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KROK 2 Medicine 2019 Questions | KROKEXAM
Browse 2019 KROK 2 Medicine exam questions with answers and explanations.
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Human body receives from atmosphere a number of chemicals. What type the of action results in the combined effect that is less than the sum of isolated effects of these chemicals on the body?
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A 30-year-old woman came to the gynecological department. She complains of sharp pain in her lower abdomen and temperature of 38.8°C. She has a history of extramarital sexual activity and 2 artificial abortions. On gynecological examination the uterus is unchanged. The appendages are bilaterally enlarged and painful. Profuse purulent discharge is being produced from the vagina. What examination needs to be conducted to clarify the diagnosis?
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A 16-year-old patient has made an appointment with an otolaryngologist. He complains of elevated body temperature and sore throat. Disease onset was 2 days ago after the patient ate two portions of ice-cream. Pharyngoscopy shows hyperemic mucosa of the palatine tonsils, with purulent exudate in the lacunae. Make the provisional diagnosis:
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At the railroad crossing a passenger train collided with a bus. In this collision 26 bus passengers died, another 18 passengers received mechanical injuries of varying severity. Where will be professional medical aid provided for the victims of this accident? Who will provide this aid?
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A 35-year-old man complains of rapidly increasing fatigue, palpitations, "visual snow" and 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 × 1017/L, Hb. 100 g/L, color index – 0.95. What type of anemia is the most likely present in this case?
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A 63-year-old man complains of unmotivated weakness and pressing and bursting sensation in the left subcostal area. According to him, these signs have been present for a year already. Previously he was healthy. He took part in containment measures during the accident at the Chornobyl Nuclear Power Plant. Objectively the skin is pale, peripheral lymph nodes are not enlarged, the liver is +3 cm, the spleen is +10 cm. Complete blood count: erythrocytes – 3.1 × 109/L, Hb- 100 g/L, leucocytes - 46 × 109/L, blasts -2%. promyelocytes – 10% myelocytes – 18%, band neutrophils – 27% segmented neutrophils – 10%, lymphocytes – 12%, eosinophils – 6%, basophil – 3%, monocytes – 2%, erythrocyte sedimentation rate – 20 mm/hour. What is the most likely diagnosis?
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A 57-year-old patient complains of dyspnea at rest. The patient presents with orthopnea. Acrocyanosis, bulging cervical veins. On percussion: dull sound over the lower lung segments. On auscultation: no respiratory sounds. Heart rate is 92/min. Right-sided cardiac dilatation is observed. The liver is +7 cm. Shins are swollen. Pleural effusion is suspected. What indicator would confirm the presence of transudate in this case?
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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 59-year-old woman was brought into the rheumatology unit. Extremely severe case of scleroderma is suspected. Objectively she presents with malnourishment, "mask-like" lace, and acro-osteolysis. Blood: erythrocytes - 2.2 × 109/L, erythrocyte sedimentation rate 40 mm/hour. Urine: elevated levels of free Oxyproline. Name one of the most likely pathogenetic links in this case:
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A 10-year-old boy was brought to the hospital with complaints of expiratory dyspnea, respirations are 30/min. He explains his state by a change in the weather conditions. For the last 4 years the boy has been registered for regular check-ups due to his diagnosis of third degree persistent bronchial asthma. To provide emergency aid for this child, first he needs to be given:
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A newborn has Apgar score of 9. When should this infant be put to the breast?
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A 55-year-old woman complains of pain and popping sounds in her left knee joint, which occur when she climbs the stairs. Occasionally during movements her joint becomes "stuck" 5 years ago she suffered a trauma of her left knee. Complete blood count and biochemical blood analysis show normal results. X-ray shows marked osteosclerosis and osteophytes. The joint space is narrowed. Make the provisional diagnosis:
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A 40-year-old man. A welder, uses manganese electrodes in his line of (18 years of experience). He complains of gait abnormalities, problems with speech and hand tremors. Objectively the following is observed in the patient hypomimia. Increased muscle tone of plastic type, and quiet monotonous speech, tremor of the tongue, pill-rolling tremor of the fingers, and retropulsion. What syndrome developed in this patient due to manganese poisoning?
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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 13-year-old girl for the last two weeks has been complaining of dyspnea and shin and foot edemas that appear after a physical exertion. In the morning the edemas significantly decrease. Clinical examination revealed enlarged liver and coarse systolic murmur over the heart area. Blood tests and urinalysis are without changes. What is the most likely cause of edemas in this child?
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A 14-year-old girl came to the general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after the previous delay of 2 months. Objectively: the skin is pale, heart rate is 90/min., BP is 110/70 mm Hg. Hb is 88 g/L. Rectal examination the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
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Heart X-ray of a 31-year-old man has revealed the following with tightly field opacified esophagus there is a marginal filling defect in its middle third on the posterior wall; the defect is 1.8×1.3 cm in size with clear oval border. Mucosal folds are retained and envelop the defect; wall peristalsis and elasticity are not affected. There are no complaints regarding the condition of the patient’s alimentary canal. Make the provisional diagnosis:
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For three years a 31-year-old woman has been complaining of pain and swelling of her radiocarpal and metacarpophalangeal articulations and their reduced mobility in the morning, which persisted up to 1.5 hours. Two weeks ago she developed pain, swelling, and reddening of her knee joints, her body temperature increased up to 37.5°C. The treatment was untimely. Examination of the internal organs revealed no pathologic alterations. Diagnosis of rheumatoid arthritis was made. What changes are most likely to be visible on the arthrogram?
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A 58-year-old man complains of weakness and tumor-like formations that appeared on the anterior surface of his neck and in the inguinal region. Palpation detects soft painless mobile cervical and inguinal lymph nodes up to 2 cm in diameter. The liver protrudes by 2 cm from the edge of the costal margin, the lower splenic pole is at the umbilical level. In blood: erythrocytes – 3.5 × 1012, Hb- 88 g/L, leucocytes - 86 × 109/L, band neutrophils – 1% segmented neutrophils – 10%, lymphocytes – 85%, eosinophils – 2%, basophil – 0%, monocytes – 2%, erythrocyte sedimentation rate – 15 mm/hour, Gumprecht shadows. What is the most likely diagnosis?
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A 20-year-old man, a calibrator of dosimetry equipment committed gross violation of safety regulations when he put two ampoules with cobalt-60, each with the Radioactivity of 7 MCi In the pockets of his trousers and jacket. He has been keeping the ampoules in his pockets for hours. The tissues at the distance of 0.5 cm from the Source received the done of 30 Gy (3000 R). while the tissues at the distance of 20 cm 2R. Did this man develop radiation sickness?
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A 46-year-old woman has diarrhea with abdominal distension, loss of body mass, and large amounts of porridge-like foul smelling stool without blood streaks or tenesmus. Objective examination detects moderate tenderness in the mesogastrium and left-abdominal flank. Feces analysis detects steatorrhea with neutral fat and creatorrhea. What prescription would be the most advisable in this case?
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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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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 thyroid-stimulating hormone (THS). What is the most likely diagnosis?
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A 48-year-old woman has been hospitalized due to the development of tachysystolic atrial fibrillation. She has lost 5 kg of body weight within 2 months. On palpation there is a node in the left lobe of the thyroid gland. What pathology resulted in the development of this condition?
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A 19-year-old young man complains of cough with expectoration of purulent sputum in the amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37,8°C, general weakness, weight loss. The patient’s condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition. pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, numerous various 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 30-year-old man came to the family physician. 2 months ago he underwent surgery for an open fracture of the humerus. On examination the patient’s condition is satisfactory, in the area of the postoperative wound there is a fistula that discharges a small amount of pus; the area itself is red: fluctuation is detected. X-ray shows destruction of the humerus with sequestra. What complication did the patient develop during the postoperative period?
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After eating shrimps, a 25-year-old man suddenly developed skin itching, some areas of his skin became hyperemic or erupted into vesicles. Make the diagnosis:
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A woman came to the doctor with complaints of increased body temperature up to 38°C and moderately sore throat for the last 3 days. Objectively: mandibular lymph nodes are enlarged up to 3 cm. Palatine tonsils are hypertrophied and covered with gray coating that spreads to the uvula and anterior pillars of the fauces. What is the most likely diagnosis?
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Indicators of work of inpatient departments in the city hospitals for the past year were analyzed. After that the meeting was held at the central city hospital and, based on the results of the analysis, a decision was made to decrease the number of beds in the inpatient departments, and instead open daycare units with partial hospitalization in the city polyclinics. What is the main goal of this decision?
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A 30-year-old woman made an appointment with the family doctor for a scheduled vaccination of her 2-year-old child. What type of healthcare provides such medical services?
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A 2-year-old child with persistent cough and subfebrile body temperature after a case of URTI developed dyspnea, cyanosis of the nasolabial triangle, percussion dullness and weakened respiration in the lower lobe of the right lung, and a slight mediastinal displacement to the left. What pulmonary pathology is likely to cause this clinical presentation?
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A 30-year-old multigravida has been in labour for 18 hours. 2 hours ago the pushing stage began. Fetal heart rate is clear, rhythmic, 136/min. Vaginal examination reveals complete cervical dilatation, the fetal head in the pelvic outlet plane. Sagittal suture is in line with obstetric conjugate, the occipital fontanel is near the pubís. The patient has been diagnosed with primary uterine inertia. What are the further tactics of labor management?
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A 40-year-old man with Bekhterev disease (ankylosing spondylitis) complains of elevated body temperature up to 37,8°C, back pain and stiffness, especially observed during the second half of the night. This condition has been lasting for 2 years. Objectively: reduced spinal mobility, painful sacroiliac joint, erythrocyte sedimentation rate – 45 mm/hour. X-ray shows narrowing of the intervertebral disc space and of the sacroiliac joint. What eye pathology is often associated with this type of disease progression?
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In the air of the feed kitchen at the poultry factory at the area where formula feed is being mixed, the dust concentration reaches 200 mg/m2. Air microflora is represented predominantly by Aspergillus and Mucor fungi. What effect determines pathogenic properties of the dust?
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A 25-year-old woman was brought into the gynecological department with profuse bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the last 3 days she was experiencing pains in her lower abdomen that eventually started resembling cramps, she developed bleeding. Her skin is pale, pulse 88/min., blood pressure – 100/60 mm Hg, body temperature – 36.8°C. Vaginal examination: the uterus size corresponds with 11 weeks of pregnancy, the cervical canal allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is bloody and profuse. What is the most likely 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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In the factory cafeteria there was an outbreak of food poisoning. Clinical presentation indicates staphylococcal etiology of this disease. 15 people are sick. To confirm the diagnosis of food poisoning, samples need to be sent to the laboratory. What samples should be obtained for analysis?
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A 47-year-old man developed the signs of decompensated laryngeal stenosis against the background of acute phlegmonous laryngitis. He presents with inspiratory dyspnea at rest, forced position, cyanotic skin covered in cold sweat, tachycardia, deficient pulse, and low blood pressure. What urgent treatment tactics should be chosen?
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A woman with the pregnancy term of 8 weeks complains of elevated temperature up to 37.6°C, skin rash that can be characterized as macular exanthema, enlargement of posterior cervical and occipital lymph nodes, small amount of bloody discharge from the genital tracts. She was examined by the infectious diseases specialist and diagnosed with rubella. What tactics should the obstetrician-gynecologist choose?
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A 20-year-old man was hospitalized on the 9th day of the disease. He attributes his disease to eating insufficiently thermally processed pork. At its onset this condition manifested as periorbital edema and fever. Objectively his body temperature is 38.5°C. The face is puffy and the eyelids are markedly swollen. Palpation of gastrocnemius muscles is sharply painful. Blood test shows hypereosinophilia. What is the etiology of this disease?
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