BASES | EXAM PREPARATION | KROK | KROK 2
Hygiene Bases 2019 Krok 2 Explanations
By Neni Emmanuel
January 31, 2020
Krok 2 Hygiene and Ecology Bases 2019 with Highlights
and Explanations
The bellow material is aimed to improve the study and under standing of the
Krok 2 Hygiene Bases 2019 with the use of highlights for relevant key
works, links to relevant study materials, reference images and
explanations to individual questions aimed at making remembrance of
questions easier and also understanding of new questions for the upcoming
Step 2 exam.
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** Refer To Krok 2 Lab values Open table in new tab
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II. PEDIATRICS 2019 BASES KROK 2 EXPLANATIONS
1. A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis
showed the following: fat content 2 %, specific density- 1,040 g/cm3, acidity
21oT, reductase probe – weak positive. What way the product is to be used in?
What would you advise?
Apply For Portugal
Golden Visa
Smarter
A. *Sell but inform customers about milk quality
B. Write the product off for animal feeding
C. Utilize technically
D. Sell without limitations
E. Annihilate the product
Explanation:
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1. Quality criteria of milk (State standard of Ukraine 3662-97)
Criterion
Class standards
Extra
First
Second
Acidity, Terner degree (oT), not more than
16-17
19
20
Grade by ethanol
І
І
ІІ
300
500
3000
400
600
800
Mass part of dry substances, %, not less than 11.8
11.5
10.6
Solid fat-free residue, %, not less than
8
8
8
1.028-
1.028-
1.028-
1.033
1.033
1.033
3.2
3.2
2.5
Bacterial contamination, thousand/cm3, not
more than
Body cells content, thousand/cm3, not more
than
Relative mass of milk, g/cm3
Fat content, %, not less than
Comment: The soda, borax (used for hiding the high acidity), starch and flour
(to hide the removal of fat) presence is determined for detection of the milk
falsification.
Milk contains the following proximate principles:
1. Proteins: 3,5% of total weight, consisting of 3 % Caseinogen, 0,4 % Lact
albumen, and 0,1% Lacto-globulin. Milk proteins are of high biological
value. Cow’s milk is rich in casein, and human milk in Lactalbumi
2. Carbohydrates: The carbohydrate in all milks is lactose or milk sugar (4 to
5%). Human milk contains more lactose than cow’s milk
3. Fats:3,5 to 4 % in the form of glycerides in emulsified form. Milk fat is a
good source of vitamins A and D When milk is allowed to stand for
sometime, fat rises to the surface as cream. Chemically milk fat consists of
myristin, olein, palmitin and stearin.
4. Vitamins: It contains all the vitamins except vitamin E. In summer, cows, if
fed on grass, produce milk containing large amount of vitamins B, C and D.
But in winter, amount of vitamins A and D in milk is much reduced.
5. Mineral Salts: Phosphates and chlorides of calcium, potassium and
sodium. It is poor in iron.
2. Patient with thyrotoxicosis is in the 2-beds hospital ward of therapeutic
department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr.
Air temperature – 20oC, relative humidity 45%, air movement velocity 0,3 m/s,
light coefficient 1/5, noise level 30 dB. Make hygienic evaluation of the
conditions.
A. *Dis-comfortable micro-climate
B. Non-effective ventilation
C. Poor lighting
D. High level of noise
E. All conditions are OK
Explanation:
hyperthyroidism symptoms and signs
Excessive sweating.
Heat intolerance.
Increased bowel movements.
Tremor (usually fine shaking)
Nervousness, agitation, anxiety.
Rapid heart rate, palpitations, irregular heart rate.
Weight loss.
Fatigue, weakness.
Thyreotoxicosis patient need temperatures at about 16 – 18 degrees Celsius.
Area of 1 bed in the ward = 7m2
Ventilation rate is 2,5/h
Air temperature is 18 – 22 c
Relative humidity is 45%
Air movement velocity is 0,07 – 0.3 m/sec
light coefficient is 1:5 – 1:6
noise level constitutes day = 45 db
noise level constitutes night= 35 db
3. 33 y.o. woman works as the secretary. Her diet contains 150 g of protein
(including 100 g of animal protein), 200 g of fat, 200 g of carbohydrates. What
pathology can develop from this diet?
A. *Obesity
B. Schizophrenia
C. Paradontosis
D. Common cold
E. Uterine fibromyoma
Explanation:
Protein : Fat : Carbohydrates = 1 : 2 : 4
4. A military unit stopped for 3-day’s rest in inhabited locality after a long
march. The sanitary-epidemiological reconnaissance found several water
sources. It is necessary to choose the source complying with the hygienic
standards for potable water in the field
A. *Artesian well water
B. Spring water
C. River water
D. Rain water
E. Water from melted snow
Exp:
Artesian well water or Well water are the best option considering the population
would use this water too.
5. A boy, aged 9, is examined: height- 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 integrated assessment of the child’s physical development?
A. *Harmonious
B. Disharmonious
C. Markedly disharmonious
D. Excessive
E. Below the average
Exp:
In normal Harmonious growth the difference in sigma deviation should not be
more than 1 sigma.
6. Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic
department. The area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr.
Air temperature – 20o , relative humidity – 45%, air movement velocity – 0,3
m/s, light coefficient – 1/5, noise level – 30 dB. Do hygienic evaluation of the
conditions meet the standards?
A. *Dis-comfortable micro-climate
B. Non-effective ventilation
C. Poor lighting
D. High level of noise
E. All conditions meet the requirements
Exp: See 2
Thyreotoxicosis patient need temperatures at about 16 – 18 degrees Celsius.
7. A 15 year old adolescent was taken to the hospital with complaints of poor
night vision. Objectively: increased darkness adaptation time, Bitot’s spots on
conjunctiva. The patient’s 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. Biotin deficit
D. Folic acid deficit
E. Napthtochynones deficit
Exp:
Dark adaptation refers to the ability of the visual system, both rod and cone
mechanisms, to recover sensitivity after exposure to light.
Bitot’s spots. Bitot’s spots are the buildup of keratin located superficially in
the conjunctiva of human´s eyes. They can be oval, triangular or irregular in
shape. The spots are a sign of vitamin A deficiency and associated with drying
of the cornea
(Retinol Deficiency)
Vitamin A deficiency can result from inadequate intake, fat malabsorption, or
liver disorders. Deficiency impairs immunity and hematopoiesis and causes
rashes and typical ocular effects (eg, xerophthalmia, night blindness).
8. A mine-shaft is situated on the territory of homestead land, it is 20 m away
from the house, 10 m – from the toilet and m – from the neighbor’s house.
What is the smallest distance that, according to the sanitary code, should be
established between the well and the source of probable water pollution?
A. *30 m
B. 25 m
C. 20 m
D. 15 m
E. 10 m
Exp:
If the well is uphill from the source of pollution 20 m
While if the well is downhill from the source of pollution 50 m
9. A boy, aged 9, was examined: height -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
Exp:
In normal Harmonious growth the difference in sigma deviation should not be
more than 1 sigma.
10. During the medical examination a port crane operator complained of
dizziness, nausea, sense of pressure against tympanic membranes, tremor,
dyspnoea, cough. He works aloft, the work is connected with emotional stress.
Workers are affected by vibration (general and local), noise, ultrasound, microclimate that warms in summer and cools in winter. What factor are the worker’s
complaints connected with?
A. *Infra-sound
B. Noise
C. Vibration
D. Intensity of work
E. Altitude work
Explanation:
Infra-sound sound waves with frequencies below the lower limit of human
audibility
11. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%,
specific density – 1,04 g/cm3, acidity – 210Т, reductase probe – weak-positive.
What way is the product to be used in?
A. *Sell but inform customers about milk quality
B. Discard for animal feeding
C. Technical utilization
D. Sell without limitations
E. Do the product away
Expiation:
Quality criteria of milk (State standard of Ukraine 3662-97)
Criterion
Class standards
Extra
First
Second
Acidity, Terner degree, not more than
16-17
19
20
Grade by ethanol
І
І
ІІ
300
500
3000
400
600
800
Bacterial
contamination, thousand/cm3, not more
than
Body cells content,
thousand/cm3, not more than
Mass part of dry substances,
11.8
11.5
10.6
Solid fat-free residue, %, not less than
8
8
8
Relative mass of milk, g/cm3
1.028-1.033
1.028-1.033
1.028-1.033
Fat content, %, not less than
3.2
3.2
2.5
%, not less than
Comment: The soda, borax (used for hiding the high acidity), starch and flour (to hide the
removal of fat) presence is determined for detection of the milk falsification.
12. An anesthesiologist gives narcosis to the patient, he uses a non-reversive
contour. Anesthetic is halothane. Air temperature in the operation room is 21oc,
humidity 50%, level of noise 30 dB. What occupational hazard is the principal
one under these conditions?
A. *Air pollution with anesthetic
B. Improper occupational microclimate
C. High level of noise
D. Mental overfatigue
E. Compelled working pose
Explanation:
Area of 1 bed in the ward = 7m2
Ventilation rate is 2,5/h
Air temperature is 18 – 22 c
Relative humidity is 45%
Air movement velocity is 0,07 – 0.3 m/sec
light coefficient is 1:5 – 1:6
noise level constitutes day = 45 db
noise level constitutes night= 35 db
13. A 56 y.o. patient has worked at the aluminium plant over 20 years. Within 3
last years he has got loosening of teeth, bone and joint pains, piercing pains in
heart region, vomiting. The provisional diagnosis is:
A. *Fluorine intoxication
B. Mercury intoxication
C. Lead intoxication
D. Phosphorus intoxication
E. Manganese intoxication
14. The patient 25 y.o. was admitted on the 1st day of the disease with
complaints of double vision in the eyes, heavy breathing. The day before the
patient ate home-made mushrooms. On objective examination: paleness,
widened pupils, disorder of swallowing, bradycardia, constipation are marked.
What is the diagnosis?
A. *Botulism
B. Yersiniosis
C. Leptospirosis
D. Salmonellosis,
E. Gastrointestinal form Lambliasis
15.Medical examination of a man revealed “geographic tongue“. This microsymptom is the evidence of the following vitamin deficiency:
A. *Vitamins of B group
B. Vitamin A
C. Vitamin C
D. Vitamin D
E. Vitamin P P
Explanation:
Geographic Tongue. Geographic tongue (also known as benign migratory
glossitis) is an inflammatory disorder that usually appears on the top and sides
of the tongue. Typically, affected tongues have a bald, red area of varying
sizes that is surrounded, at least in part, by an irregular white border
16. The major repair of a hospital included renewal of color design of hospital
premises because it is of great psychological and aesthetical importance; and
so the walls of patient wards will be painted under consideration of:
A. *Windows orientation
B. Hospital profile
C. Diseases of patients who will be staying in these wards
D. Wall reflection coefficient
E. Creation of cozy atmosphere
Explanation:
Windows orientation affects the color case of light coming from the window
17. A 5 tons milk batch was sampled. The lab analysis revealed: fat content 2%,
specific density – 1,04 g/cm3, acidity – 210Т, reductase probe – weak-positive.
What way is the product to be used in?
A. *Sell but inform customers about milk quality
B. Discard for animal feeding
C. Technical utilization
D. Sell without limitations
E. Do the product away
18. A 25 year old patient was admitted on the 1st day of the disease with
complaints of double vision in the eyes, heavy breathing. The day before the
patient ate home-made mushrooms. On objective examination: paleness,
mydriatic pupils, difficult diglutition, bradycardia, constipation. What is the
diagnosis?
A. *Botulism
B. Yersiniosis
C. Leptospirosis
D. Salmonellosis, gastrointestinal form
E. Lambliasis
19. Study of actual diet of an adult revealed the following: proteins make up
16% of energy value of daily ration, fats – 25%, carbohydrates – 59%. Evaluate
compliance of protein, fat and carbohydrate share in the energy value of daily
ration with the recommended shares of these nutrients?
A. *Carbohydrate share is insufficient, there is excess of proteins
B. Fat share is insufficient
C. Carbohydrate share is insufficicent
D. Carbohydrate share is excessive
E. Nutrient content complies with the recommended shares of energy value
Explanation:
Protein : Fat : Carbohydrates = 1 : 2 : 4
20. During inspection of sanitary conditions of studying at a technical university
it was necessary to evaluate the visual regimen of students, who study from 9
a.m to 3 p.m. What index of natural light will be the most informative?
A. *Natural light coefficient
B. Light coefficient
C. Depth of study room
D. Time of the room insolation
E. Presence of mixed (superolateral) light
21. Preventive examination of an 11 year old boy helped to determine his
habitus type. It was established that the child’s shoulders were deviated and
brought forward, with forward flexion of head, the thorax was flattened,
abdomen was convex. The child’s backbone had signs of deepened cervical
and lumbar curvatures. What habitus is it?
A. *Kyphosis
B. Lordosis
C. Round-shouldered
D. Corrected
E. Normal
Explanation:
Kyphosis is an abnormally excessive convex curvature of the spine as it occurs
in the thoracic and sacral regions. Abnormal inward concave lordotic curving of
the cervical and lumbar regions of the spine is called lordosis
22. The student has the following devices: Geiger counter, Ebert counter,
Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to
assess air germ pollution?
A. *Krotov’s apparatus
B. Ebert’s counter
C. Geiger’s counter
D. Mischuk’s device
E. Ebert’s device
Explanation:
Geiger counter is an instrument used for detecting and measuring ionizing
radiation. Also known as a Geiger–Mueller counter (or Geiger–Müller counter),
it is widely used in applications such as radiation dosimetry, radiological
protection, experimental physics, and the nuclear industry.
Aspiration method. It is based on a shock action of an air jet about a surface
of a medium. Krotov’s apparatus is used for this purpose. It give us the
possibility to let pass 50 –100 L of air with a speed of 25 L per minute through
clinoid chink in the special glass above the open dish MPA.
23. Student В. lives in the canalized house in the flat with complete set of
sanitary equipment (WC, bath, shower, local water heater). How much water
consumption has he got?
A. *160-200 l
B. 10-15 l
C. 50-100 l
D. 300-400 l
E. 500 l
24. A patient complained about problems with pain and tactile sensitivity, pain
in the nail bones at the end of the working day. He works at a plant with
mechanical devices. What pathology can be suspected?
A. *Vibration disease
B. Caisson disease
C. Noise disease
D. Overwork symptoms
E. Hypovitaminosis of B1
Explanation:
Hand-arm vibration syndrome: A disorder resulting from prolonged exposure
to vibration, specifically to the hands and forearms while using vibrating tools.
Symptoms include numbness, tingling, and loss of nerve sensitivity. The pain,
tingling, and numbness in the arms, wrists and hands may interfere with sleep.
25. As a result of prophylactic medical examination a 35 year old woman was
diagnosed with alimentary and constitutive obesity of the III degree. It is known
from her anamnesis that the patient doesn’t observe rules of rational nutrition:
she often overeats, the last food intake is usually 10-15 minutes before going to
bed, prefers fattening and rich in carbohydrates food. What is the main
alimentary risk factor of obesity development?
A. *Energetic unprofitableness of nutrition
B. Excess of carbohydrates
C. Excess of fats
D. Lack of cellulose
E. Violation of dietary pattern
26. The amount of ultraviolet radiation dose was measured in minutes. What
device was applied for measurement of the biodose?
A. *Gorbachev’s biodosimeter
B. UV-meter
C. Actinometer
D. Radiometer
E. Catathermometer
27. An outbreak of food poisoning was recorded in an urban settlement. The
illness was diagnosed as botulism on the grounds of clinical presentations.
What foodstuffs should be chosen for analysis in the first place in order to
confirm the diagnosis?
A. *Tinned food
B. Potatoes
C. Pasteurized milk
D. Boiled meat
E.Cabbage
28. It is planned to make complete isolation boxes in the infectious department
in order to prevent nosocomial airborne infections. The boxes consist of a
tambour, a ward and a lock chamber. What structure should be also included in
a complete isolation box?
A. *Bathroom unit
B. Manipulation room
C. Doctor’s consulting room
D. Patient’s examination room
E. Nursing room
29. In order to study impact of micro-climate upon the human organism it is
necessary to make systematic observation of air temperature over 3 days.
Choose a device that will allow to make the most precise temperature records:
A. Thermograph
B. Alcohol thermometer
C. Mercury thermometer
D. August’s psychrometer
E. *Assmann psychrometer
Explanation:
Aspiration psychrometers determine the air temperature and humidity of the
ambient air. They consist of two thermometers, each inside a double tube for
minimizing radiative heating both by the direct sun and longwave radiation
exchange between thermometer and surrounding tube.
Thermograph
An instrument that produces a trace or image representing a record of the
varying temperature or infrared radiation over an area or during a period of
time.
Medical instrument that uses an infrared camera to reveal temperature
variations on the surface of the body. medical instrument –
instrument used in the practice of medicine.
thermograph – a thermometer that records temperature variations on a
graph as a function of time.
30. A plot of land with total area of 2,0 hectare was intended for building of a
hospital. The maximal capacity of the hospital will be:
A. *100 beds
B. 200 beds
C. 400 beds
D. 800 beds
E. Over 1000 beds
31. Bacterial analysis of air in a living space in winter period by means of
Krotov’s apparatus revealed that total number of microorganisms in 1m 3 of air
was 7200. What is the allowed number of microorganisms for the air to be
characterized as “pure”?
A. *Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
Explanation:
Total visible Count (TVC) is used for detrmination of total microbial
contamination.
TVC is the nmber of microbes in 1 ml of water, 1 g of soil or 1m3 air.
Airborne microorganisms Normal level (CFU/m3)
Clean air: < 4500
(winter)
Mesophilic bacteria
Clean air: < 1500
(winter)
Alpha Hemolytic
streptococci
Beta Hemolytic
streptococci
Clean air: < 36 (winter)
Clean air: < 16
(summer)
Contamination level
(CFU/m3)
Inpure air > 7000 (winter)
Inpure air > 2500
(summer)
Inpure air > 124 (winter)
Inpure air > 36 (summer)
Medium infestation: 550-
Yeast
770
Clean air: < 550
Molds
Maximum infestation >
770
Source of values
32. A patient who has been consuming refined foodstuffs for a long time
complains about headache, fatiguability, depression, insomnia, irritability.
Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles,
during walking the patient lands onto his heel first, then on the external edge of
foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes
of myocardium. There are also gastrointestinal disorders. What is the most
likely diagnosis?
A. *Hypovitaminosis B1
B. Hypovitaminosis B2
C. Hypovitaminosis B12
D. Hypovitaminosis B6
E. Hypovitaminosis B15
Explanation:
Vitamins Deficiencies,
(i) Lack of vitamin A results in xerophthalmia, Bitot’s spots, night blindness and
keratomalacia.
(ii) B Complex: Deficiency of Thiamine leads to beri beri. Niacin deficiency
results in pellagra.
Riboflavin deficiency symptoms are angular stomatitis, cheilosis, scrotal
dermatitis and corneal vascularisation.
Other B Complex eficiencies also result in glossitis, cheilosis and angular
stomatitis,
(iii) Vitamin C deficiency leads to scurvy, spongy bleeding gums, haemorrhages
in skin and other haemorrhages,
(iv) Vitamin D deficiency result in rickets and osteomalacia.
(v) Vitamin K deficiency leads to hypoprothrombinaemia, which further leads to
haemorrhages.
Thiamine deficiency
is a medical condition of low levels of thiamine (vitamin B1). A severe and
chronic form is known as beriberi. Dry beriberi affects the nervous system
resulting in numbness of the hands and feet, confusion, trouble moving the
legs, and pain.
Other names: Beriberi, vitamin B1 deficiency, t…
Symptoms: : Wet: Fast heart rate, shortness of …
Treatment: Thiamine supplementation
Causes: Not enough thiamine
33. A 44-year-old man has been working in Coke industry for 16 years. Dust
concentration at his workplace is 5-10 times higher than maximum permissible
concentration. Roentgenography of lungs revealed changes that are typical for
pneumoconiosis. What is the most probable type of pneumoconiosis in this
case?
A. *Anthracosis
B. Anthracosilicosis
C. Silicatosis
D. Asbestosis
E. Siderosis
Explanation:
Exposures to respirable coal mine dust should be limited to 1 mg/m3 as a timeweighted average concentration for up to a 10 hour day(MPC is 10
mg/m3) during a 40 hour work week;
Anthracosis (anthrac- meaning coal, carbon + -osis meaning condition) is
defined in Bioline as, “the asymptomatic, milder type of pneumoconiosis as
caused by the accumulation of carbon in the lungs due to repeated exposure to
air pollution or inhalation of smoke or coal dust particles”
Nasopharyngitis is commonly known as a cold. Doctors use the
term nasopharyngitis specifically to refer to swelling of the nasal passages
and the back of the throat. Your doctor may also refer to this as an upper
respiratory infection or rhinitis. A virus or bacteria can cause nasopharyngitis.
Byssinosis is a lung disease caused by prolonged inhalation of textile fibre
dust. It is an occupational lung disease that primarily affects workers in cotton
processing, hemp or flax industries. Other names for byssinosis include
Monday fever, brown lung disease, mill fever or cotton workers’ lung
Siderosis is the deposition of excess iron in body tissue. When used without
qualification, it usually refers to an environmental disease of the lung, also
known more specifically as pulmonary siderosis or Welder’s disease, which is
a form of pneumoconiosis.
Pulmonary talcosis is a pulmonary disorder caused by talc. It has been related
to silicosis resulting from inhalation of talc and silicates. It is also tied to heroin
use where talc might be used as an adulterant to increase weight and street
value.
34. Workers of a laboratory producing measuring devices (manometers,
thermometers etc) complain about a metallic taste in mouth, stomatitis,
dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac
activity. These presentations must have been caused by the intoxication with
the following substance:
A. *Mercury
B. Lead
C. Manganese
D. Toluol
E. Tetraethyl lead
Explanation:
Mercury is used in the production of thermometers
Symptoms
Mercury may affect the nervous system, leading to neurological symptoms
such as:
nervousness or anxiety
irritability or mood changes
numbness
memory problems
depression
physical tremors
As the levels of mercury in the body rise, more symptoms will appear. These
symptoms may vary depending on a person’s age and exposure levels. Adults
with mercury poisoning may experience symptoms such as:
muscle weakness
metallic taste in the mouth
nausea and vomiting
lack of motor skills or feeling uncoordinated
inability to feel in the hands, face, or other areas
changes in vision, hearing, or speech
difficulty breathing
difficulty walking or standing straight
35. Bacterial analysis of air in a living space in winter period by means of
Krotov’s apparatus revealed that total number of microorganisms in 1m 3 of air
was 7200. What is the permissible number of microorganisms for the air to be
characterized as “pure”?
A. *Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
Explanation:
See Question 31
36.A patient who has been consuming refined foodstuffs for a long time
complains about headache, fatiguability, depression, insomnia, irritability.
Objectively: muscle asthenia, pain and cramps in the gastrocnemius muscles,
during walking the patient lands onto his heel first, then on the external edge of
foot. Cardiovascular system exhibits tachycardia, hypoxia, dystrophic changes
of myocardium. There are also gastrointestinal disorders. What is the most
likely diagnosis?
A. *Hypovitaminosis B1
B. Hypovitaminosis B2
C. Hypovitaminosis B12
D. Hypovitaminosis B6
E. Hypovitaminosis B15
Explanation:
See Question 32
37.A 44-year-old man has been working in coke industry for 16 years. Dust
concentration at his workplace is 5-10 times higher than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical
for pneumoconiosis. What is the most probable type of pneumoconiosis in this
case?
A. *Anthracosis
B. Anthracosilicosis
C. Silicatosis
D. Asbestosis
E. Siderosis
Explanation:
See Question 33
38. A driver had been fixing a car in a closed garage and afterwards
complained about headache, dizziness, nausea, muscle asthenia, sleepiness.
Objectively: pulse and respiratory rate elevation, excitement, hypertension,
delirium of persecution. What is the most likely diagnosis?
A. *Intoxication with carbon oxide
B. Intoxication with ethyl gasoline
C. Posttraumatic encephalopathy
D. Hypertensive crisis
E. Asthenovegetative syndrome
Explanation:
Signs and symptoms of carbon monoxide poisoning may include:
Dull headache
Weakness
Dizziness
Nausea or vomiting
Shortness of breath
Confusion
Blurred vision
Loss of consciousness
39. The total area of a ward at the therapeutical department is 28 m2. What is
the maximum number of beds that can be exploited in this ward?
A. *4
B. 1
C. 2
D. 3
E. 5
Explanation:
Area for one bed in a ward is 7m2
40. A heat station working on solid fuel is located in a residential district. On
cloudy foggy days in December there was an increase in diseases with upper
airway affection and signs of general intoxication. There were also mortal cases
among the elderly people. What is the most likely factor that provoked toxic
effect?
A. *Suspended materials
B. High air humidity
C. Calm
D. Low air temperature
E. Temperature gradient
41. Workers of a laboratory producing measuring devices (manometers,
thermometers etc) complain about a metallic taste in mouth, stomatitis,
dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac
activity. These presentations must have been caused by the intoxication with
the following substance:
A. *Mercury
B. Lead
C. Manganese
D. Toluol
E. Tetraethyl lead
42. Examination of a 13-year-old boy reveals that his body length is 147 сm
(+2), body weight – 38 kg (+1,5), circumference of chest – 72 cm (+0,2).
Estimate the harmonicity of the child’s physical development:
A. *Disharmonious
B. Harmonious
C. Above the average
D. Sharply disharmonious
E. Supernormal
Examination:
In normal Harmonious growth the difference in sigma deviation should not be
more than 1 sigma.
Note: The difference in sigma deviation between chest and other params is >
+-1 thus Disharmonious.
43. Working conditions of a building company worker are characterized by
cooling micro-climate effect, silica-containing dust, caustic alkali (quicklime)
and noise. What medical expert should be the chief of the commission that
periodically examines the workers of the mentioned category?
A. *Therapeutist
B. Ophthalmologist
C. Neurologist
D. Dermatologist
E. Otolaryngologist
44. After treating a field with pesticides a machine operator presents with great
weakness, headache, nausea, vomiting, diarrhea, visual impairment, watery
eyes. Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle
fibrillation of tongue and eyelids are observed. Pupils are narrowed, there is
tachycardia, lung auscultation reveals moist small and medium bubbling rales.
In blood: changed level of cholinesterase activity. What is the most likely
diagnosis?
A. *Intoxication with organophosphorous pesticides
B. Intoxication with organochlorine pesticides
C. Intoxication with organomercurial pesticides
D. Intoxication with arsenic-containing pesticides
E. Intoxication with carbamic acid derivatives
Explanation:
The effects of organophosphate poisoning on muscarinic receptors are
recalled using the mnemonic SLUDGEM (salivation, lacrimation, urination,
defecation, gastrointestinal motility, emesis, miosis) An additional mnemonic is
MUDDLES: miosis, urination, diarrhea, diaphoresis, lacrimation, excitation, and
salivation.
Hyperhidrosis (hi-pur-hi-DROE-sis) is abnormally excessive sweating that’s
not necessarily related to heat or exercise. You may sweat so much that it
soaks through your clothes or drips off your hands. Besides disrupting normal
daily activities, this type of heavy sweating can cause social anxiety and
embarrassment.
Early manifestations of poisoning by some organochlorine pesticides,
particularly DDT, are often sensory disturbances: hyperesthesia and
paresthesias of the face and extremities. Headache, dizziness, nausea,
vomiting, incoordination, tremor and mental confusion are also reported.
organomercurial: an organic compound or a pharmaceutical preparation
containing mercury.
Arsenic, a toxic element, is widely distributed in the environment. Accumulated
evidence shows that long-term exposure to arsenic is associated with cancers
of the skin, lung, bladder, liver and kidney. … Arsenic–based pesticides are
the best examples of agricultural applications of arsenic.
45. Educational rooms are illuminated with various lighting fittings. What type
of lighting fittings is the most appropriate in respect of hygienic norms?
A. *Indirect light fittings
B. Direct light fittings
C. Semi-reflected light fittings
D. Ambient light fittings
E. Combined light fittings
46. A student analyzes noise level of cold-pressing process. What device
should be applied for this hygienic study?
A. *Noise and vibration analyzer
B. Noise analyzer
C. Sound tester
D. Actinometer
E. Pyranometer
47. Environmental pollution is prevented by mechanical separation of nontoxic
solid domestic waste. Specify the method which can be used for mechanical
utilization of these wastes:
A. *Compressing of wastes into building blocks
B. Hydrolysis
C. Burning as power-plant fuel
D. Burial of wastes
E. Waste neutralization in biothermal boxes
48. It is required to analyze the level of daylight illumination in a ward of
therapeutics unit. What device should be applied to estimate the level of
daylight illumination?
A. *Illuminometer
B. Anemometer
C. Katathermometer
D. Actinometer
E. Psychrometer
Explanation:
Illuminometer: a photometer for measuring illumination usually by the
brightness of an illuminated surface.
Anemometer: an instrument for measuring the speed of the wind, or of any
current of gas.
Katathermometer: (plural kata thermometers) (measuring instrument) A
device consisting principally of an alcohol thermometer, used to measure air
cooling power and, indirectly, small wind speeds in circulating air, by measuring
the time taken for the temperature of the bulb of alcohol to make a specified
drop (100° to 95°F).
Actinometer: an instrument for measuring the intensity of radiation, especially
ultraviolet radiation.
Psychrometer: a hygrometer consisting of wet-bulb and dry-bulb
thermometers, the difference in the two thermometer readings being used to
determine atmospheric humidity.
49. While assessing the health status of graduates of a secondary school, the
doctor found one of them to have grade 3 tonsillar hypertrophy, chronic rhinitis
and vegetative-vascular dystonia. The organism functionality is reduced. This
student belongs to the following health group:
A. *III
B. II
C. I
D. IV
E. V
Examination:
Assessment of health state is the most important role of a physician, who
works with children and adolescents. It’s main importance lies in the fact, that
the formation of physical and psychological human health, organism’s
resistance to influence of unfavorable environmental factors and social
conditions takes place in childhood.
The following criteria of complex assessment of the children and adolescents h
ealth state
are used nowadays in everyday practice of sanitary doctors, doctors of general
education establishments, pediatricians, general practitioners and family
doctors:
Presence or absence of chronic diseases during examination;
Functional state of main systems of organism;
Level of organism resistance to unfavorable influence of environmental
factors;
Current level of nervous and psychological, and physical development, its
harmonicity.
According to listed above criteria, allocation scheme of children and
adolescents by health groups was elaborated. There are 5 health groups:
First health group includes healthy children and adolescents with harmonious
development and development level of organism functional systems
corresponding to the age.
Second health
group includes healthy children and adolescents who have functional and some
morphological deviations, low resistance to acute and chronic diseases, they
are ill frequently during long period of time.
Third health group includes children and adolescents suffering from chronic
diseases in compensation stage, with normal functional resources of organism.
Fourth health group includes children and adolescents suffering from chronic
diseases in sub-compensation stage with lowered functional resources of
organism.
Fifth health group includes children and adolescents suffering from chronic
diseases in decompensation stage with significantly lowered functional
resources of organism.
50. A military unit stopped for 3-day’s rest in an inhabited locality after a long
march. The sanitary-epidemiological reconnaissance found several water
sources. It is necessary to choose the source complying with the hygienic
standards for drinking water in the field conditions:
A. *Artesian well water
B. Spring water
C. River water
D. Rain water
E. Melt snow water
Explanation:
See question 4
51. At the radiological unit of a hospital gamma-devices of radiotherapy of
“Agat” type and other closed sources of ionizing radiation are used for
treatment of malignant neoplasms. What measures are to be taken to protect
personnel during working with radioactive sources of such type?
A. *Reduction of working time and screening of the source
B. Capsulation of devices and organization of room ventilation
C. Screening of the source and the use of means of individual protection of
respiration organs
D. The increase of distance to the source and individual hygiene compliance
E. Systematical cleansing of surfaces from the radioactive contamination and
shortening of working time
52. A 36-year-old female patient complains of bruises on the body, gingival
hemorrhage, general weakness. A month ago she had a severe domestic
poisoning with some pesticide (the patient can not remember the name). She
has a 7-year record of working in contact with petroleum products, particularly
benzene. In blood: RBCs – 3, 2 · 1012/l, WBC’ – 2, 7 · 109/l, thrombocytes – 70 ·
109/l. What is the most likely pathology
A. *Benzene intoxication
B. Organophosphorus pesticide intoxication
C. Organochlorine pesticide Intoxication
D. Mercury-containing pesticide intoxi-cation
E. Chronic fatigue Syndrome
Explanation:
Immediate signs and symptoms of exposure to benzene
People who breathe in high levels of benzene may develop the following
signs and symptoms within minutes to several hours:
Drowsiness
Dizziness
Rapid or irregular heartbeat
Headaches
Tremors
Confusion
Unconsciousness
Death (at very high levels)
Eating foods or drinking beverages containing high levels of benzene can
cause the following symptoms within minutes to several hours:
Vomiting
Irritation of the stomach
Dizziness
Sleepiness
Convulsions
Rapid or irregular heartbeat
Death (at very high levels)
53. Among the inhabitants of a workmen’s settlement located near an industrial
plant the cases of nervous and endocrine system diseases as well as renal
diseases became more frequent. Blood analyses revealed a decrease in
sulfhydryl groups. These pathologies might have been caused by the following
substance released into the environment:
A. *Mercury
B. Cadmium
C. Boron
D. Chromium
E. Lead
54. It is required to analyze the level of daylight illumination in a ward of
therapeutics unit. What device should be applied to estimate the level of
daylight illumination?
A. *Illuminometer
B. Anemometer
C. Katathermometer
D. Actinometer
E. Psychrometer
Explanation:
See 48
55. During the medical examination at school the schoolchildren had to
undergo plantography. After the analysis of footprints platypodia was found in
30% of pupils. What is the percentage of the flatfoot isthmus?
A. *65%
B. 30%
C. 50%
D. 55%
E. 45%
Explanation:
Platypodia. It is one of the most frequent foot deformations in infants. The
term platypodia denotes deformity of all foot’s arches. Flattening of the
longitudinal foot arch is known as longitudinal platypodia, while flattening of
the transverse arch is called transverse platypodia.
56. Production areas of a greenhouse complex have the following micro-
climate parameters: air temperature – 42oC , humidity – 98%, air velocity –
0,05 mps, temperature of enclosing surfaces – 15oC . Characterize the microclimate of production areas:
A. *Overheated
B. Comfortable
C. Cooling
D. Uncomfortable
E. Satisfactory
57. Sanitary-veterinary examination of a cow carcass revealed measles
contamination (2-3 measles per 10 cm2). What tactics should be chosen in
respect of this meat consumption?
A. *The whole carcass should be technically disposed
B. Meat can be sold without any restricti-ons
C. The carcass should be used for the production of canned meat
D. Meat should be disinfected by boiling
E. Meat should be disinfected by freezing
58. During coal extraction in a mine the concentration of coal dust in the
working area is 450 mg/m3 (MPC is 10 mg/m3). What occupational respiratory
disease may develop in miners?
A. *Anthracosis
B. Allergic nasopharyngitis
C. Byssinosis
D. Siderosis
E. Talcosis
Explanation:
See Question 33
59. During a regular medical examination at a metallurgical plant 20% of
workers were found overweight (body weight was 5-14% higher than normal),
and had early signs of obesity (grade I-II) with Quetelet index from 26 to 30.
What products share must be reduced in the diet of this group of people in the
first place in order to normalize their body weight?
A. *Bakery products
B. Vegetables
C. Fruit
D. Milk and dairy products
E. Meat and fish products
60. In an urban settlement situated on the riverbank an outbreak of hepatitis A
was registered. The disease might have water origin. This assumption can be
confirmed by growth of the following indicators of water quality:
A. *Number of coli-phages
B. Escherichia coli index
C. Oxidability
D. Presence of benign leptospirosis pathogen
E. Index of fecal coli-forms
61. A patient complains of frequent, bulky, frothy stools with greenish mucus,
cramping pain in the umbilical region, abdominal murmur, body temperature at
the rate of 39oC . The patient associates the disease with consumption of softboiled eggs. What is the most likely pathogen?
A. *Salmonella
B. Yersinia
C. Shigella
D. Enteropathogenic E.Coli
E. Vibrio cholerae El Tor
62. A city somatic hospital with 300 beds consists of the main building whi-ch
houses the therapeutic and surgical departments. Several separate buildings
house the maternity, pediatric and radi-ologic departments that are connected
to the main building by underground walkways and above-ground covered
skybridges. Specify the building system of the hospital:
A. *Central-unit
B. Centralized
C. Decentralized
D. Free
E. Combined
63. Sanitary examination of the burns unit for adults revealed that 4-bed wards
had an area of 28 m2. What is the minimally required ward area for this
department?
A. *40 m2
B. 24 m2
C. 28 m2
D. 30 m2
E. 52 m2
Explanation:
7m3 for wards
10m3 in burns unit
64. In order to reduce weed growth on agricultural land, some herbicides have
been used for a long time. In terms of environmental stability these herbicides
are rated as stable. Specify the most likely route of their entry into the human
body:
A. *Soil-plants-humans
B. Soil-microorganisms-humans
C. Soil-animals-humans
D. Soil-protozoa-humans
E. Soil-insects-humans
65.6 people live in a modern flat with the total area of 60 m2. There are TVvideo equipment, radios, microwave ovens, computer. The residents of the flat
complain of bad health, occasional headaches, arrhythmia, conjunctivitis. What
is the most likely cause of this condition?
A. *Electromagnetic fields
B. Anthropotoxins
C. Carbon dioxide
D. Tetrachlor plumbum
E. Formaldehyde
66. A 45-year-old patient complains of fever up to 40oC , general weakness,
headache and spasmodic contraction of muscles in the region of a shinwound.
The patient got injured five days ago when tilling soil and didn’t seek medical
attention. What kind of wound infection can be suspected?
A. *Tetanus
B. Anthrax
C. Erysipelas
D. Gram-positive
E. Gram-negative
67. Survey radiograph of a 52-year-old worker of an agglomeration plant (28
years of experience, the concentration of metal dust is 22-37 mg/m3) shows
mildly pronounced interstitial fibrosis with diffused contrast well-defined small
nodular shadows. The patient has no complaints. Pulmonary function is not
compromised. What is the provisional diagnosis?
A. *Siderosis
B. Silicosis
C. Anthraco-silicatosis
D. Silicatosis
E. Anthracosis
Explanation:
See Question 33
Siderosis is the deposition of excess iron in body tissue. When used without
qualification, it usually refers to an environmental disease of the lung, also
known more specifically as pulmonary siderosis or Welder’s disease, which is
a form of pneumoconiosis.
The average total dust concentration (50 % value) varies in the region of 2.5
mg/m3, the 90 % value is about 16 mg/m3.
Siderosis Symptoms
Sensorineural hearing loss– This is the most common symptom
associated with superficial siderosis and its absence is rare.
Ataxia- The impairment of gait, which is the second most common
symptom.
Pyramidal signs- Various signs that indicate a condition of the pyramidal
tracts.
68. Study of natural illumination for a workplace in a secondary school
classroom revealed that the angle of sunlight incidence was 25o, window
opening angle – 3o , window-to-floor area ratio – 1:4, daylight ratio – 0,5%,
depth ratio – 2. What indicators do not meet hygienic standards?
A. *Daylight ratio
B. Window opening angle
C. Window-to-floor area ratio
D. Depth ratio
E. Angle of incidence
69. Bakers at bread production work in conditions of high temperature and high
heat radiation. What is used to increase the body’s resistance to the
unfavorable effects of these harmful work environment factors?
A. *Vitamin preparations
B. Milk
C. Pectin
D. Therapeutic and preventive diet № 1
E. Therapeutic and preventive diet number № 3
70. A 51-year-old female is a weaving factory worker with 15 years of service
record. During a regular preventive examination she complained of frequent
headaches, poor sleep, tingling in the heart, irritability, rapid fatigability, hearing
impairment. For years, the noise level has exceeded the maximum allowable
concentration by 10-15 dB. A year ago, the patient underwent a course of
treatment for essential hypertension. Specify the most likely diagnosis:
A. *Noise disease
B. Essential hypertension
C. Neurasthenia
D. Asthenic-vegetative syndrome
E. Arteriosclerotic encephalopathy
71. Some of the population of a city district have uneven teeth color. The
individuals have white spots, transverse brown stripes on the incisors.
Occurrence of these symptoms is associated with the quality of drinking water
from a deep well. Which of the following components of water can be the cause
of the disease?
A. *F
B. Ca
C. Mg
D. J
E. Fe
72. A city somatic hospital with 300 beds has a main building which houses the
therapeutic and surgical departments. Several separate buildings house the
maternity, pediatric and radiologic departments that are connected to the main
building by underground walkways and above-ground covered skybridges.
Specify the building system of the hospital:
A. *Central-unit
B. Centralized
C. Decentralized
D. Free
E. Combined
73. Carpathian region is characterized by permanently high (over 80%) air
humidity. In the cold season the population of this region feels very cold at
moderately low temperatures. This is due to an increase in the heat transfer by:
A. *Convection
B. Emission
C. Evaporation
D. Conduction
E. Radiation
Convection is the transfer of heat by the movement of a fluid (liquid or gas)
between areas of different temperature. Warm air is less dense than cold air,
and so convection currents can form in the presence of a temperature
gradient.
An emission is something that’s been released or emitted into the world. Car
exhaust, burps, and radio broadcasts are all examples of emissions.
Technically, an emission is anything that’s been released out into the open.
Evaporation is the process by which water changes from a liquid to a gas or
vapor. Evaporation is the primary pathway that water moves from the liquid
state back into the water cycle as atmospheric water vapor.
Conduction occurs when two object at different temperatures are in contact
with each other. Heat flows from the warmer to the cooler object until they are
both at the same temperature. Conduction is the movement of heat through a
substance by the collision of molecules.
74.A 12-year-old girls has minor functional and morphological abnormalities:
1,0 D myopia, reduced body resistance. The patient has no history of chronic
diseases. Over the last year, there were 4 cases of respiratory diseases. The
girl belongs to the following health group:
A. *II
B. I
C. III
D. IV
E. V
Explanation:
See 49
75. Evaluation results of sanitary and hygiene conditions in a 4-bed ward were
as follows: ward area – 30 m2, height – 3,2 m, temperature – 20oC , humidity –
55%, air velocity – 0,1 m/s, window-to-floor area ratio – 1:5, daylight ratio –
0,6%, concentration of carbon dioxide in the air – 0,1%. Which of the given
indicators does not meet hygienic requirements?
A. *Daylight ratio
B. Air velocity
C. Window-to-floor area ratio
D. Concentration of carbon dioxide in the air
E. Ward area
76. Maximum permissible concentration of carbon dioxide in the air is
considered to be a sanitary index of air purity in a classroom. What
concentration of carbon dioxide in the air is accepted as a permissible
maximum?
A. *0,1%
B. 0,05%
C. 0,15%
D. 0,2%
E. 0,3%
Explanation:
Normal levels of co2 in air is 0.07 to 0.1% for wards, classrooms, etc.
77. An 8-year-old boy during preventive examination was determined to have
changes in his spine curvature in frontal plane: the right shoulder is lowered
and flat, scapulae angles are of different height due to the right scapula being
shifted down. Waist triangles are pronounced on the both sides; longitudinal
muscles of the back form muscle cushion on the left. What type of posture is
detected in the child?
A. *Scoliotic
B. Kyphotic
C. Lordotic
D. Stooping
E. Corrected
78. When examining the parameters of desk natural lighting in a school class it
was determi-ned that: light angle is 25o , window angle is 3o , window-to-floor
area ratio is 1:4, daylight factor is 0,5%, and window-head-to-room-depth ratio
is 2. What parameter does not correspond to hygienic norms?
A. *Daylight factor
B. Window angle
C. Window-to-floor area ratio
D. Window-head-to-room-depth ratio
E. Light angle
79. Caries morbidity rate is 89% among resi-dents of a community. It is
determined that fluorine content in water is 0,1 mg/l. What preventive measures
should be taken?
A. *Water fluorination
B. Tooth brushing
C. Fluorine inhalations
D. Sealant application
E. Introduce more vegetables to the diet
Explanation:
Normal fluorine content in water should be 1 mg/L
80. In river-side urban community there was an outbreak of hepatitis type A
possibly spread by water. What indexes of river water quality can confirm this
theory?
A. *Coliphage number
B. Colibacillus index
C. Oxidability
D. Non-icteric leptospirosis agent
E. Fecal coliform bacteria index
81. For a long time to eradicate weeds on agricultural lands herbicides retaining
in envi-ronment have been used. Point out the most probable way of herbicides
reaching human organism from soil:
A. *Soil-plants-human
B. Soil-microorganisms-human
C. Soil-animals-human
D. Soil-protozoa-human
E. Soil-insects-human
82.Residents of an industrial community situated near a plant suffer from
increased morbidity rate caused by nervous and endocrine system conditions
and kidney diseases. Blood test: decrease of sulfhydric groups content in
blood. The pathologies developed can be caused by environment being
polluted by the following:
A. *Mercury
B. Cadmium
C. Boron
D. Chromium
E. Lead
Explanation:
Sulfhydryl groups are powerful blood antioxidants. In plasma they are mainly
present on proteins and in red blood cells (RBC) mainly present as glutathione.
83. A tractor driver with the record of service of 24 years has undergone
palestesiometry test (Vibration Sensitivity Measurement). Test revealed
increased vibration sensitivity threshold at the frequencies of 63-125-259 Hz
to 25 dB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold
stimulus test is positive, time of hand temperature restoration is 52 minutes.
Blanching at pressure symptom is positive and equals 21. Hypesthesia of upper
and lower limbs is observed and can be classified as “gloves”and “socks”
polyneuritic pattern. Make the provisional diagnosis.
A. *Vibration disease, I stage, caused by combined vibration
B. Vibration disease, I stage, caused by local vibration
C. Vibration disease, II stage, caused by combi-ned vibration
D. Vibration disease, II stage, caused by local vibration
E. Vibration disease, I stage, caused by general vibration
84. Survey radiograph of a 52-year-old worker of an agglomeration plant (28
years of experience, the concentration of metal dust is 22-37 mg/m3) shows
mildly pronounced interstitial fi-brosis with diffused contrast well-defined small
nodular shadows. The patient has no complaints. Pulmonary function is not
compromised. What is the provisional diagnosis?
A. *Siderosis
B. Silicosis
C. Anthraco-silicatosis
D. Silicatosis
E. Anthracosis
Explanation:
See Question 33 & 67
85. A 60-year-old man has a diet consisting of unvaried food staples: mostly
cereals, potato, pasta; few vegetables and little fats (especially animal fats).
During medical examination he complains of deterioration of his twilight vision.
This condition can be caused by lack of:
A. *Retinol
B. Amino acids
C. Fats
D. Calcium
E. Carbohydrates
86. Clinic of a research institute for occupational diseases examined a worker
who works at a concentration plant and diagnosed him with chronic dust
bronchitis. The case is investigated by a commission including the
representatives of: the plant, clinic, local SES, department of Social Insurance
Fund, trade union. According to the ”regulation on investigation of” , the
commission should be headed by the representative of the following authority:
A. *Local SES
B. Plant
C. Social Insurance Fund
D. Trade union
E. Clinic
87.Bacterial analysis of air in a living space in winter period by means of
Krotov’s apparatus revealed that total number of microorganisms in 1 m3 of air
was 7200. What is the allowed number of microorganisms for the air to be
characterized as ”pure”?
A. *Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
Explanation:
See Question 31
88. Caries morbidity rate is 89% among residents of a community. It is
determined that fluorine content in water is 0,1 mg/l. What preventive measures
should be taken?
A. *Water fluorination
B. Tooth brushing
C. Fluorine inhalations
D. Sealant application
E. Introduce more vegetables to the diet
89. Examination of a group of persons living on the same territory revealed the
following common symptoms: dark-yellow pigmentation of the tooth enamel,
diffuse osteoporosis of bone apparatus, ossification of ligaments and joints,
functional disorders of the central nervous system. This condition may be
caused by the excessive concentration of the following microelement in food or
drinking water:
A. *Fluorine
B. Copper
C. Nickel
D. Iodine
E. Cesium
Explanation:
Fluorine Toxicity
Excess fluorine can accumulate in teeth and bones, causing fluorosis. Drinking
water containing > 10 ppm is a common cause. Permanent teeth that develop
during high fluoride intake are most likely to be affected. Exposure must be
much greater to affect deciduous teeth.
Excess exposure to fluoride can lead to a bone disease known as skeletal
fluorosis. Over many years, this can result in pain and damage to bones and
joints. The bones may become hardened and less elastic, increasing the risk of
fractures
90. In a pre-school educational establishment the menu consists of the
following dishes: milk porridge from buckwheat, pasta with minced meat,
cucumber salad, kissel (thin berry jelly), rye bread. What dish should be
excluded from the menu?
A. *Pasta with minced meat
B. Milk porridge from buckwheat
C. Kissel (thin berry jelly)
D. Rye bread
E. Cucumber salad
91. During meat testing Trichinella was detected in diaphragm crura in one of
the two muscular tissue samples. What tactics should a doctor choose
regarding this meat?
A. *Technolgical disposal
B. Incineration
C. Boiling under 1,5 atmosphere
D. Preservation in 10% salt solution
E. Freezing under -12oC
92. After a lengthy march an army regiment has set camp for 3 days near a
settlement. Sanitary-hygienic investigation detected several water sources.
Choose the source that would satisfy the demands for potable water the most
under the given field conditions:
A. *Artesian well
B. Brook
C. River
D. Rain water
E. Melt water
93. A planner designs a heating system for a pre-school educational
establishment. The highest air temperature should be in the following room:
A. *Game room of a nursery group
B. Common room of a preschool group
C. Bedroom of a nursery group
D. Bedroom of a preschool group
E. Gymnasium
94. An emergency situation at a chemical plant caused acute occupational
intoxication. A doctor who revealed the case of ”acute occupational disease
(intoxication)” must notify the following authority:
A. *Sanitary and epidemiological station
B. Plant administration
C. Trade union committee of the plant
D. Medical unit of the plant
E. Ministry of Public Health of Ukraine
95. The process of open-cut mining requires drilling and blasting operations,
rock and ore excavation, transportation of ore to fragmentation and sorting
factories and transportation of barren rock to slag-heaps, road building and
maintenance, repair works. What factor of production is most important for
miner’s health?
A. *High content of dust in the air
B. High content of explosion gas
C. Vibration
D. Noise
E. Adverse microclimate
96. Survey radiograph of a 52-year-old worker of an agglomeration plant (28
years of experience, the concentration of metal dust is 22-37 mg/m3 ) shows
mildly pronounced interstitial fibrosis with diffused contrast well-defined small
nodular shadows. The patient has no complaints. Pulmonary function is not
compromised. What is the provisional diagnosis?
A. *Siderosis
B. Silicosis
C. Anthraco-silicatosis
D. Silicatosis
E. Anthracosis
Explanation:
See Question 33 & 67
97. During medical examination of a group of children less than 4 years carried
out by a pediatric team in one of the African countries a set of similar
pathological signs was detected in some of the children. The signs are as
follows: growth inhibition, mental changes, muscle atrophy, swellings and
changes in hair and skin pigmentation. These children were diagnosed with
kwashiorkor. What food products should be added to the diet to treat this
disorder?
A. *Fish, vegetables, cereals
B. Milk, meat, vegetables
C. Vegetables, fruit
D. Cereals, fruit, berries
E. Poultry, fruit, berries
Explanation:
Bananas, fruit juice, meat, eggs, vegetables, and cereals are gradually
added to give a diet throughout most of the recovery period containing 5 to 7
g of protein and 130 to 150 cal.
98. What juice is recommended to be included in a complex drug and diet
therapy for patients suffering from gastric or duodenal ulcer and high acidity of
gastric juice to speed up ulcer healing?
A. *Potato, potato-carrot
B. Apple, apple-birch
C. Pumpkin
D. Cabbage, cabbage-carrot
E. Celery, parsley
99. Bacterial analysis of air in a living space in winter period by means of
Krotov’s apparatus revealed that total number of microorganisms in 1 m3 of air
was 7200. What is the allowed number of microorganisms for the air to be
characterized as “pure”?
A. *Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
Explanation:
See Question 31
100. When examining the parameters of desk natural lighting in a school class it
was determined that: light angle is 25o, window angle is 3o, window-to floor
area ratio is 1:4, daylight factor is 0,5%, and window-head-to-room-depth ratio
is 2. What parameter does not correspond to hygienic norms?
A. *Daylight factor
B. Window angle
C. Window-to-floor area ratio
D. Window-head-to-room-depth ratio
E. Light angle
101. A 46-year-old patient once took part in elimination of breakdown at an
atomic power plant. Currently he is being treated at an in- patient hospital unit.
He was diagnosed with progressing somatoform autonomic dysfunction. This
disease relates to the following group of ionizing radiation effects:
A. *Somato-stochastic
B. Somatic
C. Genetic
D. Hormesis
E. Heterosis
Explanation:
Somatic stochastic effects. These are late effects which occur at random with
no dose threshold. All stochastic effects are late but not all late effects
are stochastic. The probability of their occurrence increases with increase in
the absorbed dose but not their severity.
Vegetative symptoms are disturbances of a person’s functions necessary to
maintain life (vegetative functions). Vegetative symptoms in a patient with
typical depression include: Weight loss and anorexia (loss of appetite)
Insomnia. Fatigue and low energy.
BIOLOGIC EFFECTS OF IONIZING RADIATION
Determined
1. Somatic
acute radiation disease
chronic radiation disease
radiation combustion
alopecia – ray cataract
clinical registered disorders of hemopoiesis
temporary or constant sterility
2. Stochastic
Somato-stochastic
Genetic
cancerogenic effect
genetic mutation
teratogenic effect
chromosomal aberration
102. Caries morbidity rate is 89% among residents of a community. It is
determined that fluorine content in water is 0,1 mg/l. What preventive measures
should be taken?
A. *Water fluorination
B. Tooth brushing
C. Fluorine inhalations
D. Sealant application
E. Introduce more vegetables to the diet
103. Establishments participating in medical examinations include: medical and
preventive treatment facility, hygiene and preventive treatment facility,
sociomedical expert committees, Ministry of Defence medical committees,
Ministry of Domestic Affairs medical committees, forensic medicine agency,
etc. Specify what service deals with sociomedica assessment of temporary
disability:
A. *Medical and preventive treatment facility
B. Hygiene and preventive treatment facility
C. Sociomedical expert committees
D. Ministry of Defence medical committees
E. Ministry of Domestic Affairs medical committees
104. For a long time to eradicate weeds on agricultural lands herbicides
retaining in environment have been used. Point out the most probable way of
herbicides reaching human organism from soil:
A. *Soil-plants-human
B. Soil-microorganisms-human
C. Soil-animals-human
D. Soil-protozoa-human
E. Soil-insects-human
105. Residents of an industrial community situated near a plant suffer from
increased morbidity rate caused by nervous and endocrine system conditions
and kidney diseases.Blood test: decrease of sulfhydric groups content in blood.
The pathologies developed can be caused by environment being polluted by
the following:
A. *Mercury
B. Cadmium
C. Boron
D. Chromium
E. Lead
Explanation:
See 82
106. A tractor driver with the record of service of 24 years has undergone
palestesiometry test (Vibration Sensitivity Measurement).Test revealed
increased vibration sensitivity threshold at the frequencies of 63-125-259 Hz
to 25 DB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold
stimulus test is positive, time of hand temeperature restoration is 52 minutes.
Blanching at pressure symptom is positive and equals 21. Hypersthesia of
upper and lower limbs is observed and can be classified as “gloves” and
“socks” polyneuritic pattern. Make the provisional diagnosis.
A. *Vibration disease, I stage, caused by combined vibration
B. Vibration disease, I stage, caused by local vibration
C. Vibration disease, II stage, caused by combined vibration
D. Vibration disease, II stage, caused by local vibration
E. Vibration disease, I stage, caused by general vibration
107. ?During regular check-up the doctor examines a young woman, a student,
with height of 162 cm and weight of 59 kg. She complains that in the evening
she becomes unable to see clearly the objects around her. Objectively her skin
is dry, presents with hyperkeratosis. Her daily ration has the following vitamin
content: vitamin A – 0.5 mg, vitamin B1 – 2.0 mg, vitamin B2 – 2.5 mg, vitamin
B6 – 2 mg, vitamin C – 70 mg. Make the diagnosis:
A. B2 – hypovitaminosis
B. B6 – hypovitaminosis
C. C – hypovitaminosis
D. *A – hypovitaminosis
E. B1 – hypovitaminosis
Explanation:
See 32
FDA vitamins and minerals chart
The amount of vitamin A adults aged 19 to 64 need is: 0.7mg a day for men.
0.6mg a day for women.
Recommended daily allowance (RDA) of thiamin (Vitamin B1) taken by mouth
is 1.2 mg for males and 1.1 mg for females over the age of 18 years. Pregnant or
breastfeeding women of any age should consume 1.4 mg each day.
Among children and teens, the average daily riboflavin (Vitamin B2) intake
from foods is 1.8 mg for ages 2–5 years, 1.9 mg for ages 6–11, and 2.1 mg for
ages 12–19 [19]. In adults, the average daily riboflavin intake from foods is
2.5 mg in men and 1.8 mg in women.
The average vitamin B6 intake is about 1.5 mg/day in women and 2 mg/day in
men [1]. However, 11% of vitamin B6 supplement users and 24% of people in
the United States who do not take supplements containing vitamin B6 have
low plasma PLP concentrations (less than 20 nmol/L)
The amount of vitamin C you need each day depends on your age. Average
daily recommended amounts for different ages are listed below
in milligrams (mg).
Life Stage
Recommended Amount
Birth to 6 months
40 mg
Infants 7–12 months
50 mg
Children 1–3 years
15 mg
Children 4–8 years
25 mg
Children 9–13 years
45 mg
Teens 14–18 years (boys)
75 mg
Teens 14–18 years (girls)
65 mg
Adults (men)
90 mg
Adults (women)
75 mg
Pregnant teens
80 mg
Pregnant women
85 mg
Breastfeeding teens
115 mg
Breastfeeding women
120 mg
108. A population of a small town often presents with registered cases of
juvenile cardiomyopathy, atherosclerosis, hypertension, endocrinopathy,
chronic dermatitis and arthralgia – signs of Keshan disease. What is the mostly
likely cause of this pathology?
A. Excessive zinc in the environment
B. Strontium deficiency in the environment
C. *Selenium deficiency in the environment
D. Excessive iron in the environment
E. Excessive manganese in the environment
Explanation:
Selenium: An essential mineral that is a component of an antioxidant enzyme,
glutathione reductase, that is key in tissue respiration. Food sources
of selenium include seafoods; some meats, such as kidney and liver; and some
grains and seeds. … Deficiency of selenium causes Keshan disease.
The main symptom of Keshan disease is myocardial necrosis, leading to
weakening of the heart. Selenium deficiency also contributes to KashinBeck disease. Kashin-Beck disease results in atrophy, degeneration, and
necrosis of cartilage tissue in the joints.
Symptoms: Fatigue; Goitre; Hypothyroidism
109. 40 – 50 minutes after the completion of repair works conducted in closed
garage, with car engine running, the repair workers developed severe
headache in temporal area, nausea, tinnitus, vertigo, etc. These symptoms are
characteristic of acute poisoning with:
A. Aldehydes
B. Fluoride
C. Hydrogen sulfide
D. Organochloride
E. *Carbon monoxide
Explanation:
See Question 38
110. An excavator operator with 20 years of work experience at the opencast
ore mine undergoes regular medical examination. He presents with signs of
pneumoconiosis. What type of pneumoconiosis is the most likely in this case?
A. *Anthracosis
B. Silicatosis
C. Silicosis
D. Siderosis
E. Asbestosis
Explanation:
See Question 33
111. A group of 5 had been resting in a forest, they were drinking alcohol and
eating canned mushrooms and cured fish. The next day two of them were
hospitalized with disturbed vision, swallowing and respiration; the third one
presented with acute general weakness and dry mouth. The remaining two
were healthy. A tick was detected on the skin of one of the healthy group
members. What is the most likely diagnosis?
A. *Botulism
B. Tick- borne encephalitis
C. Lyme borreliosis
D. Mushroom poisoning
E. Alcohol poisoning
Explanation:
Signs and symptoms of food-borne botulism include:
Difficulty swallowing or speaking.
Dry mouth.
Facial weakness on both sides of the face.
Blurred or double vision.
Drooping eyelids.
Trouble breathing.
Nausea, vomiting and abdominal cramps.
Paralysis.
112. A man working in a casting of nonferrous metals and alloys for 12 years. In
the air of working area there was registered high content of heavy metals,
carbon monoxide, and nitrogen. During periodic health examination the patient
presents with asthenovegetative syndrome, sharp pains in the stomach,
constipations, pain in the hepatic area. In urine: aminolevulinic acid and
coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level.
Such intoxication is caused by:
A. Carbon monoxide
B. *Lead and lead salts
C. Nitric oxide
D. Zinc
E. Tin
Explanation:
The following are symptoms of lead poisoning in adults:
abdominal pain is usually the first sign if a high dose of lead is ingested.
raised blood pressure.
joint and muscle pain.
constipation.
anemia.
tingling, pain, and numbness in the extremities.
memory loss and decline in mental functions.
headache.
113. Caries morbidity rate is 89% among residents of a community. It is
determined that fluorine content in water is 0.1 mg/L. What preventive
measures should be taken?
A. Tooth brushing
B. Fluorine inhalations
C. Sealant application
D. *Water fluorination
E. Introduce more vegetables to the diet
Explanation:
Normal fluorine content in water should be 1 mg/L
114. During assessment of work conditions at the factory manufacturing
mercury thermometers, the content of mercury vapors in the air of the working
area is revealed to exceed the maximum concentration limit. Specify the main
pathway of human body exposure to mercury:
A. Intact skin
B. *Respiratory organs
C. Gastrointestinal tract
D. Damaged skin
E. Mucous tunics
115.Human body receives from the atmosphere a number of chemicals. What
type of action results in the combined effect that is less than the sum of
isolated effects of these chemicals on the body?
A. Synergistic action
B. Complex action
C. Isolated action
D. *Antagonism
E. Potentiation
116.A 38-year old woman works in the processing, she dries flax. She came to
the hospital complaining of difficult breathing, constricting sensation in her
chest, and cough attacks. These signs appear on the first day of her working
week and gradually diminish on the following days. What respiratory disease is
likely in this case?
A. *Byssinosis
B. Asthmatic bronchitis
C. Bronchial asthma
D. Allergic rhinopharyngitis
E. Silicosis
Explanation:
Carboconiosis is pneumoconiosis caused by inhalation of dust consisting of
carbonaceous dust, as anthracite cole, coke, graphite, soot
Berylliosis, or chronic beryllium disease (CBD), is a chronic allergic-type lung
response and chronic lung disease caused by exposure to beryllium and its
compounds, a form of beryllium poisoning.
Pneumoconiosis is the general term for a class of interstitial lung diseases
where inhalation of dust has caused interstitial fibrosis.
Byssinosis, is an occupational lung disease caused by exposure to cotton dust
in inadequately ventilated working environments.
Siderosis is the deposition of excess iron in body tissue. When used without
qualification, it usually refers to an environmental disease of the lung, also
known more specifically as pulmonary siderosis or Welder’s disease, which is
a form of pneumoconiosis.
117.A 9-month-old infant presents with delayed tooth eruption and fontanel
closure, weakness, and excessive sweating. What type of hypovitaminosis is
the most likely in this child?
A. Hypovitaminosis A
B. Hypovitaminosis B1
C. Hypovitaminosis B6
D. *Hypovitaminosis D
E. Hypovitaminosis C
Explanation:
See Q 32
118. During medical examination of high and middle school students, the
doctors were accessing correlation between biological and calendar age of the
school student based on the following criteria: height growth rate per year,
ossification of the carpal bones, the number of permanent teeth. What
additional development criterion should be accessed at this age?
A. Vital capacity of lungs
B. Hand strength
C. Chest circumference
D. Body mass
E. *Development of secondary sex characteristics
119. A 43- year old man, a coal face worker with 15 year long record of work
complains of cough, thoracic pain and dyspnea. The cough is mild, usually dry,
occurs mostly in the morning. The pain is localized in the interscapular region
and aggravates during a deep intake of breath. Dyspnea occurs during physical
exertion. Vesicular respiration in the lungs is weakened. Heart sounds are
rhythmic, heart rate is 86/min. Blood pressure is 135/80mmHg. The abdomen is
soft and painless. X-ray shows micro-nodular pulmonary fibrosis. Make the
provisional diagnosis:
A. Berylliosis
B. Metal pneumoconiosis
C. *Carboconiosis
D. Byssinosis
E. Siderosis
Explanation:
Carboconiosis is pneumoconiosis caused by inhalation of dust consisting of
carbonaceous dust, as anthracite cole, coke, graphite, soot
Berylliosis, or chronic beryllium disease (CBD), is a chronic allergic-type lung
response and chronic lung disease caused by exposure to beryllium and its
compounds, a form of beryllium poisoning.
Pneumoconiosis is the general term for a class of interstitial lung diseases
where inhalation of dust has caused interstitial fibrosis.
Byssinosis, is an occupational lung disease caused by exposure to cotton dust
in inadequately ventilated working environments.
Siderosis is the deposition of excess iron in body tissue. When used without
qualification, it usually refers to an environmental disease of the lung, also
known more specifically as pulmonary siderosis or Welder’s disease, which is
a form of pneumoconiosis.
120. In April during the medical examination of various population groups, 27%
of individuals presented with low working ability and rapid fatigability. The
following symptoms were observed in the affected individuals- swollen friable
gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied
by skin dryness. This symptoms most likely result from the following
pathologyA. Polyhypovitaminosis
B. Parodontosis
C. *C hypovitaminosis
D. B1 hypovitaminosis
E. A hypovitaminosis
Explanation:
see Question 32
121. During regular medical examination a lyceum student presents with signs
of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips
are bright-red, with single vertical cracks covered with brown red scalps .
These clinical signs are most likely caused by insufficient content of the
following in the diet-
A. Ascorbic acid
B. *Riboflavin
C. Retinol
D. Thiamine
E. Thiamine
Explanation:
Lyceum is a category of educational institution defined within the education
system of many countries, mainly in Europe. The definition varies among
countries; usually it is a type of secondary school.
Cheilitis is inflammation of the lips. This inflammation may include the perioral
skin (the skin around the mouth), the vermilion border, or the labial mucosa.
The skin and the vermilion border are more commonly involved, as the mucosa
is less affected by inflammatory and allergic reactions.
Symptoms: Desquamation
Riboflavin – Vit B2, Ascorbic acid – Vit C, Retinol – Vit A, Thiamine – Vit B1
Riboflavin deficiency usually occurs with other B vitamin deficiencies.
Symptoms and signs include sore throat, lesions of the lips and mucosa of the
mouth, glossitis, conjunctivitis, seborrheic dermatitis, and normochromicnormocytic anemia.
122. Employees work in conditions of high dust concentration. Certain chemical
(silicon dioxide content) and physical properties of dust aerosols contribute to
the development of occupational dust induced disease. What is the main
physical property of dust aerosols?
A. Ionization
B. Electric charge
C. Solubility
D. Magnetization
E. *Dispersion
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