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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 60-year-old woman, mother of 6 children, developed a sudden onset of upper abdominal pain radiating to the back, accompanied by nausea, vomiting, fever and chills. Subsequently, she noticed yellow discoloration of her sclera and skin. On physical examination the patient was found to be febrile with temperature of 38,9°C, along with right upper quadrant tenderness. The most likely diagnosis is:
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An electro-gas welding operator working at a machine workshop performs welding and cutting of metal, which is accompanied by intense UV-radiation. His welding station is equipped with effective mechanical ventilation. What occupational disease is most likely to develop in the electro-gas welding operator?
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A 28-year-old female patient with a six-year history of Raynaud's syndrome has recently developed pain in the small joints of hands, difficult movement of food down the esophagus. What disease can be suspected in this case?
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During examination a patient is unconscious, his skin is dry and hot, face hyperemia is present. The patient has Kussmaul's respiration, there is also smell of acetone in the air. Symptoms of peritoneum irritation are positive. Blood sugar is 33 millimole/l. What emergency actions should be taken?
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A 40-year-old patient suffers from influenza. On the 5th day of illness there are pain behind sternum, cough with sputum, inertness. Temperature is 39,5°C. Face is pale. Mucosa of conjunctivas and pharynx is hyperemic. Heart rate is 120/min, breathing rate is 38/min. In the lower lung segments shortening of percussion sound and moist rales (crackles) can be detected. What additional investigation should be performed first of all to specify the diagnosis?
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A 30-year-old male patient consulted a family doctor 2 months after he had been operated for an open fracture of brachial bone. Objectively: the patient's condition is satisfactory; in the area of the operative wound there is a fistula with some purulent discharge, redness, fluctuation. X-ray image shows brachial bone destruction with sequestra. What complication arose in the postoperative period?
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A 15-year-old patient complains of excessive body weight, headache, irritability, rapid fatigability. Significant increase of body weight occurred at the age of 14. Objectively: weight is 90 kg; height is 160 cm, proportional body built. Fatty tissue is distributed evenly. There are thin pink striae (stretch marks) on the thighs, abdomen and mammary glands. BP - 145/90 mm Hg. Provisional diagnosis is:
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A maternity patient breastfeeding for 1,5 weeks has attended a doctor. She considers the onset of her disease to be when proportional breast engorgement occurred. Mammary glands are painful. Body temperature is 36,6°C. Expression of breast milk is hindered. The most likely diagnosis is:
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What juice is recommended to be included in a complex drug and diet therapy for patients suffering from gastric or duodenal ulcer and high acidity of gastric juice to speed up ulcer healing?
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2 weeks after recovering from tonsillitis an 8-year-old boy developed edemas of face and lower limbs. Objectively: the patient is in grave condition, BP -120/80 mm Hg. Urine is of dark brown colour. Oliguria is present. On urine analysis: specific gravity - 1,015, protein - 1,2 g/l, RBCs are leached and cover the whole vision field, granular casts -1-2 in the vision field, salts are represented by urates (large quantity). What is the most likely diagnosis?
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An 8-year-old boy, who has been suffering from diabetes mellitus for 3 years, was delivered to a hospital in a condition of hyperglycemic coma. Primary dose of insulin should be prescribed basing on the following calculation:
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A patient complains of evaginations in the region of anus that appear during defecation and need resetting. Examination with anoscope revealed 1x1 cm large evaginations of mucosa above the pectineal line. What is the most probable diagnosis?
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A 45-year-old patient complains of body temperature rise up to 40°C, general weakness, headache, painfulness and spastic muscle contractions around the wound in the shin. He received this wound 5 days ago when working in his garden. He requested no medical care back then. What wound infection can be suspected?
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A 40-year-old female patient complains of having a bulge on the anterior surface of neck for 5 years. Objectively: Heart rate - 72 bpm, arterial pressure - 110/70 mm Hg, in the right lobe of thyroid gland palpation reveals a mobile 4x2 cm node, the left lobe is not palpable, the basal metabolic rate is 6%. What is the most likely diagnosis?
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A 6-year-old girl attended a general practitioner with her mother. The child complains of burning pain and itching in her external genitalia. The girl was taking antibiotics the day before due to her suffering from acute bronchitis. On examination: external genitalia are swollen, hyperemic, there is white deposit accumulated in the folds. The most likely diagnosis is:
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A 12-year-old girl complains of general weakness, rise of body temperature up to 38,2°C, pain and swelling of knee joints, feeling of cardiac rhythm disruption. The child had tonsillitis 3 weeks ago. The knee joints are swollen, local raise of temperature is observed, mobility is reduced. Heart sounds are weakened, extrasystole is present; at the cardiac apex systolic noise can be auscultated, which is not conducted to the left axillary region. ESR is 38mm/h. CRP2+. antistreptolysin-O titers are 400. The most likely disease is:
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A 40-year-old woman has been hospitalized for attacks of asphyxia, cough with phlegm. She has a 4-year history of the disease. The first attack of asphyxia occurred during her stay in the countryside. Further attacks occurred while cleaning the room. After 3 days of inpatient treatment the patient's condition has significantly improved. What is the most likely etiological factor?
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A 48-year-old patient has the following symptoms: diffuse enlargement of thyroid gland, exophthalmos, weight loss up to 4 kg within 2 months, excessive sweating. Objectively: heart rate 105/min, BP -180/70 mm Hg. Stool is normal. What therapy is advisable in the given case?
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A 43-year-old female patient complains of rash on the skin of her right leg, pain, weakness, body temperature rise up to 38°C. The disease is acute. Objectively: there is an edema on the skin of her right leg in the foot area, a well-defined bright red spot in the irregular shape of flame tips, which is hot to touch. There are isolated vesicles in the focus. What is your provisional diagnosis?
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During the newborn infant's examination redness of the skin was detected, which occurred immediately after birth and became the most pronounced on the second day of the infant's life. What provisional diagnosis can be made?
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A 60-year-old woman started feeling weakness, vertigo, rapid fatigability during the last year. Recently there have been dyspnea and paresthesia observed. Objectively: skin and mucous membranes are pale and icteric. Lingual papillae are smoothed out. Liver and spleen are situated at the edge of costal arch. Blood test: Hb- 70 g/l, erythrocytes -1,7 × 1012/l, blood color index -1,2, macrocytes. What drug can be prescribed on pathogenetic grounds?
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Estimation of community health level involved analysis of a report on diseases registered among the population of catchment area (reporting form 12). What index is calculated basing on this report?
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A 44-year-old man complains of dyspnea with sensation of lack of air on inhale, palpitations occurring during slight physical exertion, and shin edemas that appear in evening and resolve in morning. His condition has been lasting for 5 months already, deterioration is gradual. What method of instrumental diagnostics allows to verify decrease of systolic function in this patient?
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A 60-year-old man has a diet consisting of unvaried food staples: mostly cereals, potato, pasta; few vegetables and little fats (especially animal fats). During medical examination he complains of deterioration of his twilight vision. This condition can be caused by lack of:
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A 13-year-old girl complains of periodic prickly pain in the heart region. Percussion revealed no changes of cardiac borders. Auscultation revealed arrhythmic enhanced heart sounds, extrasystole at the 20-25 cardiac impulse. ECG showed the sinus rhythm, impaired repolarization, single supraventricular extrasystoles at rest. What is the most likely diagnosis?
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A patient is on sick leave for 4 months continuously from the date of injury. The treatment is going to last for another 1-2 months. Who is authorised to extend the duration of medical certificate for this patient?
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A 47-year-old patient came to see a doctor on the 7th day of disease. The disease is acute: after the chill body temperature rose to 40°C and lasted up to 7 hours, then dropped abruptly, which caused profuse sweat. There were three such attacks occurring once every other day. Two days ago the patient arrived from Africa. Objectively: pale skin, subicteric sclera, significantly enlarged liver and spleen. What is the cause of fever attacks in this disease?
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A baby was born by a young smoker. The labour was complicated by uterine inertia, difficult delivery of the baby's head and shoulders. The baby's Apgar score was 4. Which of the following is a risk factor for a spinal cord injury?
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A 34-year-old patient complains of profuse sweating at night, skin itching, weight loss (9 kg within the last 3 months). Examination revealed malnutrition, skin pallor. Palpation of neck and inguinal areas revealed dense elastic lymph nodes of about 1 cm in diameter, nonmobile, non-adhering to skin. What is the most probable diagnosis?
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A tractor driver with the record of service of 24 years has undergone palestesiometry test (Vibration Sensitivity Measurement). Test revealed increased vibration sensitivity threshold at the frequencies of 63-125-259 Hz to 25 dB. Dynamometry is 20 kg on the right and 16 kg on the left. Cold stimulus test is positive, time of hand temeperature restoration is 52 minutes. Blanching at pressure symptom is positive and equals 21. Hypesthesia of upper and lower limbs is observed and can be classified as "gloves" and "socks" polyneuritic pattern. Make the provisional diagnosis.
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When playing in a kindergarten a 3-year-old child sudenly developed dyspnea, paroxysmal compulsive dry cough. The face is cyanotic, the eyes are tearful. Vomiting occurred several times. Breathing is weakened over the whole right side of the chest. The provisional diagnosis is:
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A 45-year-old patient was hospitalized in surgical in-patient unit with intermuscular phlegmon of the right thigh on the 6th day from the onset of disease. Abscess formed under the fascia lata was diagnosed, lanced and widely drained, necrotic tissues were removed. Antibiotic therapy with cephalosporines and the III generation fluoroquinolones was prescribed, as well as immune corrective and detoxification infusion therapy (2,5 liters per day), diuresis stimulation, UV irradiation of blood and plasmapheresis. What is the main component of sepsis prevention?
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A 24-year-old patient visited a doctor complaining of enlargement of his submaxillary lymph nodes. Objectively: submaxillary, axillary and inguinal lymph nodes are enlarged. Chest X-ray shows: enlarged lymph nodes of mediastinum. Blood test: erythrocytes -3,4 × 1012/l, Hb- 100 g/l, blood colour index - 0,88, platelets - 190 × 109/l, leucocytes -7,5 × 109/l, eosinophils - 8%, band neutrophils - 2%, segmented neutrophils - 67%, lymphocytes - 23%, ESR - 22 mm/h. What test must be prescribed to verify the cause of lymphadenopathy?
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A 30-year-old woman complains of pain in the heart area ("aching, piercing pain") that arises primarily in the morning hours in autumn and spring. Pain irradiates into the neck, back, abdomen and is attended by rapid heart rate and low vital tonus. This condition occurs independently from physical exertion. In the evening her condition improves. Somatic and neurologic state and ECG have no pathologies. What pathology is likely to result in such clinical presentation?
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A 49-year-old patient 2 years ago was diagnosed with stage 1 silicosis. He complains of increased dyspnea and pain in the infrascapular regions. X-ray shows diffuse intensification and distortion of lung pattern with numerous nodular shadows 2-4 mm in diameter. Hardening of right interlobar pleura is detected. Lung roots are hardened and expanded. What X-ray type of pneumosclerosis does the patient have?
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In order to study impact of microclimate on the human organism it is necessary to make systematic observation of air temperature during the period of 3 days. Choose a device that will allow to make the most precise temperature records:
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A 57-year-old woman complains of having a sensation of esophageal compresion, palpitation, breathing difficulties when eating solid food, occasional vomiting with a full mouth, "wet pillow" sign at night for the last 6 months. Objectively: body tempearture - 39°C, height - 168 cm, weight - 72 kg, heart rate - 76/min, BP - 120/80 mm Hg. X-ray revealed considerable dilation of esophagus and its constriction in the cardial part. What pathology is most likely to have caused dysphagia in this patient?
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A patient's X-ray image (anteroposterior projection) shows deformation of lung pattern, pneumofibrosis, reticular (honeycomb) lung pattern of lower pulmonary segments, cylindric and fusiform lumps. The most likely diagnosis is:
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A patient with otopyosis is in sharply deteriorating condition: he developed headache, vomiting, febrile temperature, general hyperesthesia. Meningeal symptoms and stagnant optic disks are observed. There is no focal symptoms. Liquor is turbid, blood pressure is high, albuminocytological dissociation occurs with neutrophils. What disease can be suspected?
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An Rh-negative woman with 32-week-long term of pregnancy has been examined. It was observed that Rh-antibodies titer had increased four times within the last 2 weeks and was 1:64. First two pregnancies ended in antenatal death of fetus caused by hemolytic disease. What tactics of pregnancy management should be chosen?
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