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KROK 2 Medicine 2009 Questions | KROKEXAM
Browse 2009 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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Five days after a total hip joint 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 52-year-old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
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A 26-year-old manual worker complained of 3 weeks history of fevers and fatigue, weight loss with no other symptoms. Physical findings: Temperature 37,6°C, Ps- 88 bpm, blood pressure 115/70 mm Hg, superficial lymph nodes (occipital, submental, cervical, axillary) are enlarged, neither tender nor painful. Rubella-like rash on the trunk and extremities. Herpes simplex lesions on the lips. Candidosis of oral cavity. What infectious disease would you suspect?
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A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37,6°C. Sonography revealed that bile bladder was 5,5x2,7 cm large, its wall -0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most probable diagnosis?
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A 70-year-old man is suffering from coronary heart disease. His mood is evidently depressed, anxious. As a result of continious sleeplessness he has got fears, suicidal thoughts. He would sit for a long time in the same pose, answer after a pause, in a low, monotonous voice. His face has a look of suffering, pain, fear. What is the main psychopathologic syndrome?
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A 42-year-old man applied to a hospital 10 minutes after he got stung by a bee and complained about face edema and difficult respiration. Objectively: Ps- 98 bpm, AP- 130/80 mm Hg. A doctor on duty injected him 1 ml of 1% dimedrol solution intramuscularly and recommended to apply to his local therapeutist on the next day. What tactics of treatment should be chosen for this patient?
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Examination of a 26-year-old female patient revealed a node in the right lobe of thyroid gland. The node appeared no earlier than 3 months ago. The patient associates this node with stress. She doesn't complain either about pain or enlargement of the node. Ultrasonic scanning revealed a 2x2,5 cm large node in the inferior part of the right lobe of thyroid gland. What treatment should be administered?
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A 22-year-old female patient complains about frequent and painful urination, urge to urinate at night, enuresis, pain in the suprapubic and lumbar area. Her urine often has beer colouring. She got married a month ago. Objectively: general state is satisfactory. Lung examination revealed vesicular respiration. Heart sounds are rhythmic, heart rate is 78/min, AP- 128/68 mm Hg. Abdomen is soft, painful in the suprapubic area. Urine contains 12-18 erythrocytes and 12-15 bacteria within eyeshot. What is the most probable diagnosis?
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A 38-year-old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:
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A 62-year-old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps - 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
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A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?
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A 3-year-old child with weight deficiency suffers from permanent moist cough. In history there are some pneumonia with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?
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A 23-year-old female patient complains about periodical chill and body temperature rise up to 40°C, sense of heat taking turns with profuse sweating. The patient has had already 3 attacks that came once in two days and lasted 12 hours. She has lived in Africa for the last 2 months. Liver and spleen are enlarged. In blood: erythrocytes - 2,5 × 1012/l. What is the most probable diagnosis?
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A 44-year-old man has been working in coke industry for 16 years. Dust concentration at his workplace is 5-10 times more than maximum permissible concentration. Roentgenography of lungs revealed changes that are typical for pneumoconiosis. What is the most probable type of pneumoconiosis in this case?
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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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Examination of placenta revealed a defect. An obstetrician performed manual investigation of uterine cavity, uterine massage. Prophylaxis of endometritis in the postpartum period should involve following actions:
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A 40-year-old woman has a selfdetected hard breast mass. The procedure of choice for confirming the diagnosis is:
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A 27-year-old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Helicobacter Pylori. Diagnosis is:
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Which of the methods of examination is the most informative in the diagnostics of a tube infertility?
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A 14-year-old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Hb - 70 g/l, RBC-2,3 × 1012/l, Ht - 20. What is the most probable diagnosis?
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A 39-year-old patient suffering from hypertension suddenly gotb intense headache in the region of occiput; there appeared recurrent vomiting. These presentations has been lasting for 5 hours. Objectively: Ps - 88 bpm, Ap -205/100 mm Hg, painfulness of occipital points, rigidity of occipital muscles are present. Kernig's symptom is bilaterally positive. Subarachnoid hemorrhage is also suspected. What diagnostic method will be of the greatest importance for confirmation of provisional diagnosis?
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Study of morbidity rate in a city N revealed that population of different administrative districts differed in age structure. What statistic method allows to eliminate influence of this factor upon morbidity indices?
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A patient complains about evaginati-ons in the region of anus that appear during defecation and need to be replaced. Examination with anoscope revealed 1x1 cm large evaginations of mucosa above the pectineal line. What is the most probable diagnosis?
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A 9-year-old boy had acute respiratory viral infection. After it there appeared polydipsia, polyuria, weakness, nausea. Examination revealed the following symptoms: mental confusion, dry skin, soft eyeballs, Kussmaul's respiration, acetone smell from the mouth, muffled heart sounds, soft and painless abdomen. Blood sugar was 19 millimole/l. What acute condition is it?
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What is the maximum duration of medical certificate in case of tuberculosis?
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Prophylactic photoroentgenography examination of a 25-year-old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?
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A 38-year-old man worked at roofing and drain pipes production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has diagnosed asbestosis. What method is the most important for this diagnosis?
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A 46-year-old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed an oblong area of hyperemia, skin edema and painful cord. What complication is it?
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Immediately after delivery a woman had hemorrhage, blood loss exceeded postpartum hemorrhage rate and was progressing. There were no symptoms of placenta detachment. What tactics should be chosen?
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An outbreak of food poisoning was recorded in an urban settlement. The illness was diagnosed as botulism on the grounds of clinical presentations. What foodstuffs should be chosen for analysis in the first place in order to confirm the diagnosis?
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A 34-year-old patient was delivered to the hospital because of follicular tonsillitis charactirized by high temperature. The patient has been abusing alcohol for 12 years. In the evening on the day of hospitalization he became anxious, couldn't stay in bed, left his ward several times and applied to the staff on duty with different complaints. He reported about seeing alot of spiders and flies in his ward as well as abou hearing threats from the corridor. He was exasperated by the fact that other patients didn't hear them. He lost also spatial orientation. What psychopathological syndrome is it?
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A patient consulted a venereologist about painful urination, reddening of the external opening of urethra, profuse purulent discharges from the urethra. He considers himself to be ill for 3 days. He also associates the disease with a casual sexual contact that took place for about a week ago. If provisional diagnosis "acute gonorrheal urethritis"will be confirmed, then bacteriological study of urethral discharges will reveal:
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The student has the following devices: Geiger counter, Ebert counter, Krotov's apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?
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A woman 26 years old has abused alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal syndrome. Drinks almost every day approximately 50-100 g of wine. She is in her 4-th week of pregnancy. Primary prevention of fetal alcohol syndrome requires:
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A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?
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A 58-year-old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
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A 33-year-old patient was delivered to the infectious diseases department on the 7-th day of disease. He complained about great weakness, high temperature, pain in the lumbar area and leg muscles, icteritiousness, dark colour of urine, headache. The acute disease started with chill, body temperature rise up to 40°C, headache, pain in the lumbar area and sural muscles. Icterus turned up on the 4th day, nasal and scleral hemorrhages came on the 5th day. Fever has lasted for 6 days. Diuresis - 200 ml. What is the most probable diagnosis?
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A 72-year-old female patient has been treated for urolithiasis in the urological department. After atropine injection she got acute pain in her left eye and abrupt vision impairment. Objectively: visual acuity of the left eye is 0,01, the eye is dense but painful on palpation, cornea is opaque, there is cyanotic induration of eyeball vessels. What is the most probable diagnosis?
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On the third day of life an infant's skin got icteric colouring. The child was born with body weight of 3,200 kg, body length of 52 cm. The child is active. There is puerile respiration above the lungs. Respiratory rate is 36/min, heart sounds are rhythmic, heart rate is 130/min. Abdomen is soft, liver comes out from the edge of costal arch by 2 cm, spleen is not palpable. Feces are in form of meconium. What is the most probable diagnosis?
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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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