mm Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole). Liver
is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of examination is
most informative for assessing the child’s status dynamics?
A. Echocardiography
B. ECG
C. Diuresis monitoring
D. Monitoring of K+, Na+ concentration in blood
E. 24-hour monitoring of heart rhythm
103 A 18-year-old patient with Wolff-Parkinson-White syndrome comes to the emergency department because he has
had palpitations and racing heartbeat for the past 12 hours. Temperature is 37.0°C (98.6°F), pulse rate is 140/min,
respirations are 20/min, and blood pressure is 110/60 mmHg. Oxygen saturation is 96% on room air.
Electrocardiography shows atrial fibrillation with a rapid ventricular response of 140/min. Administration of which of
the following medications is most likely to be effective in relieving this patient's symptoms?
A. Amiodarone
B. Adenosine
C. Digoxin
D. Diltiazem
E. Metoprolol
16
104 A 14-year-old girl has fainted during a meeting. The day before she complained of a headache. The skin is pale,
the limbs are cold, shallow breathing, heart sounds are muffled; heart rate is 51/min.; BP is 90/50 mm Hg. The
abdomen is soft. Meningeal symptoms are negative. Make the provisional diagnosis:
A. Collapse
B. Unconsciousness
C. Acute left ventricular failure
D. Acute right ventricular failure
E. Respiratory failure
105 This ECG rhythm is called:
A.
B.
C.
D.
E.
Supraventricular tachycardia
Junctional tachycardia
Sinus tachycardia
Atrial fibrillation with fast ventricular response
Ventricular tachycardia
106 The girl of 11 y.o. She is ill for 1 month. She has «butterfly» type rash on face (spots and papules), pain and
swelling of small joints on arms and legs, signs of stomatitis (small-sized ulcers in mouth). CBC: Нb– 80 g/L, RBC–
2, 9 ∗ 1012/L, WBC– 15 ∗ 109/L, ESR- 40 mm/hour. Urinalysis: protein– 0,33 g/L. What is the most probable
diagnosis?
A. Systemic lupus erythematosus
B. Juvenile rheumatoid arthritis, systemic type
C. Periarteriitis nodosa
D. Acute rheumatic fever
E. Dermatomyositis
107 A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39, 50C.He had a
respiratory disease 1,5 week ago. On examination: temperature- 38, 50C, swollen knee and ankle joints, pulse- 106
bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical murmur.
What indicator is connected with possible etiology of the process?
A. Antistreptolysine-0
B. 1-antitrypsine
C. Creatinkinase
D. Rheumatic factor
E. Seromucoid
108 A 7 y.o. child had elevation of temperature to 40C in anamnesis. For the last 3 months he presents fusiform
swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal
column. What is the most probable diagnosis?
A. Juvenile rheumatic arthritis
B. Rheumatism
C. Toxic synovitis
D. Septic arthritis
E. Osteoarthrits
109 A female rheumatic patient experiences diastolic thoracic wall tremor (diastolic thrill), accentuated S1 at apex,
there is diastolic murmur with presystolic intensification, opening snap, S2 accent at pulmonary artery. What rind of
heart disorder is observed?
A. Mitral stenosis
B. Aortic valve insufficiency
C. Pulmonary artery stenosis
D. Mitral valve insufficiency
17
E. Opened arterial duct
110 A 13 year old girl was admitted to the cardiological department because of pain in the muscles and joints.
Examination of her face revealed an edematic erythema in form of butterfly in the region of nose bridge and
cheeks.What is the most probable diagnosis?
A. Systemic lupus erythematosus
B. Rheumatism
C. Dermatomyositis
D. Rheumatoid arthritis
E. Periarteritis nodosa
111 A 14 year old patient complains of chest pain, temperature up to 38, 5C, breathlessness. He had acute tonsillitis 2
weeks ago. He is in grave condition. The skin is pale. Heart borders are dilated, heart sounds are quiet. Above total
heart area you can hear pericardiumfriction sound. Electrocardiogram: the descent of QRS voltage, the inversion T.
The liver is enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 - 1260, C-reactive protein +++. Your diagnosis:
A. Rheumatic pancarditis
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
112 A patient, aged 49, complains of fever of 37, 5C, heart pain, dyspnea. S1 is clapping; S2 is accentuated in the
aortic area; opening snap, presystolic murmur can be auscultated. What is the most efficient examination for valvular
disorder assessment?
A. Echocardiography+Doppler-Echocardiography
B. Phonocardiography
C. Ballistocardiogram
D. Chest X-ray
E. ECG
113 A 14 y.o. girl complains of weakness, fatigue, fever up to 38C, rash on the face skin, pain in the wrists and the
elbows. On physical examination: erythematous rash on the cheeks with "butterfly"look, the wrists and elbow joints
are involved symmetrically, swollen, sensitive, friction rub over the lungs, the heart sounds are weak, regular, HR88/min, BP- 160/95 mm Hg. Hematology shows anemia, leucopenia, lymphopenia; on urinalysis: proteinuria,
leukocyturia, casts. What is the main mechanism of disease development?
A. Production of antibodies to doublestranded DNA
B. Production of myocytes antibodies
C. Production of antibodies to endothelial cells
D. Production of myosin antibodies
E. Production of antimitochondrial antibodies
114 A 14-year-old patient after vacation has developed severe pain in her elbow joints, dyspnea and weakness. Body
temperature is 37,6C, skin pallor and erythema on the cheeks and bridge of nose are observed, lip mucosa is ulcerated.
The joints are not visibly deformed, movement of the
115 right elbow joint is restricted. Pleura friction sound is detected in the lungs on the right side below the angle of
scapula. Heart sounds are dull, tachycardia, gallop rhythm, heart rate - 114/min, BP - 100/60 mm Hg. The most likely
diagnosis is:
A. Systemic lupus erythematosus
B. Rheumatic carditis
C. Rheumatoid arthritis
D. Infectious allergic myocarditis
E. Dry pleurisy
116 An 11-year-old boy complains of general weakness, fever up to 38,2C, pain and swelling of the knee joints,
sensation of irregular heartbeat. 3 weeks ago, the child had a case of tonsillitis. Knee joints are swollen, the overlying
skin and skin of the knee region is reddened, local temperature is increased, movements are limited. Heart sounds are
muffled, extrasystole is present, auscultation reveals apical systolic murmur that is not conducted to the left inguinal
region. ESR is 38 mm/hour. CRP is 2+, antistreptolysin O titre - 400.What is the most likely diagnosis?
A. Acute rheumatic fever
18
B.
C.
D.
E.
Vegetative dysfunction
Non-rheumatic carditis
Juvenile rheumatoid arthritis
Reactive arthritis
117 An 8-year-old boy developed a temperature of 37,5C two days after his recovery from the case of URTI. He
complains of suffocation, heart pain. Objectively: the skin is pale, tachycardia, the I heart sound is weakened, short
systolyc murmur in the 4th intercostal area near the left edge of the breastbone. What heart disorder such clincal
presentation is characteristic of?
A. Nonrheumatic myocarditis
B. Primary rheumatic carditis
C. Myocardiodystrophy
D. Fallot’s tetrad
E. Cardiomyopathy
118 А 19 y.o. girl admitted to the hospital complained of pain in the knee and fever of 38,6C. She is ill for 2 weeks
after acute tonsillitis. On exam, hyperemia and swelling of both knees, temperature is 37,4C, HR- 94/min, BP- 120/80
mm Hg, and heart border is displaced to the left; S1 is weak, systolic murmur is present. Total blood count shows the
following: Hb- 120 g/L, WBC- 9, 8 · 109/L, ESR of 30 mm/L. ECG findings: the rhythm is regular, PQ = 0,24 sec.
What is a causative agent of the disease?
A. Beta-hemolytic streptococci
B. Viral-bacterial association
C. Autoimmune disorder
D. Staphylococci
E. Ricchetsia
119 A 16 y.o. patient has been suffering from systematic scleroderma for 7 years. She was repeatedly exposed to
treatment in the in-patient department. Complains of periodical dull cardiac pain, dyspnea, headache, eyelid edemata,
weight loss, pain and deformation of extremities joints. What organ’s lesion deteriorates the prognosis for the disease?
A. Kidneys
B. Heart
C. Lungs
D. Gastrointestinal tract
E. Skin and joints
120 А 13 y.o. girl complains of having temperature rises up to febrile figures for a month, joint ache, periodical skin
rash. Examination revealed steady enhancing of ESR, LE-cells. What is the most probable diagnosis?
A. Systematic lupus erythematosus
B. Juvenile rheumatoid arthritis
C. Systematic scleroderma
D. Acute lymphoblast leukosis
E. Rheumatics
121 А 10 y.o. boy was ill with angina 2 weeks ago, has complaints of joint pain and stiffness of his left knee and right
elbow. There was fever (38,5) and ankle disfunction, enlargement of cardiac dullness by 2 cm, tachycardia, weakness
of the 1st sound, gallop rhythm, weak systolic murmur near apex. What diagnosis corresponds with such symptoms?
A. Acute rheumatic fever
B. Systemic lupus erythematosis
C. Juvenile rheumatoid arthritis
D. Reiter’s disease
E. Reactive arthritis
122 The arthritis of acute rheumatic fever usually:
A. is seen only in patients with concurrent carditis
B. is monarticular
C. heals without deformity
D. appears after the fever subsides
E. polyarticular
19
123 A 10-year-old child with muscle weakness, an erythematous, scaly rash on the face, arms and hands, and
heliotrope patches on the eyelids most likely has:
A. dermatomyositis
B. eczema
C. Henoch-Schonlein purpura
D. juvenile rheumatoid arthritis
E. trichinosis
124 The most reliable method of prevention of recurrent episodes of acute rheumatic fever is:
A. an intramuscular injection of benzathine penicillin every 4 weeks
B. prophylactic penicillin for all dental and surgical procedures as well as for trauma and febrile illnesses
C. prompt treatment with oral or intramuscular penicillin for 10 days for any signs or symptoms of pharyngitis
D. prompt treatment with oral or intramuscular penicillin for 10 days for any febrile illness
E. prompt administration of penicillin and corticosteroids for 14 days for any documented infection with group A
beta-hemolytic streptococci
125 The prognosis in children with systemic lupus erythematosus is LEAST favorable in those with:
A. nephritis
B. fever and leukocytosis
C. anti-DNA antibodies
D. polyserositis
E. seizures
126 A continuous “machinery” murmur is heart in which of the following?
A Patent ductus
B Atrial septal defect
C Tetrology of Fallot
D Coarctation of the aorta
E Ventricular septal defect
127 A boy of 3 years old is discharge from the cardiology department of hospital, where he was on treatment with the
frequent attacks of shortness of breath and cyanosys as a result of Fallo’s tetrada. What preparation is it most
expedient to use for the further prophylaxis of this attack?
A Obsidanum
B Curantylum
C Relanium
D Digoxinum
E Cordaronum
128 Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed
transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur to the left of the breastbone
in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital
cardiac pathology can be suspected?
A Defect of interventricular septum
B Defect of interatrial septum
C Coarctation of aorta
D Fallot's tetrad
E Pulmonary artery stenosis
129 A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child presents with dyspnea,
cardialgia. There are dense, nonmobile edemata on the lower extremities and sacrum. Ps- 120/min. The cardiac
borders are extended transversely. Heart sounds are muffled, there is blowing systolic murmur at the apex and over the
xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein - 58.6 g/l. In urine: protein 0,025 g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the field of vision. What is the main mechanism of edema
syndrome development:
A Venous congestion of greater circulation
B Venous congestion of lesser circulation
C Peripheral circulation disorder
D Secondary nephropathy development
20
E
Hypoproteinemia
130 A child with tetralogy of Fallo is most likely to exhibit:
A Increased pressure in the right ventricle
B Increased pulmonary blood flow
C Increased pulse pressure
D Normal pressure gradient across the pulmonary valve
E Normal oxygen tension in the left ventricle
131 For a child 13 years combined vice of mitral valve with predominance of insufficiency. In time of acute
respiratory viral infection a shortness of breath, general weakness was increased, dry cough and sense of constraint
appeared in a breast. In lungs hearkened to the different moist wheezes. Hepar was at the edge of costal arc. What
urgent state did develop for the child?
A Acute left ventricular heart failure
B Acute right ventricular heart failure
C Acute total heart failure
D Chronic left ventricular insufficiency
E Acute vascular insufficiency
132 A 8-year-old boy has suffered from tonsilitis. In 2 weeks he started complaining of migratory joint pain, edema of
joints, restriction of movements, fever. During examination was revealed an acute rheumatic heart disease, activity of
the III-rd degree, primary rheumocarditis, polyarthritis; acute course of disease, cardiovascular failure IIA. What
medication is to be prescribed?
A Prednisone
B Cefazolin
C Delagil
D Diprazinum
E Erythromycin
133 After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What
complementary instrumental method of examination should be applied for the diagnosis confirmation?
A Echocardiography
B Roentgenography of chest
C Phonocardiography
D ECG
E Veloergometry
134 A 7 y.o. child had elevation of temperature to 40ºC in anamnesis. For the last 3 months he presents fusiform
swelling of fingers, ankle joints and knee joint, pain in the upper part of the sternum and cervical part of the spinal
column. What is the most probable diagnosis?
A Juvenile rheumatic arthritis
B Rheumatism
C Toxic synovitis
D Septic arthritis
E Osteoarthritis
135 An 8 year old girl complains about joint pain, temperature rise up to 38ºC, and dyspnea. Objectively: the left
cardiac border is deviated by 2,5 cm to the left, tachycardia, systolic murmur on the apex and in the V point are
present. Blood count: leukocytes - 20,0*109/l, ESR - 18 mm/h. What sign gives the most substantial proof for
rheumatism diagnosis?
A Carditis
B Arthralgia
C Leukocytosis
D Fever
E Accelerated ESR
136 A 13 y.o. girl complains of having temperature rises up to febrile figures for a month, joint ache, periodical skin
rash. Examination revealed steady enhancing of ESR, LE-cells. What is the most probable diagnosis?
A Systematic lupus erythematosus
21
B
C
D
E
Juvenile rheumatoid arthritis
Systematic scleroderma
Acute lymphoblast leukosis
Rheumatics
137 A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two
weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
A Streptococcus
B Staphylococcus
C Pneumococcus
D Klebsiella
E Proteus
138 Six months ago, a 5-year-old child was operated for CHD. For the last 3 weeks he has complained of fever, heart
pain, aching muscles and bones. Examination results: "white-coffee" skin color, auscultation revealed systolic murmur
in the region of heart along with a noise in the III-IV intercostal space. Examination of fingertips revealed Janeway
lesions. What is your provisional diagnosis?
A Infectious endocarditis
B Sepsis
C Nonrheumatic carditis
D Acute rheumatic fever
E Typhoid fever
139 The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly deteriorated: he presents
with anxiety, acrocyanosis, peripheral edema, and dyspnea. Auscultation of lungs reveals fine moist rales on both sides
mainly in the lower parts. AP is - 65/40 mm Hg. HR - 150/min, heart sounds are muffled, arrhythmic (extrasystole).
Hepar is +4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which method of
examination is most informative for assessing the child's status dynamics?
A Echocardiography
B ECG
C Monitoring of diuresis
D Monitoring of K+, Na+ concentration in blood
E 24-hour monitoring of heart rhythm
22
Module № 3. Diseases of the digestive system in children.
1. A 8 year old girl was hospitalized with complains of weakness, pain in the joints, the appearance of
itchy papular rash. A week later, she noticed the appearance of dark urine. Objectively: yellowness of the
skin and scleras, liver is a +3 cm below the costal arch, elastic consistency, the spleen is not enlarged. The
child was carried out blood transfusions 2 months ago. After examination he was diagnosed with viral
hepatitis B. What is the main link in the pathogenesis of HBV that allows determine the result of
hepatitis?
A. Immunological reactions
B. Metabolic disorders
C. Cholestasis syndrome
D. The toxicity of the virus
E. Treatment duration
2. A 11 years old girl has been suffering from dull pain in the right upper quadrant after a meal, nausea,
feelings of bitterness in the mouth for three months. On examination: pale skin, tongue is dry and coated
white, abdomen is soft, tenderness at the point of gallbladder is observed, positive symptom Kera. Of the
following, the most likely cause of her symptoms is:
A. Chronic cholecystitis
B. Acute cholecystitis
C. Chronic gastritis
D. Chronic pancreatitis
E. Biliary dyskinesia
3. A 6 years old girl complains of attacks acute pain in the right upper quadrant of abdomen mainly after
eating. Painful attacks are short in time and decrease after having a rest or taking antispasmodics drugs.
During an attack of pain palpation of the abdomen is painful, especially at the point of projection of the
gallbladder. What is the most likely preliminary diagnosis?
A. Biliary dyskinesia
B. Chronic cholecystitis
C. Chronic gastroduodenitis
D. Chronic pancreatitis
E. Peptic ulcer of duodenum
4. A 14 years old boy complains of dull aching pain in the right upper quadrant of abdomen, periodically
- nausea, tiredness, headache. She has been suffering from these symptoms approximately six months. On
examination: abdomen palpation reveals slight pain in epigastric area and at the point of projection of the
gallbladder. The liver was protruded below ribs by 2-2.5 cm, painful. Positive Ortner′s and Kera′s
symptoms are observed. A duodenal sounding shows a presence of large numbers of white blood cells in
cystic and hepatic bile portions. What is the most likely diagnosis according to clinical signs?
A. Chronic cholecystocholangitis
B. Chronic hepatitis
C. Atresia of biliary tract
D. Chronic gastritis
E. Chronic pancreatitis
5. A 4 years old boy was admitted to the infectious department. An examination of the child revealed
jaundice, enlarged liver and spleen, and slight elevation of liver parameters and he was diagnosed with a
mild form of hepatitis A. What is the main treatment in this case?
A. Follow the regime and diet
B. Appointment of hepatoprotectors
C. Appointment of antiviral drugs
1
D. Appointment of antibiotics
E. Hormone therapy
6. A 9-year-old boy complains of intensive dull pain in the epigastric region after meals, nausea, bloating,
poor appetite, frequent bowel movements up to 3-4 times a day, glossy stool with undigested food rests
and weight loss. He has been suffering from this condition about 2 years. Objectively: tongue is moist
with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region
and Мауо-Robson’s point. What is the most likely diagnosis?
A. Chronic pancreatitis
B. Chronic gastritis
C. Functional dyspepsia
D. Gastroesophageal reflux disease
E. Chronic cholecystitis
7. A 4 years old child complains of pain in the abdominal pain, nausea, single vomiting, weakness and
loss of appetite during last four days. It is known that child attends a kindergarten, where 3 cases of
hepatitis A have been reported in the past three weeks. What method of examination is necessary to
conduct to confirm the diagnosis of viral hepatitis A in this case?
A. Determine the level of activity of ALT, Anti HAV-Ig M
B. Determine the level of activity of alkaline phosphatase, Anti HAV-Ig G
C. Determine the level of activity Anti HAV-Ig M, Anti HB cor-Ig M
D. Determine the level of activity of ALT, HBs Ag
E. Determine HBs Ag, Anti HAV-Ig G
8. A 12 years old patient was admitted to the surgical department after a fight at school with complaints
of recurrent vomiting and acute abdominal pain irradiating to the spine. On laparocentesis hemmorhagic
fluid is obtained. What disease should be suspected?
A. Acute pancreatitis
B. Renal colic
C. Acute enterocolitis
D. Splenic rupture
E. Esophageal bleeding
9. A10 years old boy complains of nausea, weakness, skin itching, jaundice, bone pains. Objectively: the
skin is hyperpigmentated, the liver is +5 cm below the costal arch, hard with acute edge. The blood
analysis revealed total bilirubin 185 mkmol/L, direct – 98 mkmol/L, AST – 1,9 mmol/L per hour, ALT–
2,1 mmol/L, alkaline phosphotase – 4,8 mmol/L per hour, cholesterol – 8,4 mmol/L, antimitochondrial
antibodies M2 in a high titer. What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Chronic viral hepatitis C
C. Acute viral hepatitis A
D. Chronic viral hepatitis B
E. Acute viral hepatitis B
10. A 14 years old girl complains of intensive girdle pain in the abdomen, profuse non-formed stool 3 - 4
times a day, loss of weight for 6 kg for last 2 months. It is known that she has taken fatty and fried foods,
chips and cola regularly for last year. On examination: abdomen is soft, painless. Blood amylase – 30
U/L. Feces examination – neutral fat 15 g per day with starch grains is observed. What is the most
reasonable treatment at this stage?
A. Creon
B. Ranitidine
C. Omeprazole
2
D. Levomicytine
E. Imodium
11. A 7-year-old girl is diagnosed with chronic viral hepatitis B. During the examination the high activity
of the process was revealed. Total bilirubin – 96 mumol/L, direct – 34 mumol/L, indirect – 62 mumol/L.
АSТ - 6,1 mmol/L, АLТ - 4,2 mmol/L. What mechanism forms the transaminase level increase of this
patient?
A. Cytolysis of hepatocytes
B. Intrahepatic cholestasis
C. Failure of bilirubin conjugation
D. Autoimmune aggression
E. Extrahepatic cholestasis
12. A 4 year-old boy was admitted to the hospital with complaints of repeated vomiting with bright red
blood that developed an hour ago. The child is pale, pulse – 118 b/min and blood pressure is 80/40 mm
Hg. The liver edge is firm and palpable approximately 4 cm below the right costal margin. The spleen is
palpable about 5 cm below the left costal margin. Past medical history is pertinent for enlarged kidneys
that were palpated initially at 1 year of age. At that time, computed tomography showed enlarged kidneys
that contained many cysts. Of the following, the most likely underlying cause of the bleeding is:
A. Alpha-1-antitrypsin deficiency
B. Peptic ulcer disease
C. Tumor of the esophagus
D. Biliary atresia
E. Cavernous transformation of the portal vein
13. A 15-year-old boy was admitted to the hospital with complains of dizziness, palpitations, moving
black specks seen before the eyes, general weakness. From the history it is known that he has previously
untreated hepatitis B which developed in decompensated liver cirrhosis. Objectively: the patient is very
pale, Ps- 124/min, AP- 75/35 mm Hg. What complication is most likely to have occurred in the patient?
A. Bleeding from esophageal varices
B. Hepatocellular insufficiency
C. Hepatic encephalopathy
D. Cancer of the liver
E. Infectious-toxic shock
14. A 10-y.o. patient complains of acute pain in the right upper quadrant of the abdomen irradiating to the
right supraclavicular region, bitter taste in the mouth, generalized weakness. Objectively: skin and sclerae
are icteric; there is tension and tenderness in the right hypochondrium on palpation. Body temperature is
39,4oC. Blood test results: WBC – 14,2 * 109/l, total bilirubin –84 mmol/l (conjugated - 46 mmol/l,
unconjugated – 38 mmol/l). What is the most likely diagnosis?
A. Acute cholangitis
B. Acute pancreatitis
C. Acute appendicitis
D. Acute viral hepatitis B
E. Liver cirrhosis
15. A 7-year-old girl has been suffering from body temperature increase up to 37.6oC, weakness, poor
appetite, nausea, a recurrent vomiting for 2 days. On the 5-th day the temperature is normal, the general
condition is better, but the jaundice has developed. Objectively: moderate ictericity of skin, liver is a +4
cm below the costal arch, elastic consistency. Ortner’s, Kehr’s and Voznesensky’s symptoms are
negative. What test will help to verify the diagnosis?
A. IgM anti-HAV detection
3
B.
C.
D.
E.
Complete blood count
Ultrasound of the abdomen
Total bilirubin
AST and ALT activity
16. A 10-year-old boy with acute viral hepatitis C has been taking inpatient treatment for the last 6
months, despite the absence of complaints and clinical signs of the disease. However, one of the
following laboratory parameters indicates the presence of chronic persistent hepatitis. Select this
indicator:
A. Significant increase in AST and ALT
B. Increased AST on the background of the normal ALT
C. Increased ALT against a background of normal AST
D. Significant reduction of thymol test
E. Increase in total protein
17. A 10 year old girl complaints of acute pain in the epigastric region and right upper quadrant of
abdomen, nausea, single vomiting, general weakness, a low-grade fever. On examination: palpation of
the abdomen revealed resistance of the muscles in the right upper quadrant, positive symptoms Kera,
Ortner, Murphy. What is the most likely preliminary diagnosis?
A. Acute cholecystitis
B. Acute appendicitis
C. Gilbert’s syndrome
D. Biliary atresia
E. Acute pancreatitis
18. A 9-year-old boy has been suffering from body temperature increase up to 37,8oC, weakness, poor
appetite, nausea, repeated vomiting for 4 days. On the 5-th day of the disease the temperature is normal,
the general condition is better, but the jaundice has developed. The light feces and dark urine is observed.
Objectively: liver is a +4.5 cm below the costal arch, elastic consistency, painful on palpation. What is the
most likely diagnosis?
A. Viral hepatitis A
B. Infectious mononucleosis
C. Acute leukemia
D. Leptospirosis
E. Opisthorchiasis
19. A 12 years old child has been suffering from temperature rise to 38 ˚C, pain in the abdomen, single
vomiting and loss of appetite, during three days. On the fourth jaundice of skin and sclera was developed.
On examination: abdomen palpation reveals slight pain in the right upper quadrant, the liver +2 cm below
the costal arch, elastic consistency. In the blood: general bilirubin –72.0 mmol/l, direct – 52.0 mmol/l,
indirect – 20.0 mmol/l, ALT – 1.8 mmol/l. What is the pathogenesis of hyperbilirubinemia in this case?
A. Violation of excretion of bilirubin
B. Violation of bilirubin synthesis
C. Violation of seizure of bilirubin
D. Violation of conjugation of bilirubin
E. Hemolysis of erythrocytes
20. A 12-year-old child was admitted to the hospital with complains of bleeding from the nose, itching
and scratching of skin, loss of appetite, jaundice, «liver smell» from the mouth for the last three months.
From the history it is known that he underwent viral hepatitis C 6 years ago. The child did not receive any
treatment for the last two years. Objectively: the boy is sleepy, periodically excited, there is "capillary
sprocket" on the skin. What complication of chronic hepatitis in a child?
4
A.
B.
C.
D.
E.
Liver failure
Cirrhosis of the liver
Toxic liver disease
Cancer of the head of pancreas
Relapse of viral hepatitis
21. A 8 years old boy complains of nausea, diarrhea, up to 3 times a day, loss of appetite, weakness,
headache, pain in the joints. The first signs of the disease in the form of dyspeptic syndrome appeared two
months ago after adenoidectomy. On examination: yellowing of the skin and sclera, abdomen palpation
reveals slight pain in the right upper quadrant, the liver is +3.5 cm below the costal arch, the spleen is
protruded below ribs by 2 cm. What is the most likely preliminary diagnosis?
A. Viral Hepatitis B
B. Viral hepatitis A
C. Autoimmune Hepatitis
D. Cytomegalovirus infection
E. Infectious mononucleosis
22. A 5 years old boy has been suffering from viral hepatitis C with severe course for three years. The
child's condition became worse after the diet violations: vomiting and abdominal pain appeared, jaundice
increased. Objectively: disturbed consciousness, skin and mucous membrane are dry and icteric, sweet
smell from the mouth. Breathing is shallow and frequent, heart tones are deaf, tachycardia. The abdomen
is enlarged, the liver is +4 cm below the costal arch. What complication has arisen in a child?
A. Hepatic coma
B. Metabolic acidosis
C. Acute hepatic cytolysis
D. Cirrhosis of the liver
E. Toxic liver disease
23. A 10 years old girl was admitted to emergency department with complaints of acute abdominal pain
with radiating to the back, repeated vomiting with a bilious contents. On palpation of the abdomen the
pain is localized in the epigastrium, Desjardins’ point and Chauffard’s triangle is determined. The
diastase rate in the urine is 2100 Un/L. What is the most likely diagnosis?
A. Acute pancreatitis
B. Acute appendicitis
C. Erosive gastritis
D. Acute cholecystitis
E. Biliary colic
24. A 14 years old child complains of dull non-spastic pain in epigastric area most often after meals,
frequent nausea, pasty stools with pieces of undigested food, weight loss to 7 kg for the last two months,
lack of appetite. He has been suffering from these symptoms for two years. Objectively: pale and dry
skin, tongue is wet with brown coating. Abdomen palpation reveals slight pain in epigastric area,
Gubergrits zone and Mayo-Robson’s point. Of the following, the most likely cause of her symptoms is:
A. Exocrine pancreatic insufficiency
B. Disorders of the biliary system
C. Violation intestinal motility
D. Gastroesophageal reflux disease
E. Inflammation of the stomach mucosa
25. A 12 year old boy complains of dull pain in the abdomen and right subcostal area, nausea, and loss of
appetite and weakness. The patient has been suffering from these symptoms for three months.
Objectively: skin and mucous membrane are icteric, abdomen is soft, painless. The blood analysis
5
revealed total bilirubin 65 mkmol/L, direct – 18 mkmol/L, indirect – 47 mkmol/L, AST – 0,45 mmol/L,
ALT– 0,68 mmol/L. It is known from the history that the boy's father also has elevated bilirubin in his
blood. What is the most likely preliminary diagnosis?
A. Gilbert's disease
B. Chronic viral hepatitis
C. Calculous cholecystitis
D. Biliary dyskinesia
E. Acute viral hepatitis
26. A 12-year-old girl complains of abdominal discomfort of six month’s duration. The discomfort is
located in the right, left, and mid-upper abdomen and there is no association of the pain with activity,
position, meals or the act of defecation. The abdominal discomfort occurs more commonly at night. The
pain may last as long as 3-6 hours. Bowel movements occur once a day and are not related to pain. What
is the most likely diagnosis?
A. Chronic non-ulcer colitis
B. Functional dyspepsia
C. Crohn's disease
D. Irritable Bowel Syndrome
E. Chronic pancreatitis
27. A 10-year old patient has a spastic pain in the abdomen, frequent bowel movements to 4-6 times a day
with liquid or mushy feces without visible blood impurities, sometimes with the presence of mucus.
Usually these symptoms occur after the psycho-emotional stress and abdominal pain decreases after the
act of defecation. Objectively: normal body weight, there is mild pain on palpation of the sigmoid colon.
Hb – 122 g/l, WBC – 6,4х109/l, ESR- 7 mm/h. In proctosigmoidoscopy: colon mucosa is not changed, in
the lumen there is a lot of mucus. What is the most likely diagnosis?
A. Irritable bowel syndrome
B. Non-specific ulcerative colitis
C. Helminth infestation
D. Acute bowel ischemia
E. Chronic non-ulcer colitis
28. A 12-year-old boy has been suffering from abdominal pain for the last year. The pain usually is
located in the right and left lower part of abdomen and umbilical region and there is no connection of the
pain with activity, position and meals. Pain occurs more commonly during the day, the child's sleep is not
disturbed. He often experiences nausea when he has the pain and vomits at least once a week. Bowel
movements occur 3-6 times a day during an exacerbation, feces are liquid and sometimes with mucus.
After the examination the diagnosis of Irritable Bowel Syndrome is confirmed. What is the most
appropriate therapy in this case?
A. Antispasmodics drugs, sedatives, sorbents
B. Enzymes, sedatives, prokinetics
C. Painkillers, enzymes, antibiotics
D. Antispasmodics drugs, sedatives, antibiotics
E. Sorbents, prokinetics, enzymes
29. A 9-year-old girl presents with a history of abdominal discomfort which is located in the right and left
lower part of abdomen and umbilical region. There is no connection of the pain with activity, position and
meals. Abdominal pains aggravate by excitement and decrease after defecation. Pain occurs more
commonly during the day, the child's sleep is not disturbed. Bowel movements occur 6-8 times a day
during an exacerbation, feces are liquid and sometimes with mucus. What is the most likely diagnosis?
A. Irritable Bowel Syndrome
B. Chronic non-ulcer colitis
6
C. Worm infestation
D. Chronic pancreatitis
E. Nonspecific ulcerative colitis
30. A mother of a 2-year-old child has been noting the presence of mucus and blood in his feces during
last month. A liquid stool 4-6 times per day is observed. The general condition of the child is not
disturbed. Body temperature is normal. Normal appetite, he has not put off weight. Objectively: abdomen
is soft, a little bit painful in the left iliac region on palpation. What diagnostic method should be
conducted to confirm the diagnosis?
A. Endoscopic examinations
B. Ultrasound of abdomen
C. Bacteriological examination of feces
D. X-ray of the intestine
E. Biochemistry of blood
31. A 6-month-old childʼs mother has noted such symptoms as diarrhea in a large volume, stearrhea and
loss of body weight in her sun. These symptoms appeared about 2 months ago, after the addition of
semolina in complementary foods. An objective examination of the child revealed an increased abdomen,
and hepatomegaly. What is the most probable diagnosis?
A. Celiac disease
B. Functional dyspepsia
C. Lactase deficiency
D. Pyloristenosis
E. Allergic to cow's milk protein
32. A 3-month-old girl was hospitalized to a child's surgical department 3 hours after the first attack of
anxiety. The attacks happen every 5-7 minutes and last for 2-3 minutes, vomiting occurred once.
According to the parents the child had not the act of defecation yesterday. Objectively: the child’s
condition is grave. Abdomen is soft, and palpation reveals a tumour-like formation in the right iliac area.
After rectal examination the doctor’s finger was stained with blood. What is the most probable diagnosis?
A. Ileocecal invagination
B. Gastrointestinal haemorrhage
C. Wilm’s tumour
D. Tumor of the rectum
E. Ulcerative colitis
33. A 4-month-old child is presented with complains of diarrhea with a pungent fetid smell. These
symptoms appeared since the end of the first month of her life. Although the child has a good appetite,
she has stopped to add in weight. The child is exhausted, underweight body is 26%. Bacteriological
examination of feces for intestinal infection is not confirmed. Coprogram: neutral fat ++++. Specify a
presumptive diagnosis?
A. Cystic fibrosis
B. Celiac disease
C. Disaccharidase deficiency
D. Chronic pancreatitis
E. Malabsorption syndrome
34. A 2-years-old child is presented with complains of weight loss, abdominal enlargement, frequent
foamy fetid feces with a greasy luster. These symptoms have lasted for over 6 months. Treatment with
enzymes, probiotics had no effect. Additional tests revealed: steatorrhea with a predominance of fatty
acids, decreased excretion of D-xylose in urine, increased titers of antibodies to gluten, the horizontal
7
fluid levels in the
information?
A.
B.
C.
D.
E.
intestine on the X-ray studies. What diagnostic method will give maximum diagnostic
Biopsy of the small intestine mucosa
Colonoscopy
Ultrasonography of the abdomen
General blood analysis
Diastasis of urine
35. A mother of a 3-year-old child has been noting the presence of mucus and blood in large amount in
his feces during last two months. A liquid stool 3-6 times per day is observed. The general condition of
the child is not disturbed. Body temperature is normal. Rektoronomanoskopi revealed single slight ulcers
and erosions, coated with fibrin on colon mucosa. What is the most likely diagnosis?
A. Nonspecific ulcerative colitis
B. Acute dysentery
C. Campylobacteriosis
D. Crohn's disease
E. Irritable Bowel Syndrome
36. A 12 year-old boy complains of acute abdominal pain, vomiting with an admixture of bile, lack of
defecation. This condition developed suddenly 2 hours ago. From the anamnesis it is known that boy has
been suffering from ulcerative colitis for 7 years. On the X-ray of the abdominal cavity a significant
extension the intestinal area is observed. What complication of the disease caused this condition?
A. Toxic dilation of the colon
B. Intestinal bleeding
C. Intestinal polyposis
D. Hirschsprung's disease
E. Tumor of the large intestine
37. A 3-year-old boy has been suffering from diarrhea, loss of body weight, recurrent broncho-pulmonary
infection for last year. In the blood: erythrocytes - 3.4 * 1012/l, leukocytes - 3.6 * 109/l, platelets – 98 *
1012/l. In koprograme - ++++ neutral fat, soaps ++. What medication should be appointed as the etiotropic
therapy of this disease?
A. Creon
B. Nifuroxazide
C. Allohol
D. Pancreatin
E. Enterol
38. A 11-year-old girl complaints of diarrhea to 3-6 times a day mixed with blood in the stool, acute
cramping pain in the left abdomen, low-grade fever, loss of appetite. Objectively: pale skin, retarded body
weight. Abdomen is soft, palpation reveals a painfulness of the left parts of the colon. In blood: Hp-86
g/L, erythrocyte sedimentation rate – 48 mm/h. After an examination the patient was diagnosed with
ulcerative colitis. What therapy is recommended in this case?
A. 5-ASA drugs
B. Cytostatics
C. Enzymes
D. Sorbents
E. Corticosteroids
39. A 7-month-old boy is is presented with complains of liquid stool 6-8 times per day. He developed this
condition (bowel dysfunction) after receiving antibiotics for treatment pyelonephritis two months ago.
Which of additional studies is the most important to substantiate the diagnosis?
8
A.
B.
C.
D.
E.
Analysis of feces on dysbiosis
Blood biochemistry
Coprogram
Feces for the presence of eggs of worms
Clinical analysis of blood
40. A 9-year-old girl complaints of abdominal pain, especially during the act of defecation, presence of
fresh blood in the stool. These symptoms appeared two months weeks ago after recovering from a viral
infection. A fibrocolonoscopy found the ulcer-necrotic changes in the mucosa of the large intestine. An
investigation of biopsy sample showed submucosal vascular sclerosis. Specify the basic mechanism of the
pathological process:
A. Autoimmune aggression
B. Food allergy
C. Pseudomembranous colitis
D. Viral inflammation
E. Intestinal infection
41. A 11-year-old girl was admitted to a hospital with complains of pain in the abdomen, refusal of food,
liquid stool up to 8-12 times a day mixed with blood, mucus and pus. A sigmoidoscopy revealed
hyperemia of mucosa with contact bleeding. What is the most probable diagnosis?
A. Ulcerative hemorrhagic colitis
B. Intestinal dysbiosis
C. Polyposis of the intestine
D. Malabsorption syndrome
E. Lymphogranulomatosis
42. A 9-year-old boy complains of spastic pain in the abdomen after the psycho-emotional stress, frequent
bowel movements to 4-6 times a day with liquid or mushy feces without visible blood impurities.
Objectively: normal body weight, there is moderate pain on palpation of the sigmoid colon. On
proctosigmoidoscopy: colon mucosa is not changed, in the lumen there is a lot of mucus. After the
examination the child was diagnosed with irritable bowel syndrome. Symptomatic therapy includes all
groups of drugs except:
A. Prokinetics
B. Sedatives
C. Reparants
D. Probiotics
E. Enzymes
43. A 12 years old girl was admitted to a hospital with complains of weakness,
abdominal pain, liquid stool up to 8-10 times a day, with mucus, blood. He has
infectious department with a diagnosis: dysentery, salmonellosis, which was
bacteriological method. It was suspected ulcerative colitis. What is the most
examination to confirm the diagnosis?
A. Endoscopy
B. Coprogram
C. Bacteriological studies of feces
D. Barium enema
E. Biochemistry of blood
fever up to 39° C,
been treated in the
not confirmed by
reliable method of
44. A 6-month-old boy since the end of the first month of life has been suffering from diarrhea with and
he has stopped to add in weight. The child is exhausted, underweight body is 30%. Bacteriological
examination of feces for intestinal infection is not confirmed. In coprogram: neutral fat ++++. After the
9
examination the child was diagnosed with intestinal form of cystic fibrosis. What medication should be
appointed as the etiotropic therapy of this disease?
A. Pangrol
B. Domperidone
C. Smekta
D. Loperamide
E. Linex
45. A 15 years old boy living in poor social and living conditions complains of intermittent acute
abdominal pain after the psycho-emotional stress, constipation, fatigue. The child is emotionally labile.
On palpation: abdominal pain is defined along the colon, sigmoid colon is spasmodic. On colonoscopy
changes of the colon mucosa were not found. What is the most likely preliminary diagnosis?
A. Irritable bowel syndrome
B. Chronic enterocolitis
C. Chronic colitis
D. Functional constipation
E. Spastic colitis
46. A 13-year-old girl has been suffering from liquid stool 4-6 times per day with mucus and blood
during last 6 months. The girl also complains of recurrent abdominal pains, headache, weakness, lack of
appetite. Body temperature is 37,2˚С. The general condition of the child is disturbed. En endoscopy
revealed deep ulcers with smooth edges on the terminal part of the mucosa of the colon, between which
areas of hyperemic and edematous mucosa is presented, which look like "cobblestone road". What is the
most likely diagnosis?
A. Crohn's disease
B. Celiac disease
C. Nonspecific ulcerative colitis
D. Dysentery
E. Polyposis of the intestine
47. A 4 years old girl has been suffering from bowel movements with a liquid stool for 5 months,
weakness. She was receiving iron preparation orally at a dose of 6 mg / kg in occasion an iron deficiency
anemia during last month. Objectively: body weight is 14 kg, pale skin and mucous membranes, enlarged
abdomen, a liquid stool 3-6 times per day with the presence of mucus. In blood: Hb – 79 g/l, RBC – 3.0 ·
1012/L, ESR – 18 mm/ h. In coprogram: starch and muscle fibers – ++, fatty acid and soaps – +++. What
is the cause of the ineffectiveness of the treatment of anemia in a child in this case?
A. Malabsorption syndrome
B. Insufficient dose of iron
C. Insensitive to iron preparations
D. Worm infestation
E. Overdose of iron preparations
48. An eight month old girl after the addition of semolina in complementary foods has developed diarrhea
in a large volume, steatorrhea and body weight loss. The antibodies to gliadin and tissue transglutaminase
are observed in the blood. What advice should be given to prevention of B12-folic acid deficiency anemia
in the child?
A. A gliadin-free diet
B. Appoint sorbents
C. Appoint a vitamin B12 and folic acid
D. Iron preparations
E. Eat red meats
10
49. A 15-year-old girl complains of severe epigastric abdominal pain preferably on an empty stomach,
night pains in the stomach, single vomiting. From anamnesis it is known that she was receiving
nonsteroidal anti-inflammatory therapy for juvenile rheumatoid arthritis. Of the following, the most likely
cause of her symptoms is:
A. Peptic ulcer disease
B. Gastritis of A type
C. Functional dyspepsia
D. Pancreatitis
E. Gastroesophageal reflux disease
50. A 15-year-old girl has abdominal pain that usually occurs in 1,5-2 hours after having meals, she also
complains of pyrosis and periodic constipation. The pain is getting worse after consuming spicy, salty or
sour food and can be relieved by means of soda and hot-water bag. The girl has been suffering from this
disease for six months. Objectively: tongue is dry with brown coating. Abdomen palpation reveals
intensive pain in epigastric area, resistance of abdominal muscles in the same region. What is the most
likely preliminary diagnosis?
A. Chronic hyperacid gastritis
B. Disorders of the biliary system
C. Chronic Pancreatitis
D. Chronic hypoacid gastritis
E. Duodenal ulcer
51. A patient complains of dull pain in the right subcostal area and epigastric region, nausea, loss of
appetite during last 3 months. He is 14 years old and he has a history of gastric peptic ulcer. On
examination: BP is 130/80 mm Hg, pulse is 77 bpm. Diffuse tenderness and resistance of muscles on
palpation is observed. What method of investigation will be the most useful?
A. Esophagogastroduodenoscopy
B. Ultrasound examination of abdomen
C. pH-metry
D. Urea breath test
E. Coprogramme
52. A 15 y.o. boy was admitted to the hospital with acute pain in substernal area following occasional
swallowing of a fish bone. On esophagoscopy the foreign body wasn’t revealed. The pain increased and
localized between scapulas. In a one day the patient′s condition became worse, temperature elevated,
dysphagia intensified. What complication has developed?
A. Perforation of esophagus with mediastinitis
B. Esophageal hemorrhage
C. Obstruction of esophagus
D. Esophageal abscess
E. Esophageal hernia
53. A 14 y.o. boy complains of repeating vomiting without relief, acute pain in the in epigastrium, fever,
dryness and bitterness in the mouth. Patient relates the onset of pain to the exercise in the gym. Physical
examination: the patient lies on the right side, pale, dry tongue, tachycardia. Right side of abdomen is
painful during palpation and tense in right hypochondrium. What is the most likely diagnosis?
A. Perforative ulcer
B. Acute cholecystitis
C. Hepatic colic
D. Spleen rupture
E. Acute appendicitis
11
54. A 8 years old patient has acute pain in epigactric area, nausea, repeated vomiting. He felt ill suddenly
about 18 hours ago after eating a lot of fried meat on a picnic yesterday. In few hours the pain was
localized in the right iliac area. On examination: positive rebound tenderness symptoms. WBC – 14,
2∗109/L, ESR – 24 mm/h. What is the most probable diagnosis?
A. Acute appendicitis
B. Acute pancreatitis
C. Perforated ulcer
D. Hepatic colic
E. Acute cholecystitis
55. A 15 years old girl complains of pain in the epigastric region most often on an empty stomach,
heartburn, a tendency to constipation, nausea. The patient has been suffering from this disease for a
month. He has been never examined previously. Stomach endoscopy revealed hyperemia and edema of
mucous membrane in the body of stomach. In pH-monitoring: the rate of acid-forming function (pH
corpus) is 1.0. Urea breath test is 2 mms. What is the most appropriate treatment in a first stage in this
case?
A. Omeprazole, nospanum, sedatives
B. Pancreatin, motilium, sedatives
C. Creon, metronidazole, nospanum
D. Omeprazole, no-spa, creon
E. Motilium, omeprazole, clarithromycin
56. A 14 years old patient complains of heartburn which is increased after fatty foods and while bending
the body, substernal pain during swallowing, acid regurgitation, frequent hiccups. It's known from history
that child has been suffering from chronic gastritis for 8 years. What functional disorder should be
expected at esophagogastroscopy?
A. Gastroesophageal reflux
B. Chronic esophagitis
C. Peptic ulcer
D. Acute erosive gastritis
E. Duodeno-gastric reflux
57. A 3 years old child that attends the kindergarten complains of abdominal pain, which often occurs at
night, poor sleep, night cough, gnashing of teeth during sleep, loss of appetite, irritability and fatigue.
Objective examination: skin and mucous membrane are pale, child is asthenic constitution. In hemogram:
erythrocytes – 3.1 * 1012/l, Hb - 90 g/l, eosinophils 19%. What pathology must be excluded first of all?
A. Helminthic invasion
B. Lymphoprolipherative process
C. Allergic reaction
D. Atrophic gastritis
E. Hypoplastic anemia
58. A 9 year old boy complains about sour eructation, heartburn, frequent constipations, and headache
and acute abdominal pain that is arising and getting worse after eating rough or spicy food. He has been
suffering from these symptoms for three months. Objectively: tongue is dry with brown coating, abdomen
is soft, painful in epigastric part. What study method will help to make a diagnosis?
A. Esophagogastroduodenoscopy
B. Biochemical blood analysis
C. Contrast radiography
D. Coprogramme
E. Fractional examination of gastric juice
12
59. A patient is 11 y.o. and he complains of the "night" and "hungry" abdominal pains, nausea, heartburn
and tendency to constipation. At fibrogastroduodenoscopy – in area of duodenum the ulcerrative defect of
6 mms in diameter is found, the floor of defect is objected with a fibrin. Test to determine the Hpinfections is 14 mms. Appoint the optimum schemes of treatment in this case:
A. De-nol+amokcicillini+nifuratel
B. Omeprasole+trichopolum+claritromicin
C. Pantoprasole+ klaritromicini+trichopolum
D. De-nol+amokcicillini+ aluminium phosphate
E. Omeprasole +ranitidin+ amokcicillini
60. A 14 years old patient complains of dull pressing pain in the epigastric region after meal, frequent
nausea without vomiting and a feeling of fullness in the epigastrium, tendency to constipation sometimes.
The girl has been suffering from this disease during three months and she has never been examined
before. Endoscopy revealed a large amount of bile in the stomach, hyperemia and edema of mucous
membrane in the body of stomach with areas of atrophy. In pH-monitoring: the rate of acid-forming
function (pH corpus) is 3.1. What is the most appropriate treatment in this stage?
A. Pancreatin, motilium, ursodeoxycholic acid
B. Creon, motilium, sedatives
C. Famotidine, metronidazole, nospanum
D. De-nol, no-spa, ursodeoxycholic acid
E. Motilium, omeprazole, pancreatin
61. A 7 years old girl complains of aching epigastric pain that occurs after meal, heartburn and nausea.
Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in
gastric fundus with areas of atrophy. What is the most likely diagnosis?
A. Chronic gastritis of type A
B. Peptic ulcer of stomach
C. Functional dyspepsia
D. Duodeno-gastric reflux
E. Chronic gastritis of type B
62. A 9-year-old boy complains of very acute epigastric pain. From the anamnesis it is known that he has
been hit on the abdomen at the school. The boy is in moderately grave condition, has a forced position in
bed. The skin is pale, heart rate - 136/min. Stress on the left costal arch causes a slight pain. Weinert's and
Kulenkampff's symptoms are positive. Macroscopically the urine is unchanged. What is the most likely
diagnosis?
A. Spleen rupture, abdominal bleeding
B. Left kidney rupture
C. Rupture of the pancreas
D. Rupture of a hollow organ, peritonitis
E. Liver rupture, abdominal bleeding
63. A 14-year-old boy complains of stomach ache arising 1.5-2 hours after meals and at night, pyrosis and
tendency to constipation. The pain is getting worse after consuming spicy, salty and sour food and it can
be relieved by means of soda. The patient has been suffering from this disease for six months.
Objectively: tongue is moist with white coating near the root; deep palpation of abdomen reveals severe
pain in the epigastric region and in the gastroduodenal region, resistance of abdominal muscles in the
same region. What is the most likely diagnosis?
A. Duodenal ulcer
B. Chronic cholecystitis
C. Functional dyspepsia
13
D. Acute pancreatitis
E. Stomach ulcer
64. А 9 years old girl complaints of periodic heartburn, pain behind the breastbone, especially after taking
of fatty foods, cough and shortness of breath attacks mainly at night, recurrent stomatitis. The patient has
been suffering from these symptoms for the last year. It's known that the girl had frequent regurgitations
in the first year of life. Allergic anamnesis is negative. On daily ph-metry of the esophagus is determined
ph = 3.5. What is the most likely diagnosis?
A. Gastroesophageal reflux disease
B. Bronchial asthma
C. Worm infestation
D. Chronic gastroduodenitis
E. Adenoiditis
65. A 14 years old patient complains of dull aching permanent pain in the right subcostal area and
epigastric area, nausea, lack of appetite during 6 months. There is a history of gastric peptic ulcer. On
examination: weight loss, pulse is 78 bpm, AP is 115/75 mm Hg. Diffuse tenderness and resistance of
muscles on palpation. There is a hard lymphatic node 1x1cm in size over the left clavicle. What method
of investigation will be the most useful in this case?
A. Esophagogastroduodenoscopy with biopsy
B. Ultrasound examination of abdomen
C. Biochemistry of blood
D. General blood analysis
E. Stomach X-ray
66. A 7-year-old girl has sudden and short term acute pain in epigastric region and the right
hypochondrium usually after having fatty food and during physical activity. What method of investigation
is to be used on the first stage of examining the patient?
A. Ultrasonic
B. Roentgenological method
C. Blood Glucose
D. General blood analysis
E. Magnetic-resonance method
67. A 10-year-old patient complains of feeling of heaviness and compression in the epigastrium, nausea,
belching after meals, tendency to constipation, general weakness. These symptoms have been observed
for about six months. Objectively: pale skin and mucous membranes, tongue is dry with brown coating.
On palpation the abdomen is soft, painless. EGD revealed no changes in the gastric mucosa and
duodenum, there is a large amount of bile in the stomach. What is the most likely diagnosis?
A. Functional dyspepsia with postprandial syndrome
B. Chronic reflux gastritis
C. Gastroesophageal reflux disease
D. Chronic atrophic gastritis
E. Dyskinesia of the biliary tract
68. A 7-year-old girl complains of feeling of heaviness in the epigastrium, frequent nausea, belching after
meals, tendency to constipation and fatigue. These symptoms have been observed for about year.
Objectively: pale skin, tongue is dry with white coating. On palpation the abdomen is soft, painless. EGD
revealed no changes in the gastric mucosa and duodenum, there is a small amount of bile in the lumen of
the stomach. General blood test and blood biochemistry are unchanged. What is the most appropriate
treatment?
A. Creon, motilium, lactulose
14
B.
C.
D.
E.
Famotidin, pancreatin, smectite
Omeprazole, pancreatin, sedatives
Motilium, ranitidine, lactulose
Creon, ranitidine, smectite
69. A 15-year-old girl complains of intense burning pains in epigastric region that occurs mostly on an
empty stomach or 1.5-2 hours after meals, and sometimes at night. Objectively: HR –76/min, BP –
115/75 mm Hg, tenderness in the epigastric region is present. EGD confirms duodenal ulcer of 0,8 cm in
diameter. Test for H. Pylori is 19 mms. Which of the following antisecretory drugs will be a compulsory
element of the treatment regimen?
A. Omeprazole
B. Ranitidine
C. Phosphalugel
D. Atropine
E. Maalox
70. A 5-years-old child fell ill 24 hours ago, when he became anxious, began to clutch his stomach and
vomited several times with bile, and then frequent liquid stool appeared. The body temperature is 39.8oC.
Objectively: the tongue is dry, coated with white bloom. Palpation is unsuccessful because of the child's
anxiety. In digital rectal examination revealed an overhang of the front wall of the rectum. What is the
most likely diagnosis?
A. Acute appendicitis, peritonitis
B. Enterovirus infection
C. Acute nonspecific mesadenitis
D. Acute cholecystitis
E. Acute pancreatitis
71. A 12-years-old patient was admitted to the hospital with complaints of weakness, dizziness, tinnitus,
nausea, vomiting "coffee grounds", and melena. These symptoms developed about 1.5 hours ago after
falling down the stairs. What a primary action should be performed to the child?
A. Esophagogastroduodenoscopy
B. X-rays of the abdomen
C. Barium enema
D. Ultrasonography of the abdomen
E. Colonoscopy
72. A 11 year old girl complains of acute pains in epigastric region which are relieved by food intake,
heartburn, acid regurgitation, nausea, weakness and tendency to diarrhea. These symptoms have been
observed for about last four months. On EGDS: antral erosive gastritis is found, biopsy of antral mucous
membrane revealed Hеlicobacter Pylori infection. What medications should be appointed at the first stage
of therapy in this case?
A. Drugs for the eradication of H. pylori infection
B. Antispasmodics to decrease pain
C. Mucosal reparants and sorbents
D. Preparations for the normalization of motility
E. Antisecretory therapy
73. A 10-years-old patient complaints of acute pain in the epigastric region and right upper quadrant of
abdomen, headache, general weakness, nausea, a low-grade fever. On examination: palpation of the
abdomen revealed resistance of the muscles in the right upper quadrant, positive Kera′s, Ortner′s and
Murphy′s symptoms. What is the most likely preliminary diagnosis?
A. Acute cholecystitis
15
B.
C.
D.
E.
Acute appendicitis
Biliary dyskinesia
Acute gastritis
Acute pancreatitis
74. A 12 year-old girl complains of aching pain in the epigastric region mostly on an empty stomach and
1.5-2 hours after eating, heartburn, acid regurgitation, nausea, fatigue, tendency to diarrhea. On
examination: tenderness in pyloroduodenal area is noted, positive Mendels′ symptom. On endoscopy: the
mucous membrane of the stomach and duodenum is rapidly swelling, mucous membrane defect of
duodenal bulb the size of 0.4-0.7 cm is observed. On pH-meter: pH corpus is 0.9. What is the most likely
diagnosis?
A. Duodenal ulcer
B. Erosive gastritis
C. Stomach ulcer
D. Biliary dyskinesia
E. Erosive duodenitis
75. A 14-year-old boy who has been suffering from periodic abdominal pain on an empty stomach or
after 1.5-2 hours after a meal, heartburn, acid regurgitation, nausea, fatigue, tendency to diarrhea for the
last year, suddenly developed «coffee grounds» vomiting, weakness, cold clammy sweat. What is the
most probable cause of bleeding?
A. Peptic ulcer
B. Erosive gastritis
C. Portal hypertension
D. Esophageal tumor
E. Reye's syndrome
76. A 14-year-old boy was admitted to the hospital with complaints of acute pain in the epigastrium,
which decreases after a meal, belching, weakness, sweating was clinically suspected with peptic ulcer
disease. What method of examination is the most informative to confirm the diagnosis?
A. Endoscopy
B. Abdominal ultrasound
C. General blood test
D. Intragastric pH-metry
E. X-ray examination
77. A 13-year-old patient has been suffering from intense pain in the epigastric area, nausea, heartburn,
belching, weakness during a last year. Endoscopic examination revealed superficial gastroduodenitis,
urease breath test is 18 mm. What antibacterial medication should be appointed as the etiotropic therapy?
A. Clarithromycin
B. Ciprofloxacin
C. Cefodox
D. Tetracycline
E. Nifuroxazide
78. A 12 years old patient complains of abdominal pain after meal, heartburn, acid regurgitation, frequent
hiccups. From the history it's known that the child has been periodically suffering from hoarse voice,
morning cough, rhinitis and stomatitis for the last year. What pathology is the cause of all these
symptoms in the child?
A. Gastroesophageal reflux disease
B. Peptic ulcer disease
C. Chronic hyperacid gastritis
16
D. Chronic hypoacid gastritis
E. Functional dyspepsia
79. A 11 year-old boy complains of acute pain in the epigastric region and right upper quadrant of
abdomen after intake a rough meal. He has been suffering from nocturnal pain, heartburn, and
constipation for the last month. Objectively: tongue is covered at the root with white bloom, tenderness in
pyloroduodenal area on palpation, positive Mendels′ symptom. What is the preliminary diagnosis?
A. Duodenal ulcer
B. Functional dyspepsia
C. Stomach ulcer
D. Chronic pancreatitis
E. Chronic gastritis hyperacid
80. A 14 y.o. boy was hospitalized in the surgical department with complaints of acute pain in epigastric
area, repeated vomiting with bile. On examination: pale skin, acrocyanosis, pulse rate – 96-102 bpm.
Breathing is frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom.
The child has been suffering a stomach ulcer for last 2 years. What complication should be suspected?
A. Ulcer perforation
B. Ulcer penetration
C. Stenosis of the pylorus
D. Internal bleeding
E. Acute cholecystitis
81. A 1 year-old boy was hospitalized to infectious department with complaints of repeated vomiting,
temperature rise up to 38.2 C˚, weakness, jaundice. From history we know that child is sick for 3 days, 6
months ago he has been received a blood transfusion for treatment of iron-deficiency anemia.
Objectively: the abdomen is soft, liver is palpated at 3 cm below the costal margin, it is dense and painful,
the spleen is 2 cm below the ribs. There is dark urine and feces discolored. Аn acute hepatitis was
diagnosed. After 2 days the child's condition got worse: increased jaundice, disturbed consciousness,
there was a hemorrhagic rash on the chest, vomiting blood, liver sizes were reduced by 2 cm. What is an
urgent condition in a child?
A. Hepatic encephalopathy
B. Cirrhosis of the liver
C. Relapse of viral hepatitis
D. Infectious-toxic shock
E. Acute leukemia
82. A 7-year-old girl complains of attack acute pain in the abdomen, nausea usually after eating, tendency
to constipation. On physical examinations: pale skin, tongue is wet with white coating, right upper
quadrant tenderness is observed on palpation, the liver is not enlarged. What is your preliminary
diagnosis?
A. Biliary dyskinesia
B. Functional constipation
C. Chronic gastritis
D. Chronic duodenitis
E. Cirrhosis of liver
83. A 14 y. o.boy complains of dull pain in the abdomen and right subcostal area, nausea, and loss of
appetite and weakness. From the history it is known that he fell ill 3 months ago after appendectomy
when jaundice appeared and he treated in an infectious hospital. One year later previously mentioned
symptoms developed. On exam: the subicteric sclerae, enlarged liver. Your preliminary diagnosis:
A. Chronic viral hepatitis
17
B.
C.
D.
E.
Autoimmune Hepatitis
Acute viral hepatitis
Gilberts disease
Relapse of viral hepatitis
84. A 7 year old girl has been suffering from attacks of right subcostal pains after fatty and fried foods
which usually occur in half an hour after meals for about a one year. Last week the attacks repeated
almost every day and became more painful. The child has never been examined before. What diagnostic
study would you recommend first of all?
A. US examination of the gallbladder
B. US study of the pancreas
C. Fibrogastroduodenoscopy
D. Blood Glucose
E. Liver function tests
85. A 12 years old girl was hospitalized to the gastroenterological department with complains of dull pain
in the abdomen, nausea, vomiting, dark urine, аcholic stool, yellowness of the skin and scleras. On
physical examinations the liver is enlarged by 3 cm. Jaundice developed on the 12th day of the disease.
The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s
condition?
A. Hepatic encephlopathy
B. Gilberts disease
C. Biliary dyskinesia
D. Relapse of viral hepatitis
E. Infectious-toxic shock
86. A 14 y. o. boy has been suffering from acute pain in the right hypochondrium radiating to the back,
accompanied by nausea, vomiting, fever and chills during two days. Then he noticed yellow
discoloration of her sclera and skin. On physical examinations: right upper quadrant tenderness is
observed, positive symptom Kera. The most likely preliminary diagnosis is:
A. Choledocholithiasis
B. Biliary dyskinesia
C. Chronic hepatitis
D. Acute pancreatitis
E. Choledochal cyst
87. A 15-year-old girl complains of pain attacks in the right hypochondrium about six months. The pain
arises mainly after taking fatty and fried food. During the last week the attacks occurred daily and became
more painful. On the second day of hospitalization the patient presented with icteritiousness of skin and
scleras, light-coloured feces and dark urine. In blood: neutrophilic leukocytosis - 11, 8 * 109/l, ESR - 18
mm/h. What is the most likely diagnosis?
A. Chronic calculous cholecystitis
B. Chronic recurrent pancreatitis
C. Fatty degeneration of liver
D. Chronic cholangitis, exacerbation stage
E. Hypertensive dyskinesia of gallbladder
88. A 6-year-old child complains of dull aching pain in the right upper quadrant of the abdomen occuring
in 1-1.5 hours after physical activity, consuming fatty and fried foods, frequent nausea, bitterness in the
mouth. Instrumental examination revealed biliary dyskinesia of hypotensive type. What group of drugs
should be prescribed for treatment?
A. Choleretics and cholekinetics
18
B.
C.
D.
E.
Antispasmodics and choleretics
Choleretics and antispasmodics
Antispasmodics and cholekinetics
Sedatives and cholekinetics
89. A 8-month-old baby was admitted to the emergency room with 3-hour history of bilious vomiting,
passage of pink jelly like material from the rectum, and intermittent episodes of severe crying.
According to the child's mother words a defecation was absent for three days. On
physical
examination: a sausage-shaped mass is detected on the right side of the abdomen. The most likely
diagnosis is:
A. Iliac passion
B. Congenital pyloric stenosis
C. Acute appendicitis
D. Necrotisizing enterocolitis
E. Functional constipation
90. A 11-year-old girl complains of liquid stool up to 6-9 times a day mixed with blood and mucus,
pain in the left abdomen, weight loss, low-grade fever to 37,2˚C. He has been suffering from these
symptoms for about month. En endoscopy revealed edema and hyperemia of the mucous membrane of
rectum and sigmoid colon, multiple symmetrical ulcers, which are surrounded by inflamed mucosa,
presence of blood and mucus in the lumen of the intestine. What is the most likely diagnosis?
A. Ulcerative colitis
B. Salmonellosis
C. Food poisoning
D. Hemorrhoidal hemorrhage
E. Tumor of the large intestine
91. A 10-year-old child was admitted with complains of pain throughout the abdomen, liquid stool up to
6-12 times a day mixed with blood, mucus and pus, weakness, weight loss by 5 kg for the last 3 months.
After the examination the child was diagnosed with nonspecific ulcerative colitis. What medication
should be appointed as the first line of therapy in this case?
A. Drugs of 5-ASA
B. Enzymes
C. Corticosteroids
D. Nitrofuran drugs
E. Sorbents
92. A 1 years old child since the end of the third month of life has been suffering from diarrhea with a
pungent fetid smell. Although the child has a good appetite, he has stopped to add in weight. The child is
exhausted, underweight body is 26%. Bacteriological examination of feces for intestinal infection is not
confirmed. In coprogram: neutral fat ++++. After the examination the child was diagnosed with intestinal
form of cystic fibrosis. Which diagnostic method should be used to confirm this diagnosis?
A. Sweat test for Gibson
B. Blood Glucose
C. The antibodies to gliadin
D. Bowel radiography
E. Biochemistry of blood
93. A 9-month-old girl is on artificial feeding and receives adapted milk formula «Nutrilon». After the
addition of biscuit in complementary foods 2 months ago the child has developed diarrhea with
polifekaliya, flatulence, anxiety. Objectively: the child is excited, underweight body is 19%. After the
19
examination she was diagnosed with celiac disease. What is the main factor in the pathogenesis of
malnutrition in this case?
A. Allergy to gliadin
B. Allergy to cow's milk protein
C. Deficiency of vitamins in the diet
D. Disaccharidase insufficiency
E. Food allergy
94. A 6-year-old boy was admitted to a hospital with complaints of diarrhea to 3-5 times a day mixed
with blood and mucus in the stool during last three months. The general condition of the child is not
disturbed. Objectively: skin is pale, body weight is normal. Abdomen is soft, painless on palpation. In
blood: Hp-126 g/L, erythrocyte sedimentation rate – 10 mm/h. In proctosigmoidoscopy: mucosa is not
changed. What is the most likely diagnosis?
A. Polyp in the upper parts of the colon
B. Ulcerative hemorrhagic colitis
C. Malabsorption syndrome
D. Dysentery
E. Irritable bowel syndrome
95. A 14 years old girl complains of episodes of intense, acute midline abdominal pain lasting three-four
hours, with intervening symptom-free intervals lasting 3-4 weeks and sometimes liquid stool up to 1-2
times per day without any admixture of blood and mucus. She is also pointing that she experiences
episodes of one side headaches and photophobia during episodes. Her complete physical examination is
normal. Routine blood biochemistry is also normal. What is the most likely pathology?
A. Abdominal migraine
B. Irribable bowel syndrome
C. Peptic ulcer disease
D. Gastro-esophageal reflux
E. Helminth infestation
96. A 8 year old boy was admitted to hospital with onset of mild diarrhea and rectal bleeding with
intermittent low grade fever and mild abdominal pain. On examination: Hb – 98 g/l, RBC – 3.0 * 1012/L,
WBC – 14.2 * 109/L, Plt. – 560 * 109/L, ESR – 42 mm/ h. Stool sample negative for pathogens.
Colonoscopy (macroscopic) revealed diffuse erythema with contact bleeding. What is the most likely
diagnosis?
A. Ulcerative colitis
B. Irribable bowel syndrome
C. Helminth infestation
D. Hemorrhoidal hemorrhage
E. Tumor of the large intestine
97. A 14 years old girl complains of intensive girdle pain in the abdomen, profuse nonformed stool 3 - 4
times a day, loss of weight for 6 kg for last 2 months. It is known that she has taken fatty and fried foods,
chips and cola regularly for last year. On examination: abdomen is soft, painless. Blood amylase – 30
U/L. Feces examination – neutral fat 15 g per day with starch grains is observed. What is the most
reasonable treatment at this stage?
A. Creon
B. Motilium
C. Omeprazole
D. Metronidazole
E. Imodium
20
98. A 11 years old patient has been suffering from nonspecific ulcerative colitis during 7 years. On
colonoscopy: inflammatory process of lower intestinal parts is observed, pseudopolyposive changes of
mucous. In blood: WBC – 10.4 * 109/L, RBC – 3, 2 * 1012/L, erythrocyte sedimentation rate – 39
mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Nifuroxazide
E. Ibuprofen
99. A 6.5 month old child after semolina’s introduction (since 5 months) was admitted to the hospital
with complains of weight loss, unstable discharges, anorexia. The child is adymanic, flabby, pale dry
skin, subcutaneous layer is emaciated. Distended and tensed abdomen, tympanitis on percussion of the
upper part of the abdomen, splashing sounds, feces are foamy, of light color, foul. On coprocytogram: a
lot of neutral fat. What is the cause of the disease?
A. Celiac disease
B. Cystic fibrosis
C. Dysbacteriosis
D. Chronic enteritis
E. Food allergy
100. A 11 month old child was on inpatient treatment in the children's surgical department because of
invagination of the large intestine after eating fatty meat. What recommendations first of all should doctor
give to mother to prevent this disease recurrence?
A. Strict following of feeding regimen
B. Common cold prophilaxis
C. Feces observation
D. X-rays of the intestines monthly
E. Avoid dairy products
101. A 10 y.o. girl has been suffering from stomach pain for over 3 months. The girl notices that the pain
relieves with defecation, and is accompanied by flatulence, rumbling, feeling of incomplete evacuation,
constipation or diarrhea in alternation. No changes in laboratory tests during the examination. What is the
most likely diagnosis?
A. Irritable bowel syndrome
B. Spastic colitis
C. Chronic non-ulcer colitis
D. Worm infestation
E. Chronic enterocolitis
102. A 14y.o. girl complains of acute paroxysmal pains in paraumbilical and iliac region that usually
reduce after defecation. Defecation takes place up to 4-6 times per day and stool is sometimes solid, with
some mucus in it. Normal appetite, she has not put off weight. First such symptoms appeared 3 years ago,
but colonoscopy data revealed no organic changes. Objectively: abdomen is soft, a little bit painful in the
left iliac region. What is the preliminary diagnosis?
A. Irritable bowels syndrome
B. Chronic pancreatitis
C. Crohn’s disease
D. Chronic non-ulcer colitis
E. Celiac disease
21
103. A 7 month old child is presented with complains of loss of appetite, diarrhea with large amounts of
feces and occasional vomiting. These symptoms appeared after the recent introduction of complementary
feeding in the form of biscuits and oatmeal porridge. Objectively: body temperature is normal, body
weight is 3.8 kg, the child is very pale, there are edemata of both legs, the abdomen is significantly
enlarged. Coprogram shows many fatty acids and soaps. The child has been diagnosed with celiac disease
and administered the gluten-free diet. What should be excluded from the ration?
A. Cereals - wheat and oats
B. Animal protein
C. Buckwheat and oatmeal porridge
D. Milk and dairy products
E. Corn porridge and cookies
104. A 15 years old girl complaints of recurrent abdominal pain, which occur in the morning, after meals
and before tests and examinations and are usually accompanied by flatulence and frequent bowel
movements without pathological impurities. The child also complains of frequent headaches, periodically
- insomnia. According to laboratory and instrumental methods of examination organic pathology of the
intestine is excluded. Which drug is most advisable to appoint for reducing diarrhea in this case?
A. Loperamide
B. Levomycetin
C. Nifuroxazide
D. Metronidazole
E. Lactulose
105. A 6-year-old girl was admitted to a hospital with complaints of acute abdominal pain mainly at
night, persistent night cough, nausea, lack of appetite and tendency to diarrhea. Objectively: pale skin,
tongue is dry with dry white coating. Abdomen is soft, available to palpation in all departments, painless.
Blood test: erythrocytes – 3.4 * 1012/l, Hb - 102 g/l, eosinophils 12%. What method of examination
should appoint to confirm the diagnosis?
A. Feces on helminths and protozoa
B. Blood chemistry
C. General blood analysis
D. Urea breath test
E. Abdominal ultrasound
106. A 12 year old boy complains of acute pain in the epigastrium that appears 2-3 hours after meal,
heartburn and acid regurgitation. As a rule exacerbations happen in spring and in autumn. The patient has
food intolerance of eggs and fish. Objectively: on palpation painfulness in the gastroduodenal area
reveals. Electrophasoduodenoscopy revealed a 8 mm ulcer on the anterior wall of duodenum. Urease test
is 19 mm. What is the most probable leading mechanism of disease development?
A. H.pylori infection
B. Genetic predisposition
C. Disorder of gastric motor activity
D. Food allergy
E. Autoantibody production
107. A 15 years old patient was admitted to a hospital with complaints of vomiting like «coffee-grounds»
that developed approximately hour ago. Objectively: the patient is pale, at an attempt to stand up he
complains of strong dizziness. BP – 80/50 mm. hg., pulse – 128 b/min. From anamnesis it is known that
boy has suffered from ulcer of the stomach, painless form during 2 years. An ulcer was exposed at
gastrofiberoscopy. Your diagnosis:
A. Ulcer of stomach, complicated with bleeding
B. Ulcer of duodenum, complicated with bleeding
22
C. Bleeding from esophageal varices
D. Erosive gastritis
E. Myocardial infarction
108. A 11 years old patient complains of acute burning pain in epigastrium which is usually relieved by
food intake. Gastrofiberoscopy revealed antral erosive gastritis, biopsy of antral mucous membrane
reveals Hеlicobacter Pylori infection. What can be diagnosed in this case?
A. Gastritis of B type
B. Gastritis of A type
C. Menetrier’s disease
D. Functional dyspepsia
E. Gastritis of C type
109. A 8-year-old girl complains of acute cramping pain occuring usually in a half an hour after mental
exertion, consuming fatty and fried foods. Instrumental examination has allowed diagnose biliary
dyskinesia of hypertensive type. What group of drugs should be prescribed for treatment?
A. Antispasmodics and choleretics
B. Choleretics and cholekinetics
C. Sedatives and cholekinetics
D. Antioxydants
E. Antibiotics
110. A 13-year-old girl complains of abdominal dull pain and distension, nausea, periodical liquid fatty
stool, grey in color, with rotten smell. She has been suffering from these symptoms for the last 2 years.
On palpation: pain in the epigastrium, Desjardins’ pancreatic point and Chauffard’s triangle; positive
Mayo- Robson’s sign. Insufficiency of pancreas exocrine function is suspected. What method is the most
informative for pancreas exocrine function assessment?
A. Detection of elastase-1 in feces
B. Tripsin content in blood serum
C. Pancreas echography
D. Ultrasound of the abdomen
E. Blood Glucose
111. A 12-year-old boy is sick for 1 month. He complains of dull aching pain in the right upper quadrant,
weakness, jaundice, itching skin. Disease onset was abrupt with fever up to 39,5oC, and progressive
jaundice developed one week later. At hospitalization jaundice was severely progressed. Liver cannot be
palpated. Gallbladder is enlarged and painless. Blood bilirubin is 98mmol/l (accounting for direct
bilirubin). Stool is acholic. It is known that the patient has been suffering from cholelithiasis since 3 years
old. What is the most likely jaundice genesis in this patient?
A. Mechanical jaundice
B. Hemolytic jaundice
C. Gilbert’s syndrome
D. Viral hepatitis B
E. Biliary atresia
112. A 12-year-old patient was diagnosed with viral hepatitis C with a high degree of activity 4 years ago
after appendectomy and received in-patient treatment in infectious disease department. But then the
patient was not examined and did not receive any treatment for the last two years. Now he complains of
feeling of heaviness in the right hypochondrium, itching of the skin, great weakness. On physical exam:
much flatulence, dilation of abdominal wall veins, protruded umbilicus, spleen enlargement. What can be
diagnosed in this case?
A. Liver cirrhosis
23
B.
C.
D.
E.
Cancer of the liver
Cancer of the head of pancreas
Relapse of viral hepatitis
Viral hepatitis C
113. A 10 y.o. boy was hospitalized to infectious department with complains of dull pain and discomfort
in the right subcostal area, skin itching, jaundice, generalized weakness. On examination: skin is jaundice,
traces of scratches, liver is +4 cm, spleen is 6x8.5 cm. In blood: alkaline phosphatase – 2100 Un/L,
general bilirubin – 108 mkmol/L, cholesterol – 7,2 mmol/L. What is the leading syndrome in the patient?
A. Сholestatic
B. Сytolytic
C. Autoimmune aggression
D. Liver-cells insufficiency
E. Asthenic
114. A 10-year-old boy has been suffering from pains in the abdomen for about one year. They usually
occur at night as well as during the day, sometimes he vomits after the onset of pain. Occult blood has
been found in his stool. His father also gets frequent stomachaches. Which of the following is the most
likely diagnosis?
A. Peptic ulcer
B. Biliary dyskinesia
C. Chronic gastritis
D. Chronic pancreatitis
E. Functional dyspepsia
115. A 12 y.o. patient complains of the "hungry" abdominal pains, nausea, heartburn and tendency to
constipation. At fibrogastroduodenoscopy – in area of duodenum the ulcerrative defect of 6 mms in
diameter is found, the floor of defect is objected with a fibrin. Test to determine the Hp-infections is 14
mms. The eradication therapy was prescribed. Which of the following drugs is not included in the
scheme of athelicobacter therapy in children?
A. Ceftriaxone
B. Klaritromicini
C. De-nol
D. Amokcicillini
E. Omeprasole
24
Module № 4
1
A.
B.
C.
D.
E.
2
A.
B.
C.
D.
E.
3
A.
B.
C.
D.
E.
A 18-year-old woman with stage 4 chronic kidney disease secondary to hypertension comes
to the office because she has had dysuria and increased urinary frequency during the past
two days. She has not had fever or hematuria. Temperature is 37.3°C (99.1°F), pulse rate is
90/min, and blood pressure is 142/85 mmHg. On physical examination, no flank tenderness
is noted. Urinalysis shows cloudy urine that is positive for leukocyte esterase, nitrites, and
protein. Results of urine culture are pending. Which of the following medications is the most
appropriate therapy for this patient's condition?
Oral administration of ciprofloxacin
Intramuscular administration of ceftriaxone
Intravenous administration of gentamicin
Intravenous administration of vancomycin
Oral administration of nitrofurantoin
A 15-year-old woman with diabetic nephropathy comes to the office because she has had
vomiting, anorexia, fatigue, itching, and a metallic taste in her mouth for the past two weeks.
Respirations are 32/min. Physical examination shows urine-like odor of the breath and 2+
pitting edema. Estimated glomerular filtration rate, calculated using the Modification of Diet
in Renal Disease (MDRD) Study equation, is 14 mL/min/1.73 m2. Additional studies in this
patient are most likely to show presence of which of the following conditions?
Primary metabolic acidosis
Hypokalemia
Primary metabolic alkalosis
Primary respiratory acidosis
Primary respiratory alkalosis
You are evaluating a 2-month-old infant for hydronephrosis. Renal ultrasonography reveals
a large, dilated right kidney (5.8 cm) and a small (2.5 cm) left kidney that has marked
echogenicity and loss of corticomedullary differentiation. You suspect that the left kidney
may have extensive dysplasia. Physical examination reveals a well-appearing child whose
height and weight are at the 5th percentile for age and who has no obvious abnormalities.
Laboratory tests reveal a serum creatinine 61.9 mcmol/L. The parents ask you what medical
therapy is available for their child. Of the following, the BEST course of treatment is
angiotensin-converting enzyme inhibitor therapy
growth hormone therapy
liberal fluid intake
no therapy
restriction of salt intake
4
A.
B.
C.
D.
E.
5
A.
B.
C.
D.
E.
6
Prenatal ultrasonography of a male fetus reveals bilateral hydronephrosis. Postnatal
abdominal ultrasonography confirms bilateral hydronephrosis, with markedly reduced renal
parenchyma. A voiding cystourethrogram reveals posterior urethral valves and bilateral
grade IV vesicoureteral reflux (VUR). A urologist performs ablation of the valves and
bilateral ureterostomies. The infant's serum creatinine at 2 weeks after birth is 2.1 mg/dL
(185.6 mcmol/L). The remainder of the serum electrolyte concentrations are normal, and the
urine output is 5.2 mL/kg per hour. The patient has no sign of volume depletion or overload.
Of the following, the MOST appropriate statement to provide the child's parents is that their
son
needs to start peritoneal dialysis immediately
is unlikely to reach ESRD until adulthood
likely will develop ESRD within 5 years
is unlikely to progress to end-stage renal disease (ESRD)
should progress slowly to ESRD by adolescence
A 13-year-old girl complains of fatigability, frequent headaches, cardialgia. Eight years ago
she had a case of pyelonephritis. Urine analyses periodically revealed leukocyturia. The
child has undergone no further treatment. On examination: increased BP up to 150/100 mm
Hg. Ultrasound investigation revealed significant reduction of the right kidney. What
process is leading in arterial hypertension pathogenesis in this case?
Hyperactivity of renin-angiotensin system
Disruption of water-electrolytic balance
Disruption of renal circulation
Hypersympathicotonia
Increased cortisol level
A.
B.
C.
D.
E.
A 14 y.o. patient complains of nausea, vomiting, headache, shortness of breath. He had an
acute nephritis being 10 y.o. Proteinuria was found out in urine. Objectively: a skin is greypale, the edema is not present. Accent of II tone above aorta. BP 140/100-180/100 mm Hg.
Blood level of residual N2- 6,6 mmol/L, creatinine- 406 mmol/L. Day’s diuresis- 2300 ml,
nocturia. Specific density of urine is 1009, albumin- 0,9 g/L, WBC- 0-2 in f/vis. RBC.single in f/vis., hyaline casts single in specimen. Your diagnosis?
Chronic nephritis with violation of kidney function
Feochromocitoma
Hypertensive illness of the II degree
Nephrotic syndrome
Stenosis of kidney artery
7
A.
B.
C.
All of the following describe the natural history of chronic kidney disease EXCEPT:
Progression of chronic kidney disease is reversible depending on the underlying cause
Hypertension develops as a consequence of chronic kidney disease
Onset of proteinuria is reflective of worsening of kidney disease
D. Proteinuria itself contributes to glomerular damage and progression of kidney disease
E. Hyperfiltration of non-injured nefrons cause eventual sclerosis
8
A.
B.
C.
D.
E.
9
A.
B.
C.
D.
E.
The patient with acute respiratory viral infection (3-rd day of disease) has complaints on
pain in lumbar region, nausea, dysuria, oliguria. Urinalysis - hematuria (100-200 RBC in
eyeshot spot), specific gravity - 1002. The blood creatinin level is 0,18 mmol/L, potassium
level - 6,4 mmol/L. Make the diagnosis:
Acute interstitial nephritis
Acute renal failure
Acute glomerylonephritis
Acute cystitis
Acute renal colic
A 18-year-old woman with end-stage renal disease comes to the clinic for routine
hemodialysis. The patient says she has cramping during hemodialysis as well as weakness
after each treatment. Post-treatment, pulse rate is 95/min and blood pressure is 90/60 mmHg.
On physical examination, auscultation of the chest shows normal breath sounds.
Examination of the extremities shows no edema. Which of the following is the most
appropriate next step?
Increase the dry weight
Continue monitoring blood pressure
Decrease the dialysate temperature
Decrease the dialysis time
Add sodium modeling
10 A 16-year-old patient with end-stage renal disease comes to the clinic for routine
hemodialysis treatment. Blood pressure prior to the treatment is 178/100 mmHg, and the
patient has a headache. Blood pressure at the end of the treatment is 150/90 mmHg. Average
pulse rate during hemodialysis treatment is 48/min. Decreasing the patient's target weight by
2 kg relieves the headache, but blood pressure remains increased and severe leg cramps
develop. Which of the following is the most appropriate next step?
A. Initiate ultrafiltration profiling
B. Continue decreasing the target weight
C. Initiate hydralazine therapy
D. Initiate metoprolol therapy
E. Initiate sodium modeling
11 A 17-year-old patient is referred to the office by his primary care provider for initial
consultation regarding stage 3 chronic kidney disease. The patient initially sought treatment
A.
B.
C.
D.
E.
12
A.
B.
C.
D.
E.
at the primary care office because he had pain in his lower back. An incidental finding of
increased blood pressure was noted at that time. Results of laboratory studies performed at
the primary care office included glomerular filtration rate, calculated using the Modification
of Diet in Renal Disease (MDRD) Study equation, of 59 mL/min/1.73 m2. The patient
currently is not taking any antihypertensive medications. Before further evaluation regarding
the cause of hypertension and decreased glomerular filtration rate, initiation of
antihypertensive therapy is planned. Which of the following classes of medications is the
most appropriate initial antihypertensive therapy for this patient?
Angiotensin-converting enzyme inhibitors
Alpha2-agonists
Beta-blockers
Calcium channel blockers
Vasodilators
The most common cause of chronic renal failure in children requiring transplantation is:
Reflux nephropathy.
Hemolytic-uremic syndrome.
Obstructive uropathy.
Polycystic kidney disease.
Familial nephritis
13 A 15-year-old girl who developed chronic renal failure due to focal segmental
glomerulosclerosis has received a kidney transplant. After the initial posttransplant period,
her chronic medication regimen includes oral tacrolimus. Of the following, the adverse
effect MOST likely to be associated with oral tacrolimus therapy is
A. neurotoxicity
B. hypertension
C. hypertrichosis
D. nephrotoxicity
E. hyperglycemia
14 During a health supervision visit for her 5-year-old son, a mother anxiously questions you
about her family history. The mother, who was adopted, has learned that her biological
mother, who had been on renal dialysis, recently died from complications of a ruptured
intracranial aneurysm. You ask if it is possible to obtain records for review. Of the
following, the MOST likely diagnosis for the grandmother is
A. autosomal dominant polycystic kidney disease
B. Alport syndrome
C. Ehlers-Danlos syndrome, vascular fragility type
D. Goodpasture syndrome
E. systemic lupus erythematosus
15 A 14-year-old boy presents to the emergency department with gross hematuria of 2 days'
duration. He had an upper respiratory tract infection 3 days prior to the onset of the gross
hematuria. He describes the urine as brown-colored and reports no pain or burning upon
urination. A similar episode of hematuria occurred about 10 months earlier and resolved in 3
days. His blood pressure is 110/72 mmHg, and there is no evidence of edema. Serum
complement levels are normal. Of the following, the MOST likely cause of this boy's
hematuria is
A. immunoglobulin A (IgA) nephropathy
B. acute pyelonephritis
C. acute postinfectious glomerulonephritis
D. sickle cell nephropathy
E. urolithiasis
16 Prenatal ultrasonography of a male fetus reveals bilateral hydronephrosis. Postnatal
abdominal ultrasonography confirms bilateral hydronephrosis, with markedly reduced renal
parenchyma. A voiding cystourethrogram reveals posterior urethral valves and bilateral
grade IV vesicoureteral reflux (VUR). A urologist performs ablation of the valves and
bilateral ureterostomies. The infant's serum creatinine at 2 weeks after birth is 2.1 mg/dL
(185.6 mcmol/L). The remainder of the serum electrolyte concentrations are normal, and the
urine output is 5.2 mL/kg per hour. The patient has no sign of volume depletion or overload.
Of the following, the MOST appropriate statement to provide the child's parents is that their
son
A. needs to start peritoneal dialysis immediately
B. is unlikely to reach ESRD until adulthood
C. likely will develop ESRD within 5 years
D. is unlikely to progress to end-stage renal disease (ESRD)
E. should progress slowly to ESRD by adolescence
17 A boy presents to the emergency department with difficulty ambulating and abdominal pain.
He has a temperature of 100.4°F (38.0°C) and normal blood pressure and heart rate. His
knees and ankles are swollen, and he has a small amount of pitting edema in the ankles and
multiple raised red lesions on his legs. There is nonspecific mild tenderness on abdominal
examination. You obtain several laboratory tests, including a urinalysis that reveals
moderate blood and 1+ protein, and microscopic analysis shows 25 to 50 red blood cells per
high-power field. The serum creatinine is 0.5 mg/dL (44.2 mcmol/L), and electrolyte levels
are normal.
18 Of the following, the BEST management of this child is to
A. obtain a 24-hour urine specimen for protein
B. obtain a repeat urinalysis in 24 hours
C. measure serum immunoglobulin A level
D. order renal ultrasonography
E. schedule a renal biopsy
19 The parents of a 3-year-old boy bring him to your office because he appears very pale and is
less active than usual. He has had diarrhea for 2 days. The parents also note that his urine
output has decreased substantially in the past 24 hours. Physical examination reveals marked
pallor and diffuse abdominal tenderness. Laboratory results reveal a blood urea nitrogen
level of 108 mg/dL
20 (38.6 mmol/L), serum creatinine of 5.2 mg/dL (460 mcmol/L), and 25 to 50 white blood
cells and too numerous to count red blood cells in the urine. The hemoglobin level is 6 g/dL
(60 g/L).
21 Of the following, the MOST likely diagnosis is
A. chronic renal failure
B. bilateral, acute pyelonephritis
C. acute glomerulonephritis
D. hemolytic-uremic syndrome
E. Henoch-Schцnlein purpura
22 A previously healthy 10-year-old boy reports a 2-day history of back pain and gross
hematuria. There is no history of trauma or passed kidney stones. His vital signs are normal,
and physical examination reveals right costovertebral angle tenderness. His older brother
had several similar episodes when he was younger, as did his mother when she was child.
You suspect that this boy has sickle cell trait and papillary necrosis. Of the following, the
BEST test to confirm the diagnosis is
A. renal scintigraphy
B. computed tomography
C. intravenous pyelography
D. abdominal radiography
E. renal ultrasonography
23 A 12-year-old boy presents to the emergency department after discovering that his urine is
red. He has had an upper respiratory tract infection for 2 days, but felt fine at school today.
He noticed that his urine was red after track practice today. He reports no trauma and no
other symptoms, including dysuria, back or abdominal pain, passage of stones, or previous
illnesses. His temperature is 98.6°F (37.0°C), heart rate is 120 b/min, and blood pressure is
90/58 mm Hg. The urine appears grossly red, and urinalysis reveals 0 to 2 white blood cells
and 0 to 2 red blood cells per high-power field. Of the following, the MOST likely cause of
the gross hematuria is
A. myoglobinuria
B. immunoglobulin A nephropathy
C. acute glomerulonephritis
D. papillary necrosis
E. ureteropelvic junction obstruction
24 You are treating a 3-year-old girl who has frequently relapsing, steroid-sensitive nephrotic
syndrome and presents with another relapse (4+ proteinuria, facial edema, and mild
abdominal distension). You initiate therapy with oral corticosteroids. The mother calls you 2
days later to report that the edema has worsened. Because the edema occasionally has
required diuretics in the past, you prescribe oral furosemide (1 mg/kg per day). Of the
following, the MOST common adverse effect associated with furosemide therapy is
A. hypokalemia
B. hyperchloremia
C. hypernatremia
D. hypercalcemia
E. hypouricemia
25 You are performing a routine physical examination of a 12-year-old boy who is planning to
play football. He feels well and has not been ill since a sore throat about 4 months ago. His
past medical history is unremarkable, and he reports no current symptoms. He is receiving
no medication. His vital signs and physical examination findings are normal. Urinalysis
reveals 3+ protein and large blood on dipstick with 25 to 50 red blood cells per high-power
field. Of the following, the MOST important next step is to
A. obtain a first morning urine specimen for analysis
B. measure serum electrolytes
C. perform a renal biopsy
D. repeat the urinalysis in 3 months
E. schedule renal ultrasonography
26 2 weeks after recovering from tonsillitis an 8-year-old boy developed edemas of face and
lower limbs. Objectively: the patient is in grave condition, BP - 120/80 mm Hg. Urine is of
dark brown color. Oliguria is present. On urine analysis: specific gravity - 1,015, protein 1,2 g/l, RBCs are leached and cover the whole vision field, granular casts - 1-2 in the vision
field, salts are represented by urates (large quantity). What is the most likely diagnosis?
A. Acute glomerulonephritis with nephritic syndrome
B. Acute glomerulonephritis with nephrotic syndrome
C. Acute glomerulonephritis with nephrotic syndrome, hematuria and hypertension
D. Acute glomerulonephritis with isolated urinary syndrome
E. Nephrolithiasis
27 A 6-year-old boy had had a quinsy. 9 days later, there appeared edemata of the face,
extremities and trunk, general health condition deteriorated. Urine became turbid.
Objectively: expressive edemata, ascites. AP- 100/55 mm Hg, diuresis - 0,2 l of urine per
day. Results of the biochemical blood analysis: total protein - 50 g/l, cholesterol - 11,28
mmol/l, urea - 7,15 mmol/l, creatinine - 0,08 mmol/l. Urinalysis results: leukocytes - 3-5 per
HPF, red blood cells are absent. What is the provisional diagnosis?
A. Acute glomerulonephritis
B.
C.
D.
E.
Acute pyelonephritis
Urolithiasis
Acute renal failure
Chronic glomerulonephritis
28 Routine examination of a child with a history of bronchial asthma reveals AP of 140/90mm
Hg. The most likely cause of the hypertension is:
A. Renal disease
B. Theophylline overdose
C. Chronic lung disease
D. Coarctation of the aorta
E. Obesity
29 A 18-year-old woman with a long history of chronic pyelonephritis complains about
considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. AP160/100 mm Hg. In blood: creatinine - 0,62 millimole/l, hypoproteinemia, albumines - 32
g/l, potassium - 6,8 millimole/l, hypochromic anemia, increased ESR. What is the first step
in the patient treatment tactics?
A. Haemodialysis
B. Antibacterial therapy
C. Enterosorption
D. Haemosorption
E. Blood transfusion
30 2 weeks after recovering from angina a 16-year-old patient noticed face edemata, weakness,
decreased work performance. There was gradual progress of dyspnea, edemata of the lower
extremities, lumbar spine. Objectively: pale skin, weakening of the heart sounds,
anasarca.AP- 160/100 mm Hg. In urine: the relative density - 1021, protein - 5 g/l,
erythrocytes - 20-30 in the field of vision, hyaline cylinders - 4-6 in the field of vision. What
is the most likely diagnosis?
A. Acute glomerulonephritis
B. Essential hypertension
C. Acute pyelonephritis
D. Infectious allergic myocarditis
E. Myxedema
31 A 7-year-old boy has been managed for a month. Immediately after hospitalization there
were apparent edemata, proteinuria - 7,1 g/l, daily urine protein - 4,2 g. Biochemical blood
test shows persistent hypoproteinemia (43,2 g/l), hypercholesterolemia (9,2 millimole/l).
The patient is most likely have the following type of glomerulonephritis:
A.
B.
C.
D.
E.
Nephrotic
Nephritic
Isolated urinary
Hematuric
Combined
32 A 15-years-old patient has chronic glomerulonephritis. Urine test reveals the following: the
relative density is 1010, protein - 1,65 g/l, RBCs - 5-7 in the field of vision, WBCs - 2-3 in
the field of vision. Blood creatinine - 0,350 millimole/l. Serum sodium - 148 millimole/l.
What is the main reason for hyperazotemia in this patient?
A. Reduction of glomerular filtration rate
B. Reduction of tubular reabsorption rate
C. Increased proteinuria
D. Reduction of renal blood flow
E. Sodium retention in the organism
33 A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory
examinations show acute condition. What nutrients must not be limited during the acute
period of glomerulonephritis?
A. Carbohydrates
B. Salt
C. Liquid
D. Proteins
E. Fats
34 3 weeks ago a patient was ill with tonsillitis. Clinical examination reveals edema, arterial
hypertension, hematuria, proteinuria (1,8 g/per day), granular and erythrocital casts. What is
the preliminary diagnosis?
A. Glomerulonephritis
B. Cystitis
C. Pyelonephritis
D. Intestinal nephritis
E. Renal amyloidosis
35 A 18 y.o. patient has been suffering from systematic scleroderma for 14 years. She was
repeatedly exposed to treatment in the in-patient department. Complains of periodical dull
cardiac pain, dyspnea, headache, eyelid edemata, weight loss, pain and deformation of
extremities joints. What organ’s lesion deteriorates the prognosis for the disease?
A. Kidneys
B. Heart
C. Lungs
D. Gastrointestinal tract
E. Skin and joints
36 A 7 y.o. boy has been treated in a hospital for a month. At the time of admission he had
evident edemata, proteinuria - 7,1 g/L, protein content in the daily urine - 4,2 g. Biochemical
blood analysis reveals permanent hypoproteinemia (43,2 g/L), hypercholesterolemia (9,2
mmol/L).What variant of glomerulonephritis is the most probable?
A. Nephrotic
B. Nephritic
C. Isolated urinary
D. Hematuric
E. Mixed
37 A13 year old patient has acute blood loss (erythrocytes - 2, 2•1012/l, Hb- 55 g/l), blood
group is A(II)Rh+. Accidentally the patient got transfusion of donor packed red blood cells
of AB(IV) Rh+ group. An hour later the patient became anxious, got abdominal and lumbar
pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature - 38,6oC. After catheterization of
urinary bladder 12 ml/h of dark-brown urine were obtained. What complication is it?
A. Acute renal insufficiency
B. Cardial shock
C. Allergic reaction to the donor red
38 blood cells
A. Citrate intoxication
B. Toxic infectious shock
39 A 8-year-old female presents to the emergency department with a seizure. On initial
evaluation, the patient appears to be post-ictal, but is otherwise okay. Initial vital signs are
significant for blood pressure of 180/110. She has never had a seizure before. On further
questioning, the patient s parents report that she had several episodes of coca-cola colored
urine a few days ago, and was seen by her doctor and given an antibiotic for presumed
urinary tract infection. Over the last few days prior to her presentation, she has been
complaining of headaches and ankle swelling. Otherwise the patient has been fine. She has
never been hospitalized, takes no medications, and she has no known allergies. She is in 3rd
grade, and plays soccer in a local league. She is very seldom ill, and with the exception of a
sore throat 2 weeks ago, she has had no other recent illnesses. CT of the head is normal.
What is the most likely diagnosis?
A. Post-infectious glomerulonephritis
B. Alport's syndrome
C. Goodpasture's syndrome
D. IgA nephropathy
E. Focal segmental glomerulonephritis
40 A patient complains about sudden onsets of paroxysmal pain in the right lumbar region. 2
hours after the onset the patient had hematuria. Plain radiograph of the lumbar region shows
no pathological shadows. USI reveals pyelocaliectasis on the right, the left kidney is normal.
What is the most likely diagnosis?
A. Renal colic
B. Acute appendicitis
C. Bowel volvulus
D. Torsion of the right ovary cyst
E. Right renal pelvis tumour
41 From urine of a 14-year-old boy with the exacerbation of secondary obstructive
pyelonephritis Pseudomonas aeruginosa was isolated with a titer of 1000000 microbes per 1
ml. Which antibiotic is most advisable to be administered in this case?
A. Ciprofloxacin
B. Ampicillin
C. Cefazolinum
D. Azithromycin
E. Chloramphenicol
42 A girl is 12-year-old. Yesterday she was overcooled. Now she is complaining on pain in
suprapubic area, frequent painful urination by small portions, temperature is 37,8C.
Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in f/vis,
RBC- 1-2 in f/vis. What diagnosis is the most probable?
A. Acute cystitis
B. Dysmetabolic nephropathy
C. Acute glomerulonephritis
D. Acute pyelonephritis
E. Urolithiasis
43 A 18-year-old patient complains about difficult urination, sensation of incomplete urinary
bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance
revealed an oval well-defined hyperechogenic formation 2x3 cm large that was changing its
position during the examination. What conclusion can be made?
A. Concrement
B. Malignant tumour of the urinary bladder
C. Urinary bladder polyp
D. Prostate adenoma
E. Primary ureter tumour
44 A 11 y.o. girl has been suffering for 5 months from pain in lumbar region, low grade fever,
frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field
of sight, bacteriuria. Blood analysis: leukocytosis, increased ESR. What is the most probable
diagnosis?
A. Chronic pyelonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Acute pyelonephritis
E. Urolithiasis
45 An 11-year old girl was taken by an acute disease: she got pain in the lumbar region, nausea,
vomiting, frequent urination, body temperature 39oC. Objectively: the abdomen is soft,
painful on palpation in the lumbar region. Common urine analysis revealed considerable
leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Acute appendicitis
C. Chronic glomerulonephritis
D. Acute vulvovaginitis
E. Acute glomerulonephritis
46 A 12-year-old boy complains about intense lumbar pain irradiating to the inguinal area,
external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive
Pasternatsky’s symptom. Urine analysis revealed that RBCs and WBCs covered the total
field of microscope; the urine exhibited high protein concentration. These clinical
presentations were most likely caused by the following pathology:
A. Urolithiasis, renal colic
B. Cholelithiasis, biliary colic
C. Renal infarct
D. Intestinal obstruction
E. Osteochondrosis, acute radicular syndrome
47 A 15 year old girl suddenly got arthralgia, headache, nausea, vomiting; pain and muscle
tension in the lumbar area; body temperature rose up to 38 −39oC. Pasternatsky’s symptom
was distinctly positive on the right. In the urine: bacteriuria, pyuria. What is the most
probable diagnosis?
A. Acute pyelonephritis
B. Renal colic
C. Acute glomerulonephritis
D. Pararenal abscess
E. Cystitis
48 A 12 year old female patient complains about frequent and painful urination, urge to urinate
at night, enuresis, pain in the suprapubic and lumbar area. Her urine often has beer
colouring. She got married a month ago. Objectively: general state is satisfactory. Lung
examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate is 78/min,
AP- 128/68 mm Hg. Abdomen is soft, painful in the suprapubic area. Urine contains 12-18
erythrocytes and 12-15 bacteria within eyeshot. What is the most probable diagnosis?
A. Infection of inferior urinary tracts - cystitis
B. Urolithiasis
C. Infection of superior urinary tracts - pyelonephritis
D. Gonorrhoea
E. Primary syphilis
49 A 16 y.o. patient complains of colicky pain in the right lumbar region that is irradiating to
the lower part of abdomen, nausea. She didn’t have such pains before. Survey radiograph of
abdominal cavity organs didn’t reveal any pathological stains. Ultrasonic sonogram revealed
in the enlarged right renal pelvis a hyperechoic mass approximately 1,5 cm large that gives
rise to an "ultrasonic track". What is the most probable diagnosis?
A. Renal calculus
B. Benign tumor of kidney
C. Renal cyst
D. Renal tuberculosis
E. Malignant tumor of kidney
50 A 14 y.o. girl critically ill. The illness is presented by high fever, chills, sweating, aching
pain in lumbar area, discomfort during urination and frequent voiding. Pasternatsky’s sign is
positive in both sides. On lab examination: WBC- 20∗109/L; on urine analysis: protein 0,6g/L, leukocyturia, bacteriuria. Your preliminary diagnosis.
A. Acute pyelonephritis
B. Exacerbation of chronic pyelonephritis
C. Acute glomerulonephritis
D. Acute cystitis
E. Nephrolithiasis
51 A girl is 12 y.o. Yesterday she was overcooled. Now she is complaining on pain in
suprapubic area, frequent painful urination by small portions, temperature is 37,8C.
Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in f/vis,
RBC- 1-2 in f/vis.What diagnosis is the most probable?
A. Acute cystitis
B. Dysmetabolic nephropathy
C. Acute glomerulonephritis
D. Acute pyelonephritis
E. Urolithiasis
52 The girl is 12 y.o. Yesterday she was overcooled. Now she complains on pain in suprapubic
area, frequent painful urination by small portions, temperature is 37,80C. Pasternatsky
symptom is negative. Urinalysis: protein- 0,033 g/L, WBC– 20-25 in f/vis, RBC– 1-2 in
f/vis. What diagnosis is most probable?
53 acute cystitis
54 acute pyelonephritis
55 urolithiasis
56 acute glomerulonephritis
57 dysmetabolic nephropathy
58 Which imaging procedure must be done to a child with urinary tract infection than is already
treated
59 abdominal ultrasound + retrograde cystogram
60 abdominal ultrasound
61 computer tomography
62 retrograde cystograme
63 IVP
64
65
66
67
68
69
Which of following is true concerning urinary tract infection in children:
is often asymptomatic
a single episode is in acceptable indication for ultrasound or micturating cystogram
likelihood or renal scarring is less if it occurs after 8 years of age
successphul surgical relief of obstruction will prevent complications in future
is usually associated with proteinuria
70 A 15-year-old football player finishes a routine practice and becomes concerned when he
notices painless, dark red urine that evening. He has no other symptoms. You see him that
night in the emergency department. Vital signs and physical examination results are normal.
A.
B.
C.
D.
E.
A urinalysis reveals: specific gravity, 1.020; pH, 6.0; 3+ blood; negative protein; 10 to 25
red blood cells; and 0 to 2 white blood cells. Abdominal ultrasonography reveals an enlarged
right kidney with hydronephrosis and normal left kidney. Of the following, the MOST likely
cause of the gross hematuria is
reflux nephropathy
acute glomerulonephritis
renal stone
renal tumor
ureteropelvic junction obstruction
71 Soon after birth, a term infant develops severe respiratory distress requiring assisted
mechanical ventilation. Prenatal ultrasonography at 20 weeks' gestation revealed markedly
enlarged kidneys, oligohydramnios, and minimal bladder fluid. Postnatal ultrasonography
reveals bilaterally enlarged kidneys with diffuse increased echogenicity, but no visible cysts.
You suspect the child has autosomal recessive polycystic kidney disease (ARPKD). Of the
following, the MOST common associated anomaly of ARPKD in infants is
A. urinary tract infections
B. hepatic fibrosis
C. pancreatic cysts
D. cerebral aneurysms
E. urolithiasis
72 You palpate an abdominal mass in a newborn. Abdominal ultrasonography reveals a normal
right kidney, but an enlarged left kidney with multiple, noncommunicating cysts. There is
thin renal parenchyma in the left kidney, which is markedly echogenic. The radiologist
suspects a left renal multicystic kidney with dysplasia. A renal scan reveals no function in
the left kidney. Of the following, your BEST initial step is to obtain
A. voiding cystourethrography
B. abdominal magnetic resonance angiography
C. intravenous pyelography
D. renal scintigraphy (scan)
E. abdominal computed tomography
73 The mother of a 7-year-old girl is concerned because her daughter has intermittent daytime
and nighttime wetting. She was toilet trained by the age of 3.5 years, but the enuresis has
been present for several years. The child is developing along the 75th percentile for height
and weight. The mother has withheld liquids after 6:00 PM each night, with subsequent
slight improvement during the night but continued wetting during the day. Results of a
urinalysis and urine culture are negative, and renal ultrasonography and serum electrolyte
measurements are normal. Of the following, the BEST course of management is to
A. prescribe oxybutynin
B. perform voiding cystourethrography
C. prescribe prophylactic antibiotics
D. refer for psychotherapy
E. wait 6 months and re-evaluate
74 A healthy 14-year-old girl complains of 3 days of pain at the initiation of urination and
increased urinary frequency with minimal hesitancy. She denies abdominal and flank pain
and is not sexually active. Findings on the physical examination include mild suprapubic
tenderness and Sexual Maturity Rating 4 genitalia. Urinalysis reveals 1+ nitrite, negative
protein, and 2+ blood. Microscopic examination of the urine documents 148 white cells per
A.
B.
C.
D.
E.
high-power field (hpf) and 46 red blood cells per hpf. Results of a urine pregnancy test are
negative. Of the following, the MOST appropriate initial treatment for this adolescent is a 3day regimen of
amoxicillin-clavulanate orally twice daily
ceftriaxone intramuscularly once daily
ciprofloxacin orally twice daily
gentamicin intramuscularly once daily
trimethoprim-sulfamethoxazole orally twice daily
75 A 3-year-old girl, whose brother has vesicoureteral reflux (VUR), has had voiding
cystourethrography (VCUG) performed because of the occasional familial incidence of
VUR. The study reveals no evidence of VUR, but it does document a narrowed urethra and
normal urine stream after bladder filling. You advise the child's parents that she needs
A. no further therapy
B. intravenous pyelography
C. prophylactic antibiotics
D. referral to urologist
E. repeat of the VCUG
76 The mother of a 9-year-old girl reports that her daughter is coming home after school with
wet panties. The amount of urine in the panties is about the same each day. This has been
occurring for several weeks, but never had occurred prior to these recent episodes. The
wetting only occurs during the day; the girl’s panties are dry in the morning. The girl reports
no other symptoms and claims to urinate about four to five times each day. Her height and
weight are normal for age, and the mother reports no recent changes in her daughter’s
weight. Of the following, the MOST likely cause of wetting for this girl is
A. overflow incontinence
B. Fanconi syndrome
C. diabetes mellitus
D. urinary tract infection
E. urine concentrating defect
77 You are asked to see a 5-year-old girl whose family moved into your neighborhood recently.
She is generally well, but the mother reports that the girl has had frequent urinary tract
infections and daily urinary incontinence. She was toilet trained by age 3 years, but the
wetting continues daily. Her vital signs are normal, but physical examination reveals no
urethral meatus and clear liquid in the vagina. Findings on urinalysis are normal. You
suspect she has an ectopic urethra. Of the following, the MOST common anomaly
associated with this condition is
A. vesicoureteral reflux
B. congenital heart disease
C. duodenal atresia
D. meningomyelocele
E. Chiari malformation
78 A 14-year-old girl presents to the emergency department with a 1-day history of severe,
colicky left flank pain that appears to be moving down to the inguinal region. She reports no
trauma. Her last menses occurred 3 weeks ago. The remainder of her past medical history is
normal. On physical examination, she is afebrile and has a blood pressure of 142/74 mm Hg.
Her urinalysis reveals a specific gravity of 1.015, pH of 6.0, and moderate blood.
Microscopic analysis of urine reveals 15 to 20 red blood cells and 5 to 10 white blood cells
per high-power field. The MOST likely cause of her symptoms is
A.
B.
C.
D.
E.
nephrolithiasis
appendicitis
acute pyelonephritis
ovarian cyst
pelvic inflammatory disease
79 A 7-year-old boy has had microscopic hematuria and back pain for 3 months. Renal
ultrasonography documents a 2-mm stone in the right renal pelvis. The only abnormality on
the 24-hour urine test is a calcium excretion rate of 6.7 mg/kg per day (normal, <4 mg/kg
per day). Of the following, the MOST appropriate treatment course, in addition to increased
fluids, is
A. furosemide
B. amiloride
C. no other therapy
D. spironolactone
E. thiazide diuretic
80 A 5-year-old girl has unexplained gross and microscopic hematuria. She has a normal
intravenous pyelogram as well as a normal ultrasound. All of her renal function tests are
normal. The presence of what urinary electrolyte abnormalities may indicate a future risk of
renal stone formation?
A. Hypercalciuria
B. Hypercalcemia
C. Hyperkaluria
D. Hyperphosphatemia
E. Hypocalciuria
81 A 2-year-old boy who has a history of poorly controlled seizures that are managed with a
ketogenic diet presents with increased fussiness and side pain. A urinalysis reveals: Specific
gravity 1.020; pH 6; 3+ketones; 2+blood; Negative for protein, glucose, nitrite, leukocyte
esterase; 5-10 RBCs/hpf; Fewer than 5 WBCs/hpf. Of the following, the MOST likely
associated urinary finding in this patient is
A. Hypercalciuria
B. Bacteruria
C. Cystinuria
D. Hemoglobinuria
E. Hyperoxaluria
82 A 7-year-old girl has a history of dysuria and foul smelling urine of 2 days duration. The
urinalysis shows: pH 8, specific gravity 1.025, 305 RBCs/HPF, 15-20 WBCs/HPF. Which
organism causing UTI is associated with an alkaline urine and may place the patient at risk
for struvite stone formation?
A. Proteus
B. Escherichia coli
C. Pseudomonas
D. Pneumococcus
E. Staphylococus saprofiticus
83 A 14-year-old boy presents for evaluation. A kidney stone passed spontaneously 2 weeks
ago. The patient feels well. An uncle also has kidney stones. The patient’s examination is
normal. Labs show sodium of 140 mEq/L, potassium of 3.2mEq/L, chloride of 116 and
bicarbonate of 14mEq/L. Creatinine is 0.8 and BUN is 14 mg/dl. Urine electrolytes are
sodium 40, potassium 36, and chloride of 75mEq/L. The urine pH is 6.5. Treatment should
focus on all of the following except:
A. Low calcium diet
B. Bicarbonate therapy
C. Diuretic therapy
D. High water intake
E. Potassium citrate therapy
84 A 5-year-old boy is referred to you because of frequent urinary tract infections. His parents
report that he has had at least seven UTIs. He has been treated each time at a local
emergency department with antibiotics, which provided almost immediate improvement. He
was toilet trained at age 4 years, but he has frequent daytime and nighttime wetting. Physical
examination reveals no abnormalities, although the boy’s height and weight are only at the
5th percentile, and the height of both parents is above the 50th percentile. He currently has a
fever with enuresis and dysuria. Urinalysis today reveals nitrites, leukocyte esterase +, and
25-50 WBC per hpf. You obtain a urine culture and order renal ultrasonography that reveals
bilateral hydronephrosis. A voiding cystourethrogram shows a dilated proximal urethra and
narrow distal urethra. His serum electrolyte levels are normal except for a serum creatinine
of 1.2 mg/dL (106.1 mcmol/L). After antibiotic treatment, his symptoms resolve and his
urinalysis is normal. Of the following, the next BEST step in the management of this child is
to
A. refer him immediately to a urologist
B. measure serum electrolytes and re-evaluate the boy in 6 months
C. initiate antibiotic prophylaxis
D. repeat the renal ultrasonography
E. repeat the urinalysis and urine culture
85 A 4-month-old boy presents to the emergency department with a fever of 2 days’ duration.
He has at least four wet diapers per day, but has frequent vomiting and occasional diarrhea.
He is able to take a bottle in the emergency department, but 30 minutes later he vomits most
of the feeding. He has a temperature of 103.2°F (39.6°C). There are no other abnormal
findings on physical examination. You obtain a complete blood count, blood culture, and a
catheterized specimen for urinalysis and urine culture. The urinalysis reveals 25 to 50 WBCs
per hpf., nitrites+, leukocyte esterase+. Of the following, the BEST management course is
A. Admission: Yes; antibiotics: Intravenous; renal ultrasonography: No; voiding
cystourethrography (once repeat urine culture is negative): In 6 weeks
B. Admission: No; antibiotics: Oral; renal ultrasonography: Yes; voiding cystourethrography
(once repeat urine culture is negative): In 6 weeks
C. Admission: Yes; antibiotics: Intravenous; renal ultrasonography: Yes; voiding
cystourethrography (once repeat urine culture is negative): In 1 week
D. Admission: No; antibiotics: Oral; renal ultrasonography: No; voiding cystourethrography
(once repeat urine culture is negative): In 6 weeks
E. Admission: No; antibiotics: Oral; renal ultrasonography: Yes; voiding cystourethrography
(once repeat urine culture is negative): In 1 week
86 A 16-year-old adolescent complains of intense lumbar pain irradiating to the inguinal area,
87 external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive
Pasternatsky’s symptom (costovertebral angle tenderness). Urine analysis revealed that
RBCs and WBCs covered the total field of microscope; the urine exhibited high protein
concentration. These clinical presentations were most likely caused by the following
pathology:
A. Urolithiasis, renal colic
B. Cholelithiasis, biliary colic
C. Renal infarct
D. Intestinal obstruction
E. Osteochondrosis, acute radicular syndrome
88 During preventive ultrasound scan of abdomen performed during regular checkup in a
school the following was revealed in an 11-year-old student of the 5th grade: the left kidney
is 3 cm below the normal position, its shape, size and structure are within the norm, the
contralateral kidney cannot be observed at its proper place. The preliminary diagnosis is as
follows: congenital anomaly of renal development, dystopic left kidney, right kidney is
absent or pelvic dystopic. What X-ray method would be required for making the final
diagnosis and determining the functional capacity of both kidneys?
A. Renal dynamic scintigraphy
B. Radioimmunoassay
C. Radionuclide renography
D. Thermography
E. Excretory urography
89 A 2-year-old child in a satisfactory condition periodically presents with moderate
proteinuria, microhematuria. US results: the left kidney is undetectable, the right one is
enlarged, there are signs of double pyelocaliceal system.What study is required to specify
the diagnosis?
A. Excretory urography
B. Micturating cystography
C. Retrograde urography
D. Doppler study of renal vessels
E. Radioisotope renal scan
90 A 17-year-old male patient complains of acute pain in his right side irradiating to the right
thigh and crotch. The patient claims also to have frequent urination with urine which
resembles a "meat slops" in color. The patient has no previous history of this condition.
There is costovertebral angle tenderness on the right (positive Pasternatsky’s symptom).
What is the most likely diagnosis?
A. Urolithiasis
B. Acute appendicitis
C. Acute pyelonephritis
D. Acute cholecystitis. Renal colic
E. Acute pancreatitis
91 A girl is 12-year-old. Yesterday she was overcooled. Now she is complaining on pain in
suprapubic area, frequent painful urination by small portions, temperature is 37,8C.
A.
B.
C.
D.
E.
Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in f/vis,
RBC- 1-2 in f/vis. What diagnosis is the most probable?
Acute cystitis
Dysmetabolic nephropathy
Acute glomerulonephritis
Acute pyelonephritis
Urolithiasis
92 A 18-year-old patient complains about difficult urination, sensation of incomplete urinary
bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance
revealed an oval well-defined hyperechogenic formation 2x3 cm large that was changing its
position during the examination. What conclusion can be made?
A. Concrement
B. Malignant tumour of the urinary bladder
C. Urinary bladder polyp
D. Prostate adenoma
E. Primary ureter tumour
93 A 11 y.o. girl has been suffering for 5 months from pain in lumbar region, low grade fever,
frequent urination. Urine analysis: moderate proteinuria, leukocytes occupy the whole field
of sight, bacteriuria. Blood analysis: leukocytosis, increased ESR. What is the most probable
diagnosis?
A. Chronic pyelonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Acute pyelonephritis
E. Urolithiasis
94 An 11-year old girl was taken by an acute disease: she got pain in the lumbar region, nausea,
vomiting, frequent urination, body temperature 39oC. Objectively: the abdomen is soft,
painful on palpation in the lumbar region. Common urine analysis revealed considerable
leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?
A. Acute pyelonephritis
B. Acute appendicitis
C. Chronic glomerulonephritis
D. Acute vulvovaginitis
E. Acute glomerulonephritis
95 A 15-year-old patient complains of burning and pain during urination, purulent discharges
from the urethra that turned up 2 days ago. Objectively: the urethral labia are edematic,
hyperemic, there are profuse purulent discharges from the urethra. Provisional diagnosis:
recent acute gonorrheal urethritis. What supplemental data of clinical examinations will
allow to specify the diagnosis?
A. Microscopy of the urethral discharges
B. Serological blood analysis
C. Common urine analysis
D. Coccal cells detection during discharge microscopy
E. Yeast cells detection during discharge microscopy
96 A 12-year-old boy complains about intense lumbar pain irradiating to the inguinal area,
external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive
Pasternatsky’s symptom. Urine analysis revealed that RBCs and WBCs covered the total
field of microscope; the urine exhibited high protein concentration. These clinical
presentations were most likely caused by the following pathology:
A. Urolithiasis, renal colic
B. Cholelithiasis, biliary colic
C. Renal infarct
D. Intestinal obstruction
E. Osteochondrosis, acute radicular syndrome
97 The most available and informative diagnostic method for closed trauma of the urinary
bladder is:
A. Retrograde cystography
B. Pelvic arteriography
C. Cystography
D. Sonography of the urinary bladder
E. Palpation and percussion of abdomen
98 A 15 year old girl suddenly got arthralgia, headache, nausea, vomiting; pain and muscle
tension in the lumbar area; body temperature 38 −39oC. Pasternatsky’s symptom was
distinctly positive on the right. In the urine: bacteriuria, pyuria. What is the most probable
diagnosis?
A. Acute pyelonephritis
B. Renal colic
C. Acute glomerulonephritis
D. Pararenal abscess
E. Cystitis
99 A 12 year old female patient complains about frequent and painful urination, urge to urinate
at night, enuresis, pain in the suprapubic and lumbar area. Her urine often has beer
colouring. She got married a month ago. Objectively: general state is satisfactory. Lung
examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate is 78/min,
AP- 128/68 mm Hg. Abdomen is soft, painful in the suprapubic area. Urine contains 12-18
erythrocytes and 12-15 bacteria within eyeshot. What is the most probable diagnosis?
A. Infection of inferior urinary tracts - cystitis
B. Urolithiasis
C. Infection of superior urinary tracts - pyelonephritis
D. Gonorrhoea
E. Primary syphilis
100 A 16 y.o. patient complains of colicky pain in the right lumbar region that is irradiating to
the lower part of abdomen, nausea. She didn’t have such pains before. Survey radiograph of
abdominal cavity organs didn’t reveal any pathological stains. Ultrasonic sonogram revealed
in the enlarged right renal pelvis a hyperechoic mass approximately 1,5 cm large that gives
rise to an "ultrasonic track". What is the most probable diagnosis?
A. Renal calculus
B. Benign tumor of kidney
C. Renal cyst
D. Renal tuberculosis
E. Malignant tumor of kidney
Module № 5
1. Which of the following developmental tests evaluates children from 0 to 6 years of age and involves gross motor,
fine motor-adaptive, language, and personal-social?
A. Denver II
B. CAT
C. CLAMS
D. B & C
E. DAT
2. What is the best indicator of future intellectual achievement?
A. Language
B. Fine motor-adaptive
C. Gross motor
D. Personal-social
E. Personal
3. At new-born in the 1th minute after birth: Respiratory rate (RR) - 26/min, Cardiac rate (CR)- 90/min, a low
myotonus. During sucking a catheter from a nose and mouth the child reacts a grimace, skin cyanochroic.
Auscultation: above the lungs hearding weaker vesicular breathing. Hearts sounds having a high volume. In 5
minutes: RR - 40/min, rhythmic, CR - 120/min, an acrocianousis, the low myotonus. What most reliable diagnosis?
A. Asphyxia of new-born
B. A borning trauma of new-born
C. Hemolitic illness of new-born
D. Hemorragic illness of new-born
E. Sepsis of new-born
4. What medication must be entered to the child, born by a caesarian section, in a state of asphyxia in default of the
independent breathing in the first minute of life?
A. Naloxonum hydrochloride
B. Ethimisolum
C. Caffeine-benzoate of sodium
D. Cordiaminum
E. Sodium bicarbonate
5. A development quotient below what level would constitute developmental delay?
A. 70
B. 90
C. 80
D. 100
E. 60
6. After birth there is a child pale, has the unrhythmic breathing which does not get better with insufflation of
oxygen. A pulse is weak and rapid, an arterial blood pressure is difficult to measure. Edema of extremities is not
present. What is the most credible reason of these symptoms?
A. Asphyxia
B. Stagnant heart failure
C. Intracraneal hemorrhage
D. Antenatal sepsis
E. Antenatal pneumonia
7. In new-born with an asphyxia at birth apnea and bradicardia (frequency of heart-throbs 70 /min) was marked,
artificial ventilation of lungs was immediately begun with 100% oxygen with the use of mask and AMBU-bag. In
30 seconds a cardiac rhythm did not change. What must a next step of reanimation measures be?
A. Indirect massage of heart
B. Haptic stimulation
C. Continue ventilation
D. Sodium hydrocarbonate intravenously
1
E. Epinephrinum intravenously
8. For the worn child who was born with winding around of umbilical cord round a neck on 1th mines of life total
cyanosys is marked, apnea, cardiac rate - 80 /min, hypomyotonia and areflexia. The signs of aspiration of
meconium are not present. After sanation of respiratory tracts breathing did not appear. Your next action?
A. Artificial lungs ventilation by means of mask with 100% О2
B. I.V. introduction of adrenalin
C. I.V. introduction of ethamsilate
D. Intubation of trachea and artificial lungs ventilation
E. Irritation of skin along a spine
9. New-born child was born in the term of gestation 38 weeks with mass of 3400 g, long 54 cm. Common state at
birth of middle degree, that conditioned by the asphyxia of middle degree. The independent breathing appeared
after realization of primary reanimation measures, frequency of heart-throbs 110/min, there is acrocyanosis. What
is the next action in this situation?
A. Additional oxygen.
B. Intubation of trachea.
C. Artificial massage of heart.
D. Suction mucus from the upper respiratory tract
E. Auxiliary ventilation of lungs.
10. A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby has a large
cephalohematoma. The results of blood count are: Hb- 120g/l, Er- 3,510*12, total serum bilirubin - 123 mmol/l,
direct bilirubin - 11 mmol/l, indirect - 112 mmol/l. What are causes of hyperbilirubinemia in this case?
A. Erythrocyte hemolysis
B. Intravascular hemolysis
C. Disturbance of the conjugative function of liver
D. Bile condensing
E. Mechanical obstruction of the bile outflow
11. Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of newborn due to Rhincompatibility was diagnosed. 2 hours later the infant has indirect serum bilirubin level is increasing up to 14
mmol/L. What is most appropriate for treatment of hyperbilirubinemia in this infant?
A. Exchange blood transfusion
B. Phototherapy
C. Phenobarbital
D. Intestinal sorbents
E. Infusion therapy
12. Which of the following intelligence quotients (IQs) would signify severely mentally retarded?
A. 30
B. 60
C. 45
D. 80
E. 10
13. A child is able to balance on one foot, can copy a cross, can catch a ball, can dress himself, and tells an
intelligible story to a stranger. How old is this child?
A. 4-years
B. 2-years
C. 3-years
D. year
E. 5-years
14. A child is able to discriminate the use of “mama” and “dada”, stands alone, cooperates with dressing, and
imitates actions. How old is this child?
A. 12-months
B. 24-months
C. 36-months
D. 6-months
E. 2-months
2
15. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) has following disorders. From beginning there
were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical excitation,
neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination reveals convergent
squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?
A. Encephalopathy due to hyperbilirubinemia
B. Skull injury
C. Brain tumour
D. Hydrocephalus
E. Spastic cerebral palsy
16. Apgar test has done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8 scores. During the
delivery there was a short-term difficulty with extraction of shoulder girdle. After birth the child had the proximal
extremity dysfunction and the arm couldn't be raised from the side. The shoulder was turned inwards, the elbow
was flexed, also were: forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?
A. Duchenne -Erb palsy
B. Trauma of thoracic spine
C. Right hand osteomyelitis
D. Intracranial haemorrhage
E. Trauma of right hand soft tissues
17. A neonate from gestation with severe gestosis of the second half was born on the 41st week with 2400 g birth
weight and 50cm long. On physical examination: skin is flaccid, subcutaneous fatty cellular tissue is thin, muscle
hypotonia, new-born period reflexes are decreased. Internal organs are without pathological changes. How would
you estimate this child?
A. Term infant with pre-natal growth retardation
B. Premature infant
C. Immature infant
D. Postmature infant
E. Term infant with normal body weight
18. A boy, aged 9, was examined: height - 127 cm (-0,36), weight - 28,2 kg (+0,96), chest circumference - 64,9 cm
(+0,66), lung vital capacity - 1520 ml (-0,16). What is the complex assessment of the child's physical development?
A. Harmonious
B. Disharmonious
C. Apparently disharmonious
D. Excessive
E. Below the average
19. A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the second
day jaundice had developed. On the 3th day appeared changes of neurologic status: nystagmus, Graefe's sign. Urea
is yellow, feces- golden-yellow. Mother's blood group is А(II) Rh-, child- А(II) Rh+. On the third day child's Hb200 g/L, RBC- 6,1*1012/L, bilirubin in the blood - 58 mk mol/L due to unconjugated bilirubin, Ht- 0,57. What is
the child's jaundice explanation?
A. Brain delivery trauma
B. Physiologic jaundice
C. Hemolytic disease of newborn
D. Bile ducts atresia
E. Fetal hepatitis
20. A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a cephalogematoma. On the 2nd day
there was jaundice, on the third the following changes in neurological status appeared: nystagmus, Graefe
syndrome. Urine was yellow, feces were of golden-yellow color. Mother's blood group is A (II) Rh-, the baby's one
- A (II) Rh+. On the third day the child's Hb was 200g/l, RBCs -6,1*1012/l, blood bilirubin - 58 micromole/l at the
expense of
unbound fraction. What caused the jaundice in the child?
A. Craniocerebral birth trauma
B. Physiological jaundice
C. Neonatal anaemia
D. Biliary atresia
E. Fetal hepatitis
3
21. A child was delivered severely premature. After the birth the child has RI symptoms, anasarca, fine bubbling
moist rales over the lower lobe of the right lung. Multiple skin extravasations, bloody foam from the mouth have
occurred after the 2 day. On chest X-ray: atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht0,45. What is the most probable diagnosis?
A. Edematous-hemorrhagic syndrome
B. Disseminated intravascular clotting syndrome
C. Pulmonary edema
D. Hyaline membrane disease
E. Congenital pneumonia
22. On the 3rd day of life a baby presented with haemorrhagic rash, bloody vomit, black stool. Examination
revealed anemia, extended coagulation time, hypoprothrombinemia, normal
thrombolytic rate. What is the
optimal therapeutic tactics?
A. Vitamin K
B. Sodium ethamsylate
C. Epsilon-aminocapronic acid
D. Fibrinogen
E. Calcium gluconate
23. A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is
4900 g. Evaluate the current weight of the child:
A. Corresponding to the age
B. 150 g less than necessary
C. Hypotrophy of the I grade
D. Hypotrophy of the II grade
E. Paratrophy of the I grade
24. On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points, presented with
jaundice. Indirect bilirubin of blood - was 80 micromole/l, 6 hours later - 160 micromole/l. What is the optimal
method of treatment?
A. Exchange blood transfusion
B. Phototherapy
C. Infusion therapy
D. Phenobarbital treatment
E. Enterosorbents
25. A child was born at a gestational age of 34 weeks in grave condition. The leading symptoms were respiratory
distress symptoms, namely sonorous and prolonged expiration, involving additional muscles into respiratory
process. The Silverman score at birth was 0 points, in 3 hours it was 3 points with clinical findings. Which
diagnostic study will allow diagnosing the form of pneumopathy?
A. X-ray of chest
B. Clinical blood test
C. Determination of blood gas composition
D. Proteinogram
E. Immunoassay
26. A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On examination the skin is
intensely red, elastic, with preserved turgor. Puerile respiration is present. Respiration rate - 40/min, cardiac sounds
are rhythmic, sonorous. HR - 138/min. The abdomen is soft. The liver extends 2 cm below the costal margin.
Diuresis is sufficient. Stool is in form of meconium. What is the most likely diagnosis?
A. Physiological erythema of the newborn
B. Toxic erythema of the newborn
C. Neonatal phlegmon
D. Erysipelas
E. Exfoliative Ritter's dermatitis
4
27. A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score - 8-10 points. What
is the optimum time for the first breast-feeding?
A. First 30 minutes
B. First 6 hours
C. First 24 hours
D. First 48 hours
E. After 48 hours
28. A 3-year-old child has been taken to a pediatrician. He has no recent history of any diseases. Objective
examination revealed no pathology of the internal organs. The child needs the routine immunization against the
following disease:
A. Poliomyelitis
B. Diphtheria and tetanus
C. Measles, rubella, parotitis
D. Pertussis
E. Type B hepatitis
29. A baby born after fast labour has palsy of hand muscles. Grasp reflex is absent, as well as hand-to-mouth reflex.
Hand sensitivity is absent. What is the most likely diagnosis?
A. Dejerine-Klumpke palsy
B. Duchenne-Erb's palsy
C. Total lesion of the brachial plexus
D. Muscle paresis
E. Bernard-Horner syndrome
30. A newborn (mother's I pregnancy) weighing 3500 g presents with jaundice, lethargy, reduced reflexes.
Objectively: second grade jaundice of skin with saffron tint, hepar - +2cm, spleen - +1 cm. Urine and feces are
yellow. Blood count: Hb- 100 g/l, RBCs - 3,2*1012/l, WBCs - 18,7*109/l, mother's blood type - 0(I) Rh(+), baby's
blood type - А(II) Rh(-), bilirubin - 170mmol/l, indirect fraction. ALT, AST rates are normal. What disease is the
child most likely to have?
A. Hemolytic disease of newborn, AB0-conflict
B. Perinatal hepatitis
C. Hemolytic disease of newborn, Rh-conflict
D. Biliary atresia
E. Physiologic jaundice
31. All the joints on the left elbow of a newborn are extended, the whole arm hangs vertically along the trunk with
the forearm pronated. Active movements in the elbow joint are absent but present in the shoulder joint. The hand is
flattened, atrophied, cold to the touch, hangs passively. Grasp reflex and hand-mouth reflex on the affected side are
missing. Haemogram values are normal. What is the most likely diagnosis?
A. Inferior distal obstetrical paralysis
B. Osteomyelitis
C. Proximal obstetrical paralysis
D. Complete obstetrical paralysis
E. Hypoxic-ischemic encephalopathy
32. A full-term newborn was born with body weight of 4000 g, body length of 57 cm. Reaction to the postnatal
check was absent. There was diffuse cyanosis, heart rate of 80/min. What resuscitation measures should be taken?
A. Start ALV with a mask
B. Give 100\% oxygen
C. Intubate the child and start ALV
D. Start tactile stimulation
E. Give an injection of naloxone
5
33. It has been shown that home apnea monitors do not decrease the likelihood of suddeninfant death syndrome
(SIDS). Which of the following is NOT a risk factor for SIDS?
A. Female gender
B. Prematurity
C. Low birth weight
D. Prone sleeping position
E. Intrauterine growth restriction (IUGR)
34. Which of the following is NOT true of attention deficit hyperactivity disorder (ADHD)?
A. Most of those affected as a child do not have persisting symptoms
B. Involves hyperactivity, inattention, and impulsivity
C. Requires information from parents and teachers using a scale such as the Conner Parent and Teacher Scales
D. Symptoms must be present for at least 6 months
E. Treatment may include drugs such as methylphenidate (Ritalin),dextroamphetamine (Dexedrine) and mixed
amphetamine salts (Adderall)
35. A child can roll in both directions, sits still, reaches with one hand, and babbles. How old is this child?
A. 6-months
B. 4-months
C. 2-months
D. 9-months
E. 12-months
36. Autism and Asperger syndrome are pervasive development disorders (PDD).Asperger is characterized by
intense interest in specific topics (e.g. dinosaurs) as well aswhich of the following?
A. Lack of abstract form understanding (e.g. sarcasm)
B. Lack of showing interest
C. Lack of emotional reciprocity
D. Lack of language ability
E. Lack of motor mannerisms and inflexibility to rituals
37. A newborn presents with an arm that is extended, internally rotated, and flexed at the wrist. Moro reflex of the
right arm is absent but right hand grasp is intact. Which of the following is most likely?
A. Erb palsy
B. Fractured clavicle
C. Klumpke palsy
D. Caput succedaneum
E. Cephalhematoma
38. Which of the following congenital infections presents with cataracts, “blueberry muffin” skin syndrome,
vertical bone striation, and patent ductus?
A. Rubella
B. Treponema pallidum
C. Toxoplasma gondii
D. Cytomegalovirus
E. Herpes simplex
39. Which of the following congenital infections is the most common and presents with skin vesicles or denuded
skin, keratoconjunctivitis, and seizures?
A. Herpes simplex
B. Treponema pallidum
C. Rubella
D. Cytomegalovirus
E. Toxoplasma gondii
6
40. What is the drug of choice for neonatal seizures?
A. Phenobarbital
B. Succinylcholine
C. Midazolam
D. Fentanyl
E. Rohypnol
41. A newborn with IUGR is born with microcephaly and mental retardation. Physical exam reveals mid-facial
hypoplasia, micrognathia, and a flattened philtrum. Which of the following did the mother likely use during
pregnancy?
A. Alcohol
B. Cocaine
C. Heroine
D. Methamphetamine
E. Marijuana
42. Which of the following is the term for bilateral lower extremity spasticity, which may be seen in cerebral palsy?
A. Diplegia
B. Hemiplegia
C. Quadriplegia
D. Seizure
E. Fractured clavicle
43. A child is bought in for neurologic screening after the mother finds him “blanking out” for a few seconds. She
says the boy will be talking, stop taking, and then pick back up at the same part of the sentence about 5 seconds
later. EEG during one of these episodes shows a characteristic 3-per-second spike and wave pattern. Which of the
following is most likely?
A. Petit mal seizure
B. Generalized seizure
C. Infantile spasm
D. Febrile seizure
E. Neonatal seizure
44. Hydrocephalus is most associated with:
A. Head size two standard deviations above mean (macrocephaly)
B. Head size two standard deviations below mean (microcephaly)
C. Head size one standard deviation below mean
D. Abnormally shaped head (craniosynostosis)
E. Head size one standard deviation above mean
45. A mother brings her 5-year-old son to your office in New Mexico for his regular health maintenance visit. A
quick review of the patient's chart reveals that he and his family a restrict vegans. Their house is very small, so all
the children spend a good deal of timeout side. The mother states that her son eats plenty of dark green vegetables
and iron-fortified grains. She does not believe in providing supplemental vitamins and minerals. This child is most
at risk for nutritional deficiency involving which of the following?
A. Vitamin D
B. Vitamin B12
C. Vitamin B6
D. Niacin
E. Riboflavin
46. A woman with a seizure disorder under medical management wants to conceive achild. Her risk of having a
child with a neural tube defect is greatest if her currentmedical regimen includes which of the following?
A. Carbamazepine
B. Phenytoin
C. Ethosuximide
D. Phenobarbital
E. Primidone
7
47. The mother of a 30-month-old boy is concerned that the child's speech is “garbled. ”The child uses “ma-ma”
and “da-da” appropriately. He uses about 30 other words, but most of them are mispronounced (for instance, “boo”
instead of “blue”). The boy's aunt, uncle, and cousins came to visit for a weekend and were unable to understand
more than half of what he said. Examination of the ears reveals normal canals with translucent, mobile tympanic
membranes, and visible landmarks. Which of the following evaluations for speech delay should be performed first?
A. Receptive language testing
B. Phonetic testing
C. Dysfluency evaluation
D. Tympanogram testing
E. Audiologic (hearing) assessment
48. A young couple is in your office for their prenatal visit, and you are discussing infant feeding. The father states
that he prefers that the mother breastfeed the baby. The mother is hesitant to commit to breastfeeding because she
plans on returning to full-time employment 6 weeks after the child is born. Neither her mother nor her sisters chose
to breastfeed. She is concerned that human breast milk may not provide all the nutrients that the child needs, and
she believes formula is a more complete nutritional source for infants. She is willing to consider exclusive
breastfeeding based on the American Academy of Pediatrics recommendation. If her baby is exclusively breastfed,
when should the child begin receiving oral vitamin D supplementation?
A. Within the first month of life
B. Never
C. Age 2 months
D. Age 4 months
E. Age 6 months
49. The mother of a 2-month-old infant brings her daughter to your office during the summer for her regular health
maintenance visit. The child is cared for by her maternal grandmother 3 days a week while the mother is at work.
The infant is exclusively fed a cow milk-based commercial formula when she is with the mother; the grandmother
believes that the child should also receive juice diluted with water due to the warm weather. Which of the following
represents the most appropriate dietary counseling regarding this infant's diet?
A. Formula-fed infants do not require any additional vitamin, mineral, caloric, or fluid supplement beyond their
formula for the first 6 months of life
B. Formula-fed infants at this age require glucose supplementation during thewarm months to maintain optimal
caloric intake
C. Formula-fed infants at this age require free water supplementation during warmmonths to maintain optimal
hydration
D. Dilution of this infant's formula with water or juice on the days that she is withthe maternal grandmother is
unnecessary but harmless
E. This infant should be switched to a soy protein-based formula
50. A parent brings her 12-week-old child to your office because he has a scaly facial rash. The boy was
exclusively breastfed for 8 weeks but was switched to commercial cow milk-based formula about a month ago
when his mother went back to work. She has been putting lotion on the rash, but it has not helped. The child's birth
weight was at the 50th percentile but has now dropped toward the 25th percentile line. The physical examination
reveals an eczematous rash over both cheeks. The stool is guaiac-positive but not grossly bloody. Based on the
history and physical examination, you suspect that the patient may be allergic to cow milk protein. Which of the
following is the best next step in the management of this patient?
A. Switch the patient from cow milk-based formula to a protein hydrolysate formula
B. Switch the patient from cow milk-based formula to whole cow's milk
C. Switch the patient from cow milk-based formula to soy formula
D. Recommend that the mother see her obstetrician about medication to help her begin lactating again
E. Begin parenteral alimentation to permit total bowel rest
51. A very tired mother brings her 6-week-old infant to your office because “he screams for hours and hours a day
and nothing makes him stop.” His parent describes the crying spells as occurring daily and lasting several hours,
usually through the late afternoon and early evening. Nothing seems to console the child during these episodes.
While he is crying, the infant often pulls his knees to his abdomen as if he is in pain. Other than the crying spells,
the child is asymptomatic. He feeds well and moves his bowels regularly. The child's weight, length, and head
circumference are normal, and his physical examination is normal. This patient's history and physical examination
are most consistent with which of the following conditions?
8
A. Colic
B. Feeding intolerance C
C. ow milk protein allergy
D. Intussusception
E. Hirschsprung disease
52. The child is 11 m.o. He suffers from nervous-arthritic diathesis. The increased synthesis of what acid is
pathogenic at nervous-arthritic diathesis?
A. Uric acid
B. Acetic acid
C. Phosphoric acid
D. Hydrochloric acid
E. Sulfuric acid
53. A mother with an infant visited the pediatrician for expertise advice. Her baby was born with body weight 3,2
kg and body length 50 cm. He is 1 year old now. How many teeth the baby should have?
A. 8
B. 10
C. 12
D. 20
E. 6
54. A mother consulted a pediatrician about her son. Her son was born with body mass of 3 kg and length of 48 cm.
He's 1 year old now. What is the required normal mass?
A. 10,5 kg
B. 9,0 kg
C. 11,0 kg
D. 12,0 kg
E. 15,0 kg
55. 6 m.o. infant was born with body's mass 3 kg and length 50 cm. He is given natural feeding. How many times
per day the infant should be fed?
A. 5
B. 7
C. 6
D. 8
E. 4
56. Infant is 6,5 months now and is given natural feeding since birth. Body mass was 3,5 kg, with length 52 cm at
birth. How many times per day the supplement (up feeding) should be given?
A. 2
B. 3
C. 1
D. 0
E. 4
57. A 2 month old healthy infant with good appetite is given artificial feeding since he turned 1 month old. When is
it recommended to start the corrective feeding (fruit juice)?
A. 4,0 months
B. 1,5 months
C. 2,0 months
D. 3,0 months
E. 1,0 months
9
58. An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years
old, suffers from rheumatic fever. Mother asked the doctor for a cardiac check up of the 3-year-old son. Where is
the left relative heart border located?
A. 1 cm left from the left medioclavicular line
B. 1 cm right from the left medioclavicular line
C. Along the left medioclavicular line
D. 1 cm left from he left parasternal line
E. 1 cm right from the left parasternal line
59. A full term infant was born after a normal pregnancy, delivery, however, was complicated by marginal
placental detachment. At 12 hours of age the child, although appearing to be in good health, passes a bloody
meconium stool. For determining the cause of the bleeding, which of the following diagnostic procedures should be
performed first?
A. Barium enema
B. An Apt test
C. Gastric lavage with normal saline
D. An upper gastrointestinal series
E. Platelet count, prothrombin time, and partial thromboplastin time
60. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following disorders. From
beginning there were severe jaundice with poor suckling, hypotomia and hypodynamia. Little bit later periodical
excitation, neonatal convulsions and neonatal primitive reflexes loss are noted. Now physical examination reveals
convergent squint, rotatory nystagmus and setting sun eye sign. How to explain this condition?
A. Encephalopathy due to hyperbilirubinemia
B. Skull injury
C. Brain tumour
D. Hydrocephalus
E. Spastic cerebral palsy
61. A full-term child survived antenatal and intranatal hypoxia, it was born in asphyxia (2-5 points on Apgar score).
After birth the child has progressing excitability, there are also vomiting, nystagmus, spasms, strabismus,
spontaneous Moro's and Babinsky's reflexes. What localization of intracranial hemorrhage is the most probable?
A. Subarachnoid hemorrhage
B. Small cerebral tissue hemorrhages
C. Subdural hemorrhage
D. Periventricular hemorrhages
E. Hemorrhages into the brain ventricles
62. A full-term neonate weighing 4500 g was born asphyxiated with Apgar score of 4-6 points. During the delivery
shoulder dystocia occurred. Neurologic assessment revealed non-focal neurologic symptoms, total flaccid paresis
of the upper extremities since the arm was atonic and pronated. Grasping, Babkin's and Moro's reflexes were
absent. What segments of spinal cord had been affected?
A. СV - ThI
B. СI - СII
C. СIII - СIV
D. ThI - ThV
E. ThVI – ThVІІ
63. A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score - 8-10
What is the optimum time for the first breast-feeding?
A. First 30 minutes
B. First 6 hours
C. First 24 hours
D. First 48 hours
E. After 48 hours
points.
10
64. A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On examination the skin is
intensely red, elastic, with preserved turgor. Puerile respiration is present. Respiration rate - 40/min, cardiac sounds
are rhythmic, sonorous. HR- 138/min. The abdomen is soft. The liver extends 2 cm below the costal margin.
Diuresis is sufficient. Stool is in form of meconium. What is the most likely diagnosis?
A. Physiological erythema of the newborn
B. Toxic erythema of the newborn
C. Neonatal phlegmon
D. Erysipelas
E. Exfoliative Ritter's dermatitis
65. A child was born at a gestational age of 34 weeks in grave condition. The leading symptoms were respiratory
distress symptoms, namely sonorous and prolonged expiration, involving additional muscles into respiratory
process. The Silverman score at birth was 0 points, in 3 hours it was 3 points with clinical findings. Which
diagnostic study will allow to diagnose the form of pneumopathy?
A. X-ray of chest
B. Clinical blood test
C. Determination of blood gas composition
D. Proteinogram
E. Immunoassay
66. On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points, presented with
jaundice. Indirect bilirubin of blood - was 80 micromol/l, 6 hours later - 160 micromole/l. What is the optimal
method of treatment?
A. Exchange blood transfusion
B. Phototherapy
C. Infusion therapy
D. Phenobarbital treatment
E. Enterosorbents
67. A 12-year-old boy was admitted to the hospital with complains of headache dizziness, palpitation. He has been
under outpatient observation for the increased arterial pressure for the last year. Since recently such attacks have
become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is
present. HR- 118/min, AP- 160/110 mm Hg. Blood test results: WBCs – 8,4 * 109/l, ESR – 19 mm/h. Blood
glucose – 8,9 mmol/l. What disease is the most likely cause of this crisis?
A. Pheochromocytoma
B. Essential hypertension
C. Secondary arterial hypertension
D. Acute glomerulonephritis
E. Diabetic glomerulosclerosis
68. A 12 year old boy complains of severe attack of heart palpitations, increased sweating and BP rising to 145/90.
From the history we known that child has been suffering from vegetovascular dystonia of pubertal period since 9
years old. The patient was diagnosed with sympathoadrenal attack. What medicine should be used for attack
reduction in this case?
A. Obsidan
B. Aminophylline
C. No-shpa
D. Nitroglycerine
E. Valeriana
69. A 12 year old patient was hospitalized to the surgical department with closed abdominal trauma after a fight at
school. In course of operation multiple ruptures of spleen and small intestine were revealed. BP is falling rapidly, it
is necessary to perform hemotransfusion. Who can specify the patient's blood group and rhesus compatibility?
A. A doctor of any speciality
B. A laboratory physician
C. A surgeon
D. A pediatrician
E. A hematologist
11
70. A 14 years-old-girl complaints about periodic nausea, dizziness, sweating, head pains, palpitation of the heart,
irritable, intolerance of journeys in a transport. She has been suffering from these symptoms during 6 months. For
this time three times the attacks of getting up of arterial pressure were marked to 130/90, it was accompanied
getting up of temperature to 37.5˚С, tachycardia, tremor, a feeling of fear. What is the most reliable diagnosis?
A. Vegetative disfunction
B. Pheochromocytoma
C. Congenital heart disease
D. Tumour of brain
E. Secondary arterial hypertension
71. A 15 years old girl complains of prolonged fever and nocturnal sweating, weakness, frequent herpetic
stomatitis. She has been losing weight for 9 kg during the last 4 months. From history we know that she had
irregular sexual relations during the last 2 years. On examination: enlargement of all groups of lymph nodes,
hepatolienal syndrom. In blood: WBC- 2, 8 ∗ 109/L. What is the most likely diagnosis?
A. HIV-infection
B. Lymphogranulomatosis
C. Infectious mononucleosis
D. Acute leukemia
E. Recurrent herpetic infection
72. A 14 y.o. boy has had four episodes of lost consciousness and attacks during the day. Patient is unconscious,
fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 3-5
minutes, ended by involuntary urination. What type of attack was observed in the boy?
A. Major epileptic seizure
B. Vegetatic crisis
C. Absence
D. Hysterical seizures
E. Tetanus
73. A 14 y.o. boy was hospitalized in the surgical department with complaints of acute pain in epigastric area,
repeated vomiting with bile. On examination: pale skin, acrocyanosis, pulse rate – 96-102 bpm. Breathing is
frequent, shallow. Abdominal muscles are tensed, positive Schotkin-Blumberg’s symptom. The child has been
suffering a stomach ulcer for last 2 years. What complication should be suspected?
A. Ulcer perforation
B. Ulcer penetration
C. Stenosis of the pylorus
D. Internal bleeding
E. Acute cholecystitis
74. A 14 years old patient with diagnosed liver cirrhosis as a result of untreated viral hepatitis C and liver failure
was admitted to the surgical department with symptoms of esophageal veins hemorrhage. It’s been the second
hemorrhage for the last year. After conservative treatment vomiting with blood stopped, general condition is better
and hemoglobin elevated from 65 g/L till 98 g/L. But profuse vomiting with blood occurred in 4 hours.
Hemoglobin decreased to 80,2 g/l then to 52,5 g/l. What is the tactics of treatment?
A. Urgent surgery
B. Deferred surgery
C. Conservative treatment
D. Conservative treatment with following surgery
E. Taylor’s treatment
75. Routine examination of a child with a history of bronchial asthma reveals BP of 145/85 mm Hg. The most
likely cause of the hypertension is:
A. Renal disease
B. Theophylline overdose
C. Chronic lung disease
D. Coarctation of the aorta
E. Obesity
12
76. A 15-year-old girl complains of recurrent vomiting, acute severe abdominal pain for the past 3 hours that
radiates to the anterior aspect of her right thigh. The girl does not have fever, dysuria, and anorexia. She is not
sexually active. Her last menstrual period was 2 weeks ago and was normal in duration. Urinalysis results are
normal, and a urine pregnancy test is negative. Based on the patient's signs and symptoms, the most appropriate
initial diagnostic study to obtain is:
A. Pelvic ultrasonography
B. Abdominal tomography
C. Abdominal radiography
D. Intravenous pyelography
E. Abdominal ultrasonography
77. A 15-year-old boy complains of presence of a small left scrotal mass. On palpation, the mass is somewhat illdefined, has the texture of a “bag of worms,” and is located superior to the testis. The testes are normal on palpation
and do not differ in size. When the patient is placed in the supine position, the mass disappears. Of the following,
the most appropriate management for this young man is to:
A. Refer him to an urologist
B. Monitor testicular size every 6 months
C. Perform a radionuclide scan of the testes
D. Advise no further evaluation or treatment
E. Treat him with azithromycin
78. A 15-year-old boy presents to the school health center after feeling a testicular mass while performing a
monthly self-examination. Of the following, males at highest risk for testicular cancer are those who have had:
A. Cryptorchidism
B. Anabolic steroid use
C. Gynecomastia
D. Mumps illness
E. Herpes infection
79. A 14-year-old girl complains of periodical paroxysmal lower abdominal pain for the past 2 months associated
with occasional nausea and bloating. She denies sexual vaginal discharge and dysuria. She has not started
menstruating. Of the following, the best next step in the evaluation of this adolescent girl is:
A. Computed tomography of the abdomen
B. General blood analysis
C. Irigraphy
D. Serum follicular stimulating hormone level
E. Urinalysis
80. A 15-year-old boy was hospitalized to the emergency department 30 minutes after school fight. He has got
multiple injuries, and closed blunt abdominal injury. Objectively: the skin is pale, HR –92/min, BP- 80/20 mm Hg.
Abdomen is tense, palpation causes severe pain, there is positive Blumberg’s sign. What is the treatment tactics of
choice?
A. Urgent diagostic laparotomy
B. Infusion therapy to stabilize blood pressure
C. Fracture immobilization, analgesia
D. Additional tests to specify the diagnosis
E. Computed tomography of the abdominal cavity
81. A 12-year-old with a medical history of haemophiliaa was admitted to a hospital after a road accident with
multiple fractures of extremities and pelvis bones. On examination: hematomes are forming on the injured areas.
The patient's condition is aggravating. BP is 80/40 mm Hg. What is the most expedient combination of infusion
medications for patient's treatment after administering polyglukine and saline?
A. Cryoprecipitate, packed red blood cells
B. Packed red blood cells
C. Fresh frozen plasma, glucose
D. Cryoprecipitate, albumin
E. Fresh frozen plasma
13
82. A 12-year-old girl comes to her family doctor with complains of sudden acute pain in the right epigastric area
after taking fatty food. What instrumental method of investigation is to be used on the first stage of examining the
patient?
A. Ultrasonic
B. Laparoscopy
C. Magnetic-resonance
D. Radionuclid
E. Laboratory
83. A 11-year-old girl was hospitalized with complains of weight loss, palpitations, heartaches, fatigue and sleep
disorders. On examination: thyroid gland hyperplasia ІІ-ІІІ degree, exophthalmus is revealed. What disorders of
hormones level are the most characteristic for this disease?
A. Increasing of the thyroxin and triiodothyronine level
B. Lowering of the triiodothyronine level
C. Increasing of the protein-bind iodine level
D. Lowering of the thyroxin level
E. Lowering of the thyroxin and triiodothyronine level
84. A 8-year-old girl fell ill a week ago after overcooling when there appeared pain in the abdomen and back pain,
fever up to 38.5°С. Urine analysis: leukocytes 35-45 per v/f, protein in urine is 0,48 g/L. Which of the following is
the most appropriate test for prescribing etiotropic treatment?
A. Urine culture
B. General blood analysis
C. Nechiporenko test
D. Cystography
E. Blood biochemistry
85. During physical examination of 9 year old boy the doctor heard heart murmurs and child was suspected with
mitral valve prolapse. What complementary instrumental method of examination should be applied for the
diagnosis confirmation?
A. Echocardiography
B. Computed tomography of the chest
C. Roentgenography of chest
D. ECG
E. Angiography of the heart
86. A 12 year old child has been suffing from vegetovascular dystonia of pubertal period for 5 years. She was
hospitalized to the emergency department with symptoms of sympathoadrenal atack. What medicine should be
used for attack reduction?
A. Obsidan
B. No-shpa
C. Magnesia sulfate
D. Corglicone
E. Enalapril
87. A 11 years old boy is allergic to insect bites. An hour ago he was twice attacked by bees as a result he had
severe anaphylactic shock. What is the most effective prophylaxis method in this case?
A. Desensibilisation by means of bee venom extract
B. Protective clothing
C. Prophylactic treatment with antihistamines
D. Limitation of outside staying during summer months
E. Prophylactic treatment with corticosteroid
14
88. A 11 y.o. boy has been suffering from acute glomerulonephritis for several years. As usual the first days of the
disease are accompanied by hypertensive syndrom. What is the role of angiotesin II in the pathogenesis of this
state?
A. Intensifies production and secretion of aldosterone
B. Increases renine level
C. Infibits deppresive action of prostaglandins
D. Increases heart output
E. Infibits production and secretion of aldosterone
89. A 12 years old girl complains of fatigue, frequent headache, dizziness, cardialgia, feeling of heatrbeating, pain
in the abdomen, tendency to constipation. Objectively: skin is moderately pale, hyperhidrosis of distal extremities,
red resistant dermographism. Heart rate is 64 beats / min, arrhythmias tones, short systolic murmur at the apex of
the heart. BP is 80/60 mmHg. ECG: bradyarrhythmia, disfunction of repolarization of ventricular myocardium.
Specify the most likely diagnosis:
A. Autonomic dysfunction syndrome
B. Non-rheumatic myocarditis
C. UPU
D. Mitral valve prolapse
E. Rheumatoid arthritis
90. A 12 years old child sometimes feels cardialgia, headache and heartbeat, which appear after physical and
emotional stress for the last year. Objectively: by physical and additional methods of examination of heart and lung
disease were not found. ECG - diffuse changes of myocard. Specify the most likely diagnosis:
A. Vegetative-vascular dysfunction
B. The infectious-allergic myocarditis
C. Endocarditis
D. Non-rheumatic myocarditis
E. Mitral valve prolapse
91. A 13 years old girl has been suffering from dizziness, pain in chest, headache for the last three months.
Objectively: pale skin with a marble figure, wet and cold hands. Pulse – 72 per min, blood pressure –145/95
mmHg. Heart sounds are muted. Limits of relative cardiac dullness are not changed. What is the most likely
diagnosis?
A. Vascular dystonia by hypertonic type
B. Esenstinal hypertension
C. Сhild rheumatic carditis
D. Vascular dystonia by hypotonic type
E. Secondary hypertension
92. A 14 years old boy complains of dizziness, pain in chest, headache, temperature rise to 38.5˚C, chills, vomiting,
numbness in the upper limbs, dry in mouth. Breathing is vesicular. Heart rate – 124 per minute. BP – 170/100
mm.Hg. Limits of the heart are not expanded. Strengthened an apical impulse. Heart tones are clean. The abdomen
is mild, painless. What is the preliminary diagnosis?
A. Sympathoadrenal crises
B. Vagoinsular crises
C. Asthmatic status
D. Panic attack
E. Vegetative-vascular dysfunction
93. A 14 years old boy was diagnosted with the arterial hypertension during a medical examination at school. The
child does not have any complaints. Physical development is middle. Blood pressure – 140/100 mm Hg. Renal
function is not changed. Urinary syndrome is non-avalible. The level of renin in plasma is increased. What form of
hypertension is observed in this case?
A. Renovascular hypertension
B. Renal hypertension
C. Endocrine hypertension
D. Vegetative-vascular dysfunction
E. Esenstinal hypertension
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94. A 12 years old girl has been suffering from fever, profuse sweating, pain in the joints and heart for last two
months. Objectively: on the thighs, buttock and back polymorphic rash and hemorrhages are observed, small
subcutaneous nodules along the vessels of the extremities. Three days ago she was developed the cerebral crises
with headache, vomiting, the presence of meningeal symptoms. BP 170/90 mm Hg. Art. What is the most likely
diagnosis?
A. Nodular nodosa
B. Systemic lupus erythematosus
C. Rheumatoid arthritis
D. Dermatomyositis
E. Esenstinal hypertension
95. A 13 years old child complains of headache, pain in chest, nasal bleeding, weakness. Objectively: pale skin,
hypotension, and hypotrophy of leg muscles. Blood pressure is on the hands – 140/90 mm.Hg, on feet – 55/35
mm.Hg. Cortisol of blood – 248 nmol/l. Complete blood count is normal. In the analysis of urine – no changes.
What is the cause of high blood pressure in a child?
A. Cortarctation of aortae
B. Primary hypertension
C. Endocrine hypertension
D. Vegetative-vascular dysfunction
E. Panic attack
96. A 13 years old boy was hospitalized to the nephrology department with complaints of red urine, facial swelling,
headache. On examination – blood pressure is 130/90 mm. In the analysis of urine: protein 2.2 g/l, red blood cells
on entire field of view. What is the most likely diagnosis?
A. Acute glomerulonephritis
B. Endocrine hypertension
C. Acute cystitis
D. Nephrolithiasis
E. Pyelonephritis
97. A 13 years old girl complains of intense bursting headaches after psycho-emotional stress, anxiety, fear, nausea,
tinnitus and paresthesia in the extremities. From the history it is known that one year ago she was diagnosed with
acute glomerulonephritis. BP is 160/110 mm Hg, left margin of the heart – on midclavicular line. HR – 89 per
minute. In the analysis of urine – protein is 1.2 g/l. What is the cause of the child's crisis?
A. Hypertension
B. Nephrolithiasis
C. Glomerulonephritis
D. Panic attacks
E. Vegetative-vascular dysfunction
98. A 14 year-old adolescent periodically develops attacks of feeling heart palpitations, heart pain and shortness of
breath. These signs are always accompanied by a sense of fear and anxiety. After the attack the child feels very
tired and sleepy. Blood pressure during an attack is 130/90 mm Hg. What is the most probable preliminary
diagnosis?
A. Vegetative-visceral dysfunction
B. Essential hypertension
C. Asthma attacks
D. Paroxysmal tachycardia
E. Panic attacks
99. A 13 year old girl comes to a doctor with complaints of poor night vision. Objectively: increased darkness
adaptation time, bitots spots on conjuctiva. The patients skin is dry, scales off, folliculitis signs of the face skin are
present. What is the cause of this disease?
A. Retinole deficit
B. Thiamine deficit
C. Omega-3 deficiency
D. Biotin deficit
E. Folic acid deficit
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100. A doctor examined a 14 years old boy who has been suffering from peptic ulcer and diagnosed an acute
bleeding of an intestine. What is the doctor's professional tactics in this situation?
A. The urgent hospitalization to the surgical department
B. Planned hospitalization to the surgical department
C. Aminocapronic acid intravenously
D. The urgent hospitalization to the terapeutic department
E. Planned hospitalization to the terapeutic department
101. A 12 years old boy complaines about rise of blood pressure up to 135/90 mm Hg, edema on his face and legs,
weakness. He fell ill two weeks after recovering from angina. Urinalysis data: protein of 0,9g/l, erythrocytes of 2025/field, leukocytes of 4-6/field, erythrocyte casts. What treatment should be initiated after confirming the
diagnosis?
A. Penicillin OS
B. Obsidan
C. Furosemide
D. Heparin
E. Dipyridamole
102. A6-year-old boy was delivered to a hospital with complains of pallor, weakness, a feeling of tightness behind
the sternum, lack of air, difficulty breathing, BP – 70/40 mmHg. This condition has developed in
30 minutes after the introduction of ampicillin for the treatment of acute tonsillitis. What should be a first aid?
A. Adrenalin
B. Dexamethasone
C. Atropine
D. Dimedrol
E. Cardiac glycosides
103. A 8 years old boy complaints of frequent headaches, nosebleeds, shortness of breath, coldness of the lower
extremities. On examination the disproportion of the body – the severity of the muscles of the shoulder girdle is
determined. The left border of the relative dullness of the heart is 1 cm to the outside of the mid-clavicular line,
auscultatory - systolic murmur on the entire surface of the heart, II tone accented. On palpation of the abdomen can
not determine the pulsation of the abdominal aorta. The doctor suspected coarctation of the aorta. What method of
examination should be conducted at first?
A. Measure blood pressure on the lower limbs
B. ECG
C. Chest X-ray
D. Aortic and aortic catheterization
E. Echocardiography
104. A 14 year old child suddenly developed a "piercing" headache, mainly in the temporomandibular and occipital
regions, nausea, vomiting, not connected with food intake, cardialgia, hearing loss, paresthesia. On ECG reduction
of segment S-T, negative tooth T is observed. What kind of condition can be suspected?
A. Hypertensive crisis
B. Vagoinsular crisis
C. Cardiogenic shock
D. Paralytic collapse
E. Acute vascular insufficiency
105. A 16 year-old adolescent complains of nausea, single vomiting, a throbbing headache in an occipital area, a
pain in heart. This condition has developed suddenly after emotional stress. The boy is overweight. Blood pressure
170/110 mm Hg. st., heart rate – 68 / min. What is most likely preliminary diagnosis?
A. Hypertensive crisis
B. Non-rheumatic carditis
C. Food poisoning
D. Meningitis
E. Stroke
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