Dr.

Ashiq Tutorials

Pediatrics Base
1. A newborn with gestational age of 31 weeks presents with hypotonia and depressed
consciousness. Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content
of erythrocytes and protein, and low glucose. These data correspond with the clinical presentation
of:
A. Intracranial hemorrhage
B. Meningitis
C. Sepsis
D. Anemia
E. Intrauterine infection

2. A 3-month-old child with signs of rickets presents with positive Chvostek, Trousseau, and
Maslov signs. One day ago the parents witnessed a cyanotic attack in their child the child broke
into a cold sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew
in a loud breath and the child's condition normalized again. What is the cause of the
described signs of the disease?
A. Decrease of blood calcium levels
B. Increase of blood calcium levels
c. Decrease of blood phosphorus levels
D. Increase of blood phosphorus levels
E. Metabolic acidosis

3. A 7-year-old boy has been an inpatient for 1.5 months. He had been brought to the hospital
with complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis:
proteins 7.1 g/L, leukocytes - 1-2 in the vision field, erythrocytes - 3-4 in the vision field. During
the course of treatment the edemas gradually dissipated, headache abated, diuresis normalized.
Daily urine proteins 3 g/L. Biochemical blood test: total protein 43.2 g/L, urea - 5.2 mmol/L,
cholesterol - 9.2 mmol/L. What glomerulonephritis syndrome is the most likely to be present in
the patient?
A. Nephrotic
B. Nephritic
c. Isolated urinary
D. Hematuric
E. Mixed

4. A child is 1 year old. After solid food was introduced into the diet, within the last several
months the child developed loss of appetite, diarrhea with large amount of feces, and occasional
vomiting. Body temperature remains normal. Body weight is 7 kg. The child is very pale, has leg
edemas and extremely distended abdomen. Feces analysis detects high levels of fatty acids and
soaps. Diagnosis of celiac disease was made and gluten-free diet was prescribed. What should
be excluded from the diet in this case?
A. Cereals - wheat, oats
B. Milk and dairy products
C. Fruits
D. Animal protein
E. Easily digestible carbohydrates

5. A 7-year-old girl has been twice treated with antibacterial agents for urinary tract infection.
US shows no severe renal defects. The child presents with recurrence of leukocyturia and
bacteriuria, elevated body temperature up to 38.5°C, and pain in her left lumbar area. What
examination should be conducted first to clarify the cause of urinary infection recurrence?
A. Micturating cystourethrography
B. Excretory urography
C. Retrograde pyelography
D. Immunogram
E. Radioisotope renography

6.A 10-year-old boy with symptoms of arthritis and myocarditis was brought to a hospital. Based
on clinical examination the provisional diagnosis of juvenile rheumatoid arthritis was made. What
symptom is the most contributive for the diagnostics of this disease?
A. Reduced mobility of the joints in the morning
B. Regional hyperemia of the joints
C. Affection of the large joints
D. Enlarged heart
E. Increased heart rate

7. A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult
inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset.
What is the most likely diagnosis?
A. Stenosing laryngotracheobronchitis
B. Acute pulmonary inflammation
C. Bronchial asthma
D. Acute bronchitis
E. Acute bronchiolitis

8. At night a 2-year-old child with upper respiratory tract infection suddenly developed dyspnea
with labored inspiration. Objectively the skin is pale, perioral cyanosis and slight acrocyanosis are
observed. Breathing is loud, respiration rate is 32/min. Jugular, supra- and infraclavicular fossae
retract during breathing. Respiration is coarse on auscultation. Heart sounds are clear and
sonorous, heart rate is 120/min. What condition was complicated by the development of the upper
respiratory tract infection?
A. Stenosing laryngotracheitis
B. Airway foreign body
c. Obstructive bronchitis
D. Bronchiolitis
E. Bronchial asthma

9. During examination a 4-month-old child with meningococcemia presents with acrocyanosis,

cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor.
What clinical syndrome is it?
A. Toxic shock syndrome
B. Neurotoxicosis
C. Exicosis
D. Encephalic syndrome
E. Acute renal failure

10. A 2-year-old child with persisting cough and subfebrile body temperature after a case of URTI
developed dyspnea, cyanosis of the nasolabial triangle, percussion dullness and weakened
respiration in the lower lobe of the right lung, and a slight mediastinal displacement to the left.
What pulmonary pathology is likely to cause this clinical presentation?
A. Pleurisy
B. Emphysema
C. Pneumonia
D. Atelectasis
E. Bronchitis

11. Mother of a 5-year-old child noticed on the the head of her child a round "bald" spot 3 cm in
diameter. All the hairs in the focus are broken off at the length of 5-6 mm. The day before the child
was petting a stray cat. Make the diagnosis:
A. Microsporia
B. Superficial trichophytosis
C. Deep trichophytosis
D. Psoriasis
E. Alopecia areata

12. A 7-year-old boy has severe pulmonary mucoviscidosis (cystic fibrosis). He complains of
dyspnea and blood expectoration. Objectively he presents with lagging physical development,
acrocyanosis, hepatomegaly, drumstick fingers, and nail plates resembling a "clock face".
Provisional diagnosis of chronic pulmonary heart disease is made. What examination would be
the most informative for diagnosis confirmation?
A. Doppler echocardiography
B. Electrocardiography
C. Chest X-ray
D. Rheography of the pulmonary artery
E. Ultrasound of the liver

13. A 13-year-old girl for the last two weeks has been complaining of dyspnea and shin and foot
edemas that appear after a physical exertion. In the morning the edemas significantly decrease.
Clinical examination revealed enlarged liver and coarse systolic murmur over the heart area.
Blood test and urinalysis are without changes. What is the most likely cause of edemas in this
child?
A. Heart failure
B. Nephrotic syndrome
C. Acute pyelonephritis
D. Angioneurotic edema
E. Hepatic cirrhosis

14. A newborn girl has Apgar score of 7-8 points at the 1-5 minutes after birth. During the labor
there was a brief difficulty with extraction of the shoulder girdle. After birth the baby presents with
disturbed function of the proximal segment and forced position of the right arm. The shoulder is
rotated inwards, the elbow is extended, the forearm is pronated, and the whole upper limb
resembles an arm of a doll. What is the most likely clinical diagnosis in this case?
A. Erb-Duchenne palsy
B. Thoracic spine trauma
C. Osteomyelitis of the right arm
D. Intracranial hemorrhage
E. Soft tissue injury of the right arm

15. A 3-month-old child with signs of rickets presents with positive Chvostek, Trousseau, and Maslov
signs. One day ago the parents witnessed a cyanotic attack in their child -the child broke into a cold
sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew in a loud
breath and the child's condition normalized again. What is the cause of the described signs of the
disease?
A. Decrease of blood calcium levels
B. Increase of blood calcium levels
C. Decrease of blood phosphorus levels
D. Increase of blood phosphorus levels
E. Metabolic acidosis

16. The 5-year-old child has been ill for 2 weeks. Cough attacks developed first and were then
followed by reprises. During coughing the child's face turns red and cervical veins bulge. The cough
attacks induce vomiting. X-ray shows intensified bronchial pattern. Blood test: leukocytes - 16 · 10°/L
, lymphocytes - 72%, erythrocyte sedimentation rate - 4 mm/hour. What is the most likely diagnosis?
A. Pertussis
B. Obstructive bronchitis
C. Pneumonia
D. Adenovirus infection
E. Foreign body

17. A 10-year-old child complains of fever (temperature is 39°C), frequent painful urination
[pollakiuria]. Urine test: proteinuria [0,066 g/L], leukocytouria [entirely within eyeshot],
bacteriuria [105 colony forming units/mL]. What is the most probable diagnosis?
A. Acute pyelonephritis
B. Acute glomerulonephritis
C. Acute cystitis
D. Urolithiasis
E. Dysmetabolic nephropathy

18. A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of
skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart
dullness: right - the parasternal line, upper – the III rib, left - 1,0 cm outwards from the midclavicular
line. Make the provisional diagnosis:
A. Infectious myocarditis
B. Functional cardiopathy
C. Somatoform autonomic dysfunction
D. Hypertrophic cardiomyopathy
E. Exudative pericarditis

19. A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp;
later the nodes suppurated. Temperature increased up to 37.7°C, intoxication symptoms appeared,
regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, raised
ESR. What diagnosis will you make?
A. Pseudofurunculosis
B. Pemphigus
C. Vesiculopustulosis
D. Scalp phlegmon
E.-

20. During regular examination of a 2- year-old boy, he presents with enlarged left kidney, painless
on palpation. The right kidney was undetectable on palpation. Excretory urography shows no
contrast on the right. Cytoscopy detected hemiatrophy of the urinary bladder trigone, the right
ureteral orifice is not detected. What pathology is it?
A. Agenesis of the right kidney
B. Dystopia of the right kidney
C. Hypoplasia of the right kidney
D. Agenesis of the right ureter
E. Ectopic right ureteral orifice

21. A full-term newborn (born with the body weight of 3900 g at gestational age of 39 weeks) on the
first day of his life developed respiratory disturbances: dyspnea, arrhythmic respiration, cyanosis
attacks. On examination there is paradoxical respiration observed and left side of the chest lags
behind in the act of breathing. On auscultation the respiration is weakened in the lungs on the left.
Neurologist diagnosed the patient with left-sided Erb-Duchenne palsy. Complete blood count shows
no changes. What is the most likely diagnosis?
A. Left-sided diaphragm paresis
B. Congenital pneumonia
C. Left-sided pneumothorax
D. Respiratory distress syndrome
E. Transient tachypnea of the newborn

22. A 3-year-old child has been brought to a hospital with complaints of pain in the legs, fever, and
loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged,
painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver
and spleen are enlarged. Hemogram: Hb-88 g/L, color index - 1.3, platelets - 80 · 10°/L, leukocytes -
25.8 · 10°/L, lymphoblasts - 70%, ESR 52 mm/hour. Make the provisional diagnosis:
A. Acute leukemia
B. Thrombocytopenic purpura
C. Acute rheumatic fever
D. Infectious mononucleosis
E. Hemorrhagic vasculitis (Henoch-Schonlein purpura)

23. During a regular examination, an 8-year-old girl with type I diabetes mellitus presents with a
swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on
palpation. The skin over this formation has normal color and temperature. Localization of the
swelling matches the place where the girl usually receives her insulin injections. What is the most
likely cause of this clinical presentation?
A. Development of hypertrophic lipodystrophy
B. Development of atrophic lipodystrophy
C. Formation of a post-injection abscess
D. Formation of a post-injection infiltration
E. Allergic response
24. A 10-year-old boy came to the polyclinic with complaints of stuffy nose. It is known that these
signs occur in the child periodically in spring and autumn). He has a history of atopic dermatitis. The
father of the child has bronchial asthma. Objectively, the boy's face is pale and slightly swollen.
Respirations are 22/min. Auscultation detects vesicular respiration over the lungs. Rhinoscopy shows
swollen and pale nasal mucosa. What disease can be suspected?
A. Allergic rhinitis
B. Recurrent respiratory disease
C. Acute rhinitis
D. Acute maxillary sinusitis
E. Acute adenoiditis

25. A 7-year-old boy after a fall from a height presents with rapid and shallow breathing and cyanotic
face. The right half of his thorax is distended and takes no part in the respiration. Percussion detects
tympanitis in the affected area, while auscultation detects no breathing there. What pathology is the
most likely cause of this clinical presentation? What instrumental examination would be the most
informative in this case?
A. Right-sided tension pneumothorax. Chest X-ray
B. Mediastinitis. Survey X-ray of the chest
C. Tension cyst of the right lung.Tracheobronchoscopy
D. Airway foreign body. Diagnostic-therapeutic bronchoscopy
E. Right-sided hemothorax. Survey X-ray of the chest

26. A 9-year-old boy fell off a tree and hit the back of his head. A brief loss of consciousness was
observed. The child's condition is satisfactory, he has a headache and vertigo. Skull X-ray scans show
a depressed fracture of the occipital bone in the area of the external occipital protuberance. What
treatment tactics is indicated for this patient?
A. Surgical intervention
B. Anti-inflammatory therapy
C. Hemostatic therapy
D. Lumbar puncture to relieve the pressure
E. Complex conservative treatment

27. After semolina was introduced into the diet, a 1-year-old child for 2 months has been presenting
with loss of appetite, irritability, loss of body mass, and loss of previously learned skills. The feces are
copious and foul-smelling. The skin is pale and dry, the hair is brittle. The abdomen is distended,
while the limbs are thin. Stool test shows high levels of fatty acids. What is the most likely diagnosis?
A. Celiac disease
B. Mucoviscidosis
C. Lactase deficiency
D. Functional diarrhea
E. Irritable bowel syndrome

28. A newborn has a round red formation in the suprapubic region. Examination shows that urine is
being discharged in pulses from the two orifices located in the lower part of this formation. Name
this developmental anomaly:
A. Bladder exstrophy
B. Vesico-umbilical fistula
C. Bladder diverticulum
D. Urachal cyst
E. Bladder agenesis

29. A 2.5-year-old child is ill for the second day. The onset of the disease was associated with the
temperature up to 37.8°C, a single bout of vomiting, and watery diarrhea up to 5 times per day.
During the second day, vomiting occurred twice, body temperature is 38.0°C, the child has low
appetite, watery diarrhea continues. The treatment of the child should start with the following:
A. Prescribe oral rehydration
B. Prescribe nifuroxazide
C. Prescribe ceftriaxone
D. Prescribe polymyxin
E. Prescribe loperamide

30. After playing with "mosaics”, a 2-year-old child suddenly developed cough, stridorous
respirations, urges to vomit, and cyanosis against the background of relative somatic health. What
should the doctor suspect first when examining this child?
A. Foreign body aspiration
B. Acute laryngotracheitis
C. Pertussis
D. Pneumonia
E. Acute obstructive bronchitis

31. A 6-year-old girl complains of body temperature up to 39°C, rhinitis, dry cough, dyspnea. She has
been presenting with these signs for 5 days already. On examination her condition is of moderate
severity. Her dyspnea is of mixed genesis. Respirations are 28/min., pulse is 120/min. Percussion
produces a dull sound in the right lower segments; in the same area auscultation detects weakened
respiration and fine vesicular wet crackles; coarse respiration can be detected on the left. Make the
provisional diagnosis:
A. Right-sided community-acquired pneumonia
B. Acute obstructive bronchitis
C. Stenosing laryngotracheitis
D. Acute simple bronchitis
E. Acute bronchiolitis

32. An 8-day-old boy was delivered to the hospital on the second day after the onset of the disease.
His parents complain of his fussiness, regurgitation, body temperature up to 38.5°C, red skin with
infiltration in the lumbar area. His medical history has no peculiarities. The child is in the severe
condition, inert, pale, suckles poorly. In the lumbar area, on the sacrum and buttocks there is a tense
infiltration with hyperemic and cyanotic areas and with a soft spot 8x7 cm in its center. The stool is
10 times in 24 hours, with green and mucous admixtures. What is the most likely diagnosis?
A. Phlegmon of the newborn
B. Adiponecrosis
C. Erysipelas
D. Hemangioma
E. Congenital soft-tissue tumor

33. A newborn has Apgar score of 9. When should this infant be put to the breast?
A. In the delivery room
B. After 12 hours
C. After 2 hours
D. On the 2nd day
E. On the 3rd day

34. A 3-week-old infant developed large, flaccid vesicles with purulent contents on the skin of
chest and abdomen. The vesicles rupture quickly. Make the provisional diagnosis:
A. Pemphigus neonatorum
B. Vesiculopustulosis
C. Toxic erythema
D. Pemphigus syphiliticus
E. Pseudofurunculosis

35. 10 hours after birth a child developed jaundice, hypotonia, hyporeflexia, and moderate
hepatosplenomegaly. Feces and urine are of normal color. Umbilical cord blood bilirubin is 51
mcmol/L due to unconjugated bilirubin levels. In venous blood: erythrocytes - 3.5·1012/L, Нb- 140
g/L, reticulocytes - 1.5%, bilirubin - 111 mcmol/L, conjugated - 11 mcmol/L, ALT- 40 U/L, AST30
U/L. Mother’s blood group is А(II) Rh(-), child’s blood group is А(II) Rh(+). What laboratory test
can confirm the diagnosis?
A. Coombs test
B. Viral hepatitis markers analysis
C. Measurement of erythrocyte osmotic resistance
D. Erythrocytometry
E. Measurement of glucose 6-phosphate dehydrogenase levels in erythrocytes

36. A 8-year-old boy has suffered from tonsilitis. In 2 weeks he started complaining of
migratory joint pain, edema of joints, restriction of movements, fever. On examination, an
acute rheumatic heart disease, activity of the III-rd degree, primary rheumocarditis,
polyarthritis; acute course of disease, cardiovascular failure IIA. What medication is to be
prescribed?
A. Prednisone
B. Cefazolin
C. Diprazinum
D. Erythromycin
E. Delagil

37. The 10 y.o. boy has complains on headache, weakness, fever 40°C, vomiting, expressed
dyspnea, pale skin with flush on right cheek, lag of right hemithorax respiratory movement,
dullness on percussion over low lobe of right lung, weakness of vesicular respiration in this
zone. The abdomen is painless and soft at palpation. Which disease lead to these
symptoms and signs?
A. Pneumonia croupousa
B. Acute cholecystitis
C. Flu
D. Intestinal infection
E. Acute appendicitis
38. A patient with acute respiratory viral infection (3rd day of disease) complains of pain in
lumbar region, nausea, dysuria, oliguria. Urinalysis - hematuria (100-200 RBC in eyeshot
spot), specific gravity - 1002. The blood creatinin level is 0,18 millimole/l, potassium level -
6,4 millimole/l. Make the diagnosis:
A. Acute interstitial nephritis
B. Acute glomerylonephritis
C. Acute renal failure
D. Acute cystitis
E. Acute renal colic

39. A neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd
day of life, then it became more acute. The adynamia, vomiting and hepatomegaly were
observed. Indirect bilirubin level was 275 mumol/L, direct bilirubin level – 5 mumol/L, Hb150 g/l.
Mothers blood group - 0(I), Rh+, childs blood group - A(II), Rh+. What is the most
probable diagnosis?
A. Hemolytic disease of the neonate (??0 incompatibility), icteric type
B. Physiological jaundice
C. Hemolytic disease of the neonate (Rh - incompatibility)
D. Jaundice due to conjugation disorder
E. Hepatitis

40. A baby boy was born in time, it was his mothers 1st pregnancy. The jaundice was
revealed on the 2nd day of life, then it progressed. The adynamia, vomiting and
hepatomegaly were presented. The indirect bilirubin level was 275 mcmol/L, the direct
bilirubin level - 5 mcmol/L, Hb- 150 g/L. Mothers blood group - 0(I), Rh+, childs blood
group - A(II), Rh+. Make a diagnosis.
A. Hemolytic disease of newborn (Rh incompatibility), icteric type
B. Hemolytic disease of newborn (Rh - incompatibility)
C. Hepatitis
D. Jaundice due to conjugation disorder
E. Physiological jaundice

41. A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration
rate - 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration and
pulse - ratio is 1:2. The heart dullness under normal size. Such signs characterise:
A. Respiratory failure of III degree
B. Respiratory failure of I degree
C. Myocarditis
D. Congenital heart malformation
E. Respiratory failure of II degree

42. The 7 m.o. infant is suffering from acute pneumonia which was complicated by
cardiovascular insufficiency and respiratory failure of II degree. The accompanied
diagnosis is malnutrition of II degree. Choose the best variant of therapy:
A. Ampiox and Amicacin
B. Gentamycin and Macropen
C. Ampiox and Polymixin
D. Macropen and Penicillin
E. Penicillin and Ampiox

43. A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days.
He has been taking sulfadimethoxine. Today it has fever up to 39°C and maculopapular
rash on its face. Except of rash the childs skin has no changes. What is your diagnosis?
A. Measles
B. Pseudotuberculosis
C. Rubella
D. Allergic rash
E. Scarlet fever

44. A 2 year old girl has been ill for 3 days. Today she has low grade fever, severe catarrhal
presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph
nodes. What is your diagnosis?
A. Rubella
B. Scarlet fever
C. Adenoviral infection
D. Pseudotuberculosis
E. Measles

45. A 3 year old boy fell ill abruptly: fever up to 39°C, weakness, vomitng. Haemorrhagic rash
of various size appeared on his lower limbs within 5 hours. Meningococcemia with
infective - toxic shock of the 1 degree was diagnosed. What medications should be
administered?
A. Chloramphenicol succinate and prednisone
B. Penicillin and immunoglobulin
C. Ampicillin and immunoglobulin
D. Chloramphenicol succinate and interferon
E. Penicillin and prednisone

46. A 7 year old girl has mild form of varicella. Headache, weakness, vertigo, tremor of her
limbs, ataxia, then mental confusion appeared on the 5th day of illness. Meningeal signs
are negative. Cerebrospinal fluid examination is normal. How can you explain these signs?
A. Encephalitis
B. Meningitis
C. Myelitis
D. Neurotoxic syndrome
E. Meningoencephalitis

47. A 7 y.o. girl fell ill abruptly: fever, headache, severe sore throat, vomiting. Minute bright red
rash appear in her reddened skin in 3 hours. It is more intensive in axillae and groin.
Mucous membrane of oropharynx is hyperemic. Greyish patches is on the tonsills.
Submaxillary lymph nodes are enlarged and painful. What is your diagnosis?
A. Scarlet fever
B. Rubella
C. Measles
D. Pseudotuberculosis
E. Enteroviral infection
48. An 8-year-old boy fell ill acutely: he presents with fever, weakness, headache, abdominal
pain, recurrent vomiting, then diarrhea and tenesmus. Stools occur 12 times daily, are
scanty, contain a lot of mucus, pus, streaks of blood. His sigmoid gut is tender and
hardened. What is your diagnosis?
A. Dysentery
B. Cholera
C. Escherichiosis
D. Staphylococcal gastroenteritis
E. Salmonellosis

49. The child has complains of the "night" and "hungry" abdominal pains. At fibroscopy in area
a bulbus ofa duodenum the ulcerrative defect of 4 mms diameter is found, the floor is
obtected with a fibrin, (H.p +). Administer the optimum schemes of treatment:
A. Omeprasole - Trichopolum - Claritromicin
B. Maalox - Ranitidin
C. De-nol
D. Vicalinum - Ranitidin
E. Trichopolum

50. A woman delivered a child. It was her fifth pregnancy but the first delivery. Mothers blood
group is A(II)Rh-, newborns - A(II)Rh+. The level of indirect bilirubin in umbilical blood was
58 micromole/l, haemoglobin - 140 g/l, RBC- 3,8×1012/l. In 2 hours the level of indirect
bilirubin turned 82 micromole/l. The hemolytic disease of newborn (icteric-anemic type,
Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:
A. Replacement blood transfusion (conservative therapy)
B. Blood transfusion (conservative therapy)
C. Conservative therapy
D. Symptomatic therapy
E. Antibiotics

51. A mother with an infant visited the pediatrician for expertise advice. Her baby was born
with body weight 3,2 kg and body length 50 cm. He is 1 year old now. How many teeth the
baby should have?
A. 8
B. 12
C. 10
D. 20
E. 6

52. A mother consulted a pediatrician about her son. Her son was born with body mass of 3 kg
and length of 48 cm. He is 1 year old now. What is the required normal mass?
A. 10,5 kg
B. 9,0 kg
C. 12,0 kg
D. 15,0 kg
E. 11,0 kg
53. 6 m.o. infant was born with bodys mass 3 kg and length 50 cm. He is given natural
feeding. How many times per day the infant should be fed?
A. 5
B. 4
C. 6
D. 7
E. 8

54. Infant is 6,5 months now and is given natural feeding since birth. Body mass was 3,5 kg,
with length 52 cm at birth. How many times per day the supplement (up feeding) should be
given?
A. 2
B. 1
C. 4
D. 0
E. 3

55. A 2 month old healthy infant with good appetite is given artificial feeding since he turned 1
month old. When is it recommended to start the corrective feeding (fruit juice)?
A. 4,0 months
B. 2,0 months
C. 1,5 months
D. 3,0 months
E. 1,0 months

56. An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old.
His brother is 7 years old, suffers from rheumatic fever. Mother asked the doctor for a
cardiac check up of the 3-year-old son. Where is the left relative heart border located?
A. 1 cm left from the left medioclavicular line
B. 1 cm right from the left medioclavicular line
C. 1 cm left from he left parasternal line
D. 1 cm right from the left parasternal line
E. Along the left medioclavicular line

57. A boy of 7 y.o. had an attack of asthma and distant whistling rales after playing with a dog.
In the medical hystory: atopic dermatitis caused by eating eggs, chicken, beef. What group
of allergens is the reason of the development of bronchial astma attacks?
A. Epidermal
B. Chemical
C. Pollen
D. Dust
E. Itch mite

58. A 14-year-old boy has rheumatism. Over the last 2 years he has had 3 rheumatic attacks.
What course of rheumatism does the patient have?
A. Prolonged
B. Subacute
C. Persistent-reccurent
D. Latent
E. Acute

59. The patient with aquired heart failure has diastolic pressure of 0 mm Hg. What heart failure
does the child have?
A. Aortal insufficiency
B. Aortal stenosis
C. Mitral stenosis
D. Mitral insufficiency
E. Rheumatism

60. A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?
A. Intestinal bacillus
B. Influenza
C. Salmonella
D. Helicobacter pylory
E. Lambliosis

61. A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory
examinations show acute condition. What nutrients must not be limited during the acute
period of glomerulonephritis?
A. Carbohydrates
B. Liquid
C. Fats
D. Proteins
E. Salt

62. An 18-month-old child was taken to a hospital on the 4-th day of the disease. The disease
began acutely with temperature 39, weakness, cough, breathlessness. He is pale,
cyanotic, has had febrile temperature for over 3 days. There are crepitative fine bubbling
rales on auscultation. Percussion sound is shortened in the right infrascapular region. Xray picture
shows non-homogeneous segment infiltration 8-10 mm on the right, the
intensification of lung pattern. Your diagnosis:
A. Segmentary pneumonia
B. Bronchiolitis
C. Interstitial pneumonia
D. Grippe
E. Bronchitis

63. A 9-year-old girl has attacks of abdominal pain after fried food. No fever. She has pain in
Cera point. The liver is not enlarged. Portion B [duodenal probe] - 50 ml. What is your
diagnosis?
A. Biliary tracts dyskinesia, hypotonic type
B. Hepatocirrhosis
C. Chronic duodenum
D. Peptic ulcer
E. Acute colitis
64. A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby
has a large cephalohematoma. The results of blood count are: Hb- 120g/l, Er- 3,5×1012/l,
total serum bilirubin - 123 mmol/l, direct bilirubin - 11 mmol/l, indirect - 112 mmol/l. What
are causes of hyperbilirubinemia in this case?
A. Erythrocyte hemolysis
B. Mechanical obstruction of the bile outflow
C. Disturbance of the conjugative function of liver
D. Intravascular hemolysis
E. Bile condensing

65. A 4-month-old girl with blond hair and blue eyes has "mousy" odor of sweat and urine,
delayed psychomotoric development. The most typical laboratory data for this disorder is:
A. Positive urine ferric chloride test
B. High level of oxyproline in urine
C. High concentration of chlorides in sweat
D. Low level of thyroid gland hormones in blood
E. High level of glycosaminoglycanes in urine

66. A neonate is 5 days old. What vaccination dose of BCG vaccine (in mg) is necessary for
vaccination of this child?
A. 0,05 mg
B. 0,075 mg
C. 0,2 mg
D. 0,1 mg
E. 0,025 mg

67. 7 y.o. boy with chronic sinusitis and rercurent pulmonary infections has chest X-ray
demonstrating a right-sided cardiac silhouette. What is the most likely diagnosis?
A. Kartagener syndrome
B. Bronchiolitis obliterans
C. Cystic fibrosis (mucoviscidosis)
D. Laryngotracheomalacia
E. alpha-antitrypsin deficiency

68. A 2,9-kg term male infant is born to a mother who developed polyhydramnios at 34 weeks
gestation. At birth, the Apgar scores were 9 and 9. The infant develops choking and
cyanosis with the first feed. In addition, is unable to place a nasogastric tube. What is the
most likely diagnosis?
A. Esophageal atresia
B. Laryngomalacia
C. Respiratory distress syndrome
D. Tracheal atresia
E. Choanal atresia

69. Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of
newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect
serum bilirubin level increasing up to 14 mmol/L. What is most appropriate for treatment of
hyperbilirubinemia in this infant?
A. Exchange blood transfusion
B. Infusion therapy
C. Phenobarbital
D. Phototherapy
E. Intestinal sorbents

70. A 4 year old girl was playing with her toys and suddenly she got an attack of cough,
dyspnea. Objectively: respiration rate - 45/min, heart rate - 130/min. Percussion revealed
dullness of percutory sound on the right in the lower parts. Auscultation revealed
diminished breath sounds with bronchial resonance on the right. X-ray pictue showed
shadowing of the lower part of lungs on the right. Blood analysis revealed no signs of
inflammation. The child was diagnosed with foreign body in the right bronchus. What
complication caused such clinical presentations?
A. Atelectasis
B. Emphysema
C. Bronchitis
D. Pneumonia
E. Pneumothorax

71. A man, 42 years old, died in a road accident after the hemorrhage on the spot, because of
acute hemorrhagic anemia. What minimum percent of the whole blood volume could result
in death by acute hemorrhage?
A. 25-30%
B. 10-14%
C. 35-50%
D. 15-20%
E. 6-9%

72. A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although
conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical
examination reveals tachypnea, bilateral inspiratory crackles and single expiratory
wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no
history of fever. White blood cell count is 15×109/l, with 28% of eosinophils. The most
likely cause of this childs symptoms is:
A. Clamydia trachomanis
B. Varicella
C. Mycoplasma pneumoniae
D. Pneumocystis carinii
E. Visceral larva migrans

73. A 6 y.o. asthmatic child was taken to the emergency hospital because of severe coughing
and wheezing for the last 24 hours. Physical examination reveals that the child is
excitable, has intercostal and suprasternal retractions, expiratory wheezing throughout all
lung fields, RR- 60/min. Initial treatment may include the prescription of:
A. Subcutaneous epinephrine
B. Parenteral phenobarbital
C. N-acetyl cysteine and cromolyn by inhalation
D. Parenteral gentamicyn
E. Intravenous fluids in the first 2 h to compensate water deficiency

74. A full term infant was born after a normal pregnancy, delivery, however, was complicated
by marginal placental detachment. At 12 hours of age the child, although appearing to be
in good health, passes a bloody meconium stool. For determining the cause of the
bleeding, which of the following diagnostic procedures should be performed first?
A. Barium enema
B. An upper gastrointestinal series
C. Platelet count, prothrombin time, and partial thromboplastin time
D. An Apt test
E. Gastric lavage with normal saline

75. In the 43rd week of gestation a long, thin infant was delivered. He is apneic, limp, pale,
and covered with "pea soup" amniotic fluid. The first step in the resuscitation of this infant
at delivery should be:
A. Suction of the trachea under direct vision
B. Artificial ventilation with endotracheal tube
C. Catheterization of the umbilical vein
D. Administration of 100% oxygen by mask
E. Artificial ventilation with bag and mask

76. A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and
cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per
minute. The child most likely has congestive heart failure caused by:
A. Paroxysmal atrial tachycardia
B. A large atrial septal defect and valvular pulmonary stenosis
C. Atrial flutter and partial atrioventricular block
D. A ventricular septal defect and transposition of the great vessels
E. Hypoplastic left heart syndrome

77. A 6-year-old boy was brought to the emergency room with a 3-hour history of fever up to
39,5°C and sore throat. The child looks alert, anxious and has a mild inspiratory stridor.
You should immediately:
A. Prepare to establish an airway
B. Admit the child and place him in a mist tent
C. Order a chest x-ray and lateral view of the neck
D. Obtain an arterial blood gas and start an IV line
E. Examine the throat and obtain a culture

78. A 7 d.o. boy is admitted to the hospital for evaluation of vomiting and dehydration. Physical
examination is otherwise normal except for minimal hyperpigmentation of the nipples.
Serum sodium and potassium concentrations are 120 meq/L and 9 meq/L respectively.
The most likely diagnosis is:
A. Congenital adrenal hyperplasia
B. Pyloric stenosis
C. Panhypopituitarism
D. Hyperaldosteronism
E. Secondary hypothyroidism
79. A 7 y.o. boy has crampy abdominal pain and a rash on the back of his legs and buttocks
as well as on the extensor surfaces of his forearms. Laboratory analysis reveals
proteinuria and microhematuria. He is most likely to be affected by:
A. Anaphylactoid purpura
B. Polyarteritis nodosa
C. Dermatomyositis
D. Systemic lupus erythematosus
E. Poststreptococcal glomerulonephritis

80. A 5-year-old boy was progressively getting worse compared to the previous 2 months. A
chest x-ray has shown right middle lobe collapse. A tuberculin skin test was strongly
positive. What is the most characteristic finding in primary tuberculosis?
A. Hilar or paratracheal lymph node enlargement
B. Cavity formation
C. Hematogenous dissemination leading to extrapulmonary tuberculosis
D. Miliary tuberculosis
E. Atelectasis with obstructive pneumonia

81. A girl is 12-year-old. Yesterday she was overcooled. Now she is complaining on pain in
suprapubic area, frequent painful urination by small portions, temperature is 37,8°C.
Pasternatsky symptom is negative. Urine analysis: protein - 0,033 g/L, WBC- 20-25 in
f/vis, RBC- 1-2 in f/vis. What diagnosis is the most probable?
A. Acute cystitis
B. Dysmetabolic nephropathy
C. Acute pyelonephritis
D. Urolithiasis
E. Acute glomerulonephritis

82. The girl of 11 y.o. She is ill for 1 month. She has "butterfly"-type rash on face (spots and
papules), pain and swelling of small joints on arms and legs, signs of stomatitis (smallsized ulcers in
mouth). CBC: Hb– 80 g/L, RBC– 2,9×1012/L, WBC– 15×109/L, ESR- 40
mm/hour. Urinalysis: protein– 0,33 g/L. What is the most probable diagnosis?
A. Systemic lupus erythematosus
B. Periarteriitis nodosa
C. Juvenile rheumatoid arthritis, systemic type
D. Acute rheumatic fever
E. Dermatomyositis

83. An infant aged 1 year on the third day of common cold at night developed inspiratory
stridor, hoarse voice and barking cough. Physical examination revealed suprasternal and
intercostal chest retractions. There is a bluish skin discoloration moistly seen over the
upper lip. The respiratory rate is 52 per min and pulse- 122 bpm. The body temperature is
37,5°C. What disease does the infant have?
A. Acute infectious croup due to viral laryngotracheitis
B. Acute bronchiolitis with respiratory distress
C. Acute epiglottitis
D. Acute laryngitis
E. Bronchopneumonia without complications

84. A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following
disorders. From beginning there were severe jaundice with poor suckling, hypotomia and
hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal
primitive reflexes loss are noted. Now physical examination reveals convergent squint,
rotatory nystagmus and setting sun eye sign. How to explain this condition?
A. Encephalopathy due to hyperbilirubinemia
B. Spastic cerebral palsy
C. Brain tumour
D. Skull injury
E. Hydrocephalus

85. A child is 2 years old. The child complains of hoarse voice, dyspnea with obstructed
inspiration. The disease started 3 days ago from dry cough and nose stuffiness.
Objectively: general condition is unbalanced, stridor is present. The childs skin is pale.
Body temperature is 37,7°C. The palatine arches are hyperemic. There is no deposit.
Heart sounds are rhythmic. Auscultation of lungs reveals rough breathing sounds,
crepitation is absent. Parainfluenza virus has been detected in nasopharynx lavage. What
is the most likely diagnosis?
A. Acute laryngotracheitis
B. Foreign body
C. Epiglottitis
D. Diphtheria
E. Laryngospasm

86. A 3-year-old child has been admitted to a hospital because of ostealgia and body
temperature rise up to 39°C. Objectively: the patient is in grave condition, unable to stand
for ostealgia, there is apparent intoxication, lymph nodesare enlarged up to 1,5 cm. Liver
can be palpated 3 cm below the costal margin, spleen - 2 cm below the costal margin. In
blood: RBCs - 3,0×1012/l, Hb- 87 g/l, colour index - 0,9, thrombocytes – 190×109/l, WBCs
- 3,2×109/l, eosinophils - 1, stab neutrophils - 1, segmented neutrophils - 0, lymphocytes -
87, monocytes - 2, ESR - 36 mm/h. What examination should be conducted in order to
specify the diagnosis?
A. Sternal puncture
B. Computer tomography
C. Lymph node puncture
D. Ultrasound
E. Lymph node biopsy

87. Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8
scores. During the delivery there was a short-term difficulty with extraction of shoulder
girdle. After birth the child had the proximal extremity dysfunction and the arm couldnt be
raised from the side. The shoulder was turned inwards, the elbow was flexed, there was
also forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?
A. Duchenne-Erb palsy
B. Trauma of right hand soft tissues
C. Right hand osteomyelitis
D. Trauma of thoracic spine
E. Intracranial haemorrhage

88. Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement.
Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed
continuous systolic murmur to the left of the breastbone in the 3-4 intercostal space. This
murmur is conducted above the whole cardiac region to the back. What congenital cardiac
pathology can be suspected?
A. Defect of interventricular septum
B. Pulmonary artery stenosis
C. Coarctation of aorta
D. Defect of interatrial septum
E. Fallots tetrad

89. A worker was temporarily off work because of illness for 16 days, was under out-patient
treatment. The doctor in charge issued a sick-list first for 5 days, then prolonged it for 10
days. Who can further prolong the sick-list of this patient?
A. The doctor in charge of the case together with the head of department
B. The doctor in charge of the case with the permission of the head of department
C. The head of department
D. Deputy head physician on the working ability expertise
E. Working ability expertise committee

90. A 13 y.o. patient was treated in dermatological hospital for atopic dermatitis exacerbation.
He was discharged in the condition of clinical remission. What recommendations should
the doctor give to prevent exacerbations?
A. Use of neutral creams to protect skin
B. Frequent skin washing with detergents
C. Systematic skin disinfection
D. Avoidance of skin insolation
E. Systematic use of local corticosteroids

91. On the 21 day after appearance of vesiculous chickenpox rash a 7-year-old child
developed ataxia, nystagmus, intention tremor, muscle hypotonia. Liquor analysis shows a
low-grade lymphocytic pleocytosis, slightly increased protein rate. What complication is it?
A. Encephalitis
B. Purulent meningitis
C. Acute nephritis
D. Postherpetic neuralgia
E. Pneumonitis

92. An 8-year-old boy suffering from haemophilia was undergoing transfusion of packed red
cells. Suddenly he felt pain behind the breastbone and in the lumbar area, dyspnea, cold
sweat. Objectively: pale skin, heart rate - 100/min, AP - 60/40 mm Hg; oliguria, brown
urine. For the treatment of this complication the following drug should be administered:
A. Prednisolone
B. Adrenaline
C. Analgine
D. Aminophylline
E. Lasix

93. A 3-year-old child has been diagnosed with type I diabetes mellitus, hyperosmolar coma.
The laboratory confirmed the diagnosis. Which laboratory findings are characteristic for
such condition?
A. High hyperglycemia without ketonemia
B. Hyperglycemia and glucosuria
C. Hyperglycemia and high indicators of acid-base balance
D. Hyperglycemia and ketonuria
E. Hyperglycemia and ketonemia

94. A 3-year-old child was playing in a playpen when he suddenly developed paroxysmal
cough and shortness of breath. Objectively: dry cough, mixed dyspnea. Lung auscultation
revealed some wheezes. Breathing sounds on the right are diminished. The child doesnt
mix with other children. Immunization is age-appropriate. What pathological condition can
be suspected?
A. Foreign body in the respiratory tracts
B. Pneumonia
C. Pertussis
D. Bronchial asthma
E. Acute respiratory viral infection

95. A 10-year-old child has been folowed-up for the dilated cardiomyopathy. The child
presents with dyspnea, cardialgia. There are dense, nonmobile edemata on the lower
extremities and sacrum. Ps- 120/min. The cardiac borders are extended transversely.
Heart sounds are muffled, there is blowing systolic murmur at the apex and over the
xiphoid process. Liver is 3 cm enlarged, urine output is reduced. The blood total protein -
58.6 g/l. In urine: protein - 0,025 g/l, WBCs - 2-4 in the field of vision, RBCs - 2-3 in the
field of vision. What is the main mechanism of edema syndrome development:
A. Venous congestion of greater circulation
B. Secondary nephropathy development
C. Hypoproteinemia
D. Venous congestion of lesser circulation
E. Peripheral circulation disorder

96. After objective clinical examination a 12 year old child was diagnosed with mitral valve
prolapse. What complementary instrumental method of examination should be applied for
the diagnosis confirmation?
A. Echocardiography
B. Phonocardiography
C. Veloergometry
D. ECG
E. Roentgenography of chest

97. A full-term child survived antenatal and intranatal hypoxia, it was born in asphyxia (2-5
points on Apgar score). After birth the child has progressing excitability, there are also
vomiting, nystagmus, spasms, strabismus, spontaneous Moros and Babinskys reflexes.
What localization of intracranial hemorrhage is the most probable?
A. Subarachnoid hemorrhage
B. Subdural hemorrhage
C. Hemorrhages into the brain ventricles
D. Periventricular hemorrhages
E. Small cerebral tissue hemorrhages

98. A 15 y.o. boy was twice attacked by bees, as a result he had severe anaphylactic shock.
What is the most effective prophylaxis method?
A. Desensibilisation by means of bee venom extract
B. Prescription of corticosteroids for summer
C. Limitation of outside staying during summer months
D. Protective clothing
E. Long-term prophylactic treatment with antihistamines

99. A 9-year-old boy has been suffering from bronchoectasis since he was 3. Exacerbations
occur quite often, 3-4 times a year. Conservative therapy results in short periods of
remission. The disease is progressing, the child has physical retardation. The childs skin is
pale, acrocyanotic, he has "watch glass" nail deformation. Bronchography revealed
saccular bronchiectases of the lower lobe of his right lung. What is the further treatment
tactics?
A. Surgical treatment
B. Sanatorium-and-spa treatment
C. Tempering of the childs organism
D. Further conservative therapy
E. Physiotherapeutic treatment

100. A child with tetralogy of Fallot is most likely to exhibit:

A. Increased pressure in the right ventricle
B. Normal oxygen tension (PaO2) in the left ventricle
C. Increased pulse pressure
D. Increased pulmonary blood flow
E. Normal pressure gradient across the pulmonary valve

101. A 2-months-old child after preventive vaccination had a prolonged hemorrhage from the
vaccination place and due to those an intramuscular hematoma. During examination of the
child a considerable rise of prothrombin consumption and a significant prolongation of the
activated partial thromboplastic time were found. What is the most probable diagnosis?
A. Hemophilia
B. Henoch-Schoenlein disease
C. Inborn afibrinogenemia
D. Hemorrhagic disease of the neonate
E. Werlhofs disease

102. A 10 y.o. boy with hemophilia has signs of acute respiratory viral infection with fever.
What of the mentioned antifebrile medications are contraindicated to this patient?
A. Acetylsalicylic acid
B. Paracetamol
C. Panadol extra
D. Analgin
E. Pipolphen

103. A 7-year-old child is sick for 2 weeks with running nose, was taking nasal drops. The boy
suffers with alimentary allergy. He applied to doctor due to suppurative and bloody
discharges from nose, maceration of ala nasi and upper lip. Rhinoscopy results: there are
whitish-greyish areas at nasal septum. Mucous membrane of oropharynx is not changed.
What is the most probable disease?
A. Diphtheria of the nose
B. Allergic rhinitis
C. Sinusitis (maxillar sinus))
D. Adenovirus
E. Rhinovirus

104. A 10-year-old boy underwent treatment in cardiological department for rheumatism, I

acute attack of rheumatic fever, active phase, II degree. The patient was discharged in
satisfactory condition. Which drug should be chosen for prevention of rheumatism
recurrence?
A. Bicillinum-5
B. Erythromycin
C. Oxacillin
D. Ampicillin
E. Bicillinum-1

105. A child is 4 years old, has been ill for 5 days. There are complaints of cough, skin rash,
to- 38,2°C, face puffiness, photophobia, conjunctivitis. Objectively: there is bright, maculopapulous,
in some areas confluent rash on the face, neck, upper chest. The pharynx is
hyperemic. There are seropurulent discharges from the nose. Auscultation revealed dry
rales in lungs. What is the most likely diagnosis?
A. Measles
B. Adenoviral infection
C. Rubella
D. Enterovirus exanthema
E. Scarlet fever

106. A 10 month old boy has been ill for 5 days after consumption of unboiled milk. Body
temperature is 38-39°C, there is vomiting, liquid stool. The child is pale and inert. His
tongue is covered with white deposition. Heart sounds are muffled. Abdomen is swollen,
there is borborygmus in the region of ubbilicus, liver is enlarged by 3 cm. Stool is liquid,
dark-green, with admixtures of mucus, 5 times a day. What is the most probable
diagnosis?
A. Salmonellosis
B. Acute shigellosis
C. Rotaviral infection
D. Staphylococcal enteric infection
E. Escherichiosis
107. A 3 year old child with weight deficiency suffers from permanent moist cough. In history
there are some pneumonias with obstruction. On examination: distended chest, dullness
on percussion over the lower parts of lungs. On auscultation: a great number of different
rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?
A. Mucoviscidosis (cystic fibrosis)
B. Bronchiectasis
C. Pulmonary hypoplasia
D. Bronchial asthma
E. Recurrent bronchitis

108. A 12 y.o. child with acute glomerulonephritis presented with hypertensive syndrom
during first days of the disease. What is the role of angiotesin II in the pathogenesis?
A. Intensifies production and secretion of aldosterone
B. Increases erythropoetin production
C. Increases renine level
D. Increases heart output
E. Infibits deppresive action of prostaglandins

109. A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive
spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome.
Nikolskys symptom is positive. General condition of the infant is grave. Anxiety,
hyperesthesia, febrile temperature are evident. What is the most probable diagnosis?
A. Exfoliative dermatitis
B. Impetigo neonatorum
C. Mycotic erythema
D. Phlegmon of newborn
E. Fingers pseudofurunculosis

110. District pediatrician examines a healthy carried 1-month-old child. The child is breastfed.
Prophylaxis of what disease will the doctor recommend to do first?
A. Rachitis
B. Parathropy
C. Hypotrophia
D. Anemia
E. Spasmophilia

111. A 7-year-old boy has been managed for a month. Immediately after hospitalization there
were apparent edemata, proteinuria - 7,1 g/l, daily urine protein - 4,2 g. Biochemical blood
test shows persistent hypoproteinemia (43,2 g/l), hypercholesterolemia (9,2 millimole/l).
The patient is most likely have the following type of glomerulonephritis:
A. Nephrotic
B. Isolated urinary
C. Combined
D. Hematuric
E. Nephritic

112. A 3 y.o. girl has had a temperature rise up to 38°C, rhinitis, dry superficial cough,
flabbiness, appetite loss. Palpation didnt reveal any changes over her lungs. Percussion
sound has a wooden resonance, auscultation revealed puerile breathing, no rales. In
blood: leukopenia, lymphocytosis, increased ESR. What is the most probable diagnosis?
A. Acute simple tracheitis
B. Recurrent bronchitis, acute condition
C. Bilateral microfocal pneumonia
D. Acute simple bronchitis
E. Acute obstructive bronchitis

113. A 5-year-old girl with the transitory immunodeficiency according to T-system has a
clinical picture of a right-sided pneumonia during 2 months. How pneumonia progress can
be described?
A. Delaying
B. Chronic
C. Recidivating
D. Wavelike
E. Acute

114. Mother of a 10-month-old baby reports significant pallor, poor appetite, enlarged
abdomen in the baby. As a neonate, the child underwent treatment in the in-patient
hospital for jaundice and anemia. Objectively: the skin is pale and jaundiced, teeth are
absent, abdomen is enlarged, spleen is palpable. Blood test results: Hb - 90 g/l, RBC -
3,0×1012/l, color index - 0,9, microspherocytosis, reticulocytosis up to 20%, serum
bilirubin - 37 mmol/l, unconjugated bilirubin - 28 mmol/l. What type of anemia has occurred
in the patient?
A. Hemolytic anemia
B. Protein-deficiency anemia
C. Hereditary elliptocytosis
D. B12-deficiency anemia
E. Iron-deficiency anemia

115. A 12 y.o. girl took 2 pills of aspirine and 4 hours later her body temperature raised up to
39-40°C. She complains of general indisposition, dizziness, sudden rash in form of red
spots and blisters. Objectively: skin lesions resemble of second-degree burns, here and
there with erosive surface or epidermis peeling. Nikolskys symptom is positive. What is the
most probable diagnosis?
A. Acute epidermal necrolisis
B. Polymorphous exudative erythema
C. Duhrings disease
D. Bullous dermatitis
E. Pemphigus vulgaris

116. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized
fatigue. On ECG: tachycardia with heartbeat rate of 220/min. Ventricle complexes are
deformed and widened. P wave is absent. What medication is to be prescribed to provide
first aid?
A. Lydocain
B. Novocainamides
C. Strophantin
D. Isoptin
E. Seduxen

117. Examination of a 4 month old child revealed some lemon-yellow squamae with fatty
crusts on the scalp. What is the most probable diagnosis?
A. Gneiss
B. Pseudofurunculosis
C. Infantile eczema
D. Milk crust
E. Strophulus

118. A lumbar puncture was performed for a newborn suspected of having an intracranial
birth injury. Bloody cerebrospinal fluid was obtained. What hemorrhage occurred in this
case?
A. Subarachnoid
B. Supratentorial
C. Subtentorial
D. Cephalohematoma
E. Epidural

119. A neonate from gestation with severe gestosis of the second half was born on the 41st
week with 2400 g birth weight and 50 cm long. On physical examination: skin is flaccid,
subcutaneous fatty cellular tissue is thin, muscle hypotonia, new-born period reflexes are
decreased. Internal organs are without pathological changes. How would you estimate this
child?
A. Term infant with pre-natal growth retardation
B. Premature infant
C. Postmature infant
D. Term infant with normal body weight
E. Immature infant

120. A child was taken to a hospital with focal changes in the skin folds. The child was
anxious during examination, examination revealed dry skin with solitary papulous
elements and ill-defined lichenification zones. Skin eruption was accompanied by strong
itch. The child usually feels better in summer, his condition is getting worse in winter. The
child has been artificially fed since he was 2 months old. He has a history of exudative
diathesis. Grandmother by his mothers side has bronchial asthma. What is the most likely
diagnosis?
A. Atopic dermatitis
B. Urticaria
C. Seborrheal eczema
D. Contact dermatitis
E. Strophulus

121. A boy, aged 9, was examined: height - 127 cm (-0,36), weight - 28,2 kg (+0,96), chest
circumference - 64,9 cm (+0,66), lung vital capacity - 1520 ml (-0,16). What is the complex
assessment of the childs physical development?
A. Harmonious
B. Apparently disharmonious
C. Disharmonious
D. Excessive
E. Below the average

122. A child is 7 months old. Birth weight was 3450, the child is breastfed. Supplemental
feeding was introduced on time. Determine the daily protein requirements for the child:
A. 3,0 g/kg
B. 2,0 g/kg
C. 3,5 g/kg
D. 4,0 g/kg
E. 2,5 g/kg

123. 2 weeks after recovering from angina an 8-year-old boy developed edemata of face and
lower limbs. Objectively: the patient is in grave condition, AP- 120/80 mm Hg. Urine is of
dark brown colour. Oliguria is present. On urine analysis: relative density - 1,015, protein -
1,2 g/l, RBCs are leached and cover the whole vision field, granular casts - 1-2 in the
vision field, salts are represented by urates (big number). What is the most likely
diagnosis?
A. Acute glomerulonephritis with nephritic syndrome
B. Acute glomerulonephritis with nephrotic syndrome, hematuria and hypertension
C. Nephrolithiasis
D. Acute glomerulonephritis with isolated urinary syndrome
E. Acute glomerulonephritis with nephrotic syndrome

124. A 14 year old child suffers from vegetovascular dystonia of pubertal period. He has got
sympathoadrenal atack. What medicine should be used for attack reduction?
A. Obsidan
B. No-shpa
C. Aminophylline
D. Corglicone
E. Amysyl

125. A child is 9 months old. The patients body temperature is 36,7°C, the skin is pale, humid,
there is pain in leg muscles. There is no extremities mobility, sensitivity is present. The
child has been diagnosed with poliomyelitis. The causative agent of this disease relates to
the following family:
A. Picornavirus
B. Adenovirus
C. Rotavirus
D. Paramyxovirus
E. Tohovirus

126. A 4 month old child fell seriously ill: body temperature rose up to 38,5°C, the child
became inert and had a single vomiting. 10 hours later there appeared rash over the
buttocks and lower limbs in form of petechiae, spots and papules. Some haemorrhagic
elements have necrosis in the centre. What is the most probable disease?
A. Meningococcemia
B. Influenza
C. Rubella
D. Haemorrhagic vasculitis
E. Scarlet fever

127. A 5-year-old child had strong headache, vomiting, ataxy, dormancy, discoordination of
movements, tremor of the extremities on the 8th day of the disease. It was followed by rise
in body temperature, vesiculosis rash mainly on the skin of the body and the hairy part of
the head. At the second wave of the fever a diagnosis of encephalitis was given. What
disease complicated encephalitis in this case?
A. Chicken pox
B. Herpetic infection
C. German measles
D. Measles
E. Enterovirus infection

128. A 13 year old girl was admitted to the cardiological department because of pain in the
muscles and joints. Examination of her face revealed an edematic erythema in form of
butterfly in the region of nose bridge and cheeks. What is the most probable diagnosis?
A. Systemic lupus erythematosus
B. Periarteritis nodosa
C. Dermatomyositis
D. Rheumatism
E. Rheumatoid arthritis

129. A 4 y.o. boy was admitted to the hospital with complaints of dyspnea, rapid fatigability.
His anamnesis registers frequent respiratory diseases. On percussion: heart borders are
dilatated to the left and upwards. On auscultation: amplification of the SII above pulmonary
artery, a harsh systolodyastolic "machine" murmur is auscultated between the II and the III
rib to the left of breast bone, this murmur is conducted to all other points including back.
AP is 100/20 mm Hg. What is the most probable diagnosis?
A. Opened arterial duct
B. Isolated stenosis of pulmonary arterial orifice
C. Interventricular septal defect
D. Interatrial septal defect
E. Valvar aortic stenosis

130. A 12 year old girl complains about abrupt weakness, nausea, dizziness, vision
impairment. The day before she ate home-made stockfish, beef. Examination revealed
skin pallor, a scratch on the left knee, dryness of mucous membranes of oral pharynx,
bilateral ptosis, mydriatic pupils. The girl is unable to read a simple text (mist over the
eyes). What therapy would be the most adequate in this case?
A. Parenteral introduction of polyvalent antibotulinic serum
B. Parenteral introduction of antitetanus serum
C. Parenteral introduction of antibiotics
D. Parenteral disintoxication
E. Gastric lavage
131. A child from the first non-complicated pregnancy but complicated labor had
cephalhematoma. On the second day there developed jaundice. On the 3th day appeared
changes of neurologic status: nystagmus, Graefes sign. Urea is yellow, feces- goldenyellow. Mothers
blood group is A(II)Rh-, child- A(II)Rh+. On the third day childs Hb- 200
g/L, RBC- 6,1×1012/L, bilirubin in blood - 58 mk mol/L due to unconjugated bilirubin, Ht0,57. What is
the childs jaundice explanation?
A. Brain delivery trauma
B. Hemolytic disease of newborn
C. Physiologic jaundice
D. Bile ducts atresia
E. Fetal hepatitis

132. A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a
cephalogematoma. On the 2nd day there was jaundice, on the third the following changes
in neurological status appeared: nystagmus, Graefe syndrome. Urine was yellow, feces
were of golden-yellow colour. Mothers blood group is A(II)Rh-, the babys one - A(II)Rh+.
On the third day the childs Hb was 200g/l, RBCs - 6,1×1012/l, blood bilirubin - 58
micromole/l at the expense of unbound fraction. What caused the jaundice in the child?
A. Craniocerebral birth trauma
B. Biliary atresia
C. Fetal hepatitis
D. Physiological jaundice
E. Neonatal anaemia

133. After birth a child was pale and had arrhythmical breathing. Oxygen therapy didnt have
any effect. Pulse was weak and rapid. It was difficult to measure arterial pressure
accurately. There were no edemata. What is the most likely reason for these symptoms?
A. Asphyxia
B. Congestive heart failure
C. Intrauterine sepsis
D. Congenital pneumonia
E. Intracranial haematoma

134. A child was delivered severely premature. After the birth the child has RI symptoms,
anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin
extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray:
atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0,45. What is the
most probable diagnosis?
A. Edematous-hemorrhagic syndrome
B. Pulmonary edema
C. Disseminated intravascular clotting syndrome
D. Hyaline membrane disease
E. Congenital pneumonia

135. An infant is 2 days old. He was born full-term with signs of intrauterine infection, and
therefore receives antibiotics. Neonates should be given antibiotics at longer intervals and
lower doses compared to older children and adults because:
A. Neonates have lower glomerular filtration
B. Neonates have a reduced activity of glucuronyl transferase
C. Neonates have higher hematocrit
D. Neonates have a decreased blood pH
E. Neonates have lower concentration of protein and albumin in blood

136. An infant is 2 d.o. It was full-term born with signs of intrauterine infection, thats why it
was prescribed antibiotics. Specify, why the gap between antibiotic introductions to the
new-born children is longer and dosage is smaller compared to the older children and
adults?
A. The newborns have a lower level of glomerular filtration
B. The newborns have reduced activity of glucuronil transferase
C. The newborns have bigger hematocrit
D. The newborns have diminished blood pH
E. The newborns have lower concentration of protein and albumins in blood

137. A 10-year-old child is sick with chronic viral hepatitis B with marked activity of the
process. Total bilirubin – 70 mumol/L, direct - 26mumol/L, indirect – 44 mumol/L. AST - 6,2
mmol/L, ALT - 4,8 mmol/L. What mechanism underlies the transaminase level increase of
this patient?
A. Cytolysis of hepatocytes
B. Intrahepatic cholestasis
C. Failure of bilirubin conjugation
D. Failure of the synthetical function of the liver
E. Hypersplenism

138. A 12-year-old girl applied to doctor with complaints of swelling on the front part of the
neck. The doctor diagnosed hyperplasia of the thyroid gland of the second degree,
euthyroidism. Ultrasound suspected autoimmune thyroiditis. Blood was taken for titre of
antibodies to thyroglobulin. What titre of antibodies will be diagnostically important?
A. 1:100
B. 1:250
C. 1:150
D. 1:50
E. 1:200

139. A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A
year ago she was also found to have diffuse enlargement of the thyroid gland (II grade).
This condition was regarded as a pubertal manifestation, the girl didnt undergo any
treatment. The girls irritability gradually gave place to a complete apathy. The girl got puffy
face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density
progressed, the skin became of a waxen hue. What disease may be suspected?
A. Autoimmune thyroiditis
B. Subacute thyroiditis
C. Juvenile basophilism
D. Diffuse toxic goiter
E. Thyroid carcinoma

140. In the anamnesis of a 2-year-old girl there are recurrent pneumonias with signs of
obstruction. There are heterogeneous moist and dry rales, respiration is weakened.
Dense, viscous secretion is difficult to hawk. There are "drumsticks", physical retardation.
What is the most probable diagnosis?
A. Mucoviscidosis, pulmonary form
B. Bronchial asthma
C. Pulmonary tuberculosis
D. Congenital pulmonary polycystosis
E. Recidivating bronchitis

141. On the 3rd day of life a baby presented with haemorrhagic rash, bloody vomit, black
stool. Examination revealed anaemia, extended coagulation time, hypoprothrombinemia,
normal thrombocyte rate. What is the optimal therapeutic tactics?
A. Vitamin K
B. Calcium gluconate
C. Epsilon-aminocapronic acid
D. Sodium ethamsylate
E. Fibrinogen

142. A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding.
Current weight is 4900 g. Evaluate the current weight of the child:
A. Corresponding to the age
B. Hypotrophy of the I grade
C. 150 g less than necessary
D. Hypotrophy of the II grade
E. Paratrophy of the I grade

143. A 2 m.o. breast-fed child suffers from cheek skin hyperemia, sporadic papulous
elements on the skin of the chest and back following the apple juice introduction. The child
is restless. What is the initial pediatritians tactics?
A. Clarify mothers diet and exlude obligate allergens
B. Apply ointment with corticosteroids to affected skin areas
C. Administer general ultraviolet irradiation
D. Refer to prescribe dermathologist
E. Treat with claritine

144. A 5 month old boy was born prematurely, he didnt suffer from any disease at the infant
age and later on. Examination at an outpatients hospital revealed paleness of skin,
sleepiness. Blood count: Hb - 95 g/l, erythrocytes - 3,5×1012/l, reticulocytes – 9 o/oo,
colour index - 0,7, osmotic stability of erythrocytes - 0,44-0,33%, serum iron - 4,9
micromole/l. What is the most probable cause of anemia?
A. Iron deficit
B. Hemogenesis immaturity
C. Erythrocyte hemolysis
D. B12 deficit
E. Infectious process

145. A 7 y.o. child had elevation of temperature tol 40°C in anamnesis. For the last 3 months
he presents fusiform swelling of fingers, ankle joints and knee joint, pain in the upper part
of the sternum and cervical part of the spinal column. What is the most probable
diagnosis?
A. Juvenile rheumatic arthritis
B. Osteoarthrits
C. Toxic synovitis
D. Rheumatism
E. Septic arthritis

146. An 8 year old girl complains about joint pain, temperature rise up to 38°C, dyspnea.
Objectively: the left cardiac border is deviated by 2,5 cm to the left, tachycardia, systolic
murmur on the apex and in the V point are present. Blood count: leukocytes – 20×109/l,
ESR - 18 mm/h. What sign gives the most substantial proof for rheumatism diagnosis?
A. Carditis
B. Leukocytosis
C. Arthralgia
D. Fever
E. Accelerated ESR

147. A 5 y.o. child with stigmas of dysembryogenesis (small chin, thick lips, opened mouth,
hyperthelorismus) has systolic murmur in the second intercostal to the right of the
sternum. The murmur passes to the neck and along the sternum left edge. The pulse on
the left brachial artery is weakened. BP on the right arm is 110/60 mm Hg, on the left -
100/60 mm Hg. ECG results: hypertrophy of the right ventricle. What defect is the most
probable?
A. Aortic stenosis
B. Coarctation of the aorta
C. Open aortic duct
D. Defect of interventricular septum
E. Defect of interatrial septum

148. A 1,5-year-old child fell ill acutely with high temperature 38°C, headache, fatigue. The
temperature declined on the fifth day, muscular pain in the right leg occured in the
morning, there were no movements and tendon reflexes, sensitivity was reserved. What is
the initial diagnosis?
A. Polyomyelitis
B. Viral encephilitis
C. Osteomyelitis
D. Hip joint arthritis
E. Polyartropathy

149. A 3-year-old child has been delivered to a hospital in soporose state with considerable
amyotonia, inhibition of tendon and periosteal reflexes. Miosis and asthenocoria are also
present. Corneal reflexes are preserved. Pulse is rapid and weak. AP- 80/50 mm Hg. The
parents suspect the child of accidental taking some tablets. Such clinical presentations are
typical for intoxication with the following tableted drugs:
A. Tranquilizers
B. Beta-2-adrenoceptor agonists
C. Antihypertensive drugs
D. Antropine drugs
E. Barbiturates

150. A 2 m.o. child with birth weight 5100 g has jaundice, hoarse cry, umbilical hernia,
physical development lag. Liver is +2 cm enlarged, spleen is not enlarged. In anamnesis:
delayed falling-away of umbilical cord rest. In blood: Hb- 120 g/L, erythrocytes -
4,5×1012/L, ESR- 3 mm/h. Whole serum bilirubin is 28 mcmole/L, indirect - 20 mcmole/L,
direct - 8 mcmole/L. What is the most probable diagnosis?
A. Congenital hypothyreosis
B. Hemolitic anemia
C. Cytomegalovirus infection
D. Conjugated jaundice
E. Congenital hepatitis

151. A 5-year-old child developed an acute disease starting from body temperature rise up to
38,5°C, running nose, cough and conjunctivitis. On the 4th day the child presented with
maculo-papular rash on face. Body temparature rose again up to 39,2°C. Over the next
few days the rash spread over the whole body and extremities. Mucous membrane of
palate was hyperemic, there was whitish deposition on cheek mucous membrane next to
molars. What is your provisional diagnosis?
A. Measles
B. Acute viral respiratory infection
C. Enterovirus diseases
D. Rubella
E. Yersinia

152. A 3 year old child fell acutely ill, body temperature rose up to 39,5°C, the child became
inert, there appeared recurrent vomiting, headache. Examination revealed positive
meningeal symptoms, after this lumbal puncture was performed. Spinal fluid is turbid, runs
out under pressure, protein concentration is 1,8 g/l; Pandy reaction is +++, sugar
concentration is 2,2 millimole/l, chloride concentration - 123 millimole/l, cytosis is 2,35×109
(80% of neutrophils, 20% of lymphocytes). What is the most probable diagnosis?
A. Purulent meningitis
B. Brain tumour
C. Serous tuberculous meningitis
D. Serous viral meningitis
E. Subarachnoid haemorrhage

153. A 13 y.o. girl complains of having temperature rises up to febrile figures for a month, joint
ache, periodical skin rash. Examination revealed steady enhancing of ESR, LE-cells. What
is the most probable diagnosis?
A. Systematic lupus erythematosus
B. Rheumatics
C. Systematic scleroderma
D. Juvenile rheumatoid arthritis
E. Acute lymphoblast leukosis

154. A 7-year-old child was brought to a doctor for a check. The child has a 4-year history of
bronchial asthma, asthma attacks occur mainly in spring and summer. Allergy tests
revealed hypersensitivity to poplar seed tufts, field herbs. What recommendation should
be given?
A. Specific hyposensitization
B. Phytotherapy
C. Needle reflexotherapy
D. Physiotherapy
E. Treatment at a health resort

155. A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5
days ago after a contact with a person having ARVI. Objectively: the child is in grave
condition. Temperature of 38°C, cyanosis of nasolabial triangle is present. RR- 54/min,
nasal flaring while breathing. There was percussion dullness on the right below the
scapula angle, and tympanic sound over the rest of lungs. Auscultation revealed bilateral
fine moist rales predominating on the right. What is the most likely diagnosis?
A. Acute pneumonia
B. Acute bronchiolitis
C. Acute laryngotracheitis
D. ARVI
E. Acute bronchitis

156. An 8 y.o. boy complains of constant cough along with discharge of greenish sputum,
dyspnea during physical activities. At the age of 1 year and 8 months he fell ill for the first
time with bilateral pneumonia that had protracted course. Later on there were recurrences
of the disease 5-6 times a year, during the remission periods there was constant
productive cough. What examination results will be the most important for making a final
diagnosis?
A. Bronchography
B. Bacterial inoculation of sputum
C. Roentgenography of thorax organs
D. Bronchoscopy
E. Spirography

157. A mother of a 5 y.o. girl consulted a doctor about doughters involuntary urination at
night, nightmares, sleep disorders, slow gaining of body weight. Objectively: malnutrition,
intellectual development is good, the girl can read and explains common situations quite
adultly. Her skin is very pale, liver is enlarged in size. Her mother suffers from holetithiasis.
What type of diathesis is the most probable in the childs case?
A. Gouty diathesis
B. Lymphohypoplastic diathesis
C. Exudative diathesis
D. Urine acid diathesis
E. Allergic diathesis

158. A 10 year old girl complains about abdominal pain that is arising and getting worse after
eating rough or spicy food. She complains also about sour eructation, heartburn, frequent
constipations, headache, irritability. She has been suffering from this for 12 months.
Objectively: the girls diet is adequate. Tongue is moist with white deposit at the root.
Abdomen is soft, painful in its epigastric part. What study method will help to make a
diagnosis?
A. Esophagogastroduodenoscopy
B. Biochemical blood analysis
C. Fractional examination of gastric juice
D. Intragastral pH-metry
E. Contrast roentgenoscopy

159. A 40 h.o. child age has hyperosthesia, CNS depression, dyspepsia. Sepsis is suspected.
What should the differential diagnosis be made with?
A. Hypoglycemia
B. Hypomagnesemia
C. Hyperbilirubinemia
D. Hypocalcemia
E. Hyperkaliemia

160. Examination of a full-term 6-day-old infant revealed that different areas of skin had
erythemas, flaccid bubbles, eroded surface, cracks, peeling of the epidermis looking like
being scalded with boiling water. There was positive Nikolskys symptom. General
condition of the child was serious. The child was restless, hypersensitive, febrile. What is
the most likely diagnosis in this case?
A. Ritters exfoliative dermatitis
B. Neonatal pemphigus
C. Epidermolysis
D. Neonatal phlegmon
E. Fingers pseudofurunculosis

161. A 1,5 y.o. child fell seriously ill: chill, body temperature rise up to 40,1°C, then rapid
dropping to 36,2°C, skin is covered with voluminous hemorrhagic rash and purple cyanotic
spots. Extremities are cold, face features are sharpened. Diagnosis: meningococcosis,
fulminant form, infection-toxic shock. What antibiotic must be used at the pre-admission
stage?
A. Soluble Levomycetine succinate
B. Lincomycin
C. Penicillin
D. Gentamycin
E. Sulfamonometoxin

162. A 10 year old boy suffers from chronic viral hepatitis type B with maximal activity. What
laboratory test can give the most precise characteristic of cytolysis degree?
A. Transaminase test
B. Takata-Ara test
C. Weltmans coagulation test
D. Prothrombin test
E. Test for whole protein

163. A 6 y.o child complains of thirst, polyuria, increased appetite for 2 months with weight
loss for 3 kg. There has been nocturnal enuresis during last week. On examination:
hyperglycemia 14 mol/L. The diagnosis is diabetis mellitus I type. What is the genesis of
this disease?
A. Autoimmune
B. Neurogenic
C. Virus-bacterial
D. Viral
E. Bacterial

164. A 10 y.o. child who is at oligoanuretic stage of acute renal insufficiency has got
sensations of pricking in the mucous membrane of oral cavity and tongue, extremities
numbness, reduced reflexes, respiratory disturbance, arrhythmia. What are these
symptoms caused by?
A. Hyperkaliemia
B. Hyperazotemia
C. Alkalosis
D. Acidosis
E. Hyponatremia

165. Examination of a 12 year old child revealed diffuse thyroid enlargement of the II degree.
Heart auscultation revealed dullness of heart sounds, heart rate was 64/min. The child has
frequent constipations, anemia. Concentration of thyreoglobulin antibodies is increased.
What disease might have caused such symptoms?
A. Autoimmune thyroiditis
B. Thyroid carcinoma
C. Endemic goiter
D. Thyroid hyperplasia
E. Diffuse toxic goiter

166. An 8-year-old girl has been admitted to the cardiology department. Objectively: there is a
skin lesion over the extensor surfaces of joints with atrophic cicatrices, depigmentation,
symmetrical affection of skeletal muscles (weakness, edema, hypotrophy). What disease
are these changes most typical for?
A. Dermatomyositis
B. Systemic scleroderma
C. Systemic lupus erythematosus
D. Reiters disease
E. Nodular periarteritis

167. An 8-year-old child with a 3-year history of diabetes was hospitalized in hyperglycemic
coma. Specify the initial dose of insulin to be administered:
A. 0,1-0,2 U/kg of body weight per hour
B. 0,05 U/kg of body weight per hour
C. 0,3-0,4 U/kg of body weight per hour
D. 0,4-0,5 U/kg of body weight per hour
E. 0,2-0,3 U/kg of body weight per hour

168. A 12-year-old girl undergoes regular gastroenterological check-ups for duodenal ulcer,
biliary dyskinesia. What is the recommended frequency of anti-relapse treatment?
A. Twice a year
B. Every 3 months
C. Every two months
D. Once a year
E. Three times a year

169. A 13 y.o. teenager who suffers from hemophilia A was taken to the hospital after a fight
at school. His diagnosis is right-sided hemarthros of knee joint, retroperitoneal hematoma.
What should be primarily prescribed?
A. Fresh frozen plasma
B. Washed thrombocytes
C. Aminocapronic acid
D. Placental albumin
E. Dry plasma

170. A 3 m.o. child fell seriously ill, body temperature rised up to 37,8°C, there is semicough.
On the 3-rd day the cough grew worse, dyspnea appeared. On percussion: tympanic
sound above lungs, on auscultation: a lot of fine moist and wheezing rales during
expiration. What is the most probable diagnosis?
A. Acute respiratory viral infection, bronchiolitis
B. Acute respiratory viral infection, bronchitis with asthmatic component
C. Acute respiratory viral infection, focal pneumonia
D. Acute respiratory viral infection, bronchopneumonia
E. Acute respiratory viral infection, bronchitis

171. On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8
points, presented with jaundice. Indirect bilirubin of blood - was 80 micromole/l, 6 hours
later - 160 micromole/l. What is the optimal method of treatment?
A. Exchange blood transfusion
B. Phototherapy
C. Phenobarbital treatment
D. Enterosorbents
E. Infusion therapy

172. A child was born at a gestational age of 34 weeks in grave condition. The leading
symptoms were respiratory distress symptoms, namely sonorous and prolonged
expiration, involving additional muscles into respiratory process. The Silverman score at
birth was 0 points, in 3 hours it was 3 points with clinical findings. Which diagnostic study
will allow to diagnose the form of pneumopathy?
A. X-ray of chest
B. Determination of blood gas composition
C. Clinical blood test
D. Proteinogram
E. Immunoassay

173. A 10-year-old girl consulted a doctor about thirst, frequent urination, weight loss. She
has been observing these symptoms for about a month. Objectively: no pathology of
internal organs was revealed. What laboratory analysis should be carried out in the first
place?
A. Blood glucose analysis on an empty stomach
B. Acetone in urine test
C. Glucose in urine test on the base of daily diuresis
D. Glucose tolerance test
E. Glucosuric profile

174. A 6-year-old child complains of frequent liquid stool and vomiting. On the 2nd day of
desease the child presented with inertness, temperature rise up to 38,2°C, Ps- 150 bpm,
scaphoid abdomen, palpatory painful sigmoid colon, defecation 10 times a day with liquid,
scarce stool with mucus and streaks of green. What is a provisional diagnosis?
A. Shigellosis
B. Escherichiosis
C. Salmonellosis
D. Intestinal amebiasis
E. Yersiniosis

175. A 4-year-old boy had untimely vaccination. He complains of painful swallowing,

headache, inertness, fever. Objectively: the child is pale, has enlarged anterior cervical
lymph nodes, swollen tonsils with cyanotic hyperemia, tonsils are covered with gray-white
pellicles which cannot be easily removed. When the pellicles are forcibly removed, the
tonsils bleed. What is the most likely diagnosis?
A. Oropharyngeal diphtheria
B. Infectious mononucleosis
C. Follicular tonsillitis
D. Lacunar tonsillitis
E. Pseudomembranous tonsillitis

176. After a 10-year-old child had been bitten by a bee, he was delivered to a hospital. There
were lip, face and neck edemata. The patient felt hot and short of breath. Objectively:
breathing was laboured and noisy. There were foamy discharges from the mouth, cough.
The skin was pale and cold. There was bradypnoea. Heart sounds were muffled and
arrhythmic. Thready pulse was present. What diagnosis was made by the expert in
resuscitation?
A. Anaphylactic shock
B. Bronchial asthma
C. Cerebral coma
D. Acute cardiovascular collapse
E. Quinckes edema

177. A 13-year-old girl complains of fever up to 37,4°C during the last 2 months after
recovering from ARVI. Objectively: malnutrition, diffuse grade II enlargement of the thyroid
gland feeling dense on palpation, exophthalmos, tachycardia. What kind of pathological
syndrome is it?
A. Thyrotoxicosis
B. Hypoparathyroidism
C. Thymomegaly
D. Hyperparathyroidism
E. Hypothyroidism

178. A 3-year-old girl presents with pertussis-like cough with thick sputum. There have been
persistent changes in lungs since the age of 6 months when she was first diagnosed with
acute pneumonia. Chloride concentration in the perspiration is 112 mEq/l. The child has
been diagnosed with mucoviscidosis. What is the basis for autosomal recessive disease -
mucoviscidosis?
A. Inadequate transport of sodium and chloride ions
B. ?1-antitrypsin deficiency
C. Pulmonary cysts
D. Pulmonary artery hypoplasia
E. Deposition of calcium triphosphates and carbotates in the alveoles

179. A newborn has purulent discharges from the umbilical wound, the skin around the navel
is swollen. The babys skin is pale, with a yellow-gray tint, generalized hemorrhagic rash is
present. What is the most likely diagnosis?
A. Sepsis
B. Omphalitis
C. Hemolytic disease of the newborn
D. Hemorrhagic disease of the newborn
E. Thrombocytopathy

180. From urine of a 14-year-old boy with the exacerbation of secondary obstructive
pyelonephritis Pseudomonas aeruginosa was isolated with a titer of 1000000 microbes per
1 ml. Which antibiotic is most advisable to be administered in this case?
A. Ciprofloxacin
B. Azithromycin
C. Chloramphenicol
D. Ampicillin
E. Cefazolinum

181. A 14-year-old boy with a history of chronic tonsillitis and sinusitis has developed a
feeling of heart irregularities and additional pulse. HR- 83/min. ECG results: regular
impulses with no visible P wave that occur every two sinus contractions, QRS complex is
dramatically deformed and prolonged to over 0,11 s, T wave is discordant followed by a
complete compensatory pause. Specify the arrhythmia type:
A. Trigeminal extrasystole
B. Left bundle branch block
C. Partial AV-blockade
D. Bigeminal extrasystole
E. Complete AV-block

182. An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest
compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale,
respiratory rate - 40/min, jugular pulse is present. Ps- 185 bpm, of poor volume. AP- 75/40
mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed.
At the end of an attack a compensatory pause is observed. The most likely cause of the
attack is:
A. Paroxysmal atrial tachycardia
B. Paroxysmal ventricular tachycardia
C. Atrial fibrillation
D. Complete AV-block
E. Sinus tachycardia

183. A 10-year-old child with a history of nonrheumatic carditis has periodic attacks
manifested by heart pain, dyspnea, pallor, high blood pressure, a dramatic increase in
heart rate up to 180/min. What drug would be most effective to treat this patient?
A. Obsidan
B. Procainamide
C. Verapamil
D. Ajmaline
E. Lidocaine

184. A 1-month-old child became restless and presented with an increase in head sweating.
Its known from the history that the child has been fed with cows milk since birth
(September 5). Examination revealed craniotabes. A doctor administered a course of UV
radiation. Decide, if the child needs ergocalciferol:
A. 2-2,5 months after the UVR withdrowal
B. In combination with UVR
C. A month after the UVR withdrowal
D. Immediately after the UVR withdrowal
E. Does not need

185. 15 minutes after the second vaccination with DTP vaccine a 4-month-old boy exhibited
the symptoms of Quinckes edema. What medication should be given for emergency aid?
A. Prednisolone
B. Adrenalin
C. Heparin
D. Furosemide
E. Seduxen

186. A baby is 3 months old. The mother consulted a pediatrician about lack of breast milk.
After several test weighings it was found that the child had to receive supplementary
feeding. What is the optimal milk formula for this child?
A. Malysh
B. Milk formula No. 3
C. Malutka
D. Whole cows milk
E. Milk formula No. 2

187. Examination of a newborn revealed skin redness that appeared immediately after birth
and reached the maximum intensity on the second day of life. What is your provisional
diagnosis?
A. Simple erythema
B. Transient erythema
C. Toxic erythema
D. Erythema nodosum
E. Annular erythema

188. A child is 2 days old. He was born with a weight of 2900 g, body length of 50 cm. On
examination the skin is intensely red, elastic, with preserved turgor. Puerile respiration is
present. Respiration rate - 40/min, cardiac sounds are rhythmic, sonorous. HR- 138/min.
The abdomen is soft. The liver extends 2 cm below the costal margin. Diuresis is
sufficient. Stool is in form of meconium. What is the most likely diagnosis?
A. Physiological erythema of the newborn
B. Neonatal phlegmon
C. Exfoliative Ritters dermatitis
D. Erysipelas
E. Toxic erythema of the newborn

189. A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score
- 8-10 points. What is the optimum time for the first breast-feeding?
A. First 30 minutes
B. First 6 hours
C. First 48 hours
D. After 48 hours
E. First 24 hours

190. A 3-year-old child has been taken to a pediatrician. He has no recent history of any
diseases. Objective examination revealed no pathology of the internal organs. The child
needs the routine immunization against the following disease:
A. Poliomyelitis
B. Type B hepatitis
C. Measles, rubella, parotitis
D. Diphtheria and tetanus
E. Pertussis

191. An 11-year-old girl has been immunized according to her age and in compliance with the
calendar dates. What vaccinations should the children receive at this age?
A. Diphtheria and tetanus
B. TB
C. Hepatitis B
D. Pertussis
E. Polio

192. A 6-year-old child has duodenal ulcer. What antibacterial drug should be coadministered
together with metronidazole and De-Nol in order to eradicate Helicobacter
pylori infection?
A. Amoxicillin
B. Oleandomycin
C. Sulfadimethoxinum
D. Biseptol
E. Tetracycline
193. A baby born after fast labour has palsy of hand muscles. Grasp reflex is absent, as well
as hand-to-mouth reflex. Hand sensitivity is absent. What is the most likely diagnosis?
A. Dejerine-Klumpke palsy
B. Duchenne-Erbs palsy
C. Muscle paresis
D. Bernard-Horner syndrome
E. Total lesion of the brachial plexus

194. A child is 12 years old. He complains of a dull aching pain in the epigastrium and right
hypochondrium, that is getting worse after taking fatty or fried food, headache, weakness,
nausea, low-grade fever. Abdominal palpation reveals a marked resistance of muscles in
the right hypochondrium, positive Kerrs, Ortners, Murphys symptoms. What is the most
likely diagnosis?
A. Chronic cholecystitis
B. Acute gastritis
C. Acute pancreatitis
D. Acute appendicitis
E. Viral hepatitis

195. A 3-month-old girl presents with rhinitis, dyspnea, dry cough. These manifestations has
been observed for two days. Objectively: the child has pale skin, acrocyanosis, shallow
respiration at the rate of 80/min. Percussion reveals handbox resonance over the whole
surface of lungs, massive fine rales. What is the most likely diagnosis?
A. Acute bronchiolitis
B. Acute bronchitis
C. Mucoviscidosis
D. Pneumonia
E. Foreign body of the airway

196. During the first home visit to a full-term boy after his discharge from the maternity
hospital a pediatrician revealed a symmetrical swelling of mammae without skin changes
over them, swelling of the scrotum. The body temperature was of 36,5°C. The baby was
calm, sucked the mothers breast actively. What condition should you think of?
A. Hormonal crisis of the newborn
B. Congenital adrenal dysfunction
C. Sclerema
D. Neonatal mastitis
E. Necrotic neonatal phlegmon

197. A full-term neonate weighing 4500 g was born asphyxiated with Apgar score of 4-6
points. During the delivery shoulder dystocia occurred. Neurologic assessment revealed
non-focal neurologic symptoms, total flaccid paresis of the upper extremities since the arm
was atonic and pronated. Grasping, Babkins and Moros reflexes were absent. What
segments of spinal cord had been affected?
A. CV - ThI
B. CIII - CIV
C. ThVI - ThV
D. ThI - ThV
E. CI - CII

198. A newborn (mothers I pregnancy) weighing 3500 g presents with jaundice, lethargy,
reduced reflexes. Objectively: second grade jaundice of skin with saffron tint, liver - +2 cm,
spleen - +1 cm. Urine and feces are yellow. Blood count: Hb- 100 g/l, RBCs - 3,2×1012/l,
WBCs - 18,7×109/l, mothers blood type - A(I) Rh(+), babys blood type - A(II) Rh(-),
bilirubin - 170 mmol/l, indirect fraction. ALT, AST rates are normal. What disease is the
child most likely to have?
A. Hemolytic disease of newborn, AB0-conflict
B. Hemolytic disease of newborn, Rh-conflict
C. Physiologic jaundice
D. Biliary atresia
E. Perinatal hepatitis

199. A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from
the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the
most likely etiological factor in this case?
A. Streptococcus
B. Pneumococcus
C. Staphylococcus
D. Klebsiella
E. Proteus

200. All the joints on the left elbow of a newborn are extended, the whole arm hangs vertically
along the trunk with the forearm pronated. Active movements in the elbow joint are absent
but present in the shoulder joint. The hand is flattened, atrophied, cold to the touch, hangs
passively. Grasp reflex and hand-mouth reflex on the affected side are missing.
Haemogram values are normal. What is the most likely diagnosis?
A. Inferior distal obstetrical paralysis
B. Complete obstetrical paralysis
C. Hypoxic-ischemic encephalopathy
D. Osteomyelitis
E. Proximal obstetrical paralysis

201. Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel
is 2x2 cm large. After feeding the child regurgitates small portions of milk; stool is normal
in respect of its volume and composition. Muscle tonus is within norm. What is the most
likely diagnosis?
A. Pylorospasm
B. Microcephaly
C. Craniostenosis
D. Meningitis
E. Pylorostenosis

202. 10 days after birth, a newborn developed a sudden fever up to 38,1°C. Objectively: the
skin in the region of navel, abdomen and chest is erythematous; there are multiple peasized blisters
with no infiltration at the base; single bright red moist erosions with
epidermal fragments on the periphery. What is your provisional diagnosis?
A. Epidemic pemphigus of newborn
B. Streptococcal impetigo
C. Atopic dermatitis
D. Vulgar impetigo
E. Syphilitic pemphigus

203. On the second day after preventive vaccination a 2-year-old boy presented with
abdominal pain without clear localization, body temperature rose up to 38°C. On the third
day the child got red papular haemorrhagic eruption on the extensor surfaces of limbs and
around the joints. Knee joints were edematic and slightly painful. Examination of other
organs and systems revealed no pathological changes. What is the most likely diagnosis?
A. Haemorrhagic vasculitis
B. Thrombocytopenic purpura
C. Urticaria
D. DIC syndrome
E. Meningococcemia

204. On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the
region of occiput, neck and buttocks. General condition of the child is normal. What
disease should be suspected?
A. Vesiculopustulosis
B. Miliaria
C. Impetigo neonatorum
D. Impetigo
E. Epidermolysis bullosa

205. A patient is 14 years old. Cytochemical study of punctate revealed 40% of blasts, there
was negative reaction to peroxidase and with Sudan black, positive reaction to glycogen.
Specify the form of acute leukemia:
A. Lymphoblastic
B. Monoblastic
C. Undifferentiated
D. Promyelocytic
E. Myeloblastic

206. Six months ago, a 5-year-old child was operated for CHD. For the last 3 weeks he has
complained of fever, heart pain, aching muscles and bones. Examination results: "whitecoffee" skin
colour, auscultation revealed systolic murmur in the region of heart along with
a noise in the III-IV intercostal space. Examination of fingertips revealed Janeway lesions.
What is your provisional diagnosis?
A. Infectious endocarditis
B. Nonrheumatic carditis
C. Sepsis
D. Acute rheumatic fever
E. Typhoid fever

207. The condition of a 3-year-old child with acute non-rheumatic myocarditis has suddenly
deteriorated: he presents with anxiety, acrocyanosis, peripheral edemata, dyspnea.
Auscultation of lungs reveals fine moist rales on both sides mainly in the lower parts. AP65/40 mm
Hg. HR- 150/min, heart sounds are muffled, arrhythmic (extrasystole). Liver is
+4 cm. Oliguria is present. The child has been diagnosed with acute heart failure. Which
method of examination is most informative for assessing the childs status dynamics?
A. Echocardiography
B. 24-hour monitoring of heart rhythm
C. Diuresis monitoring
D. ECG
E. Monitoring of K+, Na+ concentration in blood

208. A hospital admitted an 11-year-old boy diagnosed with medium-severe asthma,

exacerbation period. In order to arrest the attacks the boy was administered broncholytic
nebulizer therapy. During the day the childs condition stabilized. What is the most
appropriate method for further monitoring of respiratory function in this patient?
A. Peak flowmetry
B. Pneumotachometry
C. Veloergometry
D. Bronchodilatation tests
E. Spirometry

209. A full-term newborn was born with body weight of 4000 g, body length of 57 cm.
Reaction to the postnatal check was absent. There was diffuse cyanosis, heart rate of
80/min. What resuscitation measures should be taken?
A. Start ALV with a mask
B. Intubate the child and start ALV
C. Give an injection of naloxone
D. Start tactile stimulation
E. Give 100% oxygen

210. A 2-year-old child in a satisfactory condition periodically presents with moderate

proteinuria, microhematuria. USI results: the left kidney is undetectable, the right one is
enlarged, there are signs of double pyelocaliceal system. What study is required to specify
the diagnosis?
A. Excretory urography
B. Retrograde urography
C. Radioisotope renal scan
D. Doppler study of renal vessels
E. Micturating cystography

211. An 8-year-old boy has a 2-year history of blotchy itchy rash appearing after eating citrus
fruit. The first eruption occurred at the age of 6 months after the introduction of juices to
the babys diet. Father has a history of bronchial asthma, mother - that of allergic rhinitis.
What is the most likely diagnosis?
A. Atopic dermatitis
B. Psoriasis
C. Urticaria
D. Quinckes edema
E. Pityriasis Rosea
212. An 8-year-old child was hospitalized for fever up to 39,8°C, inertness, moderate
headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was
performed. The obtained fluid had raised opening pressure, it was transparent, with the
cell count of 450 cells per 1mcL (mainly lymphocytes - 90%), glucose level of 2,6 mmol/l.
What causative agent might have caused the disease in the child?
A. Enterovirus
B. Kochs bacillus
C. Pneumococcus
D. Staphylococcus
E. Meningococcus

213. A 3-year-old child with ARVI had been administered biseptol, paracetamol, nazoferon.
On the third day of treatment the babys condition deteriorated: he developed sore throat,
stomatitis, conjunctivitis, hypersalivation, painful dark red spots on the neck, face, chest and legs,
then the spots were replaced with vesicles. Examination revealed lesions of mucous membranes
around the mouth and anus. What is your provisional diagnosis?
A. Stevens-Johnson syndrome
B. Serum sickness
C. Bullous dermatitis
D. Atopic dermatitis
E. Chickenpox

214. A 6-month-old child on breastfeeding is hospitalized in the inpatient department. After the
child recovers, the doctor recommends the mother to start introducing solid food to the child’s
diet. What products should be introduced to the child’s diet first?
A. Vegetable puree
B. Fermented dairy products
C. Grated apple
D. Semolina porridge
E. Buckwheat porridge

215. The 5-year-old child has been ill for 2 weeks. Cough attacks developed first and were then
followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The
cough attacks induce vomiting. X-ray shows intensified bronchial pattern. Blood test: leukocytes
16 · 109
/L , lymphocytes - 72%, erythrocyte sedimentation rate - 4 mm/hour. What is the most
likely diagnosis?
A. Pertussis
B. Obstructive bronchitis
C. Pneumonia
D. Adenovirus infection
E. Foreign body

216. A 3-year-old child presents with dyspnea that abates in the sitting position, occasional loss
of consciousness and seizures, delayed physical development, cyanosis, drumstick fingers.
Echocardioscopy detects aortic dextraposition, ventricular septal defect, pulmonary artery
stenosis, and right ventricular hypertrophy. What is the most likely diagnosis?
A. Tetrad of Fallot
B. Coarctation of the aorta
C. Transposition of the great vessels
D. Ventricular septal defect
E. Acquired valvular disease

217. A 15-year-old girl complains of dizziness and sensation of lack of air that she develops in
emotionally straining situations. Relief occurs after she takes corvalol. Objectively: hyperhidrosis
and marble-like pattern of the skin of her palms and feet. Clinical and instrumental examination
revealed no organic changes in the central nervous, cardiovascular, and respiratory systems.
What provisional diagnosis can be made?
A. Somatoform autonomic dysfunction
B. Obstructive bronchitis
C. Bronchial asthma
D. Stenosing laryngotracheitis
E. Acute epiglottitis

218. A 1.5-month-old child on breasfeeding presents from birth with daily vomiting, irregular liquid
foamy feces, and meteorism, which are resistant to antibacterial and probiotic therapy; no
increase of body mass is observed. The child’s condition improved, when breastmilk was
substituted with ”NAN low lactose” formula. What pathology is it?
A. Lactase deficiency
B. Intestinal lambliasis (Giardiasis)
C. Infectious enteritis
D. Drug-induced enteritis
E. Functional dyspepsia

219. A 13-year-old girl for a month has been complaining of fatigability, dull pain in her right
subcostal area, abdominal distension, and constipations. Abdominal palpation reveals positive
Kehr, Murphy, and Ortner signs, while Desjardins and Mayo-Robson points are painless. Total
bilirubin is 14.7 mcmol/L, predominantly indirect, ALT- 20 U/L, AST- 40 U/L, amylase - 6.3 mmol/L.
Echocholecystography shows practically no contraction of the gallbladder. Make the provisional
diagnosis:
A. Hypokinetic biliary dyskinesia
B. Hyperkinetic biliary dyskinesia
C. Chronic pancreatitis
D. Acute pancreatitis
E. Chronic hepatitis

220. A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp;
later the nodes suppurated. Temperature increased up to 37.7oC, intoxication symptoms
appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis,
neutrocytosis, increased ESR. What diagnosis can be made?
A. Pseudofurunculosis
B. Pemphigus
C. Vesiculopustulosis
D. Scalp phlegmon
E. -
221. A 10-year-old boy was brought into the hospital with complaints of expiratory dyspnea,
respirations are 30/min. He explains his state by a change in the weather conditions. For the last
4 years the boy has been registered for regular check-ups due to his diagnosis of third degree
persistent bronchial asthma. To provide emergency aid for this child, first he needs to be given:
A. Salbutamol or short-acting β2-agonists
B. Dexamethasone
C. Adrenaline
D. Euphylline (Aminophylline)
E. Claritin (Loratadine)

222. A 3-year-old child has been brought to a hospital with complaints of pain in the legs, fever,
and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are
enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are
painful. The liver and spleen are enlarged. Hemogram: Hb- 88 g/L, color index - 1.3, platelets -
80 · 109 /L, leukocytes - 25.8·109 /L, lymphoblasts - 70%, ESR- 52 mm/hour. Make the provisional
diagnosis:
A. Acute leukemia
B. Thrombocytopenic purpura
C. Acute rheumatic fever
D. Infectious mononucleosis
E. Hemorrhagic vasculitis (Henoch-Schonlein purpura)

223. During an outdoors school event in hot weather, a 10-year-old girl lost her consciousness.
Body temperature - 36.7oC. Objectively her skin is pale and cold to touch, her pupils are dilated.
Blood pressure - 90/50 mm Hg. Heart rate - 58/min. What pathology occurred in this case?
A. Syncope
B. Sympathicotonic collapse
C. Paralytic collapse
D. Sunstroke
E. –

224. An 8 year old child has low-grade fever, arthritis, colicky abdominal pain and a purpuric rash
llocalized on the lower extremities. laboratory studies reveal a guaiac-positive stool, urinalysis
with red blood cell (RBC) casts and mild proteinuria, and a normal platelet count. The most
likely diagnosis is:
A. Henoch-Schonleins vasculitis
B. Rocky Mountain spotted fever
C. Systemic lupus erythematosus (SLE)
D. Idiopathic thrombocytopenic purpura
E. Poststreptococcal glomerulonephritis

225. A young man has painful indurations in the peripapillary regions of both mammary glands.
The most reasonable action will be:
A. To leave these indurations untouched
B. To administer steroids locally
C. To cut and drain them
D. To remove them
E. To take an aspirate for bacterial inoculation and cytology
226. A 9 year old girl with a history of intermittent wheezing for several years is brought to the
pediatrician. The child has been taking no medications for some time. Physical examination
reveals agitation and perioral cyanosis. Intercostal and suprasternal retractions are present.
The breath sounds are quiet, and wheezing is audible bilaterally. The child is admitted to the
hospital. Appropriate interventions might include all of the following EXCEPT:
A. Prescribe nebulized cromolyn sodium
B. Prescribe intravenous corticosteroids
C. Prescribe nebulized metaproterenol
D. Prescribe intravenous aminophylline
E. Administer supplemental oxygen

227. Routine examination of a child with a history of bronchial asthma reveals AP of 140/90 mm
Hg. The most likely cause of the hypertension is:
A. Renal disease
B. Chronic lung disease
C. Theophylline overdose
D. Coarctation of the aorta
E. Obesity

228. Patient with thyreotoxicosis is in the 2 beds hospital ward of therapeutic department. The
area of the ward is 18 m2, height 3 m, ventilation rate 2,5/hr. Air temperature - 20°C, relative
humidity - 45%, air movement velocity - 0,3 m/s, light coefficient - 1/5, noise level - 30 dB.
Do hygienic evaluation of the conditions meet the standards?
A. Discomfortable microclimate
B. Poor lighting
C. Non-effective ventilation
D. High level of noise
E. All conditions meet the requirements

229. The child is 11 m.o. He suffers from nervous-arthritic diathesis. The increased synthesis of
what acid is pathogenic at nervous-arthritic diathesis?
A. Uric acid
B. Phosphoric acid
C. Sulfuric acid
D. Hydrochloric acid
E. Acetic acid