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KROK 2 Medicine 2019 Questions | KROKEXAM
Browse 2019 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 34-year-old man complains of pale edema of the face, feet, shins, and lumbar area. elevated blood pressure up to 160/100 mm Hg, and general weakness. He has a clinical history of nonspecific ulcerative colitis. Objectively: pulse – 84/min., rhythmic, blood pressure – 165/100 mm Hg: edemas all over the body: the skin is pale and dry with low turgor. The kidneys cannot be palpated, on an attempt to palpate them they are painless. Blood test: erythrocytes – 3.0 × 1012/L, Hb- 100 g/L erythrocyte sedimentation rate – 50 mm/hour. Urinalysis: proteins – 3.5 g/L, erythrocytes – 7-10 in the vision field, leukocytes – 5-6 in the vision field. Daily proteinuria – 6 grams. What analysis should be conducted additionally to verify the diagnosis?
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A 26-year-old woman is suspected to suffer from systemic lupus erythematosus due to systemic lesions of skin, vessels, joints, serous tunics, and heart that developed after photosensitization. The following is detected: LE cells, antibodies to native DNA, isolated anti-centromere antibodies, rheumatoid factor is 1:100, Wassermann reaction is positive, the circulating immune complex is 120 units. What immunological indicators are considered to be specific to this disease?
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A patient is being treated in the tuberculosis clinic. Throughout the last 3 weeks he has been suffering from headaches of increasing intensity. Neurological examination detects nuchal rigidity without focal signs. Make the provisional diagnosis:
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A 13-year-old girl has 30% of excessive body mass, she started to gain weight at the age of 3. She has a family history of obesity, Her height and sexual development are normal for her age. The appetite is excessive. She complains of periodical headaches. Blood pressure – 120/80 mm Hg. Subcutaneous fat is evenly distributed, she has no stretch marks. There is juvenile acne on her face. What type of obesity is it?
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A 45-year-old man, a farmer, presents with acute onset of a disease. He complains of headache, high temperature, pain in the gastrocnemius muscles, icteric face, and dark urine. Objectively: body temperature – 38°C. blood pressure – 100/70 mm Hg, conjunctival hemorrhages, hepatosplenomegaly, and oliguria. What is the most likely provisional diagnosis?
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During analysis of morbidity in the city, it was determined that age structure of population is different in each district. What statistical method allows to exclude this factor, so that it would not skew the morbidity data?
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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 50-year-old patient was brought to a hospital with complaints of blood in urine. Urination is painless and undisturbed. Macrohematuria had been observed for 3 days. Objectively: kidneys cannot be palpated. The suprapubic area is without alterations, external genitalia are non-pathologic. On rectal investigation: prostate is not enlarged, painless, has normal structure. Cystoscopy revealed no changes. What is the most likely 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 district doctor has diagnosed one of his patients with dysentery. What accounting document reflects this type of morbidity?
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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 he developed a 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 a soft systolic murmur. What factor would be the most indicative of the likely disease etiology?
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A 24-year-old pregnant woman on her 37th week of pregnancy has been brought to the maternity obstetric service with complaints of weak fetal movements. Fetal heartbeats are 95/min. On vaginal examination the uterine cervix is tilted backwards, 2 cm long, external orifice allows inserting a fingertip. Biophysical profile of the fetus equals 4 points. What tactics of pregnancy management should be chosen?
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A 48-year-old woman complains of disturbed menstrual cycle: her periods last for 7.9 days and are excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure – 150/90 mm Hg. pulse – 90/min., rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornices are free. What is the most likely diagnosis?
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A 38-year-old woman after physical overexertion suddenly developed palpitations, dyspnea, and a dull pain in the cardiac area. For 10 years she has been registered for regular check-ups due to rheumatism and mitral valve disease with non-disturbed blood circulation. Objectively her pulse is 96/min., of unequal strength. Blood pressure is 110/70 mm Hg, heart rate is 120/min. ECG registers small unevenly-sized waves in place of P-waves, R-R intervals are of unequal length. What is the most likely diagnosis?
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A 38-year-old woman works in flax processing, she dries fax. She came to the hospital complaining of difficult breathing, constricting sensation in her chest, and cough attacks. These signs appear on the first day of her working week and gradually diminish on the following days. What respiratory disease is likely in this case?
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At night a 2-year-old child with upper respiratory tract infection suddenly developed dyspnea with labored inspiration. Objectively the skin is pale, perioral cyanosis and slight acrocyanosis are observed. Breathing is loud, respiration rate is 32/min. Jugular, supra- and infraclavicular fossae retract during breathing. Respiration is coarse on auscultation. Heart sounds are clear and sonorous, heart rate is 120/min. What condition was complicated by the development of the upper respiratory tract infection?
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A 62-year-old woman was brought into the admission room with complaints of severe burning retrosternal pain and asphyxia. She has a 10-year-long history of essential hypertension. Objectively her condition is moderately severe. She presents with skin pallor, cyanotic lips, and vesicular respiration over her lungs. The II heart sound is accentuated over the aorta. Blood pressure – 210/120 mm Hg, heart rate (pulse) – 76/min. ECG shows elevation of ST segment in the leads I. AVL, and V5-V6. What is the most likely diagnosis?
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A child is 1-year-old. After solid food was introduced into the diet, within the last several months the child developed loss of appetite, diarrhea with large amount of feces, and occasional vomiting. Body temperature remains normal. Body weight is 7 kg. The child is very pale, has leg edemas and an extremely distended abdomen. Feces analysis detects high levels of fatty acids and soups. Diagnosis of celiac disease was made and gluten-free diet was prescribed. What should be excluded from the diet in this case?
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A 35-year-old woman complains of high body temperature and pain in the upper outer quadrant of her right buttock, which developed after an injection. She has been presenting with this condition for 3 days. At the site of injection the skin is hyperemic, there is a painful infiltrate with an area of softening in its center. The woman is diagnosed with a post injection abscess of the right buttock. What tactics should the surgeon choose in this case?
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A 57-year-old woman during a regular ultrasound examination presented with a space-occupying heterogeneous lesion in the right kidney. What is the most informative method of renal tumor diagnostics?
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A 23-year-old man has accidentally swallowed brake fluid. After that he has been presenting with anuria for 5 days already: his creatinine levels elevated up to 0.569 mmol/L. What treatment tactics should be chosen in this case?
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A 35-year-old man suffers from insulin dependent diabetes mellitus and chronic cholecystitis. He takes NPH insulin: 20 units in the morning and 12 units in the evening. After a meal he developed pain in the right subcostal area, nausea, vomiting, sleepiness, and increased polyuria. What prehospital measures will be the most effective for prevention of crisis within the next several Hours?
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A 7-year-old boy has been an inpatient for 1.5 months. He had been brought to the hospital with complaints of edemas all over his body, low urine output, and headache. Clinical urinalysis: proteins – 7.1 g/L, leukocytes - 1-2 in the vision field, erythrocytes 3-4 in the vision field. During the course of treatment the edemas gradually dissipated, headache abated, diuresis normalized. Daily urine proteins – 3 g/L. Biochemical blood test: total protein – 43.2 g/L, urea – 5.2 mmol/L, cholesterol – 9.2 mmol/L. What glomerulonephritis syndrome is the most likely to be present in the patient?
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A chronic alcoholic was hospitalized into the therapeutic inpatient unit due to pneumonia. On the day 5 of his hospitalization he became disoriented in time and space, developed fear-inducing visual hallucinations and motor agitation. Full body tremor and tremor of the limbs are observed. X-ray and physical examinations detect the signs of his convalescence from pneumonia. What tactics should be chosen regarding this patient?
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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. The 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 5-year-old child was brought to the ENT department by an ambulance. The child presents with cough and difficult respiration From the patient’s history it is known that the child was playing with a toy construction set, when suddenly started coughing and developed labored breathing. Examination detects periodical cough, labored expiration, and respiratory lag in the left side of the child’s thorax. Auscultation: diminished respiration on the left. Percussion: tympanitis. X-ray shows a displacement of the mediastinal organs to the right. Make the diagnosis:
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On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
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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 37.2°C intoxication symptoms appeared. regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis. neutrocytosis, increased ESR. What diagnosis can be made?
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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 58-year-old woman came to the gynecological clinic. She complains of bloody discharge from her genital tracts. Menopause is 8 years. Gynecological examination: the uterus is slightly enlarged, dense to touch with limited mobility: the uterine appendages cannot be detected; parametrium is free. Fractional curettage of the uterine cavity yields a significant amount of medullary substance in the scrape. What is the most likely diagnosis?
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A 72-year-old man diagnosed with ischemic heart disease presents with diffuse cardiosclerosis, permanent tachysystolic atrial fibrillation, heart failure lla, FCI Objective examination of vital signs blood pressure is 135/80 mm Hg, heart rate is 160/min., pulse is 125/min. Left ventricular ejection fraction is 32%. What drug is indicated in this case and should be prescribed to the patient?
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A pregnant woman is 28 years old. Anamnesis: accelerated labor complicated by the II-degree cervical rupture. The following two pregnancies resulted in spontaneous abortions at the terms of 12 and 14 weeks. On mirror examination: the uterine cervix is scarred from previous ruptures at 9 and 3 hours, the cervical canal is gaping. On vaginal examination: the cervix is 2 cm long, the external orifice is open 1 cm wide, the internal orifice is half-open: the uterus is enlarged to the 12th week of pregnancy, soft, mobile, painless, the appendages are without changes. What diagnosis can be made?
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A 40-year-old victim of a traffic accident sustained the following injuries: closed diaphyseal femur fracture, brain concussion, multiple rib fractures. hemopneumothorax degloving shin injuries. What injuries ress the most urgent attention?
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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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A 10-year-old boy with symptoms of arthritis and myocarditis was brought to a hospital. Based on clinical examination the provisional diagnosis of juvenile rheumatoid arthritis was made. What symptom is the most contributive for the diagnostics of this disease?
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An 11-year-old boy for a month has been presenting with increasing pain in the right femur. In the painful area there is a nonmobile painful tumor with unclear margins. The child complains of general indisposition, weakness, increased body temperature up to 39°C. X-ray shows widened medullary cavity small foci of cancellous bone destruction, and onion-like lameliar exfoliation of the cortical layer. What is the most likely pathology resulting in such clinical presentation?
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At night a 63-year-old woman suddenly developed an asphyxia attack. She has a 15-year-long history of essential hypertension and had a myocardial infarction 2 years ago. Objectively her position in bed is orthopneic, the skin is pale, the patient is covered with cold sweat, acrocyanosis is observed. Pulse – 104/min. Blood pressure – 210/130 mm Hg, respiration rate – 38/min. Pulmonary percussion sound is clear, with slight dullness in the lower segments, throughout the lungs single dry crackles can be heard that become bubbling and non-resonant in the lower segments. What is the most likely complication in this patient?
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A 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. Disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work he is often away on business trips. What is the most likely etiological factor of this disease?
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The 5-year-old child has been ill for 2 weeks. Cough attacks developed first and were then followed by reprises. During coughing the child’s face turns red and cervical veins bulge. The cough attacks induce vomiting, X-ray shows intensified bronchial pattern. Blood test: leukocytes – 16 x 109/L . lymphocytes 72%, erythrocyte sedimentation rate – 4 mm/hour. What is the most likely diagnosis?
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During medical examination a cadet in the naval college was detected to have a painless dense ulcer 1.5×0.5 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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