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KROK 2 Medicine 2018 Questions | KROKEXAM
Browse 2018 KROK 2 Medicine exam questions with answers and explanations.
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A 35-year-old man complains of persisting enlargement of his peripheral lymph nodes that cause him no discomfort. The case history states that the first lymph nodes to enlarge were cervical, supraclavicular, and axillary; new groups of lymph nodes emerged. Objectively the lymph nodes are soft and elastic on palpation, enlarged, painless, not fixed to the surrounding tissue. What examination method would be the most informative for early diagnostics of this disease?
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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 64-year-old man suddenly sensed pain in his occipital area, dizziness, general weakness. He has a 15-year-long history of hypertension. Objectively the skin and mucosa are of normal color. Auscultation reveals vesicular respiration across the lung surface. At the cardiac apex the I heart sound is weakened, the II heart sound is accentuated over the aorta. Pulse is 84/min., blood pressure is 180/100 mm Hg. Other body organs and systems are unaffected. What drug should be prescribed in the first place?
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During regular check-up the doctor examines a young woman, a student, with height of 162 cm and weight of 59 kg. She complains that in the evening she becomes unable to see clearly the objects around her. Objectively her skin is dry, presents with hyperkeratosis. Her daily ration has the following vitamin content: vitamin A – 0.5 mg, vitamin B1 – 2.0 mg, vitamin B2 – 2.5 mg, vitamin B6 – 2 mg, vitamin C – 70 mg. Make the diagnosis:
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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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A 9-year-old girl complains of fever up to 38.5°C, headache, inertness, weakness, loss of appetite, stomachache, and frequent painful urination. Provisional diagnosis of acute pyelonephritis is made. Clinical urine analysis: specific gravity – 1016, no protein, leukocytes – 10-15 in the vision field. What investigation method can verify the diagnosis of urinary tract infection?
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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. The examination revealed the following: 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 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 burn victim with flame burns of the IIIA-B and IV degrees on his face, neck, and anterior surface of the thorax was brought into the admission room. The hairs in his nostrils are burnt, his labial and glossal mucosa are gray-white. The voice is hoarse; respirations are frequent and shallow; the patient has trumpet-like cough that produces soot-streaked sputum. The signs of respiratory failure were progressing, while the patient was being transported into the intensive care unit. What emergency care must be provided to this patient?
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On ultrasound of the thyroid gland, a 47-year-old woman presents with a hypoechoic node 1.6 cm in diameter with blurred margins and intranodular hypervascularization. The doctor suspects thyroid carcinoma. What method should be used to verify the diagnosis?
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A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38°C. Examination shows him to be in a moderately severe condition; there are small pale pinknon-merging spots on the skin of his back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
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A 1.5-month-old child on breastfeeding presents from birth with daily vomiting, irregular liquid foamy feces, and flatulence, which are resistant to antibacterial and probiotic therapy; no increase of body mass is observed. The child’s condition improved, when breastmilk was substituted. What pathology is it?
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After a long drive with the window open a man developed facial asymmetry; he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of gustatory sensation in the tongue on the right. No other neurological pathologies were detected. What disease can be provisionally diagnosed in this patient?
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A 60-year-old man presents with subcompensated viral liver cirrhosis (HCV), Child-Pugh class B. What tactics should be chosen regarding the vaccination against influenza 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 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 16-year-old adolescent living in a rural area has been bitten in the shin by a stray dog. The wound is superficial. Regular vaccination against tetanus was received 3 months ago. What treatment tactics would be the most advisable in this case?
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A 20-year-old woman, gravida 2, para 1 has been in labor for 4 hours. Her condition is satisfactory. Moderately painful contractions occur every 3 minutes and last for 35-40 seconds. The waters have not burst yet. The fetus is in longitudinal position. Fetal heartbeats are 136/min., clear and rhytmic. Major segment of the fetal head is engaged to the pelvic inlet. Vaginal examination shows smooth cervix of 6 cm, amniotic sac is intact, sagittal suture is in the left oblique diameter, occipital fontanel is on the right near the symphysis pubis. What stage of the labor is it?
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A 45-year-old woman came to the maternity clinic with complaints of periodical pains in her mammary glands that start 1 day before menstruation and stop after the menstruation begins. Palpation of the mammary glands detects diffuse nodes predominantly in the upper outer quadrants. What is the most likely diagnosis?
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A man complains of sore throat on the left, pain in his left ear, to up to 39°C, and nasal sound of his voice. Disease onset was 5 days ago. Marked trismus and increased salivation are observed. The head tilts to the left shoulder. Left side of the soft palate presents with swelling, hyperemia, and infiltration. Retromandibular lymph nodes on the left are acutely painful on palpation. Otoscopy results are normal. Make the diagnosis:
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A 28-year-old woman complains of nausea, stomachache, pain in her tongue, and liquid feces. Three days ago she ate poorly salted pike caviar. Objectively her skin is pale, the tongue looks "lacquered" (bald tongue). Pulse is 100/min., with muffled heart sounds and systolic murmur over the cardiac apex. Blood pressure is 95/50 mm Hg. The liver is enlarged by 3 cm. Hemogram shows anemia, eosinophils – 18%. Oval helminth eggs were detected in feces. Make the provisional diagnosis:
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A 47-year-old woman came to the admission room with complaints of general weakness, dizziness, vomiting with blood clots. Condition onset was 3 hours ago. The patient has no preceding illnesses. Blood pressure is 90/60 mm Hg, pulse is 106/min., of poor volume. The abdomen is soft, with mild tenderness in the epigastrium. Blood test: erythrocytes – 2.1 × 1012/L, Hb- 70 g/L, hematocrit – 28%. What tactics should the doctor on duty choose?
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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: temperature – 38.9°C, respirations – 24/min., pulse – 100/min., blood pressure – 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. Complete blood count 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 in this case?
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Due to introduction of a new treatment method, average duration of therapy in the experimental group was 12.3±2 days compared to 15.4±0.4 days in the control group that was treated by the old method. What calculations should be made to estimate the statistical significance of the difference in the results?
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A 45-year-old man developed constricting retrosternal pain that occurs during walks at the distance of 200 m. Objectively heart rate is 80/min., BP is 160/90 mm Hg. During cardiopulmonary exercise test at 50 W there is a depression of S-T segment by 3 mm below the isoline in V3-V4. What is the provisional diagnosis?
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A 60-year-old woman complains of unbearable pain in her right subcostal area. She has a history of acute pancreatitis. Temperature is 38.2°C. Objectively her sclera are icteric. There are no signs of peritoneal irritation. Ortner’s and Gubergrits’ symptoms are positive. Urine diastase is 320 U/L. 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 40-year-old man developed fever up to 37.5°C and macular rash 10 days after the first dose of MMR (Measles-Mumps-Rubella) vaccine was administered. The vaccination was considered necessary as there was a measles outbreak in the city and the patient had not received MMR vaccination in his childhood. Is revaccination with MMR vaccine possible?
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A 60-year-old man presents with ischemic heart disease and heart failure of the IV class according to NYHA (New York Heart Association) that manifests as dyspnea at rest. There are moist crackles in the patient’s lungs. Liver +4 cm, lower limbs are swollen. Ejection fraction is 25%. What sign is the most indicative when determining functional class of heart failure according to NYHA?
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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 5-year-old child that contacts with viral hepatitis in the kindergarten presents with increased body temperature up to 38°C, weakness, low appetite, single case of vomiting, dull pain in the subcostal area on the right. The child is provisionally diagnosed with viral hepatitis. What examination would be the most informative for diagnosis confirmation?
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A 15-year-old girl suffers from systemic lupus erythematosus and has been receiving prednisolone therapy in the daily dosage of 2 mg/kg for the last 6 weeks. The plans are made to gradually lower the dosage of the medicine. No clinical signs of her disease are observed. Previously she has received no immunization against measles. Due to measles outbreak it is necessary to develop the immunity against this infection in the patient. When can she be vaccinated?
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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 3-day-old infant with hyperbilirubinemia (428 mcmol/L) developed disturbances manifesting as periodical excitation and convulsions against the background of inertness, hypotension, hypodynamia, and inhibition of unconditioned reflexes, convergent strabismus, rotational nystagmus, and setting-sun eye phenomenon. What is the most likely cause of such symptoms?
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A 14-year-old boy presents with moderate bronchial asthma in its exacerbation period. What drug should be prescribed to stop an acute attack of expiratory dyspnea?
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A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. Objectively his skin is gray; there is pink-gray stripe on his gums; the stomach is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. There is tendency to constipation. What is the most likely provisional diagnosis?
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A newborn has Apgar score of 9. When should the infant be put to the breast?
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A 36-year-old man complains of marked dyspnea and cardiac pain. He ascribes his disease to the case of influenza that he had 2 weeks ago. Objectively he leans forward when sitting. The face is swollen, cyanotic, cervical veins are swollen. Heart borders are extended on the both sides, heart sounds are muffled, heart rate = Ps = 118/min., BP is 90/60 mm Hg. Blood test: ESR is 16 mm/hour. ECG shows low voltage. X-ray shows trapezoidal cardiac silhouette and signs of pulmonary congestion. Choose the treatment tactics:
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A 7-year-old boy has been an inpatient for 1.5 months. He had been delivered to the hospital with complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis: proteins – 7.1 g/L, leukocytes – 1-2 in the vision field, erythrocytes – 3-4 in the vision field. During the course of treatment the edemas gradually dissipated, headache abated, diuresis normalized. Daily urine proteins – 3 g/L. Biochemical blood test: total protein – 43.2 g/L, urea – 5.2 mmol/L, cholesterol – 9.2 mmol/L. What glomerulonephritis syndrome is the most likely to be present in the patient?
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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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