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KROK 2 Medicine 2004 Questions | KROKEXAM
Browse 2004 KROK 2 Medicine exam questions with answers and explanations.
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A woman, aged 40, primigravida, with infertility in the medical history, on the 42–43 week of pregnancy. Labour activity is weak. Longitudinal presentation of the fetus, I position, anterior position. The head of the fetus is engaged to pelvic inlet. Fetus heart rate is 140 bmp, rhythmic, muffled. Cervix dilation is 4 cm. On amnioscopy: greenish colour of amniotic fluid and fetal membranes. Cranial bones are dense, cranial sutures and small fontanel are diminished. What should be tactics of delivery?
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When examining a patient with supposed pelvis fracture, the doctor exerts pressure with both hands on the wings of ileum in opposite direction. What is the cause of pain syndrome appearing in this case?
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A 7-year-old girl suddenly fell ill with fever, headache, severe sore throat, vomiting. Minute bright red rash appeared on her reddened skin 3 hours later. It is more intensive in axillas and groin. Mucous membrane of oropharynx is hyperemic. On tonsils there are greyish patches. Submaxillary glands are enlarged and painful. What is the most likely diagnosis?
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A man, aged 64, complains of cough with sputum discharge, sometimes with blood spitting. Smokes during 30 years. In the last 3 months has lost 8 kg. On roentgenologic examination in the middle lobe of the right lung there is a cavernous formation, the inner outline is irregular, contains a small quantity of fluid, on the right the central lymph nodes are enlarged. What examination is the most informative to define the diagnos
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A 16-year-old woman complains of the abdominal pain and purpuric spots on the skin. Laboratory investigations discovered normal platelet count with hematuria and proteinuria. What is the most probable diagnosis?
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A child, aged 4, has being ill for 5 days, suffers from cough, skin rash, t°- 38,2°С, facial hydropy, photosensitivity, conjunctivitis. On the face, neck, upper part of the chest there is bright maculopapular rash with areas of merging. Hyperemic throat. Seropurulent nasal discharge. In lungs there are dry crackles. What is the most probable preliminary diagnosis?
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A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joints pain. On examination: excited, t°- 39°С, Ps - 110/min. Tonic and clonus cramps. Uncertain meningeal signs. What is the most likely diagnosis?
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A patient, aged 32, diagnosed with multiple injuries: closed craniocerebral injury, closed chest injury, closed right hip fracture. BP - 100/60 mm Hg, Рs - 124/min, RR - 28/min. 2 hours after skeletal extension under local anaesthesia with lidocaine, there appeared abrupt aggravation of the patients condition: developed face and neck cyanosis, BP - 60/40 mm Hg, HR - 160/min, RR - 44/min. What complication most probably aggravated the severity of multiple injuries?
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A 5-year-old child had an attack of palpitation with nausea, dizziness, generalised fatigue. On ECG: tachycardia with HR of 220/min. Ventricle complexes are deformed and widened. P wave is absent. What medication should be given for emergent care?
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A man, aged 52, fell down from the height of 3 m on the level surface of the earth hurting his right lumbar region. Complains of the pain in the right lumbar region. Urinalysis: microhematuria. Excretory urography: kidneys function is satisfactory. What is the most likely diagnosis?
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A man, aged 54, complains of constant dull ache in mesogastric area, weight loss, dark blood admixtures in feces, constipations. In the course of the year the weight loss is up to 10 kg. In blood: RBC - 3,5*1012/L, Hb - 87 g/L, WBC – 12,6*109/L, stab shift, ESR – 43 mm/h. What is the most probable preliminary diagnosis?
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A sample of milk was taken for testing from a 5 ton milk batch. Lab analysis showed the following: fat content 2%, specific density- 1,04 g/cm3, acidity 21°С, reductase probe – weak positive. What way the product is to be used in? What would you advise?
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A 30-year-old man complains of a sharp pain in the right ear, hearing loss, high temperature during three days. Objectively – right ear whispering language – 0,5 m, external ear is intact, otoscopically - eardrum protrusion, hyperaemia and swelling, loss of landmarks. What is the most likely diagnosis?
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A woman, aged 30, in labour, is brought to the maternity in term of 35–36 weeks with weakened labour activity. Fetal movements are not felt. On echography: fetuss heartbeat not determined. Vaginal inspection: cervix is 6 cm dilated, green amniotic fluid has discharged, the head of the fetus is engaged to pelvic inlet. What is the further tactic of delivery?
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A 27-year-old man complains of pain in epigastrium which is relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. What can be diagnosed in this case?
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A patient complains of periodic rash eruptions in the course of the year on the elbow and knee joints. The first eruption occurred after stress. Now it consists of multiple plates, the central part of which is covered with silvery scales. What is the most likely diagnosis?
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A girl, aged 13, consults the school doctor on account of moderate bloody discharge from the genital tracts, which appeared 2 days ago. Secondary sexual characters are developed. What is the most probable cause of bloody discharge?
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A 3-year-old boy fell suddenly ill: fever up to 39°С, weakness, vomiting. Haemorrhagic rash of various size appears on his lower limbs in 5 hours. Meningococcemia with infective - toxic shock of 1 degree was diagnosed. What medications should be administered?
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A patient, aged 58, was fishing in the winter. On return home after some time felt some pain in the feet. Consulted a doctor. On examination: feet skin was pale, then after rewarming became red, warm to the touch. Edema is not significant, limited to the toesAll types of sensitivity are preserved. No blisters. What degree of frostbite is observed?
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A baby, aged 2 months, is hospitalized to the surgery unit with fever up to 38,5°С, edema, hyperaemia and absence of movements in the left shoulder joint. In medical history – omphalitis, pseudofurunculosis. What is the most likely diagnosis?
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A male patient, aged 38, accountant. During acute allergic infectious myocarditis developed the full left bundle-branch block. After treatment and 2 months of observation patients condition is satisfactory, absence of complains or objective and clinical manifestations of disease, but there are still changes on the ECG. What should be the doctors tactics in this case?
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A worker (battery attendant) at the end of the working day complains of intensive pains in the epigastric area, diarrhea, subfebrility, BP - 170/110 mm Hg, skin and scleras are yellow. At the lunch he has drunk 250 ml of vodka. What diagnosis is the most likely?
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A worker was temporarily off work because of illness during 16 days, was under out-patient treatment. The doctor in charge of the case issued a sick-list first for 5 days, then prolonged it for 10 days. Who can further prolong the sick-list to this patient?
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In treatment and prevention establishments, regardless of their organisational and proprietary form, the rights of the patients should be observed. Which of these rights is the most significant?
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A woman, aged 23, complains of periodical febrile chills with fever up to 40°С, sensation of heat alternating with profuse sweat. During last three months has lived in a tropical African country. The patient has already suffered 3 such attacks, which appeared every other day, lasted 12 hours, were accompanied by the headache, lumbar and muscular pain. The face is pale with yellowish tinge. Cyanotic lips. Liver, spleen are enlarged. In blood: RBC - 2,5×1012/l. What is the most likely diagnosis?
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Body temperature of a 12-year-old girl increased up to 39-40°С in 4-5 hours after she had taken 2 pills of aspirin. Complains of general discomfort, dizziness, sudden appearance of red spots on the skin with blister formation or exfoliation of the epidermis with erosive surface. Lesions on the skin looked like burns of II-degree. Nikolsky syndrome is positive. What is the most probable diagnosis?
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A 10-year-old boy complains of a headache, weakness, fever (temperature - 40°С), vomiting. On physical examination: there is an expressed dyspnea, pale skin with a flush on a right cheek, right hemithorax respiratory movement delays, dullness on percussion of the lower lobe of the right lung, weakness of vesicular respiration in this region. The abdomen is painless and soft by palpation. What disease causes these symptoms and signs?
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On examination of a patient, aged 49, cancer of the right lung, ІІА stage, is diagnosed. What TNM combination corresponds to this stage?
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The occipital part of new-born head of dolichocephalic form shows with labour edema with centre in the area of small fontanel. In which presentation of fetal head did child-birth occur?
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A patient, aged 81, complains of constant urinary excretion in drops, feeling of fullness in the lower abdomen. On examination: above pubis there is a spherical protrusion, over which there is a dullness of percussion sound, positive suprapubic punch. What symptom is observed in this patient?
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A female patient, aged 45. Two weeks after pneumonia developed shortness of breath during walking, constant ache in precardiac area, shin edema. On examination: t°= 37,2°С, Heart borders without changes, Sound 1 on the apex is weakened. ECG: atrioventricular heart block I degree, lowering of the amplitude of Т wave in V2-V6. In blood: Hb - 124 g/L, WBC - 5,68*109/L, ESR - 18 mm/h. What is the most likely diagno
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A patient is hospitalized with the complaints of acute fatigue, fever up to 39,2°С, pain in the throat during swallowing, hemorrhagic rash on the skin of the trunk. On examination the blood analysis shows anaemia, thrombocytopenia, blastocytes – 14%, ESR - 40 mm/h. What examination is necessary to define the diagnosis?
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The diagnosis of a right-sided pneumothorax is set to a 36-year-old patient. What method of treatment is indicated to the patient?
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A woman in labour, on vaginal inspection: cervix dilation is up to 2 cm, fetal bladder is intact. Sacral cavity is free, sacral promontory is reachable only with a bent finger, the inner surface of the sacrococcygeal joint is accessible for inspection. The head of the fetus presents. Sagittal suture occupies the transverse diameter of pelvic inlet, the small fontanel to the left, on the side. What labour stage is this?
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A boy, aged 7, is under treatment during 1 month. On hospitalization: significant edema, proteinuria - 7,1 g/L, protein in daily urine - 4,2 g. Blood biochemical profile: stable hypoproteinaemia (43,2 g/L), hypercholesterinaemia (9,2 mmol/L). Which variant of glomerulonephritis is the most probable in this case?
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In medical history of a 2-years-old girl: recurring pneumonia with obstructive courseAuscultation: heterogeneous moist and dry rales in lungs, weakened breathing. Difficult excretion of thick, viscous sputum. Observed "drumstick" fingers, mental deficiency. What is the preliminary diagnosis?
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A woman, primipara, consults a gynecologist on 05.03.2002A week ago felt the fetus movements for the first time. Last menstruation was on 10.01.2002. When she should be given maternity leave?
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An employee of a private company was ill with acute respiratory viral infection. Consulted a district doctor, who determined the fact of temporary loss of working ability, but refused to issue a sick-list, arguing that the patient worked in the private and not state-owned company. Should the sick-list be issued to the employees of private companies?
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A 76-year-old man, with the cardiac pacemaker (demand mode) has periodic episodes of loss of consciousness. Physical examination: Ps - 42 bpm, cardiac rhythm is regular. What can cause the development of such condition?
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A military unit after long march stopped for 3-days rest in the vicinity of a inhabited locality. The sanitary-epidemiological reconnaissance found several water sources. It is necessary to choose the source complying with the hygienic standards for potable water in the field conditions
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