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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 25-year-old patient was delivered to an infectious diseases unit on the 3rd day of illness with complaints of headache, pain in lumbar spine and gastrocnemius muscles, high fever, chill. Objectively: condition 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 colour. Stool is normal in colour. The most likely diagnosis is:
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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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During winter epidemics of influenza caused predominantly by virus А/California/04/2009 (H1N1), on the 2nd day after the disease onset a 30-year-old hospitalized man presented with high fever, dry cough, myalgia, headache, and general weakness. What should be prescribed as etiotropic treatment in this case?
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A 20-year-old student was brought to the first-aid center. He has a closed fracture of the left forearm and a contused lacerated wound on his left shin. After the patient received initial wound management, he presented the documents confirming that he has received all the necessary preventive vaccination as scheduled. What should the doctor do to prevent tetanus in this patient?
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During assessment of work conditions at the factory manufacturing mercury thermometers, the content of mercury vapors in the air of the working area is revealed to exceed the maximum concentration limit. Specify the main pathway of human body exposure to mercury:
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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 has been persisting for 4 years. Exacerbations occur 2-3 times per 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 35-year-old patient has been suffering from an illness for 3 days. 5 days ago he returned from a trip to Africa. The onset of disease was accompanied by fever up to 40°C, chills, acute headache, myalgia. In the axillary region the lymph node enlarged up to 3 x 6 cm can be palpated. The lymph node is dense, intensely painful, slightly mobile, without clear margins; the skin over the node is hyperemic and tight. Tachycardia is present. Make the preliminary diagnosis:
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Establishments participating in medical examinations include: medical and preventive treatment facilities, hygiene and preventive treatment facilities, sociomedical expert committees, Ministry of Defence medical committees, Ministry of Domestic Affairs medical committees, forensic medicine agency, etc. Specify what service deals with sociomedical assessment of temporary disability:
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A 26-year-old woman is suspected to suffer from systemic lupus erythematosus with systemic lesions of skin, vessels, joints, serous tunics, and heart tissue that developed after photosensitization. The following is detected in blood analysis: LE cells, antibodies to native ds-DNA, isolated anti-centromere antibodies, rheumatoid factor is 1:100, Wassermann reaction is positive, circulating immune complex is 120 units. What immunological indicators are considered to be specific to this disease?
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The inpatient surgery unit has introduced the method of laparoscopic cholecystectomy into its practice. As the result the average duration of postoperative care provided to the patients could be reduced to 3.4±8 days compared to 7.3±1.1 days that were required after non-laparoscopic cholecystectomy. What method of medical statistics can confirm the statistical significance of the difference between these two estimates?
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In autumn a 45-year-old man was recommended an elective surgery for coronary artery bypass grafting due to multivessel coronary artery disease. The patient has never received anti-influenza vaccination. Why would the family doctor offer a scheduled yearly vaccination against influenza to this patient?
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A 3-year-old child presents with sharp deterioration of his general condition. He has a history of purulent otitis. His temperature is now 38.5°C. The left leg is pressed to the torso, active movements are absent, the lower third of the thigh and knee joint are thickened, hyperemic, with localized fever. Axial load leads to acute discomfort of the patient. What is the most likely diagnosis?
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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 group of 5 had been resting in a forest, they were drinking alcohol and eating canned mushrooms and cured fish. The next day two of them were hospitalized with disturbed vision, swallowing and respiration; the third one presented with acute general weakness and dry mouth. The remaining two were healthy. A tick was detected on the skin of one of the healthy group members. What is the most likely diagnosis
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A 22-year-old woman, gravida 1, para 0 arrived with complaints of sharply painful contractions that occur every 4-5 minutes and last for 25-30 seconds. Amniotic fluid did not burst. The fetus is in transverse lie, fetal heartbeats are not affected. Contraction ring is acutely painful, located obliquely at the umbilicus. What is the most likely diagnosis?
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A 26-year-old man is undergoing a regular check-up. One year ago he had a case of tonsillar diphtheria complicated with myocarditis. Presently his condition is satisfactory, no signs of cardiovascular failure; ECG shows first-degree atrioventricular block. What vaccine was administered to this man according to his age?
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A 72-year-old man complains of lower extremity edema, sensation of heaviness in the right subcostal area, dyspnea in 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 58-year-old patient complains of pain in the lower left extremity, which aggravates during walking, and 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. Pulse cannot be detected over the pedal and popliteal arteries and is weakened over the femoral artery. On the right limb pulsation of the popliteal artery is retained. What is the most likely diagnosis?
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A 45-year-old veterinary worker has made an appointment with the doctor for regular examination. In his duties he frequently deals with animals, however he denies working with rabies-affected animals. Previously he has received no antirabic vaccination. What should the doctor recommend in this case?
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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 decreased thyroid-stimulating hormone (TSH). What is the most likely diagnosis?
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A 59-year-old patient suffering from hypertension was delivered to the hospital with complaints of acute headache, nausea, recurrent vomiting. On examination she presents with acute meningeal symptom complex. BP is 185/105 mm Hg. What additional examination would you recommend to the patient in the first place?
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A woman complains of temperature increase up to 39°C, sharp pains in her lower abdomen, and sanguinopurulent discharge from her genital tracts. From her case history it is known that 6 days ago she underwent illegal abortion. Objectively her blood pressure is 100/60 mm Hg, pulse is 110/min. Abdominal rigidity, rebound tenderness (Bloomberg’s sign), and painful palpation of the lower abdomen are observed. On bimanual examination the uterus is enlarged up to 7 weeks of pregnancy, painful, and soft; posterior vaginal fornix overhangs. Make the 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 28-year-old man, a teacher, after emotional stress developed painful muscle spasms in his right hand that occur during writing; now he has to hold the pen between the second and third fingers. He has no problems with typing or writing on the blackboard; no other motor disturbances or neurological pathologies are detected. What is the most likely diagnosis?
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In April during the medical examination of various population groups, 27% of individuals presented with low working ability and rapid fatigability. The following symptoms were observed in the affected individuals: swollen friable gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied by skin dryness. These symptoms most likely result from the following pathology:
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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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To assess the effectiveness of medical technologies and determine the power and direction of their effect on the public health indicators, the research was conducted to study the immunization rate of children and measles incidence rate by district. What method of statistical analysis should be applied in this case?
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A 30-year-old patient was hospitalized in an intensive care unit with a diagnosis of multiple bee stings. Skin is pale and covered with cold sweat. Pulse can be palpated only at the carotid arteries and is 110/min.; breathing rate is 24/min., rhytmical, weakened. What drug must be administered immediately?
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A 36-year-old man has been complaining of marked weakness, low appetite, and nausea for the last year, year and a half. Within the last year he has lost 10 kg of body mass. The skin is darkened, especially on his face, neck, and arms. Skin folds and nipples are hyperpigmented, there are pigment spots on the patient’s inner thighs. Pulse is 60/min., blood pressure is 80/50 mm Hg. What is the provisional diagnosis?
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The right arm of a newborn is stretched along the torso with all its joints extended; the shoulder is rotated inwards, while the forearm is pronated, the hand is in the position of palmar flexion. Spontaneous movements are absent in the shoulder and elbow joints, passive movements are painless. What is the most likely diagnosis?
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A 72-year-old woman suffers from diabetes mellitus type II, concomitant diseases are stage II hypertension and stage IIB 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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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 moon-like face), acne, striae on the thighs and lower abdomen, hirsutism. What hormone can cause such symptoms, when in excess?
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An 18-year-old young man complains of pain in his knee and elbow joints and body temperature up to 39.5°C. One week and a half earlier developed sore throat. On examination his body temperature is 38.5°C. Swelling of the knee and elbow joints is observed. Pulse is 106/min., rhythmic. Blood pressure is 90/60 mm Hg. Cardiac borders are unchanged, heart sounds are weakened, at the cardiac apex there is soft systolic murmur. What factor would be the most indicative of the likely disease etiology?
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A 28-year-old man after car accident received a wound to the right side of his chest inflicted by a sharp metal object. A foamy liquid flows out from the wound, there are tympanitis and acutely weakened respirations in the right. Blood pressure is 70/30 mm Hg, pulse is 120/min., Hb is 28 g/L. X-ray shows collapsed right lung, horizontal fluid level is at the 3rd rib. What treatment tactics should be chosen?
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A 28-year-old woman has made an appointment with the family doctor to receive vaccination against influenza. However, having collected the patient’s medical history, the doctor claimed this procedure to be absolutely contraindicated for this woman. What anamnestic data is the absolute contraindication to vaccination?
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A 37-year-old man suffers from attacks of unconsciousness, dyspnea during physical exertion, periodical sensations of heart rate disorder. Father of the patient died suddenly at the age of 45. Objectively: heart rate is 90/min., BP is 140/90 mm Hg. On heart US: ejection fraction – 55%, significant myocardium thickening of the left ventricle and interventricular septum. What drug should be prescribed for the treatment?
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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 other people, through which he receives "thoughts of strangers" and transmits his own thoughts for everyone to hear. He thinks his thoughts and actions are manipulated through this "telepathy". Make the preliminary diagnosis:
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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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The objective of a statistical research was to find out to what extent the population peruses the available medical services. For this purpose 300 residents of the area were interviewed. Information was collected by means of a special questionnaire. What method of collecting information was used by the researchers?
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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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