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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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During examination of a healthy infant, the child takes a toy into his hands, turns from the back to the side; when lying on the stomach he can firmly prop himself up on his forearms; the child laughs and makes joyful exclamations. The age of the child is:
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After significant physical exertion a 66-year-old man with deep vein thrombosis of the extremities developed shortness of breath, intense pain in the chest on the left, marked palpitations. The patient's condition is grave, his face is cyanotic, the cervical veins are swollen, BP is 60/40 mm Hg. What investigation method would be the most advisable in this case?
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A 32-year-old woman complains of general fatigue, low-grade fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis: pH 4,8, leukocyturia, hematuria. Complete blood count: leukocytosis, lymphocytosis, increased ESR. Urography concludes: dilatation of renal pelvis and calyceal system of both kidneys, foci of calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?
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A full-term newborn (born with the body weight of 3900 g at gestational age of 39 weeks) on the first day of his life developed respiratory disturbances: dyspnea, arrhythmic respiration, cyanosis attacks. On examination there is paradoxical respiration observed and left side of the chest lags behind in the act of breathing. On auscultation the respiration is weakened in the lungs on the left. Neurologist diagnosed the patient with left-sided Erb-Duchenne palsy. Complete blood count shows no changes. What is the most likely diagnosis?
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A 12-year-old child had three attacks of acute rheumatic fever accompanied by carditis. Examination revealed the symptoms of chronic tonsillitis, mitral insufficiency, and carious teeth. What is the optimal method of secondary prophylaxis?
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A 24-year-old patient had been delivered to a thoracic department with a chest injury, fracture of the IV, V, VI ribs on the right. Plan radiography showed the fluid level in the pleural cavity to be reaching the III rib on the right. Puncture contained blood clots. What is the optimal treatment tactics?
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A 3-year-old child has been delivered to a hospital with complaints of pain in the legs, fever, loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb- 88 g/l, color index - 1,3, platelets - 80 × 109/l, leukocytes - 25,8 × 109/l, lymphoblasts - 70%, ESR - 52 mm/hour. Make the provisional diagnosis:
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A 60-year-old man has a diet consisting of unvaried food staples: mostly cereals, potato, pasta; few vegetables and little fats (especially animal fats). During medical examination he complains of deterioration of his twilight vision. This condition can be caused by lack of:
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A 14-year-old girl came to a general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after previous delay of 2 months. Objectively: the skin is pale, heart rate is 90/min., BP is 110/70 mm Hg, Hb is 88 g/l. Rectal examination: the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
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A postpartum woman on the 12th day after the normal delivery complains of pain localized in her left gastrocnemius muscle. Body temperature is 37,2°C; pulse is 85/min, rhythmic; blood pressure is 128/80 mm Hg. Mammary glands are soft and painless. The uterus is behind the pubis. The left leg in the area of gastrocnemius muscle is by 3 cm larger than the right leg in the diameter. Internal organs present no pathologies. What complication can be suspected?
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Examination of a Rh-negative pregnant woman at 32 weeks of gestation revealed a four-time rise of Rh-antibody titer within 2 last weeks; the titer is 1:64. The first two pregnancies resulted in antenatal fetal death due to hemolytic disease. What is the optimal tactics of pregnancy management?
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During last several weeks an 11-year-old girl has been complaining of dyspnea and edema of shins and feet after physical exercise. After a long rest or sleep through the night her edemas diminish significantly. On clinical examination there are enlarged liver and rasping systolic murmur over the cardiac area. Blood and urine analyzes are without changes. What is the most likely cause of the child's edema?
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A 74-year-old man visited an urologist with complaints of pain above the pubis and inability to urinate for 8 hours. At home he had taken antispasmodics and had a warm bath but no improvement occurred. Objectively: the abdomen is soft and painful above the pubis; dullness of percussion sound is observed above the pubis. Murphy's punch sign (costovertebral angle tenderness) is negative on both sides. What condition does the patient have?
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During preventive examination a 58-year-old man on chest X-ray presents with multiple globular pale shadows 3 cm in diameter within parenchyma of the both lungs. Examination in the oncologic hospital: the primary focus is not found; transbronchial biopsy with cytologic investigation detected cells of glandular neoplasm. What tactics should the physician choose?
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A 36-year-old man developed a disease with acute onset 6 hours ago. The patient presents with pain in the epigastric, ileocecal, and paraumbilical areas, vomiting, weakness, nausea, and body temperature of 38,5°C. Stool is liquid, profuse, frequent, retains fecal nature, foul-smelling, frothy, colored dark green. The stomach is moderately distended and painful on palpation. The patient attributes his disease to eating raw chicken eggs one day before the clinical signs of the disease appeared. What is the most likely diagnosis?
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A 55-year-old woman came to a gynecologist with complaints of leukorrhea and bloody discharge from the vagina after 5 years of menopause. Anamnesis states no pregnancies. Bimanual examination: the uterus and uterine appendages are without changes. During diagnostic curettage of the uterine cavity the physician scraped off enchephaloid matter. What is the most likely diagnosis in this case?
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A 10-year-old boy is delivered into a polytrauma unit after he received a blunt trauma of the thorax, having fallen from the bicycle. Upon hospitalization his blood pressure is 110/80 mm Hg, heart rate is 96/min. Chest X-ray is noncontributive to the diagnosis. Echocardiogram shows free liquid in the pericardial cavity, in the amount of up to 100 ml. In an hour after the hospitalization the patient started to develop increasing signs of heart failure: jugular venous distention, decreased blood pressure down to 90/70 mm Hg, tachycardia up to 120/min. On auscultation muffled heart sounds. What would be the primary tactics of a physician?
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After the celebratory feast that took place the day before, a 35-year-old man was hospitalized with complaints of marked pain within the I metatarsophalangeal articulation on the right, which developed late in the night, and impaired walking. Objectively: the metatarsophalangeal articulation is swollen, hyperemic, hot to touch, painful on movement. In blood: erythrocytes -5,1 × 1012 /l, Hb-155 g/l, leukocytes-13,0 × 109/l, ESR - 50 mm/hour, CRP- 46 mg/dl, uric acid - 720 mcmol/l. X-ray of feet articulations: osteoporosis, narrowing of interarticular spaces, numerous punched-out erosions. Make the preliminary diagnosis:
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A woman in her early- to mid-thirties has lost her consciousness 3-5 minutes ago. On examination: the skin is pale, no pulse over the carotid arteries, no spontaneous respiration, pupils are dilated; the patient is nonresponsive, presents with atony. The patient's condition can be determined as:
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A 32-year-old woman complains of body weight loss despite her increased appetite, nervousness, and tremor of the extremities. Objectively: the skin is moist; the thyroid gland is diffusely enlarged, painless, soft, and mobile. Blood test: increased level of T3, T4, and thyroid-stimulating hormone (THS). What is the most likely diagnosis?
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A 57-year-old patient complains of sensation of dryness and pain during swallowing, frequent unbearable cough, the voice is hoarse. Disease onset was abrupt. On laryngoscopy: laryngeal mucosa is hyperemic, vocal folds are swollen, laryngeal lumen contains viscous secretion. What diagnosis is it?
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A 24-year-old pregnant woman on her 37th week of pregnancy has been delivered to a maternity obstetric service with complaints of weak fetal movements. Fetal heartbeats are 95/min. On vaginal examination the uterine cervix is tilted backwards, 2 cm long, external orifice allows inserting a fingertip. Biophysical profile of the fetus equals 4 points. What tactics of pregnancy management should be chosen?
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During regular preventive gynecological examination a 30-year-old woman was detected to have dark blue punctulated ''perforations" on the vaginal portion of the uterine cervix. The doctor suspects endometriosis of the vaginal portion of the uterine cervix. What investigation method would be most informative for diagnosis confirmation?
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A 26-year-old woman came to a gynecologist for a regular check-up. She has no complaints. Per vaginum: the uterus lies in anteflexion, not enlarged, dense, mobile, painless. On the left from the uterus in the area of uterine appendages there is a mobile painless outgrowth that can be moved independently from the uterus. On the right the appendages cannot be detected. What additional investigation would be informative for diagnosis clarification?
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A 57-year-old patient complains of dyspnea at rest. The patient presents with orthopnea, acrocyanosis, bulging cervical veins. On percussion: dull sound over the lower lung segments; on auscultation: no respiratory murmurs. Heart rate is 92/min. Right-sided cardiac dilatation is observed. The liver is enlarged by 7 cm. Shins are swollen. Pleural effusion is suspected. What indicator would confirm the presence of transudate in this case?
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A 28-year-old woman complains of girdle pain in her epigastric and left subcostal areas with irradiation to the back, nausea, and vomiting without relief. On examination a surgeon observes stomach distension and meteorism. There are positive Mondor's, Mayo-Robson's, and Cullen's symptoms. What is the most likely diagnosis?
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A 36-year-old woman complains of pain in her lumbar area, which irradiates to her lower right limb and increases during movements, and sensation of numbness in her limb. Objectively: palpation of the shin and thigh muscles is painful, positive stretch symptom on the right. MRI scan: herniation of intervertebral disk L5-S1 4 mm in size. What is the most likely diagnosis?
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During routine medical examination a 35-year-old woman presents with enlarged cervical and mediastinal lymph nodes. Her overall health is satisfactory. ESR is 30 mm/hour. Cervical node biopsy was performed. In the specimen there are granulomas composed of epithelial and giant cells, no caseous necrosis detected. What is the most likely diagnosis?
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A 39-year-old woman complains of violent pain in her left lumbar area with irradiation to the right iliac area. Several years ago she was diagnosed with cholelithiasis and urolithiasis. The patient's condition is moderately severe, the skin is dry. Ortner's symptom is negative; costovertebral angle tenderness is observed on the right. The most reasonable treatment tactics would be:
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An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5 years. The first instance of this disease occurred after a car accident. Objectively: the patient presents with papular rash covered in silvery scales, "thimble" symptom (small pits on the nails), affected joints. What is the most likely diagnosis?
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A woman complains of frequent, liquid stool (up to 9-10 times per day) with mucus and blood admixtures, dull pain in the hypogastrium, weight loss of 4 kg within the last year. Objectively: malnutrition, dry skin, low turgor, aphthous stomatitis. The stomach is soft, the sigmoid colon is spastic and painful on palpation. Occult blood test is positive. Fi-brocolonoscopy: edema, hyperemia, mucosal granulation, pseudopolyps, small ulcers with irregular edges. Make the diagnosis:
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A 48-year-old woman has been hospitalized due to development of tachysystolic atrial fibrillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?
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On the 9th day after childbirth the obstetric patient developed high fever up to 38°C. She complains of pain in the right mammary gland. On examination a sharply painful infiltrate can be palpated in the right mammary gland, the skin over the infiltrate is red, subareolar area and nipple are swollen and painful. What is your diagnosis?
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A 32-year-old woman complains of episodes of intense fear that occur without visible cause and last for 10-20 minutes; the episodes are characterized by rapid pulse, sweating, labored breathing, and vertigo. Specify the likely diagnosis:
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A resuscitation unit received a 46-year-old woman, who has been suffering from diabetes mellitus type 1 for approximately 30 years. Objectively: the skin is pale, heart sounds are weakened, BP is 170/100 mm Hg, lower limbs are markedly swollen. Blood creatinine -1125 mcmol/l, urea - 49,6 mmol/l, potassium - 6.3 mmol/l, glucose - 7,6 mmol/l, glomerular filtration rate - 5 ml/min. What treatment is indicated for the patient in the first place?
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A woman is on the 32nd week of her second pregnancy. She complains of fever, chills, nausea, vomiting, lumbar pain, and dysuria. Costovertebral angle tenderness is present on both sides. Urine analysis: pyuria, bacteriuria. Blood test: leukocytosis. What is the most likely diagnosis?
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A 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 ml per day, hemoptysis, dyspnea, increased body temperature up to 37,8°C, general weakness, weight loss. The patient's condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, various numerous moist crackles in the lower pulmonary segments on the left can be observed. In blood: erythrocytes - 3,2 × 1012/l, leukocytes - 8,4 × 109/l, ESR - 56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?
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A 37-year-old man working as a typesetter in a print shop complains of rapid fatigability, paroxysmal attacks of stomachache, weak drooping hands. Examination of neurological status revealed hypotrophy of the forearm muscles. Carporadial reflexes are sharply weakened. Sensitivity is not disturbed. Gums present with dark blue border. What neurological pathology is it?
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A 54-year-old woman takes antihypertensive drugs for hypertension. Having discovered that her son was arrested and is under investigation, became agitated and extremely anxious. She lost her orientation in place, stopped recognizing her relatives, started hearing ''voices" threatening her and her son with violence. She had opened her window (on the 8th floor) and tried to jump out, resisted the people, who were holding her back. What drugs should be administered to terminate such condition of the patient?
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A 43-year-old man, who has been abusing alcohol and suffering from pulmonary tuberculosis, in the course of two weeks gradually developed general weakness, headache, diplopia, vomiting. Objectively: ptosis on the left, anisocoria S>D, exotropia of the left eye, neck stiffness; Kernig's and Brudzinski's signs are positive. In cerebrospinal fluid: lymphocytic pleocytosis, low glucose, precipitation of cerebrospinal fluid resulted in production of fibrin film. What is the most likely diagnosis?
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