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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 has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining about unmotivated bad mood, problems with attention concentration; she forgets to close the entrance door, cannot recall events of the past day. Computer tomography shows areas of postinfarction changes in the cortical postfrontal areas. What is the most probable diagnosis?
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A 59-year-old female patient attended a maternity welfare clinic with complains of bloody discharge from the genital tracts. Postmenopause is 12 years. Vaginal examination revealed that external genital organs had signs of age involution, uterus cervix was not erosive, small amount of bloody discharge came from the cervical canal. Uterus is of normal size, uterine appendages are unpalpable. Fornices were deep and painless. What method should be applied for the diagnosis specification?
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A 24-year-old patient complains of general weakness, dizziness, body temperature rise up to 37,5°C, sore throat, neck edema, enlargement of submaxillary lymph nodes. Objectively: mucous membrane of oropharynx is edematic and cyanotic, tonsils are enlarged and covered with films that spread beyond the tonsils and cannot be easily removed. What is the leading mechanism of this illness development?
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Against the background of angina a patient has developed pain in tubular bones. Examination revealed generalized enlargement of lymph nodes, hepatolienal 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 25-year-old man complains of pain in the lower third of his left thigh, which occurs both with and without physical exertion. Possibility of trauma is denied by the patient. Objectively: skin colour is normal; pastosity and pain can be detected with deep palpation; knee joint mobility is reduced. X-ray of distal femoral metaphysis shows an area of destruction and spicule. Blood test: immature cells, no signs of inflammation. The most likely diagnosis is:
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A 41-year-old patient with Addison's disease had influenza. After that he developed adynamia, depression, nausea, vomiting, diarrhea and hypoglycemia. BP is 75/50 mm Hg. Blood test: decreased content of corticosterone, hydrocortisone, 13-oxycorticosteroids, 17-oxycorticosteroids. What condition has developed in the patient?
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A 25-year-old patient is not married and has sexual relations with several partners. During the last 3 months he noticed small amount of mucoserous secretions produced from urethra. Subjectively: periodical itching or burning pain in urethra. Two months ago pain in knee join developed. Possibility of trauma or exposure to cold is denied by the patient. During the last week eye discomfort is noted - lacrimation and itching. What provisional diagnosis can be suggested?
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A 2-year-old child has been suffering since birth from recurring inflammatory diseases of lungs, purulent pansinusites, hearing deterioration, multiple cylindrical bronchiectases. Dextrocardia is observed. On biopsy: ultrastructural change of ciliated epithelium. What is the basis of the given syndrome?
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Clinic of a research institute for occupational diseases examined a worker who works at a concentration plant and diagnosed him with chronic dust bronchitis. The case is investigated by a commission including the representatives of the plant, medical unit, territorial sanitation center, department of Social Insurance Fund, trade union. According to the "regulation on investigation of...", the commission should be headed by the representative of the following authority:
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A 41-year-old patient, a hunter, complains of heaviness in the right subcostal area. No other complaints recorded. Anamnesis states causeless urticaria and skin itching that occurred 1 year ago. Objectively: liver margin is rounded, painless, and can be palpated 3 cm below the costal arch. No other pathology was detected during physical examination of the patient. Body temperature is normal. X-ray reveals a hemispherical protrusion in the right cupula of the diaphragm. What disease can be suspected in the given case?
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A 40-year-old woman with a history of combined mitral valve disease with predominant stenosis complains of dyspnea, asthma attacks at night, heart problems. At present, she is unable to do even easy housework. What is the optimal tactics of the patient treatment?
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For a long time to eradicate weeds on agricultural lands herbicides retaining in environment have been used. Point out the most probable way of herbicides reaching human organism from soil:
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A 37-year-old woman complains of sharp pains in her external genitalia, edema of the vulvar lips, pain when walking. Objectively: body temperature is 38,7°C, heart rate is 98/min. Inside the right vulvar lip there is a dense, painful, tumor-like growth 5,0х4,5 cm in size; skin and mucosa of the external genitalia are hyperemic, copious foul-smelling discharge is observed. The most likely diagnosis is:
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After a contact with chemicals a plant worker has suddenly developed stridor, voice hoarseness, barking cough, progressing dyspnea. Objective examination reveals acrocyanosis. What is your provisional diagnosis?
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A 19-year-old patient complains of severe pain in axillary crease. Condition onset was a week ago after her swimming in cold river and epilation. The next day painful "boil" appeared that was becoming larger every day and became a plum-sized tumor. Upon examination nodular conical growths joined together are detected, the skin covering them is bluish-red in colour. Some nodules have fistulous openings producing thick purulent mass. Body temperature is 38,5°C, general malaise. The most likely diagnosis is:
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A newborn infant (the first labor, lasted for 26 hours) is 1-day-old, postmature; body weight is 3850 g; body length is 52 cm. Delivery was performed by applying obstetrical forceps in sincipital presentation, Apgar score is 1/3. The face is bluish-pale. The head is thrown back; severe birth trauma is present; the infant is excitable, shrill "cerebral scream" is present; the eyes are half-open; facial expression is attentive; hyperesthesia, hypersthenia and readiness for convulsions are present. Liquor has high content of erythrocytes, lymphocytic cytosis occurs. The most likely diagnosis is:
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4 days after a patient received a gunshot wound of the middle third of the thigh soft tissues his condition suddenly began deteriorating. There are complaints of bursting pain in the wound; pain increases during the last 12 hours. Edema of skin and hypodermic tissue quickly grows. Body temperature is 38,2°C, heart rate is 102/min. The wound edges gape, are dull in color; the muscles, viable as of day before, now protrude into the wound, look boiled, are dull in colour, have dirty-grey coating and fall apart when being held with forceps. What infection has developed in the wound?
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A 14-year-old girl has been presenting with irritability and tearfulness for about a year. A year ago she was also found to have diffuse enlargement of the thyroid gland (II grade). This condition was regarded as a pubertal manifestation, the girl did not undergo any treatment. The girl's irritability gradually gave place to a complete apathy. The girl got puffy face, soft tissues pastosity, bradycardia, constipations. Skin pallor and gland density progressed, the skin got a waxen hue. What disease can be suspected?
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A 30-year-old woman with a long history of chronic pyelonephritis complains of considerable weakness, sleepiness, decrease in diuresis down to 100 ml per day. BP is 200/120 mm Hg. In blood: creatinine - 0,62 millimole/l, hypoproteinemia, albumines - 32 g/l, potassium - 6,8 millimole/l, hypochromic anemia, increased ESR. What is the first step in the patient treatment tactics?
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A 52-year-old patient complains of pain in the right part of her chest, dyspnea, cough with a lot of albuminoid sputum emitting foul smell of "meat slops". Objectively: the patient's condition is grave, cyanosis is observed, breathing rate is 31/min, percussion sound above the right lung is shortened, auscultation revealed various moist rales (crackles). What is the most probable diagnosis?
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In a rural health care area there is a case of child dying during the first month of his life. To analyze this situation, among other measures, an expert assessment of medical records is performed. What medical document should be considered first?
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A 58-year-old patient complains of general weakness, weight loss up to 10 kg within the last 1,5 months, progressive pain in the small of the back, raise of blood pressure to 220/160 mm Hg, subfebrile body temperature. Objectively: tuberous slightly movable lump can be palpated in the right subcostal area; veins of spermatic cord and scrotum are dilated. Blood test: Hb - 86 g/l, ESR - 44 mm/h. Urine test results: specific gravity - 1020, protein - 0,99 g/l, RBCs - cover the whole field of vision, WBCs - 4-6 in the field of vision. What is the provisional diagnosis?
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A patient complains of weight gain, chill, edemas, xeroderma, somnolence, difficulties with focusing. Objectively: height is 165 cm; weight is 90 kg; body proportions are of female type, to- 35,8°C, heart rate - 58/min, BP -105/60 mm Hg. Heart sounds are weakened, bradycardia is observed. Other internal organs have no changes. Thyroid gland cannot be palpated. Milk secretion from mammary glands is observed. Hormone investigation revealed increased levels of thyroid-stimulating hormone (TSH) and prolactin, and decreased level of thyroxine (T4). Which one is the cause for obesity?
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A 74-year-old patient visited a urologist with complaints of pain above the pubis and inability to urinate for 8 hours. At home he had taken antispasmodics and had a warm bath but no improvement occurred. Objectively: abdomen is soft and painful above the pubis; dullness of percussion sound is observed above the pubis. Murphy's (Pasternatski's) punch sign is negative on the both sides. What condition does the patient have?
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Bacterial analysis of air in a living space in winter period by means of Krotov's apparatus revealed that total number of microorganisms in 1m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as "pure"?
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A 26-year-old woman, who delivered a child 7 months ago, has been suffering from nausea, morning vomiting, sleepiness for the last 2 weeks. She breastfeeds the child, menstruation is absent. She has not applied any contraceptives. What method should be applied in order to specify her diagnosis?
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A 43-year-old patient had right-sided deep vein thrombosis of iliofemoral segment 3 years ago. Now he is suffering from the sense of heaviness, edema of the lower right extremity. Objectively: moderate edema of shin, brown induration of skin in the lower third of shin, varix dilatation of superficial shin veins are present. What is the most probable diagnosis?
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A 15-year-old patient suffers from headache, nasal hemorrhages, sense of lower extremity coldness. Objectively: muscles of shoulder girdle are developed, lower extremities are hypotrophied. Pulsation on the pedal and femoral arteries is sharply dampened. BP is 150/90 mm Hg, 90/60 in the legs. Systolic murmur can be auscultated above carotid arteries. What is the most probable diagnosis?
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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 the following actions:
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A 58-year-old patient complains of headache in the occipital region, nausea, choking, opplotentes. The presentations appeared after a physical exertion. Objectively: the patient is excited. Face is hyperemic. Skin is pale. Heart sounds are regular, the 2nd aortic sound is accentuated. BP - 240/120 mm Hg, heart rate - 92/min. Auscultation reveals some fine moist rales (crackles) in the lower parts of the lungs. Liver is not enlarged. ECG shows signs of hypertrophy and left ventricular overload. What is the most likely diagnosis?
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A 54-year-old patient complains of weakness, jaundice, itching skin. Disease onset was 1,5 months ago: fever up to 39°C appeared at first, with progressive jaundice developed 2 weeks later. On hospitalization jaundice was severely progressed. Liver cannot be palpated. Gallbladder is enlarged and painless. Blood bilirubin is 190 micromole/l (accounting for direct bilirubin). Stool is acholic. What is the most likely jaundice genesis in this patient?
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A 37-year-old patient has been undergoing treatment of diskogenic lumbosacral radiculitis for a month. There is skin numbness observed at the lateral surface of the right lower extremity, Achilles jerk is absent. MRI of lumbar spine revealed intervertebral disk L5-S prolapse up to 8 mm. Choose the further tactics for patient treatment:
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Maximum permissible concentration of carbon dioxide in the air is considered to be a sanitary index of air purity in a classroom. What concentration of carbon dioxide in the air is accepted as a permissible maximum?
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Over a current year among workers of an institution 10% have not been ill a single time, 30% have been ill once, 15% - twice, 5% - 4 times, the rest - 5 and more times. What is the percentage of workers belonging to the I health group?
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A 28-year-old woman has bursting pain in the lower abdomen during menstruation; chocolate-like discharges from vagina are observed. It is known from the anamnesis that the patient suffers from chronic adnexitis. Bimanual examination revealed a tumour-like formation of heterogenous consistency 7х7 cm large to the left from the uterus. The formation is restrictedly movable, painful when moved. What is the most probable diagnosis?
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A patient with frostbite of both feet was delivered to an admission ward. What actions should be taken?
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A 15-year-old boy has developed pain in the area of his left knee joint. Objectively: thigh soft tissues in the painful area are infiltrated, joint function is reduced. X-ray: there is a focus of destruction in the left distal femoral metaphysis, with periosteum detachment and formation of Codman triangle in the bone cortical layer at the margin of the defect. Chest X-ray reveals numerous microfocal metastases. What pathology is the most likely to cause such presentation?
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A 37-year-old patient complains of pain in the lumbar spine, which increases during walking, limited mobility, edema of the right side of abdomen. Focal tuberculosis is recorded in the anamnesis. X-ray shows destruction of adjacent surfaces of the bodies of the 12 lumbar vertebrae, vertebral bodies height is decreased, intervertebral fissure cannot be detected. Abdominal US reveals a growth 15x20 cm in size in the retroperitoneal space and echo signs of liquid. What diagnosis can be suspected?
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A 22-year-old patient complains of 8-months-long delay of menstruation. Anamnesis: menarche since the age of 12,5. Since the age of 18 menstruations are irregular. No pregnancies. Mammary glands have normal development; when the nipples are pressed, milk drops are discharged. On gynecological examination: moderate uterus hypoplasia. On hormonal examination: prolactin level exceeds the norm two times. On computed tomogram of the sellar region: a space-occupying lesion 4 mm in diameter is detected. The most likely diagnosis is:
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A 40-year-old patient complains of constant moderate pain in the lumbar spine and significantly reduced mobility. The patient has been suffering from this condition for the last 7 years since pain appeared first in the sacrum area. X-ray: ankylosis of sacroiliac articulation, significant narrowing of intervertebral joint fissures of lumbar vertebrae and calcification of spinal ligaments. What pathology is most likely to cause such X-ray image?
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