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KROK 2 Medicine 2017 Questions | KROKEXAM
Browse 2017 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 58-year-old woman complains of spontaneous bruises, weakness, bleeding gums, dizziness. Objectively: the mucous membranes and skin are pale with numerous hemorrhages of various time of origin. Lymph nodes are not enlarged. Ps- 100/min, BP-110/70 mm Hg. There are no alterations of internal organs. Blood test results: RBC-3,0 × 1012/l, Hb- 92 g/l, color index - 0,9, anisocytosis, poikilocytosis, WBC- 10 × 109/l, eosinophils - 2%, stab neutrophils - 12%, segmented neutrophils - 68%, lymphocytes -11%, monocytes - 7%, ESR - 12 mm/h. What laboratory test should be performed additionally to make the diagnosis?
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After tonsillectomy a woman with systemic lupus erythematosus, who has been taking prednisolone for a year, developed acute weakness, nausea, vomiting, pain in the right iliac area, watery stool up to 5 times per day. Ps- 96/min., BP- 80/50 mm Hg. What preventive therapy should have been administered prior to the surgery?
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A 45-year-old woman complains of paroxysmal intolerable facial pain on the left with attacks that last for 1-2 minutes. Attacks are provoked by chewing. The disease onset was two month ago after overexposure to cold. Objectively: pain at the exit points of the trigeminal nerve on the left. Touching near the wing of nose on the left induces new pain attack with tonic spasm of the facial muscles. What is the most likely diagnosis among those listed?
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A 28-year-old man complains of skin rash and itching on the both of his hands. The condition persists for 1,5 years. The exacerbation of his condition he ascribes to the occupational contact with formaldehyde resins. Objectively: lesion foci are symmetrically localized on both hands. Against the background of erythema with blurred margins there are papulae, vesicles, erosions, crusts, and scales. What is the most likely pathology?
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A 10-year-old boy with symptoms of arthritis and myocarditis was delivered into a hospital. Based on clinical examination the preliminary diagnosis of juvenile rheumatoid arthritis was made. What symptom is the most contributive for the diagnostics of this disease?
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A 25-year-old patient was delivered to an infectious diseases unit on the 3rd day of illness with complaints of headache, pain in the lumbar spine and gastrocnemius muscles, high fever, chills. Objectively: condition is of moderate severity. Scleras are icteric. Pharynx is hyperemic. Tongue is dry with dry brown coating. Abdomen is distended. Liver is enlarged by 2 cm. Spleen is not enlarged. Palpation of muscles, especially gastrocnemius muscles, is painful. Urine is dark in color. Feces are normal in color. What is the most likely diagnosis?
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A 28-year-old woman complains of skin hemorrhages after minor traumas and spontaneous appearance of hemorrhages on the front of her torso and extremities. On examination: the skin is variegated (old and new hemorrhages), bleeding gums. Blood platelets - 20 × 109/l; in the bone marrow there is increased number of megakaryocytes and no platelet production. Treatment with steroid hormones was effective. What disease is it?
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A 74-year-old patient was delivered into admission room with clinical presentations of acute deep vein thrombosis of the shin. What symptom is the most typical of this pathology?
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A 9-month-old child presents with fever, cough, dyspnea. The symptoms appeared 5 days ago after a contact with a person with URTl. Objectively: the child is in grave condition. Temperature is 38°C, cyanosis of nasolabial triangle is present. RR- 54/min, nasal flaring during breathing is observed. There was percussion dullness on the right below the scapula angle and tympanic sound over the other areas of lungs. Auscultation revealed bilateral fine moist crackles predominating on the right. What is the most likely diagnosis?
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The mother of a 3-month-old child came to a family doctor with complaints of her child being physically underdeveloped and suffering from cough attacks and dyspnea. Anamnesis: the child is the result of the second full-term pregnancy with the risk of miscarriage (the first child died of pulmonary pathology at the age of 4 months, according to the mother). Body mass at birth is 2500 g. Cough attacks were observed from the first days of life, twice the child was treated for bronchitis. Considering the severity of the child's condition the doctor made the referral for hospitalization. What diagnosis was most likely stated in the referral?
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A 46-year-old man notes swollen legs, weakness, sensation of fullness and heaviness in the right subcostal area; it is the first occurrence of these signs in the patient. The patient has 20-year-long history of rheumatoid arthritis. The liver and spleen are enlarged and dense. Blood creatinine -0,23 mmol/l, proteinemia - 68 g/l, cholesterol - 4,2 mmol/l, urine specific gravity - 1012, proteinuria - 3,3 g/l, isolated wax-like cylinders, leached erythrocytes in the vision field, leukocytes - 5-6 in the vision field. What is the most likely complication?
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A 23-year-old man had taken 1 g of aspirin to treat acute respiratory infection. After that he developed an asthmatic fit with labored expiration that was arrested by introduction of aminophylline. The patient has no medical history of allergies. The patient has undergone two surgeries for nasal polyposis in the past. What is the most likely diagnosis?
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A 50-year-old patient was delivered to a hospital with complaints of blood traces in urine. Urination is painless and undisturbed. Macrohematuria had been observed for 3 days. Objectively: kidneys cannot be palpated, suprapubic area is without alterations, external genitalia are non-pathologic. On rectal investigation: prostate is not enlarged, painless, has normal structure. Cystoscopy revealed no alterations. What is the most likely diagnosis?
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A man complains of constant dull pain in the perineum and suprapubic area, weak flow of urine, frequent difficult painful urination, nocturia. The patient has been suffering from this condition for several months, during which urination was becoming increasingly difficult, and pain in the perineum has developed. On rectal examination: the prostate is enlarged (mainly its right lobe), dense, asymmetrical, central fissure is smoothed out, the right lobe is of stony density, painless, tuberous. What disease is it?
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A boy was born at 32 weeks of gestation. 2 hours after the birth he developed respiratory distress (RD). The RD severity assessed by Silverman score was 5. The respiratory disorders progressed, respiratory failure could not be eliminated by Martin-Bouyer CPAP (continuous positive airway pressure). X-ray of lungs shows reticular and nodular pattern, air bronchogram. What is the most likely cause of respiratory distress syndrome?
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An 8-year-old child with a 3-year-long history of diabetes was hospitalized in hyperglycemic coma. Specify the initial dose of insulin to be administered:
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A 17-year-old young man complains of general weakness, trismus, twitching of the muscles in his left shin. 7 days ago he pierced his foot with a nail. Objectively: at the sole of the foot there is a wound, 0,3x0,2 mm in size, with small amount of serous-purulent discharge, the skin around the wound is hyperemic. What is the most likely diagnosis?
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A patient with trauma of the lower third of the forearm volar surface caused by a glass shard came to a first-aid center. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the inner dorsal and palmar surfaces of the hand and IV finger is decreased. What nerve is damaged?
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A 58-year-old patient complains of pain in the lower left extremity, which aggravates during walking, sensation of cold and numbness in the both feet. The patient has been suffering from this condition for 6 years. Objectively: the skin is pale and dry, with hyperkeratosis. On the left shin hair is scarce, "furrow" symptom of inflamed inguinal lymph nodes is positive. Pulse cannot be detected over the pedal and popliteal arteries and is weakened over the femoral artery. In the right limb popliteal artery pulsation is retained. What is the most likely diagnosis?
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An infant is 2,5 months old. The onset of the disease was gradual, the child had normal body temperature but presented with slight cough. Within a week the cough intensified, especially at night; on the 12th day the child developed cough fits occurring up to 20 times per day and followed by vomiting. There was one instance of respiratory arrest. Make the diagnosis:
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Vaginal examination reveals the head of the fetus, which fills the posterior surface of symphysis pubis and hollow of the sacrum. The lower edge of symphysis pubis, ischiadic spines, and sacrococcygeal joint can be palpated. Where in the lesser pelvis is the fetal head situated?
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A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp pains in the stomach, constipations, pain in the hepatic area. In urine: aminolevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
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A 30-year-old multigravida has been in labour for 18 hours. 2 hours ago the pushing stage began. Fetal heart rate is clear, rhythmic, 136/min. Vaginal examination reveals complete cervical dilatation, the fetal head in the pelvic outlet plane. Sagittal suture is in line with obstetric conjugate, the occipital fontanel is near the pubis. The patient has been diagnosed with primary uterine inertia. What is the further tactics of labour management?
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A patient, who had eaten canned mushrooms (honey agaric) three days ago, developed vision impairment (diplopia, mydriasis), speech disorder, disturbed swallowing. What type of food poisoning occurred in the patient?
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An infant is 3 weeks old. Since birth there has been observed periodical vomiting within a few minutes after feeding. The amount of vomitive masses does not exceed the volume of previous feeding. The infant has age-appropriate body weight. What is the most likely cause of this symptom?
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A newborn with gestational age of 31 weeks presents with hypotonia and depressed consciousness. Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content of erythrocytes and protein, and low glucose. These data correspond with the clinical presentation of:
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From urine of a 14-year-old boy with the exacerbation of secondary obstructive pyelonephritis Pseudomonas aeruginosa was isolated with a titer of 1000000 microbes per 1 ml. What antibiotic is the most advisable in this case?
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A 20-year-old woman on the 10th day after her discharge from the maternity ward developed fever up to 39°C and pain in her left mammary gland. On examination the mammary gland is enlarged, in its upper outer quadrant there is a hyperemic area. In this area a dense spot with blurred margins can be palpated. The patient presents with lactostasis and no fluctuation. Lymph nodes in the right axillary crease are enlarged and painful. Specify the correct diagnosis:
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A 3-year-old girl is being treated at a resuscitation unit with diagnosis "acute kidney failure, oligoanuric stage". ECG: high T wave, extended QRS complex, displacement of S-T interval downwards below the isoline. What electrolyte imbalance is it?
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Mother of an 8-year-old girl complains that the child is too short and has excessive body weight. Objectively: obesity with fat deposits on the torso and face (round moonlike face), acne, striae on the thighs and lower abdomen, hirsutism. What hormone can cause such symptoms, when in excess?
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A 9-year-old girl complains of fever up to 37,5°C, headache, inertness, weakness, loss of appetite, stomachache, and frequent painful urination. Provisional diagnosis of acute pyelonephritis is made. Clinical urine analysis: specific gravity - 1018, no protein, leukocytes - 10-15 in the vision field. What investigation method can verify the diagnosis of urinary system infection?
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During assessment of work conditions at the mercury thermometer manufacture, content of mercury vapors in the air of working area is revealed to exceed maximum concentration limit. Specify the main way of mercury penetration into the body:
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During health assessment of car drivers and police officers on point duty, the physicians detected carboxyhemoglobin in the blood of the patients, weakened reflex responses, disturbed activity of a number of enzymes. Revealed professional health disorders are most likely to be associated with the effect of:
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On the 3rd day of life a newborn, who had suffered birth asphyxia, developed hemorrhage from the umbilical wound. Laboratory analysis reveals hypocoagulation, thrombocytopenia, and hypothrombinemia. What is the cause of such clinical developments?
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A 46-year-old woman came to a maternity clinic with complaints of moderate blood discharge from the vagina, which developed after the menstruation delay of 1,5 months. On vaginal examination: the cervix is clean; the uterus is not enlarged, mobile, painless; appendages without changes. Make the diagnosis:
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A patient has the second and third degree burns of the 15% of the body surface. On the 20th day after the trauma the patient presents with sharp increase of body temperature, general weakness, rapid vesicular respiration; facial features are sharpened, BP is 90/50 mm Hg, heart rate is 112/min. What complication is it?
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A 30-year-old woman complains of amenorrhea that lasts for 2 years after she has given birth, loss of hair and body weight. The labor was complicated with hemorrhage caused by uterine hypotonia. Objectively the patient is of asthenic type, her external genitalia are hypoplastic, the uterine body is small in size and painless. No uterine appendages can be detected. What is the most likely diagnosis?
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On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
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Examination of a 43-year-old man objectively revealed pallor of skin and mucous membranes, loss of tongue papillae, transverse striation of fingernails, cracks in the mouth corners, tachycardia. Blood test results: Hb- 90 g/l, anisocytosis, poikilocytosis. The most likely causative factor of this condition is the inadequate intake of:
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A 52-year-old woman presents with affected mucosa in the mouth angles where fissures, erosions, and ulcers develop; vertical fissures appear on the lips during their closing (cheilosis); there are tongue alterations (glossitis), angular stomatitis, seborrheic dermatitis around the mouth and wings of the nose, and pericorneal injection. The listed symptoms are characteristic of:
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