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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 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart dullness: right - the parasternal line, upper - the III rib, left -1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
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A 48-year-old man complains of fatigue, excessive sweating, severe skin itching, undulant fever, enlarged cervical and supraclavicular lymph nodes. Objectively: paleness of skin and mucosa, cervical lymph nodes are mobile, dense, elastic, walnut-sized, painless, not attached to the skin. Complete blood count: erythrocytes - 3,0 × 1012/l, Hb-100 g/l, leukocytes - 14 × 109/l, eosinophils -6%, basophils - 3%, band neutrophils -11%, segmented neutrophils - 69%, lymphocytes -7, monocytes - 4%, platelets - 280 × 109/l, ESR - 37 mm/hour. What method should be applied to verify the diagnosis?
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A patient after a blow to the head developed general symptoms of cerebral disturbance, nausea, vomiting, focal signs hemihyperreflexia S>D, hemihyperesthesia on the left, marked meningeal syndrome. Neither cranial X-ray nor computer tomography revealed any pathologies. What examination method would allow making and clarification of the diagnosis?
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A 72-year-old man complains of lower extremity edema, sensation of heaviness in the right subcostal area, dyspnea of rest. For over 25 years he has been suffering from COPD. Objectively: orthopnea, jugular venous distention, diffuse cyanosis, acrocyanosis. Barrel chest is observed, on percussion there is vesiculotympanitic (bandbox) resonance, sharply weakened vesicular respiration on both sides, moist crepitant crackles in the lower segments of the lungs. Heart sounds are weakened, the II heart sound is accentuated over the pulmonary artery. The liver is +3 cm. What complicated the clinical course of COPD in this patient?
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A multigravida at 39 weeks of gestation presenting with regular labour activity for 8 hours has been delivered to a hospital; the waters broke an hour ago. She complains of headache, seeing spots. BP is 180/100 mm Hg. Urine test results: protein - 3,3 g/l, hyaline cylinders. Fetal heart rate is 140/min, rhythmical. Vaginal examination reveals complete cervical dilatation, the fetal head is on the pelvic floor, sagittal suture is in line with obstetric conjugate, the occipital fontanel is under the pubis. What is the optimal tactics of labour management?
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After the contact with chemicals a plant worker has suddenly developed stridor, voice hoarseness, barking cough, progressing dyspnea. Objective examination reveals acrocyanosis. What is the provisional diagnosis?
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An 18-year-old woman complains of pain in her lower abdomen, profuse purulent discharge from the vagina, temperature rise up to 37,8°C. Anamnesis states that she had a random sexual contact the day before the signs appeared. She was diagnosed with acute bilateral adnexitis. On additional examination: leukocytes are present throughout all vision field, bacteria, diplococci with intracellular and extracellular position. What is the most likely agent in the given case?
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A 58-year-old man complains of general weakness, loss of 10 kg of weight within 1,5 months, progressive pain in the lumbar region, increased blood pressure up to 220/160 mm Hg, low grade fever. Objectively: in the right hypochondrium deep palpation reveals a formation with uneven surface and low mobility; veins of the spermatic cord and scrotum are dilated. Blood test results: Hb- 86 g/l, ESR - 44 mm/h. Urine test results: specific gravity - 1020, protein - 0,99 g/l, RBC cover the whole field of vision, WBC- 4-6 in the field of vision. What is the provisional diagnosis?
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Anamnesis of a 30-year-old patient includes closed thoracic injury. Lately the patient has been suffering from increasing dyspnea, sensation of heaviness in the right subcostal area, and heart rate disturbances. Objectively: acrocyanosis, bulging cervical veins, ascites, edema of the lower extremities. Heart auscultation reveals muffled heart sounds, additional III heart sound is detected. Provisional diagnosis of constrictive pericarditis was made. What diagnostic technique would NOT confirm the diagnosis?
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A 72-year-old woman suffers from diabetes mellitus type 2, concomitant diseases are stage 2 hypertension and stage 2B heart failure. She takes metformin. Hypertensic crisis had occurred the day before, after which the patient developed extreme weakness, myalgias, thirst, dry mouth, polyuria. BP is 140/95 mm Hg, heart rate is 98/min., no edemas or smell of acetone detected. What measures should be taken to prevent development of comatose state in the patient?
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The body of a 24-year-old woman with probable signs of poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the Criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
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It is the 3rd day after the normal term labor; the infant is rooming-in with the mother and is on breastfeeding. Objectively: the mother's general condition is satisfactory. Temperature is 36,4°C, heart rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless; lactation is moderate, unrestricted milk flow. The uterus is dense, the uterine fundus is located by 3 fingers width below the navel. Lochia are sanguino-serous, moderate in volume. Assess the dynamics of uterine involution:
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Survey radiograph of a 52-year-old worker of an agglomeration plant (28-year-long record of service, the concentration of metal dust is 22-37 mg/m3) shows mildly pronounced interstitial fibrosis with diffused contrasting 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 53-year-old woman complains of weight loss up to 10 kg within the last 2 years, liquid foul-smelling stool two times a day that poorly washes off the toilet, periodic bouts of nausea, girdle pain in the upper abdomen. Objectively: pain in Gubergrits zone (on the right from navel) and at Mayo-Robson's point. Biochemical blood analysis: glucose - 3,2 mmol/l, bilirubin - 16,5 mcmol/l, crude protein - 56,4 g/l. Urine diastase/amylase - 426 g/h/l. D-xylose test (oral administration of 25 g of d-xylose) after 5 hours reveals 3 g of xylose in urine. The most likely diagnosis is:
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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 the most informative for determining diagnosis?
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A 64-year-old patient has been hospitalized with complaints of progressive jaundice that developed over 3 weeks without pain syndrome and is accompanied by general weakness and 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 by these symptoms?
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A 6-year-old girl came to 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 37-year-old patient complains of pain in the spinal column, reduced mobility. The condition persists for 7 years. "Sway back" is observed, there is no movement in all spinal regions. On X-ray: "bamboo spine" is detected. What is the most likely diagnosis?
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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 a small amount of mucoserous discharge from the urethra. Subjectively: periodical itching or burning pain in the urethra. Two months ago pain in the knee joint 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 made?
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A 19-year-old woman complains of severe pain in the axillary crease. Condition onset occurred a week ago after her swimming in a cold river and epilation. The next day a painful "boil" appeared. The "boil" was increasing in size every day and became a plum-sized tumor. Upon examination there are nodular conical growths joined together 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. What is the most likely diagnosis?
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A woman complains of weight gain, chills, edema, xeroderma, somnolence, difficulties with focusing. Objectively: height is 165 cm; weight is 90 kg; body proportions are of female type, to- 35,8°C, heart rate -58/min, BP- 105/60 mm Hg. Heart sounds are weakened, bradycardia is observed. Other internal organs have no alterations. Thyroid gland cannot be palpated. Milk secretion from mammary glands is observed. Hormone test revealed increased levels of thyroid-stimulating hormone (TSH) and prolactin, and decreased level of thyroxine (T4). What is the cause of obesity?
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ECG revealed the following in a 10-year-old child: sharp acceleration of the heart rate - 240/min., P wave overlaps with T wave and deforms it, moderate lengthening of PQ interval, QRS complex is without alterations. What pathology does this child have?
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A 54-year-old patient complains of weakness, jaundice, itching skin. Disease onset was 1,5 months ago: fever up to 39°C appeared at first, with progressive jaundice developed 2 weeks later. On hospitalization jaundice was severely progressed. Liver cannot be palpated. Gallbladder is enlarged and painless. Blood bilirubin is 190 mcmol/l (accounting for direct bilirubin). Stool is acholic. What is the most likely jaundice genesis in this patient?
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During hemotransfusion the patient developed nausea, tremor, lumbar and retrosternal pain. On examination the skin is hyperemic, later developed pallor; the patient presents with hyperhidrosis, labored respiration, pulse is 110/min., BP is 70/40 mm Hg. Urine is black colored. What complication developed in the patient?
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A 22-year-old man suddenly developed extreme weakness, nausea, vomiting with traces of blood. The patient is known to suffer from peptic ulcer disease of duodenum and hemophilia A. Objectively: heart rate -102/min., BP-100/60 mm Hg. Complete blood count: erythrocytes - 3,2 × 1012/l, Hb- 98 g/l, color index - 0,92, leukocytes - 7,4 × 109/l, platelets - 240 × 109/l, ESR - 11 mm/hour. What measure would most effectively decrease hemorrhaging in this case?
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A 22-year-old woman complains of amenorrhea for 8 months. Anamnesis states that menarche occured at the age of 12,5. Since the age of 18 the patient has a history of irregular menstruation. The patient is nulli-gravida. The mammary glands are developed properly, nipples discharge drops of milk when pressed. Hormone test: prolactin level is 2 times higher than normal. CT reveals a bulky formation with diameter of 4 mm in the region of sella. What is the most likely diagnosis?
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A 13-year-old girl complains of fatigability, frequent headaches, cardialgia. Eight years ago she had a case of pyelonephritis. Urine analyzes periodically revealed leukocyturia. The child has undergone no further treatment. On examination: increased BP up to 150/100 mm Hg. Ultrasound investigation revealed significant reduction of the right kidney. What process is leading in arterial hypertension pathogenesis in this case?
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A 3-month-old child presents with saffron-yellow coloring of the skin, sclera, and mucous membranes. The abdomen is enlarged, hepatomegaly and splenomegaly are observed. In blood there is conjugated bilirubin-induced hyperbilirubinemia. On intravenous cholangiocholecystography: opacified bile is discharged into the intestine. Transaminase activity is normal. What is the most likely diagnosis?
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A 51-year-old woman complains of headache, trembling, paresthesiae, palpitations, increased blood pressure up to 280/160 mm Hg. The day before she experienced exhausting headache, vascular pulsation, palpitations, asphyxia, stomachache, unbearable fear of coming death. The patient paled and broke out in cold sweat. In urine there is increased content of vanillylmandelic acid. What disease causes such clinical presentation in the patient?
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A 52-year-old patient suffers from marked dyspnea during physical exertion, non-productive cough. The patient's condition has been persisting for 8 months. The patient has been a smoker for 30 years. In the lungs there are cellophane-type crackles auscultated on both sides. Respiration rate is 26/min., oxygen saturation of blood is 92%. On spirometry: moderate restrictive-type disturbance of external respiration. What is the most likely diagnosis?
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A 26-year-old patient with affective bipolar disorder has developed a condition manifested by mood improvement, behavioural and sexual hyperactivity, verbosity, active body language, reduced need for sleep. Which of the following drugs would be most effective in this case?
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A 19-year-old patient complains of dyspnea on exertion. He often has bronchitis and pneumonia. Since childhood the patient presents with cardiac murmur. Auscultation revealed splitting of the II sound above the pulmonary artery, systolic murmur in the 3rd intercostal space at the left sternal border. ECG detected right bundle branch block. What is the provisional diagnosis?
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A 30-year-old patient was in a car accident. He is unconscious, pale, has thready pulse. In the middle third of the right thigh there is an extensive laceration with ongoing profuse external arterial bleeding. What urgent actions must be taken to save the life of the patient?
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A 25-year-old patient has been admitted to the hospital with the following problems: weakness, sweating, itching, weight loss, enlarged submandibular, cervical, axillary, inguinal lymph nodes. Objectively: hepatomegaly. Lymph node biopsy revealed giant Berezovsky-Reed-Sternberg cells, polymorphocellular granuloma composed of lymphocytes, reticular cells, neutrophils, eosinophils, fibrous tissue, and plasma cells. What is the most likely diagnosis?
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An 9-year-old child was hospitalized for fever up to 39,8°C, inertness, moderate headache, vomiting. Examination revealed meningeal symptoms. Lumbar puncture was performed. The obtained fluid was characterized by increased opening pressure, was transparent, with the cell count of 450 cells per 1 mcL (mainly lymphocytes - 90%), glucose level of 3,6 mmol/l. What agent could have caused the disease in the child?
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A 25-year-old woman has a self-detected tumor in the upper outer quadrant of her right breast. On palpation there is a painless firm mobile lump up to 2 cm in diameter, peripheral lymph nodes are without alterations. In the upper outer quadrant of the right breast ultrasound revealed a massive neoplasm with increased echogenicity sized 21x18 mm. What is the most likely diagnosis?
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A 68-year-old man complains of inability to urinate for a day. On attempt of urinary bladder catheterization there was detected a rough stricture in the membranous portion of the urethra. What first aid tactics should be applied in this case?
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Heart X-ray of a 31-year-old man has revealed the following: with tightly filled opacified esophagus there is a marginal filling defect in its middle third on the posterior wall; the defect is 1,8x1,3 cm in size with clear oval border. Mucosal folds are retained and envelop the defect; wall peristalsis and elasticity are not affected. There are no complaints regarding the condition of the patient's alimentary canal. Make the provisional diagnosis:
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A patient with signs of general overexposure to cold presenting with local frostbites of fingers has been delivered into an admission room. Objectively: conscious, inert, speech is slow, the skin of the face is cold, body temperature is 34°C, heart rate is 68/min. What would be the actions of a doctor on call?
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A 22-day-old infant developed subcutaneous red nodes from 1,0 to 1,5 cm in size on the scalp; later the nodes suppurated. Temperature increased up to 37,7°C, intoxication symptoms appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, increased ESR. What diagnosis will you make?
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