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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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A 53-year-old man complains of general weakness, loss of appetite, and painful vesicles appearing on his skin. The disease onset occurred suddenly, after hyperinsolation one week ago. Examination detects isolated vesicles with wrinkled opercula and occasional painful erosions on the skin of the patient’s torso and limbs. The Nikolsky sign is positive. What is the most likely diagnosis?
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A 23-year-old man complains of severe pain in his left knee joint. Objectively the left knee joint is enlarged with hyperemic skin, painful on palpation. Complete blood count: erythrocytes – 3.8 × 1012/L, Hb- 122 g/L, leukocytes – 7.4 × 1012/L, platelets – 183 × 109/L. Erythrocyte sedimentation rate – 10 mm/hour. Bleeding time (Duke method) – 4 min., Lee White coagulation time 24 min. Partial thromboplastin time (activated) – 89 seconds. Rheumatoid factor – negative. What is the most likely diagnosis?
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A 32-year-old woman complains of episodes of intense fear that occur without visible cause and last for 10-20 minutes, the episodes are characterized by rapid pulse. sweating, labored breathing, and vertigo. Specify the likely diagnosis:
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During medical examination of high and middle school students, the doctors vere assessing correlation between biological and calendar age of the school students based on the following criteria: height growth rate per year, ossification of the carpal bones, the number of permanent teeth. What additional development criterion should be assessed at this age?
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During an outdoor school event in hot weather, a 10-year-old girl lost consciousness. Body temperature – 36.7°C. Objectively her skin is pale and cold to touch, her pupils are dilated. Blood pressure – 90/50 mm Hg. Heart rate – 58/min. What pathology occurred in this case?
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A 78-year-old man with a prostate adenoma underwent a herniotomy for a direct inguinal hernia. After the surgery he presents with absent urination. Enlarged urinary bladder is detectable above the patient’s pubis. What measures should be taken in this case?
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A 27-year-old woman complains of foul smelling discharge from her genital tracts, pain in her lower abdomen, and elevated temperature. The complaints arose 2 days ago. She has a history of surgical abortion at the term of 8 weeks one week ago. Mirror examination: the uterine cervix is clear, external orifice produces foul-smelling discharge. Vaginal examination: the uterus lies in anteflexion, is mobile, painful, and slightly enlarged. The appendages are without changes. Make the provisional diagnosis:
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A woman with atopic bronchial asthma was found to have one allergen to dog hair +++. Carpets were removed from the apartment, the apartment was renovated, and the air conditioner was installed. However, recurrent asphyxia attacks still occur every night, despite the patient undergoing pathogenetic therapy. What long-term treatment tactics can help this patient to decrease her sensitivity to the allergen?
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A 45-year-old man with thrombophlebitis of the deep veins in his legs suddenly after physical exertion developed sharp pain in his thorax on the right, dyspnea, and hemoptysis. Objectively his condition is severe; he presents with acrocyanosis, shortening of pulmonary percussion sound on the right, and weakened respiration. Respiration is 30/min., blood pressure is 110/80 mm Hg ECG shows sinus tachycardia, heart rate is 120/min., electric axis of the heart deviates to the right, S1-Q111. What is the most likely diagnosis?
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A 40-year-old man claims that his wife is cheating on him and presents a "proof" of her infidelity. He repeatedly initiated scandals with his wife at home and at work, demanding that she confess her infidelity, insulted her, and threatened to kill her. What preventive measures should be taken against socially dangerous actions on his part?
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A 1.5-month-old child on breastfeeding presents from birth with daily vomiting. irregular liquid foamy feces, and meteorism, which are resistant to antibacterial and probiotic therapy: no increase of body mass is observed. The child’s condition improved, when breastmilk was substituted with "NAN low lactose" formula. What pathology is it?
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A 37-year-old patient complains of pain in the spinal column, reduced mobility. The condition persists for 7 years. "Sway back" is observed, there is no movement in all spinal regions. X-ray shows "bamboo spine" vertebral column. What is the most likely diagnosis?
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After a long drive with the window open a man developed facial asymmetry, he cannot close his right eye, his right nasolabial fold is smoothed out, movements of expression are absent on the right, there is a disturbance of gustatory sensation in the tongue on the right. No other neurological pathologies were detected. What disease can be provisionally diagnosed in this patient?
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A man was brought into the admission room after overexposure to cold. He complains of sharp pain in the small of his back and elevated body temperature up to 38°C. He took some aspirin. Blood test: leucocytes - 10.5 × 1012/L, eosinophils – 5%. band neutrophils – 8%, segmented neutrophils 51%, lymphocytes – 32%, monocytes . 4% erythrocyte sedimentation rate – 28 mm/hour Urinalysis: protein – 0.6 g/L, leukocytes – cover the whole vision field, large amount of mucus. What is the most likely diagnosis?
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A 28-year-old woman complaining of irregular menstruations and infertility came to the gynecological clinic. Menstruations occur since the age of 15, irregular, with delays up to 2 months. On examination she presents with marked hirsutism and excessive body weight. On vaginal examination the uterus is reduced in size and painless. The ovaries on both sides are dense and enlarged. Ultrasound shows microcystic changes in the ovaries, the ovaries are 5×4 cm and 4.5×4 cm in size with dense ovarian capsule. Basal body temperature is monophasic. What is the most likely diagnosis?
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A newborn with gestational age of 31 weeks presents with hypotonia and depressed consciousness. Hematocrit is 35%, general cerebrospinal fluid analysis shows increased content of erythrocytes and protein, and low glucose. These data correspond with the clinical presentation of:
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A 25-year-old woman has been suffering from diabetes mellitus since she was 9. She was admitted into the nephrology unit with significant edemas of the face, arms, and legs. Blood pressure – 200/110 mm Hg. Hb- 90 g/L, blood creatinine – 850 mcmol/L, urine proteins – 10 g/L, leukocytes – 10-15 in the vision field. Glomerular filtration rate – 10 mL/min. What tactics should the doctor choose
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A 43-year-old man, a coal-face worker with a 15-year-long record of work, complains of cough, thoracic pain, and dyspnea. The cough is mild, usually dry, and occurs mostly in the morning. The pain is localized in the interscapular region and aggravates during deep intake of breath. Dyspnea occurs during physical exertion. Vesicular respiration in the lungs is weakened. Heart sounds are rhythmic. heart rate is 86/min., blood pressure is 135/80 mm Hg. The abdomen is soft and painless, X-ray shows micronodular pulmonary fibrosis. Make the provisional diagnosis:
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A 26-year-old woman presents with amenorrhea. 10 months ago she gave birth for a second time. In her early postpartum period she developed a massive hypotonic hemorrhage. No breastfeeding. Lately she has been presenting with loss of weight, loss of hair, and indisposition. Gynecological examination revealed atrophy of the external genitals, the uterus is abnormally small, no uterine appendages can be detected. What is the most likely diagnosis?
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A 7-year-old girl has been twice treated with antibacterial agents for urinary tract infection. US shows no severe renal defects. The child presents with recurrence of leukocyturia and bacteriuria, elevated body temperature up to 38.5°C, and pain in her left lumbar area. What examination should be conducted first to clarify the cause of urinary infection recurrence?
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A 3-month-old child with signs of rickets presents with positive Chvostek, Trousseau, and Maslov signs. One day ago the parents witnessed a cyanotic attack in their child – the child broke into a cold sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew in a loud breath and the child’s condition normalized again. What is the cause of the described signs of the disease?
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A 25-year-old man was hospitalized with complaints of pain in his lower abdomen and right lumbar area that appeared one hour ago. Patient’s general state is moderately severe. Body temperature – 38.2°C, heart rate – 102/min. The tongue is dry. The abdomen is painful on deep palpation in the right iliac area and in the Petit triangle. Aure-Rozanov and Gabay signs are positive. Make the provisional diagnosis:
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Clinical statistical investigation was performed to determine effectiveness of a new pharmacological preparation for patients with ischemic heart disease. What parametric test (coefficient) can be used to estimate the reliability of the results?
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A 45-year-old man underwent cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively his body temperature is hectic. His cardiac borders are expanded. apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?
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A surgery unit received a person with an incised stab wound on the upper third of the right thigh. Examination detects an incised stab wound 3.0×0.5×2.0 cm in size on the inner surface of the upper third of the right thigh. Bright-red blood flows from deep within the wound in a pulsing stream. Characterize this type of bleeding:
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A 33-year-old man developed multiple rashes on the skin of his torso and extensor surfaces of his upper and lower limbs. The rashes itch and occasionally fuse together and form plaques. The elements of rash are covered with silver-white fine scales that easily flake off when scratched. Grattage test results in three sequential phenomena: stearin spot, terminal film, and punctate hemorrhage. What diagnosis can be suspected?
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A 15-year-old girl complains of dizziness and sensation of lack of air that she develops in emotionally straining situations. Relief occurs after she takes Corvalol. Objectively hyperhidrosis and marble-like pattern of the skin of her palms and feet. Clinical and instrumental examination revealed no organic changes in the central nervous, cardiovascular, and respiratory systems. What provisional diagnosis can be made?
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A 32-year-old woman complains of tumor-like formation on the anterior surface of her neck that appeared 2 years ago. Within the last 3 months the tumor has been rapidly growing. It hinders swallowing and impairs speech; the tumor causes a sensation of pressure. Objectively the skin moisture is normal, pulse is 80/min., rhythmic, blood pressure is 130/80 mm Hg. In the right lobe of the thyroid gland there is a dense lumpy node 3.0×3.5 cm that moves during swallowing. Scanning image shows a "cold nodule" in the thyroid gland. Make the provisional diagnosis:
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A 3-week-old infant developed large, flaccid vesicles with purulent contents on the skin of chest and abdomen. The vesicles rupture quickly. Make the provisional diagnosis:
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Disease onset was acute. A developed general weakness, pain in the joints, and elevated temperature. Later these signs became accompanied by itching skin rash manifested as erythematous spots 25 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen: pain attacks periodically occur in the periumbilical area; there are signs of intestinal hemorrhage. What is the most likely diagnosis?
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A 23-year-old woman came to the gynecological clinic. She complains of pain, itching and burning in her vulva, general weakness, indisposition, elevated body temperature up to 37.2°C, and headache. On examination in the vulva there are multiple vesicles up to 2-3 mm in diameter with clear contents against the background of hyperemia and mucosal edema. Make the provisional diagnosis:
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A 72-year-old man complains of lower extremity edema, sensation of heaviness in the right subcostal area, dyspnea at rest. For over 25 years he has been suffering from COPD. Objectively: orthopnea, jugular venous distention, diffuse cyanosis, acrocyanosis. Barrel chest is observed, on percussion there is a vesicular tympanitic (bandbox) resonance, sharply weakened vesicular respiration on both sides, moist crepitant crackles in the lower segments of the lungs. Heart sounds are weakened, the II heart sound is accentuated over the pulmonary artery. The liver is +3 cm. What complicated the clinical course of COPD in this patient?
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A woman is 40 weeks pregnant. The fetus is in the longitudinal lie and cephalic presentation. Pelvic size: 26-29-31-20. Expected weight of the fetus is 4800 gram. The labor contractions have been lasting for 12 hours, within the last 2 hours they were extremely painful. The parturient woman is anxious. The waters broke 4 hours ago. On external examination the contraction ring is located 2 finger widths above the navel, Henkel-Vasten sign is positive. Fetal heart rate is 160/min., muffled. On internal examination the uterine cervix is fully open, the head is engaged and pressed to the entrance into the lesser pelvis. What is the most likely diagnosis?
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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 the patient’s grandmother had cervical cancer. 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 52-year-old man for the last 3 years has been suffering from difficult swallowing of solid food, burning retrosternal pain that aggravated during eating, loss of body mass, and occasional vomiting with undigested food. Esophageal X-ray shows S-shaped deformation of the esophagus and its dilation; at the cardiac orifice the esophagus is constricted: esophageal mucosa is smooth, without signs of peristalsis. Make the provisional diagnosis
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A 30-year-old man was brought to the neurosurgical department with complaints of constant headaches, nausea, vomiting, fever, and weakness of the right-side limbs. Anamnesis states that one month ago the patient had surgery for left-sided suppurative otitis and mastoiditis. He has been undergoing treatment in an ENT department. Approximately 2 weeks ago the temperature increased, and the patient developed headaches. Objectively: heart rate – 98/min., BP-140/90 mm Hg, temperature – 38.3°C. Neurologically manifested stiff neck: bilateral Kernig’s symptom. unsteadiness during the Romberg’s maneuver. Computer tomography of the brain revealed a three dimensional growth with a capsule in the left hemisphere. Make the diagnosis:
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A 65-year-old man complains of dyspnea, severe cough with expectoration of small amounts of blood-streaked sputum, weight loss, body temperature 37.2°C. loss of appetite, and weakness. He has been suffering from this condition for years. The patient’s condition deteriorated one year ago, dyspnea developed 3 weeks ago. The patient is a lifelong smoker. He is a carpenter by occupation. Objectively he is of normal body type but emaciated. Right side of the chest is retracted, excursions are limited, accessory muscles take part in the respiration, respiratory rate is 22 /min percusion detects dull sound over the upper segment. Chest X-ray shows shrunken right upper lobe with homogenous shadow connected to the root of the lung: the root is deformed: mediastinal organs are displaced to the right. What is the most likely diagnosis?
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A 20-year-old student after failing an exam developed complaints of a sensation of a round foreign body in her throat, difficult swallowing. She fixates on her condition, limits her diet, often cries, seeks attention, exhibits demonstrative attitude. She is highly susceptible to psychotherapeutic suggestions. What psychiatric diagnosis can be made in this case?
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Having studied the relationship between the distance from villages to the local outpatient clinics and frequency of visits to the clinics among the rural population of this area it was determined that the rank correlation coefficient in this case equals -0.9. How can this relationship be characterized?
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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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