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KROK 2 Medicine 2013 Questions | KROKEXAM
Browse 2013 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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Medical examination of a 19-year-old worker revealed generalized lymphadenopathy mainly affecting the posterior cervical, axillary and ulnar lymph nodes. There are multiple injection marks on the elbow bend skin. The man denies taking drugs, the presence of injection marks ascribes to influenza treatment. Blood count: RBCs- 3,2 × 1012/l, Hb- 100 g/l, WBCs- 3,1 × 109/l, moderate lymphopenia. What study is required in the first place?
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A 24-year-old female teacher complains of dizziness and heart pain irradiating to the left nipple. Pain is not associated with physical activity and cannot be relieved by nitroglycerin, it abates after taking Valocordin and lasts an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Ps- 76 bpm. AP- 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. Radiograph of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
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Examination of a 13-year-old girl revealed acute glomerulonephritis, nephritic syndrome at the initial stage without renal dysfunction. What is the main drug of choice for the basic therapy of this patient?
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A 49-year-old patient complains of dyspnea, cough. There are no sputum discharges. He has repeatedly used salbutamol and intal but with no effect. Objectively: he is only able to sit while leaning on the table. Cyanosis of face, acrocyanosis are present. Breathing is shallow, laboured, in some parts it cannot be auscultated; there are diffuse rales,expirationissignificantlyprolonged. Heart sounds are muffled, tachycardia is present. Ps - 112/min, AP- 110/70 mm Hg. Liverislocatednearthecostalarch.There are no peripheral edemata. What is your provisional diagnosis?
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A 57-year-old patient taken to the surgical department by ambulance has been provisionally diagnosed with acute intestinal obstruction. Acute pancreatitis is suspected. What is the most informative method of study to verify the diagnosis?
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On the first day after a surgery for diffuse toxic goiter a patient developed difficulty breathing, cold sweats, weakness. Objectively: pale skin, body temperature - 38,5°C, RR - 25/min, Ps- 110/min, AP-90/60 mm Hg. What early postoperative complication occurred in the patient?
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A 22-year-old vegetarian patient with signs of malnutrition consulted a doctor about smell and taste distortion, angular stomatitis. Objectively: expressively blue sclerae. The patient was diagnosed with iron deficiency anemia. What is the dominating clinical syndrome?
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2 weeks after labour a parturient woman developed breast pain being observed for 3 days. Examination revealed body temperature at the rate of 39°C, chills, weakness, hyperaemia, enlargement, pain and deformity of the mammary gland. On palpation the infiltrate was found to have an area of softening and fluctuation. What is the most likely diagnosis?
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A patient got flame burns of both hands. On the dorsal and palmar surface of hands the blisters are filled with serous fluid. The wrist joint region is hyperemic. The forearms were not injured. What is the provisional diagnosis?
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A 60-year-old male patient, who works as a construction worker, complains of pain in the right hip and knee joints, that is getting worse on exertion. These presentations have been observed for the last 5 years. Objectively: the patient is overnourished. Right knee joint is moderately deformed. Examination of other organs and systems revealed no pathology. Blood tet results: WBCs -8, 2 × 109/l, eSr -15 mm/h. Uric acid - 0,35 mmol/l. What is the most likely diagnosis?
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A 28-year-old patient consulted a surgeon about pain, edema and hyperemia of the left side of his face, weakness, fever up to 39°C. These manifestations has been present for three days. Objectively: there is an inflammatory infiltrate of the left nasolabial fold 4x4 cm large with a necrotic core in the center, the pronounced edema of the left side of face, moderate nuchal rigidity. What treatment is needed?
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Blood typing resulted in positive isohemagglutination reaction with standard sera of A(II) and B(III) groups and negative reaction with sera of 0(I) and AB(IV) groups. What is this result indicative of?
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After myocardial infarction, a 50-year-old patient had an attack of asthma. Objectively: bubbling breathing with frequency of 32/min, cough with a lot of pink frothy sputum, acrocyanosis, swelling of the neck veins. Ps- 108/min, AP- 150/100 mm Hg. Heart sounds are muffled. Mixed moist rales can be auscultated above the entire lung surface. What drug would be most effective in this situation?
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A 49-year-old patient consulted a doctor about difficult swallowing, voice hoarseness, weight loss. These symptoms have been gradually progressing for the last 3 months. Objectively: the patient is exhausted, there are enlarged supraclavicular lymph nodes. Esophagoscopy revealed no oesophageal pathology. Which of the following studies is most appropriate in this case?
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A 13-year-old girl was admitted to the gynecological department with heavy bleeding, which appeared after a long delay of menstruation. Shortly before, the girl suffered a serious psychotrauma. Her menarche occurred at the age of 11, she has a 30-day cycle with 5 to 6 days of moderate, painless bleeding. The patient is somatically healthy, of normosthenic constitution with height of 160 cm, weight of 42 kg. The patient is pale. Rectoabdominal examination revealed that the uterus was of normal size and consistency, anteflexio-versio, the appendages were not changed. What is the most likely diagnosis?
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A 22-day-old infant had developed red subcutaneous nodules from 1,0 to 1,5 cm large on the scalp. Later the nodules suppurated, body temperature rose up to 37,7°C, there appeared symptoms of intoxication, the regional lymph nodes grew bigger. Blood test results: anemia, leukocytosis, neutrophilia, accelerated ESR. What is the most likely diagnosis?
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During the periodic medical examination an assembly fitter (works on soldering details) didn't report any health problems. Closer examination revealed signs of asthenic-vegetative syndrome. Blood included red blood cells with basophilic aggregations and a somewhat higher number of reticulocytes, urine had a high concentration of delta-aminolevulinic acid. The complex of symptoms indicates the initial stage of chronic intoxication with:
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Chief physician of a polyclinic encharged a district doctor with a task to determine the pathological prevalence of disease N in his district. What document allows to estimate the disease prevalence in the population of a medical district?
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A 6-year-old child complains of frequent liquid stool and vomiting. On the 2nd day of desease the child presented with inertness, temperature rise up to 38,2°C, Ps- 150 bpm, scaphoid abdomen, palpatory painful sigmoid colon, defecation 10 times a day with liquid, scarce stool with mucus and streaks of green. What is a provisional diagnosis?
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A patient complains of jerking, throbbing pain in the III finger on the right hand. The patient associates these pain onsets with an injury by a nail. The finger skin is hyperemic and tense, palpation with a bulbous-end probe reveals the most painful area. What is the provisional diagnosis?
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A baby born after fast labour has palsy of hand muscles. Grasp reflex is absent, as well as hand-to-mouth reflex. Hand sensitivity is absent. What is the most likely diagnosis?
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A 45-year-old female patient complaining of general weakness, nausea and vomiting hass been delivered to a hospital by the ambulance. Recently there has been a lack of appetite, weight loss. Objectively: hyperpigmentation of skin, blood pressure at the rate of 70/45 mm Hg, bradycardia. Additional studies revealed the reduced concentration of aldosterone and cortisol in blood, decreased excretion of 17-ketosteroids and 17-oxyketosteroids in the urine, hyponatremia, chloropenia, hypokalemia. What therapeutic measures are required?
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It is planned to build a multidisciplinary hospital with 500 beds in a town. Specify the location of a polyclinic within the medical centre:
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A 70-year-old patient consulted a doctor about arrhythmic cardiac activity, dyspnea. Objectively: AP- 150/90 mm Hg, extrasystole arrhythmia (10-12 beats per minute), left ventricular systolic dysfunction (ejection fraction at the rate of 42%). Which of antiarrhythmic drugs should be administered as initial therapy in this case?
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A patient complains about sudden onsets of paroxysmal pain in the right lumbar region. 2 hours after the onset the patient had hematuria. Plain radiograph of the lumbar region shows no pathological shadows. USI reveals pyelocaliectasis on the right, the left kidney is normal. What is the most likely diagnosis?
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A 32-year-old female complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient observation for the increased arterial pressure. Since recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. HR- 110/min, AP- 220/140 mm Hg. Heart sounds are muffled. Blood test results: WBCs - 9,8 × 109/l, ESR - 22 mm/h. Blood glucose - 9,8 millimole/l. What disease is the most likely cause of this crisis?
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A 48-year-old patient complains of having dull pain in the right lumbar region for over three years. USI shows that kidneys are of normal size, at the upper pole of the right kidney there is a fluid-containing formation up to 12 cm in di- ameter. Excretory urograms show normal condition on the left, and the deformation of the superior renal calyces with satisfactory function on the right. What kind of disease can you think of?
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Sanitary examination of the burns unit for adults revealed that 4-bed wards had an area of 28 m2. What is the minimally required ward area for this department?
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Against the background of angina a patient has developed pain in tubular bones. Examination revealed generalized enlargement of lymph nodes, hepatoli-enal syndrome, sternalgia. In blood: RBCs - 3,6 × 1012/l, Hb- 87 g/l, thrombocytes - 45 × 109/l, WBCs - 13 × 109/l, blasts -87%, stab neutrophils - 1%, segmented neutrophils - 7%, lymphocytes - 5%, ESR - 55 mm/h. What is the most likely diagnosis?
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A 23-year-old female patient has a mental disease since the age of 18, the course of disease has no remission periods. At a hospital the patient mostly presents with non-purposeful foolish exci- tation: she makes stereotypic grimaces, exposed, masturbating in front of a loud laugh, repeating the stereotypical abusive shouts. The patient should be assigned:
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A 48-year-old patient complains of weakness, subfebrile temperature, aching pain in the kidney region. These presentations turned up three months ago after hypothermia. Objectively: kidneys are painful on palpation, there is bilaterally positive Pasternatsky's symptom. Urine test res: acid reaction, pronounced leukocyturia, microhematuria, minor proteinuria - 0,165-0,33 g/l. After the urine sample had been inoculated on conventional media, bacteriuria were not found. What research is most required in this case?
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A 38-year-old male works within the range of ionizing radiation. At a routine medical examination he presents no problems. In blood: RBCs - 4,5- 1012/l, Hb-80 g/l, WBCs - 2,8 × 109/l, thrombocytes -30 × 109/l. Decide if this person can work with sources of ionizing radiation:
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Examination of a group of persons living on the same territory revealed the following common symptoms: dark-yellow pigmentation of the tooth enamel, diffuse osteoporosis of bone apparatus, ossification of ligaments and joints, functional disorders of the central nervous system. This condition may be caused by the excessive concentration of the following microelement in food or drinking water:
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A 55-year-old male has a 1,5-year history of viral cirrhosis with symptoms of portal hypertension. Over the last month the weakness has progrssed, there appeared coffee ground vomit. Fi-brogastroduodenoscopy revealed vari-ceal esophageal hemorrhage. What drug should be used to reduce the pressure in the portal vein?
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While staying in a stuffy room a 19-year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are cold. AP- 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological signs. What is the most likely diagnosis?
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A patient presented to a hospital with a carbuncle of the upper lip. The body temperature is 39°C. There is a pronounced edema of the upper lip and eyelids. What is the surgeon's tactics of choice?
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In order to reduce weed growth on agricultural land, some herbicides have been used for a long time. In terms of environmental stability these herbicides are rated as stable. Specify the most likely route of their entry into the human body:
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A young woman with seborrhea adi-posa has numerous non-itchy light brown and white spots with clear outlines and defurfuration on the torso and shoulder skin. What is the provisional diagnosis?
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A 22-year-old patient complains of amenorrhea for 8 months. Menarche occured at the age of 12,5. Since the age of 18 the patient has a history of irregular menstruation. The patient is nulligravi-da. The mammary glands are developed properly, nipples discharge drops of milk when pressed. Gynecological study results: prolactin level is 2 times higher than normal. CT reveals a bulky formation with a diameter of 4 mm in the region of sella. What is the most likely diagnosis?
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A puerpera breastfeeding for 1,5 weeks consulted a doctor about uniform breast engorgement. Breasts are painful. The body temperature is of 36,6°C. Milk expressing is difficult. What is the most likely diagnosis?
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