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KROK 2 Medicine 2018 Questions | KROKEXAM
Browse 2018 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A man diagnosed with closed-angle glaucoma, grade IIa, of the right eye is registered for regular medical check-ups. In the evening an acute glaucoma attack occurred in his right eye; an ambulance was called. What emergency aid would be optimal in this case?
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A 9-month-old infant presents with delayed tooth eruption and fontanel closure, weakness, and excessive sweating. What type of hypovitaminosis is the most likely in this child?
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A patient with Morgagni-Adams-Stokes syndrome has fainted when walking up the stairs. The skin is pale, the pupils are dilated, tonoclonic spasms are observed, rib cage is immobile. Make the diagnosis:
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A 43-year-old woman complains of pain in the lumbar area, which irradiates to her left leg and aggravates on movement, and sensation of numbness in this leg. Objectively palpation of her shin and thigh is painful, there are painful stretch symptoms of on the left and gastrocnemius cramps. There is no sensory loss or weakening of reflex responses. Make the diagnosis:
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For a week a 42-year-old patient has been suffering from fever attacks followed by high temperature, which occur every 48 hours. Body temperature raises up to 40°C and decreases in 3-4 hours with excessive sweating. The patient presents with loss of appetite and general fatigue. The skin is pale and sallow. The liver and spleen are enlarged and dense on palpation. What method of diagnosis verification would be most efficient?
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When her car collided with a tree, a 37-year-old woman felt sharp pain in her left hip joint. She was unable to get out of the car. Her position is forced, the hip is pressed to the abdomen, fixed, and rotated inwards; the limb is flexed in the knee, any attempt to change the position results in sharp pain. Make the diagnosis:
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The mother of a 3-month-old child came to a family doctor with complaints of her child being physically underdeveloped and suffering from cough attacks and dyspnea. Anamnesis: the child is the result of the second full-term pregnancy with the risk of miscarriage (the first child died of pulmonary pathology at the age of 4 months, according to the mother). Body mass at birth is 2500 g. Cough attacks were observed from the first days of life, twice the child was treated for bronchitis. Considering the severity of the child’s condition the doctor made the referral for hospitalization. What diagnosis was most likely stated in the referral?
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A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric sclera, and bright-red fissured tongue. Lymph nodes are not enlarged. Pulse – 100/min. BP- 105/70 mm Hg. Liver +3 cm, the spleen cannot be palpated. Blood test: erythrocytes – 1.2 × 1012/L, Нb- 56 g/L, color index – 1.4, macrocytes, leukocytes – 2,5 × 109/l, eosinophils – 1%, juvenile – 1%, metamyelocytes – 1%, band neutrophils – 8%, segmented neutrophils – 47%, lymphocytes – 38%, monocytes – 4%, reticulocytes – 0.1%, platelets – 100 × 109/l, ESR - 30 mm/hour, indirect bilirubin – 26 mmol/L. What changes can be expected in the bone marrow puncture material?
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A 52-year-old patient complains of pain in the right part of her chest, dyspnea, cough with large amounts of foamy sputum emitting foul smell and resembling "meat slops". Objectively: the patient’s condition is grave, cyanosis is observed, breathing rate is 31/min. percussion sound above the right lung is shortened, auscultation revealed various moist rales (crackles). What is the most likely diagnosis?
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A 27-year-old man was hospitalized in severe condition 50 minutes after receiving a penetrating wound to the left side of the chest. Objectively the patient is in a stupor, his skin is pale and acrocyanotic. Pulse is 120/min., of poor volume, weak. Blood pressure is 80/40 mm Hg. Heart sounds are muffled, cardiac borders are markedly expanded. In the III intercostal area along the parasternal line on the left there is a stab-incised wound. Plain chest X-ray shows enlarged heart shadow with smoothed out waist of the heart, there is hemothorax on the left to the 5th rib. What contributes the most to the severity of the patient’s condition?
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After overexposure to cold a 45-year-old woman developed acute pain in her suprapubic and lumbar areas during urination, sharp pains at the end of urination, false urges to urinate. Urine is turbid with blood streaks. The doctor suspects urinary tract infection. What results of laboratory analysis would be the most indicative of such infection?
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The dermatologist has an appointment with a 30-year-old man that complains of severely itching rashes that especially disturb him at night. The rashes developed 2 weeks ago, after he had returned from a travel. Objectively on the lateral surfaces of his fingers, hands, wrists, elbows, lower abdomen, genitals, and thighs there are paired papulovesicles, single pustules, and scratch marks. What disease can be suspected?
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A 19-year-old student was urgently hospitalized due to marked dyspnea and chest pain on the left. Her body temperature is 38.8°C. She has been presenting with these signs for 3 days. Respiratory rate is 42/min., shallow. Percussion sound is dull to the left from the center of the scapula, no respiration can be auscultated. The left heart border is displaced outwards by 3 cm. Embryocardia and heart rate of 110/min are observed. Palpation of the right subcostal area is painful. What urgent measures should be taken in this case?
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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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During administration of planned DPT vaccination the child suddenly developed acute anxiety, signs of pain response, dyspnea, grunting respirations, cutis marmorata, cold sweat. Objectively the child’s consciousness is disturbed, heart rate is 150/min., blood pressure is 60/40 mm Hg, heart sounds are muffled. The child was diagnosed with anaphylactic shock. What drug should be administered first?
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A 5-year-old child has body temperature risen up to febrile numbers, suffers from inertness, weakness. Examination revealed hemorrhage on the skin of limbs and torso. Enlargement of cervical and axillary lymph nodes can be detected. The liver is 4 cm below the costal arch; the spleen is 6 cm below the costal arch. Blood test: erythrocytes – 2.3 × 1012/l, Hb- 60 g/L, platelets – 40 × 109/l, leukocytes – 32.8 × 109/l, eosinophils – 1%, band neutrophils – 1%, segmented neutrophils – 12%, lymphocytes – 46%, monocytes – 1%, blasts – 40%, Duke’s bleeding time test result is 9 min. What examination is necessary to make the diagnosis?
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A 16-year-old girl has primary amenorrhea, no pubic hair growth, normally developed mammary glands; her genotype is 46 XY; uterus and vagina are absent. What is your diagnosis?
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For the last 15 years a 48-year-old patient has been working at the factory producing synthetic resins. Lately he has been complaining of significant general fatigue, headaches, frequent urination (predominantly during the day), red color of urine. What complication of benzene nitro compounds poisoning can be suspected?
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A 44-year-old woman has undergone subtotal thyroid resection due to diffuse toxic goiter. On the second day after the surgery the patient’s condition deteriorated; she developed palpitations, dyspnea, sweating, and diarrhea, and became fearful. The patient is anxious, her skin is moist and hot to the touch. Her temperature is 39.2°C. Heart sounds are muffled, tachycardia is observed, pulse is 160/min, blood pressure is 85/40 mm Hg. The stomach is soft and painless. What should be measured to clarify the patient’s condition?
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A 32-year-old pregnant woman at the term of 5-6 weeks was vaccinated against influenza along with her whole family. At that time she was not aware of her pregnancy. The pregnancy is wanted. The woman needs an advice from the family doctor regarding the maintenance of her pregnancy, namely whether there is a risk of fetal malformations because of received vaccination. What advice should the doctor give in this case?
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A 23-year-old man complains of facial edema, headache, dizziness, low urinary output, urine discoloration (dark red). These complaints arose after the patient had had a case of acute tonsillitis. On examination there are facial edema, the skin is pale, temperature is 37.4°C; heart rate is 86/min., blood pressure is 170/110 mm Hg. Heart sounds are muffled, the II heart sound is accentuated over the aorta. What etiological factor is the most likely in this case?
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The doctor has an appointment with a patient, who 2 days ago developed severe chest pain on the left, general weakness, high temperature, and headache. Objectively along the 4th and 5th intercostal nerves on the left the skin is hyperemic and there are tight clusters of small vesicles filled with clear serous content. What is the most likely diagnosis?
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The gynecology unit received a patient with uterine bleeding that started 6 hours after induced abortion at the term of 11-12 weeks. Objectively the skin is pale, pulse is 100/min., blood pressure is 100/70 mm Hg. On vaginal examination the uterus is painless, its enlargement corresponds to the 10th week of pregnancy; uterine cervix is dilated enough to let in one finger, there are fragments of the fertilized ovum. What actions should be taken next:
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A 6-month-old infant is not vaccinated. The physician recommends a DPT (diphtheria, pertussis, tetanus) vaccination but the mother is absolutely against this procedure. Choose the most substantial argument in favor of vaccination:
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A 23-year-old woman came the gynecologist with complaints of blood smears from her genital tracts that have been observed for a long time. Her menstruation has been delayed for 8 weeks. Examination shows the uterine body to be enlarged up to 14 weeks of pregnancy. US detected a vesicular mole. What tactics should the doctor choose?
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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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A 48-year-old woman was arrived to the surgical unit with wounds in her thigh. On examination the wound surface has dirty-gray coating with unpleasant sweet smell. Wound content resembles raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What microflora is the most likely to cause such inflammation?
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A 32-year-old woman complains of increasing spastic pains in her lower abdomen that occur after emotional stress. Bowel movements are intermittent: 2-3 defecations after waking in the morning alternate with constipations that last for 1-2 days. Objectively body mass is retained, palpation of the sigmoid colon is moderately painful. Hb- 130 g/L, leukocytes – 5.2 g/L, ESR - 9 mm/hour. Rectoromanoscopy is painful due to spastic condition of the intestine, intestinal mucosa is without changes. Intestinal lumen contains large amounts of mucus. What is the most likely diagnosis in this case?
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A 35-year-old man complains of rapidly increasing fatigue, palpitations, "visual snow", dizziness. He has a history of peptic ulcer of the stomach. Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic murmur is detected over the cardiac apex, heart rate is 100/min., BP is 100/70 mm Hg. The epigastrium is slightly tender on palpation. Blood test: erythrocytes – 3.2 × 1012/l, Hb- 100 g/L, color index – 0.94. What type of anemia is the most likely present in this case?
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A 38-year-old man underwent surgical treatment of a wound with a suppuration focus. On the 8th day after the procedure the wound cleared of purulo-necrotic discharge and granulations appeared. However, against the background of antibacterial therapy, the patient’s body temperature persists as high as 38.5-39.5°C; chills, excessive sweating, and euphoria are observed in the patient; heart rate is 120/min. What complication of the local suppurative inflammatory process can be suspected?
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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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A 37-year-old worker during a fire ended up in the area of high CO. He was delivered to a hospital in unconscious state. Objectively: the skin of his face and hands is crimson. Respiration rate is 20/min. ECG: alterations specific for hypoxic myocardium. Hourly diuresis is 40 ml. Blood test: erythrocytes – 4.5 × 1012/L, Нb- 136 g/L, color index – 0.9, ESR - 3 mm/hour, carboxyhemoglobin – 5%. What criterion allows determining the severity of the patient’s condition?
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A 43-year-old woman complains of persistent stomachache with recurrent pain attacks, nausea, repeated vomiting with stagnant bowel content, abdominal distension, and flatulence. She has been presenting with these signs for 7 hours. Pulse is 116/min. The tongue is dry and brown. The abdomen is symmetrically distemded, soft, painful. Percussion reveals tympanitis. On auscultation there are bowel sounds with metallic overtone, splashing, and dripping. Make the diagnosis:
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A 10-year-old boy, who was outdoors in windy and cold weather, developed moderate pain and tingling in his fingers and toes. When he had returned home, his parents noticed that the tips of his fingers and toes were white and their sensitivity was lost. The affected areas are warming up, the fingers are tingling and in pain. Skin pallor changed into redness, tingling stopped, slight itching and swelling of the fingers appeared. Determine the frostbite degree in this child:
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A patient suffering from infiltrative pulmonary tuberculosis was prescribed streptomycin, rifampicin, isoniazid, pyrazinamide, vitamin C. One month after the beginning of the treatment the patient started complaining of reduced hearing and tinnitus. What drug has such a side effect?
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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 10-year-old girl exhibits high level of physical development (Μ + 3σ), her body length increased by 10 cm within a year (which is double the norm for her age group), the number of permanent teeth corresponds with the age norm (20), the development of her secondary sex characteristics is three years ahead of her age (Ма, Р, Ах, Menarche). Development rate ahead of her biological age can occur due to:
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A 52-year-old man came to see his family physician complaining of pain in the chest. After taking history and performing physical exam the doctor decided to direct the patient to cardiologist for a consultation. What level of medical care is being proposed to the patient?
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A woman came to the general practitioner with complaints of fatigability, significant weight loss, weakness, and loss of appetite. She has been presenting with amenorrhea for the last 8 month. One year ago she gave birth to a live full-term child. Blood loss during delivery was 2 liters. The woman received blood transfusion and blood components. What is the most likely diagnosis?
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An 8-year-old girl with complaints of painful urination, frequent low-volume urination, and leukocyturia was diagnosed with acute cystitis. 10 days before the disease onset she was treated by the gynecologist for acute vulvitis. 5 days ago she presented with mild catarrhal symptoms. Her mother ascribes the child’s disease to her overexposure to cold. Specify the most likely infection route:
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