that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day,
stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First
such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes.
Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are
normal. What is the preliminary diagnosis?
A. Irritable bowels syndrome
B. Celiac disease
C. Crohn’s disease
D. Pseudomembranous colitis
E. Dispancreatism
Explanation : Diagnostic Criteria for Irritable Bowel Syndrome (IBS) :
1) Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months
Plus two or more of the following
2) Improvement with defecation
3) change in frequency of stool
4) change in stool form(appearance)
Note: There is no pathological changes in bowel.
22). The family doctor examined a patient and diagnosed an acute bleeding of an intestine.
What is professional tactics of the doctor in this situation?
A. The urgent hospitalization in surgical department
B. To inject intravenously the aminocapronic acid
C. The urgent hospitalization in therapeutic department
D. Treatment at a day time hospital
E. Treatment at home
Explanation : Acute bleeding of an intestine is medical emergency.
23). A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea.
Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous
membrane in gastric fundus with areas of atrophy. Make a diagnosis.
A. Chronic gastritis of type A
B. Chronic gastritis of type B
C. Peptic ulcer of stomach
D. Chronic gastritis of type C
E. Menetrier’s disease
Explanation: Gastritis A type is autoimmune gastritis which cause atrophy of gastric mucosa.
Mnemonic:
Autoimmune gastritis type A = Autoimmune (Atrophy)
Autoimmune gastritis type B = Bacteria (H. pylori)
Autoimmune gastritis type C = Chemical (Bile)
24). 47 y.o. patient complains of intensive skin itching, jaundice, bone pain. The skin is
hyperpigmentated. There are multiple xanthelasma palpebrae. The liver is +6 cm enlarged, solid
with acute edge. The blood analysis revealed total bilirubin - 160 mkmol/L, direct - 110
mkmol/L, AST- 2,1 mmol/L, ALT- 1,8 mmol/L, alkaline phosphotase - 4,6 mmol/L, cholesterol-
9,2 mmol/L, antimitochondrial antibodies M2 in a high titer. What is the probable diagnosis?
A. Primary biliary liver cirrhosis
B. Primary liver cancer
C. Chronic viral hepatitis B
D. Acute viral hepatitis B
E. Alcoholic liver cirrhosis
Explanation: High titer for antimitochondrail antibody M2 is specific for primary bilary cirrhosis. It is an autoimmune condition.
25). A 60 y.o. woman complains of unbearable pains in the right hypochondrium. In the
medical hystory: acute pancreatitis. Body temperature is 38, 20. Objectively: sclera
icteritiousness. No symptoms of peritonium irritation arepresent. There are positive Ortner’s
and Hubergrits-Skulski’s symptoms. Urine diastase is 320 g/h. What diagnosis is the most
probable?
A. Chronic pancreatitis
B. Acute cholangitis
C. Chronic cholecystitis
D. Acute cholecystitis
E. Cancer of pancreas
Explanation: Ortner’s and Hubergrits-Skulski’s sign posative sign for pancreatitis in this case patient had history of acute pancreatitis thus, history of acute pancreatitis leads to chronic pancreatitis.
26). A 42 y.o. man who has been ill with duodenal ulcer for 20 years complains of getting a
sense of heaviness in stomach after meal, foul-smelling eructation, vomiting, weight loss.
Objectively: his state is relatively satisfactory, tissue turgor is diminished. On palpation the belly
is soft, there are no symptoms of peritenium irritation, "splashing sounds"in epigastrium.
Defecation - once in 3 days. What complication corresponds with the patient’s state and
described clinical presentations?
A. Ulcerative pyloric stenosis
B. Concealed ulcer perforation
C. Stomach cancer
D. Ulcer penetration
E. Chronic pancreatitis
Explanation: Duodenal ulcer is one of rick factor for pyloric stenosis. Heaviness in stomach after meal, foul-smelling eructation, weight loss due to pyloric stenosis.
27). A 63 y.o. woman complains of motiveless weakness, rapid fatigability, loss of appetite,
aversion to meat. Two days ago she had stomach bleeding. Objectively: temperature - 37, 50,
BR- 20/min, Ps- 96/min, AP- 110/75 mm Hg. On palpation in epigastrium - pain and muscle
tension. Blood count: Hb- 82 g/L, ESR- 35 mm/h. What examination will allow to make a
diagnosis?
A. Cytologic
B. Radiography
C. Endoscopy
D. Stomach content examination
E. Coprology
Explanation: Cytology is that branch of life science that deals with the study of cells in terms of structure, function and chemistry.Above patient is elderly( 63 yr) has alarm sign stomach bleeding , ESR ( 35 mm/h) elevated ,motiveless weakens ,rapid fatigability ,loss of appetite aversion to meat suspect to have cancer . Thus, cytologic study is done in order to confirm cancer.
28). A 41 y.o. woman has suffered from nonspecific ulcerative colitis for 5 years. On
rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive
changes of mucous membrane. In blood: WBC- 9, 8∗109/L, RBC- 3, 0∗1012/L, sedimentation
rate - 52 mm/hour. What medication provides pathogenetic treatment of this patient?
A. Sulfasalasine
B. Motilium
C. Vikasolum
D. Linex
E. Kreon
Explanation: Drug of choice for Ulcerative colitis is sulfasalizine.
29). Plan radiography of the patient’s abdominal cavity reveals some hemispherical lucent
areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
A. Intestinal obstruction
B. Perforative ulcer
C. Meteorism
D. Cancer of large intestine
E. Price’s disease
Explanation: Hemispherical lucent area situated above distinct horizontal levels is xray sign of intestinal obstruction.
30). An 8 y.o. boy was ill with B hepatitis one year ago. In the last 2 months he has complaints
of undue fatiguability, sleep disorder, appetite loss, nausea, especially in the mornings. Skin isn’t icterious, liver and spleen are 1 cm below the costal margins, painless. Alanineaminotransferase activity is 2,2 mcmolL. How can this condition be estimated?
A. Development of chronic hepatitis
B. Recurrance of viral hepatitis type B
C. Biliary dyskinesia
D. Residual effects of old viral hepatitis type B
E. Development of liver cirrhosis
Explanation: History of hepatitis B one year ago.
part 4
