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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 10-year-old boy is delivered into a polytrauma unit after he received a blunt trauma of the thorax, having fallen from the bi-cycle. 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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An employee has been sick for 4 months, further treatment is necessary, the patient is unable to work. Who is authorized to provide further disability examination of this patient?
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A worker of a blowing shop complains of headache, irritability, sight impairment – he sees everything as if through a "net". Objectively: hyperemic sclera, thickened cornea, decreased opacity of pupils, visual acuity is 0.8 in the left eye, 0.7 in the right eye. The worker uses no means of personal protection. What diagnosis is the most likely?
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A 25-year-old woman complains of fatigue, dizziness, hemorrhagic rashes on the skin. She has been presenting with these signs for a month. Blood test: erythrocytes – 1.0 × 1012/L, Hb- 37 g/L, colour index – 1.1, leukocytes – 1.2 × 109/L, platelets – 42 × 109/l. What analysis would be the most advisable for diagnosis-making in this case?
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A man complains of high fever, pain in the area of his right mastoid bone, and purulent discharge from the right ear. One week ago he had a case of URTI. Objectively the right auricle protrudes, the skin behind the ear is hyperemic and pastose; on palpation of the mastoid bone the pain intensifies; the auditory meatus is filled with thick pus, posterosuperior meatal wall sags; the tympanic membrane is red and perforated. Make the diagnosis:
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During examination a 4-month-old child with meningococcemia presents with acrocyanosis, cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor. What clinical syndrome is it?
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A 22-year-old woman complains of itching and profuse discharge from her genital tracts. The condition developed 10 days ago after a sexual contact. Bacterioscopy of a discharge sample detected trichomonads. What drug should be prescribed for treatment in this case?
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A patient with chronic pancreatitis complains of diarrhea occurring up to 5 times per day (no blood traces), loss of body weight, abdominal distention, dryness of skin, loss of hair, thirst, bleeding gums, convulsions. Complete blood count: leukocytes – 5.8 × 109/l; Hb- 86 g/L; ESR - 15 mm/g; Blood protein test: total protein – 48 g/L; albumins – 28 g/L. What indicators of coprological analysis would accompany this syndrome?
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Estimation of community health level involved analysis of a report on diseases registered among the population of district under charge (reporting form 12). What index is calculated based on this report?
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A patient in the state of clinical death is being resuscitated through mouth-to-mouth artificial pulmonary ventilation and external cardiac massage. A doctor noticed that air does not flow into the patient’s airways and his head and torso are positioned at the same level. Why is artificial respiration ineffective in the given case?
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A 38-year-old patient has been delivered by an ambulance to a surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Blood test: Hb- 108 g/L, thrombocytopenia. Anamnesis states that similar condition was observed 1 year ago. Make the diagnosis:
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A 25-year-old woman during self-examination detected a tumor in the upper external quadrant of her right mammary gland. On palpation: painless, dense, mobile growth 2 cm in diameter is detected in the mammary gland; no changes in the peripheral lymph nodes are observed. On US of the mammary glands: in the upper external quadrant of the right mammary gland there is a space-occupying lesion of increased echogenicity 21x18 mm in size. The most likely diagnosis is:
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A 10-year-old girl complains of stomachache that appears and intensifies after she eats rough or spicy food, sour eructation, heartburn, frequent constipations, headaches, irritability. She has been presenting with these signs for 12 months. Her meals are irregular and consist of dry food. Objectively her diet is sufficient in calories. The tongue is moist with white coating near the root. The abdomen is soft and painful in the epigastrium. What method would be optimal for diagnosis-making in this case?
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A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset. What is the most likely diagnosis?
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A patient with trauma of the lower third of the forearm volar surface caused by a glass shard came to a first-aid center. Objectively: flexion of the IV and V fingers is impaired, sensitivity of the inner dorsal and palmar surfaces of the hand and IV finger is decreased. What nerve is damaged?
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For 4 days a 35-year-old man has been treated in the resuscitation unit for acute renal failure caused by compartment syndrome. The patient is disoriented. ECG shows high T waves and right ventricular extrasystoles. His central venous pressure is 159 mmH2O; for the last 3 hours auscultation has been detecting isolated moist crackles in the lungs. Respirations are 32/min. Blood test: residual nitrogen – 62 mmol/L, K+ - 7.1 mmol/L, Cl- - 78 mmol/L, Na+ - 120 mmol/L, Ht- 0.32 L/L, Hb- 100 g/L, blood creatinine – 0.9 mmol/L. In this case the most advisable would be to perform:
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Caries morbidity rate is 89% among residents of a community. It is determined that fluorine content in water is 0.1 mg/L. What preventive measures should be taken?
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A 23-year-old patient had taken 1 g of aspirin to treat acute respiratory infection. After that he developed an asthmatic fit with labored expiration that was arrested by introduction of aminophylline. The patient’s medical history is not burdened with allergies. The patient has undergone two surgeries for nasal polyposis in the past. What diagnosis is most likely?
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40-50 minutes after the completion of repair works conducted in a closed garage, with car engine running, the repair workers developed severe headache in the temporal area, nausea, tinnitus, vertigo, etc. These symptoms are characteristic of acute poisoning with:
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A healthy child 1 year and 5 months of age is being vaccinated against hepatitis B. The child did not receive the first dose of the vaccine previously, while in the maternity hospital. The doctor makes an individual vaccination schedule for this child and plans the administration of the next dose of the vaccine. What is the minimum interval between doses of vaccine in this case?
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A 39-year-old man suffers from chronic adrenal insufficiency and receives replacement glucocorticoid therapy (hydrocortisone – 15 mg/day). He is to undergo elective surgery for calculous cholecystitis. What medication adjustment should be made on the day of the surgery to prevent the development of acute adrenal insufficiency?
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A 48-year-old woman developed insomnia, depressive mood, anxiety, fears and suicidal thoughts after the death of her husband that occurred one month ago. During her stay in the hospital she speaks in a low voice, is depressed, anxious, avoids sleeping, refuses to eat. What medications should be prescribed in this case?
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An excavator operator with 20 years of work experience at the opencast ore mine undergoes regular medical examination. He presents with signs of pneumoconiosis. What type of pneumoconiosis is the most likely in this case?
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The mother of an epileptic son complains of her son periodically presenting with irritable depression, when he becomes excited and prone to physical agression and violence. These moods last for 5-10 minutes, after which the patient exhausts himself and falls asleep. Upon waking he is depressed, sad, cannot recall his actions or recalls them only partially. What psychopathologic condition is it?
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A 45-year-old woman complains of paroxysmal intolerable facial pain on the left with attacks that last for 1-2 minutes. Attacks are provoked by chewing. The disease onset was two month ago after overexposure to cold. Objectively: pain at the exit points of the trigeminal nerve on the left. Touching near the wing of nose on the left induces new pain attack with tonic spasm of the facial muscles. What is the most likely diagnosis among those listed?
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A 20-year-old patient complains of severe headache, double vision, weakness, fever, irritability. Objectively: body temperature is 38.1°C, the patient is reluctant to contact, sensitive to stimuli. There are ptosis of the left eyelid, exotropia, anisocoria S>D, pronounced meningeal syndrome. On lumbar puncture the cerebrospinal fluid flowed out under a pressure of 300 mm Hg, the fluid is clear, slightly opalescent. 24 hours later there appeared fibrin film. Protein – 1.4 g/L, lymphocytes – 600/3 per mm3, sugar – 0.3 mmol/L. What is the provisional diagnosis?
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A 46-year-old man came to the surgeon’s office. He complains of twitching sensation in the wound on his left foot, insomnia, and anxiety. According to the patient, he received this wound 5 days ago, when he accidentally stepped on a glass shard, while on the beach. He requested no medical assistance. Objectively the patient’s general condition is satisfactory, pulse is 75/min., blood pressure is 130/80 mm Hg, temperature is 36.9°C. On the plantar surface of his foot there is a wound 1.5 cm long and up to 3 cm deep. The wound edges are moderately hyperemic, no discharge from the wound is observed. What disease can be suspected in this patient?
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During appointment with the doctor a man complains of painful itching rashes that appeared on his skin under the beard and moustache one year ago, with frequent exacerbations occurring throughout the year. Objectively the skin of the facial hair growth areas is bluish-purple, thickened, with pustules, erosions, and scabs covering its moist surface. The fistulous tracts are surrounded by the area of loose pink-red granulation and discharge pus. The skin resembles mulberry in appearance. Make the diagnosis:
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A 25-year-old patient is not married and has sexual relations with several partners. During the last 3 months he noticed small amount of mucoserous secretions produced from urethra. Subjectively: periodical itching or burning pain in urethra. Two months ago pain in knee join developed. Possibility of trauma or exposure to cold is denied by the patient. During the last week eye discomfort is noted – lacrimation and itching. What provisional diagnosis can be suggested?
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A 45-year-old woman underwent one year ago mastectomy followed by chemo and radiation therapy. She now complains of dyspnea at rest and temperature up to 37.2°C. Her general condition is severe, acrocyanosis is observed. The right side of her chest practically does not participate in respiration. Percussion reveals a dull sound below the 3rd rib; auscultation detects acute weakening of the respiratory sounds. Pleural puncture on the right has yielded a large amount of hemorrhagic exudate. What complication has developed in the patient?
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A postparturient woman, who has been breastfeeding for 3 weeks, made an appointment with the doctor. For the last 6 days she has been feeling unwell, complains of body temperature of 38-39°C, general weakness; within the last 2 days she developed pain and redness in the area of her right mammary gland. Examination revealed her mammary gland to be significantly enlarged and deformed; breast tissue fluctuations and lymphadenitis are observed. What type of mastitis is the most likely?
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A 5-year-old boy complains of severe dyspnea and sensation of lack of air. Objectively the child assumes orthopneic position, presents with marked peripheral cyanosis, drumstick fingers, nail plates resembling a "clock face", the borders of cardiac dullness are bilaterally extended; coarse systolic murmur can be detected over the whole surface of the heart and is especially pronounced in the II intercostal area on the left near the sternum. What disease can be characterized by such presentations?
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A 15-year-old adolescent girl came the gynecologist with complaints of painful menstruations that are accompanied by nausea, vomiting, and dizziness. Her menarche was at 12. Menstruations became painful since she was 14, remain regular. What treatment should be prescribed in this case?
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A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, to is 39.5-40°C, no urination for a whole day. Objectively the patient is conscious. Respiratory rate is 36/min. Over the right lower pulmonary lobe percussion sound is dull; on auscultation there is bronchial respiration and numerous moist crackles. Blood pressure is 80/60 mm Hg. Heart rate is 120/min. Heart sounds are muffled, there is tachycardia. What tactics should the family doctor choose in the management of this patient
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A 30-year-old woman complains of milk discharge from her breasts and no menstruation for the last 5 months. One physiologic childbirth was 4 years ago. There are no maldevelopments of mammary glands. Bi-manual examination revealed diminished uterus and normal sized ovaries. MRI-scan shows no brain pathologies. Thyroid-stimulating hormone is within normal limits. Serum prolactin is high. What is the most likely diagnosis?
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The body of a 24-year-old woman with probable signs of poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the Criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
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A 35-year-old patient developed an epileptic attack with tonoclonic spasms that lasted for 3 minutes. After the attack the patient fell asleep but in 5 minutes the second attack occurred. The first step of emergency aid would be to:
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A 60-year-old man complains of discomfort when swallowing solid food, which he has been observing for a month. He changed his diet to semiliquid food products. At first the discomfort had abated but later it renewed despite the change in the diet. The patient developed gaseous eructation and hoarse voice. What examination should be performed to clarify the diagnosis?
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Among first-year schoolchildren there was a case of measles registered. A 7-year-old boy from the same group was not vaccinated against measles due to refusal of his parents. His clinical history has no cases of measles in the past and is not contraindicatory to immunobiological agents. Choose the most rational tactics of measles prevention in this schoolboy:
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A 30-year-old woman complains of increased body weight and problems with physical exertion. Her parents are of increased body weight as well; typical meals in their family are high in fats and carbohydrates. Objectively her blood pressure is 135/80 mm Hg, pulse is 89/min., weight is 87 kg, height is 165 cm. The patient’s skin is clear, with even distribution of subcutaneous fat; the thyroid gland is not enlarged; there are no menstrual cycle disturbances. What obesity prevention methods would be the most advisable in this case?
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