STAGE 1

A 55-year old man is being treated by a general practitioner for chronic pancreatitis. He complains of
periodic epigastric discomfort and bloating after meals. On examination: general condition is
satisfactory, moderate tenderness in the epigastric region. Which intervention is most effective in
improving digestion and reducing the severity of symptoms?
A) Prescribing antispasmodic medications
B) Prescribing enzyme preparations
C) Prescribing antacid medications
D) Prescribing prokinetic medications
E) Prescribing anbiotic therapy
ANSWER:
A 31-year-old woman at 30 weeks’ gestation complains of general weakness, dizziness, and rapid
fatigue. On examination: the skin is pale; thinning and brittleness of the nails are noted, as well as a
distortion of taste. Blood tests show hemoglobin 88g/L, red blood cells 3.2 × 10 12/L, hematocrit 28%,
MCH 22, MCV 76 fl. Pulse 92 beats per minute, blood pressure 100/60 mmHg. Uterine size
corresponds to gestational age. Fetal heartbeat is clear and rhythmic at 140 beats per minute. What is
the MOST likely diagnosis?
A) Aplastic anemia
B) Iron-deficiency anemia
C) Folic acid-deficiency anemia
D) Arterial hypotension
E) Vitamin B12 deficiency anemia
ANSWER:
A 6-month-old baby holds up their head, rolls from back to stomach, and grabs toys with both hands.
The mother is interested in preventing motor development delays. What is an important preventive
measure at this stage?
A) Development games while lying on the stomach
B) Placing the child in a walker for long periods
C) Restricting physical activity to conserve energy
D) Avoiding all toys until age of one
E) Forced sitting
ANSWER:
A 52-year-old woman developed severe shortness of breath at home, along with a persistent cough
producing frothy pink sputum. She is agitated and is in an orthopneic position. Over the entire lung
field, coarse breathing with wet rales of varying intensity is auscultated. Respiratory rate: 36 breaths
per minute. Heart sounds are muffled; tachycardia-120 beats per minute. Blood pressure-220/130 mm
Hg. What complication has developed in the patient?
A) Asthma attack
B) Pulmonary hemorrhage
 C) Pulmonary infarction
D) Pulmonary embolism
E) Pulmonary edema
ANSWER:
During fatal development, the lungs do not function. Oxygenated blood from the placenta flows
through the umbilical veins into the inferior vena cava and from there into the right atrium. How does
this blood enter the systematic circulation if only a small amount of blood passes through the lungs?
A) Through the oval window
B) By the bypass vessels
C) Through the right ventricle
D) Through the left ventricle
E) Through the pulmonary trunk
ANSWER:
A 45-year-old man calls the reception desk at his local clinic. He complains of a sudden rise in body
temperature to 39.0°C, severe weakness, muscle aches, and a dry cough. Due to his severe weakness,
the patient is unable to walk to the clinic on his own. What is the most appropriate action for the
medical receptionist to take in this situation, according to the rules for providing primary health care?
A) Schedule the patient for an outpatient appointment with the doctor on duty
B) Arrange for the district to make a house call
C) Forward the call to the emergency medical services dispatch center
D) Send a district nurse to collect samples
E) Suggest that the patient visit the triage office on his own
ANSWER:
A 5-year-old girl was brought in for an appointment due to nocturnal enuresis. Since the age of 3, she
has been using the toilet independently both day and night without any episodes of incontinence.
However, over the past 2 weeks, the child has been wetting the bed every night. In addition, the girl
has started drinking more, urinates more frequently during the day, and has had episodes of urinary
incontinence at school. Upon questioning, increased fatigue is noted; dysuria and difficulty urinating
are denied. There have been no serious illnesses in the past, and psychomotor development was age-
appropriate. A month ago, the family moved into a new home 3 after the birth of the younger brother.
Vital signs are normal. Height and weight are at the 20 th and 40th percentiles, respectively; however,
at the previous examination 3 months ago, both measurements were at the 40 th percentile. On
examination, she appears tired, and her mucous membranes are dry. The rest of the physical
examination findings are unremarkable. Which of the following explanations for the symptoms is
most likely?
A) Autoimmune destruction of pancreatic β-cells
B) Bacterial bladder infection
C) Behavioral regression due to the family changes
D) Excessive vasopressin production
E) Functional fecal retension
 ANSWER:
A 35-year-old patient developed moderate facial swelling three weeks after suffering from
streptococcal tonsillitis; his urine took on a ‘meat washings’ appearance, and his blood pressure rose
to 170/110 mm Hg. Urinalysis revealed proteinuria of 2.5 g/day and marked hematuria with leached
red blood cells. Electron microscopy of a kidney biopsy specimen revealed sub epithelial immune
deposits in the form of ‘bumps’ on the glomerular basement membrane. Which clinical-morphological
syndrome is most characteristic of this condition?
A) Nephrotic syndrome
B) Nephritic syndrome
C) Urinary syndrome
D) Dysuric syndrome
E) Uremic syndrome
ANSWER:
A 29-year-old woman presenting with complaints of episodes of breath and a nonproductive cough.
History of hay fever for several years. Blood pressure 120/80 mmHg, pulse 78 beats per minute,
respiratory rate 18 breaths per minute. Pulse oximetry: 96%. Auscultation of the lungs reveals dry
wheezing in all fields. Chest X-ray is unremarkable. Spirometry: post-bronchodilator FEV1/FVC ratio
– 71% and FEV1 – 60%. Which of the following is the most likely diagnosis?
A) Pneumonia
B) Bronchial asthma
C) Chronic bronchitis
D) Bronchiectasis
E) COPD
ANSWER:
A 65-year-old man was brought to the emergency room by ambulance complaining of palpitations
and dizziness. The symptoms developed acutely over the past 4 hours. On examination: confused,
blood pressure 90/60 mmHg, heart rate 145 bpm, irregular rhythm. What is the next step in treating
this patient?
A) Administer 300 mg of amiodarone intravenously
B) Perform electrical cardioversion
C) Administer digoxin
D) Administer metoprolol
E) Perform urgent PCI
ANSWER:
A 48-year-old woman of normal build presented with complaints of poor sleep, general malaise,
drowsiness, irritability, and "flickering pains throughout the body" that do not subside after taking
analgesics. On examination: tenderness, varying in intensity, on palpation of the muscle roll over the
m. Trapezius, the lower cervical spine, the lower lumbar spine, the pectoral muscles (primarily in the
second intercostal space), the upper gluteal region, and over the medial fat pads of the knee joints.
Your provisional diagnosis:
 A) Neurasthenic syndrome
B) Scleroderma
C) Osteochondrosis of the cervical-thoracic spine
D) Fibromya fia
E) Osteochondrosis of the lumbar spine
ANSWER:
A 32-year-old woman, first pregnancy, 26-27 weeks. At her routine checkup, her blood glucose level
was 6.2 mmol/L. Two years ago, her blood glucose level was 5.2 mmol/L. What is the most likely
prognosis for the baby in this case?
A) High risk of a macrosomic fetus
B) Probability of intrauterine growth restriction
C) High risk of developing congenital anomalies
D) Probability of birth weight less than 2500 g
E) High risk of preterm birth
ANSWER:
A 42-year-old man was admitted to the hospital complaining of vomiting coffee-ground-like material,
black stools, moderate epigastric pain, and weakness. According to his medical history, he has been
ill for three days. He previously reported periodic epigastric pain of a seasonal nature, for which he
had not been examined previously. Upon admission, the patient's general condition is moderate. The
skin is pale. Hemodynamics are stable. Indicate which test should be performed first to confirm the
diagnosis
A) fecal occult blood test
B) contrast barium swallow
C) gastric juice occult blood test
D) fibrogastroscopy
E) hemoglobin and hematocrit measurement
ANSWER:
A 60-year-old woman. She developed severe nephrotic syndrome following a viral respiratory
infection. A comprehensive examination (including endoscopy, ultrasound, and X-rays) revealed no
evidence of neoplastic disease. She has had type 2 diabetes for a long time and is taking Manninil.
Which diagnostic method will determine the cause of the nephrotic syndrome?
A) Biopsy of the gingival mucosa
B) urinalysis, urine culture
C) Radioisotope scintigraphy
D) Sternal puncture
E) KidneyTopsy
ANSWER:
Since the age of 3 months, this 5-year-old boy has had frequent bouts of bronchitis and recurrent
pneumonia with isolation of Pseudomonas aeruginosa; over the past 6 months, he has developed
bronchial asthma that is refractory to conventional therapy. Persistent cough, grade grade 2 protein-
energy malnutrition, "puppet" face, enlarged, deformed barrel-shaped chest, large, distended
abdomen. Wet fine and medium-bubble rales are audible over the entire surface of the lungs. Stool
analysis: greasy, shiny stools with a large amount of neutral fat. Which of the following diagnostic
tests is most necessary to confirm the diagnosis?
A) Serum IgA twice
B) Serum IgE twice
C) Irrigoscopy/irrigography
D) Chest X-ray
E) Sweat chloride measurement (3 times)
ANSWER:
A 4-year-old child. Weight: 15 kg. The mother reports that the child has a poor appetite, is irritable
and easily agitated, tires quickly, and has difficulty concentrating. When asked about the child's diet,
the mother reported that the child eats very little, mainly instant porridge, fruit puree and juices,
cookies, and bread. Physical examination: the child's condition is satisfactory; pallor of the skin and
mucous membranes is noted, as well as brittle and splitting nails. Peripheral lymph nodes are not
enlarged.
On cardiac auscultation, a systolic murmur is heard. The abdomen is soft; the liver protrudes 2 cm
beyond the costal margin. Complete blood count: WBC - 3.6 × 1012/L, Hb - 84 g/L, color index-0.84,
ESR-10 mm/h, reticulocytes-1%, MCV-78 fl, MCH—23 pg, MCHC-260 g/L, RDW-18%, platelets—
220.0 x 10°/L, white blood cells - 5.7 × 10°/L, Indicate the preliminary diagnosis:
A) Grade Il iron-deficiency anemia
B) Grade I iron-deficiency anemia
C) Grade III iron-deficiency anemia
D) Folate-deficiency anemia
E) Vitamin B12-deficiency anemia
ANSWER:
A 60-year-old man presenting with complaints of aching pain in his hands, joint deformity, stiffness
before noon, and weakness. Medical history: He has considered himself ill for 15 years, following a
bout of lacunar tonsillitis. On examination: The joints of the hands are deformed, with moderate
tenderness on palpation. Ulnar deviation. Muscle strength 3-4 points. X-ray of the hand including the
radiocarpal joint shows periarticular osteoporosis, narrowing of the joint space, and erosion of the
articular surfaces. Blood tests: ESR 43 mm/h, white blood cell count 9.0 x 10/L, serum uric acid 240
umol/L, CRP 3 myL, rheumatoid factor (RF) - 90 IU/L, anti-CCP - up to 859 IU/mL. What is the most
likely diagnosis?
A) Rheumatoid arthritis
B) Rheumatic fever
C) Osteoarthritis
 D) Psoriatic arthritis
E) Gout
ANSWER:
An 18-month-old girl was brought by her parents to a clinic for a consultation due to fever and
abdominal pain. According to the parents, the child began crying while urinating the day before.
Today, the parents noticed a small amount of blood in her urine, which also has an unpleasant odor.
The child was born at full term and has no chronic illnesses. Physical examination: Temperature-38.9
°C, blood pressure-96/62 mmHg, pulse-130/min, respiratory rate-20/min. Palpation reveals tenderness
in the suprapubic region and the left lumbar region (tenderness on percussion is positive on the left).
Complete blood count - leukocytosis. Creatinine and electrolytes — within normal limits.
Catheterized urine analysis: Blood — moderate Leukocyte esterase — positive Nitrites - positive
Bacteria - moderate Leukocytes — 50+ per field of view. Red blood cells - 20-30 per field of view.
Casts — absent. Urine culture revealed growth of Escherichia coli at 100,000 CFU/mL. After
antibiotic therapy was initiated, the child's condition improved. In addition to completing the course
of antibiotic therapy, which of the following actions is most appropriate?
A) Prescribe daily prophylactic antibiotic therapy
B) No further testing is required
C) Perform voiding cystourethrography
D) Perform an ultrasound of the kidneys and bladder
E) Repeat the complete blood count and urine culture
ANSWER:
A 15-year-old child, who had returned from India with his parents, developed profuse watery diarrhea
with floating flakes up to 10 times a day on the third day of his stay. On the second day of the illness,
vomiting without preceding nausea began; bowel movements increased to 20 times a day, and the
temperature was 36.2°C. The patient is in serious condition, adynamic, lethargic, with marked thirst;
the tongue is dry, the eyes are sunken with periorbital cyanosis, the pulse is rapid at 110 beats per
minute, heart sounds are muffled, and blood pressure is 80/50. The abdomen is soft, sunken, and
rumbling. Stools are watery, resembling "rice water." What is the most likely diagnosis?

A) dysentery
B) rotavirus gastroenteritis
C) salmonellosis
D) Cholera
E) Escherichia coli infection
ANSWER:
Patient with chronic heart failure. Macroscopic: pleura thickened, shiny, with serofibrinous deposits,
lungs normal. Microscopic: fibrin deposits on pleura, moderate lymphocytic infiltrate, no necrosis.
Which morphological lesion is characteristic?

A) Fibrinous pleuritis
B) Pneumothorax
 C) Acute alveolitis
D) Hemothorax
E) Pleural amyloidosis
ANSWER:
A patient diagnosed with heart failure, stage 1 hypertension, and hyperlipidemia is being treated with
furosemide, captopril, simvastatin, amlodipine, and trimetazidine. He has been taking these
medications for a month as prescribed by his doctor, but has begun complaining of a frequent dry
cough. He had no other complaints, and his physical condition was consistent with his medical
condition. Which medication is causing this side effet?
A) Captopril
B) Furosemide
C) Simvastatin
D) Amlodipine
E) Trimetazidine
ANSWER:
The patient, a 67-year-old woman, first presented to the outpatient clinic with complaints of gradually
worsening difficulty swallowing: initially, she choked when eating solid foods, and in recent weeks,
this has extended to semi-liquid foods. Upon further questioning, she reported a sensation of food
"getting stuck" (a lump) behind the breastbone, discomfort, pain behind the breastbone while eating,
heartburn, general weakness, and a 7-kilogram weight loss over the past five months. From her
medical history: the patient does not consume alcohol and denies smoking. She also notes a habit of
frequently consuming very hot food and tea. There is no family history of cancer. Physical
examination. The skin is pale; body mass index is 20.9 kg/m2. Peripheral lymph nodes are not
enlarged. On examination and palpation of the neck, no pathological formations were detected. The
abdomen is soft and painless; the liver and spleen are not enlarged; no ascites is detected.
Esophagogastroduodenoscopy: On examination of the mid-thoracic esophagus, approximately 30 cm
from the incisors, a circular infiltrative-ulcerative lesion approximately 4 cm in length was identified,
with irregular edges, wall rigidity, and narrowing of the esophageal lumen; the endoscope was passed
with difficulty. The mucosa in the affected area is infiltrated, and contact bleeding is noted. Multiple
biopsies were taken from the suspicious area. According to the initial histological examination,
carcinoma is suspected. What is the most likely diagnosis?
A) Gastroesophageal reflux disease.
B) Cancer of the middle and lower esophagus.
C) Chronic esophagitis.
D) Barrett's esophagus.
E) Scarring of the middle and lower esophagus.
ANSWER:
A 10-year-old girl developed severe edema, headaches, and decreased urine output two weeks after
suffering from acute streptococcal pharyngitis. Blood chemistry: total protein - 50g/L, cholesterol 6.5
mmol/L, CBC: ESR - 60 mm/h; urinalysis: specific gravity 1025, isolated red blood cells, protein 3.5
g/day. What is the most likely preliminary diagnosis?
acute pyelonephritis acute glomerulonephritis chronic pyelonephritis chronic glomerulonephritis
acute tubulointerstitial nephritis

An analysis of the causes of overall mortality in the assigned territory revealed that cardiovascular
diseases account for 45%, neoplasms for 18%, and injuries for 12%. Which area of primary health
care should be prioritized to reduce mortality?
A) Expanding cancer screening programs
B) Organizing health education programs on managing hypertension and addressing risk factors
C) Strengthening injury prevention efforts among the working-age population
D) Expanding rehabilitation program for cancer patents
E) Increasing the coverage of fluorography screenings for the detection of lung cancer
ANSWER:
A 3-year-old child. According to the mother, the child complains of shortness of breath during
physical activity, fatigue while playing, and blue lips and tongue, especially when crying.
The mother also noted that the child has been getting paler every year, and in recent days has
frequently experienced tachycardia. An X-ray revealed right ventricular hypertrophy, and an
echocardiogram showed structural changes in the heart chambers. After the examination and
additional tests, the doctor made a diagnosis characterized by a combination of four typical symptoms:
cyanosis, shortness of breath, episodes of suffocation, and tachycardia. Laboratory tests confirmed
changes in the blood vessels, as well as abnormalities in the interventricular septum. Which of the
following diagnoses is most likely in this case?
A) Atrial septal defect
B) Tetralogy of Fallot
C) Ebstein's anomaly
D) Fibroelastosis
E) Mitral valve defect
ANSWER:
The child is 9 months old. Complaints of lethargy and poor appetite. Physical examination: pallor of
the skin and visible mucous membranes, dry and flaky skin, muscle hypotonia, heart rate 152 beats
per minute, systolic murmur at the apex. Blood test: RBCs-3.1 × 1012/L, Hb-78 g/L, color index-0.84,
reticulocytes-1.05%, platelets-245 × 10ª/L.
Determine the treatment approach.
A) Multivitamin complex with micro-and macronutrients, administered orally
B) Oral administration of an iron ion preparation at a dose of 3 mg/kg
C) Parenteral administration of an iron preparation at a dose of 5 mg/kg
D) Cyanocobalamin administered parentally according to the regimen
 E) Blood transfusion
ANSWER:
A 54-year-old man presents with complaints of epigastric pain occurring 25-30 minutes after eating,
belching, and a 3-kilogram weight loss over the past month. Medical history: has been ill for three
years, has not undergone any examinations; the pain is seasonal. On examination: skin is pale and
clear. Abdomen is soft, with localized tenderness in the epigastric region. Upper GI endoscopy:
esophagus is unaltered; cardia closes completely. Stomach distends well with air. On the lesser
curvature, there is an ulcer with edematous, inflamed edges, measuring 6x8 mm. A blood clot is
present in the depth of the ulcer. The duodenal bulb is unaltered. A small amount of Helicobacter
pylori was detected. What is the most likely diagnosis?
A) Gastric ulcer
B) Chronic superficial (antral) H. pylori-associated gastritis
C) Duodenal ulcer
D) Gastric adenocarcinoma
E) Functional (non-ulcer) dyspepsia
ANSWER:
A 58-year-old man visited his primary care physician for a routine checkup. He complains of a chronic
cough with a small amount of sputum and shortness of breath when walking briskly. He has been
smoking for over 35 years. He has been diagnosed with stage! COPD and is receiving a long-acting
inhaled bronchodilator. Exacerbations of the disease have occurred twice in the past year. On
examination: respiratory rate 20/min, Sp02 95%, breathing is weak, scattered dry rales are heart. The
patient asks what measures can most effectively slow the progression of the disease and reduce the
risk of further exacerbations. Which preventive measure is most effective?
A) Regular breathing exercises and exhalation training
B) Complete cessation of smoking and avoidance of secondhand smoke
C) Long-term use of mucolytic therapy in courses
D) Prescription of preventive courses of antibacterial medications
E) Regular use of vitamin and antioxidant complexes
ANSWER:
A patient suffering from peptic ulcer disease of the stomach has been taking an antacid for a long
time. As a result, the patient started experiencing nausea, abdominal pain, and loss of appetite.
An examination revealed a disturbance in acid-base balance (alkalosis). Which drug could have
caused this side effect?
A) sodium bicarbonate
B) magnesium oxide
C) magnesium trisilicate
D) aluminum hydroxide
E) pepsity
ANSWER:
A 60-year-old patient presented with a cough producing purulent sputum, a temperature of 38.5°C,
weakness, and shortness of breath on exertion. Medical history: COPD, ischemic heart disease. X-
ray: focal opacity in the right middle lobe. On examination: labored breathing, fine crackles, oxygen
saturation 91%, pulse 98 bpm. Which factor determines the need for hospitalization?
A) Focal opacity on chest X-ray
B) Oxygen saturation <92%
C) Presence of COPD
D) Temperature 38.5°C
E) Rigid breathing, fine crackles
ANSWER:
A 4-year-old child was admitted to the emergency department of an infectious diseases hospital.
Medical history: the child has been ill for 1 day; the illness began acutely with a rise in body
temperature to 39°C, abdominal pain, nausea, and vomiting 3-4 times. Physical examination: the child
is restless; skin turgor returns immediately. The abdomen is soft and tender in the left iliac region. A
spastic sigmoid colon is palpable, tender, with tenesmus and anal gaping. Stools are loose, scanty,
with mucus and streaks of blood. Complete blood count: RBCs - 4.2 × 1012/L, Hematocrit - 105 g/L,
WBCs - 15.8 × 10ª/L, segmented neutrophils - 10%, band neutrophils - 54%, monocytes - 6%,
lymphocytes - 34%, ESR - 25 mm/h. MOST LIKELY preliminary diagnosis
A) Salmonellosis
B) Escherichia coli infection
C) Yersinia infection
D) Klebsiella infection
E) Shigellosis
ANSWER:
A 68-year-old man presented with complaints of watery diarrhea up to 7 times a day, vomiting,
abdominal pain, and a temperature of up to 38°C. The illness began after eating chicken eggs. Medical
history: type 2 diabetes mellitus, chronic heart failure. Physical examination: signs of grade I-II
dehydration. The most appropriate treatment strategy:
A) Prescription of ciprofloxaculmvith rehydration
B) Prescription of amoxicillin at a standard dose
C) Prescription of a short course of azithromycin
D) Limiting treatment to oral rehydration only
E) Single-dose administration of ceftriaxone
ANSWER:
A 12-day-old girl was found to have a fever of 38.5°C. Physical examination revealed purulent
omphalitis and watery stools with pathological impurities up to 15 times a day. She is in a stuporous
state, with recurrent seizures, tremors, hyperesthesia, bulging of the large fontanelle, mottled skin,
acrocyanosis, and hepatosplenomegaly. Auscultation of the lungs reveals labored breathing. Heart
sounds are muffled, and tachycardia is present. What is the primary management strategy for acute
liver failure in this case?
A) Establishing home care
B) Issuing an emergency alert
C) Urgent hospitalization
D) Urgent disinfection of the affected area
E) Close monitoring
ANSWER:
The patient was diagnosed with severe B12-deficiency anemia with impaired hematopolesis and the
appearance of altered red blood cells in the blood. Anamnesis: total gastric resection. Which cells in
the peripheral blood can confirm the diagnosis?
A) Normocytes
B) Microcytes
C) Ovalocytes
D) Megalocytes
E) Anulocytes
A 52-year-old patient has liver cirrhosis due to chronic hepatitis. An ultrasound examination revealed
a liver mass measuring 2.4 cm in diameter. The alpha-fetoprotein level is moderately elevated. Which
diagnostic method is most informative for determining the nature of the mass?
A) Contrast-enhanced computed tomography (CT) of the liver
B) Repeat ultrasound examination of the liver
C) Measurement of liver transaminase levels
D) Abdominal X-ray
E) Radionuclide liver scintigraphy
IgG antibodies against measles have been detected in the blood of a newborn baby, even though the
baby has not had the disease and has not been vaccinated. The baby's mother had measles as a child.
What type of immunity is providing protection for the baby?
A) Active natural
B) Active acquired
C) Passive natural
D) Passive acquired
E) Non-specific resistance
ANSWER:
A 52-year-old woman presents with complaints of pain and stiffness in the joints of the fingers of her
right hand, which have been worsening toward the end of the day over the past 4 months. She takes
ibuprofen for the pain. Medical history: works as a hairdresser; often takes breaks from work due to
pain. She has hypertension and takes hydrochlorothiazide. Local findings: swelling and tenderness on
palpation in the areas of the 1st, 2nd, and 4th distal interphalangeal joints of the fingers of the right
hand. Reduced range of active and passive motion in the joints. What mechanism is most likely
underlying the development of this condition?
 A) Deposition of monosodium urate crystals in the joints
B) Bacterial infection of the joint space
C) Autoimmune cartilage erosion
D) Degenerative joint disease
E) Deposition of calcium pyjpphosphate dihydrate crystals in the joints
ANSWER:
A 55-year-old patient complains of knee pain that worsens with activity and improves at rest, as well
as morning stiffness lasting less than 30 minutes. The joint is deformed, and range of motion is
reduceHistological examination reveals thinning and fragmentation of the articular cartilage, focal
loss of chondrocytes, microcracks in the cartilage, and subchondral bone sclerosis. What histological
process underlies these changes?
A) Chronic serous inflammation
B) Degeneration and dystrophy of articular carte
C) Fibrinoid necrosis
D) Purulent inflammation
E) Metaplasia of cartilage tissue
ANSWER:
The child is 9 years old.
Complaints of decreased urine output, changes in urine color and clarity, fever, and weakness. Medical
history: had scarlet fever 3 weeks ago. Physical examination: pale skin, facial edema, body
temperature 37.5°C; BP 140/90 mmHg, HR 120 beats per minute. Oliguria. Urine is brown and
cloudy. Identify the primary syndrome.
A) Urinary
B) Nephrotic
C) Nephritic
D) Hypertension
E) Renal failure
ANSWER:
A 55-year-old man, a farmer. He presented with complaints of a fever reaching 38-39°C, profuse
sweating (especially at night), severe weakness, and pain in the large joints (knees and hips). The
illness has lasted for 3 weeks; he was treated with amoxicillin without improvement. On examination:
hepatosplenomegaly. Complete blood count: leukopenia, lymphocytosis. Epidemiological history:
works with small ruminants. What diagnosis should be considered first?
A) Tuberculosis
B) Brucellosis
C) Infectious mononucleosis
D) Sepsis
E) Leukemia
ANSWER:
A 10-year-old boy has been ill for a year. He has not grown, has lost 5 kg, limps frequently, and
reports pain in his knees and heels, as well as decreased vision. An ophthalmologist diagnosed
iridocyclitis. Physical examination: deformity of both knee joints, muscle atrophy. Laboratory
findings: Hb - 121 g/L, WBC - 10 × 109/L, ESR - 23 mm/h. RF - 10 IU/L, CRP
- 5 mg/L, HLA-B27 positive. What is the most optimal treatment strategy initially?
A) Sulfasalazine
B) NSAIDs
C) Antibiotics
D) Leflunomide
E) Topical corticosteroid therapy
ANSWER:
Myocardial muscle biopsy was obtained during coronary artery bypass surgery in patient with
ischemic heart disease. Name the signs that differentiate working and conducting cardiomyocytes:
A) Neurofibrils and glycogen inclusions
B) Myofibrils and glycogen inclusions
C) Tonofibrils and melanin inclusions
D) Neurofibrils and lipid inclusions
E) Myofibrils and lipofuscin inclusions
ANSWER:
A 22-year-old woman presents with complaints of periodic throbbing headaches, usually on one side
of the head. The pain lasts for several hours and is accompanied by nausea, photophobia, and
phonophobia. Before the pain begins, she sometimes experiences flashes of light before her eyes.
Which of the following is most likely?
A) Tension headache
B) Migrape
C) Subarhnoid hemorrhage (SAH)
D) Transient ischemic attack
E) Vertebral artery stenosis
ANSWER:
The patient presented in July with complaints of a runny nose, lacrimation, and cough. Body
temperature is normal. These phenomena are seasonal. Specify the cells and mediator responsible for
this reaction in the patient:
A) macrophage, heparin
B) neutrophil, myeloperoxidase
C) lymphocyte, immunoglobulin G
D) mast cells, histamine
E) plasma cells, interleukin-1l
 ANSWER:

A 41-year-old woman presented with complaints of heartburn, acid regurgitation, and a burning
sensation behind the sternum, which worsen after eating, when bending forward, and while lying
down, especially at night. The symptoms have persisted for more than 6 months and are partially
relieved by antacids. Medical history: notes an increase in symptoms in recent months. Lifestyle
history: Class I obesity (BMI - 31 kg/m2), sedentary lifestyle, drinks coffee daily, denies smoking.
Physical examination: no significant abnormalities, no tenderness on abdominal palpation.
Instrumental findings: Upper endoscopy-signs of erosive esophagitis without complications. Where
should drug therapy begin?
A) Omeprazole 20-40 mg once daily for 4-8 weeks
B) Ranitidine 150 mg twice daily on an ongoing basis
C) Almagel after each meal
D) Metoclopramide 10 mg three times daily
E) Antacids as needed without maintenance therapy
ANSWER:
A 54-year-old woman complains of dull pain in the right upper quadrant after eating fatty foods, a
bitter taste in the mouth, and nausea. Physical examination: Tenderness at the gallbladder's projection
point. Ortner's and Mussi-Georgievsky's signs are positive. Tests: Ultrasound - gallbladder wall 5mm,
thickened; lumen contains sludge. No gallstones.
What is the key recommendation?
A) Strict fasting for one week
B) Diet No. 5 and cholagogue therapy
C) Immediate gallbladder removal
D) Prescription of potent analgesics
E) Administration of broad-spectrum antibiotics
ANSWER:
A 28-year-old woman presented with complaints of irritability, increased fatigue, weight loss,
palpitations, and irregular heartbeat. On palpation, the thyroid gland is enlarged in both lobes and the
isthmus; it has a soft, elastic consistency and is painless. Ocular symptoms are present: exophthalmos,
infrequent blinking, and impaired convergence. Pulse rate is 110 beats per minute. Ultrasound reveals
diffuse enlargement of the thyroid gland, with a volume of 25 ml. You have made a diagnosis. Which
of the following diagnostic methods is the most informative in this case?
A) Basal metabolic rate test
B) Thyroid hormones
C) Fine-needle aspiration biopsy
D) Radioisotope iodine scan
E) Lymphography
ANSWER:
A 36-year-old man presented to a general practitioner with complaints of severe weakness, bleeding
gums, a fever of 38.2 °C, and the appearance of multiple bruises on his skin without any history of
trauma. The symptoms began about three weeks ago and have been gradually worsening. On
examination: marked pallor of the skin, petechie on the extremities, and enlarged cervical lymph
nodes. The liver protrudes 2 cm beyond the costal margin; the spleen is enlarged. Complete blood
count: Hb-74 g/L, white blood cells-32×109/L, platelets - 28×109/L. Blast cells are detected in a
peripheral blood smear. Which diagnostic criterion confirms the diagnosis of acute leukemia?
A) Leukocytosis grester than 20x109/L
B) Blasts greater than 20% in the bone marrow
C) Thrombocytopenia less than 100x10ª/L
D) Enlarged spleen on examination
E) Elevated lactate dehydrogenase levels
ANSWER:
A 39-year-old patient with a long-standing history of gastric ulcer suddenly experienced severe
weakness, dizziness, and blurred vision. He vomited once, producing coffee-ground-like material. On
examination: skin and visible mucous membranes were pale, pulse 110 bpm, blood pressure 90/60
mmg. What pathological process underlies the development of tachycardia and hypotension in this
patient?
A) Reflex response to pain
B) Infectious-toxic effect
C) Liver failure
D) Impaired gastric motor and evacuation tunction
E) Acute blood loss with a derease in circulating blood volume
ANSWER:
A 52-year-old man has been invited for a preventive medical examination. He reports no
gastrointestinal complaints. He has not undergone any previous bowel examinations. Which
diagnostic method is recommended as the first stage of screening?
A) Immunochemical fecal occult blood test
B) Total colonoscopy
C) Irrigoscopy
D) Digital rectal examination
E) Computed tomography of the abdominal organs
ANSWER:
A patient suffering from coronary heart disease and bronchial asthma consulted his doctor with
complaints of asthma attacks that appeared after he began taking a drug to prevent cardialgia.
Prescription of what drug could provoke the occurrence of asthma attacks?
A) propronalol
B) clonidine
C) nifedipine
D) captopril
 E) prazosin
ANSWER:
A 34-year-old pregnant woman, 24 weeks gestation, third pregnancy, previous pregnancies without
complications, pre-pregnancy BMI 29 kg/m2, weight gain of 8 kg. No complaints, blood pressure
122/78 mmHg, no glycosuria. An oral glucose tolerance test (75 g) was performed: fasting 5.1
mmol/L, after 1 hour 9.7 mmol/L, after 2 hours 8.3 mmol/L. HbA1c 5.3%. Ultrasound: fetal size is
appropriate for gestational age; no signs of macrosomia. What is the most reasonable interpretation
and management strategy?
A) Dietary therapy is indicated
B) The results are within the normal range for pregnancy
C) A repeat OGTT is required to monitor trends
D) Immediate insulin therapy is indicated
E) Hospitalization is indicated for further evaluation
ANSWER:
The infant mortality rate in the region was 9.8 per 1,000 live births. A detailed analysis revealed that
72% of deaths among children under one year of age occur within the first 28 days of life. Which
management decision is the top priority for reducing this rate?
A) Strengthening home-based monitoring of children in their first year of life within the primary
healthcare system
B) Home-based monitoring is effective in reducing post-neonatal mortality caused by infections
or injuries at home
C) Expanding the network of pediatric infectious disease hospitals in the region
D) Strengthening the material and technical base of perinatal care and obstetric services
E) Conducting mass vaccination of children against pneumococcal infection
ANSWER:
The child is 10 years old and weighs 35 kg. Complaints include migratory pain and swelling in the
knee and ankle joints, palpitations, shortness of breath during physical activity, weakness, fatigue, and
occasional fever up to 38°C. According to the mother, the child had an acute respiratory viral infection
(ARVI) two weeks ago, with a sore throat; later, peeling of the palms was observed, and they treated
it at home. Objectively, the child is malnourished. Breathing in the lungs is vesicular. The apical
impulse of the heart is diffuse, low-amplitude, and is detected in the 5th intercostal space, 2 cm lateral
to the left mid-clavicular line. Heart sounds are muffled; the first heart sound is moderately weakened;
a blowing systolic murmur is present at the apex, intensifying when the patient lies on the left side.
Diagnosis: Acute rheumatic fever. Identify the diagnostic criteria on which the preliminary diagnosis
is based:
A) Carditis + migratory arthritis + fever
B) Polyarthritis + chorea + subcutaneous rheumatic nodules
C) Fever + erythema marginatum + carditis
D) Migratory polyarthritis + fever
 E) Fever + carditis
ANSWER:
A 30-year-old woman, an airport cleaner, was brought to the clinic complaining of general weakness,
severe headaches, high fever, abdominal pain, sleep disturbances, nausea, vomiting, and diarrhea. She
has been ill for two days. Physical examination: temperature 39.5°C, inflammation of the laryngeal
and pharyngeal mucosa, photophobia. Consciousness is clear. Nuchal rigidity, positive Brudzinski's
sign. Movement in the limbs is preserved, tendon reflexes D=S. No sensory disturbances detected. No
pathological reflexes. Pelvic organ function is intact. Lymphocytic pleocytosis in the cerebrospinal
fluid. What is the MOST likely etiology of meningitis?
A) Meningococcal
B) Staphylococcal
C) Tuberculous
D) Enteroviral
E) Candida
ANSWER:
A 39-year-old miner experienced an angina attack while descending into the mine with heavy tools
on his back; however, the episode did not recur at home while at rest. A treadmill test revealed high
exercise tolerance. What is the preliminary diagnosis?

A) Stable angina, Class

B) Non-Q-wave myoc&ial infarctio
C) Stable angina, Class I
D) Stable angina, Class III
E) Vasospastic angina
ANSWER:
Patient P. 15 years old, a pupil of the school. He got sick 8 days ago, body temperature up to 38 ° C,
stuffy nose, perspiration in the throat. He was treated independently, took aspirin, antigrippin. The
body temperature returned to normal, however, the state of health worsened: the appetite disappeared,
weakness increased, and urine darkened. Yesterday, the mother noticed the sclera icterus and called a
doctor who sent the patient to the infectious disease hospital. When examining the patient, the skin
and sclera are icteric, regional lymph nodes are not enlarged. The abdomen is soft, painless, the liver
protrudes from under the lower edge of the costal arch to 2 cm, painless. The urine is dark. It was
found out that two more patients with the same symptoms became ill in the class. What kind of disease
can you think of?
A) influenza
B) hepatitis A
C) nasopharyngeal diphtheria
D) meningococcus rhinopharyngitis
E) typhoid fever
ANSWER:
A 4-year-old child. Cystography during the filling and emptying phases of the bladder reveals contrast
agent flow into the lower segments of the ureters. Your diagnosis:
A) Bladder mass
B) Chronic cystitis
C) Vesicoureteral reflux
D) Chronic pyelonephritis
E) Bilateral megaurethra
ANSWER:
A 60-year-old patient presents with fever, weakness, and pale skin. Macroscopically: enlarged, soft
lymph nodes. Microscopically: hypercellular bone marrow with a predominance of myeloid cells,
including mature and immature neutrophils. Peripheral blood: white blood cells 35x10°/L,
neutrophilia with a left shift. Which condition explains the laboratory and morphological findings?

A) Reactive leukocytosis in acute infection

B) | Aplastic anemia
C) Leukemia
D) Iron-deficiency anemia
E) Thrombocytopenia
ANSWER:
A 50-year-old woman is being treated by a general practitioner. She has no complaints, but an
abdominal ultrasound revealed signs of biliary sludge. Her medical history includes obesity and a
sedentary lifestyle. On examination: general condition is satisfactory; the abdomen is soft and
painless. Which preventive measure is most appropriate to reduce the risk of gallstone formation?
A) Prescribing antacids
B) Gradual weight loss
C) , Prescribing enzyme preparations
D) Prescribing prokinetic agents
E) Prescribing antibiotic therapy
ANSWER:
A 7-year-old child. Complaints of swelling and pain in the knees, rapid fatigue, palpitations, and a
fever of 38.3°C. According to the mother, the child had scarlet fever three weeks ago. Physical
examination: condition of moderate severity. Pale pink ring-shaped rashes are noted on the trunk and
proximal parts of the limbs. On cardiac auscultation, a soft systolic murmur is heard at the apex of the
heart. Laboratory data: Complete blood count-hemoglobin 115g/L, white blood cells 15.8 × 10 9/L,
erythrocyte sedimentation rate 30 mm/h; Biochemistry: CRP 30 mg/L, ASL 480 U. Make a
preliminary diagnosis:
A) Infectious arthritis associated with parvovirus
B) Juvenile idiopathic arthritis
C) Acute rheumatic fever
D) Systemic lupus erythematosus
 E) heumatoid arthritis
A 38-year-old woman is at her doctor's office. She believes she has been ill for 3 days and complains
of chills accompanied by a fever of 39.2°C, severe headaches, and weakness.
Five days ago, she cut herself while cutting meat; a small pustule covered with a scab and a painless
ulcer appeared. Her hand is swollen. The doctor suspects anthrax. What should the doctor's next steps
be upon identifying an infectious disease that is dangerous to others?

A) Send an emergency alert independently

B) Call an ambulance
C) Call the head physician of the clinic
D) Notify the clinic's administration
E) Administer anthrax globulin
ANSWER:
First postnatal visit for a newborn. No complaints. Medical history unremarkable. Physical
examination reveals a uniform decrease in the child's weight and height, with normal physical
development. Select the term that best describes this condition:

A) Hypotrophy
B) Hypostatura
C) Hyposomnia
D) hypoplasia
E) eutrophy
ANSWER:
A 4-month-old infant was born to a mother with confirmed HIV infection. The mother received
antiretroviral therapy during pregnancy. The infant has no clinical manifestations of the disease.
Which laboratory test is most informative for the early diagnosis of HIV infection in this infant?

A) Polymerase chain reaction (PCR) to detect HIV RNA

B) Enzyme inkod inmurosor ben sar (ELISA For IN glibodies)
C) Determination of blood CD4 lymphocyte count
D) Complete blood count with white blood cell count
E) Determination of blood immunoglobulin levels
ANSWER:
A 27-year-old patient consulted a general practitioner on the 10th day of illness with complaints of
severe weakness, loss of appetite, nausea, intermittent vomiting, pain in the large joints, low-grade
fever up to 37.8 °C, and dark urine. Over the past 2 days, he noted the appearance of icteric
discoloration of the sclera and skin, increased general weakness, and worsening of his well-being.
Epidemiological history: over the past 3 years-intravenous drug use, irregular sexual contacts, no
blood transfusions, no vaccination against viral hepatitis. Physical examination: condition of moderate
severity. Skin and sclera icteric, no rash. The liver protrudes 2 cm beyond the costal margin; it is firm
and tender on palpation.
The spleen is not enlarged. Urine is dark; stools are acholic. Which diagnosis is most likely?

A) Acute viral hepatitis A

B) Acute viral hepatitis B
C) Acute viral hepatitis D
D) Acute viral hepatitis E
E) Toxic hepatitis
ANSWER:
A 56-year-old male patient, who has never previously visited a clinic for medical care, was invited
for a screening. He reports no complaints, feels well, and has a hypersthenic physique with a BMI of
32 kg/m2. He is an office worker. His family history reveals that his father suffered a myocardial
infarction. During screening, an increased blood pressure of 160/95 mmg was detected. Patient was
diagnosed with Stage 2 hypertension, Risk 3, Grade 1 obesity. In which program should this patient
be enrolled at the primary healthcare level with his consent?
A) Rehabilitation program
B) Disease management program (ПУЗ)
C) Universal patient monitoring
D) Integrated patient management
E) Health school
ANSWER:
A married man has been diagnosed with infiltrative tuberculosis. His 8-year-old son was summoned
for an examination at his place of residence. No complaints. Temperature 36.6°C. Physical
examination of organs and systems reveals no pathology. Which of the following tests should be
performed first during the outpatient phase?

A) Mantoux tuberculin test with 2TE

B) Ultrasound of the pleura and pleural cavity
C) Test with recombinant tuberculosis allergen in standard dilution
D) CT scan of the chest and mediastinum (with contrast)
E) Microprecipitation reaction with cardiolipin antigen in blood serum
ANSWER:
A 40-year-old woman presented with complaints of a sudden, severe headache, which she described
as "the worst of her life." The pain began while she was exercising at the gym one hour ago. Her
medical history includes only episodes of migraine during adolescence. On examination: nuchal
rigidity, alert and oriented. What is the most likely diagnosis?
A) Acute migraine
B) Tension headache
C) Subarachnoid hemorrhage (SAH)
D) Sinusitis
E) Cluster headache
A 15-year-old girl came to the clinic with her mother. For the past two days, the girl has been
experiencing abdominal pain, nausea, vomiting, diarrhea, and a loss of appetite. Her last menstrual
period was three weeks ago. Her temperature is 37.6°[Link] examination, there is tenderness and
abdominal rigidity on palpation in the right lower quadrant. Blood count: white blood cells-
12,600/mm. What is the likely cause of the patient's condition?
A) Bacterial mesenteric lymphadenitis
B) Diverticulitis
C) Acute appendicitis
D) Ectopic pregnancy
E) Acute intestinal obstruction
ANSWER:
In a clinical trial of patients with sideroblastic anemia, participants were followed for 5 years after the
start of treatment. The primary outcome was time to death or time to disease recurrence.
Some patients were alive at the end of the study, while others were lost to follow-up (censored data).
Which statistical analysis method is most appropriate for assessing differences between treatment
groups?
A) t-test
B) x2-test (chi-square test)
C) Logistic regression
D) Survival analysis
E) Analysis of variance (ANOVA)
ANSWER:
A 5-year-old child was admitted to the emergency department following a traffic accident. A blood
transfusion is necessary. Due to their religious beliefs, the parents do not consent to a blood
transfusion. What should the doctor do?
A) Call the police to arrest the parents
B) Administer the blood transfusion despite the parents' refusal
C) Convene a medical consultation to assess the child's condition, then administer the blood
transfusion without the parents' consent
D) Talk to the parents again; if they refuse, use other forms of treatment
E) Call a psychiatric team
A 23-year-old woman has increased sensitivity to aspirin and, as a result, severe bronchospasm upon
administration of even small doses of the drug. What mechanism leads to the development of
bronchospasm?
A) blockade of the synthesis of endogenous prostaglandins, which have a bronchodilator effect
B) increased hypersensitivity of H1 - bronchial smooth muscle receptors
C) increased hypersensitivity of M3- bronchial smooth muscle receptors
 D) increased hypersensitivity of adenosine receptors
E) preventing the binding of epinephrine to B2 - adrenergic receptors
ANSWER:
A 25-year-old woman presented with complaints of weakness, headache, pain in the right lumbar
region, and fever. She is 12 weeks pregnant. On examination: condition of moderate severity,
temperature 38°C, pulse 92 bpm, blood pressure 120/80 mmg. Abdomen soft, painless. Percussion
symptom positive on the right. Urination painless. Urinalysis: leukocytes up to 20-30 per high-power
field, bacteria +++. Which antibiotic is MOST likely to be prescribed?

A) Aminoglycosides
B) Macrolides
C) Nitrofurans
D) Aminopenicillins
E) Fluoroquinolones
ANSWER:
A 34-year-old man complains of weakness, nausea, loss of appetite, dark urine, and pale stools. His
symptoms began 10 days ago. Medical history includes a blood transfusion 2 months ago. On
examination: the skin and sclera are slightly jaundiced; the liver is enlarged by 2 cm, soft, and painless.
Biochemistry: ALT - 980 U/L, AST - 760 U/L, bilirubin — 86 umol/L (direct 62), thymol test - 9.
Serology: HBsAg +, anti-HBc IgM +, anti-HCV - negative. What is the most likely diagnosis?

A) Acute viral hepatitis B

B) Chronic viral hepatitis B
C) Viral hepatitis C
D) Toxic hepatitis
E) Autoimmune hepatitis
ANSWER:
A 5-year-old child. The mother brought the child to a general practitioner with complaints of frequent
recurring episodes of dry cough, an evening fever reaching 37.5°C, weakness, and lethargy: the child
tires quickly during active play and sweats frequently. Medical history: The child periodically stayed
at the home of a cousin who was recently diagnosed with tuberculosis. Physical examination:
Condition of moderate severity. Passive response to examination. Temperature at the time of
examination: 37.1°Skin and visible mucous membranes are pale and free of rash. The child has an
asthenic build and is underweight. The patient has an X-ray with him: Which test should be ordered
first to confirm the diagnosis?
 A) CT of the chest
B) Microscopy and bacterial culture ffsputum for MBT
C) Mantoux test and Diaskintest
D) Bacterial culture of sputum for pathogenic flora
E) Bronchoscopy with biopsy
ANSWER:
A 42-year-old patient presenting with acute abdominal pain was found to have a "crescent-shaped"
gas shadow beneath the dome of the diaphragm on an abdominal X-ray. Identify the condition for
which this symptom is characteristic:
A) acute perforated appendicitis
B) acute perforated cholgystitis
C) acute intestinal obstruction
D) acute pancreatic necrosis
E) perforated gastric ulcer
ANSWER:
A 28-year-old man, A., visited the emergency department with complaints of mixed-type dyspnea at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C.
He has felt unwell for six days after experiencing hypothermia and has not sought medical care. On
examination: skin is of normal color but moist. Body temperature—38.8°C.
Oxygen saturation-93%. Respiratory rate-25 breaths per minute. Auscultation reveals weakened
breath sounds and moist fine crackles in the lower part of the right chest. Heart rate-110 bpm, blood
pressure-105/75 mmHg. A chest X-ray was performed, and leukocytosis was detected in the blood.
Which of the following diagnoses is MOST likely?
 A) Bilateral lower-lobe pneumonia, severe course, acute respiratory distress syndrome (ARDS)
B) Community-acquired lower-lobe pneumonia, severe course, acute respiratory distress
syndrome (ARDS)
C) Community-acquired polysegmental pneumonia, severe course, respiratory failure II
D) Community-acquired lower-lobe pneumonia, mild course, respiratory failure I
E) Bilateral lower-lobe pneumonia, severe cours frespiratory failure II
ANSWER:
A 28-year-old man, A., visited the emergency department with complaints of mixed-type dyspnea at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C.
He has felt unwell for six days after experiencing hypothermia and has not sought medical care. On
examination: skin is of normal color but moist. Body temperature-38.8°C.
Oxygen saturation-93%. Respiratory rate-25 breaths per minute. Auscultation reveals weakened
breath sounds and moist fine crackles in the lower part of the right chest. Heart rate-110 bpm, blood
pressure-105/75 mmg. A chest X-ray was performed, and leukocytosis was detected in the blood. The
patient was dignosed with Community-acquired lower-lobe pneumonia, mild course, respiratory
failure I. Which laboratory tests will help to determine the severity of a disease and treatment strategy?

A) Microbiological analysis of sputum, CRP, procalcitonin

B) Microbiological analysis of sputum, electrolytes: Na, Ca, Cl
C) PCR swab from the nasopharynx for influenza virus RNA, fibrinogen, prothrombin time (PT)
D) Microbiological analysis of sputum, D-dimer
E) Cultural analysis of two venous blood samples
ANSWER:
A 28-year-old man, A., visited the emergency department with complaints of mixed-type dyspnea at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C.
He has felt unwell for six days after experiencing hypothermia and has not sought medical care. On
examination: skin is of normal color but moist. Body temperature-38.8°C.
Oxygen saturation-93%. Respiratory rate-25 breaths per minute. Auscultation reveals weakened
breath sounds and moist fine crackles in the lower part of the right chest. Heart rate-110 bpm, blood
pressure-105/75 mmg. A chest X-ray was performed, and leukocytosis was detected in the blood. The
patient was dignosed with Community-acquired lower-lobe pneumonia, mild course, acute respiratory
failure I. Results of laboratory tests: CRP-25 mg/L, procalcitonin-0.8 ng/mL. Streptococcus
pneumoniae detected. What is the recommended treatment strategy?
A) Amoxicillin orally 0.5 g 3 times a day
B) Azithromycin orally 500 mg once daily
C) Levofloxacin orally 500 mg once daily
D) Cefazolin intramuscularly 1000 mg once daily
E) Cefepime intramuscularly 1000 mg once daily
ANSWER:
A 50-year-old man presented for a routine medical examination. Harmful habits: he has smoked one
pack a day for the past 5 years. No complaints. On examination: blood pressure 160/100 mmHg, heart
rate 72 beats per minute, regular. Chest examination unremarkable. Enforced apical impulse. Other
physical signs unremarkable. Fundus examination reveals narrowing of the arterioles and tortuosity
of the vascular pattern. CBC and urinalysis unremarkable. Your preliminary diagnosis:
A) Stage 2 hypertension, Risk 2
B) Stage 3 hypertension. Risk 3
C) Stage 3 hypertension. Risk 2
D) Stage 1 hypertension. Risk 2
E) Stage 1 hypertension. Risk 1
ANSWER:
A 50-year-old man presented for a routine medical examination. Harmful habits: smokes one pack a
day for the past 5 years. No complaints. On examination: BP 160/100 mm Hg, HR 72 beats per minute,
regular. Chest without abnormalities. Enforced apical impulse. Other physical signs unremarkable.
Fundus examination reveals narrowing of the arterioles and tortuosity of the vascular pattern.
Complete blood count and urinalysis unremarkable. Preliminary diagnosis: Stage 2 Hypertension,
Risk 2. Your management plan:
A) Referral to the hospital for evaluation
B) Emergency administration of antihypertensive medications
C) Establish a diagnosis of essential hypertension and prescribe antıhypamensive therapy
D) Repeat blood pressure measurements within three days and then monor the patient
E) Conduct an examination to identify target organ damage
ANSWER:
A 10-year-old girl presented to a general practitioner with complaints of periodic pain in the right
upper quadrant, occurring after emotional stress and dietary irregularities, a bitter taste in the mouth
in the mornings, and episodic nausea; body temperature is normal, stools are unremarkable; On
examination, her condition was satisfactory; the abdomen was soft, with moderate tenderness in the
right upper quadrant; there were no signs of peritoneal irritation; no pathological changes were
detected in the complete blood count or blood chemistry. The diagnosis was established: biliary tract
dyskinesia. According to ultrasound with a functional test, the following was revealed:
A) Prescription of prokinetic agents for a course of 10-14 days
B) Prescription of antispasmodic agents for 7-10 days
C) Scheduled surgical treatment in the coming days
D) Antibiotic therapy for 7-10 days
E) Prescription of enzyme preparations for 14-21 days
ANSWER:
A 30-year-old woman, an airport cleaner, was brought to the clinic complaining of general weakness,
severe headaches, high fever, abdominal pain, sleep disturbances, nausea, vomiting, and diarrhea. She
has been ill for two days. Physical examination: temperature 39.5°C, inflammation of the laryngeal
and pharyngeal mucosa, photophobia. Consciousness is clear. Nuchal rigidity, positive Brudzinski's
sign.
Movement in the limbs is preserved, tendon reflexes D=S. No sensory disturbances detected. No
pathological reflexes. Pelvic organ function is intact. Lymphocytic pleocytosis in the cerebrospinal
fluid. What is the MOST likely etiology of meningitis?
A) Meningococcal
B) Staphylococcal
C) Tuberculous
D) Enteroviral
E) Candida
ANSWER:
An epidemiologist is analyzing the number of reported malaria cases in a small town over the past 10
years: 250, 320, 190, 300, 5000, 100, 260, 350, 320, 160. In a preliminary analysis of the data, he
notes that the distribution of values is asymmetrical, has a long "tail" to the right, and includes one
extremely high value (5,000), associated with a possible outbreak of the disease or a registration error.
Which measure of central tendency is most appropriate for estimating the average number of malaria
cases in this town over the given period?
A) Arithmetic mean
B) Mode
C) Median
D) Geometric mean
E) Standard deviation
ANSWER:
A 1-month-old infant. House call. According to the mother, the infant has had frequent watery stools
up to 8-10 times a day for the past two weeks; at the time of examination, the eyes are sunken, the
infant is breastfeeding, and the skin fold returns to normal within two seconds. Classify this condition
according to the IVBDV and determine the management strategy for this patient:
A) Diarrhea. Severe dehydration. Hospitalization. Treatment. Plan C
B) Diarrhea. Moderate dehydration. Home [Link] B
C) Diarrhea. No dehydration. Persistent diarrhea. Home treatment. Plan A
D) Persistent diarrhea. Home treatment. Plan B
E) NSevere persistent Diarrhea. Hospitalization. Treatment according to Plan B
ANSWER:
A 23-year-old woman has increased sensitivity to aspirin and, as a result, severe bronohospasm upon
administration of even small doses of the drug. What mechanism leads to the development of
bronchospasm?
A) blockade of the synthesis of endogenous prostaglandins, which have a bronchodilator effect
B) increased hypersensitivity of H1 - bronchial smooth muscle receptors
C) increased hypersensitivity of M3 - bronchial smooth muscle receptors
D) increased hypersensitivity of adenosine receptors
E) preventing the binding of epinephrine to ß2 - adrenergic receptors
ANSWER:
The child is 9 months old. Complaints of lethargy and poor appetite. Physical examination: pallor of
the skin and visible mucous membranes, dry and flaky skin, muscle hypotonia, heart rate 152 beats
per minute, systolic murmur at the apex. Blood test: RBCs—3.1 x 10’12/L, Hb-78 g/L, color index—
0.84, reticulocytes—1.05%, platelets—245 x 10'9/L. Determine the treatment approach.
A) Multivitamin complex with micro- and macronutrients, administered orally
B) Oral administration of an iron ion preparation at a dose of 3 mg/kg
C) Parenteral administration of an iron preparation at a dose of 5 mg/kg
D) Cyanocobalamin administered parentally according to the regimen
E) Blood transfusion
ANSWER:
A 4-year-old child. Weight: 15 kg. The mother reports that the child has a poor appetite, is irritable
and easily agitated, tires quickly, and has difficulty concentrating. When asked about the child's diet,
the mother reported that the child eats very little, mainly instant porridge, fruit puree and juices,
cookies, and bread. Physical examination: the child's condition is satisfactory: pallor of the skin and
mucous membranes is noted, as well as brittle and splitting nails. Peripheral lymph nodes are not
enlarged. On cardiac auscultation, a systolic murmur is heard. The abdomen is soft; the liver protrudes
2 cm beyond the costal margin.
Complete blood count: WBC - 3.6 x 10’12/L, Hb - 84 g/L, color index-0.84, ESR-10 mm/h,
reticulocytes—1%, MCV—78 fl, MCН-23 pg, MCHC-260 g/L, RDW—18%, platelets -220.0 ×
10'9/L, white blood cells — 5.7 × 10'9/L, Indicate the preliminary diagnosis:
A) Grade II iron-deficiency anemia
B) Grade I iron-deficiency anemia
C) Grade III iron-deficiency anemia
D) Folate deficiency anemia
E) vitamin B12-deficiency anemia
ANSWER:
The child is 9 months old. Complaints of lethargy and poor appetite. Physical examination: pallor of
the skin and visible mucous membranes, dry and flaky skin, muscle hypotonia, heart rate 152 beats
per minute, systolic murmur at the apex. Blood test: RBCs—3.1 x 10’12/L, Hb-78 g/L, color index—
0.84, reticulocytes—1.05%, platelets—245 x 10'9/L. Determine the treatment approach.
A) Multivitamin complex with micro- and macronutrients, administered orally
B) Oral administration of an iron ion preparation at a dose of 3 mg/kg
C) Parenteral administration of an iron preparation at a dose of 5 mg/kg
D) Cyanocobalamin administered parentally according to the regimen
E) Blood transfusion
ANSWER:

A 38-year-old woman is at her doctor's office. She believes she has been ill for 3 days and complains
of chills accompanied by a fever of 39.2°C, severe headaches, and weakness. Five days ago, she cut
herself while cutting meat; a small pustule covered with a scab and a painless ulcer appeared. Her
hand is swollen. The doctor suspects anthrax. What should the doctor's next steps be upon identifying
an Infectious disease that is dangerous to others?
A) Send an emergency alert independently
B) Call an ambulance
C) Call the head physician of the clinic
D) Notify the clinic's administration
E) Administer anthrax globulin
ANSWER:
Patient K, 13 years old, excretes up to 15 Iiters of urine per day. The urine is light in colour, density
is 1002-1005, and sugar is absent. Blood glucose is 5.5 mmol/L. What is the mechanism of polyuria
in this child?
A) Decrease in the vasopressin secretion
B) Decrease in the insulin secretion
C) Decrease in the renin secretion
D) Decrease In the aldesterone secretion
E) Increase in erythropoietin secretion
ANSWER:

A 34-year-old pregnant woman, 24 weeks gestation, third pregnancy, previous pregnancies without
complications, pre-pregnancy BMI 29 kg/m’2, weight gain of 8 kg. No complaints, blood pressure
122/78 mmHg, no glycosuria. An oral glucose tolerance test (75 g) was performed: fasting 5.1
mmol/L, after 1 hour 9.7 mmol/L, after 2 hours 8.3 mmol/L. HbA1c 5.3%. Ultrasound: fetal size is
appropriate for gestational age; no signs of macrosomia. What is the most reasonable interpretation
and management strategy?
A) Dietary therapy is indicated
B) The results are within the normal range for pregnancy
C) A repeat OGTT is required to monitor trends
D) Immediate insulin therapy is indicated
E) Hospitalization is indicated for further evaluation
ANSWER:

A 52-year-old man has been Invited for a preventive medical examination. He reports no
gastrointestinal complaints. He has not undergone any previous bowel examinations. Which
diagnostic method is recommended as the first stage of screening?
A) Immunochemical fecal occult blood test
B) Total colonoscopy
C) Irrigoscopy
D) Digital rectal examination
E) Computed tomography of the abdominal organs
ANSWER:
Patient P. 15 years old, a pupil of the school. He got sick 8 days ago, body temperature up to 38 ° C,
stuffy nose, perspiration in the throat. He was treated independently, took aspirin, antigrippin. The
body temperature returned to normal, however, the state of health worsened: the appetite disappeared,
weakness increased, and urine darkened. Yesterday, the mother noticed the sclera icterus and called a
doctor who sent the patient to the infectious disease hospital. When examining the patient, the skin
and sclera are icteric, regional lymph nodes are not enlarged. The abdomen Is soft, painless, the liver
protrudes from under the lower edge of the costal arch to 2 cm, painless. The urine is dark. It was
found out that two more patents with the same symptoms became ill in the class. What kind of disease
can you think of?
A) influenza
B) hepatitis A
C) nasopharyngeal diphtheria
D) meningococcus rhinopharyngitis
E) typhoid fever
ANSWER:

A 12-month-old boy at a routine checkup. According to his mother and previous records, he has been
developing appropriately for his age. During the examination, he stands up while holding onto a
support, takes a few steps on his own, says "mama" and 'papa' clearly, and waves "bye-bye." Which
of the following skills also corresponds to his age?
A) Eats Independently with a spoon without spilling
B) Copies a circle when drawing
C) Builds a tower out of 2 blocks
D) Hops on one foot
E) Jumps rope
ANSWER:

A 32-year-old woman at 30 weeks' gestation complains of general weakness, dizziness, and rapid
fatigue. On examination: the skin is pale; thinning and brittleness of the nails are noted, as well as a
distortion of taste. Blood tests show hemoglobin 88 g/L, red blood cells 3.2 x 10’12/L, hematocrit
28%, MCH 22, MCV 76 fl. Pulse 92 beats per minute, blood pressure 100/60 mmHg. Uterine size
corresponds to gestational age. Fetal heartbeat is clear and rhythmic at 140 beats per minute. What is
the MOST likely diagnosis?
A) Aplastic anemia
 B) Iron deficiency anemia
C) Folic acid deficiency anemia
D) Arterial hypotension
E) Vitamin B12-deficiency anemia
ANSWER:

A 39-year-old miner experienced an angina attack while descending into the mine with heavy tools
on his back; however, the episode did not recur at home while at rest. A treadmill test revealed high
exercise tolerance. What is the preliminary diagnosis?
A) Stable angina, Class II
B) Non- Q-wave myocardial infarction
C) Stable angina, Class I
D) Stable angina, Class III
E) Vasospastic angina
ANSWER:

Patient A., 58 years old, presents with complaints of elevated blood pressure (BP) up to 180/100
mmHg, accompanied by headaches, dizziness, and tinnitus. She has had hypertension for about four
years. Family history: mother has hypertension and diabetes mellitus, sister has hypertension a nd
obesity, weight > 100 kg. Leads a sedentary Iifestyle and does not follow a diet. Body weight 76 kg,
helght 158 cm, body mass Index (BMI) 30.44 kg/m’2. Waist circumference 102 cm. Which
antihypertensive medications should be prescribed in this case?
A) ACE Inhibitors
B) Beta-blockers
C) Diuretics
D) Centrally acting agents
E) Sympatholytics
ANSWER:

A married man has been diagnosed with infiltrative tuberculosis. His 8-year-old son was summoned
for an examination at his place of residence. No complaints. Temperature 36.6°C. Physical
examination of organs and systems reveals no pathology. Which of the following tests should be
performed first during the outpatient phase?
 A) Mantoux tuberculin test with 2TE
B) Ultrasound of the pleura and pleural cavity
C) Test with recombinant tuberculosis allergen in standard dilution
D) CT scan of the chest and mediastinum (with contrast)
E) Microprecipitation reaction with cardiolipin antigen in blood serum
ANSWER:

10-year-old girl developed severe edema, headaches, and decreased urine output two weeks after
suffering from acute streptococcal pharyngitis. Blood chemistry: total protein - 50 g/L, cholesterol 6.5
mmol/L, CBC: ESR - 60 mm/h; urinalysis: specific gravity 1025, isolated red blood cells, protein 3.5
g/day. What Is the most likely preliminary diagnosis?
A) acute pyelonephritis
B) acute glomerulonephritis
C) chronic pyelonephritis
D) chronic glomerulonephritis
E) acute tubulointerstitial nephritis
ANSWER:

A 7-year-old child. Complaints of swelling and pain in the knees, rapid fatigue, palpitations, and a
fever of 38.3°C. According to the mother, the child had scarlet fever three weeks ago. Physical
examination: condition of moderate severity. Pale pink ring-shaped rashes are noted on the trunk and
proximal parts of the limbs. On cardiac auscultation, a soft systolic murmur is heard at the apex of the
heart. Laboratory data: Complete blood count—hemoglobin 115 g/L, white blood cells 15.8 x 10'9/L,
erythrocyte sedimentation rate 30 mm/h; Biochemistry: CRP 30 mg/L, ASL 480 U. Make a
preliminary diagnosis:
A) Infectious arthritis associated with parvovirus
B) Juvenile idiopathic arthritis
C) Acute rheumatic fever
D) Systemic lupus erythematosus
E) Rheumatold arthritis
ANSWER:
39-year-old patient with a long standing history of gastric ulcer suddenly experienced severe
weakness, dizziness, and blurred vision. He vomited once, producing coffee ground-like material. On
examination: skin and visible mucous membranes were pale, pulse 110 bpm, blood pressure 90/60
mmHg. What pathological process underlies the development of tachycardia and hypotension in this
patient?
A) Reflex response to pain
B) Infectious-toxic effect
C) Liver failure
D) Impaired gastric motor and evacuation function
E) Acute blood loss with a decrease in circulating blood volume
ANSWER:

A 20-year-old woman complains of brief stabbing pains in the right upper quadrant that occur during
times of stress and resolve quickly, Physical examination: No tenderness on palpation. No signs of
peritoneal irritation. Tests: Ultrasound - gallbladder of normal shape, no stones. After a "test
breakfast," the gallbladder empties 80% in 20 minutes. Type of dyskinesia and management?
A) Hypomotor; prescribe cholekinetics
B) Hypermotor, prescribe antispasmodics:
C) Obstructive; prescribe litholytics
D) Inflammatory; prescribe sorbents
E) Mixed; prescribe antibiotics
ANSWER:

A 10-year-old boy has been Ill for a year. He has not grown, has lost 5 kg, limps frequently, and
reports pain in his knees and heels, as well as decreased vision. An ophthalmologist diagnosed
iridocyclitis. Physical examination: deformity of both knee joints, muscle atrophy. Laboratory
findings: Hb - 121 g/L, WBC - 10 x 10'9/L, ESR - 23 mm/h. RF - 10 IU/L, CRP - 5 mg/L, HLA-B27
positive. What Is the most optimal treatment strategy initially?
A) Sulfasalazine
B) NSAIDs
C) Antibiotics
D) Leflunomide
E) Topical corticosterold therapy
 ANSWER:

A 40-year-old woman presented with complaints of a sudden, severe headache, which she described
as "the worst of her life." The pain began while she was exercising at the gym one hour ago. Her
medical history Includes only episodes of migraine during adolescence. On examination: nuchal
rigidity, alert and oriented. What Is the most likely diagnosis?
A) Acute migraine
B) Tension headache
C) Subarachnoid hemorrhage (SAH)
D) Sinusitis
E) Cluster headache
ANSWER:

A 52-year-old patient has liver cirrhosis due to chronic hepatitis, An ultrasound examination revealed
a liver mass measuring 2.4 cm in diameter. The alpha-fetoprotein level Is moderately elevated. Which
diagnostic method is most informative for determining the nature of the mass?
A) Contrast-enhanced computed tomography (CT) of the liver
B) Repeat ultrasound examination of the liver
C) Measurement of liver transaminase levels
D) Abdominal X-ray
E) Radionuclide liver scintigraphy
ANSWER:

A 2-year-old child has a lag in physical development, frequent pneumonia. The diagnosis was
established: Persistent ductus arteriosus. Which blood vessels are responsible for the hemodynamic
disturbance?
A) Pulmonary trunk and pulmonary veins
B) Aorta and pulmonary trunk
C) Superior vena cava and aorta
D) Superior vena cava and pulmonary trunk
E) Aorta and pulmonary veins
ANSWER:
IgG antibodies against measles have been detected in the blood of a newborn baby, even though the
baby has not had the disease and has not been vaccinated. The baby's mother had measles as a child.
What type of immunity is providing protection for the baby?
A) Active natural
B) Ace acquired
C) Passive natural
D) Passive acquired
E) Non specific resistance
ANSWER:

A 41-year-old woman presented with complaints of heartburn, acid regurgitation, and a burning
sensation behind the sternum, which worsen after eating, when bending forward, and while lying
down, especially at night. The symptoms have persisted for more than 6 months and are partially
relleved by antacids. Medical history: notes an increase in symptoms in recent months. Lifestyle
history: Class I obesity (BMI-31 kg/m’2), sedentary lifestyle, drinks coffee daily, denies smoking.
Physical examination: no significant abnormalities, no tenderness on abdominal palpation.
Instrumental findings: Upper endoscopy-signs of erosive esophagitis without complications. Where
should drug therapy begin?
A) Omeprazole 20-40 mg once dally for 4-8 weeks
B) Ranitidine 150 mg twice daily on an ongoing basis
C) Almagel after each meal
D) Metoclopramide 10 mg three times daily
E) Antacids as needed without maintenance therapy
ANSWER:

A 50-year-old woman Is being treated by a general practitioner. She has no complaints, but an
abdominal ultrasound revealed signs of biliary sludge. Her medical history includes obesity and a
sedentary lifestyle. On examination: general condition is satisfactory; the abdomen is soft and
painless. Which preventive measure is most appropriate to reduce the risk of gallstone formation?
A) Prescribing antacids
B) Gradual weight loss
C) Prescribing enzyme preparations
D) Prescribing prokinetic agents
 E) Prescribing antibiotic therapy
ANSWER:

A 4-year-old child. Cystography during the filling and emptying phases of the bladder reveals contrast
agent flow into the lower segments of the ureters. Your diagnosis:
A) Bladder mass
B) Chronic cystitis
C) Vesicoureteral reflux
D) Chronic pyelonephritis
E) Bilateral megaurethra
ANSWER:

Myocardial muscle biopsy was obtained during coronary artery bypass surgery in patient with
ischemic heart disease. Name the signs that differentiate working and conducting cardiomyocytes:
A) Neurofibrils and glycogen inclusions
B) Myofibrils and glycogen inclusions
C) Tonofibrils and melanin inclusions
D) Neurofibrils and lipid inclusions
E) Myofibrils and lipofuscin inclusions
ANSWER:

A 62-year-old man with a history of stroke and diabetes mellitus. 10 year risk according to the SCORE
scale ≥ 10%. He is receiving antihypertensive therapy. He participates in a disease management
program. What frequency of examinations by a primary care physician is recommended for this patient
according to the "Regulations on the Organization of Medical Care for Persons with Chronic Diseases:
Frequency and Duration of Follow-up. Mandatory Minimum, and Frequency of Diagnostic Tests"
(Order No. 149 of October 23, 2020)?
A) Once every 3 months
B) Once every month
C) Once every 2 months
D) Once every 6 months
E) Once every 12 months
 ANSWER:

A 58 year-old patient presented to the local clinic complaining of general weakness, loss of appetite,
slight weight loss (4 kg over 3 months), and occasional pain in the upper abdomen after eating. He
has not undergone any previous medical examinations. Medical history: He reports no chronic
illnesses. He has been smoking for over 30 years. Family history: his father was diagnosed with
stomach cancer at age 62. He has not undergone any medical examinations in the last 5 years. Physical
examination. General condition is satisfactory. Skin color is normal; lymph nodes are not enlarged.
The abdomen Is soft, with moderate tenderness in the epigastrium. The liver and spleen are not
enlarged. Initial tests. Complete blood count: Hb 118 g/L, white blood cells 6.7 × 10'9/L, ESR 34
mm/h. Fecal occult blood test - positive, Upper GI endoscopy: moderate thickening of the antral wall
of the stomach, uneven structure. What is the first correct action for the physician according to the
organization of the oncology service in the Republic of Kazakhstan?
A) Refer the patient to an oncology clinic without delay to confirm the diagnosis
B) Request a consultation with a gastroenterologist at the clinic before further examination
C) Arrange an urgent referral for an upper endoscopy with biopsy as part of the patient's
referral pathway
D) Prescribe symptomatic therapy and schedule a follow-up examination in fourteen days
E) Conduct an in depth laboratory workup followed by an evaluation of the results
ANSWER:

A 58-year-old female patient complains of weakness, rapid fatigue, pruritus, blurred vision, and
frequent urination at night. Medical history: has been ill for about six months; the condition is
progressive. Frequent colds, cholecystectomy, Physical examination: BMI - 35, dry skin, signs of
scratching, acanthosis nigricans, trophic disorders on the skin of the feet, thickened nail plate. Apical
impulse in the 5th intercostal space, 1.5 cm lateral to the left midclavicular line. BP 135/85 mmHg.
Determine the treatment strategy for the patient on an outpatient basis.
A) Orlistat 120 mg 3 times dally with meals
B) Metformin 1000 mg 2 times daily
C) Insulin lispro 50/50 biphasic, subcutaneously
D) Insulin detemir 100 IU/mL, subcutaneously
E) Irsulin glargine 300 IU/mL, subcutaneously
ANSWER:
A 28-year-old man, A., visited the emergency department with complaints of mixed type aspens at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C. He has felt unwell for
six days after experiencing hypothermia and has not sought medical care. On examination: skin is of
normal color but moist. Body temperature -38.8°C, Oxygen saturation-93%. Respiratory rate-25
breaths per minute. Auscuitation reveals weakened breath sounds and moist fine crackles in the lower
part of the right chest. Heart rate—110 bpm, blood pressure-105/75 mmHg. A chest X-ray was
performed, and leukocytosis was detected in the blood. Which of the following diagnoses is MOST
likely?

A) Bilateral lower-lobe pneumonia, severe course, acute respiratory distress syndrome

(ARDS)
B) Community-acquired lower-lobe pneumonia, severe course, acute respiratory distress
syndrome (ARDS)
C) Community-acquired polysegmental pneumonia, severe course, respiratory failure II
D) Community acquired lower be pneumonia, mild course, respiratory failure I
E) Bilateral lower-lobe pneumonia, severe course, respiratory failure II
ANSWER:

A 28-year-old man, A., visited the emergency department with complaints of mixed-type dyspnea at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C. He has felt unwell for
six days after experiencing hypothermia and has not sought medical care. On examination: skin is of
normal color but moist. Body temperature—38.8°C. Oxygen saturation-93%. Respiratory rate—25
breaths per minute. Auscultation reveals weakened breath sounds and moist fine crackles in the lower
part of the right chest. Heart rate—110 bpm, blood pressuré-105/75 mmHg. A chest X-ray was
performed, and leukocytosis was detected in the blood. The patient was dignosed with Community
acquired lower-lobe pneumonia, mild course, respiratory failure I. Which laboratory tests will help to
determine the severity of a disease and treatment strategy?
A) Microbiological analysis of sputum, CRP, procalcitonin
B) Microbiological analysis of sputum, electrolytes: Na, Ca, CI
C) PCR swab from the nasopharynx for influenza virus RNA, fibrinogen, prothrombin time
(PT)
D) Microbiological analysis of sputum, D-dimer
E) Cultural analysis of two venous blood samples
ANSWER:

A 54-year-old woman complains of dull pain in the right upper quadrant after eating fatty foods, a
bitter taste in the mouth, and nausea. Physical examination: Tenderness at the gallbladder's projection
point. Ortner's and Mussi-Georgievsky's signs are positive. Tests: Ultrasound — gallbladder wall 5
mm, thickened; lumen contains sludge. No gallstones. What is the key recommendation?
A) Strict fasting for one week
B) Diet No. 5 and cholagogue therapy
C) Immediate gallbladder removal
D) Prescription of potent analgesics
E) Administration of broad-spectrum antibiotics
ANSWER:

A 27-year-old man, who works as a driver, presented to the clinic. He complained of weakness,
fatigue, cough, and a fever of 37.4°On examination, crackles were heard in the lungs, and a chest X-
ray revealed small Infiltrative shadows on both sides. A repeat X-ray examination (7 days later)
revealed the same changes in the lungs, but in a different location. The patient developed a rash and
itchy skin. Blood test results showed leukocytosis and eosinophilia (15%). Epidemiological history:
lives In a dormitory and eats in the cafeteria. What is the probable diagnosis?
A) ascariasis
B) typhoid fever
C) lung tumor
 D) pulmonary tuberculosis
E) pinworm infection
ANSWER:

A 5-year-old child was admitted to the emergency department following a traffic accident. A blood
transfusion is necessary. Due to their religious beliefs, the parents do not consent to a blood
transfusion. What should the doctor do?
A) Call the police to arrest the parents
B) Administer the blood transfusion despite the parents' refusal
C) Convene a medical consultation to assess the child's condition, then administer the blood
transfusion without the parents' consent
D) Talk to the parents again; if they refuse, use other forms of treatment
E) Call a psychiatric team
ANSWER:

A 28-year-old man, A., visited the emergency department with complaints of mixed-type dyspnea at
rest, a cough with tenacious mucopurulent sputum, and a fever of up to 38.6°C. He has felt unwell for
six days after experiencing hypothermia and has not sought medical care. On examination: skin is of
normal color but moist. Body temperature-38.8°C. Oxygen saturation 93%. Respiratory rate—25
breaths per minute. Auscultation reveals weakened breath sounds and moist fine crackles in the lower
part of the right chest. Heart rate-110 bpm, blood pressure—105/75 mmHg. A chest X-ray was
performed, and leukocytosis was detected in the blood. The patient was dignosed with Community-
acquired lower-lobe pneumonia, mild course, respiratory failure I. Which laboratory tests will help to
determine the severity of a disease and treatment strategy?
A) Microbiological analysis of sputum, CRP, procalcitonin
B) Microbiological analysis of sputum, electrolytes: Na, Ca, Cl
C) PCR swab from the nasopharynx for influenza virus RNA, fibrinogen, prothrombin time
(PT)
D) Microbiological analysis of sputum, D-dimer
E) Cultural analysis of two venous blood samples
ANSWER:

A 54-year-old woman complains of dull pain in the right upper quadrant after eating fatty foods, a
bitter taste in the mouth, and nausea. Physical examination: Tenderness at the gallbladder's projection
point. Ortner's and Mussl-Georgievsky's signs are positive. Tests: Ultrasound - gallbladder wall 5 mm,
thickened; lumen contains sludge. No gallstones. What is the key recommendation?
A) Strict fasting for one week
B) Diet No. 5 and cholagogue therapy
C) Immediate gallbladder removal
D) Prescription of potent analgesics
E) Administration of broad-spectrum antibiotics
ANSWER:

A 5-year-old child was admitted to the emergency department following a traffic accident. A blood
transfusion is necessary. Due to their religious beliefs, the parents do not consent to a blood
transfusion. What should the doctor do?
A) Call the police to arrest the parents
B) Administer the blood transfusion despite the parents' refusal
C) Convene a medical consultation to assess the child's condition, then administer the blood
transfusion without the parents' consent
D) Talk to the parents again; If they refuse, use other forms of treatment
E) Call a psychiatric team
ANSWER:

A 70-year-old patient with chronic ischemic heart disease reports syncope. Histology of the sinoatrial
node shows: focal degeneration of Purkinje cells, moderate fibrosis of intercellular substance, vascular
changes - thickened arteriolar walls. Which morphological change explains the clinical attacks?
A) Focal necrosis of cardiomyocytes
B) Atrophy of atrial myocardium
C) Fibrosis and degeneration of the sinoatrial node
D) Ventricular myocyte hypertrophy
E) Eosinophilic infiltrate
ANSWER:

The patient, a 67-year-old woman, first presented to the outpatient clinic with complaints of gradually
worsening difficulty swallowing: initially, she choked when eating solid foods, and in recent weeks,
this has extended to semi-liquid foods. Upon further questioning, she reported a sensation of food
getting stuck" (a lump) behind the breastbone, discomfort, pain behind the breastbone while eating,
heartburn, general weakness, and a 7-kilogram weight loss over the past five months. From her
medical history: the patient does not consume alcohol and denies smoking. She also notes a habit of
frequently consuming very hot food and tea. There is no family history of cancer. Physical
examination. The skin is pale; body mass index is 20.9 kg/m?. Peripheral lymph nodes are not
enlarged. On examination and palpation of the neck, no pathological formations were detected. The
abdomen is soft and painless, the liver and spleen are not enlarged; no ascites is detected.
Esophagogastroduodenoscopy: On examination of the mid-thoracic esophagus, approximately 30 cm
from the incisors, a circular infiltrative-ulcerative lesion approximately 4 cm in length was Identified,
with irregular edges, wall rigidity, and narrowing of the esophageal lumen; the endoscope was passed
with difficulty. The mucosa in the affected area is infiltrated, and contact bleeding is noted. Multiple
biopsies were taken from the suspicious area. According to the Initial histological examination,
carcinoma is suspected. What is the most likely diagnosis?
A) Gastrosophageal reflux disease.
B) Cancer of the middle and lower esophagus.
C) Chronic esophagitis.
D) Barrett's esophagus.
E) Scarring of the middle and lower esophagus.
ANSWER:

A 56-year-old male patient, who has never previously visited a clinic for medical care, was invited
for a screening. He reports no complaints, feels well, and has a hypersthenic physique with a BMI of
32 kg/m’2. He is an office worker. His family history reveals that his father suffered a myocardial
infarction. During screening, an Increased blood pressure of 160/95 mmHg was detected. Patient was
diagnosed with Stage 2 hypertension, Risk 3, Grade 1 obesity. In which program should this patient
be enrolled at the primary healthcare level with his consent?
A) Rehabilitation program
B) Disease management program (ПУ3)
C) Universal patient monitoring
D) Integrated patient management
E) Health school
ANSWER:

A 60-year-old female patient is seen in the clinic; she has been receiving treatment for rheumatoid
arthritis for 20 years. She resides in the city of Kostanay, where she is also registered with a healthcare
facility. She does not follow her treatment regimen consistently and often stops taking her
medications. She complains of increased pain in her knee and hip joints over the past few months.
The patient requests hospitalization and hip replacement at the Research Institute of Traumatology in
Astana. In which cases do citizens have the right to choose a healthcare facility providing inpatient
care within the Mandatory Health Insurance system?
A) In all cases
B) There is no such right
C) In cases of planned medical care
D) Only in cases of emergency medical care
E) Only by the decision of the commission
ANSWER:

A 52-year-old woman presents with complaints of pain and stiffness in the joints of the fingers of her
right hand, which have been worsening toward the end of the day over the past 4 months. She takes
ibuprofen for the pain. Medical history: works as a hairdresser, often takes breaks from work due to
pain. She has hypertension and takes hydrochlorothiazidLocal findings: swelling and tenderness on
palpation in the areas of the 1st, 2nd, and 4th distal interphalangeal joints of the fingers of the right
hand. Reduced range of active and passive motion in the joints. What mechanism Is most likely
underlying the development of this condition?
A) Deposition of monosodium urate crystals in the joints
B) Bacterial infection of the joint space
C) Autoimmune cartilage erosion
D) Degenerative joint disease
E) Deposition of calcium pyrophosphate dihydrate crystals in the joints
ANSWER:

Patient K., 13 years old, excretes up to 15 liters of urine per day. The urine is light in colour, density
is 1002-1005, and sugar is absent. Blood glucose is 5.5 mmol/L. What is the mechanism of polyuria
in this child?
A) Decrease in the vasopressin secretion
B) Decrease in the insulin secretion
C) Decrease in therenin secretion
D) Decrease in the aldesterone secretion
E) Increase in erythropoietin secretion
 ANSWER:
1.A 40-year-old woman presented with complaints of a sudden, severe headache, which she described
as "the worst of her life."The pain began while she was exercising at the gym one hour ago. Her
medical
history includes only episodes of migraine during adolescence. On examination: nuchal rigidity, alert
and oriented. What is the most likely diagnosis?
A) Acute migraine
B) Tension headache
C) Subarachnoid hemorrhage (SAH)
D) Sinusitis
E) Cluster headache
Answer:
2. A 60-year-old patient presents with fever, weakness, and pale skin. Macroscopically: enlarged, soft
lymph nodes. Microscopically: hypercellular bone marrow with a predominance of myeloid cells,
including mature and immature neutrophils. Peripheral blood: white blood cells 35x109/L,
neutrophilia with a left shift. Which condition explains the laboratory and morphological findings?
A)Reactive leukocytosis in acute infection
B)Aplastic anemia
C)Leukemia
D)Iron-deficiency anemia
E)Thrombocytopenia
Answer:
3. A 7-year-old child. Complaints of swelling and pain in the knees, rapid fatigue, palpitations, and a
fever of 38.3C. According to the mother, the child had scarlet fever three weeks ago. Physical
examination:
condition of moderate severity. Pale pink ring-shaped rashes are noted on the trunk and proximal parts
of the limbs. On cardiac auscultation, a soft systolic murmur is heard at the apex of the heart.
Laboratory
data: Complete blood count-hemoglobin 115 g/L, white blood cells 15.8 x 109/L, erythrocyte
sedimentation rate 30 mm/h; Biochemistry: CRP 30 mg/L, ASL 480 U. Make a preliminary diagnosis:
A)Infectious arthritis associated with parvovirus
B)Juvenile idiopathic arthritis
C)Acute rheumatic fever
D)Systemic lupus erythematosus
E)Rheumatoid arthritis
Answer:
4. A 35-year-old woman. Abnormal vaginal bleeding. Complaints of intermenstrual bleeding and
lower abdominal discomfort for 3 months. Medical history. No pregnancies or deliveries. Sexually
active; has not received HPV vaccines. Pap test showed atypical cells; colposcopy revealed suspicious
areas; biopsy showed squamous intraepithelial neoplasia (CIN III) or carcinoma in situ: invasive
component to be determined. Cervical examination with speculums: cervical mucosa with
erythematous and eroded areas. Which of the following is the most appropriate next step at the primary
care level?
A)Prescribe oral hormonal contraceptives and monitor
B)Perform colposcopy with targeted biopsy and refer to a gynecologic oncologist
C)Perform a single cervical disinfection and monitor
D)Prescribe systemic chemotherapy immediately
E)Refer the patient for a pelvic ultrasound as a priority
Answer:
5.A 60-year-old man presenting with complaints of aching pain in his hands, joint deformity, stiffness
before noon, and weakness. Medical history: He has considered himself ill for 15 years, following a
bout of lacunar tonsillitis. On examination: The joints of the hands are deformed, with moderate
tenderness on palpation. Ulnar deviation. Muscle strength 3-4 points. X-ray of the hand including the
radiocarpal joint shows periarticular osteoporosis, narrowing of the joint space, and erosion of the
articular surfaces. Blood tests: ESR 43 mm/h, white blood cell count 9.0 x 109/L, serum uric acid 240
umol/L, CRP 3 mg/L, rheumatoid factor (RF) - 90 IU/L, anti-CCP - up to 859 IU/mL. What is the
most likely diagnosis?
A)Rheumatoid arthritis
B)Rheumatic fever
C)Osteoarthritis
D)Psoriatic arthritis
E)Gout
Answer:
6. A 27-year-old man, who works as a driver, presented to the clinic. He complained of weakness,
fatigue, cough, and a fever of 37.4°On examination, crackles were heard in the lungs, and a chest X-
ray revealed small infiltrative shadows on both sides. A repeat X-ray examination (7 days later)
revealed the same changes in the lungs, but in a different location. The patient developed a rash and
itchy skin. Blood test results showed leukocytosis and eosinophilia (15%). Epidemiological history:
lives in a dormitory and eats in the cafeteria. What is the probable diagnosis?
A)ascariasis
B)typhoid fever
C)lung tumor
D)pulmonary tuberculosis
E)pinworm infection
Answer:
7. A 32-year-old woman at 30 weeks' gestation complains of general weakness, dizziness, and rapid
fatigue. On examination: the skin is pale; thinning and brittleness of the nails are noted, as well as a
distortion of taste. Blood tests show hemoglobin 88 g/L, red blood cells 3.2 x 1012/L, hematocrit 28%,
MCH 22, MCV 76 fl. Pulse 92 beats per minute, blood pressure 100/60 mmHg. Uterine size
corresponds to gestational age. Fetal heartbeat is clear and rhythmic at 140 beats per minute. What is
the MOST likely diagnosis?
A)Aplastic anemia
B)Iron-deficiency anemia
C)Folic acid-deficiency anemia
D)Arterial hypotension
E)Vitamin B12-deficiency anemia
Answer:
8. A 45-year-old man complains of severe pain in his right ankle. Medical history: the pain began
suddenly; he swims in a pool; he works as a cook at a grill bar. Local findings: the skin over the right
ankle is erythematous and warm to the touch; sharp tenderness is noted on palpation and during
movement. What changes are expected in this patient's blood tests?
A)Elevated ASL-O titer
B)Elevated uric acid
C)Positive rheumatoid factor
D)Positive Wright-Heddleston reaction
E)Presence of IgM and IgA antibodies to infectious agents
Answer:
9. A 58-year-old man visited his primary care physician for a routine checkup. He complains of a
chronic cough with a small amount of sputum and shortness of breath when walking briskly. He has
been smoking for over 35 years. He has been diagnosed with stage II COPD and is receiving a long-
acting inhaled bronchodilator. Exacerbations of the disease have occurred twice in the pa st year. On
examination: respiratory rate 20/min, SpO2 95%, breathing is weak, scattered dry rales are heart. The
patient asks what measures can most effectively slow the progression of the disease and reduce the
risk of further exacerbations.
Which preventive measure is most effective?
A)Regular breathing exercises and exhalation training
B)Complete cessation of smoking and avoidance of secondhand smoke
C)Long-term use of mucolytic therapy in courses
D)Prescription of preventive courses of antibacterial medications
E)Regular use of vitamin and antioxidant complexes
Answer:
10. A 60-year-old man came for a follow-up appointment with an oncologist to discuss the results of
his prostate and lymph node biopsies. However, due to scheduling errors, the patient had to wait in
line for an hour and a half. Upon entering the doctor's office, the patient looked very angry; he
immediately lashed out at the doctor and nurse, demanding, "Why did you make me wait? I'm dying
here in your hallway, and you don't even bat an eyelid !!! " Which of the doctor's reactions listed
below is most appropriate for this situation?
A)I understand your frustration and anger; I apologize for the inconvenience. Let's talk about the
biopsy results."
B)"You certainly have the right to be angry, but please don't raise your voice at me! Leave the office!"
C)"It's not my fault that you were scheduled incorrectly and had to wait. I'm at my workplace and
doing my job as I should."
D)'I sincerely apologize; this is certainly our fault. I assure you it won't happen again."
E)"You're not the only patient here; everyone here has cancer. There's no need to freak out!"
Answer:
11. Patient K., 13 years old, excretes up to 15 liters of urine per day. The urine is light in colour,
density is 1002-1005, and sugar is absent. Blood glucose is 5.5 mmol/L. What is the mechanism of
polyuria in this child?
A)Decrease in the vasopressin secretion
B)Decrease in the insulin secretion
C)Decrease in the renin secretion
D)Decrease in the aldesterone secretion
E)Increase in erythropoietin secretion
Answer:
12. A 15-year-old girl came to the clinic with her mother. For the past two days, the girl has been
experiencing abdominal pain, nausea, vomiting, diarrhea, and a loss of appetite. Her last menstrual
period was three weeks ago. Her temperature is [Link] examination, there is tenderness and
abdominal rigidity on palpation in the right lower quadrant. Blood count: white blood cells-
12,600/mm3. What is the likely cause of the patient's condition?
A)Bacterial mesenteric lymphadenitis
B)Diverticulitis
C)Acute appendicitis
D)Ectopic pregnancy
E)Acute intestinal obstruction
Answer:
13. After eating undercooked wild boar meat, the patient developed severe muscle pain, facial
swelling, and fever. Blood tests revealed eosinophilia and elevated creatine kinase levels. Which
parasite is most likely the causative agent of the disease?
A)Ascaris lumbricoides
B)Trichinella spiralis
C)Enterobius vermicularis
D)Taenia saginata
E)Fasciola hepatio
Answer:
14. A 65-year-old man was brought to the emergency room by ambulance complaining of palpitations
and dizziness. The symptoms developed acutely over the past 4 hours. On examination: confused,
blood pressure 90/60 mmHg, heart rate 145 bpm, irregular rhythm. What is the next step in treating
this patient?
A)Administer 300 mg of amiodarone intravenously
B)Perform electrical cardioversion
C)Administer digoxin
D)Administer metoprolol
E)Perform urgent PCI
Answer:
15. A 52-year-old woman presents with complaints of pain and stiffness in the joints of the fingers of
her right hand, which have been worsening toward the end of the day over the past 4 months. She
takes ibuprofen for the pain. Medical history: works as a hairdresser; often takes breaks from work
due to pain. She has hypertension and takes hydrochlorothiazidLocal findings: swelling and
tenderness on palpation in the areas of the 1st, 2nd, and 4th distal interphalangeal joints of the fingers
of the right hand. Reduced range of active and passive motion in the [Link] mechanism is most
likely underlying the development of this condition?
A)Deposition of monosodium urate crystals in the joints
B)Bacterial infection of the joint space
C)Autoimmune cartilage erosion
D)Degenerative joint disease
E)Deposition of calcium pyrophosphate dihydrate crystals in the joints
Answer:
16. The child is 9 years old. Complaints of decreased urine output, changes in urine color and clarity,
fever, and weakness. Medical history: had scarlet fever 3 weeks ago. Physical examination: pale skin,
facial edema, body temperature 37.5C; BP 140/90 mmHg, HR 120 beats per minute. Oliguria. Urine
is brown and cloudy. Identify the primary syndrome.

A)Urinary
B)Nephrotic
C)Nephritic
D)Hypertension
E)Renal failure
Answer:
17. According to his school report: the boy shows a high aptitude for molecular genetics, is inclined
toward logical reasoning, is characterized by straightforwardness, lacks the ability to discuss other
people's actions, and does not understand other people's emotions. However, he was also observed in
the company of a boy with antisocial behavior, repeating his words and mimicking his emotions and
socially unacceptable rules of social communication-kicking trash cans and shouting profanities after
him. What is the MOST likely disorder?
A)childhood autism
B)Kanner syndrome
C)Asperger syndrome
D)personality disorder
E)childhood-onset schizophrenia
Answer:
18. According to his school report: the boy shows a high aptitude for molecular genetics, is inclined
toward logical reasoning, is characterized by straightforwardness, lacks the ability to discuss other
people's actions, and does not understand other people's emotions. However, he was also observed in
the company of a boy with antisocial behavior, repeating his words and mimicking his emotions and
socially unacceptable rules of social communication-kicking trash cans and shouting profanities after
him. What is the MOST likely disorder?
A)childhood autism
B)Kanner syndrome
C)Asperger syndrome
D)personality disorder
E)childhood-onset schizophrenia
Answer:
19. A 32-year-old woman, first pregnancy, 26-27 weeks. At her routine checkup, her blood glucose
level was 6.2 mmol/L. Two years ago, her blood glucose level was 5.2 mmol/L. What is the most
likely prognosis for the baby in this case?
A)High risk of a macrosomic fetus
B)Probability of intrauterine growth restriction
C)High risk of developing congenital anomalies
D)Probability of birth weight less than 2500 g
E)High risk of preterm birth
Answer:
20. A 55-year-old man is undergoing a routine checkup. He has no complaints. A fecal occult blood
test came back positive. Which of the following diagnostic tests is most appropriate for determining
the cause?
A)Repeat fecal occult blood test
B)Colonoscopy with targeted biopsy
C)Computed tomography (CT) scan of the abdominal organs
D)Measurement of carcinoembryonic antigen (CElevels
E)Abdominal ultrasound
Answer:
21. A 36-year-old man presented to a general practitioner with complaints of severe weakness,
bleeding gums, a fever of 38.2 C, and the appearance of multiple bruises on his skin without any
history of trauma. The symptoms began about three weeks ago and have been gradually worsening.
On examination: marked pallor of the skin, petechiae on the extremities, and enlarged cervical lymph
nodes. The liver protrudes 2 cm beyond the costal margin; the spleen is enlarged. Complete blood
count: Hb-74 g/L, white blood cells-32x109/L, platelets-28x109/L. Blast cells are detected in a
peripheral blood smear. Which diagnostic criterion confirms the diagnosis of acute leukemia?
A)Leukocytosis greater than 20x109/L
B)Blasts greater than 20% in the bone marrow
C)Thrombocytopenia less than 100x109/L
D)Enlarged spleen on examination
E)Elevated lactate dehydrogenase levels
Answer:
22. A 36-year-old man presented to a general practitioner with complaints of severe weakness,
bleeding gums, a fever of 38.2C, and the appearance of multiple bruises on his skin without any history
of trauma. The symptoms began about three weeks ago and have been gradually worsening. On
examination: marked pallor of the skin, petechiae on the extremities, and enlarged cervical lymph
nodes. The liver protrudes 2 cm beyond the costal margin; the spleen is enlarged. Complete blood
count: Hb-74 g/L, white blood cells-32x109/L, platelets-28x109/L. Blast cells are detected in a
peripheral blood smear. Which diagnostic criterion confirms the diagnosis of acute leukemia?
A)Leukocytosis greater than 20x109/L
B)Blasts greater than 20% in the Bone marrow
C)Thrombocytopenia less than 100x109/L
D)Enlarged spleen on examination
E)Elevated lactate dehydrogenase levels
Answer:
23. A 36-year-old man presented to a general practitioner with complaints of severe weakness,
bleeding gums, a fever of 38.2C, and the appearance of multiple bruises on his skin without any history
of trauma. The symptoms began about three weeks ago and have been gradually worsening. On
examination: marked pallor of the skin, petechiae on the extremities, and enlarged cervical lymph
nodes. The liver protrudes 2 cm beyond the costal margin; the spleen is enlarged. Complete blood
count: Hb-74 g/L, white blood cells-32x109/L, platelets-28x109/L. Blast cells are detected in a
peripheral blood smear. Which diagnostic criterion confirms the diagnosis of acute leukemia?
A)Leukocytosis greater than 20x109/L
B)Blasts greater than 20% in the bone marrow
C)Thrombocytopenia less than 100x109/L
D)Enlarged spleen on examination
E)levated lactate dehydrogenase levels
Answer:
24. The infant mortality rate in the region was 9.8 per 1,000 live births. A detailed analysis revealed
that 72% of deaths among children under one year of age occur within the first 28 days of life. Which
management decision is the top priority for reducing this rate?
A)Strengthening home-based monitoring of children in their first year of life within the primary
healthcare system
B)Home-based monitoring is effective in reducing post-neonatal mortality caused by infections or
injuries at home
C)Expanding the network of pediatric infectious disease hospitals in the region
D)Strengthening the material and technical base of perinatal care and obstetric services
E)Conducting mass vaccination of children against pneumococcal infection
Answer:
25. The patient is a 65-year-old man with metastatic prostate cancer who is under the care of a
rheumatologist in collaboration with an oncologist. He presented with complaints of constant pain in
the lumbar spine over the past two weeks, which worsens at night. Medical history: He was diagnosed
with prostate cancer three years ago. He underwent radical treatment, but bone metastases developed.
Pain management: takes NSAIDs irregularly; low efficacy. Complaints of pain in the lumbar spine
for the past 2 weeks, worsening at night, weakness, and decreased activity. Physical examination.
Spinal palpation: moderatetenderness in the lumbar region. Limited mobility, no neurological deficits.
Peripheral lymph nodes are not enlarged. Investigations: X-ray/CT: multiple metastatic lesions in the
lumbar vertebra. Complete blood count: no significant abnormalities. Elevated PSA (42 ng/mL).
Which of the following actions is most appropriate within the framework of treating cancer-related
pain?

A)Prescribe analgesic therapy according to WHO guidelines (stepwise approach)

B)Recommend only physical therapy methods without pharmacotherapy
C)Arrange for urgent hospitalization without prescribing pain relief
D)Limit treatment to NSAIDs without changing the dosage
E)Recommend exclusively traditional folk remedies and exercise therapy
Answer:
26. A 55-year-old man is being treated by a general practitioner for chronic pancreatitis. He complains
of periodic epigastric discomfort and bloating after meals. On examination: general condition is
satisfactory; moderate tenderness in the epigastric region. Which intervention is most effective in
improving digestion and reducing the severity of symptoms?
A)Prescribing antispasmodic medications
B)Prescribing enzyme preparations
C)Prescribing antacid medications
D)Prescribing prokinetic medications
E)Prescribing antibiotic therapy
Answer:
27. A 45-year-old patient complains of an intense, throbbing headache, which is most severe in the
morning and when bending the head forward. The pain is accompanied by vomiting, which provides
temporary relief. On examination, the patient appears sluggish: he responds to questions with a delay
and tires quickly. The examination reveals signs of increased intracranial pressure. What is the
mechanism of the patient's headache?
A)Vascular headache
B)Muscle headache
C)Cerebrospinal fluid headache
D)Meningeal headache
E)Psychogenic headache
Answer:
28. A 55-year-old man, a farmer. He presented with complaints of a fever reaching 38-39C, profuse
sweating (especially at night), severe weakness, and pain in the large joints (knees and hips). The
illness has lasted for 3 weeks; he was treated with amoxicillin without improvement. On examination:
hepatosplenomegaly. Complete blood count: leukopenia, lymphocytosis. Epidemiological history:
works with small ruminants. What diagnosis should be considered first?
A)Tuberculosis
B)Brucellosis
C)Infectious mononucleosis
D)Sepsis
E)Leukemia
Answer:
29. quickly during active play and sweats frequently. Medical history: The child periodically stayed
at the home of a cousin who was recently diagnosed with tuberculosis. Physical examination:
Condition of moderate severity. Passive response to examination. Temperature at the time of
examination: 37.1°Skin and visible mucous membranes are pale and free of rash. The child has an
asthenic build and is underweight. The patient has an X-ray with him: Which test should be ordered
first to confirm the diagnosis?
A)CT of the chest
B)Microscopy and bacterial culture of sputum for MBT
C)Mantoux test and Diaskintest
D)Bacterial culture of sputum for pathogenic flora
E)Bronchoscopy with biopsy
Answer:
30. A 58-year-old woman visited her primary care physician for a routine checkup. She entered
menopause 6 years ago. She complains of occasional back pain after prolonged walking. She has been
smoking for over 20 years and has a low level of physical activity. Body mass index: 20 kg/m2. On
examination: height has decreased by 2 cm over the past 5 years; posture is slightly stooped. No
history of fractures. Which preventive measure is most effective for reducing the risk of osteoporotic
fractures?
A)Prescribing a course of treatment with nonsteroidal anti-inflammatory drugs
B)Regular weight-bearing physical activity combined with calcium and vitamin D supplementation
C)Long-term use of muscle relaxants for back pain
D)Prescribing chondroprotectors in preventive courses
E)Limiting physical activity to prevent injuries
Answer:
31. A 58-year-old woman visited her primary care physician for a routine checkup. She entered
menopause 6 years ago. She complains of occasional back pain after prolonged walking. She has been
smoking for over 20 years and has a low level of physical activity. Body mass index: 20 kg/m2. On
examination: height has decreased by 2 cm over the past 5 years; posture is slightly stooped. No
history of fractures. Which preventive measure is most effective for reducing the risk of osteoporotic
fractures?
A)Prescribing a course of treatment with nonsteroidal anti-inflammatory drugs
B)Regular weight-bearing physical activity combined with calcium and vitamin D supplementation
C)Long-term use of muscle relaxants for back pain
D)Prescribing chondroprotectors in preventive courses
E)Limiting physical activity to prevent injuries
Answer:
32. A 56-year-old female patient complains of shortness of breath and swelling in her legs. Medical
history: she has suffered from rheumatism since childhood and is registered with a specialist; her
condition has worsened over the past 2 months. On examination: swelling of the lower legs.
Respiratory rate at rest: 27 breaths per minute. Breathing is weakened in the lower segments, with
occasional non-resonant rales. Enlargement of the left border. Heart sounds: first heart sound is
accentuated, diastolic murmur at the apex. Heart rate is 125 beats per minute. Blood pressure is 110/70
mm Hg. The liver protrudes 4.0 cm from the edge of the costal margin. What complication has
developed in the patient?
A)mitral valve insufficiency
B)mitral valve stenosis
C)aortic valve insufficiency
D)aortic valve stenosis
E)tricuspid valve insufficiency
Answer:
33. A 20-year-old man felt a sudden wave of weakness after working out at the gym, after which he
lost consciousness. Medical history: He has type 1 diabetes and is receiving insulin therapy. Physical
examination:Skin is moist and cold; eye tone is increased; heart rate is 100 beats per minute. What
emergency condition has developed in this case?
A)hyperglycemic hyperosmolar state
B)ketoacidotic coma
C)diabetic ketoacidosis
D)lactic acidosis
E)hypoglycemic coma
Answer:
34. A 4-month-old infant was born to a mother with confirmed HIV infection. The mother received
antiretroviral therapy during pregnancy. The infant has no clinical manifestations of the disease.
Which laboratory test is most informative for the early diagnosis of HIV infection in this infant?
A)Polymerase chain reaction (PCR) to detect HIV RNA
B)Enzyme-linked immunosorbent assay (ELISA for HIV antibodies)
C)Determination of blood CD4 lymphocyte count
D)Complete blood count with white blood cell count
E)Determination of blood immunoglobulin levels
Answer:
35. The patient, a 67-year-old woman, first presented to the outpatient clinic with complaints of
gradually worsening difficulty swallowing: initially, she choked when eating solid foods, and in recent
weeks, this has extended to semi-liquid foods. Upon further questioning, she reported a sensation of
food "getting stuck" (a lump) behind the breastbone, discomfort, pain behind the breastbone while
eating, heartburn, general weakness, and a 7-kilogram weight loss over the past five months. From
her medical history: the patient does not consume alcohol and denies smoking. She also notes a habit
of frequently consuming very hot food and tea. There is no family history of cancer. Physical
examination. The skin is pale; body mass index is 20.9 kg/m2. Peripheral lymph nodes are not
enlarged. On examination and palpation of the neck, no pathological formations were detected. The
abdomen is soft and painless; the liver and spleen are not enlarged; no ascites is detected.
Esophagogastroduodenoscopy: On examination of the mid-thoracic esophagus, approximately 30 cm
from the incisors, a circular infiltrative-ulcerative lesion approximately 4 cm in length was identified,
with irregular edges, wall rigidity, and narrowing of the esophageal lumen; the endoscope was passed
with difficulty. The mucosa in the affected area is infiltrated, and contact bleeding is noted. Multiple
biopsies were taken from the suspicious area. According to the initial histological examination,
carcinoma is suspected. What is the most likely diagnosis?
A)Gastroesophageal reflux disease.
B)Cancer of the middle and lower esophagus.
C)Chronic esophagitis.
D)Barrett's esophagus.
E)Scarring of the middle and lower esophagus.
Answer:
36. A 4-year-old child was admitted to the emergency department of an infectious diseases hospital.
Medical history: the child has been ill for 1 day; the illness began acutely with a rise in body
temperature to 39℃, abdominal pain, nausea, and vomiting 3-4 times. Physical examination: the child
is restless; skin turgor returns immediately. The abdomen is soft and tender in the left iliac region. A
spastic sigmoid colon is palpable, tender, with tenesmus and anal gaping. Stools are loose, scanty,
with mucus and streaks of blood. Complete blood count: RBCs-4.2 x 1012/L, Hematocrit - 105 g/L,
WBCs - 15.8 x 109/L, segmented neutrophils - 10%, band neutrophils - 54%, monocytes - 6%,
lymphocytes - 34%, ESR-25 mm/h. MOST LIKELY preliminary diagnosis
A)Salmonellosis
B)Escherichia coli infection
C)Yersinia infection
D)Klebsiella infection
E)Shigellosis
Answer:
STAGE 2
Case 2
General Information (Task/Case Description)
Child A

Age
5

Profession
No

Setting/location
Clinic

Complaints
Periodic vomiting for 2 days, fever up to 39.5°C, loose stools, lethargy, weakness.

Medical history
Child is growing and developing according to age.
Epidemiological history: One day before symptom onset, the child consumed cottage cheese with sour
cream.
Allergy history: Positive (rash to ceftriaxone).

Vital signs on admission

RR – 26, HR – 118, BP – 90/60 mmg, Sp02 – 96%. Weight – 19 kg, Height – 102 cm
Physical examination
Moderate severity. Child is fussy, tearful, periodically restless. Appetite reduced. Meningeal signs
negative. Eyes not sunken. Skin clean, pale, moist. Subcutaneous fat moderately developed. Skin fold
recoils immediately. Oropharyngeal mucosa clean; tongue moist, slightly coated white. Drinks fluids
well. Lung sounds clear, auscultation reveals vesicular breathing, no wheezing. Heart sounds clear
and rhythmic. Liver and spleen not enlarged. Abdomen not distended, soft on palpation, tender in
epigastric and periumbilical regions. Rumbling along the large intestine. Anus closed. At the time of
examination, stool is green and foul-smelling. Urination free and painless

Laboratory results
Complete Blood Count: Hemoglobin – 96.0 g/L; RBC – 3.58×1012/L; Hematocrit – 29.40%; Platelets
– 248.0×10°/L; WBC – 13.00×10°/L; Neutrophils – 67.1%; Eosinophils –
1.0%; Basophils – 0.0%; Monocytes – 3.0%; Lymphocytes – 48.9%; ESR (Panchenkov) – 11 mm/h.
Blood biochemistry: ALT – 24.98 U/L; Albumin – 32.2 g/L; AST – 20.54 U/L; Total bilirubin – 4.48
umol/L; Direct bilirubin – 1.84 umol/L; Glucose – 3.51 mmol/L; Iron – 6.1 umol/L; Potassium – 3.3
mmol/L; Calcium (total) – 2.42 mmol/L; Creatinine – 40.123 umol/L; Sodium – 128 mmol/L; Total
protein – 48.6 g/L; CRP – 53.4 mg/L; Chloride – 96.0 mmol/L; GGT – 38 U/L; Urea – 3.2 mmol/L;
Alkaline phosphatase – 152 U/L.
Perianal scraping for pinworms: Enterobius vermicularis eggs not detected.
Urinalysis: Relative density – 1010; Protein – 0.033%o; WBC – 3-4 per high-power field.

Step 01
What is your presumptive IMCI diagnosis?
Invasive diarrhea, no dehydration
Secretory diarrhea, moderate dehydration
Osmotic diarrhea, moderate
dehydration Foodborne illness, severe dehydration
Invasive diarrhea, severe dehydration

Step 02
In yoür opinion, what is the most likely causative agent?
Shigella sonnei
Shigella flexneri
Salmonella
Rotavirus
Proteus

Step 03
What additional laboratory tests should be ordered to clarify the diagnosis?
PCR, ELISA
Biochemical blood test, stool PCR
ELISA, Diaskintest
Bacteriological culture of nasopharyngeal mucus
Bacteriological stool culture

Step 04
What is the rehydration plan for this patient?
Plan C – intravenous glucose-saline solutions

Plan A – oral rehydration agents100-200 ml after each loose stool or episode of vante
Plan A – oral rehydration agents 50-100 ml per day
Plan B – oral rehydration agents 1050 ml over 4 hours
Plan B – 820 ml over 12 hours

Step 05
According to IMCI guidelines, what is the drug of choice for etiotropi
Ciprofloxacin
Clarithromycin
Amoxicillin
Meropenem
Cefazolin
Case 03

PATIENT INFORMATION

General Information (Task/Case Description)

Pregnant woman Zh.
Age
37.
Profession
No
Setting/location
Clinic

Complaints
Headache, visual disturbances (“floaters”), nausea.

Medical history
Occipital and temporal headache appeared suddenly en route to the clinic, lasting about one hour.
Nausea also began one hour ago. On questioning: she takes methyldopa tablet twice daily but missed
two doses yesterday. Takes aspirin 150 mg since week 12.

Antenatal Record Card

Gestational age 32 weeks, registered since week 10, hypertension since age 34, under cardiologist
follow-up. Menstrual function normal. Sexual activity since age 19. Cu pregnancy is her third; two
previous uncomplicated deliveries in 2017 and 2019.
Physical examination:
Conscious, no seizures. RR – 18/min. Temperature – 36.8°C. Pulse – 80 bpm. BP – 180/110 mmg.
Sp02 – 98%. Lungs: vesicular breathing, no crackles or wheezing. Sounds muffled, rhythmic. No
edema. Urination free and painless.

Obstetric status
Fundal height – 32 cm. Uterus normal tone, not irritable. Fetal heart rate clear and rhythmic at 140
bpm. Longitudinal lie, cephalic presentation. No pathological vaginal discharge.

Instrumental findings
Cardiotocography: Baseline FHR – 119 bpm; Variability – 3-5 bpm; Decelerations – absent.
Conclusion: Normal CTG pattern.
ECG: Sinus rhythm, HR 64 bpm, normal electrical axis. Diffuse dystrophic myocardial changes.

Step 01

What is the preliminary diagnosis?

Gestational hypertension
Chronic hypertension
Mild preeclampsia
Severe preeclampsia
Folampsie

Step 02
What antihypertensive management should the physician provide at the outpatient level?

Nifedipine 20-60 mg orally with BP monitoring every 20 minutes

Methyldopa 250-500 mg orally 2-3 times daily
Diazepam 10 mg intravenously
Acetylsalicylic acid 150 mg
Magnesium sulfate 2 g intravenously slowly

Step 03
What are the target blood pressure values (mmHg) for antihypertensive therapy in this case?
100/60 – 110/70
110/75 – 120/80
120/80 – 130/100
130/80 – 140/85
140/70 – 150/110

Step 04
What is the further management plan for this pregnancy?
Outpatient follow-up until 37 weeks with activity restriction and dietary modification
Outpatient follow-up until 38 weeks with weight reduction
Outpatient follow-up until 37 weeks with tocolytic therapy
Planned hospitalization to a level 3 facility
Emergency hospitalization to a level 3 facility

Step 05
What is the purpose of magnesium sulfate in this case?
Anticonvulsant therapy
Antihypertensive therapy
Antithrombotic therapy
Magnesium supplementation
Electrolyte balance correction
CASE 04

PATIENT INFORMATION

General Information (Task/Case Description)

Male A.

Age
51.

Profession
Office manager

Setting/location
Clinic

Complaints
Severe pain in the right upper quadrant, nausea, bilious vomiting, yellowing of the sclera.
V History of present illness
Severe upper abdominal pain began approximately 12 hours ago. For one week prior, he experienced
mild pain and discomfort in the right upper quadrant, which he ignored Pain worsened after eating
fatty food the day before. Pain was constant and dull with periodic acute episodes. He took
paracetamol for pain relief without improvement.
Noticed bitterness in the mouth over recent days. Yellowing of the sclera appeared in the past 2 -3
hours. Called emergency services when pain became unbearable and vomiting began.
V Medical history
Common colds; hypertension since age 45 (takes antihypertensives irregularly); gastritis diagnosed
approximately 5 years ago (recommended treatment and diet not followed). Denies surgeries, trauma,
or blood transfusions. Married, works as a truck driver. Sedentary lifestyle, infrequent physical
activity. Smokes since age 20 (~15 cigarettes/day). Drinks alcohol on weekends. No known allergies.
V Physical examination
Temperature – 37.8°C. Height – 170 cm. Weight – 95 kg. BMI-33 kg/m. General condition relatively
satisfactory, but noticeably distressed due to severe pain. Pale with visible discomfort. Adopts forced
position: sitting with arms wrapped around abdomen, knees drawn up to reduce pain. Skin moderately
moist, pale with slight jaundiced tint.
Scleral icterus present. Lungs: vesicular breathing throughout all fields. RR – 22/min, shallow. Heart
sounds rhythmic and clear, no pathological murmurs. Pulse – 100 bpm. BP
- 150/90 mmHg. Tongue dry, coated white. Abdomen slightly distended and asymmetric due to
right upper quadrant muscle guarding. Marked tenderness on palpation in the right upper
quadrant. Positive Murphy’s sign, Ortner’s sign, Mussi-Georgievsky sign. Percussion:
dullness in the right upper quadrant. Auscultation: reduced bowel sounds

Laboratory results
CBC: Hemoglobin – 102 g/L; WBC – 18×10°/L; RBC – 4.74×1012/L; Platelets – 450×10°/L;
Hematocrit – 35.20%; Lymphocytes – 54.80%; Neutrophils – 35.50%; Monocytes – 5.90%;
Eosinophils – 1.30%; ESR – 25 mm/h.
Biochemistry: Sodium – 137 mmol/L; Potassium – 3.9 mmol/L; lonized calcium – 1.09 mmol/L;
Glucose – 4.7 mmol/L; Urea – 4.2 mmol/L; Creatinine – 59 mmol/L; Total bilirubin – 22 umol/L;
Direct bilirubin – 3 umol/L; Total protein – 57 g/L; Albumin – 36 g/L; AST – 15 U/L; ALT – 18 U/L;
CRP – 23 mg/L; Alkaline phosphatase – 221 U/L;
Serum iron – 4.9 umol/L.
Coagulation panel: APTT – 27.40 sec; INR – 0.96; PTI (Quick) – 82.40%; PT – 10.40 sec; Thrombin
time – 15.90 sec; Fibrinogen – 2.50 g/L.
Fecal occult blood test: Occult blood detected.

Instrumental findings
Abdominal ultrasound: Gallbladder enlarged (length 9.5 cm, width 4.5 cm). Wall thickened to 5mm,
hypochoic, suggesting inflammation. Contents: thick, heterogeneous bile with hyperechoic
formations up to 1.2 cm with acoustic shadowing. Common bile duct dilated to 9 mm; hyperechoic
structures with acoustic shadowing (stones) up to 7 mm visible in the lumen, obstructing the duct.
Positive sonographic Murphy’s sign. Liver size within normal limits, homogeneous structure, normal
echogenicity, no signs of inflammation.
Upper GI Endoscopy (EGD): Esophagus: clear lumen, pale pink mucosa, no inflammation, erosions,
or ulcers; cardiac sphincter closes adequately. Stomach: hyperemic mucosa in the antrum, normal
peristalsis, moderate amount of bile in stomach contents, normal folds, no deformity – features
consistent with antral gastritis. Duodenal bulb: pale pink, edematous mucosa, no ulcers or erosions,
no deformity or narrowing. Descending duodenum: hyperemic mucosa with signs of bile reflux
irritation; major duodenal papilla appears normal, but pressure produces cloudy bile.
Conclusion: Signs of duodenogastric reflux with bile into the stomach, erythematous antral gastritis,
signs of obstruction with common bile duct dilatation.

Step 01
What is the most likely diagnosis?

Acute appendicitis

Acute pancreatitis

Acute cholecystitis

Biliary colic

Perforated gastric ulcer

Step 02
Which sign is most specific for confirming the diagnosis in this case?
Pain in the right upper quadrant
Positive Murphy’s sign
Yellowing of the sclera
Bilious vomiting
Elevated body temperature

Step 03
Which condition should be excluded first in the differential diagnosis?
Acute appendicitis
Acute pancreatitis
Perforated gastric ulcer
Biliary colic
Myocardial infarction

Step 04
Which laboratory findings most support the diagnosis in this case?
Elevated bilirubin
Elevated AST and ALT
Elevated platelets
Elevated WBC and ESR
Elevated alkaline phosphatase

Step 05
Whet is the most appropriate treatment for this patient?
Conservative management with antibiotics and analgesics
Dietary therapy and observation
Treatment of gastritis
Treatment of hypertension
Urgent surgical intervention (cholecystectomy)

CASE 05

PATIENT INFORMATION

General Information (Task/Case Description)

Male D
Age
55

Profession
Driver

Setting/Location
Clinic

Complaints
Developed severe chest pain accompanied by a sense of impending doom, dyspnea at rest, weakness.
Pain has lasted more than 20 minutes.

Medical history
While at a clinic after giving a blood sample, suddenly felt unwell – developed severe chest pain
accompanied by a sense of impending doom, dyspnea at rest, weak has lasted more than 20 minutes.

Life history
Ischemic heart disease, hypertension for 5 years (maximum BP 170/90 mmHg), registered for follow-
up. Takes isosorbide dinitrate (Cardiket), aspirin, and captopr for elevated BP. Reports annual
outpatient treatment.

Physical examination
Pale skin, cold sweat. Temperature – 36.6°C. Lungs: vesicular breathing, no wheezing. RR – 24/min.
Heart sounds muffled, regular rhythm. HR – 92 bpm. BP – 1
No abdominal pathology detected.
Step 01
Which of the following preliminary diagnoses is most likely?

Acute coronary syndrome (ACS)

Hypertensive crisis

Allergic reaction

Vasovagal/autonomic dysfunction

Post-procedure reaction

Step 02
According to the emergency care algorithm for this condition, what is the most appropriate initial
treatment?
Obtain ECG, emergency hospitalization
Oxygen therapy, emergency hospitalization
Administer aspirin and nitroglycerin sublingually
Emergency hospitalization for coronary angiography and ECG

Administer morphine 1 ml IV, emergency hospitalization

Step 03
What diagnostic method is most informative for this patient?
Chest X-ray
Electrocardiogram
Ultrasound of the pleural cavities
Abdominal ultrasound
Renal and adrenal ultrasound

Step 04

An ECG was performed (see image). Initial treatment given: aspirin 325 mg and nitroglycerin 0.5 mg

sublingually. After treatment, the patient’s condition is moderate severity.

Vital signs: RR – 18/min, HR – 96 bpm, BP – 140/80 mmHg. What is the next most appropriate step
to improve hemodynamics?
Clopidogrel 160 mg orally
Bisoprolol 5 mg orally
Enalapril 1.25 mg intravenously
Metoprolol 50 mg orally
NSAID (ketorolac) intramuscularly
Step 05
What is the correct next step in managing this patient after hemodynamic stabilization?
Repeat ECG, urgently call the clinic cardiologist
Emergency hospitalization under physician supervision
Outpatient treatment followed by planned hospitalization
Involve family members in the hospitalization decision
Emergency echocardiography