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KROK 2 Medicine 2015 Questions | KROKEXAM
Browse 2015 KROK 2 Medicine exam questions with answers and explanations.
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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 due to disturbance of blood clotting. Choose the most suitable investigation:
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A 9-year-old boy has been suffering from bronchoectasis since he was 3. Exacerbations occur quite often, 3-4 times a year. Conservative therapy results in short periods of remission. The disease is progressing, the child has physical retardation. The child's skin is pale, acrocyanotic, he has "watch glass" nail deformation. Bronchography revealed saccular bronchiectases of the lower lobe of his right lung. What is the further treatment tactics?
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A 32-year-old woman complains of dizziness, headache, palpitation, tremor. For the last several months she has been under outpatient monitoring for increased arterial pressure. Recently such attacks have become more frequent and severe. Objectively: skin is covered with clammy sweat, tremor of the extremities is present. Heart rate - 110/min, BP - 220/140 mm Hg. Heart sounds are weakened. In blood: 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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After lifting a load, a 36-year-old male patient has experienced a severe pain in the lumbar region, which spread to the right leg and was getting worse when he moved his foot or coughed. Objectively: the long back muscles on the right are strained. Achilles jerk is reduced on the right. There is a pronounced tenderness of paravertebral points in the lumbar region. The straight leg raise (Lasegue's sign) is positive on the right. What additional tests should be performed in the first place?
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A 26-year-old woman has attended maternity center complaining of her inability to become pregnant despite 3 years of regular sex life. Examination revealed the following: increased body weight; male-type pubic hair; excessive poliosis of thighs; ovaries are dense and enlarged; basal body temperature is monophasic. The most likely diagnosis is:
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A 54-year-old patient has been suffering from diabetes mellitus for 5 years, with diet being his only treatment. Within the last half a year he lost 7 kg of body weight, complains of thirst, vertigo when raising from bed, decrease of erectile function, frequent stool, especially at night. Objectively: malnutrition, dry skin. BP in lying position is 160/90 mm Hg; BP in standing position is 170/85 mm Hg. No edemas. Fasting plasma glucose level is 12 mmol/l. Glycated hemoglobin accounts for 11%. Albumin excreted with urine is 20 mg per day. The most likely diagnosis is:
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A 5-year-old child has body temperature risen up to febrile numbers, suffers from inertness, weakness. Examination revealed hemorrhage on the skin of limbs and torso. Enlargement of cervical and axillary lymph nodes can be detected. The liver is 4 cm below the costal arch; the spleen is 6 cm below the costal arch. Blood test: erythrocytes -2,3 × 1012/l, Hb- 60 g/l, platelets - 40 × 109/l, leukocytes - 32,8 × 109/l, eosinophils - 1%, band neutrophils - 1%, segmented neutrophils - 12%, lymphocytes - 46%, monocytes - 1%, blasts - 40%, Duke’s bleeding time is 9 min. What examination is necessary to make the diagnosis?
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A 19-year-old patient complains of dyspnea during physical exertion. He often has bronchitis and pneumonia. Cardiac murmur has been observed since his childhood. On auscultation: there is splitting of II heart sound over pulmonary arteria, systolic murmur in the third intercostal space near the left sternum margin. ECG test shows right bundle-branch block. What is the provisional diagnosis?
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A 24-year-old primipara was hospitalized with complaints of discharge of the amniotic waters. The uterus is tonic on palpation. The position of the fetus is longitudinal, it is pressed with the head to pelvic outlet. Palpitation of the fetus is rhythmical, 140 bpm, auscultated on the left below the navel. Internal examination: cervix of the uterus is 2,5 cm long, dense, the external opening is closed, light amniotic waters are discharged. Point out the correct component of the diagnosis:
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A 29-year-old female patient complains of dyspnea, heaviness and chest pain on the right, body temperature rise up to 37,2°C. The disease is associated with a chest trauma received 4 days ago. Objectively: skin is pale and moist. Heart rate is 90 bpm, regular. Palpation reveals a dull sound on the right, auscultation reveals significantly weakened vesicular breathing. In blood: RBCs - 2,8 × 1012/l, colour index - 0,9, Hb-100 g/l, WBCs - 8,0 × 109/l, ESR -17 mm/h. What results of diagnostic puncture of the pleural cavity can be expected?
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A 45-year-old patient complains of pain in the epigastric region, left subcostal area, abdominal distension, diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively: tongue is moist with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region and Мауо-Robson's point. Liver is painless and protrudes 1 cm from the costal arch. Spleen cannot be palpated. What disease can be primarily suspected?
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A patient is active, lively, fussy. He resists 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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A workshop resident doctor makes a list of workers, who are often ill, for special supervision. He takes into account the number of etiologically connected cases resulting in temporary disability that occurred in the span of a year for each worker. How many such cases should a worker have to be included in this group?
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A young woman suffering from seborrhea oleosa has numerous light-brown and white spots on the skin of her torso and shoulders. The spots have clear margins, branny desquamation, no itching. What provisional diagnosis can be made?
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A child from primi pregnancy was born in a term labor and has body weight of 4000 g and body length of 57 cm. When born, he was nonresponsive to examination. Diagnosis is diffuse. Heart rate is 80/min. What resuscitation measures should be prescribed?
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A 30-year-old patient was in a car accident. He is unconscious, pale, has thready pulse. In the middle third of the right thigh there is an extensive laceration with ongoing profuse external arterial bleeding. What urgent actions must be taken to save the life of the patient?
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A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax; it is indicated to perform drainage of pleural cavity. Pleural puncture should be made:
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A 54-year-old man had been drowning at sea, when he was found and evacuated to the shore. Objectively: unconscious, pale face, no breathing can be auscultated, thready pulse. Resuscitation measures allowed to save the man. What complication can develop in him in the nearest future?
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A 58-year-old woman complains of spontaneous bruises, weakness, bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Heart rate - 100/min, BP- 110/70 mm Hg. There are no changes of internal organs. Blood test results: RBC - 3,01012/l, Hb - 92 g/l, colour index - 0,9, anisocytosis, poikilocytosis, WBC 10 × 109/l, eosinophils - 2%, stab neutrophils - 12%, segmented neutrophils - 68%, lymphocytes - 11%, monocytes - 7%, ESR - 12 mm/hour. What index should be determined additionally by a laboratory to make a diagnosis?
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A 4-year-old boy was vaccinated in violation of his vaccination schedule. There are complaints of pain in the throat during swallowing, headache, inertness, fever. Objectively: the child is pale; anterior cervical lymph nodes are enlarged; tonsils are swollen, with cyanotic hyperemy, and covered with grey-white coating that cannot be removed; if it is forcibly removed, tonsils bleed. The most likely diagnosis is:
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A 28-year-old woman complains of increased intermenstrual periods up to 2 months, hirsutism. Gynaecological examination revealed that the ovaries were enlarged, painless, compact, uterus had no pecularities. Pelvic ultrasound revealed that the ovaries were 4-5 cm in diameter and had multiple enlarged follicles on periphery. X-ray of skull base showed that sellar region was dilated. What is the most probable diagnosis?
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10 days after birth an infant developed a sudden fever up to 38,1°C. Objectively: the skin of navel, abdomen and chest is erythematous; there are multiple pea-sized blisters with no infiltration at the base; single bright red moist erosions with epidermal fragments on the periphery. What is your provisional diagnosis?
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A 20-year-old patient was delivered to a surgical unit complaining of an incised wound on his right forearm that has been bleeding for 1,5 days. Suffers from general weakness, vertigo, cold sweat, opplotentes. Skin and visible mucous membranes are pale. Heart rate is 110/min, BP is 100/70 mm Hg. Blood test: Hb is 100 g/l, erythrocytes 2,5 × 1012/l. What is the cause for the paient's general condition?
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A 75-year-old male patient complains of slight pain in the right iliac region. The abdominal pain arose 6 days ago and was accompanied by nausea. Surgical examination revealed moist tongue, heart rate - 76 bpm. BP -130/80 mm Hg. Abdomen is soft, slightly painful in the right iliac region on deep palpation, the symptoms of the peritoneum irritation are doubtful. In blood: RBCs - 4,0 × 1012/l, Hb-135 g/l, WBCs - 9,5 × 109/l, stab neutrophils - 5%, segmentonuclear - 52%, lymphocytes -38%, monocytes - 5%, ESR - 20 mm/h. Specify the doctors further tactics:
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A primagravida with pregnancy of 37-38 weeks complains of headache, nausea, pain in epigastrium. Objectively: the skin is acyanotic. Face is hydropic, there is short fibrillar twitching of blepharons, muscles of the face and the inferior extremities. The stare is fixed. BP - 200/110 mm Hg; sphygmus is of 92 bpm, intense. Respiration rate is 32/min. Heart activity is rhythmical. Appreciable edemas of the inferior extremities are present. Urine is cloudy. What medication should be administered?
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A 7-year-old child complains of cramping pain occuring after mental exertion, cold drinks and eating ice-cream. Instrumental examination allowed to diagnose biliary dyskinesia of hypertensive type. What group of drugs should be prescribed for treatment?
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After examination a 46-year-old patient was diagnosed with left breast cancer T2N2M0, clinical group II-a. What will be the treatment plan for this patient?
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A 26-year-old male patient complains of piercing pain during breathing, cough, dyspnea. Objectively: to- 37,3°C, respiration rate is 19/min, heart rate is 92/min; BP is 120/80 mm Hg. Vesicular respiration is observed. In the inferolateral parts of chest auscultation in both inspiration and expiration phase revealed noise that was getting stronger at phonendoscope pressing and could be still heard after cough. ECG showed no pathological changes. What is the most likely diagnosis?
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A woman consulted a therapeutist about fatigability, significant weight loss, weakness, loss of appetite. She has been having 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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In a traffic accident two persons died. An appointed forensic medical expert was called on duty to another accident location; therefore, according to the criminal law in force in Ukraine, an investigator called in the following specialist for examination of the location and bodies:
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A 20-year-old parturient woman has the I labor stage. The pregnancy is full-term. Labors occur every 3 minutes and last for 55 seconds. Fetus presentation is polar, the head is pressed to the small pelvis entrance. Heart rate of the fetus is 150/min, distinct and rhythmic. Vagina examination: uterus cervix is smoothed out; mouth of the womb is 2 cm open; fetal bladder is intact; the head is presented over the I plane of small pelvis; moderate mucous-bloody discharge is observed. What phase of the I labor stage is it?
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On the 10th day postpartum a puerperant woman complains of pain and heaviness in the left mammary gland. Body temperature is 38,8°C, Ps- 94 bpm. The left mammary gland is edematic, the supero-external quadrant of skin is hyperemic. Fluctuation symptom is absent. The nipples discharge drops of milk when pressed. What is a doctor's further tactics?
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A patient with high temperature came to a first-aid post in the evening. The fact of temporary disability was established. Indicate the measure to be taken in this case:
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Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0,1 mg/l. What preventive measures should be taken?
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In river-side urban community there was an outbreak of hepatitis type A possibly spread by water. What indexes of river water quality can confirm this theory?
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A child is 3-week-old. Since his birth periodical vomiting is observed occuring several minutes after feeding. Vomit mass does not exceed previous feeding volume. Body mass is appropriate to the child's age. What is the most likely cause for the symptoms described?
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The correlation between service record and eosinophils concentration in blood was studied in workers at dyeing shops of textile factories. What index will be the most informative for the analysis of this data?
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A 35-year-old female patient has gained 20 kg weight within a year with the normal diet. She complains of chill, sleepiness, dyspnea. The patient's mother and sister are corpulent. Objectively: height - 160 cm, weight - 92 kg, BMI - 35,9. Obesity is uniform, there are no striae. The face is amimic. The skin is dry. The tongue is thickened. Heart sounds are muffled. Heart rate - 56/min, BP - 140/100 mm Hg. The patient has constipations, amenorrhea for 5 months. TSH - 28 mkME/l (normal rate - 0,32-5). Craniogram shows no pathology. What is the etiology of obesity?
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A 23-year-old woman after stress has developed thirst, polydipsia, polyuria, weight loss, increasing fatigue. Later she developed nausea and somnolence, lost consciousness and was hospitalized. Glycemia is 27 mmol/l, acetone in urine is sharply positive. Treatment for ketoacidotic coma was initiated. When would it be advisable to start preventive treatment of hypoglycemia by introduction of 5% glucose solution?
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An 8-year-old child was hospitalized for fever up to 39,8°C, inertness, moderate headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was performed. The obtained fluid had raised opening pressure, it was transparent, with the cell count of 450 cells per 1 mcL (mainly lymphocytes - 90%), glucose level of 2,6 mmol/l. What causative agent might have caused the disease in the child?
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