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KROK 2 Medicine 2016 Questions | KROKEXAM
Browse 2016 KROK 2 Medicine exam questions with answers and explanations.
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You are a doctor on duty. A patient after a successful resuscitation (drowning) was delivered to an admission room. BP is 90/60 mm Hg, heart rate is 120/min., respiration rate is 26/min. The patient is unconscious, pupils are moderately dilated, general clonic and tonic convulsions are observed. Make the diagnosis:
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A 32-year-old welder complains of weakness and fever. His illness initially presented as tonsillitis one month earlier. On examination: BT- 38,9°C, RR- 24/min., HR-100/min., BP- 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb- 70 g/l, RBC- 2,2 × 1012/l, WBC- 3,0 × 109/l with 32% of blasts, 1% of eosinophils, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR - 47 mm/hour. What is the cause of anemia?
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A regional cardiologist is tasked with the development of a plan for medioprophylactic measures aimed at decrease of cardiovascular mortality. What measures should be planned for secondary prevention?
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An 8-year-old boy developed a temperature of 37,5°C two days after his recovery from the case of URTI. He complains of suffocation, heart pain. Objectively: the skin is pale, tachycardia, the I heart sound is weakened, short systolyc murmur in the 4th intercostal area near the left edge of the breastbone. What heart disorder such clinical presentation is characteristic of?
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A woman complains of muscle weakness and general fatigue, dyspnea, vertigo, brittleness of her hair and nails, an urge to eat chalk. Anamnesis states uterine fibroid. Common blood analysis: erythrocytes - 2,8 T/l, Hb- 80 g/l, color index - 0,78, anisocytosis, polycythemia, serum iron - 10 mcmol/l. What diagnosis is most likely?
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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/hour. What test must be prescribed to verify the cause of lymphadenopathy?
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A 32-year-old patient complains of cardiac irregularities, dizziness, dyspnea at physical exertion. He has never suffered from such condition before. Objectively: Ps- 74/min., rhythmic. BP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most probable diagnosis?
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A 35-year-old patient's wound with suppurative focus was surgically cleaned. On the 8th day after the surgery the wound cleared from its purulo-necrotic content and granulations appeared. However, against the background of antibacterial therapy the body temperature keeps at 38,5-39,5°C. There are chills, excessive sweating, euphoria, heart rate is 120/min. What complication of local proinflammatory process can it be?
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A 60-year-old woman has been suffering from arterial hypertension for 15 years. After recurrent stroke she started complaining of 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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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, clinic, local SES, 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 37-year-old woman complains of headaches, nausea, vomiting, spasms. The onset of the disease occurred the day before due to her overexposure to cold. Objectively: fever up to 40°C; somnolence; rigid neck; Kernig's symptom is positive on the both sides; general hyperesthesia. Blood test: leucocytosis, increased ESR. Cerebrospinal fluid is turbid, yellow-tinted. What changes of the cerebrospinal fluid are most likely?
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A 48-year-old woman complains of pain in the thoracic spine, sensitivity disorder in the lower body, disrupted motor function of the lower limbs, body temperature rise up to 37,5°C. She has been suffering from this condition for 3 years. Treatment by various specialists was ineffective. X-ray reveals destruction of adjacent surfaces of the VIII and IX vertebral bodies. In the right paravertebral area at the level of lesion there is an additional soft tissue shadow. What diagnosis is most likely?
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A pregnant woman is 28 years old. Anamnesis: accelerated labor complicated by the II-degree cervical rupture. The following two pregnancies resulted in spontaneous abortions at the terms of 12 and 14 weeks. On mirror examination: the uterine cervix is scarred from previous ruptures at 9 and 3 hours, the cervical canal is gaping. On vaginal examination: the cervix is 2 cm long, the external orifice is open 1 cm wide, the internal orifice is half-open; the uterus is enlarged to the 12th week of pregnancy, soft, mobile, painless, the appendages are without changes. What diagnosis would you make?
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A 56-year-old patient complains of pain in the epigastrium after eating, eructation, loss of appetite, slight loss of weight, fatigability. The patient smokes; no excessive alcohol consumption. Objectively: pale mucosa, BP-110/70 mm Hg. The tongue is 'lacquered'. The abdomen is soft, sensitive in the epigastric area. Blood test: erythrocytes - 3,0 T/l, Hb- 110 g/l, color index - 1,1; macrocytosis; leukocytes - 5,5 g/l, ESR - 13 mm/hour. On fibrogastroduodenoscopy: atrophy of fundic mucosa. What pathogenesis does this disorder have?
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A 26-year-old secundipara at 40 weeks of gestation arrived at a maternity ward after the beginning of labor activity. The bursting of waters occurred 2 hours prior. The fetus was in a longitudinal lie with cephalic presentation. Abdominal circumference was 100 cm, fundal height - 42 cm. Contractions occurred every 4-5 minutes and lasted 25 seconds each. Internal obstetric examination revealed cervical effacement, opening by 4 cm. Fetal bladder was absent. Fetal head was pressed against the pelvic inlet. What complication arose in the childbirth?
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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 1 m3 of air was 7200. What is the allowed number of microorganisms for the air to be characterized as "pure"?
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A 24-year-old patient received a puncture injury below the Poupart's ligament accompanied by intense arterial bleeding. The best method to temporarily stop the bleeding in the patient would be:
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A 42-year-old woman has been hospitalized with complaints of intense pain attacks in the lumbar and right iliac areas, which irradiate to the vulvar lips, frequent urination, nausea. The pain onset was acute. Objectively: the abdomen is soft, moderately painful in the right subcostal area, costovertebral angle tenderness on the right. Common urine analysis: specific gravity - 1016, traces of protein, leukocytes - 6-8 in the vision field, erythrocytes - 12-16 in the vision field, fresh. What diagnosis can be made?
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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 shadows 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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A 62-year-old patient has been hospitalized with complaints of pain in the thorax on the right during breathing, dyspnea, dry cough. Ten days ago he slipped and fell hitting his right side. On examintaion: the patient lies on the left side. The right side of the thorax lags during breathing. On the right there are crepitation and pain in the III-IV ribs. Dullness of percussion sound and sharply diminished breath sounds can be observed. On X-ray: signs of exudate, fracture of the III-IV ribs. On pleurocentesis: blood is detected. Choose the further tactics:
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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. Ps- 90/min., 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/hour. What results of diagnostic puncture of the pleural cavity can be expected?
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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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Examination of a group of persons living on the same territory revealed the following common symptoms: dark-yellow pigmentation of the tooth enamel, diffuse osteoporosis of bone apparatus, ossification of ligaments and joints, functional disorders of the central nervous system. This condition may be caused by the excessive concentration of the following microelement in food or drinking water:
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In a pre-school educational establishment the menu consists of the following dishes: milk porridge from buckwheat, pasta with minced meat, cucumber salad, kissel (thin berry jelly), rye bread. What dish should be excluded from the menu?
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An infant has been born at the 41st week of gestation. The pregnancy was complicated with severe gestosis of the second semester. The weight of the baby is 2400 g, the height is 50 cm. Objectively: the skin is flabby, the layer of subcutaneous fat is thin, hypomyotonia, neonatal reflexes are weak. The internal organs are without pathologic changes. This newborn can be estimated as a:
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A patient suffering from infiltrative pulmonary tuberculosis was prescribed streptomycin, rifampicin, isoniazid, pyrazinamide, vitamin C. One month after the beginning of the treatment the patient started complaining of reduced hearing and tinnitus. What drug has such a side effect?
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A woman has developed sudden thoracic pain on the right with expectoration of pink sputum and body temperature rise up to 37,7°C on the 4th day after the surgery for cystoma of the right ovary. On lung examination: dullness of the lung sound on the lower right is observed. Isolated moist crackles can be auscultated in the same area. What complication is the most likely?
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A 58-year-old patient was delivered to an admission room with complaints of pain in the thorax on the left. On clinical examination: aside from tachycardia (102/min.) no other changes. On ECG: pathologic wave Q in I, aVL, QS in V1, V2, V3 leads and 'domed' ST elevation with negative T. What diagnosis is most likely?
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A 48-year-old woman has thermal burns of both hands. The epidermis of the palms and backs of her hands is exfoliating, and blisters filled with serous liquid are forming. The forearms are intact. What diagnosis is most likely?
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A 39-year-old patient complains of morning headache, appetite loss, nausea, morning vomiting, periodic nasal hemorrhages. The patient had a case of 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 most important for making diagnosis in this case?
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A 30-year-old patient, who has been suffering from headaches, suddenly developed extreme headache after lifting a heavy load, as if he had been hit over the head. Nausea, vomiting, and slight dizziness are observed. In a day he developed pronounced meningeal syndrome and body temperature up to 37,6°C. A doctor suspects subarachnoid hemorrhage. What additional examination is necessary to confirm this diagnosis?
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A worker of a blowing shop complains of headache, irritability, sight impairment - he sees everything as if through a "net" Objectively: hyperemic sclera, thickened cornea, decreased opacity of pupils, visual acuity is 0,8 in the left eye, 0,7 in the right eye. The worker uses no means of personal protection. What diagnosis is most likely?
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A 45-year-old woman is undergoing treatment for active rheumatism, combined mitral valve failure. During her morning procedures she suddenly sensed pain in the left hand, which was followed by numbness. Pain and numbness continued to aggravate. Objectively: the skin of the left hand is pale and comparatively cold. Pulse in the hand arteries is absent along the whole length. What treatment tactics is most efficient?
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A 10-year-old boy had a case of viral hepatitis type B four years ago. Currently the assumption was made about the formation of hepatic cirrhosis in the patient. What additional investigation can clarify the diagnosis?
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A 40-year-old patient has acute onset of disease caused by overexposure to cold. Temperature has increased up to 39°C. Foul-smelling sputum is expectorated during coughig. Various moist crackles can be auscultated above the 3rd segment on the right. Blood test: leukocytes - 15,0 × 109/l, stab neutrophils - 12%, ESR - 52 mm/hour. On X-ray: in the 3rd segment on the right there is a focus of shadow 3 cm in diameter, low density, with fuzzy smooth margins and a clearing in its center. What disease is most likely in the given case?
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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 efficient mechanical ventilation. What occupational disease is most likely to develop in an electro-gas welding operator?
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A 48-year-old patient was found to have diffuse enlargement of the thyroid gland, exophthalmia, weight loss of 4 kg in 2 months, sweating. Objectively: HR- 105/min., BP-140/70 mm Hg. Defecation act is normal. What kind of therapy is recommended in this case?
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A woman addressed a doctor with complaints of increased body temperature up to 37,8°C and moderately sore throat for the last 3 days. Objectively: mandibular lymph nodes are enlarged up to 3 cm. Palatine tonsils are hypertrophied, covered with grey coating that spreads to the uvula and anterior pillars of the fauces. What diagnosis is most likely?
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A 48-year-old man complains of constant pain in the upper abdomen, predominantly on the left, which aggravates after eating, diarrhea, loss of weight. The patient has alcohol use disorder. Two years ago he had a case of acute pancreatitis. Blood amylase is 4 g/hour·l. Feces analysis: steatorrhea, creatorrhea. Blood sugar is 6,0 mmol/l. What treatment should be prescribed?
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In 10 hours after eating canned mushrooms a 27-year-old patient has developed diplopia, bilateral ptosis, disrupted swallowing, shallow breathing with respiratory rate 40/min., muscle weakness, enteroparesis. What measure should be taken first?
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