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KROK 1 Medicine 2020 Questions | KROKEXAM
Browse 2020 KROK 1 Medicine exam questions with answers and explanations.
Exam questions
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When preparing for an important sports contest, it is recommended to train at high altitude (2-3 km above mean sea level). Prolonged exposure to such conditions leads to:
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ECG of the patient shows increased duration of the QRS complex. What is the most likely cause?
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Microscopy of autopsy material detected that the alveolar lumens in the lungs are filled with exudate, consisting mainly of erythrocytes. What is the most likely cause of this development?
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When examining a biopsy material obtained from the thyroid — gland, the pathologist discovered lymphocyte infiltration of the thyroid tissues and destruction of the parenchymal elements. Diffuse lymphocyte infiltration with lymphoid follicles was detected in the stroma. What is the most likely diagnosis?
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A diet must contain fats. What plasticity function do they fulfill in the body?
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A patient diagnosed with liver abscess was hospitalized into the surgery department. He has a history of frequent gastrointestinal disturbances. Laboratory analysis of the patient’s feces detected round cells with 4 nuclei. What species of protozoa is this patient infected with?
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After examination, the doctor diagnosed the patient with parainfluenza, based on the clinical findings. What route of transmittion is characteristic of this disease?
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A child has cataract, delayed mental development, and enlarged liver. The doctor suspects these signs are caused by the deficiency of hexose-1-phosphate uridyltransterase. What pathological process is observed in this case?
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A patient was diagnosed with a parathyroid tumor. He has generalized fibrous osteodystrophy and periodic attacks of renal colic. Ultrasound detected small stones in the kidneys. What is the most likely cause of kidney stone formation?
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A 29-year-old man complains of headache, swelling, weight gain, low urine output, and marked weakness. Laboratory testing revealed increased concentration of TSH. The levels of estrogen, growth hormone, glucose, urea, and creatinine are normal. What medical condition corresponds with these signs?
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A person received a penetrating wound of the abdominal cavity. The anterior abdominal wall is injured. The wound tract passes through the plica umbilicalis lateralis. What vessel is damaged?
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A 20-year-old man from the early childhood suffered from type I diabetes mellitus and was constantly undergoing insulin therapy. Within the last year he started breaking his diet and was taking his insulin doses irregularly. To detect possible complications, particularly glomerular diseases, the endocrinologist referred him for urinalysis. What is the first persistent sign of glomerular filtration disorder?
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A patient has developed status epilepticus. What medicine should be used in this case to stop the seizures?
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A woman, who takes an indirect anticoagulant, developed intestinal bleeding. What antagonist drug should she be presribed?
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Biological studies proved that the intensity of testosterone secretion and spermatogenesis varies in men throughout each 24 hours. These biorhythms are called:
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A 48-year-old man is unconscious. He has a history of several syncopal episodes with convulsions. ECG shows deformed QRS complexes unconnected with P waves, atrial contractions are approximately 70/min., ventricular contractions - 25-30/min. Name the type of arrhythmia in this case:
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A person received a head wound. To temporarily stop the bleeding, the doctor pressed with his finger an arterial vessel located in front of the auditory meatus and above the zygomatic arch. Name the damaged artery:
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A 47-year-old woman with chronic pancreatitis accompanied by exocrine pancreatic insufficiency was prescribed pancreatic enzymes. What type of therapy is it?
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A woman has lately been excessively excitable and irritable and had insomnia. She was prescribed diazepam. What is the main mechanism of action of this drug?
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A patient developed a purulent inflammatory process in the periodontal tissues. The process was caused by activation of the microorganisms inherent in the body, which are a part of oral mucosal microflora. What type of infection is it?
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A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for the past month. On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On physical examination, she is a tiredappearing thin woman. Hyperpigmentation is present over many areas of her body, most prominently over the face, neck and back of hands (areas exposed to light). Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient?
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A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth. On physical examination, her vital signs are stable. She does not have pubic hair and her breast is slightly elevated with areola remaining in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?
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A 43-year-old man seeks evaluation at an emergency department with complaints of fever with chills, malaise, diffuse abdominal pain for over a week, diarrhea and loss of appetite. He says that his symptoms are progressively getting worse. He recalls that the fever began slowly and climbed its way up stepwise to the current 39.8°C. His blood pressure is 110/70 mm Hg. A physical exam reveals a coated tongue, enlarged spleen and rose spots on the abdomen. Serologic study shows the agglutinin O titre of 1:200 by the Widal test. Which of the following is the most likely causative organism for this patient’s condition?
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A 6-year-old boy is brought to the pediatrician by his mother, who complains of low-grade fever, chronic cough and night sweats in her child. She describes the cough as productive, producing white sputum that is sometimes streaked with blood. She also says that her son has lost some weight in the last month. His vital signs include blood pressure of 115/75 mm Hg, heart rate of 110/min., respiratory rate of 18/min, and temperature of 36.6°C. On physical examination, the patient is ill looking. Pulmonary auscultation reveals some fine crackles in the right upper lobe. The pediatrician suspects an active infection and performs Mantoux test. Intradermal injection of which of the following substances has been most likely used by pediatrician for screening test in this clinical case?
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A 14-year-old girl presents to the emergency department for evaluation of an "infected leg". She states there is no history of trauma but mentions she had a history of sickle cell disease. On physical examination, her upper part of right shin is very painful, red, swollen and hot. Her temperature is 39.2°C. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia. Increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?
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A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the Trousseau’s sign and Chvostek’s sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The surgeon suggests surgical destruction of parathyroid glands. Which of the following is the most likely cause of this patient’s neurologic abnormality?
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On your physiology class, the professor asks you to report about the effects of various body hormones and neurotransmitters on the metabolism of glucose. You begin your report with the statement that the use of glucose by the cell is preceded by absorption through the plasma membrane from the extracellular matrix into the cell. Which of the following hormones is most likely responsible for the glucose uptake by the cell?
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A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
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A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c) - 8.0%, Fasting Blood Glucose - 12 mmol/L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug’s action?
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A group of researchers aimed to study cardiac physiology found that overstretching of atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause of physiologic effects discovered by researchers?
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An 11-year-old girl is brought to the doctor’s office by her mother who states her daughter has been weak with swollen face for 3 days. The mother states her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria and microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?
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A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse - 91/min., temperature - 36.8°C and respiratory rate - 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypercholesterolemia, hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE’s complication in this patient?
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A 40-year-old woman dies of intracerebral hemorrhage after the hypertensive emergency. During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini populated by a homogenous cluster of deeply basophilic cells. Which of the following was the most likely underlying disease?
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An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The organ can be subdivided into two regions: a cortex with lymphoid nodules and medulla with medullary cords populated by plasma cells, B-cells and T-cells. Which of the following structures is most likely the origin of this surgical specimen?
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A 46-year-old man presents with fatigue and joint pain in his lingers and wrists for the last 2 months. The pain is present in both hands and the wrists are swollen. Furthermore, he describes morning stiffness in his joints lasting about 2 hours, which improves with use. His past medical history reveals he has been successfully treated for H. pylori related ulcers last year. He denies smoking and stopped drinking when his gastric symptoms started. Which of the following drugs is the best choice for his joints pain management?
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A 60-year-old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient’s death?
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A team of medical students is performing research on phases of cell cycle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely takes place in the cell?
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A mother of a 4-month-old male infant brought him to pediatrician with complaints of food rejection and weight loss. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomegaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he continues to reject food. Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
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After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?
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A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for "many years", but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is afebrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination. There is a "pillrolling" resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by fingernose testing. When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug?
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