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KROK 2 Medicine 2008 Questions | KROKEXAM
Browse 2008 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 56-year-old man complains of fatigue, dyspnea on exertion and palpitations. He has had a murmur since chi- ldhood. Examination reveals a lift at the left sternal border, split Si, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. Chest X-ray shows right ventricular enlargement and prominent pulmonary arteries. ECG demonstrates atrial fibrillation with a right bundle branch block. The most likely diagnosis is:
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A 3-year-old boy fell ill abruptly: fever up to 39°C, weakness, vomi-tng. Haemorrhagic rash of various size appeared on his lower limbs in 5 hours. Meningococcemia with infective - toxic shock of the 1 degree was diagnosed. What medications should be administered?
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A 75-year-old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:
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A 56-year-old patient has worked at the aluminium plant over 20 years. Within 3 last years he has been experiencing loosening of teeth, bone and joint pains, piercing pains in heart region, vomiting. The provisional diagnosis is:
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A 35-year-old woman consulted a doctor about affection of arm skin and lower third of forearm in form of a large edema, hyperemia, vesiculation and maceration. The disease developed after using a laundry detergent "Lotos". The patient has been using it for a month. She hasn't suffered from dermatological diseases before. What is the most probable diagnosis?
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A 35-year-old patient who suffers from chronic glomerulonephritis and has been hemodialysis-dependent for the last three years developed intermissions of heart activity, hypotension, progressing weakness, dyspnea. ECG showed bradycardia, atrioventricular block type I, high pointed waves T. The day before the flagrant violation of diet took place. What is the most probable cause of these changes?
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In order to improve organism tolerance of boarding-school pupils a doctor developed a program. The program is based upon the following principles: graduality, consistency, individuality, coomplexity. What of the main principles of organism tempering wasn't taken into account?
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A 46-year-old woman who has been suffering from hypertension for 5 years was diagnosed with hypertensive crisis. She complains about palpitation, sense of head pulsation; heart rate is 100/min, AP is 190/100 mm Hg (haemodynamics is of hyperkinetic type). What medication should be the medication of choice?
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Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and <10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT:
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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?
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A 33-year-old male patient was brought to Emergency Department with the signs of cardiovascular collapse: BP - 60/30 mm Hg, Ps - 140 bpm, the skin is pale and moist, diuresis 20 ml/h, Hb - 80 g/l, red blood cell count - 2,5 × 1012/l. The reduction of blood volume averages:
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An excited patient constantly tries to look into the next room because he is sure of his friends' presence. He claims to hear his friends and other people talking although no-one is there. He tries to persuade his doctor that people in the next room are disputing about "his punishment", repeats aloud phrases he has allegedly heard from the next room. What state is it?
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A 32-year-old patient complains about heartburn and dull pain in the epigastrium that appear 2-3 hours after meal. Exacerbations happen in spring and in autumn. The patient has food intolerance of eggs and fish. Objectively: stomach palpation reveals painfulness in the gastroduodenal area. Electrophasoduodenoscopy revealed a 5 mm ulcer on the anterior wall of duodenum. Urease test is positive. What is the most probable leading mechanism of disease development?
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A 34-year-old coal miner who has been in service for 10 years was discharged from an occupational disease clinic after examination and treatment. He was diagnosed with the I stage of anthracosilicosis, peribronchitis, 0 stage of respiratory failure. What expert decision should be taken about his working capacity?
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A patient complains about pyrosis and permanent pain behind his breastbone. When he bends forward after eating there appears regurgitation. Roentgenological examination revealed extrasaccular cardiofunctional hernia of esophageal opening of diaphragm. Esophagoscopy revealed signs of reflux-esophagitis. What is the necessary tretment tactics?
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A 30-year-old patient complains about inability to become pregnant over 3 years of married life. The patient is of supernutrition type, she has hair along the median abdominal line, on the internal thigh surface and in the peripapillary area. Menses started at the age of 16, they are infrequent and non-profuse. US revealed that the uterus was of normal size, ovaries were 4x5x5 cm large and had a lot of cystic inclusions. What is the most probable diagnosis?
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Five days after a total hip replacement a 72-year-old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST — T wave changes. The most likely diagnosis is:
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A 14-year-old patient complains of chest pain, temperature up to 38,5°C, breathlessness. He had acute tonsillitis 2 weeks ago. He is in grave condition. The skin is pale. Heart borders are dilated, heart sounds are quiet. Above total heart area you can hear pericardium friction sound. Electrocardiogram: the descent of QRS voltage, the inversion T. The liver is enlarged by 3 cm. ESR - 4 mm/h, ASL - 0 - 1260, C-reactive protein . Your diagnosis:
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A 19-year-old girl was admitted to emergency department: unconsciousness, cyanosis, myotic pupils are present, superficial breathing is 12/min. BP is 90/60 mm Hg, Ps- 78/min. Choose the action necessary in this clinical situation:
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Survey radiograph of chest of a 62-year-old smoker who often suffers from "pneumonia"showed a triangle shadow in the right lung, its vertex is pointing towards the lung root. It also showed devi- ation of heart and mediastinum shadows towards the lesion. What is the most probable diagnosis?
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A 48-year-old woman complains about weakness, weight loss, appetite loss, headache. The patient had acute glomerulonephritis when she was young. She has been suffering from arterial hypertension since she was 25. She didn't undergo systematic treatment, consulted a doctor rarely. Examination revealed signs of chronic renal insufficiency of the I stage (creatinine - 0,43 millimole/l). What dietary recommendations are the most reasonable?
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A 52-year-old woman complains about face distortion. It appeared 2 days ago after supercooling. Objectively: body temperature is 38,2°C. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than right one and doesn't close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes - 10 × 109/l, ESR - 20 mm/h. What is the most probable diagnosis?
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15 minutes after the second vaccination with diphteria and tetanus toxoids and pertussis vaccine a 4 month old boy manifested symptoms of Quincke's edema. What medication should be applied for emergency aid?
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A 4 month old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 23 minutes, there was also one-time vomiting. Objectively: the child's condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor's finger was stained with blood. What is the most probable diagnosis?
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A child is 6 years old. Within one year of observation he had URI that lasted 8 days. Physical state is satisfactory. Specify hi health group:
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A woman born a child. It was her fith pregnancy but the first delivery. Mother's blood group is A(II)Rh-, newborn's -A(II)Rh . The level of indirect bilirubin in umbilical blood was 58 micromole/l, hemoglobin -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:
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A pregnant woman may be diagnosed with hepatitis if it is confirmed by the presence of elevated:
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A 68-year-old patient has been suffering from chronic pancreatitis for 35 years. During the last 5 years he has been observing abatement of pain syndrome, abdominal swelling, frequent defecations up to 3-4 times a day (feces are greyish, glossy, with admixtures of undigested food), progressing weight loss. Change of symptom set is caused by joining of:
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A 50-year-old woman complains about dull cardiac pain, asphyxia, body temperature rise up to 38°C. She had influenza a week ago. Objectively: Ps -100 bpm, dropped-beat pulse during inspiration. AP - 100/70 mm Hg, heart sounds are muffled. ECG: reduced voltage, ST segment is above the isoline in all leads. X-ray picture shows extensively enlarged cardiac silhouette. Palmus is of small amplitude. What is the most probable diagnosis?
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A patient complained about general weakness, fever, painful rash on his trunk skin . He has been suffering from this for 3 days. Objectively: lateral surface of trunk on the left is hyperemic and edematic, there are some groups of vesicles with serous and haemorrhagic contents. What is the most probable diagnosis?
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During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul's respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is at the rate of 33 millimole/l. What emergency actions should be taken?
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During preventive examination a 16-year-old patient presented no problems. Objectively: the patient has signs of malnutrition, he is asthenic, AP is 110/70 mm Hg, Ps is 80 bpm, cardiac border is normal, auscultation above the cardiac apex reveals three sounds, cardiac murmur is absent. ECG shows no pathological changes, phonocardiogram shows that the third sound comes 0,15 s after the second one above the apex. How are these changes called?
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Which of the following IS NOT TYPICAL for Addison's disease?
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A mother consulted a pediatrician about her son. Her son was born with body mass of 3 kg and length of 48 cm. He's 1-year-old now. What is the required normal mass?
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An endometrial adenocarcinoma that has extended to the uterine serosa would be classified as stage:
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A 60-year-old patient has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining about amotivational bad mood, problems with attention concentration; she forgets to close the entrance door, cannot recall events of the last day. Computer tomography shows areas of postinfarction changes in the cortical postfrontal regions. What is the most probable diagnosis?
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Examination of a 4 month old child revealed some lemon-yellow squamae with fatty crusts on the scalp. What is the most probable diagnosis?
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Internal obstetric examination of a parturient woman revealed that the sacrum hollow was totally occupied with fetus head, ischiadic spines couldn't be detected. Sagittal suture is in the straight diameter, occipital fontanel is directed towards symphysis. In what plane of small pelvis is the presenting part of the fetus?
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In order to study impact of microclimate upon the human organism it is necessary to make systematic observation of air temperature over 3 days. Choose a device that will allow to make the most precise temperature records:
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A 52-year-old patient with disseminated vertebral osteochondrosis lifted a significant load that resulted in lumbar pain and pain along the sciatic nerve. Objectively: positive Lasegue's sign on the left, reduced Achilles reflex. What drug would be the most effective from the pathogenetic point of view?
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