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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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Two days ago a woman fell from the height of 1,5 m. She complains of severe thoracic pain on the left and dyspnea. Chest X-ray reveals hydropneumothorax on the left with fluid level at the 7th rib and the lung collapsed by 1/3. The 6th-7th ribs are fractured along the scapular line. Serohemorrhagic fluid was obtained during thoracic puncture. What treatment tactics should be chosen?
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A patient complains of suppuration from the ear and impaired hearing of the left ear, which have been observed for the past 6 years. The patient had periodical headaches, general indisposition, fever. Objectively: otoscopy of the external auditory meatus revealed mucopurulent odorless substance. The eardrum is of normal color, with central perforation. What is the most likely diagnosis?
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In 2 hours after a traffic accident a 28-year-old man in grave condition was delivered to a hospital. The patient complains of abdominal pain. He received a blow to the abdomen with the steering wheel. Objective examination revealed the following: the abdomen does not participate in respiration, is tense and acutely painful on palpation; the abdominal muscles are defensively tense, peritoneal irritation signs are positive, hepatic dullness is absent. BP is 90/60 mm Hg, heart rate is 120/min. What further treatment tactics should be chosen?
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A 28-year-old woman complains of increased intervals between menstruations, up to 2 months, and hirsutism. Gynecological examination revealed the following: ovaries are enlarged, painless, and dense; no alterations of the uterus. US of the lesser pelvis: ovaries are 4-5 cm in diameter, with numerous enlarged follicles on the periphery. X-ray of the skull base: sellar region is widened. What is the most likely diagnosis?
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Posture of an 11-year-old boy was determined during preventive examination. The child presents with curled forward rounded shoulders, the head is bowed forward, the thorax is flattened, the stomach is bulging. In the vertebral column there are deepened cervical and lumbar flexures. What posture does the child have?
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A 46-year-old woman has been hospitalized with open fracture of the left thigh in its middle third. She underwent the surgery - fixation with extraosseous osteosynthesis plates. On the 4th day after the surgery she developed pain in the wound, body temperature rose over 39°C. What measures should be taken in this case?
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A multigravida on the 38th week of her pregnancy complains of increased BP up to 140/90 mm Hg, edema of the shins for 2 weeks. In the last month she gained 3,5 kg of weight. Urine analysis: protein - 0,033 g/l. Make the diagnosis:
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A 44-year-old patient with postinfarction cardiosclerosis presents with frequent heart rate disorders and lower extremity edema. Objectively: Ps- 95/min., irregular, 10-12 extrasystoles per minute. BP- 135/90 mm Hg. The 1st heart sound at the apex is weakened. Pulmonary respiration is rough. The liver is enlarged 2 cm. ECG: irregular sinus rhythm, heart rate - 95/min, frequent polytopic ventricular extrasystoles. What antiarrhythmic drug is advisable in this case for treatment and prevention of extrasystole?
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A 60-year-old woman has been suffering from weakness, dizziness, and fatigue over the last year. Recently she has also developed dyspnea, paresthesia. Objectively: the skin and mucous membranes are pale and slightly icteric. The tongue is smooth due to the loss of lingual papillae. Liver and spleen are located at the costal margin. Blood count: Hb- 70 g/l, RBC- 1,7 × 1012/l, color index -1,2, macrocytes. Administer the patient a pathogenetically justified drug:
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After excessive consumption of fatty food a 60-year-old woman suddenly developed pain in her right subcostal area, nausea, bile vomiting, sharp bitter taste in her mouth. In 2 days she developed jaundice, her urine darkened. Objectively: sclera and skin are icteric, the abdomen is distended, the liver is enlarged by 3 cm, soft and painful on palpation, Ortner's, Murphy's, Kehr's, Zakharyin's, Mayo-Robson's signs are positive. What diagnostic technique should be used in the first place?
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A 42-year-old woman working at a poultry farm complains of dyspnea, thoracic pain on the left, increased body temperature up to 38-39°C in the evening, and cough. The patient suffers from essential hypertension. Objectively: vesicular respiration in the lungs, vesicular resonance without alterations. X-ray of both lungs reveals numerous small low-intensity foci, 2-3 mm in size, located in a row along the blood vessels. ESR - 32 mm/hour. What is the most likely diagnosis?
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A 65-year-old patient has been suffering from liver cirrhosis associated with hepatitis C virus for 7 years. During the last 3 weeks the patient developed severe edema of the lower extremities, the abdomen is significantly distended with fluid. Ultrasound: signs of liver cirrhosis, portal hypertension, lymph nodes are in the area of hepatic portal. Concentration of α-fetoprotein in blood serum is 285 ng/ml. What complication could have developed in this case?
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A 43-year-old man has undergone a surgery for osteomyelitis of the left thigh. On the 6th day the patient's condition was complicated with sepsis. Despite complex therapy of sepsis on the 9th day the patient persistently presents with temperature up to 40°C, heart rate is 110/min., respiration rate is 23/min., BP is 100/60 mm Hg. Blood test: leukocytes - 16 × 109/l, band neutrophils -16%. What phase of clinical course is it?
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A 23-year-old woman presents with diabetes mellitus type 1. She complains of weakness, headache, nausea, and vomiting. Objectively: temperature is 37,6°C, heart rate is 98/min., BP is 95/65 mm Hg, respiration rate is 32/min., loud. Smell of acetone is detected, heart sounds are muffled, pulse is rhythmic. The stomach is sensitive in the epigastrium. Costovertebral angle tenderness (Murphy's punch sign) is present. Blood glucose is 28,5 mmol/l; blood leukocytes - 16,5 × 109/l. In urine: acetone++, leukocytes - 25-40 in the vision field. Blood pH is 7,1. What correction method would be the most advisable?
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A 57-year-old woman complains of a sensation of esophageal compression, palpitations, difficult breathing when 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 study revealed considerable dilation of esophagus and its constriction in the cardial part. What pathology is the most likely to have caused dysphagia in this patient?
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A 47-year-old man is employed at the weaving workshop, has 15-year-long record of service at this factory; his work conditions are associated with high-frequency and high-intensity noise. During periodical examination he was diagnosed with occupational deafness. What are the grounds for making such a diagnosis?
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A 37-year-old woman complains of acute pain in the genital area, swelling of the labia, pain when walking. Objectively: body temperature is 38,7°C, Ps- 98/min. In the interior of the right labia there is a dense, painful tumor-like formation 5,0x4,5 cm in size, the skin and mucous membrane of genitals are hyperemic, there is profuse foul-smelling discharge. What is the most likely diagnosis?
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A woman undergoing in-patient treatment for viral hepatitis type B developed headache, nausea, recurrent vomiting, memory lapses, flapping tremor of her hands, rapid pulse. Sweet smell from the mouth is detected. Body temperature is 37,6°C, heart rate is 89/min. What complication developed in the patient?
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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, marked dyspnea. Objectively: the patient's condition is extremely grave, there is marked cyanosis of face, swelling and throbbing of neck veins, peripheral pulse is absent, the 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 tactics for this patient?
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A patient with chronic pancreatitis complains of diarrhea occurring up to 5 times per day (no blood traces), loss of body weight, abdominal distention, dryness of skin, loss of hair, thirst, bleeding gums, convulsions. Complete blood count: leukocytes -5,8 × 109/l; Hb- 86 g/l; ESR - 15 mm/g; Blood protein test: protein - 48 g/l; albumins - 28 g/l. What indicators of coprological analysis would accompany this syndrom?
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A 35-year-old patient complains of heartburn, gasseous and sour eructation, burning constricting pain behind the sternum and along the esophagus, developing when bowing the torso to the front. No previous examination; the patient takes almagel at his own discretion, after which he notes improvement of his general state. Make the provisional diagnosis:
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The left hand of a newborn is extended in all its joints, stretched along the torso, and pronated in the forearm. Active movements of the shoulder joint are retained. The hand is flattened, atrophied, cold to touch, hangs passively. Grasping and Babkin's reflexes are absent at the affected side. Hemogram indicators are normal. Make the most likely diagnosis:
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A 34-year-old man is being treated for schizophrenia exacerbation in a psychiatric unit. Objectively: the patient remains in bed, is sluggishly mobile, unresponsive, does not react to questions. His position is unvaried, hypomimic, snout reflex and Dupre's symptom are present, muscles exhibit waxy flexibility. He has been remaining in this state for approximately a week. Feeding is parenteral. Determine the neuromotor disturbance:
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A 14-year-old girl has been delivered to a gynecological department with complaints of profuse blood discharge from her genital tract for 2 weeks. Anamnesis: menstruation since 13, irregular, painful, profuse; the last one was 2 months ago. Objectively: pale skin and mucosa, BP- 100/60 mm Hg, Hb-108 g/l. The abdomen is soft and painless on palpation. Rectal examination revealed no pathologies of reproductive organs. What condition is it?
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An infant cries during urination, the foreskin swells and urine is excreted in drops. What approach to treatment should be chosen?
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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 the 3rd 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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A 49-year-old patient consulted a doctor about difficult swallowing, voice hoarseness, weight loss. These symptoms have been gradually progressing for the last 3 months. Objectively: the patient is exhausted, there are enlarged supraclavicular lymph nodes. Esophagoscopy revealed no esophageal pathology. Which of the following investigations is the most appropriate in this case?
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A 15-year-old girl complains of dizziness and sensation of lack of air that she develops in emotionally straining situations. Relief occurs after she takes Corvalol. Objectively: hyperhidrosis and marble-like pattern of the skin of her palms and feet. Clinical and instrumental examination revealed no organic alterations of the central nervous, cardiovascular, and respiratory systems. What provisional diagnosis can be made?
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A 14-year-old patient complains of alopecia foci on his scalp. The patient has been presenting with this condition for 2 weeks. Objectively: on the scalp there are several small oval foci with blurred margins. The skin in the foci is pink-red, the hairs are broken off at 4-5 mm length or at skin level. Under Wood's lamp there are no foci of green luminescence detected. What disease is it?
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A 38-year-old patient has been delivered by an ambulance to a surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Blood test: Hb- 108 g/l, thrombocytopenia. Anamnesis states that similar condition was observed 1 year ago. Make the diagnosis:
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A 35-year-old patient developed an epileptic attack with tonoclonic spasms that lasted for 3 minutes. After the attack the patient fell asleep but in 5 minutes the second attack occurred. The first step of emergency aid would be to:
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A 23-year-old woman has been suffering from a mental disease since the age of 18, the course of disease has no remission periods. At a hospital the patient mostly presents with non-purposeful foolish excitation: she makes stereotypic grimaces, exposes herself, publicly masturbates with a loud laughter, repeates stereotypical abusive shouts. The patient should be prescribed:
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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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10 days after birth a newborn developed sudden fever up to 38,1°C. Objectively: the skin in the region of navel, abdomen and chest is erythematous; there are multiple peasized blisters with no infiltration at the base; isolated bright red moist erosions with epidermal fragments are observed on the periphery. What is the provisional diagnosis?
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A man came to an urologist with complains of painful urination, discharge from urethra. The patient has been suffering from this condition for a week. Objectively: hyperemic urinary meatus, edema, purulent discharge. Microscopy of smears detected gram-negative bacteria. Specify the diagnosis:
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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 the other people, through which he receives "thoughts of strangers" and transmits his own thoughts for everyone to hear. He is convinced that his thoughts and actions are being manipulated through this "telepathy". Make the preliminary diagnosis:
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A 35-year-old woman has gained 20 kg weight within a year with the normal diet. She complains of chills, sleepiness, shortness of breath. 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. HR- 56/min, BP-140/100 mm Hg. The patient has been suffering from amenorrhea for 5 months, has constipations. TSH- 28 mclU/l (norm is 0,32-5). Craniogram shows no pathology. What is the etiology of obesity?
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A patient complains of painless 'sores' on his penis and inguinal lymph nodes enlargement. Synthomycin emulsion that the patient have been applying to the 'sores' was ineffective. Objectively: on the inner leaf of the foreskin there are three closely situated rounded erosions, 0,5 cm in diameter, with dense infiltration that can be palpated at their bases. Make the preliminary diagnosis:
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A 1,5-month-old child on breasfeeding presents from birth with daily vomiting, irregular liquid foamy feces, and meteorism, which are resistant to antibacterial and probiotic therapy; no increase of body mass is observed. The child's condition improved, when breastmilk was substituted with "NAN low lactose" formula. What pathology is it?
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