1. A 38-year-old patient is under observation having polyneuritic syndrome with considerable
loss of weight, fever, rise in BP. Blood test: considerable inflammatory changes. What
examination is the most expedient to make the diagnosis?
A. Blood culture
B. Determination of antinuclear antibodies
C. Electromyography
D. Muscular biopsy with histological investigation of the material
E .Determination of HLA antigens
2. 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. HR120/min, heart sounds are weak. Blood count: leukocytes - 12*109/L, ESR- 40 mm/h.
What is the most probable diagnosis?
A. Rheumathoid arthritis
B. Systemic lupus erythematosus
C. Dermatomyositis
D. Atopic dermatitis
E .Reactive polyarthritis
3. A 35-year-old patient complains about pain and morning stiffness of hand joints and
temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2
years. Objectively: edema of proximal interphalangeal digital joints and limited motions of
joints. What examination should be administered?
A. Proteinogram
B. Complete blood count
C. Rose-Waaler reaction
D. Immunogram
E Roentgenography of hands
4. A 17 y.o. patient complains of acute pain in the knee joint and t0- 380C. 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. Systemic lupus erythematodes
B. Rheumatism, polyarthritis
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E Rheumatoid arthritis
5. A 30 y.o. man complains of intense pain, skin reddening in the region of ankle joint,
temperature rise up to 390С. He fell ill suddenly. In the past there were such onsets that
lasted for 5-6 days and didn't cause any residual changes of the joint. The skin over the
joint is hyperemic, without distinct outlines and infiltrative bank at the periphery. What is the
most probable diagnosis?
A. Rheumatoid arthritis
B. Infectional arthritis
C. Gout
D. Erysipelatous inflammation
E Osteoarthrosis
6. A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum rate of uric acid. What is the
diagnosis?
A. Rheumatic arthritis
B. Reiter's disease
C. Rheumatoid arthritis
D. Gout arthritis
E Osteoarthritis
7. A 34 year old woman fell ill 3 months ago after cold exposure. She complained of pain in
her hand and knee joints, morning stiffness and fever up to 38oC. Interphalangeal,
metacarpophalangeal and knee joints are swollen, hot, with reduced ranges of motions;
ESR of 45 mm/h, CRP (+++), Vaaler-Rouse test of 1:128. What group of medicines would
you recommend the patient?
A. Fluorchinolones
B. Cephalosporines
C. Tetracyclines
D. Sulfonamides
E .Nonsteroidal anti-inflammatory drugs
8. A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the
first three fingers of her right hand over past 6 weeks. The pain seems especially severe at
night often awakening her from sleep. The most likely cause is?
A. Carpal tunnel syndrome
B. Atlanto-axial sublaxation of cervical spine
C. Sensory peripheral neuropathy
D. Rheumatoid vasculitis
E Rheumatoid arthritis without complication
9. In the development of the inflammation processes glucocorticoids reduce the level of
certain most important active enzyme. It results also in the reducing of the synthesis of
prostaglandins and leucotrienes which have a key role in the development of inflammation
processes. What is the exact name of this enzyme?
A. Lipoxygenasе
B. Arachidonic acid
C. Phospholipase A2
D. Cyclooxygenase – 1
E Cyclooxygenase – 2
10. A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, 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, HR- 88/min, BP160/95 mm Hg. Hematology shows anemia, leucopenia, lymphopenia; on urinalysis:
proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
A. Production of myocytes antibodies
B. Production of antibodies to double-stranded DNA
C. Production of antibodies to endothelial cells
D. Production of myosin antibodies
E Production of antimitochondrial antibodies
11. A 42 y.o. patient complains of weakness, heartbeat, nasal hemorrhages, cutaneous
hemorrhages. His condition has been worsening progressively for a month. Objectively:
grave condition, the extremities and body skin has spotted and petechial hemorrhages,
lymph nodes are not palpable, Ps- 116/min, liver is +2 cm enlarged, spleen is not palpable.
Blood has evident pancytopenia. What disease should you think about first of all?
A. Werlhof's disease
B. Acute leukosis
C. Hypoplastic anemia
D. Hemorrhagic vasculitis
E Acute agranulocytosis
12. An 18 y.o. girl complains of weakness, dizziness, loss of appetite, menorrhagia. There are
many-coloured petechiae on the skin of the upper extremities. Blood test: Hb- 105 g/l;
RBC- 3,2*1012/L; C.I.- 0,95; thromb.- 20*109/L. The sedimentation time according
to Lee White is 5'; hemorrhagia duration according to Duke is 8', "pinch and
tourniquet" test is positive. What is the most probable diagnosis?
A. Hemorrhagic diathesis
B. Hemophilia
C. Idiopathic thrombocytopenic purpura
D. Iron deficiency anemia
E Marchiafava-Micheli's disease
13. A 27 year old patient suffers from haemophilia. He was admitted to the hospital with melena
and skin pallor. Objectively: Ps- 110 bpm, AP- 100/60 mm Hg. In blood: Hb- 80 g/l,
erythrocytes - 2,8*1012/l. What medication should be administered in the first place?
A. Epsilon-aminocapronic acid
B. Stored blood
C. Packed red blood cells
D. Dicinone
E Cryoprecipitate
14. A 54-year-old patient complains of weakness, jaundice, itching skin. Disease onset was 1,5
months ago: fever up to 39oC appeared at first, with progressive jaundice developed 2 weeks
later. On hospitalisation jaundice was severely progressed. Liver cannot be palpated.
Gallbladder is enlarged and painless. Blood bilirubin is 190 micromole/l (accounting for direct
bilirubin). Stool is acholic. What is the most likely jaundice genesis in this patient?
A. Hepatocellular jaundice
B. Mechanical jaundice
C. Hemolytic jaundice
D. Caroli syndrome
E. Gilbert’s syndrome
15. A 32-year-old man complains of pain in the chest on the left, dyspnea, temperature rise up
to 38, 0oC, slight cough. The disease onset was 2 weeks ago after overexposure to cold. He
had suffered from bronchoadenitis in his childhood. The affected side lags during breating;
percussion reveals dull sound with oblique margin in the lower left lung, where breathing is
absent. The right heart border is displaced outwards. Mantoux test with 2 TU resulted in a
papule 16 mm in size. What diagnosis is most likely?
A. Tuberculous pleurisy
B. Central carcinoma of the left lung
C. Congestion pneumonia
D. Thromboembolism of the pulmonary artery branches
E. Community-acquired pneumonia
16. A 42-year-old woman working at a poultry farm complains of dyspnea, thoracic pain on the
left, increased body temperature up to 38- 39oC in the evening, and cough. The patient suffers
from essential hypertension. Objectively: vesicular respiration in the lungs, vesicular resonance
without alterations. X-ray of both lungs reveals numerous small lowintensity foci, 2-3 mm in size,
located in a row along the blood vessels. ESR- 32 mm/hour. What is the most likely diagnosis?
A. Acute disseminated tuberculosis
B. Infiltrative tuberculosis
C. Pulmonary carcinomatosis
D. Focal tuberculosis
E. Community-acquired pneumonia
17. A 57-year-old woman complains of a sensation of esophageal compression, palpitations,
difficult breathing when eating solid food, occasional vomiting with a full mouth, ”wet pillow” sign
at night for the last 6 months. Objectively: body tempearture - 39oC, height - 168 cm, weight 72 kg, Ps- 76/min, BP- 120/80 mm Hg. X-ray study revealed considerable dilation of esophagus
and its constriction in the cardial part. What pathology is the most likely to have caused
dysphagia in this patient?
A. Primary esophageal spasm
B. Achalasia cardiae
C. Hiatal hernia
D. Esophageal carcinoma
E. Reflux esophagitis
18. A 19-year-old young man complains of cough with expectoration of purulent sputum in
amount of 100 ml per day, hemoptysis, dyspnea, increased body temperature up to 37,8oC,
general weakness, weight loss. The patient’s condition lasts for 4 years. Exacerbations occur 23 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick
(clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, various
numerous moist crackles in the lower pulmonary segments on the left can be observed. In
blood: erythrocytes - 3, 2 · 1012/l, leukocytes - 8, 4 · 109/l, ESR- 56 mm/hour. On X-ray: lung
fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most
likely diagnosis?
A. Multiple bronchiectasis of the left lung
B. Chronic left-sided pneumonia
C. Chronic abscess of the left lung
D. Left-sided pulmonary cystic dysplasia
E. Suppuration of the cyst in the left lung
19. A 41 y.o. woman complains of weakness, fatigue, fever up to 380C, 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, HR- 88/min, BP160/95 mm Hg. Hematology shows anemia, leucopenia, lymphopenia; on urinalysis:
proteinuria, leukocyturia, casts. What is the main mechanism of disease development?
A Production of myocytes antibodies
B Production of antibodies to double-stranded DNA
C Production of antibodies to endothelial cells
D Production of myosin antibodies
E Production of antimitochondrial antibodies
20. 4 days after a patient received a gunshot wound to the soft tissues of middle third of the
thigh, his condition suddenly began deteriorating. There are complaints of bursting pain in the
wound; pain has been increasing during the last 12 hours. Edema of skin and hypodermic
tissue quickly grows. Body temperature is 38,2oC, heart rate is 102/min. The wound edges
gape, are dull in color; the muscles, viable as of day before, now protrude into the wound, look
boiled, are dull in color, have dirty-gray coating, and fall apart when held with forceps. What
infection has developed in the wound?
A. Anaerobic
B. Aerobic gram-negative
C. Putrid
D. Aerobic gram-positive
E. Diphtheria of the wound
21. A 36 year old female patient complains ofgeneral weakness, edemas of her face and hands,
rapid fatigability during walking, difficult diglutition, cardiac irregularities. These symptoms
developed 11 days after holiday at the seaside. Objectively: face erythema, edema of shin
muscles. Heart sounds are muffled, BP is 100/70 mm Hg. In blood: ASAT activity is 0,95
millimole/h·l, ALAT1,3 micromole/h·l, aldolase - 9,2 IU/l, creatinephosphokinase2,5micromoleР/g·l.What method of study would be most specific?
A. Muscle biopsy
B. ECG
C. Echocardiogram
D. Electromyography
E. Determination of cortisol concentration in blood and urine
22. A 25-year-old patient is not married and has sexual relations with several partners. During
the last 3 months he noticed small amount of mucoserous secretions produced from urethra.
Subjectively: periodical itching or burning pain in urethra. Two months ago pain in the knee join
developed. Possibility of trauma or exposure to cold is denied by the patient. During the last
week eye discomfort is noted-lacrimation and itching. What provisional diagnosis can be
suggested?
A. Rheumatoid arthritis
B. Reactive arthritis
C. Seasonal pollinosis
D. Bacterial nonspecific urethral conjunctivitis
E. URTI with conjunctiva and joints affected
23. A 28-year-old female patient with a six-year history of Raynaud’s syndrome has recently
developed pain in the small joints of hands, difficult movement of food down the esophagus.
What disease can be suspected in this case?
A. Systemic scleroderma
B. Periarteritis nodosa
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Pseudotrichiniasis
24.
A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV
fingers, muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia,
dysphagia, constipations. The patient's face is masklike, solid edema of hands is present. The
heart is enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude
protein - 85/l, γ-globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud's disease
25. A 39-year-old male patient complains of moderate pain and weakness in the shoulder, back
and pelvic girdle muscles, that has been progressing for the last 3 weeks; great difficulty in
getting out of bed, going up and down the stairs, shaving. Dermatomyositis has been
suspected. Blood test results: Hb- 114 g/l, WBC- 10,8*109/l, eosinophils - 9%, ESR -22 mm/h,
C-reactiveprotein - (++). The alteration in the following laboratory value wil be of decisive
diagnostic significance:
A. Gamma-globulins
B. Ceruloplasmin
C. Sialic acids
D. dsDNA antibodies
E. Creatine phosphokinase
26. 5 weeks after hypothermia a 22-year-old patient developed fever, weakness, muscle pain,
inability to move independently. Objectively: tenderness, induration of shoulder and shin muscles,
restricted active movements, erythema on the anterior surface of chest. There is a periorbital edema
with heliotropic erythema. Gottron’s sign is present. What study is required to verify the diagnosis?
A. Muscle biopsy
B. Aminotransferase activity
C. Pneumoarthrography
D. ASO titre
E. Rheumatoid factor
27. A 37-year-old female patient with a six-year history of Raynaud’s syndrome has recently
developed pain in the small joints of hands, difficult movement of food down the esophagus.What
kind of disease can you think of in this case?
A. Pseudotrichiniasis
B. Periarteritisnodosa
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Systemic scleroderma
28. A 60-year-old patient complains of recurrent pain in the proximal interphalangeal and wrist joints,
their periodic swelling and reddening that have been observed for 4 years. X-ray picture represents
changes in form of osteoporosis, joint space narrowing and single usuras. What is the most likely
diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout
E. Multiple myeloma
29. A 60-year-old male patient, who works as a construction worker, complains of pain in the right
hip and knee joints, that is getting worse on exertion. These presentations have been observed for
the last 5 years. Objectively: the patient is overnourished. Right knee joint is moderately deformed.
Examination of other organs and systems revealed no pathology. Blood tet results: WBCs
8,2·109/l,ESR - 15 mm/h. Uricacid - 0,35 mmol/l. What is the most likely diagnosis?
A. Osteoarthritis
B. Reactivearthritis
C. Gout
D. Rheumatoid arthritis
E. Reiter’sdisease
30. A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR 56 mm/h. Roentgenography revealed
symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most
likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’sdisease
E. Spondylosis