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KROK 2 Medicine 2010 Questions | KROKEXAM
Browse 2010 KROK 2 Medicine exam questions with answers and explanations.
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A 40-year-old patient complains of colic pains in the lower abdomen and profuse bloody discharges from the genital tracts. Over the last 2 years she has been having menses for 15-16 days, profuse, with clots, painful. In anamnesis there are 2 medical abortions. On bimanual investigation: in the canal of the uterine cervix some fibromatous nodes are palpable, they are 3 cm in diameter, on the thin crus. Discharges are bloody, moderate. Choose the correct treatment tactics:
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A young patient who came to a poli- clinic was diagnosed with the 1 stage of hypertension. How often should he undergo the medical check-up?
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A 22-year-old girl has been complaining of having itching rash on her face for 2 days. She associates this disease with application of cosmetic face cream. Objectively: apparent reddening and edema of skin in the region of cheeks, chin and forehead; fine papulovesicular rash. What is the most likely diagnosis?
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On the 4th day after suturing the perforative stomach ulcer a patient with pulmonary emphysema developed spontaneous pneumothorax. What is the best place for pleural drainage?
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After supercooling a 38-year-old woman developed muscle pain, body temperature rise up to 39°C, headache, dysuria, positive Pasternatsky's symptome. In the urine: leukocyturia, bacteriuria. In blood: Decrease in Hb rate down to 103 g/l, left shift leukocytosis, ESR acceleration up to 32 mm/h. Blood urea - 6,0 millimole/l. What is the most likely diagnosis?
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A 27-year-old military servant was delivered to the regimental aid post 1,5 hour after getting an abdominal injury with an aerial bomb splinter. Objectively: the patient is in grave condition, pale, Ps-132/min, AP- 80/60 mm Hg. Subcostal area has a bandage on from the first-aid pack, the bandage is soaked with blood. The abdomen is tense. Percussion revealed dullness in flat parts that changes its location with the change of body position. There are symptoms of peritoneal irritation. What department of the regimental aid post should provide medical care?
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1 day ago a 19-year-old male patient got a trauma after a fall from 1,5 m height when he "bestrode" a wooden beam. Urination is extremely difficult, there is macrohematuria, urethrorrhagia. There is a hematoma in the perineum and on the scrotum. Urethrography revealed flowing of contrast medium into the membranous part of urethra. What is the treatment tactics of choice?
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A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely etiological factor in this case?
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13 months after the first labor a 24-year-old patient complained of amenorrhea. Pregnancy ended in Caesarian section because of premature detachment of normally positioned placenta which resulted in blood loss at the rate of 2000 ml owing to disturbance of blood clotting. Choose the most suitable investigation:
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A 45-year-old male patient was admitted to the intensive care unit because of myocardial infarction. An hour later the ventricular facilitation occurred. Which of the following should be administered?
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Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8 scores. During the delivery there was a short-term difficulty with extraction of shoulder girdle. After birth the child had the proximal extremity dysfunction and the arm couldn't be raised from the side. The shoulder was turned inwards, the elbow was flexed, there was also forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?
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A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints, painfulness and stiffness in the lumbar spine for a year. ESR - 56 mm/h. Roentgenography revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What is the most likely diagnosis?
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A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. He pain arises mainly after taking fattening food. Over the last week the attacks occurred daily and became more painful. On the 3rd day of hospitalization the patient presented with icteritiousness of skin and scleras, light-colored feces and dark urine. In blood: neutrophilic leukocytosis -13,1 × 109/l, ESR - 28 mm/h. What is the most likely diagnosis?
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A sergeant got injured with a shell splinter in the left subcostal region. He was bandaged by his fellow soldiers with an individual field dressing. Afterwards he was delivered to the regimental medical station. The patient complains of dizziness, weakness, thirst, abdominal pain. His general condition is grave, he is pale, Ps-120 bpm. The abdomen is painful, soft on palpation. The dressing is well-fixed but slightly soaked with blood. The victim should be evacuated to the collecting battalion with the following type of transport and in the following turn:
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A 40-year-old patient underwent an operation for a lumbar phlegmon. Body temparature rose again up to 38°C, he got intoxication symptoms, there was an increase of leukocyte number in blood. The wound that was nearly free from necrotic tissues and full of granulations started to discharge pus, the granulations turned pale. What complication dveloped in this patient?
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A department chief of an in-patient hospital is going to inspect resident doctors as to observation of medical-technological standards of patient service. What documentation should be checked for this purpose?
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A 20-year-old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First medical aid involved application of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?
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A 47-year-old obese man complained of periodic attacks of acute arthritis in the st left tarsophalangeal joint. Lab exam revealed increased serum rate of uric acid. What is the diagnosis?
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Examination of a 9-month-old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
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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 30-year-old gravida consulted a gynecologist about bright red bloody discharges from the vagina in the 32 week of gestation. She was hospitalized with suspicion of placental presentation. Under what conditions is it rational to conduct the internal examination for the diagnosis specification?
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On the 5th day after labor body temperature of a 24-year-old 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 likely diagnosis?
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A 40-year-old female patient has a history of rheumatism. She complains about acute pain in her left eye, especially at night, vision impairment, photophobia, lacrimation. The patient cannot suggest any reasons for the disease. Objectively: weak pericorneal injection, flattening of iris relief, iris discoloration. What is the most likely diagnosis?
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Workers of a laboratory producing measuring devices (manometers, thermometers etc) complain about a mettalic taste in mouth, stomatitis, dyspepsia, sleep disturbance, unsteady walk, abrupt decrease in cardiac activity. These presentations must have been caused by the intoxication with the following substance:
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Head of a department and a trade-union group have appealed to the head of a hospital about dismissal of the senior nurse who has 17 year record of service. The facts of charge were confirmed and recognized by the nurse herself. This nurse lives with a daughter (who is divorced and unemployed) and a 9-month-old grandson. Make an administrative decision:
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A 40-year-old woman who has worked in weaving branch for 10 years complains of frequent headache, sleeplessness, irritability, fatigue, tiredness. Physical examination revealed instability of blood pressure, internal organs are without changes. What is the most likely diagnosis?
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A 27-year-old patient with a history of ronchial asthma was stung by a bee. He had a sensation of chest compression, breath shortage, difficult expiration, sense of heat in the upper half of body, dizziness, apparent itch, convulsions. Objectively: noisy wheezing breath, AP - 90/60 mm Hg, Ps- 110 bpm. Auscultation revealed weak rhythmic heart sounds, rough respiration above lungs, sibilant rales. What drug group should be administered in the first place?
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A 50-year-old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?
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A 72-year-old male patient complains about itch in his left shin, especially around a trophic ulcer. Skin is reddened and edematic, there are some oozing lesions, single yellowish crusts. The focus of affection is well-defined. What is the most likely diagnosis?
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An 11-yearold girl was taken by an acute disease: she got pain in the lumbar region, nausea, vomiting, frequent urination, body temperature 39°C. Objectively: the abdomen is soft, painful on palpation in the lumbar region. Common urine analysis revealed considerable leukocyturia, bacteriuria. The urine contained colibacilli. What is the most likely diagnosis?
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Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he felt acute pulsating pain at the end of the nail bone which was getting worse at pressing. Nail fold became hyperemic, body temperature rose up to 37,5°C, there was a change in nail plate colour. What is the most likely diagnosis?
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A full-term infant has respiratory rate of 26/min, heart rate of 90/min, blue skin, muscle hypotonia. During catheter suction of mucus and amniotic fluid from the nose and mouth the child reacted with a grimace. Low reflexes. Auscultation revealed weakened vesicular respiration above lungs. Heart sounds are loud. After 5 minutes the respiration became rhythmic, at the rate of 38/min, heart rate of 120/min. What is the most likely diagnosis?
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25 unorganized children in the age 2-3 year will be observed on a pediatric district it in the current year. What scheduled number of initial visitations will make to this group of children?
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A 45-year-old driver was admitted to the hospital with 5 hour substernal pain. Nitroglycerin is not effective. He is pale, heart sounds are regular but weak. HR -96 per minute, BP of 100/60 mm Hg. What is the most likely diagnosis?
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A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most likely diagnosis?
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A child was taken to a hospital with focal changes in the skin folds. The child was anxious during examination, examination revealed dry skin with solitary papulous elements and ill-defined lichenification zones. Skin eruption was accompanied by strong itch. The child usually feels better in summer, his condition is getting worse in winter. The child has been artificially fed since he was 2 months old. He has a history of exudative diathesis. Grandmother by his mother's side has bronchial asthma. What is the most likely diagnosis?
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A 30-year-old patient presented with body temperature rise up to 38,5°C, pain in the small articulations of hands; face edemata and erythema. In blood: RBCs -2,6 × 1012/l; Hb- 98 r/n; WBCs - 2 × 109/l; ESR - 58 mm/h. In the urine: protein - 3,1 g/l; RBCs -10-15 in the vision field. What disease can be suspected in this case?
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A patient is active, lively, fussy. He opposes the examination. His speech is fast and loud, his statements are spontaneous and inconsequent. Specify the psychopathological state of this patient:
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Statistic of patients of common medical practice displays constant increase in elderly and old people number. What kind of pathology is expected to prevail in the morbidity structure of population in question?
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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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