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KROK 2 Medicine 2009 Questions | KROKEXAM
Browse 2009 KROK 2 Medicine exam questions with answers and explanations.
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A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?
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A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate - 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration and pulse - ratio is 1:2. The heart dullness under normal size. Such signs characterise:
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A 22-year-old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:
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A 34-year-old female patient has been suffering from anxious depression accompanied by panic attacks for 2 years. She has been a patient of a psychotherapist. Treatment resulted in incomplete remission. The patient had to break off psychotherapy because of moving to a new place of residence. Soon after this her condition grew significantly worse, she was almost permanently anxious, panic attacks turned up 5-6 times a day and were accompanied by palpitation, dyspnea, cold sweat, thanatophobia. What drug group is the most appropriate for medicamental therapy?
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A 19-year-old patient was admitted to a hospital with acute destructive appendicitis. He suffers from hemophilia of B type. What antihemophilic medications should be included in pre- and postoperative treatment plan?
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It was noticed that a 7-year-old pupil had been innattentive several times during the lessons. The teacher also noticed that the child had been smacking his lips and had vacant look. There were no falls and convulsions. During such short periods of absence the child didn't react to calling his name. His mother notic such phenomena before but didn't pay much attention to them thinking that the child was deep in thought. What type of epileptic attack (according to the standard classification) is it?
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A 3-year-old boy has petechial eruption. Examination revealed no other pathological changes. Thrombocyte number is 20 × 109 g/l; haemoglobin and leukocyte concentration is normal. What is the most probable diagnosis?
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A 26-year-old woman complains about edemata, swelling and painfulness of mammary glands, headache, tearfulness, irritability. These signs turn up 5 days before menstruation and disappear after its start. What clinical syndrome is it?
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A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:
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A 3-year-old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39°C and maculopapular rash on its face. Except of rash the child's skin has no changes. What is your diagnosis?
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A 25-year-old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?
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1,5 hour after start of gullet bougienage a 48-year-old patient suffering from corrosive stricture felt acute abdominal pain. Previously he had been suffering from duodenal ulcer. Examination revealed that abdomen was very tense and painful; Ps- 110 bpm, painful sialophagia, skin pallor. What is the most probable diagnosis?
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A 59-year-old female patient applied to a maternity welfare clinic and complained about bloody discharges from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharges came from the cervical canal. Uterus was of normal size, uterine appendages were unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?
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A 41-year-old woman has suffered from nonspecific ulcerative colitis for 5 years. On rectoromanoscopy: evident inflammatory process of lower intestinal parts, pseudopolyposive changes of mucous membrane. In blood: WBC-9,8 × 109/l, RBC- 3,0 × 1012/l, ESR -52 mm/hour. What medication provides pathogenetic treatment of this patient?
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Indices that characterize population health include demographic indices. What environment is used for calculation of these indices?
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A 27-year-old patient suffers from hemophilia. He was admitted to the hospital with melena and skin pallor. Objectively: Ps-110 bpm, AP-100/60 mm Hg. In blood: Hb- 80 g/l, erythrocytes -2,8 × 1012/l. What medication should be administered in the first place?
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A 26-year-old woman had the second labour within the last 2 years with oxytocin application. The child's weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding:
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A 2-year-old 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 fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?
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A healthy 75-year-old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?
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A 26-year-old woman who delivered a child 7 months ago has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She suckles the child, menstruation is absent. She hasn't applied any contraceptives. What method should be applied in order to specify her diagnosis?
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A 38-year-old female patient complains about body stiffness in the morning, especially in the articulations of her upper and lower limbs, that disappears 30-60 minutes later after active movements. She has also arthritis of metacarpophalangeal and proximal phalangeal articulations, subfebrile temperature. ESR - 45 mm/h. Roentgenography revealed osteoporosis and erosion of articular surface of small hand and foot articulations. What is the most probable diagnosis?
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An infant is full-term. Delivery was pathological, with breech presentation. Examination of the infant revealed limited abduction of the right leg to 50º, positive "clicking" symptom on the right, asymmetric inguinal folds. What is the most probable diagnosis?
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A 38-year-old patient complains about inertness, subfebrile temperature, enlargement of lymph nodes, nasal hemorrhages, bone pain. Objectively: the patient's skin and mucous membranes are pale, palpation revealed enlarged painless lymph nodes; sternalgia; liver was enlarged by 2 cm, spleen - by 5 cm, painless. In blood: erythrocytes - 2,7 × 1012/l, Hb- 84 g/l, leukocytes - 58 × 109/l, eosinophils -1%, stab neutrophils - 2%, segmented neutrophils - 12%, lymphocytes - 83%, lymphoblasts - 2%, smudge cells; ESR - 57 mm/h. What is the most probable diagnosis?
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A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:
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A 3-year-old boy fell ill abruptly: fever up to 39°C, weakness, vomiting. Haemorrhagic rash of various size appeared on his lower limbs within 5 hours. Meningococcemia with infective - toxic shock of the 1 degree was diagnosed. What medications should be administered?
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A 42-year-old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
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A parturient complains about pain in the mammary gland. Palpation revealed a 3x4 cm large infiltration, soft in the centre. Body temperature is 38,5°C. What is the most probable diagnosis?
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A boy is 1-year-old. Previously he had purulent otitis. After that he started complaining about pain in the upper third of his left thigh, body temperature rose up to 39°C. Objectively: the thigh is swollen in its upper third, inguinal fold is smoothed. Extremity is in half-bent position. Active and passive movements are impossible because of acute pain. What is the most probable diagnosis?
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A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month the actual weight is sufficient (4350 g), psychophysical development corresponds with the age. The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?
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A 30-year-old man complains of intense pain, reddening of skin, edema in the ankle-joint area, fever up to 39°C. There was an 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 and ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?
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A 36-year-old female patient complains about general weakness, edemata of her face and hands, rapid fatigability during walking, difficult deglutition, cardiac irregularities. These symptoms turned up 11 days after holiday at the seaside. Objectively: face erythema, edema of shin muscles. Heart sounds are muffled, AP is 100/70 mm Hg. In blood: ASAT activity is 0,95 millimole/h-l, ALAT - 1,3 micromole/h-l, aldolase - 9,2 IU/l, creatine phosphokinase - 2,5 micromole P/g-l. What method of study would be the most specific?
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In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics - anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:
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A woman delivered a child. It was her fifth 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, haemoglobin -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 32-year-old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38,9°C, RR of 24/min, HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb of 70 g/l, RBC of 2,2 × 1012/l, WBC of 3,0 × 109/l with 32% of blasts, 1% of eosinophils, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the cause of anemia?
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A 52-year-old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin hemorrhages in form of ecchymoses and spots, nasal and stomachal hemorrhages. After clinical examinations her illness was diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?
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A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight is 4900 g. Evaluate the current weight of the child:
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Three weeks after acute angina the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
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The results of 5 year monitoring allowed to estimate the level of environmental influence upon health indices of popultaion. What statistic method should be chosen?
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A 33-year-old patient has acute blood loss (erythrocytes - 2,2• 1012/l, Hb- 55 g/l), blood group is A(II)Rh+. Accidentally the patient got transfusion of donor packed red bloom cells of AB(IV)Rh+ group. An hour later the patient became anxious, got abdominal and lumbar pain. Ps- 134 bpm, AP- 100/65 mm Hg, body temperature - 38,6°C. After catheterization of urinary bladder 12 ml/h of dark-brown urine were obtained. What complication is it?
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