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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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In a rural health care area there is a case of child dying during the first month of 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 region attended by a central regional hospital demonstrates increased hemorrhagic stroke morbidity. Essential hypertension morbidity, however, remains at the same level and is below the average level registered within the larger area. What managerial decision should be made in this case?
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A 42-year-old man was delivered to a surgical in-patient department with complaints of icteric skin, pain in the right subcostal area. Biochemical blood analysis: total bilirubin - 140 mcmol/l, direct bilirubin - 112 mcmol/l. On US: choledochal duct - 1,4 cm, a concrement is detected in the distal area. Gallbladder is 40 cm, no concrements. What treatment tactics should be chosen?
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4 weeks after myocardial infarction a 56-year-old patient developed acute heart pain, pronounced dyspnea. Objectively: the patient's condition is extremely grave, there is marked cyanosis of the face, swelling and throbbing of the neck veins, peripheral pulse is absent, carotid artery pulse is rhythmic, 130/min., BP is 60/20 mm Hg. Auscultation of the heart reveals extremely muffled sounds, percussion reveals heart border extension in both directions. What is the optimal treatment tactic for this patient?
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A 45-year-old man was delivered to a hospital with complaints of vomiting with streaks of blood, loss of weight. On esophago fiberscope a cauliflower-shaped mucosal growth was detected in the abdominal esophagus. The mucosa there bleeds on contact. What preliminary diagnosis can be made?
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A 35-year-old man complains of intense lumbar pain irradiating to the inguinal area, external genitalia, thigh; frequent urination, chill, nausea, vomiting. Objectively: positive Pasternatsky's symptom (costovertebral angle tenderness). Urine analysis revealed that RBCs and WBCs covered the total field of microscope; the urine exhibited high protein concentration. These clinical presentations were most likely caused by the following pathology:
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A 20-year-old patient complains of pain in the left lumbar region, arterial pressure rise up to 160/110 mm Hg. US revealed that the structure and size of the right kidney were within age norms, there were signs of 3 degree hydronephrotic transformation of the left kidney. Doppler examination revealed an additional artery running to the lower pole of the kidney. Excretory urogram shows a narrowing in the region of ureteropelvic junction. Specify the treatment tactics:
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As a result of load lifting a 68-year-old woman developed acute pain in the lumbar region, in a buttock, posterolateral surface of her right thigh, external surface of the right shin and dorsal surface of foot. Objectively: weakness of the anterior tibial muscle, long extensor muscle of the right toes, short extensor muscle of the right toes. Low Achilles reflex on the right. Positive Lasegue's sign. What examination method would be most effective for specification of the diagnosis of L5 root discogenic compression?
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A 23-year-old female patient has been suffering from mental disorder since the age of 18, the course of disorder has no remission periods. At hospital the patient mostly presents with non-purposeful foolish excitation: she makes stereotypic grimaces, exposes herself, publically masturbating, loudly laughs, repeating stereotypical obscene shouts. The patient should be prescribed:
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During preventive ultrasound scan of abdomen performed during regular checkup in a school the following was revealed in an 11-year-old student of the 5th grade: the left kidney is 3 cm below the normal position, its shape, size and structure are within the norm, the contralateral kidney cannot be observed at its proper place. The preliminary diagnosis is as follows: congenital anomaly of renal development, dystopic left kidney, right kidney is absent or pelvic dystopic. What X-ray method would be required for making the final diagnosis and determining the functional capacity of both kidneys?
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A young woman suffering from seborrhea oleosa has numerous light-brown and white spots on the skin of her torso and shoulders. The spots have clear margins, branny desquamation, no itching. What provisional diagnosis can be made?
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In a traffic accident two persons died. An appointed forensic medical expert was called on duty to another accident location; therefore, according to the criminal law in force in Ukraine, an investigator called in the following specialist for examination of the location and bodies:
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A patient is 28 years old. He has been suffering from mental disorder since he was 22. His current condition has changed acutely: for 3 days the patient has been refusing to leave his home. He claims that there is a ''telepathy" occurring between him and other people, through which he receives "thoughts of strangers" and transmits his own thoughts for everyone to hear. He thinks his thoughts and actions are manipulated through this "telepathy". Make the preliminary diagnosis:
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A 40-year-old patient is registered in a narcological dispensary. Somatically: skin is dramatically hyperemic, sclera are injected, hyperhidrosis is present. BP- 140/100 mm Hg, heart rate - 100/min. Mental state: autopsychic orientation is intact, allopsychic orientation is distorted. The patient presents with motor anxiety. There is an expression of fear on his face. He refuses to talk about his problems and asks to release him immediately, because he "may be killed". This state developed in a day after one of his regular drinking bouts. What is your provisional diagnosis?
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A 35-year-old female patient has gained 20 kg weight within a year with the normal diet. She complains of chill, sleepiness, dyspnea. The patient's mother and sister are corpulent. Objectively: height - 160 cm, weight - 92 kg, BMI- 35,9. Obesity is uniform, there are no striae. The face is amimic. The skin is dry. The tongue is thickened. Heart sounds are muffled. Heart rate - 56/min., BP- 140/100 mm Hg. The patient has constipations, amenorrhea for 5 months. TSH- 28 mkME/l (normal rate - 0,32-5). Craniogram shows no pathology. What is the etiology of obesity in this case?
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A 10-week pregnant woman was admitted to a hospital for recurrent pain in the lower abdomen, bloody discharges from the genital tracts. The problems developed after a case of URTI. The woman was registered for antenatal care. Speculum examination revealed cyanosis of vaginal mucosa, clean cervix, open cervical canal discharging blood and blood clots; the lower pole of the gestational sac was visible. What tactics should be chosen?
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A patient with fibromyoma of uterus sized up to 8-9 weeks of pregnancy consulted a gynecologist about acute pain in the lower abdomen. Examination revealed pronounced positive symptoms of peritoneal irritation, high leukocytosis. Vaginal examination revealed that the uterus was enlarged corresponding to 9 weeks of pregnancy due to the fibromatous nodes, one of which was mobile and extremely painful. Appendages were not palpable. There were moderate mucous discharges. What is the optimal treatment tactics?
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A 4-month-old child was admitted to a surgical department 8 hours after the first attack of anxiety. The attacks happen every 10 minutes and last for 2-3 minutes, vomiting occurred once. Objectively: the child's condition is grave. Abdomen is soft, palpation reveals a tumor-like formation in the right iliac area. After rectal examination the doctor's finger was stained with blood. What is the most probable diagnosis?
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A woman has focal encephalitis in the anamnesis. Her spatial orientation is not disrupted. She has a sensation, as if "everything seems surreal: buildings are small, round or distorted; trees are upside down; people are very tall with thin limbs". Determine the psychopathologic syndrome:
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A 56-year-old woman complains of itching skin of her torso, constant nausea, constipation, sensation of heaviness and pain in the right subcostal area, extreme general fatigue. The patient suffers from biliary cirrhosis. The skin is pale icteric. The abdomen is soft, the liver protrudes 2,0 cm from under the margin of the right costal arch, sensitive on palpation. Biochemical investigation: total bilirubin - 142,0 mcmol/l, conjugated bilirubin - 139,0 mcmol/l, alanine aminotransferase -0,98 mmol/hour·l, aspartate aminotransferase - 0,82 mmol/hour·l alkaline phosphatase - 8,7 mmol/hour·l. What drug should be prescribed in the first place?
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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: Ps- 72/min., arterial pressure - 110/70 mm Hg, in the right lobe of thyroid gland palpation reveals a mobile node 4x2 cm in size, the left lobe is not palpable, the basal metabolic rate is 6%. What is the most likely diagnosis?
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Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated based on this report?
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A 32-year-old woman addressed a dermatologist with complaints of slightly itching rashes in the mouth angles. She has been suffering from this condition for 3 days. Objectively: there are isolated small phlyctenas and superficial erosions covered in honey-yellow scabs against the background of slight hyperemia. Make the diagnosis:
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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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An 18-year-old woman complains of pains in her lower abdomen, purulent discharge from the vagina, temperature rise up to 37,8°C. Anamnesis states that she had random sexual contact the day before the signs appeared. She was diagnosed with acute bilateral adnexitis. On additional examination: leukocytes in the all field of vision, bacteria, diplococci with intracellular and extracellular position. What agent is most likely in the given case?
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A 45-year-old man has been suffering from duodenal ulcer disease for 5 years. He complains of weakness, dizziness, dryness of the skin. Objectively: the skin and visible mucosa are pale, chapped lips; heart rate is 100/min., BP- 100/70 mm Hg, systolic murmur at all points on heart auscultation. All other internal organs are unchanged. Fecal occult blood test is positive. Blood test: erythrocytes - 3,1 × 1012/l, Hb- 88 g/l, color index - 0,7, leukocytes - 4,6 × 109/l, platelets - 350 × 109/l, ESR - 21 mm/hour, anisocytosis, polycythemia, serum iron - 9,5 mcmol/l. What treatment tactics would you choose?
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A 58-year-old patient complains of a 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, HR- 92/min. Auscultation reveals some fine moist crackles in the lower 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 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 32-year-old woman addressed a maternity clinic with complaints of infertility that has been lasting for 7 years. Her menstrual cycle occurs in two phases. Hysterosalpingography reveals obstruction of the uterine tubes in the ampullar areas, an adhesive process in the small pelvis can be observed. What treatment is most advisable in this 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 week ago a 65-year-old patient suffered an acute myocardial infarction, his general condition 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 observed 2 cm from the apex beat to the left. What is the most likely diagnosis?
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A 60-year-old patient complains of nearly permanent sensation of heaviness and fullness in the epigastrium, which 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 pains. 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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A 5-year-old child has body temperature increased up to febrile numbers, suffers from inertness, weakness. Examination revealed hemorrhage on the skin of limbs and torso. Enlargement of cervical and axillary lymph nodes can be detected. The liver is 4 cm below the costal arch; the spleen is 6 cm below the costal arch. Blood test: erythrocytes - 2,3 × 1012/l, Hb- 60 g/l, platelets - 40 × 109/l, leukocytes - 32,8 × 109/l, eosinophils - 1%, band neutrophils - 1%, segmented neutrophils - 12%, lymphocytes - 46%, monocytes -1%, blasts - 40%, Duke's bleeding time is 9 min. What examination is necessary to make the diagnosis?
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A child from primi pregnancy was born in a term labor and has body weight of 4000 g and body length of 57 cm. When born, he was nonresponsive to examination. Diagnosis is diffuse. Heart rate is 80/min. What resuscitation measures should be taken?
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A 15-year-old teenager has undergone medical examination in military recruitment center. The following was revealed: interval systolic murmur at the cardiac apex, accent of the II heart sound over the pulmonary artery, tachycardia. What additional examination method will be most informative for determining a diagnosis?
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A 64-year-old patient has been hospitalized with complaints of progressive jaundice that developed over 3 weeks ago without pain syndrome, along with general weakness, loss of appetite. Objectively: temperature is 36,8°C, heart rate is 78/min., abdomen is soft and painless, peritoneum irritation symptoms are not detected, palpation reveals sharply enlarged tense gallbladder. What disease can be characterized with these symptoms?
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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 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 are no focal symptoms. Liquor is turbid, blood pressure is high, albuminocytological dissociation occurs with neutrophils. What disease can be suspected?
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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 the 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 19-year-old patient complains of severe pain in axillary crease. Condition onset was a week ago after her swimming in a 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 color. 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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