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KROK 2 Medicine 2015 Questions | KROKEXAM
Browse 2015 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 10-year-old boy complains of pain in his left eye and strong photophobia after he has injured his left eye with a pencil at school. Left eye examination revealed: 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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A 46-year-old patient once took part in elimination of breakdown at an atomic power plant. Currently he is being treated at an inpatient hospital unit. He was diagnosed with progressing somatoform autonomic dysfunction. This disease relates to the following group of ionizing radiation effects:
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A 25-year-old patient was delivered to an infectious diseases unit on the 3rd day of illness with complaints of headache, pain in lumbar spine and gastrocnemius muscles, high fever, chill. Objectively: condition of moderate severity. Scleras are icteric. Pharynx is hyperemic. Tongue is dry with dry brown coating. Abdomen is distended. Liver is enlarged by 2 cm. Spleen is not enlarged. Palpation of muscles, especially gastrocnemius muscles, is painful. Urine is dark in color. Feces are normal in color. What is the most likely diagnosis?
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A 30-year-old parturient woman was delivered to a maternity hospital with full-term pregnancy. She complains of severe lancinating pain in the uterus that started 1 hour ago, nausea, vomiting, cold sweat. Anamnesis states cesarean section 2 years ago. Uterine contractions stopped. Skin and mucous membranes are pale. Heart rate is 100/min., BP is 90/60 mm Hg. Uterus has no clear margins, is sharply painful. No heartbeat can be auscultated in the fetus. Moderate bloody discharge from the uterus can be observed. Uterus cervix is 4 cm open. Presenting part is not visible. The most likely diagnosis is:
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A 39-year-old woman suffering from schizophrenia constantly strains to hear something insisting that "there is a phone connection in her brain and she hears her brother's voice demanding that she come back home". The patient is anxious, suspicious, constantly looking around. Specify the psychopathologic syndrome.
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A 45-year-old patient has been suffering from essential hypertension for 10 years. After hot bath he suddenly developed sharp headache and recurrent vomiting. Objectively: pronounced meningeal symptoms; BP is 180/110 mm Hg. He was hospitalized in a neurology unit. What additional tests should be primarily prescribed?
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A 53-year-old woman complains of weight loss up to 10 kg within the last 2 years, liquid foul-smelling stool two times a day that poorly washes off the toilet, periodic bouts of nausea, girdle pain in the upper abdomen. Objectively: pain in Gubergrits zone (on the right from navel) and Mayo-Robson’s point. Biochemical blood analysis: glucose - 3,2 mmol/l, bilirubin -16,5 micromole/l, crude protein - 56,4 g/l. Urine diastase - 426 g/h/l. D-xylose test (oral administration of 25 g of d-xylose) after 5 hours reveals 3 g of xylose in urine. The most likely diagnosis is:
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A 25-year-old patient during selfexamination detected a tumor in the upper external quadrant of the right mammary gland. On palpation: painless, dense, mobile growth 2 cm in diameter is detected in the mammary gland; no changes in the peripheral lymph nodes are observed. On mammary glands US: in the upper external quadrant of the right mammary gland there is a space-occupying lesion of increased echogenicity 21x18 mm in size. The most likely diagnosis is:
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An infant was born with body mass 3 kg and body length 50 cm. Now he is 3 years old. His brother is 7 years old, suffers from rheumatic fever. Mother asked a doctor for a cardiac check up of the 3-year-old son. Where is the left relative heart border located?
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A patient complains of fatigue, lack of appetite, pain and burning sensation in the tongue, numbness of the distal limbs, diarrhea. Objectively: pale skin with lemon-yellow tint, face puffiness, brown pigmentation in the form of a "butterfly", bright red areas on the tongue. The liver is +3 cm below the costal margin, soft. Blood count: RBCs -1,5 × 1012/l, colour index -1,2, WBCs - 3,8 × 109/l, thrombocytes - 180 × 109/l, eosinophils - 0%, stab neutrophils - 1%, segmented neutrophils - 58%, lymphocytes - 38% monocytes - 3%, RBC macrocytosis. ESR - 28 mm/h. What diagnosis are these presentations typical for?
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A patient suffering from acute posttraumatic pain received an injection of morphine that brought him a significant relief. Which of the following mechanisms of action provided for antishock effect of morphine in this patient?
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A 26-year-old female patient has an 11-year history of rheumatism. Four years ago she suffered 2 rheumatic attacks. Over the last 6 months there have been paroxysms of atrial fibrillation every 2-3 months. What option of antiarrhythmic therapy or tactics should be proposed?
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A 3-month-old girl has rhinitis, dyspnea, dry cough. She has been sick for 2 days. Objectively: pale skin, acrocyanosis, hypopnoea; breathing rate is 80/min; over the whole pulmonary surface there is vesiculotympanitic (bandbox) resonance observed with numerous bubbling rales (crackles). The most likely diagnosis is:
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A 77-years-old patient complains of inability to urinate and bursting pain above his pubis. Acute onset of his condition occurred 12 hours ago. Objectively: overfilled urinary bladder can be palpated above the pubis. On rectal examination: prostate is enlarged, dense-elastic, with clear margins and no nodules. Interlobar sulcus is pronounced. US examination: prostate volume is 120 cm3, it protrudes into urinary bladder cavity, parenchyma is homogeneous. Prostate specific antigen is 5 ng/ml. What disease is the most likely to cause acute urinary retention?
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A 23-year-old patient after intake of brake fluid has developed anuria that has been lasting for 5 days already. Creatinine level increased up to 0,769 mmol/l. What treatment tactics should be chosen in the given case?
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A 20-year-old woman complains of feeling of air shortage, lingering dull pain in the heart area, irritability. Objectively: general condition is satisfactory, heart rate lability, BP is 130/60 mm Hg. ECG reveals disruption of repolarization proceses. The patient is diagnosed with somatoform autonomic dysfunction of cardial type. Specify the conditions of the patient treatment:
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A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby has a large cephalohematoma. The results of blood count are: Hb- 120 g/l, Er- 3,5 × 1012/l, total serum bilirubin - 123 mmol/l, direct bilirubin -11 mmol/l, indirect - 112 mmol/l. What are the causes of hyperbilirubinemia in this case?
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A 25-year-old female patient complains of marked weakness, sleepiness, blackouts, dizziness, taste disorder. The patient has a history of menorrhagia. Objectively: the patient has marked weakness, pale skin, cracks in the corners of her mouth, peeling nails, systolic apical murmur. Blood test results: RBC - 3,4 × 1012/l, Hb- 70 g/l, colour index - 0,75, platelets -140 × 109/l, WBC- 6,2 × 109/l. What is the most likely diagnosis?
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A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact with a person having URTI. Objectively: the child is in grave condition. Temperature of 38°C, cyanosis of nasolabial triangle is present. Respiration rate - 54/min, nasal flaring while breathing. There was percussion dullness on the right below the scapula angle, and tympanic sound over the rest of lungs. Auscultation revealed bilateral fine moist rales (crackles) predominating on the right. What is the most likely diagnosis?
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A 47-year-old female patient complains of cough with purulent sputum, pain in the lower left chest, periodical body temperature rise. She has been suffering from this condition for about 10 years. Objectively: "drumstick" distal phalanges. What examination would be the most informative for making a diagnosis?
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A 30-year-old patient was hospitalized in an intensive care unit with a diagnosis of multiple bee stings. Skin is pale and covered with cold sweat. Pulse can be palpated only at the carotid arteries and is 110/min; breating rate is 24/min, rhytmical, weakened. What drug must be administered immediately?
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A patient with uterine fibromyoma sized up to 8-9 weeks of pregnancy consulted a gynecologist about acute pain in the lower abdomen. Examination revealed pronounced positive symptoms of peritoneal irritation, high leukocytosis. Vaginal examination revealed that the uterus was enlarged up to 9 weeks of pregnancy due to the fibromatous nodes, one of which was mobile and extremely painful. Appendages were not palpable. Discharges were mucous, coming in moderate amounts. What is the treatment tactics?
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A 15-year-old teenager has undergone medical examination in military recruitment center. The following was revealed: interval systolic murmur at the cardiac apex, accent of the II heart sound over the pulmonary artery, tachycardia. What additional examination method will be the most informative for determining diagnosis?
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A 70-year-old patient consulted a doctor about arrhythmic cardiac activity, dyspnea. Objectively: BP - 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 has been hospitalized. The onset of the disease was gradual: nausea, vomiting, dark urine, аcholic stool, yellowness of the skin and scleras. The liver is enlarged by 3 cm. Jaundice developed 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 39-year-old patient complains of morning headache, appetite loss, nausea, morning vomiting, periodic nasal hemorrhages. The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin hemorrhages on his arms and legs, pallor of skin and mucous membranes. What biochemical parameter is the most important for making diagnosis in this case?
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A 50-year-old patient complains about having pain attacks in the right subcostal area for about a year. The pain arises mainly after taking fatty 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-coloured 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 patient is 60-year-old, retired, worked as deputy director of a research institute. Behavioural changes appeared 2 years ago after the death of her husband: she stopped looking after herself and leaving the house; then she stopped to clean the apartment and cook. Mental status: temporal disorientation. The patient does not understand many of the questions, is confused; does not know how to cook soup or fasten a button. Her speech is characterized by stumbling and logoclonia. She does not recognize doctors, fellow patients. She cries a lot but can not explain thereason for tears. What is the mechanism of thispathology?
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A 24-year-old patient complains of gaining body mass and increased appetite. Objectively: built of hypersthenic type, body mass index is 33,2 kg/m2, waist circumference is 100 cm. Waist to hips circumference ratio is 0,95. What is the provisional diagnosis?
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A 4-month-old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, vomiting occurred once. Objectively: the child's condition is grave. Abdomen is soft, palpation reveals a tumour-like formation in the right iliac area. After rectal examination the doctor's finger was stained with blood. What is the most probable diagnosis?
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A 64-year-old patient has been hospitalized with complaints of progressive jaundice that developed over 3 weeks ago without pain syndrome, general weakness, loss of appetite. Objectively: temperature is 36,8°C, heart rate is 78/min, abdomen is soft and painless, peritoneum irritation symptoms are not detected, palpation reveals sharply enlarged tense gallbladder. What disease can be characterized with these symptoms?
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A 45-year-old male patient complains of acute pain in his right side irradiating to the right thigh and crotch. The patient claims also to have frequent urination with urine which resembles a "meat slops" in color. The patient has no previous history of this condition. There is costovertebral angle tenderness on the right (positive Pasternatsky's symptom). What is the most likely diagnosis?
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An 18-year-old patient was admitted to a hospital with complaints of headache, weakness, high fever, 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 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 on bottle feeding since he was 2 months old. He has a history of exudative diathesis. His grandmother on his mother’s side has bronchial asthma. What is the most likely diagnosis?
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A 52-year-old woman complains of face distortion. It appeared 2 days ago after exposure to cold. Objectively: body temperature is 38,2°C. Face asymmetry is present. Frontal folds are flattened. Left eye is wider than the right one and cannot close. Left nasolabial fold is flattened, mouth corner is lowered. Examination revealed no other pathology. Blood count: leukocytes -10 × 109/l, ESR - 20 mm/h. What is the most probable diagnosis?
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An 8-year-old girl periodically has sudden short-term heart pain, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min, jugular pulse is present. Heart rate - 185 bpm, of poor volume. BP - 75/40 mm Hg. ECG taken during an attack shows ectopic P waves, QRS wave is not deformed. At the end of an attack a compensatory pause is observed. The most likely cause of the attack is:
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A parturient woman is 27-year-old, it was her second labour, delivery was at full-term, normal course. On the 3rd day of postpartum period body temperature is 36,8°C, heart rate - 72/min, BP -120/80 mm Hg. Mammary glands are moderately swollen, nipples are clean. Abdomen is soft and painless. Fundus of uterus is 3 fingers below the umbilicus. Lochia are bloody, moderate. What is the most probable diagnosis?
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A 68-year-old patient complains of pain, slight swelling and creaking in the distal joints of her fingers and knee joints. She has been suffering from this condition for 4 years. Objectively: thickening of knee and interphalangeal joints, restricted mobility of these joints. Blood test: leukocytes -5,4 × 109/l, ESR - 12 mm/h, fibrinogen - 3,5 g/l; Rheumatoid factor -1:32; anti-streptolysin O -160 units; seromucoid - 0,20 units.; CRP+. What mechanism of development is likely for this condition?
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A 22-year-old woman on a reduced diet, vegetarian, attended a hospital with complaints of distorted smell and taste perception and lesions in the angles of her mouth. Objectively: sclera is distinctly blue. Diagnosis: iron-deficiency anemia. What clinical syndrome is expressed primarily?
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A 38-year-old man 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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