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KROK 2 Medicine 2016 Questions | KROKEXAM
Browse 2016 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 30-year-old patient has been hospitalized with diagnosis of intestinal obstruction. The surgery revealed the obstruction of the small intestine to be caused by a helminth ball. What kind of helminth is it?
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Mother of a newborn suffers from chronic pyelonephritis; she had a case of URTI before the delivery. The delivery is at term, for a long period waters were not breaking. On the 2nd day of life the child developed an erythematic rash, later the rash developed into blisters approximately 1 cm in diameter filled with serous purulent substance. Nikolsky's symptom is positive. After the blisters had been lanced, erosions developed in their place. The child is inert. The child's body temperature is subfebrile. What diagnosis is most likely?
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Three weeks after a case of acute tonsillitis the patient is still weak, inert, subfebrile, his retromaxillary lymph nodes are enlarged. Tonsils are flabby, stick together with arches, there are purulent plugs in lacunae. What is the most probable diagnosis?
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The following indicators were calculated to analyze population health and treatment quality in a cardiological hospital: primary cardiovascular morbidity - 62%; total cardiovascular morbidity - 483,55%; cardiovascular mortality - 10,9%; proportion of cardiovascular mortality within total mortality -67,0%; primary disablement caused by cardiovascular diseases -16,2 per 10.000 population. What indicator is an extensive value?
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A 6-year-old child complains of frequent liquid stool and vomiting. On the 2nd day of disease the child presented with inertness, temperature rise up to 38,2°C, Ps- 150/min., scaphoid abdomen, palpatory painful sigmoid colon, defecation 10 times a day with liquid, scarce stool with mucus and streaks of green. What is the provisional diagnosis?
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The institutions that take part in medical examinations include prevention and treatment facilities, medical board of Ministry of Defense, medical board of Ministry of Home Affairs, medico-social expert commissions, forensic medical boards etc. What institutions are responsible for temporary disability examination?
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After a lengthy march an army regiment has set camp for 3 days near a settlement. Sanitary-hygienic investigation detected several water sources. Choose the source that would satisfy the demands for potable water the most under the given field conditions:
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Clinical statistical investigation was performed to determine efficiency of a new pharmacological preparation for patients with ischemic heart disease. What parametric test (coefficient) can be used to estimate reliability of the results?
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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 parturient woman is 23 years old. Internal obstetric examination shows the uterine cervix to be completely open. Fetal bladder is absent. Cephalic presentation is observed in the plane of the small pelvic outlet. Sagittal suture is at the longitudinal section of the small pelvic outlet, small fontanel is situated closer to the uterus. What cephalic position will the newborn have during birth in this case?
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During the dynamic observation of a parturient woman in the second stage of labor it was registered that the fetal heart rate decreased to 90-100/min, and did not normalize after contractions. Vaginal examination revealed the complete cervical dilatation, the fetal head filling the entire posterior surface of the pubic symphysis and sacral hollow; the sagittal suture was in the anteroposterior diameter of the pelvic outlet, the posterior fontanelle was in front under the pubic arch. What plan for further labour management should be recommended?
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An 8-year-old girl periodically has sudden short-term heart pains, sensation of chest compression, epigastric pain, dizziness, vomiting. Objectively: the patient is pale, respiratory rate - 40/min., jugular pulse is present. Ps- 185/min., 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 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary glands; her genotype is 46 XY; uterus and vagina are absent. What is your diagnosis?
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A planner designs a heating system for a pre-school educational establishment. The highest air temperature should be in the following room:
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A 27-year-old sexually active woman complains of numerous vesicles on the right sex lip, itch and burning. Eruptions regularly appear before menstruation and disappear 8-10 days later. What is the most likely diagnosis?
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A 35-year-old woman addressed a gynecological in-patient department with complaints of regular pains in her lower abdomen, which increase during menstruation, and dark-brown sticky discharge from the genital tracts. On bimanual examination: the uterine body is slightly enlarged, the appendages are not palpated. Mirror examination of the uterine cervix reveals bluish spots. What diagnosis is most likely?
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A 10-year-old patient has a history of mild bronchial asthma. During a regular check-up the patient should be recommended:
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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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An emergency situation at a chemical plant caused acute occupational intoxication. A doctor who revealed the case of "acute occupational disease (intoxication)" must notify the following authority:
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A 27-year-old woman has been treated in a surgical department for pleural empyema for 6 months. Multiple paracenteses of the pleural cavity were performed along with antibacterial treatment. The patient's condition is slowly aggravating; attempts to fully stretch the lung were unsuccessful. Choose the tactics:
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A prematurely born girl is now 8 months old. She has dyspnea, tachycardia, hepatosplenomegaly, physical developmental lag, limb cyanosis. There is parasternal cardiac hump, auscultation revealed systolodiastolic murmur in the II intercostal space on the left. BP is 90/0 mm Hg. What disease can be suspected?
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Three days ago a boy underwent removal of a foreign body from under a nail plate. 2 days later he developed acute pulsating pain at the end of the nail bone which aggravated at pressing. Nail fold became hyperemic, body temperature rose up to 37,5°C, there was a change in nail plate colour. What is the most likely diagnosis?
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A 25-year-old woman complains of menstruation retention lasting for 3 years. The patient explains it by a difficult childbirth complicated with profuse hemorrhage, weight loss, brittleness and loss of hair, loss of appetite, depression. Objective examination reveals no pathologic changes of uterus and uterine appendages. What pathogenesis is characteristic of this disorder?
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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 45-year-old patient with urolithiasis had an attack of renal colic. What is the mechanism of the attack development?
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A 26-year-old woman has attended maternity center complaining of her inability to become pregnant despite 3 years of regular sex life. Examination revealed the following: increased body weight; male-type pubic hair; excessive poliosis of thighs; ovaries are dense and enlarged; basal body temperature is monophasic. The most likely diagnosis is:
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The process of open-cut mining requires drilling and blasting operations, rock and ore excavation, transportation of ore to fragmentation and sorting factories and transportation of barren rock to slagheaps, road building and maintenance, repair works. What factor of production is most important for miner's health?
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A woman addressed a gynecologist on the 20th day of puerperal period with complaints of pain in the left mammary gland, purulent discharge from the nipple. Objectively: Ps- 120/min., body temperature is 39°C. The left mammary gland is painful, larger than the right one, the skin there is hyperemic; in the upper quadrant there is an infiltrate 10x15 cm in size with soft center. Blood test: ESR - 50 mm/hour, leukocytes - 15,0 × 109/l. What would be the treatment tactics?
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The correlation between the service record and eosinophil concentration in blood was studied in workers at dyeing shops of textile factories. What index will be most informative for the analysis of this data?
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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 crackles. The most likely diagnosis is:
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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 36-year-old female patient complains of general weakness, edemas of her face and hands, rapid fatigability during walking, difficult deglutition, cardiac irregularities. These symptoms developed 11 days after holiday at the seaside. Objectively: face erythema, edema of shin muscles. Heart sounds are muffled, BP is 100/70 mm Hg. In blood: ASAT activity is 0,95 millimole/hl, ALAT-1,3 micromole/hl, aldolase - 9,2 IU/l, creatine phosphokinase - 2,5 micromole P/gl. What method of study would be most specific?
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A 14-year-old girl has fainted during a meeting. The day before she complained of a headache. The skin is pale, the limbs are cold, shallow breathing, heart sounds are muffled; heart rate is 51/min.; BP is 90/50 mm Hg. The abdomen is soft. Meningeal symptoms are negative. Make the provisional diagnosis:
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For the last 15 years a 48-year-old patient has been working at the factory producing synthetic resins. Lately he has been complaining of significant general fatigue, headaches, frequent urination (predominantly during the day), red color of urine. What complication of benzene nitro compounds poisoning can be suspected?
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A 60-year-old woman developed 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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In the morning upon waking a 65-year-old patient developed weakness in the right-side limbs, speech disorder, decreased sensitivity of the left side of the body. On examination: conscious, BP- 100/60 mm Hg, motor aphasia, right-sided central hemiparesis and hemihypalgesia. Make the preliminary diagnosis:
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The objective of a statistical study was to find out the extent of seeking medical care by the population. For this purpose 300 residents of the area were interviewed. Information was collected by means of a special questionnaire. What method of collecting information was used by researchers?
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A 57-year-old woman complains of having a sensation of esophageal compresion, palpitation, difficult breathing during 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, Ps-76/min., BP- 120/80 mm Hg. X-ray revealed a considerable dilation of the 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 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 30-year-old woman suffers from polycystic renal disease. She has been admitted with signs of fatigue, thirst and nocturia. Diuresis is up to 1800 ml per day. BP is 200/100 mm Hg. Blood test: erythrocytes -1,8 × 109/l, Hb- 68 g/l. Urine analysis: specific gravity - 1005, leukocytes - 50-60, erythrocytes - 3-5 in the vision field, creatinine - 0,82 mmol/l, potassium - 6,5 mmol/l, glomerular filtration rate - 10 ml/min. What tactics would be leading in the patient's treatment?
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