Step 2
1. A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can
be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in
the lumbar part of his spine, increase of muscle tonus in the lumbar area and sluch during moving. X-ray
pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most
necessary for confirming a diagnosis?
A. Rheumatoid factor
B. Antinuclear antibodies
C. Uric acid in blood plasma
D. * HLA-B27
E. ESR
2. A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to
the posterior surface of his left leg. The pain increases during changing body position and also in the upright
position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?
A. Myelopathy
B. Polyneuritis
C. * Pathology of intercostal disks
D. Spinal cord tumor
E. Arachnomyelitis
3. A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
A. * Gout arthritis
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
4. A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia during small
physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is protodiastolic
murmur on xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. * Mitral stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
,E. Aortic stenosis
5. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in
the wrists and the elbows. On physical exam, erythematous rash on the cheeks with “butterfly” appearance,
the wrists and elbow joints are involved symmetrically, swollen, tender on motions, friction rub over the
lungs, the heart sounds are weak, regular, HR of 88/ minute, BP of 160/95 mm Hg. CBC shows anemia,
leucopenia, lymphopenia; on urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism of
disease development?
A. * Production of antibodies to double-stranded DNA.
B. Production of antibodies to myocytes.
C. Production of antibodies to endothelial cells.
D. Production of antibodies to myosin.
E. Production of antimitochondrial antibodies.
6. A 14 year old patient. He complains of chest pain, temperature 38,5, breathlessness. He had acute
tonsillitis2 weeks ago. He is in a bad state. The skin is pale. Heart borders are widened, the tones are
weakened. Above all heart area you can hear pericardium friction sound. Electrocardiogramm: the descent of
voltage QRS, the inversion T. The liver is 3 sm enlarged. ESR – 4mm/h, ASL – 0 – 1260, C-reaction protein
+++. Your diagnosis:
A. * Rheumatic pancarditis
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
7. A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
A. * Gout arthritis
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
8. A 25 -year-old woman complained of edema on the face and legs, elevation in blood pressure up to
160/100 mm Hg, and weakness. She fell ill 3 weeks after sore throat. On urinalysis, protein of 0.5 g/L,
erythrocytes of 17 – 20/field, leukocytes of 2 – 3/field, erythrocyte casts. What treatment should be initiated
after establishing of the
A. * Penicillin OS
,B. Heparin
C. Ceftriaxone
D. Dipyridamole
E. Ciprofloxacine
9. A 19-year-old girl admitted to the hospital complained of pain in the knee and fever of 38.6°C. She is
ill for 2 weeks after acute tonsillitis. On exam, hyperemia and swelling of both knees, BT of 37.4°C, HR of
94/min, BP of 120/80 mm Hg, and heart border is displaced to the left; S1 is weak, systolic murmur is
present. Total blood count shows the following: Hb – 120 g/L, WBC – 9.8•109/L, ESR of 30 mm/L. ECG
findings: the rhythm is regular, PQ = 0.24 sec. What is a causative agent of the disease?
A. * Beta-hemolytic streptococci.
B. Viral-bacterial association.
C. Autoimmune disorder.
D. Staphylococci.
E. Ricchetsia.
10. A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia during small
physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is protodiastolic
murmur on xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. * Mitral stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
E. Aortic stenosis
11. A 33-year-old man with a history of rheumatic fever complains of fever up to 38 - 39°, abdominal
pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs
above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is
enlarged by 3 cm, spleen is palpable. Urine is brown-yellow. What is the most probable diagnosis?
A. * Infectious endocarditis
B. Rheumatic fever
C. Acute hepatitis
D. Acute nephritis
E. Aortic regurgitation
12. Woman age 40,ill on rheumatic disease with composite mitral disease with prevalence of the stenosis
of left venous foramen.Complainse on the palpitation,fatigability progressing dyspnea,attacks of a dyspnea
and hemoptysis.Now she can not execute even the mild activities.What tactics is the most expedient?
, A. * Mitral comissurotomia.
B. Conduction of current bicilino-prophilaxis.
C. Assiging of anticoagulants.
D. Assiging of venous vasodilatators .
13. A patient 55 years complains about pain, slight swelling in the joints of brushes, long constraint at
mornings, limitation of mobility. 1 year is ill. Treated oneself with ibuprofen with a small effect. Objectively:
swelling of metacarpal-phalange, proximal interphalange joints of the II-III fingers of both brushes with pain
limitation of mobility. ESR 37 mm/hour. What researches are most informing for clarification of diagnosis of
rheumatoid
A. * Rheumatoid factor, X-ray of brushes joints
B. Determination of uric acid in blood
C. Titers of antichlamidias antibodies
D. Presence of LE-cells
E. Determination of blood lipids level
14. The atrial flutter with heart rate up to 130 per min firstly appeared in a woman aged 28 yr
considered before healthy. Physical examination reveals pale bluish cheeks. The respiratory rate is 24 per
min. Cardiac auscultation is difficult because of high rate but S1 tone is loud. The chest is free and
abdomen is soft and painless. ECG revealed right ventricle hypertrophy and atrial flutter. This woman was
not consulted by any doctor because she lives in a small village. What is the most probable diagnosis?
A. * Mitral stenosis
B. Myocarditis
C. Thyrotoxicosis
D. Artherosclerotic cardiosclerosis
E. Myocardiodistrophy
15. The patient, 32 years old, came to the doctor with complaints for the increase of body temperature up
to 38 degrees Celsius, pain in his joints, conjunctivitis. He felt ill acute after the accidental sexual contact.
During the examination the skin over the right ankle joint, the left knee joint and the right hip joint was
hyperemic, hot to
A. * Reyter’s disease
B. Psoriatic arthritis
C. Behterev’s disease
D. Lupus aerytematosis
E. Arthritis rheumatoidis
1. A 21 y.o. man complains of having morning pains in his back for the last three months. The pain can
be relieved during the day and after physical exercises. Physical examination revealed reduced mobility in
the lumbar part of his spine, increase of muscle tonus in the lumbar area and sluch during moving. X-ray
pattern of spine revealed bilateral sclerotic changes in the sacrolumbal part. What test will be the most
necessary for confirming a diagnosis?
A. Rheumatoid factor
B. Antinuclear antibodies
C. Uric acid in blood plasma
D. * HLA-B27
E. ESR
2. A 38 y.o. patient lifted a heavy object that resulted in pain in the lumbar part of spine irradiating to
the posterior surface of his left leg. The pain increases during changing body position and also in the upright
position. Examination revealed positive symptoms of tension. What is the preliminary diagnosis?
A. Myelopathy
B. Polyneuritis
C. * Pathology of intercostal disks
D. Spinal cord tumor
E. Arachnomyelitis
3. A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
A. * Gout arthritis
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
4. A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia during small
physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is protodiastolic
murmur on xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. * Mitral stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
,E. Aortic stenosis
5. A 41-year-old woman complains of weakness, fatigue, fever up to 38°C, rash on the face skin, pain in
the wrists and the elbows. On physical exam, erythematous rash on the cheeks with “butterfly” appearance,
the wrists and elbow joints are involved symmetrically, swollen, tender on motions, friction rub over the
lungs, the heart sounds are weak, regular, HR of 88/ minute, BP of 160/95 mm Hg. CBC shows anemia,
leucopenia, lymphopenia; on urinalysis: proteinuria, leukocyturia, casts. What is the main mechanism of
disease development?
A. * Production of antibodies to double-stranded DNA.
B. Production of antibodies to myocytes.
C. Production of antibodies to endothelial cells.
D. Production of antibodies to myosin.
E. Production of antimitochondrial antibodies.
6. A 14 year old patient. He complains of chest pain, temperature 38,5, breathlessness. He had acute
tonsillitis2 weeks ago. He is in a bad state. The skin is pale. Heart borders are widened, the tones are
weakened. Above all heart area you can hear pericardium friction sound. Electrocardiogramm: the descent of
voltage QRS, the inversion T. The liver is 3 sm enlarged. ESR – 4mm/h, ASL – 0 – 1260, C-reaction protein
+++. Your diagnosis:
A. * Rheumatic pancarditis
B. Rheumatic pericarditis
C. Rheumatic myocarditis
D. Rheumatic endocarditis
E. Septic endocarditis
7. A 47-year-old obese man complained of periodic attacks of acute arthritis in the 1st left
tarsophalangeal joint. Lab exam revealed increased serum level of uric acid. What is the diagnosis?
A. * Gout arthritis
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
8. A 25 -year-old woman complained of edema on the face and legs, elevation in blood pressure up to
160/100 mm Hg, and weakness. She fell ill 3 weeks after sore throat. On urinalysis, protein of 0.5 g/L,
erythrocytes of 17 – 20/field, leukocytes of 2 – 3/field, erythrocyte casts. What treatment should be initiated
after establishing of the
A. * Penicillin OS
,B. Heparin
C. Ceftriaxone
D. Dipyridamole
E. Ciprofloxacine
9. A 19-year-old girl admitted to the hospital complained of pain in the knee and fever of 38.6°C. She is
ill for 2 weeks after acute tonsillitis. On exam, hyperemia and swelling of both knees, BT of 37.4°C, HR of
94/min, BP of 120/80 mm Hg, and heart border is displaced to the left; S1 is weak, systolic murmur is
present. Total blood count shows the following: Hb – 120 g/L, WBC – 9.8•109/L, ESR of 30 mm/L. ECG
findings: the rhythm is regular, PQ = 0.24 sec. What is a causative agent of the disease?
A. * Beta-hemolytic streptococci.
B. Viral-bacterial association.
C. Autoimmune disorder.
D. Staphylococci.
E. Ricchetsia.
10. A 42-year-old woman complains of dyspnea, edema of the legs, and tachycardia during small
physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is protodiastolic
murmur on xiphoid process. The liver is enlarged by 5 cm. What is the cause of heart failure?
A. * Mitral stenosis
B. Mitral regurgitation
C. Tricuspid stenosis
D. Tricuspid regurgitation
E. Aortic stenosis
11. A 33-year-old man with a history of rheumatic fever complains of fever up to 38 - 39°, abdominal
pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic and diastolic murmurs
above aorta, BP of 160/30 mm Hg. Petechial rash occurs after measurement of blood pressure. Liver is
enlarged by 3 cm, spleen is palpable. Urine is brown-yellow. What is the most probable diagnosis?
A. * Infectious endocarditis
B. Rheumatic fever
C. Acute hepatitis
D. Acute nephritis
E. Aortic regurgitation
12. Woman age 40,ill on rheumatic disease with composite mitral disease with prevalence of the stenosis
of left venous foramen.Complainse on the palpitation,fatigability progressing dyspnea,attacks of a dyspnea
and hemoptysis.Now she can not execute even the mild activities.What tactics is the most expedient?
, A. * Mitral comissurotomia.
B. Conduction of current bicilino-prophilaxis.
C. Assiging of anticoagulants.
D. Assiging of venous vasodilatators .
13. A patient 55 years complains about pain, slight swelling in the joints of brushes, long constraint at
mornings, limitation of mobility. 1 year is ill. Treated oneself with ibuprofen with a small effect. Objectively:
swelling of metacarpal-phalange, proximal interphalange joints of the II-III fingers of both brushes with pain
limitation of mobility. ESR 37 mm/hour. What researches are most informing for clarification of diagnosis of
rheumatoid
A. * Rheumatoid factor, X-ray of brushes joints
B. Determination of uric acid in blood
C. Titers of antichlamidias antibodies
D. Presence of LE-cells
E. Determination of blood lipids level
14. The atrial flutter with heart rate up to 130 per min firstly appeared in a woman aged 28 yr
considered before healthy. Physical examination reveals pale bluish cheeks. The respiratory rate is 24 per
min. Cardiac auscultation is difficult because of high rate but S1 tone is loud. The chest is free and
abdomen is soft and painless. ECG revealed right ventricle hypertrophy and atrial flutter. This woman was
not consulted by any doctor because she lives in a small village. What is the most probable diagnosis?
A. * Mitral stenosis
B. Myocarditis
C. Thyrotoxicosis
D. Artherosclerotic cardiosclerosis
E. Myocardiodistrophy
15. The patient, 32 years old, came to the doctor with complaints for the increase of body temperature up
to 38 degrees Celsius, pain in his joints, conjunctivitis. He felt ill acute after the accidental sexual contact.
During the examination the skin over the right ankle joint, the left knee joint and the right hip joint was
hyperemic, hot to
A. * Reyter’s disease
B. Psoriatic arthritis
C. Behterev’s disease
D. Lupus aerytematosis
E. Arthritis rheumatoidis
