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KROK 2 Medicine 2017 Questions | KROKEXAM
Browse 2017 KROK 2 Medicine exam questions with answers and explanations.
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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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After a 5-day-long celebration of his daughter's wedding a 65-year-old patient "saw" in his yard many cats, chickens, and rats. He tried to chase them away, but was scared off when the animals started to scold him and tried to harm him. Make the diagnosis:
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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 28-year-old woman has been delivered to a hospital with acute pain in the lower abdomen. There was a brief syncope. The delay of menstruation is 2 months. Objectively: the patient has pale skin, BP- 90/50 mm Hg, Ps- 110/min. Lower abdomen is extremely painful. Vaginal examination reveals uterus enlargement. Promtov's sign (pain during bimanual gynecological examination) is positive. Right uterine appendages are enlarged and very painful. Posterior vault hangs over. What is the most likely diagnosis?
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5 weeks after hypothermia a 22-year-old patient developed fever, weakness, muscle pain, inability to move independently. Objectively: tenderness, induration of shoulder and shin muscles, restricted active movements, erythema on the anterior surface of the chest. There is a periorbital edema with heliotropic erythema. Gottron's sign is present. What investigation is required for the diagnosis verification?
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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 44-year-old patient complains of difficult urination, sensation of incomplete urinary bladder emptying. Sonographic examination of the urinary bladder near the urethra entrance revealed an oval well-defined hyperechogenic formation 2x3 cm large that was changing its position during the examination. What conclusion can be made?
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4 days after a patient received a gunshot wound to the soft tissues of middle third of the thigh, his condition suddenly began deteriorating. There are complaints of bursting pain in the wound; pain has been increasing 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 color, have dirty-gray coating, and fall apart when held with forceps. What infection has developed in the wound?
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A 35-year-old patient has been suffering from an illness for 3 days. 5 days ago he returned from a trip to Africa. The onset of disease was accompanied by fever up to 40°C, chills, acute headache, myalgia. In the axillary region the lymph node enlarged up to 3x6 cm can be palpated. The lymph node is dense, intensely painful, slightly mobile, without clear margins; the skin over the node is hyperenic and tight. Tachycardia is present. Make the preliminary diagnosis:
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A parturient woman complains of pain in her mammary gland. In the painful area there is an infiltration 3x4 cm in size with softened center. Body temperature is 38,5°C. What is the most likely diagnosis?
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A 52-year-old patient, who has been suffering from angina pectoris, for 2 weeks has increasingly frequent pain attacks in the area behind his sternum and his need for nitroglycerine has increased. Objectively: the condition is of moderate severity. The skin is pale. Heart sounds are weakened, rhythmic. Heart rate is 84/min. ECG shows no signs of focal myocardial injury. What is the most likely diagnosis?
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A 9-year-old boy has been suffering from multiple bronchiectasis since he was 3 years old. Exacerbations occur frequently (34 times a year), after conservative therapy there are short remission periods. The disease progresses, the child is physically underdeveloped, presents with pale skin, acrocyanosis, deformed nail plates in the shape of "clock-face" Bronchography reveals saccular bronchiectases in the lower lobe of the right lung. What further treatment tactics should be chosen?
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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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A patient received flame burns of both hands. On the dorsal and palmar surface of the hands there are blisters filled with serous fluid. The wrist joint region is hyperemic. The forearms were not injured. What is the provisional diagnosis?
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During the periodic medical examination an assembly fitter (works on soldering details) didn't report any health problems. Closer examination revealed signs of asthenic-vegetative syndrome. Blood included red blood cells with basophilic aggregations and a somewhat higher number of reticulocytes, urine had a high concentration of delta-aminolevulinic acid. The complex of symptoms indicates the initial stage of chronic intoxication with:
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A 29-year-old woman came to a gynecologist with complaints of irritability, tearfulness, headache, nausea, occasional vomiting, pain in the heart area, tachycardia attacks, memory impairment, meteorism. These signs appear 6 days before menstruation and disappear the day before menstruation or during its first 2 days. On vaginal examination: the uterus and uterine appendages are without alterations. What diagnosis is the most likely?
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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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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 is observed, neonatal reflexes are weak. The internal organs are without pathologic alterations. This newborn can be assessed 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 39-year-old man complains of morning headaches, 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 the most important for making diagnosis in this case?
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A worker of a glass-blowing workshop complains of headache, irritability, visual 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 is the most likely diagnosis?
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For a week a 42-year-old patient has been suffering from fever attacks followed by high temperature, which occur each 48 hours. Body temperature raises up to 40°C and decreases in 3-4 hours with excessive sweating. The patient presents with loss of appetite and general fatigue. The skin is pale and sallow. The liver and spleen are enlarged and dense on palpation. What method of diagnosis verification would be most efficient?
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A 28-year-old patient is a drug addict. He has been sick for a year, when noticed general weakness, increased sweating, and weight loss. He often had cases of respiratory diseases. Within the last 2 days he demonstrates intermittent fever with profuse night sweating, increased general weakness, developed diarrhea with mucus and blood admixtures. On examination: polylymphadenopathy, herpetic rashes in the oral cavity; on abdominal palpation: the liver and spleen are enlarged. What is the most likely 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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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 26-year-old woman is suspected to suffer from systemic lupus erythematosus due to systemic lesions of skin, vessels, joints, serous tunics, and heart that developed after photosensitization. The following is detected: LE cells, antibodies to native DNA, isolated anti-centromere antibodies, rheumatoid factor is 1:100, Wassermann reaction is positive, circulating immune complex is 120 units. What immunological indicators are considered to be specific to this disease?
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A woman came to 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, with gray coating that spreads to the uvula and anterior pillars of the fauces. What is the most likely diagnosis?
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A primigravida at the term of 20 weeks complains of pain in her lower abdomen, smearing blood-streaked discharge from the genital tracts. Uterine tone is increased, fetus is mobile. On vaginal examination: the uterus is enlarged according to the term, uterine cervix is shortened to 0,5 cm, external cervical orifice is open by 2 cm. What is the most likely diagnosis?
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A 65-year-old man was diagnosed with B12-deficient anemia and the treatment was prescribed. A week later control blood test was performed. What would be the early indicator of the therapy effectiveness?
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A 35-year-old woman complains of heart pain ("aching and drilling") occurring mainly in the morning in autumn and spring and irradiating to the neck, back and abdomen; rapid heartbeat; low vitality. Occurrence of this condition is not associated with physical activity. In the evening, the patient's condition improves. Study of somatic and neurological status and ECG reveal no pathology. What pathology is most likely to have caused these clinical presentations?
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On the 4th day after recovery from a cold a patient was hospitalized with complaints of solitary spittings of mucoid sputum. On the 2nd day there was a single discharge of about 250 ml of purulent blood-streaked sputum. Objectively: the patient's condition is moderately severe. Respiratory rate -28-30/min., Ps- 96/min., BP- 110/70 mm Hg. Respiration over the left lung is vesicular, over the right lung weakened. There are various moist crackles over the lower lobe and amphoric breath sounds near the angle of scapula. What is the most likely diagnosis?
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A 65-year-old woman on abdominal palpation presents with a tumor in the umbilical region and above it; the tumor is 13x8 cm in size, moderately painful, non-mobile, pulsing. On auscultation systolic murmur can be observed. What is the most likely diagnosis?
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A 45-year-old man complains of cough fits and tickling in his nasopharynx. He had been staying for 10 days in the polluted area created by the Chornobyl nuclear power plant accident. Rhinoscopy shows signs of severe nasopharynx irritation. What radionuclide is the cause of this irritation?
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A 20-year-old patient complains of severe headache, double vision, weakness, fever, irritability. Objectively: body temperature is 38,1°C, the patient is reluctant to contact, sensitive to stimuli. There are ptosis of the left eyelid, exotropia, anisocoria S>D, pronounced meningeal syndrome. On lumbar puncture the cerebrospinal fluid flowed out under a pressure of 300 mm Hg, the fluid is clear, slightly opalescent. 24 hours later there appeared fibrin film. Protein - 1,4 g/l, lymphocytes - 600/3 per mm3, sugar - 0,3 mmol/l. What is the provisional diagnosis?
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A 37-year-old worker during a fire ended up in the area of high CO concentration. He was delivered to a hospital in unconscious state. Objectively: the skin of his face and hands is crimson. Respiration rate is 20/min. ECG: alterations specific for hypoxic myocardium. Hourly diuresis is 40 ml. Blood test: erythrocytes - 4,5 × 1012/l, Hb- 136 g/l, color index - 0,89 ESR - 3 mm/hour, carboxyhemoglobin - 5%. What criterion allows determining the severity of the patient's condition?
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After a case of purulent otitis a 1-year-old boy has developed pain in the upper third of the left thigh, body temperature up to 39°C. Objectively: swelling of the thigh in its upper third and smoothed out inguinal fold. The limb is in semiflexed position. Active and passive movements are impossible due to severe pain. What diagnosis is the most likely?
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A patient with suspected pheochromocytoma has normal blood pressure in the periods between the atacks and a tendency towards tachycardia. Urine test revealed no pathologies. It was decided to use a provocative test with histamine. What medication should be prepared to provide emergency care in case of positive test result?
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A 42-year-old woman complains of severe pulsing headache in the frontoparietal area, vertigo, palpitations. She has been suffering from hypertension for 3 years. Significant increase of BP occurs 2-3 times per month and lasts for 3-8 hours. The left ventricle is enlarged, heart sounds are clear, heart rate - 105/min., BP- 225/115 mm Hg. ECG: signs of left ventricular hypertrophy. What drug would be the most effective for termination of cerebral crisis attack?
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A 45-year-old patient complains of pain in the epigastric region, left subcostal area, abdominal distension, diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively: the tongue is moist with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region and Mayo-Robson's point. Liver is painless and protrudes by 1 cm from the costal arch. Spleen cannot be palpated. What disease can be primarily suspected?
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For three years a 31-year-old woman has been complaining of pain and swelling of her radiocarpal and metacarpophalangeal articulations, their reduced mobility in the morning, which persisted up to 1,5 hours. Two weeks ago she developed pain, swelling, and reddening of her knee joints, her body temperature increased up to 37,5°C. The treatment was belated. Examination of the internal organs revealed no pathologic alterations. Diagnosis of rheumatoid arthritis was made. What alterations are the most likely to be visible on the arthrogram?
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