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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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When examining the parameters of desk natural lighting in a school class it was determined that: light angle is 25°, window angle is 3°, window-to-floor area ratio is 1:4, daylight factor is 0,5%, and window-head-to-room-depth ratio is 2. What parameter does not correspond to hygienic norms?
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A 34-year-old patient after vacation in Crimea has developed severe pain in her elbow joints, dyspnea and weakness. Body temperature is 37,6°C, skin pallor and erythema on the cheeks and bridge of nose are observed, lip mucosa is ulcerated. The joints are not visibly deformed, movement of the right elbow joint is restricted. Pleura friction sound is detected in the lungs on the right side below the angle of scapula. Heart sounds are dull, tachycardia, gallop rhythm, heart rate -114/min, Bp - 100/60 mm Hg. The most likely diagnosis is:
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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, heart rate -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 in a clinical death condition is being resuscitated through mouth-to-mouth artificial pulmonary ventilation and external cardiac massage. A doctor noticed that air does not flow into the patient's airways and his head and torso are positioned at the same level. Why is artificial respiration not effective in the given case?
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A 74-year-old man complains of pain in the left foot and dark color of the 1st toe. He has been sick for 6 days. Objectively: heart rate is 84/min. Body temperature is 37,8°C. The left foot resembles "chicken claw" due to soft tissues decreasing in volume, skin is dark red. The 1st toe is black, small amount of dark substance is being discharged from under the nail. Pulse over the peripheral arteries of extremity is absent. The most likely diagnosis is:
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A 45-year-old patient (14-year-long work record as a house painter) upon the contact with synthetic paint develops skin reddening, edema, severe itching and oozing lesions on her face. Symptoms disappear after the contact with this chemical substance stops but even the smell of paint alone is enough to make them reappear each time. Each recurrence is characterized by increased severity of symptoms. What provisional diagnosis can be made?
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A 2-year-old child in a satisfactory condition periodically presents with moderate proteinuria, microhematuria. US results: the left kidney is undetectable, the right one is enlarged, there are signs of double pyelocaliceal system. What investigation is required to specify the diagnosis?
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A 7-year-old child became ill again 2 weeks after he had tonsillitis. There are the following complaints: temperature rise up to 38°C, hemorrhagic rash on the extremities, enlargement of the ankle joints. Blood test: hemoglobin is 120 g/l, platelets are 170 × 109/l, ESR is 30 mm/h. Urine test: proteinuria up to 0,7 g/l, cylinders - 5-6 in the field of vision, erythrocytes - 8-10 in the field of vision. What mechanism of hemorrhagic syndrome is present in the given case?
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A 29-year-old patient works as a motor mechanic. Anamnesis shows frequent exposure to cold, exacerbation of chronic bronchitis attended by cough with relatively small amount of mucopurulent sputum, subfebrility, sometimes joined by hemoptysis and pain in the right side of chest. Breathing is vesicular. X-ray shows darkening and sharp decrease in size of the lower lobe distinctly visible on the X-ray image as a streak 2-3 cm wide situated at the angle from lung root to the frontal costodiaphragmatic recess. The most likely diagnosis is:
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Several hours before, a 28-year-old patient suddenly developed acute headache and repeated vomiting, then lost consciousness. Objectively: focal neurological symptoms were not found. Pronounced meningeal symptoms were revealed. BP - 120/80 mm Hg. According to clinical and liquorological findings the patient was diagnosed with subarachnoid hemorrhage. After administration of dehydrants the patient's condition somewhat improved. What is the main component of further emergency care?
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A 65-year-old patient complains of pain in the lumbar spine, moderate disuria. He has been suffering from this condition for about half a year. Prostate volume is 45 cm3 (there are hypoechogenic nodes in both lobes, capsule invasion). Prostate-specific antigen is 60 ng/ml. Prostate biopsy revealed an adenocarcinoma. Which of the supplementary examination methods will allow to determine the stage of neoplastic process in this patient?
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Hygienic assessment of a sample taken from the batch of grain revealed 2% of grains infected with microscopic Fusarium fungi. On the grounds of laboratory analyzes this batch of grain should be:
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Head circumference of a 1-month-old boy with signs of excitement is 37 cm, prefontanel is 2x2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in its volume and composition. Muscle tone is within norm. What is the most likely diagnosis?
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In cold season a patient was delivered to a hospital. He was rescued from drowning in a body of water. There was no contact of his airways with water. The patient is anxious, pale, complains of pain and numbness of limbs, has cold shivering. Breathing rate is 22/min, BP is 120/90 mm Hg, heart rate is 110/min, rectal temperature is 34,5°C. What kind of warming should be prescribed to the patient?
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For the last 3 years a 12-year-old boy has been suffering from stomachache, abdominal distension, nausea, periodical liquid fatty stool, grey in color, with rotten smell. On palpation: pain in the epigastrium, Desjardins' pancreatic point and Chauffard's triangle; positive Mayo-Robson's sign. Insufficiency of pancreas exocrine function is suspected. What method is the most informative for pancreas exocrine function assessment?
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A 48-year-old patient was delivered to a hospital in-patient unit with uterine bleeding that occurred after the 2-week-long delay of menstruation. Anamnesis states single birth. Examination of the uterine cervix with mirrors revealed no pathologies. On bimanual examination: uterus is of normal size, painless, mobile; uterine appendages have no changes. Discharge is bloody and copious. What primary hemostatic measure should be taken in the given case?
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A 52-year-old patient, who has been suffering from angina pectoris for 2 weeks, has more and more frequent pain attacks in the area behind his sternum and his need for nitroglycerine increased. Objectively: the condition is of moderate severity. Skin is pale. Heart sounds are weakened, rhythmic. Heart rate is 84 per minute. ECG shows no signs of focal myocardial damage. What is the most likely diagnosis?
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A 42-year-old man has undergone gastric analysis. Free hydrochloric acid is absent at all phases. On endoscopy: pallor, gastric mucosa loss, gastric folds are smoothed out. On microscopy: glands atrophy with intestinal metaplasia. What disease can be characterized by such presentation?
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A 12-year-old cild has been hit on the stomach. The patient is in moderately grave condition, has a forced position in bed. The skin is pale, heart rate - 122/min. Stress on the left costal arch causes a slight pain. Weinert and Kulenkampff symptoms are positive. Macroscopically the urine is unchanged. What is the most likely diagnosis?
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Residents of an industrial community situated near a plant suffer from increased morbidity rate caused by nervous and endocrine system conditions and kidney diseases. Blood test: decrease of sulfhydric groups content in blood. The pathologies developed can be caused by environment being polluted by the following:
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A 49-year-old patient complains of difficulties when swallowing food, hoarse voice, weight loss. The patient has been suffering from these symptoms for the last 3 months. The symptoms are gradually progressing. Objectively: the patient is emaciated, supraclavicular lymph nodes are enlarged. Esophagoscopy revealed no pathologies of esophagus. What investigation would be the most advisable in the given case?
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Survey radiograph of a 52-year-old worker of an agglomeration plant (28 years of experience, the concentration of metal dust is 22-37 mg/m3) shows mildly pronounced interstitial fibrosis with diffused contrast well-defined small nodular shadows. The patient has no complaints. Pulmonary function is not compromised. What is the provisional diagnosis?
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A 34-year-old patient was delivered to a first-aid center with open fracture of the lower leg bones. Upon examination bleeding is stated: blood flows in pulsating bursts. What actions should be taken at this stage of medical aid?
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A 30-year-old woman complains of irregular copious painful menstruations, pain irradiates to the rectum. Anamnesis states 10-year-long infertility. On bimanual examination: uterus is of normal size; uterine appendages on the both sides are corded, with rectricted mobility, painful; there are dense nodular painful growths detected in the posterior fornix. A doctor suspects endometriosis. What method allows to verify this diagnosis?
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An 8-year-old boy during preventive examination was determined to have changes in his spine curvature in frontal plane: the right shoulder is lowered and flat, scapulae angles are of different height due to the right scapula being shifted down. Waist triangles are pronounced on the both sides; longitudinal muscles of the back form muscle cushion on the left. What type of posture is detected in the child?
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A 24-year-old woman, teacher by profession, 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 for an hour or more. The patient has a nearly 2-year history of this disease. Objectively: Heart rate - 76 bpm. BP - 110/70 mm Hg. Heart borders are normal, heart sounds are clear. The ECG shows respiratory arrhythmia. X-ray of the cervicothoracic spine shows no pathology. Lungs, abdomen are unremarkable. What changes in blood formula can be expected?
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Establishments participating in medical examinations include: medical and preventive treatment facility, hygiene and preventive treatment facility, sociomedical expert committees, Ministry of Defence medical committees, Ministry of Domestic Affairs medical committees, forensic medicine agency, etc. Specify what service deals with sociomedical assessment of temporary disability:
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Various population groups mortality has been studied for a long time; territorial distribution of population and resulting changes in mortality trends are considered. What statistical method can be applied?
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A 36-year-old male patient complains of having headache, obstructed nasal breathing, purulent nasal discharge for 2 weeks. A month before, he had his right maxillary premolar filled. X-ray revealed an intense opacity of the right maxillary sinus. Diagnostic puncture revealed a large amount of thick malodorous crumbly pus. What is the most likely diagnosis?
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A week before, a 65-year-old male patient suffered an acute myocardial infarction. His general condition has deteriorated: he complains of dyspnea at rest, pronounced weakness. Objectively: edema of the lower extremities, ascites is present. Heart borders are extended, paradoxical pulse is 2 cm displaced from the apex beat to the left. What is the most likely diagnosis?
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A 26-year-old patient with affective bipolar disorder has developed a condition manifested by mood improvement, behavioural and sexual hyperactivity, verbosity, active body language, reduced need for sleep. Which of the following drugs are most effective in this case?
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A 14-year-old girl complains of tooth caries; the tooth should be filled. Anamnesis states that artificial mitral valve was installed 2 years ago due to mitral insifficiency. What antibacterial drug should be prescribed to prevent infective endocarditis?
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A patient with cardiac infarction is on sick leave with his medical certificate being continuously extended for 4 months according to a standard procedure. The disease is progressing. The issue is put forward to refer the patient to the industrial injury assessment board. Who among the medical staff of medical and preventive treatment facility is authorized to do this?
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Chief physician of a polyclinic tasked a district doctor with determining 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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An unconscious 35-year-old patient has been delivered by an ambulance to the intensive care unit. Objectively: the patient is in semicoma. Moderate mydriasis is present. The reaction of pupils to light is reduced. The patient is non-responsive to verbal instructions. BP is 150/100 mm Hg, tachycardia is present. Blood contains methanol. What antidote should be administered?
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A 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?
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During a surgical operation necessitated by the patient's suffering from autoimmune thyroiditis with concomitant multinodular goiter the right lobe was removed and subtotal resection of the left lobe was performed. What should be prescribed to the patient for postoperative hypothyroidism prevention?
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A 60-year-old patient complains of nearly permanent sensation of heaviness and fullness in the epigastrium, that increases after eating, foul-smelling eructation, occasional vomiting with food consumed 1-2 days ago, weight loss. 12 years ago he was first found to have an ulcer of pyloric channel. The patient has taken ranitidine for periodic hunger pain. The patient's condition has been deteriorating over the last 3 months. Objectively: splashing sound in the epigastrium is present. What kind of complication is it?
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An emergency doctor has diagnosed a 32-year-old woman with generalized convulsive status epilepticus. The deterioration in the patient's condition is caused by a sudden gap in the epilepsy treatment. Specify the doctor's further tactics:
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A 30-year-old woman complains of infertility during her 10-year-long married life. Menstruations occur since she was 14 and are irregular, with delays up to a month and longer. Body mass is excessive. Hirsutism is observed. On bimanual examination: uterine body is decreased in size; ovaries are increased in size, dense, painless, and mobile. The most likely diagnosis is:
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