147. Під час розтину порожнин серця на внутрішній стінці були виявлені гребінцеві м'язи. Які відділи порожнин серця розкриті ?
*Праве і ліве вушко
Правий і лівий шлуночок
Ліве вушко і лівий шлуночок
Ліве передсердя і лівий шлуночок
Праве передсердя і правий шлуночок
148. Під час ендоскопічного дослідження лікар виявив порушення цілісності стінки шлунка в межах слизової оболонки. Вкажіть. яким типом епітелію в нормі вистелена з середини стінку шлунка:
Псевдобагатошаровий
Перехідний
*Одношаровий призматичний залозистий
Багатошаровий плоский незроговілий
Багатошаровий плоский зроговілий
149. Хворому 50-ти років після операції з метою прискорення загоєння рани місцево був призначений препарат, який має репаративну та імуностимулюючу активність. Визначте препарат:
Меркаптопурин
Дексаметазон
Діазолін
Циклоспорин
*Метилурацнл
150. Хворому на сепсис призначте антимікробний препарат з групи фторхінолонів.
Оберіть його серед наведених препаратів
*Ципрофлоксацин
Метронідазол
Цефпіром
Ампіцилін
Цефалексин
151. A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination roved s Ihe organ encased by thin connective tissue capsule that enters the substance oi the lobes to further subdivide the organ into irregular lobular units. Bach lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity ol the follicle. Which of the following organs does this tissue most likely belong to?
Parotid gland
Parathyroid gland
Thymus
*Thyroid gland
Pancreas
152. A 23-year-old woman presents to the emergency department complaining of bloody diarrhea, fatigue and confusion. A few days earlier, she went to a fast food restaurant for a birthday party. Her friends are experiencing similar symptoms. Laboratory studies show anemia. Which of the following would you most likely obtain for microbiologic testing?
Cerebrospinal fluid
*Stool
Bile
*Праве і ліве вушко
Правий і лівий шлуночок
Ліве вушко і лівий шлуночок
Ліве передсердя і лівий шлуночок
Праве передсердя і правий шлуночок
148. Під час ендоскопічного дослідження лікар виявив порушення цілісності стінки шлунка в межах слизової оболонки. Вкажіть. яким типом епітелію в нормі вистелена з середини стінку шлунка:
Псевдобагатошаровий
Перехідний
*Одношаровий призматичний залозистий
Багатошаровий плоский незроговілий
Багатошаровий плоский зроговілий
149. Хворому 50-ти років після операції з метою прискорення загоєння рани місцево був призначений препарат, який має репаративну та імуностимулюючу активність. Визначте препарат:
Меркаптопурин
Дексаметазон
Діазолін
Циклоспорин
*Метилурацнл
150. Хворому на сепсис призначте антимікробний препарат з групи фторхінолонів.
Оберіть його серед наведених препаратів
*Ципрофлоксацин
Метронідазол
Цефпіром
Ампіцилін
Цефалексин
151. A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination roved s Ihe organ encased by thin connective tissue capsule that enters the substance oi the lobes to further subdivide the organ into irregular lobular units. Bach lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity ol the follicle. Which of the following organs does this tissue most likely belong to?
Parotid gland
Parathyroid gland
Thymus
*Thyroid gland
Pancreas
152. A 23-year-old woman presents to the emergency department complaining of bloody diarrhea, fatigue and confusion. A few days earlier, she went to a fast food restaurant for a birthday party. Her friends are experiencing similar symptoms. Laboratory studies show anemia. Which of the following would you most likely obtain for microbiologic testing?
Cerebrospinal fluid
*Stool
Bile
Blood
Urine
153. An 18-year-old girl comes to her physician with concern about her health because she has not achieved menarche. She denies any significant weight loss, changes in mood, or changes in her appetite. She mentions that her mother told her about mild birth defects, but she cannot recall the specifics. Past medical history and family history are benign. On physical examination, the patient is short in stature, has a short and webbed neck and wide chest. Staining of buccal smear reveals absence of Barr bodies in the nucleus of epithelial cells. A urine pregnancy test is negative.
Which of the following genetic disorders is the most likely cause of this patient’s condition?
Palau syndrome
Klinefelter syndrome
Cri du chat ("cat-cry”) syndrome
Edwards syndrome
*Turner syndrome
154. A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse – 91/min., temperature – 36.8 C and respiratory rate –
15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE`s complication in this patient?
Acute infection ol-the kidney
Decrease in renal blood flow (ischemic nephropathy)
Increased plasma oncotic pressure
*Immune complex-mediated glomerular disease
155. A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wile reports he became more irritable and forgetlul in the past year. In addition, she notes that be became a vegan a year ago and currently, his diet consists of starchy foods like potatoes, corn and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczemalike lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a ’’gloves and socks” distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?
Lysine
Arginine
Threonine
Histidine
*Tryptophan
156. A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset a right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next two hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened, gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient`s death?
*Ischemic stroke
Tumor
Cyst
Intracerebral hemorrhage
Abscess
157. A 34-year-old-man visits dentist complaining of toothache. After a dental procedure that onvolved extraction of several teeth, he develops severe bleeding lasting more than 15 minutes.
He has a history of chronic hepatitis C. Which of the following is the most likely cause of prolonged bleeding in this patient?
Hypoalbuminemia
Hypocalcemia
*Hypofibrinogenemia
Trombocytopenia
158. A 43-year-old man seeks evaluation at emergency department with complaints of fever with chills, melaise, diffuse abdominal pain for over a week, diarrhea and loss of appetite. He says that his symptoms are progressively getting worse. He recalls that the fever began slowly and climbed its way- up stepwise to the current 39.8°C. His blood pressure is 110/70 mm Hg. A physical exam reveals a coated tongue, enlarged spleen and rose spots on the abdomen. Serologic study shows the agglutinin O titre of 1:200 by the Widal test. Which of the following is the most likely causative organism for this patient's condition?
Vibrio cholerae
*Salmonella typhi
Mycobacterium tuberculosis
Enterohemorrhagic E. coli
Leptospira interrogans
159. A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for "many years", but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is afebrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination. There is a
"pillrolling" resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by finger nose testing. When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug?
Cholinesterase inhibition
Inhibition of M2-cholinergic receptors
*Stimulation of dopamine production
Activation of M2-cholinergic receptors
160. A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a lever, expectoration, or any accompanying symptoms. She has a history ol right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
*Tromboembolism
Myocardial infarction
Pneumonia
Pneumothorax
161. An 11-year-old girl is brought to the doctor’s office by her mother who stales her daughter has been weak with swollen face for 5 days. The mother slates her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria and microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?
*Increased permeability across the glomerular capillary wall
Increased plasma oncotic pressure
Increased glomerular hydrostatic pressure
Increased hydrostatic pressure in Bowman's capsule
162. A group of researchers aimed to study cardiac physiology found that overstretching ol atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause ot physiologic effects discovered by researchers?
Aldosterone
Angiotensin
Antidiuretic hormone
*Natriuretic peptide
Renin
163. After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?
Opisthorchiasis
Echinococcosis
Diphyllobothriasis
*Taeniasis
164. A 14-year old girl presents to the emergency department for evaluation of an "infected leg’.’ She states there is no history of trauma but mentions she had a history- of sickle cell disease.
On physical examination, her upper part of right shin is very painful, red, swollen and hot. Her temperature is 39.2°C. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia, increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?
Chondroblasts
Osteocytes
Chondrocytes
*Osteoclasis
Osteoblasts
165. A male neonate born to a 24-year- old primigravida had jaundice at 8 hours f life The neonates red blood cell time was A+, while the mothers RBC type was 0+. Laboratory studies revealed elevated titer of mother's anti-A antibody, normal erythrocyte glucose-6-phosphate and negative sickle cell test. The infant’s hemoglobin was 106 g/L. Which of the following is the most likely cause of infant’s jaundice?
Sickle cell disease
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
Hyperbilirubinemia
Rh incompatibility
Decrease in hemoglobin level
166. A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth. On physical examination, her vital signs are stake. She does not have pubic hair and her breast fe sliehtlv elevated with areola remaining in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?
Hyperthyroidism
Pancreatic islet insufficiency
Hypothyroidism
*Ovarian insufficiency
Adrenal medulla hyperfunction
167. A 46-year-old man presents w ith fatigue and joint pain in his lingers and wrists lor the last 2 months. The pain is present in both hands and the wrists are swollen. Furthermore, he describes morning stiffness in his joints lasting about 2 hours, which improves with use. His past medical history reveals he has been successfully treated for H. pylori related ulcers last year. He denies smoking and stopped drinking when his gastric symptoms started. Which of the following drugs is the best choice for his joints` pain management?
Prednisone
*Celecoxib
Paracetamol
Aspirin
Morphine
169. A 68-year-old man comes to his physician with complaints of severe fatigue and altered sensations in his extremities. Past medical history is remarkable for chronic gastritis. He drinks alcohol almost every day. His blood pressure is 130/80 mm Hg, heart rate is 95/min., respiratory rate -14/min. and temperature of 37.1 C. His heart has a regular rate and rhythm, his lungs are clear to auscultation bilaterally. Neurologic examination reveals loss ol touch and vibration sense in both upper and lower limbs. Laboratory investigation results include a hemoglobin of 80 g/L,
Mean Corpuscular Volume (MCV) of 115 fL (the reference range is 80-100 fL) and White Blood
Cells (WBC) of 3.0*109/L. Which of the following is the most likely diagnosis?
Iron deficiency
Vitamin A deficiency
*Viitamin B12 deficiency
Vitamin C deficiency
170. A 6-year-old boy is brought to the pediatrician by his mother, who complains of low- grade fever, chronic cough and night sweats in her child. She describes the cough as productive, producing white sputum that is sometimes streaked with blood. She also says thet her son has lost some weight in the last month. His vital sings include blood pressure of 115/75 mm Hg, heart rate of 110/min., respiratory rate of 18/min and temperature ot 36.6 C. On physical examination, the patient is ill looking. Pulmonary auscultation reveals some fine crackles 'in the right upper lobe.
The pediatrician suspects an active infection and performs Mantoux test. Intradermal injection of which of the following substances has been most likely used by pediatrician for screening test in this clinical case?
*Tuberculin
Tetanus and diphtheria toxoids vaccine (Td)
Diphtheria-tetanus toxoids-acellular pertussis vaccine (DTaP)
Bacillus Calmcttc-Guerin (BCG) vaccine
171. A 37-year old female presents to the clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. Hie pain started as an occasional throb and she could ignore it or take ibuprofen but now the pain is much worse and wakes her up at night. She works as a typist and her pain mostly increases alter typing all day. Her right wrist and fingers are line Nerve conduction studies reveal ncive compression. Which of the following nerves is most likely compressed in this patient?
Radial nerve
*Median nerve
Musculocutaneous nerve
Axillary nerve
Ulnar nerve
172. A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for the past month. On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On physical examination, she is a tired-appearing thin woman. Hyperpigmentation is present over many areas of her body, most
prominently over the face, neck and back of hands (areas exposed to light). Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient?
Gonadotropins
Thyroid-stimulaiing hormone (TSII)
Growth hormone (GII)
B-Lipolropin
*Melanocytc-stimulating hormone (MSH)
173. A 40-year-old woman dies of intracerebral hemorrhage alter hypertensive emergency.
During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini populated by a homogenous cluster of deeply basophilic cells. Which of the following was the most likely underlying disease
*Cushing disease
Sheehan's syndrome
Arterial hypertension
Hyperthyroidism
174. A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dvsuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastaiin. captopril and furosemide Laboratory findings arc significant for the following: Glycated Hemoglobin (Hb A1c) - 8.0%. Fasting Blood Glucose - 12 mmol L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug's action?
Inhibition of insulin release
*Stimulation of insulin release
Stimulation of glucose reuptake by the cell
175. After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?
Opisthorchiasis
Echinococcosis
Diphyllobothriasis
*Taeniasis
176. A mother of a 4-month-okl male infant brought him to pediatrician with complaints of food rejection and weight loss. I le started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomcgaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatospienomegaly progresses, the boy fails to thrive, and he continues to reject food.
Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
Galactocerebrosidase
Glucose-6-phosphatase
Phenylalanine-hydroxylase
*Sphingomyelinase
Glucocerebrosidase
177. An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The organ can be subdivided into two regions: a cortex with lymphoid
Gonadotropins
Thyroid-stimulaiing hormone (TSII)
Growth hormone (GII)
B-Lipolropin
*Melanocytc-stimulating hormone (MSH)
173. A 40-year-old woman dies of intracerebral hemorrhage alter hypertensive emergency.
During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini populated by a homogenous cluster of deeply basophilic cells. Which of the following was the most likely underlying disease
*Cushing disease
Sheehan's syndrome
Arterial hypertension
Hyperthyroidism
174. A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dvsuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastaiin. captopril and furosemide Laboratory findings arc significant for the following: Glycated Hemoglobin (Hb A1c) - 8.0%. Fasting Blood Glucose - 12 mmol L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug's action?
Inhibition of insulin release
*Stimulation of insulin release
Stimulation of glucose reuptake by the cell
175. After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?
Opisthorchiasis
Echinococcosis
Diphyllobothriasis
*Taeniasis
176. A mother of a 4-month-okl male infant brought him to pediatrician with complaints of food rejection and weight loss. I le started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomcgaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatospienomegaly progresses, the boy fails to thrive, and he continues to reject food.
Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
Galactocerebrosidase
Glucose-6-phosphatase
Phenylalanine-hydroxylase
*Sphingomyelinase
Glucocerebrosidase
177. An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The organ can be subdivided into two regions: a cortex with lymphoid
nodules and medulla with medullary cords populated by plasma ceils, B-cells and T-cells. Which of the following structures is most likely the origin of this surgical specimen?
*Lymph node
Tonsils
Thymus
Spleen
Bone marrow
178. A team of medical students is performing research on phases ol cell c\cle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely lakes place in ihe cell?
*Telophase
Prophase
Anaphase
Metaphase
179. A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision.Her doctor reveals loss of vision in the lateral halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?
Right optic nerve
Left optic tract
*Optic chiasm
Right optic tract
Left optic nerve
180. A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the
Trousseaus sign and Chvostek’s sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The suigeon suggests surgical destruction of parathyroid glands.
Which of the following is the most likely cause of this patient`s neurologic abnormality?
Hyperchloremia
Hyperkalemia
Hyponatremia
Hypophosphatemia
*Hypocalcemia
*Lymph node
Tonsils
Thymus
Spleen
Bone marrow
178. A team of medical students is performing research on phases ol cell c\cle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely lakes place in ihe cell?
*Telophase
Prophase
Anaphase
Metaphase
179. A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision.Her doctor reveals loss of vision in the lateral halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?
Right optic nerve
Left optic tract
*Optic chiasm
Right optic tract
Left optic nerve
180. A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the
Trousseaus sign and Chvostek’s sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The suigeon suggests surgical destruction of parathyroid glands.
Which of the following is the most likely cause of this patient`s neurologic abnormality?
Hyperchloremia
Hyperkalemia
Hyponatremia
Hypophosphatemia
*Hypocalcemia
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