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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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After a pain attack in the right subcostal area, a 38-year-old woman with overnutrition developed icteric skin and sclera, light colored feces, and dark urine. Her abdomen is distended and painful on palpation in the right subcostal area. Palpation detects liver enlargement by 2-3 cm. Blood test: total bilirubin – 90 mcmol/l, conjugated bilirubin 60 mcmol/L, What method of examination will be the most informative for diagnosis clarification?
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A 65-year-old woman on abdominal palpation presents with a tumor in the umbilical region and above it; the tumor is 13×8 cm in size, moderately painful, nonmobile, pulsing. On auscultation systolic murmur can be observed. What is the most likely diagnosis?
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A woman has been provisionally diagnosed with pheochromocytoma. At the stage of intermission her BP is within norm: there is a tendency towards tachycardia. No urine pathologies. The decision has been made to perform a provocative test with histamine. What drug should be kept close at hand for emergency aid in case of a positive test result?
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A middle school teacher with a 4-year long record of work was issued a medical certificate for pregnancy and childbirth leave. What amount of pay will she receive for the duration of her leave in this case?
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A 38-year-old woman developed a medical condition 7 days after her return from Bangladesh. Periodical elevation of temperature was accompanied by chills and excessive sweating. She was diagnosed with tropical malaria. Next day her condition further deteriorated: body temperature – 38°C. inertness, periodical loss of consciousness, generalized seizures, tachycardia. hypotension, and icteric skin. What complication can be suspected in this case?
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A 45-year-old man was brought by an ambulance into the emergency hospital. He complains of sudden pain in the lumbar area frequent painful urination, and vomiting Examination detects pain in the lumbar area. costovertebral angle tenderness, pain on palpation of kidneys and along the ureter on the right. Urine test: proteins, fresh erythrocytes, leukocytes. Make the provisional diagnosis:
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An 8-year-old girl complains of frequent painful urination in small amounts and urinary incontinence. The signs have been present for 2 days already. She explains her disease by overexposure to cold. Costovertebral angle tenderness is absent. Complete blood count is without pathologies. Urine test: leukocytes – 20-30 in the vision field, erythrocytes – 40-50 in the vision field, unchanged, bacteriuria. What is the most likely diagnosis?
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After a surgery for a left thigh phlegmon the disease progression was complicated by sepsis. On the 7th day after the surgery there are marked signs of a generalized inflammatory reaction, in blood there are signs of toxic anemia and progressing hypoproteinemia, bilirubin levels are 40 mcmol/L, AST and ALT exceed the norm by 2.5 times. Oliguria persists (700 mL of urine per day). Name the phase of sepsis progression:
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3 hours after a trauma, a young man developed bradycardia of 46/min., anisocoria D>S, hemihyperreflexia S>D, hemihypesthesia on the left, and a convulsive disorder. The character of this process needs to be clarified. What method of examination will be the most accurate for this purpose?
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Having examined a 52-year-old patient, the doctor diagnosed him with obesity (body mass index – 34 kg/m2. waist circumference – 112 cm) and arterial hypertension (170/105 mm Hg). 2-hour postprandial blood sugar is 10.8 mmol/L. What biochemical blood analysis needs to be conducted to diagnose the patient with metabolic syndrome X?
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Mother of a 5-year-old child noticed on the head of her child a round "bald" spot 3 cm in diameter. All the hairs in the focus are broken off at the length of 5-6 mm. The day before the child was petting a stray cat. Make the diagnosis:
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A 23-year-old man complains of facial edemas, headache, dizziness, low urinary output, and urine discoloration (dark red). These complaints arose after a case of acute tonsillitis. On examination there are facial edemas, the skin is pale, temperature is 37.4°C; heart rate is 86/min., blood pressure is 170/110 mm Hg. Heart sounds are muffled, the II heart sound is accentuated over the aorta. What etiological factor is the most likely 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 35-year-old patient developed an epileptic attack with tonic clonic 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 young man has made an appointment with the dermatologist. He complains of a painful facial rash in the beard and mustache area. This condition has been persisting for several weeks already. After shaving, the patient’s condition aggravates. The diagnosis of sycosis is made. What primary morphological elements can be observed in the rash in this case?
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A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38°C. Examination shows him to be in a moderately severe condition, there are small pale pink non-merging spots on the skin of his abdomen, and extremities. Palpation revealed enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
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A 37-year-old man suddenly developed an acute headache accompanied by nausea. vomiting, and impaired consciousness. Objectively blood pressure is 190/120 mm Hg. The face is hyperemic. Patient’s consciousness is clouded, his answers to the questions are short, monosyllabic. Movement and sensory disturbances are absent. Meningeal signs are positive. Cerebrospinal fluid contains blood. What provisional diagnosis can be made?
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A 45-year-old man diagnosed with acute pulmonary abscess suddenly developed sharp pain in his chest on the right and dyspnea up to 30/min. Examination detects facial cyanosis and shallow rapid respiration. Auscultation reveals acutely weakened respiration throughout the whole right lung percussion reveals a vesicular tympanitic (bandbox) resonance at the lung apex and dullness in the lower lobe. What complication developed in this patient?
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2 hours after a traffic accident a 28-year-old man in a grave condition was brought 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: the abdominal muscles are defensively tense, 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 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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A woman has been working as a polisher for a year and a half. Her workstation is equipped with a grinding machine (grinding wheels). She complains of white discoloration of her fingers and toes that appears when she is nervous. Objectively there are no changes in the coloration of the distal segments of her limbs. Grip strength measured with a dynamometer is 25 kg, algesimetry findings are 0.1; 0.3; 0.5. Cold stimulus is extremely positive on the upper and lower limbs. Internal organs are without pathologies. Make the diagnosis:
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In April during the medical examination of various population groups, 27% of individuals presented with low working ability and rapid fatigability. The following symptoms were observed in the affected individuals swollen friable gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied by skin dryness. These symptoms most likely result from the following pathology
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A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, non localized colicky abdominal pains, and nausea. Objectively his skin is gray. there is a pink-gray stripe on his gums, the stomach is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. Constipation tends to occur every 3-4 days. What is the most likely provisional diagnosis?
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A 62-year-old patient has been hospitalized with complaints of pain in the thorax on the right during breathing, dyspnea, and dry cough. Ten days ago he slipped and fell hitting his right side. On examination: the patient lies on the left side. The right side of the thorax lags during breathing. On the right there is crepitation and pain in the III-IV ribs. Dullness of percussion sound and sharply diminished breath sounds can be observed. On X-ray: signs of exudate, fracture of the IIIIV ribs. On pleurocentesis: blood is detected. Choose the further tactics.
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A 38-year-old patient has been brought by an ambulance to the 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 a similar condition was observed 1 year ago. Make the diagnosis:
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A 10-year-old boy, who was outdoors in Windy and cold weather, developed pain and tingling in his fingers and toes when he returned home. His parents noticed that the tips of his fingers and toes were white and their sensitivity was lost. As the affected areas were warming up the fingers and toes developed tingling and painful sensations. Skin pallur changed into redness, tingling stopped. Mild itching and swelling of the fingers appeared. Determine the frostbite degree in this child:
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A 24-year-old woman, a kindergarten teacher, has been sick for 2 days already. Disease onset was acute. She presents with elevated body temperature up to 38.0°C, pain attacks in her lower left abdomen, liquid stool in small amounts with blood and mucus admixtures 10 times a day. Pulse – 98/min., blood pressure – 110/70 mm Hg. Her tongue is moist and coated with white deposits. The abdomen is soft, the sigmoid colon is painful and spastic. Make the provisional diagnosis
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A 36-year-old man complains of marked dyspnea and cardiac pain. He ascribes his disease to the case of influenza that he had 2 weeks ago. Objectively he leans forward when sitting. The face is swollen. cyanotic, cervical veins are distended. Heart borders are extended on both sides, heart sounds are muffled, heart rate = Ps = 118/min., BP is 90/60 mm Hg. Blood test: ESR is 46 mm/hour. ECG shows low voltage. X-ray shows trapezoidal cardiac silhouette and signs of pulmonary congestion. Choose the treatment tactics:
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A 73-year-old woman came to the family physician for one of her regular follow-up examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to her diet and exercise plan and taking phytopreparations. On examination her fasting glucose was within the range of 7.8 – 8.6 mmol/L, HbAlc – 79%. Height – 134 cm, weight – 83 kg. What blood sugar-controlling medicine should she be prescribed first in the course of her pharmacological therapy?
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A newborn girl has an Apgar score of 7-8 points at the 1-5 minutes after birth. During the labor there was a brief difficulty with extraction of the shoulder girdle. After birth the baby presents with disturbed function of the proximal segment and forced position of the right arm. The shoulder is inwards, the elbow is extended, the forearm pronated, and the whole upper limb resembles the arm of a doll. What is the most likely clinical diagnosis in this case?
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2 hours after eating unknown mushrooms a 28-year-old man sensed a decrease in his mobility and deterioration of his ability to focus. This condition was then followed by a state of agitation and aggression. On examination he is disoriented and his speech is illegible. 4 hours later he developed fetor hepaticus and lost his consciousness. What syndrome can be observed in this patient?
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A 45-year-old woman came to the maternity clinic with complaints of periodical pains in her mammary glands that start 1 day before menstruation and stop after the menstruation begins. Palpation of the mammary glands detects diffuse nodes predominantly in the upper outer quadrants. What is the most likely diagnosis?
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A 32-year-old man complains of pain in his legs that intensifies during walking was intermittent claudication, numbness of his toes, extremity coldness, and inability to walk more than 100 meters. When he sleeps his leg usually hangs down. The patient has been smoking since he was 16. He drinks alcohol in excess. The left leg is colder than the right one; the skin of the extremities is dry. No pulse can be detected on the pedal arteries, while pulsation of the femoral arteries is retained. What is the most likely diagnosis?
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A 46-year-old woman came to the maternity clinic with complaints of moderate blood discharge from the vagina, which developed after the menstruation delay of 1.5 months. On vaginal examination: the cervix is clean; the uterus is not enlarged, mobile, painless; appendages without changes. Make the diagnosis:
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A woman undergoing in-patient treatment for viral hepatitis type B developed a headache, nausea, recurrent vomiting, memory lapses, flapping tremor of her hands, and rapid pulse. Sweet smell from her mouth is detected. Body temperature is 37.6°C and the heart rate is 89/min. What complication developed in the patient?
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An 18-year-old patient always obeys others and adapts his needs to the demands of the people on whom he depends. He excessively defers to their wishes and makes them responsible for his well being, cannot defend his interests and needs support from other people. Such a psychic profile has been formed in childhood, and remains unchanged, and hinders adaptation. What psychic disorder is observed in this patient?
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It is the 3rd day after the first normal term labor; the infant is rooming-in with the mother and is on breastfeeding. Objectively: the mother’s general condition is satisfactory Temperature is 36.4°C, heart rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless, lactation is moderate, unrestricted milk flow. The uterus is dense, the uterine fundus is located 3 finger widths below the navel. Lochia are sanguino-serous. moderate in volume. Assess the dynamics of uterine involution:
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A boy had a foreign body removed from under his nail plate. 3 days later he developed a sharp throbbing pain at the end of his distal phalanx, which intensifies when the phalanx is pressed, hyperemia of the nail fold, elevated body temperature up to 38.5°C, and nail plate discoloration. Make the diagnosis:
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A 42-year-old man, a dispatcher, suffers from peptic ulcer disease of the duodenum. The disease is of moderate severity. He wants to be assigned a disability group. Make the conclusion regarding his working ability:
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A 48-year-old woman has arrived to the surgical unit with wounds in her thigh. On examination the wound surface has dirty-gray coating with unpleasant sweet smell. Wound content resembles raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What microflora is the most likely to cause such inflammation?
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