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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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A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:
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A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, acholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient's condition?
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A 28-year-old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP- 200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal investigation revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
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A 14-year-old child suffers from vegetovascular dystonia of pubertal period. He has got sympathoadrenal atack. What medicine should be used for attack reduction?
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A 13-year-old patient is suffering from an acute disease with the following symptoms: thirst, polyuria, weakness. Objectively: his general condition is satisfactory, there is no smell of acetone. Glucose concentration in blood on an empty stomach is 32 micromole/l, in urine - 6%, acetone +. What treatment should be administered?
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On the 5th day after labor body temperature of a parturient suddenly rose up to 38,7°C. She complains about weakness, headache, abdominal pain, irritability. Objectively: AP- 120/70 mm Hg, Ps- 92 bpm, to- 38,7°C. Bimanual examination revealed that the uterus was enlarged up to 12 weeks of pregnancy, it was dense, slightly painful on palpation. Cervical canal lets in 2 transverse fingers, discharges are moderate, turbid, with foul smell. In blood: skeocytosis, lymphopenia, ESR - 30 mm/h. What is the most probable diagnosis?
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A 25-year-old woman applied to a maternity welfare clinic and complained about being unable to conceive within 3 years of regular sexual life. Examination revealed weight gain, male pattern of hair distribution on the pubis, excessive poliosis of thighs. Ovaries were dense and enlarged, basal temperature was monophase. What is the most probable diagnosis?
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Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated on the grounds of this report?
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A 10-year-old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?
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An 18-year-old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In blood: leukocytosis, atypical lymphocytes - 15%. What is the most probable diagnosis?
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A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?
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A 52-year-old male patient complains about attacks of asphyxia, pain in his left side during respiration. These manifestations turned up all of a sudden. It is known from his anamnesis that he had been treated for thrombophlebitis of the right leg for the last month. In the admission ward the patient suddenly lost consciousness, there was a sudden attack of asphyxia and pain in his left side. Objectively: heart rate - 102/min, respiratory rate - 28/min, AP- 90/70 mm Hg. Auscultation revealed diastolic shock above the pulmonary artery, gallop rhythm, small bubbling rales above the lungs under the scapula on the right, pleural friction rub. What examination method will be the most informative for a diagnosis?
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Surgical department admitted a 37-year-old patient with a big crushed wound of his left thigh 4 hours after he got this trauma. What is the main provision for successful prevention of gaseous gangrene?
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A 19-year-old boy was admitted to a 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 specify the patient's blood group and rhesus compatibility?
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A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has had amenorrhea for 8 months. A year ago she born a full-term child. Haemorrhage during labour made up 2 l. She got blood and blood substitute transfusions. What is the most probable diagnosis?
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A 37-year-old male patient was admitted to the resuscitation department because of attacks of tonoclonic spasms repeating every half an hour. Between the attacks the patient remains unconscious. AP is 120/90 mm Hg, Ps- 100 bpm. A day before the patient was at wedding and consumed alcohol. 5 years ago he had a closed craniocerebral trauma and brain contusion that later caused single convulsive attacks accompanied by loss of consciousness, but the patient didn't undergo antiepileptic treatment. What drug should be injected for emergency aid?
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A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadi-owing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?
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A 4-year-old girl was playing with her toys and suddenly she got an attack of cough, dyspnea. Objectively: respiration rate - 45/min, heart rate - 130/min. Percussion revealed dullness of percutory sound on the right in the lower parts. Auscultation revealed diminished breath sounds with bronchial resonance on the right. X-ray pictue showed shadowing of the lower part of lungs on the right. Blood analysis revealed no signs of inflammation. The child was diagnosed with foreign body in the right bronchus. What complication caused such clinical presentations?
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A 25-year-old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1,0 × 1012/l, Hb- 37 g/l, colour index - 0,9, leukocytes - 1,2 × 109/l, thrombocytes -42 × 109/l. What diagnostic method will be the most effective?
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A 4 month old child fell seriously ill: body temperature rose up to 38,5°C, the child became inert and had a single vomiting. 10 hours later there appeared rash over the buttocks and lower limbs in form of petechiae, spots and papules. Some haemorrhagic elements have necrosis in the centre. What is the most probable disease?
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A 40-year-old patient was bitten by a stray dog for about an hour ago. The bite can be seen on the patient's left shin in form of a wound 4x2x0,5 cm large. What kind of aid would be recommended in this case?
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A 36-year-old man was delivered to the surgical department an hour after a road accident. His condition is getting worse: respiratory insufficiency is progressing, there are cardiac abnormalities. Clinical and roentgenological investigations revealed mediastinal displacement. What process has caused this complication?
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A 35-year-old female patient suffering from cholelithiasis has broken her diet, and this caused an acute pain attack in the right subcostal are. The pain eased off on the third day, but the patient got progressing jaundice. What non-invasive diagnostic method should be applied?
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A 43-year-old female patient was delivered to the hospital in grave condition. She suffers from Addison's disease. The patient had been regularly taking prednisolone but a week before she stopped taking this drug. Objectively: sopor, skin and visible mucous membranes are pigmented, skin and muscle turgor is lowered. Heart sounds are muffled, rapid. AP- 60/40 mm Hg, heart rate - 96/min. In blood: Na-120 millimole/l, K- 5,8 micromole/l. Development of this complication is primarily caused by the deficit of the following hormone:
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The most available and informative diagnostic method for closed trauma of the urinary bladder is:
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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 68-year-old female patient complains about temperature rise up to 38,3°C, haematuria. ESR - 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?
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A 13-year-old girl was admitted to the cardiological department because of pain in the muscles and joints. Examination of her face revealed an edematic erythema in form of butterfly in the region of nose bridge and cheeks. What is the most probable diagnosis?
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A patient has got acute macrofocal myocardial infarction complicated by cardiogenic shock. The latter is progresing under conditions of weak general peripheric resistance and lowered cardiac output. What antihypotensive drug should be injected to the patient in the first place?
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An 18-year-old primigravi-da in her 27-28 week of pregnancy underwent an operation on account of acute phlegmonous appendicitis. In the postoperative period it is necessary to take measures for prevention of the following pegnancy complication:
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A 68-year-old patient complains about acute pain in his right foot, toe edema and darkening of skin of the IV toe. He has been suffering from diabetes mellitus for 15 years, doesn't receive regular treatment. What complication of diabetes mellitus is it?
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A 67-year-old female patient complains about edemata of face and legs, pain in the lumbar area that is getting worse at moving; great weakness, sometimes nasal hemorrhages, rise of body temperature up to 38,4°C. Objectively: painfulness of vertebral column and ribs on palpation. Laboratorial study revealed daily proteinuria of 4,2 g, ESR - 52 mm/h. What changes of laboratory indices are to be expected?
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Female 45-year-old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:
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A 60-year-old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:
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A 48-year-old female patient complains about contact hemorrhage. Speculum examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is dense and can be easily injured. Bimanual examination revealed that forni-ces were shortened, uterine body was nonmobile. What is the most probable diagnosis?
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A 15-year-old girl suddenly got arthralgia, headache, nausea, vomiting; pain and muscle tension in the lumbar area; body temperature rose up to 38 -39°C. Pasternatsky's symptom was distinctly positive on the right. In the urine: bacteriuria, pyuria. What is the most probable diagnosis?
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A patient applied to the traumatology cenre and complained about a trauma of the lower third of the volar forearm surface caused by cut on a piece of galss. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the interior dorsal and palmar surface of hand as well as of the IV finger is reduced. What nerve is damaged?
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It is planned to make complete isolation boxes in the infectious department in order to prevent nosocomial airborne infections. The boxes consist of a tambour, a ward and a lock chamber. What structure should be also included in a complete isolation box?
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A plot of land with total area of 2,0 hectare was intended for building of a hospital. The maximal capacity of the hospital will be:
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A female patient consulted a doctor about gain in weight, chill, edemata, dry skin, sleepiness, problems with concentration. Objectively: the patient's height is 165 cm, weight is 90 kg, gynoid body proportions, to- 35,8°C, ESR - 58/min, AP- 105/60 mm Hg. Heart sounds are weakened, bradycardia is present. Other internal organs have no changes. Thyroid gland is not palpable. Mammary glands ooze milk droplets. Hormonal study revealed rise of TSH and prolactin concentration, reduction of T4. What factor caused obesity?
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