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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 woman with blood group B(III) Rh(+) gave birth to a full-term healthy boy. Examination on the 3rd day of the infant’s life shows him to have icteric tint to his skin. The child has no problems with suckling, sleep is nondisturbed. The abdomen is soft, the liver protrudes by 2 cm from under the costal margin. Complete blood count: hemoglobin – 200 g/L, erythrocytes – 5.5 × 1012/l, total bilirubin – 62 mcmol/L, indirect bilirubin – 52 mcmol/L. What condition can be suspected?
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A 38-year-old woman has been working as a milker for 15 years. She made an appointment with the doctor due to development of red rashes on her hands, predominantly in the interdigital space. The rashes are weeping, itching, and expanding on her skin. Examination of her hands shows her nail plates to be yellow and brittle. These presentations aggravate during work. Make the provisional diagnosis:
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After excessive consumption of fatty food a 60-year-old woman suddenly developed pain in her right subcostal area, nausea, bile vomiting, sharp bitter taste in her mouth. In 2 days she developed jaundice, her urine darkened. Objectively: sclera and skin are icteric, the abdomen is distended, the liver is enlarged by 3 cm, soft and painful on palpation, Ortner’s, Murphy’s, Kehr’s, Zakharyin’s, Mayo-Robson’s signs are positive. What diagnostic technique should be used in the first place to confirm the diagnosis?
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A 7-year-old boy has severe pulmonary mucoviscidosis (cystic fibrosis). He complains of dyspnea and blood expectoration. Objectively he presents with lagging physical development, acrocyanosis, hepatomegaly, drumstick fingers, and nail plates resembling a "clock face". Provisional diagnosis of chronic pulmonary heart disease is made. What examination would be the most informative for diagnosis confirmation?
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During reanimation procedures an attempt to intubate trachea was made. Neither glottis nor epiglottis can be visualized via laryngoscopy. What tactics should be chosen in this case?
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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 mainly for direct bilirubin). Stool is acholic. What is the most likely reason for jaundice in this patient?
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After a 5-day-long celebration of his daughter’s wedding a 65-year-old patient "saw" in his yard many cats, chickens, and rats. He tried to chase them away, but was scared off when the animals started scolding him and tried to harm him. What is the likely diagnosis?
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During physical exertion a man suddenly developed acute chest pain on the right and dyspnea. Objectively he assumes forced half-sitting position in the bed, presents with diffuse cyanosis, resting tachypnea of 38/min., the right side of the thorax is enlarged and does not participate in the respiratory process; percussion on the right reveals tympanic resonance and absence of respiration. What is the most likely diagnosis in this case?
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A 55-year-old woman, a cook, complains of pain in her right knee joint that has been troubling her for a month and intensifies in the evening. Objectively she is overweight, the knee joint is swollen, creaks during movement, palpation reveals localized pain. The 1st metatarsophalangeal articulation is deformed on the both feet. No changes in blood and urine are detected. What should be visible on the patient’s X-ray?
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During regular examination of a 2-year-old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cytoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
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A 69-year-old woman was diagnosed with the following: ischemic heart disease; stable exertional angina pectoris, FC III; heart failure IIA with retained left ventricular ejection fraction, functional class III (NYHA). What vaccine should be chosen for influenza prevention and to avoid destabilization of the patient’s condition?
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A 64-year-old man complains of cough with expectoration consisting of blood-streaked mucus, dyspnea, low grade fever and general fatigue. He has been presenting with these symptoms for 3 months. He has been smoking since early adolescence. Objectively to is 37.4°C, respirations are 26/min., pulse is 82/min., rhythmic, blood pressure is 130/85 mm Hg. The right side of the thorax lags behind in the respiratory process, dull percussion sound and acute decrease of breathing activity are observed there. X-ray shows homogeneous shadow of the lung field on the right with mediastinum displacement towards the affected side. What is the most likely diagnosis?
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A population of a small town often presents with registered cases of juvenile cardiomyopathy, atherosclerosis, hypertension, endocrinopathy, chronic dermatitis, and arthralgia – signs of Keshan disease. What is the most likely cause of this pathology?
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A regional cardiologist is given a task to develop a plan for preventive measures aimed at decreasing cardiovascular mortality rates. What measures should be planned for secondary prevention?
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A 74-year-old patient visited a 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: abdomen is soft and painful above the pubis; dullness of percussion sound is observed above the pubis. Murphy’s (Pasternatski’s) punch sign is negative on the both sides. What condition does the patient have?
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An infant has been born at the 41st week of gestation. The pregnancy was complicated with severe gestosis of the second semester. The weight of the baby is 2400 g, the height is 50 cm. Objectively: the skin is flabby, the layer of subcutaneous fat is thin, hypomyotonia, neonatal reflexes are weak. The internal organs are without pathologic changes. This newborn can be assessed as a:
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In the process of hiring, a prospective employee has undergone preventive medical examination and was declared fit to work in this manufacturing environment. What type of preventive medical examination was it?
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A 60-year-old woman started feeling weakness, vertigo, rapid fatigability during the last year. Recently she has developed dyspnea and paresthesia observed. Objectively: skin and mucous membranes are pale and icteric. Lingual papillae are smoothed out. Liver and spleen are at the edge of costal arch. Blood test: Hb- 70 g/L, erythrocytes – 1.7 × 1012/L, blood color index – 1.2, macrocytes. What drug can be prescribed on pathogenetic grounds?
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A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No signs of gynecological pathology were detected. In the family history there was a case of cervical cancer that occurred to the patient’s grandmother. The patient was consulted about the maintenance of her reproductive health. What recommendation will be the most helpful for prevention of invasive cervical cancer?
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A 44-year-old patient with postinfarction cardiosclerosis presents with frequent heart rate disorders and lower extremity edema. Objectively: Ps- 95/min., irregular, 10- 12 extrasystoles per minute. BP- 135/90 mm Hg. The 1st heart sound at the apex is weakened. Pulmonary respiration is rough. The liver is enlarged 2 cm. ECG: irregular sinus rhythm, heart rate – 95/min., frequent polytopic ventricular extrasystoles. What antiarrhythmic drug is advisable in this case for treatment and prevention of extrasystole?
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A 24-year-old patient visited a doctor complaining of enlargement of his submaxillary lymph nodes. Objectively: submaxillary, axillary and inguinal lymph nodes are enlarged. Chest X-ray shows: enlarged lymph nodes of mediastinum. Blood test: erythrocytes – 3.4 × 1012/l, Hb- 100 g/L, blood colour index – 0.88, platelets – 190 × 109/l, leucocytes – 7.5 × 109/l, eosinophils – 8%, band neutrophils – 2%, segmented neutrophils – 67%, lymphocytes – 23%, ESR – 22 mm/hour. What test must be prescribed to verify the cause of lymphadenopathy?
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In 2 hours after a traffic accident a 28-year-old man in grave condition was delivered to a hospital. The patient complains of abdominal pain. He received a blow to the abdomen with the steering wheel. Objective examination revealed the following: the abdomen does not participate in respiration, is tense and acutely painful on palpation; abdominal guarding is present, peritoneal irritation signs are positive, hepatic dullness is absent. BP is 90/60 mm Hg, heart rate is 120/min. What further treatment tactics should be chosen?
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A 12-year-old boy with hypertrophic cardiomyopathy complains of dyspnea caused by the slightest physical exertion. Echocardiography detected asymmetrical left ventricular hypertrophy, signs of pulmonary hypertension, and left ventricular dilatation, its ejection fraction is 59%. These developments are indicative of:
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A 46-year-old woman has been hospitalized with open fracture of the left thigh in its middle third. She underwent the surgery – fixation with extraosseous osteosynthesis plates. On the 4th day after the surgery she developed pain in the wound, body temperature rose over 39°C. What measures should be taken in this case?
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A 46-year-old woman complains of severe pain attacks in the right lumbar area, which irradiate to the lower abdomen, and nausea. This kind of pain attacks has never been detected in the patient before. Plain abdominal X-ray reveals no pathologic shadows. Ultrasound detects a hyperechogenic mass 1.5 cm in diameter, which reflects sound wave, in the enlarged right renal pelvis. What diagnosis is the most likely?
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A 28-year-old woman complains of skin hemorrhages after minor traumas and spontaneous appearance of hemorrhages on the front of her torso and extremities. On examination: the skin is variegated (old and new hemorrhages), bleeding gums. Blood platelets – 20 × 109/l; in the bone marrow there is increased number of megakaryocytes and no platelet production. Treatment with steroid hormones was effective. What is the likely diagnosis?
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A 52-year-old woman has been suffering for 2 years from dull, occasionally exacerbating pain in her right subcostal area, occurring after eating high-fat foods, bitter taste in her mouth in the morning, constipations, and flatulence. Objectively she has excess weight, her body temperature is 36.9°C; there is a coating on the root of her tongue; the abdomen is moderately distended and painful in the area of gallbladder projection. What examination would be the most helpful for diagnosis-making?
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A 23-year-old man came to the surgeon with complaints of pain, redness of the skin, and swelling in the area of his proximal interphalangeal joint of the III finger on the right hand. Six days ago he pricked his finger with a wire. Objectively the III finger on the right hand is swollen, hyperemic, prominent in the projection of interphalangeal joint, sharply painful on touch and during movements. Finger mobility is reduced. Fluctuation sign is present. What diagnosis corresponds to the given clinical presentation?
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A 65-year-old woman was diagnosed with the following: chronic rheumatic heart disease, I degree of rheumatic activity; combined mitral heart disease with prevalence of III-degree stenosis; heart failure IIA with retained left ventricular ejection fraction, functional class III (NYHA). What tactics of vaccination against respiratory infections should be chosen to provide secondary prevention of exacerbations and to avoid heart failure decompensation in this patient?
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6 hours ago the waters of a 30-year-old gravida 1, para 0, burst; her preliminary period was pathologic and lasted for over 2 days; the term of pregnancy is 39 weeks. No labor activity is observed. Fetal head presents above the pelvic inlet. Fetal heartbeats are 142/min., clear and rhytmic. On vaginal examination the uterine cervix is not dilated. What further tactics should the doctor choose?
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A patient has gradually lost consciousness. The skin is pale and dry. There is smell of ammonia from the mouth. Respirations are deep and noisy. Heart sounds are muffled, pericardial friction rub is present. Blood pressure is 180/130 mm Hg. Blood test: Hb- 80 g/L, leukocytes – 12 × 109/l, blood glucose – 6.4 mmol/L, urea – 50 mmol/L, creatinine – 1200 mcmol/L, blood osmolality – 350 mOsmol/kg H2O. No urinary excretion. Make the diagnosis:
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During medical examination a cadet in the naval college was detected to have a painless dense ulcer 1.5 x 0.5 in size in his perianal area at the 2 o’clock position. The ulcer floor resembles "old fat". What is the provisional diagnosis?
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A 30-year-old woman made an appointment with the family doctor for scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?
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An 8-year-old child presents with blood pressure up to 180/100 mm Hg in the upper limbs accompanied by headaches, tinnitus, occasional nosebleeds, and high fatigability. On examination there is no pulse over the leg arteries. ECG shows left ventricular hypertrophy. MRI-scan shows aortic narrowing to 5 mm in the typical place. Coarctation of aorta is diagnosed. What kind of treatment should be prescribed in this case?
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A 34-year-old man on the 3rd day of ceftriaxone treatment for acute otitis (daily dosage – 2 grams) developed diarrhea occurring 5-6 times per day. Feces are without mucus or blood admixtures. Temperature is 36.6°C. Gregersen reaction (occult blood in feces) is negative. Stool culture detected no pathogenic germs. What is the most likely cause of diarrhea in this case?
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A 26-year-old woman has been undergoing treatment for community-acquired pneumonia for 10 days. It is known that her husband had been treated for drug addiction. Sequential intravenous administration of Amoksiklav (Amoxicillin + Clavunate) Levofloxacin combination and vancomycin in the prescribed dosage was ineffective. Within the last two days the patient’s dyspnea and intoxication acutely exacerbated, bilateral pulmonary infiltrates are observed. What is the most likely cause of the medication ineffectiveness?
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The pregnancy is full term. The body weight of the parturient woman is 62 kg. Fetus is in a longitudinal lie, the head is engaged to the pelvic inlet. Belly circumference is 100 cm. Uterine fundus height is 35 cm. What body weight of the fetus can be expected?
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A 45-year-old woman has been suffering from rheumatoid arthritis for 10 years and takes methotrexate twice a week. What statement regarding vaccination against pneumococci (23-valent vaccine) would conform to the recommendations for the management of rheumatoid arthritis issued by the European League Against Rheumatism in 2010?
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A 6-year-old girl arrived to the in-patient unit with complaints of enlargement of the lower third of her right thigh. According to the case history, she has been stepping carefully on her right leg and limping for 6 months. Blood test detected anemia. X-ray of the right thigh shows a round bone defect with clear margins resembling melting sugar in the distal metaphysis. What provisional diagnosis can be made in this case?
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A 22-year-old man at 18:00 developed persisting dull pain in the epigastrium. Three hours later nausea appeared, he vomited once. By the morning the pain shifted to the right iliac area. Body temperature rose to 38.6°C, developed tachycardia of 110/min. On examination there are muscle rigidity and Bloomberg’s sign (rebound tenderness) in the right iliac area of the anterior abdominal wall. Plain X-ray of the abdomen shows no fluid levels, free air under the diapragm on the right. Make the diagnosis:
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