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KROK 2 Medicine 2006 Questions | KROKEXAM
Browse 2006 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 38 y.o. man complains of having occasional problems with swallowing of both hard and fluid food for many months. Sometimes he feels intense pain behind his breast bone, epecially after hot drinks. There are asphyxia onsets at night. He has not put off weight. Objectively: his general condition is satisfactory, skin is of usual colour. Examination revealed no changes of gastrointestinal tract. X-ray picture of thorax organs presents esophagus dilatation with level of fluid in it. What is the preliminary diagnosis?
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A baby boy was born in time, it was his mother's 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. Mother's blood group - 0(I),Rh, child's blood group - A(II),Rh . Make a diagnosis.
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A 29 y.o. woman is critically ill. The illness is presented by high fever, chills, sweating, aching pain in lumbar area, discomfort during urination and frequent voiding. Pasternatsky's sign is positive in both sides. On lab examination: WBC-20 × 109/l; on urine analysis: protein -0,6g/L, leukocyturia, bacteriuria. Your preliminary diagnosis.
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According to results of medical and pedagogical observation during the gymnastics lesson in the 9th grade there was plotted a phisiological curve characterized by gradual increasing of pulse rate during the opening part of lesson, 80% increase during the main part; the curve has 4 waves. How can the lesson's structure be assessed?
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A man, aged 68, complains of tiredness, sweating, enlargement of cervical, submaxillary and axillary lymph nodes. Blood test: WBC- 35 × 109/l, lymphocytes - 60%, Botkin and Gumprecht bodies, level of haemoglobin and quantity of thrombocytes is normal. Myelogram showed 40% of lymphocytes. What is the most probable diagnosis?
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A 31 y.o. woman has complained for 3 years of pain and swelling of radiocarpal and metacarpophalangeal articulations, morning stiffness that lasts up to 1,5 hours. Two weeks ago she felt pain, swelling and reddening of knee joints, body temperature raised up to 37,5°C. Examination of her internal organs revealed no pathologic changes. Her diagnosis was rheumatoid arthritis. What changes in X-ray pictures of her joints are the most probable?
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A 32 y.o. patient lives in an endemic echinococcous region. For the last 6 months he has been having pain in the right hypochondrium, temperature rise. An echinococcus liver affection is suspected. What type of examination will be the most informative in this case?
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Plan radiography of the patient's abdominal cavity reveals some hemispherical lucent areas situated above distinct horizontal levels. What is the cause of such X-ray picture?
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A woman is admitted to the maternity hospital with stopped birth activity and mild bloody discharges from the vagina. The condition is serious, the skin is pale, consciousness is confused. AP- 80/40 mm Hg. The palpitation of the fetus is not determined. In medical hystory there was a Cesarean section a year ago. Make a diagnosis:
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Ambulance was called to a 48 y.o. man. According to the relatives he has had three episodes of lost consciousness and attacks during the day. Patient is unconscious, fell on the floor, tonic and then clonic convulsions of trunk and extremities happened. The attack lasted for 4 minutes, ended by involuntary urination. What type of attack was observed?
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A 45 y.o. man has complained of having epigastric and right subcostal aching pain, pruritus, indigestion, dark color of the urine and acholic stool, fever and significant weight loss for 1 month. On examination: jaundice, presence of Curvuasier's sign. US scan did not reveal stones in the gallbladder and choledochus. What is the most likely diagnosis?
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A patient is 16 y.o. In the last year his behaviour has gradually changed: he secluded himself, was not interested in communication with friends, in learning. He became indifferent towards relatives, motivelessly rude, was speaking or laughing to himself. He answers the questions formally correctly, laconically. Considers himself to be absolutely healthy but a little tired, says, he's thinking about writing a book "Projection of humanity on the plane of Universe". He always has a copybook with which is full of a great many of the same daggers. What is the most
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Examination of a 32 y.o. patient who had apendectomy because of gangrenous appendicitis revealed clinical picture of pelvic abscess. What is the best way to expose pelvic abscess of this patient?
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8 hours after a road accident an unconscious victim with closed craniocerebral trauma was admitted to the hospital. Objectively: anisocoria, wound in the parietal region - 3,0x1,0 cm, neck muscles rigidity, Ps- 58/min, tense. Convulsive syndrome. What is the most important indication for the immediate surgical procedure?
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A 30 y.o. primigravida woman has got intensive labor pains every 1-2 minutes that last 50 seconds. The disengagement has started. The perineum with the height of 4 cm has grown pale. What actions are necessary in this situation?
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A patient of a somatic hospital has got psychomotor agitation as a result of high fever: he tried to run about the department; thought that some water was running down the walls, he pretended to see rats and cockroaches on the floor. Claimed he were in a hostel, recognized his "aquaintances". After introduction of sedative drugs he fell asleep. In the morni- ng he remembered this condition. What psychopathologic syndrome is it?
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A 35 y.o. woman consulted a doctor about occasional pains in paraumbilical and iliac region that reduce after defecation or passage of gases. Defecation takes place up to 6 times a day, stool is not solid, with some mucus in it. Appetite is normal, she has not put off weight. First such symptoms appeared 1,5 year ago, but colonoscopy data reveals no organic changes. Objectively: abdomen is soft, a little bit painful in the left iliac region. Blood and urine are normal. What is the preliminary diagnosis?
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A 2 y.o. 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?
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A 27 y.o. man complained of aching epigastric pain right after meal, heartburn and nausea. Stomach endoscopy revealed a large amount of mucus, hyperemia and edema of mucous membrane in gastric fundus with areas of atrophy. Make a diagnosis.
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A worker was temporarily off work because of illness for l6 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?
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Examination of a just born placenta reveals defect 2x3 cm large. Hemorrhage is absent. What tactic is the most reasonable?
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A girl, aged 13, consulted 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 50 y.o. patient was admitted to the hospital with complaints of blood in urine. There was no pain or urination disorders, hematuria has lasted for 3 days. Objectively: kidneys are not palpable, suprapubic region has no pecularities, external genitals have no pathology. Rectal examination revealed: prevesical gland is not enlarged. Cytoscopy revealed no changes. What disease would you think about first of all?
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A 19 y.o. boy was admitted to the hospital with closed abdominal trauma. In course of operation multiple ruptures of spleen and small intestine were revealed. Ap is falling rapidly, it is necessary to perform hemotransfusion. Who can determine the patient's blood group and rhesus compatibility?
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A 60 y.o. man complains of sense of heaviness in the region of scrotum. Objectively: scrotum edema in the left part. Testicle is of normal size, but there is a soft, scrotum limited edema over it that can be pressed and disappears when the patient lies down. What is the preliminary diagnosis?
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A 7 y.o. 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?
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A 25 y.o. woman complained of fatigue, hair loss and brittle nails. The examination revealed pallor of skin, Ps- 94/min, BP- 110/70 mm Hg. On blood count: Hb- 90 g/L, RBC- 3,5 × 1012/l, C.I.- 0,7; ESR - 20 mm/h. Serum iron level was 8,7 mcmol/L. What treatment would you initiate?
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The results of a separate diagnostic curettage of the mucous of the uterus' cervix and body made up in connection with bleeding in a postmenopausal period: the scrape of the mucous of the cervical canal revealed no pathology, in endometrium - the highly differentiated adenocarcinoma was found. Metastases are not found. What method of treatment is the most correct?
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A 3 y.o. girl has had a temperature rise up to 38°C, rhinitis, dry superficial cough, flabbiness, appetite loss. Palpation didn't 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?
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A pregnant woman was registered in a maternity welfare clinic in her 11th week of pregnancy. She was being under observation during the whole term, the pregnancy course was normal. What document must the doctor give the pregnant woman to authorize her hospitalization in maternity hospital?
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A patient complains of skin painfullness and reddness of the right gastrocnemius muscle. Objectively: body temperature is 38,5°C, enlarged and painful inguinal lymph nodes on the right. Skin of extremity is edematic, hyperemic, covered with eruption in form of vesicles containing dark fluid; its palpation is painful. There is distinct border between normal and hyperemic skin. What is the most probable diagnosis?
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A 20 y.o. patient complains of amenorrhea. Objectively: hirsutism, obesity with fat tissue prevailing on the face, neck, upper part of body. On the face there are acne vulgaris, on the skin - striae cutis distense. Psychological and intellectual development is normal. Gynecological condition: external genitals are moderately hairy, acute vaginal and uterine hypoplasia. What diagnosis is the most probable?
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A 26 y.o. woman complains of sudden pains in the bottom of abdomen irradiating to the anus, nausea, giddiness, bloody dark discharges from sexual tracts for one week, the delay of menses for 4 weeks. Signs of the peritoneum irritation are positive. Bimanual examination: borders of the uterus body and its appendages are not determined because of sharp painfullness. The diverticulum and painfullness of the back and dextral fornixes of the vagina are evident. What is the most probable diagnosis?
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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?
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A 60 y.o. woman has had increased BP up to 210/110 mm Hg for the last 7 years. On examination: heart apex is displaced to the left. There are signs of left ventricular hypertrophy on ECG. What is the most probable diagnosis?
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A 27 y.o. woman complains of having the disoders of menstrual function for 3 months, irregular pains in abdomen. On bimanual examination: in the dextral appendage range of uterus there is an elastic spherical formation, painless, 7 cm in diameter. USI: in the right ovary - a fluid formation, 4 cm in diameter, unicameral, smooth. What method of treatment is the most preferable?
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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. Nikolsky's symptom is positive. What is the most probable diagnosis?
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In course of observation of sanitary conditions of studying at the technical university it was necessary to evaluate the visual regimen of students, who study from 9 a.m to 3 p.m. What index of natural light will be the most informative?
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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?
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A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°C. There was acute onset of the illness. In the past there were similar attacks lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic without definite borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
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