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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 10-year-old girl exhibits a high level of physical development (Μ + 3σ). her body length increased by 10 cm within a year (which is double the norm for her age group), the number of permanent teeth corresponds with the age norm (20), the development of her secondary sex characteristics is three years ahead of her age (Ma, P, Ax, Menarche). Development rate ahead of her biological age can occur due to:
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In the inpatient gynecological unit within a year 6500 women underwent treatment. They spent there a total of 102000 bed-days there. What indicator of the gynecological unit work can be calculated based on this data?
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A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric sclerae, and bright red fissured tongue. Lymph nodes are not enlarged. Pulse – 100/min. BP- 105/70 mm Hg. Liver +3 cm, the spleen cannot be palpated. Blood test: erythrocytes – 1.2 × 1012/L, Hb- 56 g/L, color index – 1.4, macrocytes, leukocytes – 2,5 × 109/L, eosinophils – 1%, juvenile – 1%. metamyelocytes – 1%, band neutrophils – 8%, segmented neutrophils – 47%, lymphocytes – 38%, monocytes – 4%, reticulocytes – 0.1% platelets – 100 × 109/L, ESR - 30 mm/hour, indirect bilirubin – 26 mmol/L. What changes can be expected in the bone marrow puncture material?
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The burns unit received a patient, who 6 hours ago during a fire received flame burns. On the patient’s body there is a gray brown area of necrosis that covers 3/4 of the body perimeter. Occasionally there are small blisters with hemorrhagic contents and patches of shredded epidermis. What local therapy is necessary in this case?
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A 45-year-old woman is registered for regular check-ups due to Werlhof disease (immune thrombocytopenia). Complete blood count: Hb- 100 g/L. erythrocytes – 2.8 × 109/L. platelets – 90,0 × 109/L, leukocytes – 8.4 × 109/L, erythrocyte sedimentation rate – 13 mm/hour. Examination detects a single small hematoma on the anterior surface of the thigh, developed after the patient accidentally stumbled on a table. What treatment tactics should be chosen in this case?
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In the process of hiring, a prospective employee has undergone preventive medical examination and was declared fit to work in this manufacturing environment. What type of preventive medical examination was it?
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A 27-year-old woman, a teacher in the elementary school, complains of frequent stools, up to 3 times per day, with lumpy feces and large amount of mucus, abdominal pain that gradually abates after a defecation. irritability. Her skin is pale and icteric. Pulse IS 74/min, rhythmic, can be characterized as satisfactory. Blood pressure is 115/70 mm Hg. The abdomen is soft, moderately tender along the colon on palpation. Fiberoptic colonoscopy detects no changes. What disease can be suspected?
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A 6-month-old child on breastfeeding is hospitalized in the inpatient department. After the child recovers, the doctor recommends the mother to start introducing solid food to the child’s diet. What products should be introduced to the child’s diet first?
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10 hours after birth a child developed jaundice, hypotonia, hyporeflexia, and moderate hepatosplenomegaly. Feces and urine are of normal color. Umbilical cord blood bilirubin is 51 mcmol/L due to unconjugated bilirubin levels. In venous blood: erythrocytes – 3.5 × 1012/L, Hb- 140 g/L. reticulocytes – 1.5%, bilirubin – 111 mcmol/L, conjugated – 11 mcmol/L, ALT-40 U/L, AST- 30 U/L. Mother’s blood group is A(II) Rh(-), child’s blood group is A(II) Rh(+). What laboratory test can confirm the diagnosis?
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The body of a 24-year-old woman with suspected 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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During regular preventive gynecological examination a 30-year-old woman was detected to have dark blue punctulated "perforations" on the vaginal portion of the uterine cervix. The doctor suspects endometriosis of the vaginal portion of the uterine cervix. What investigation method would be most informative for diagnosis confirmation?
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A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, 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 parturient woman is 30 years old, Stage 1 of the labor is ongoing. The fetus is in the cephalic presentation. Auscultation of the fetal heart sounds detects bradycardia. Evaluation of cardiotocogram yielded the following data: decrease of basal heart rate down to 90/min., variability – monotonous (2 and less): late decelerations with amplitude of 50/min. Make the diagnosis and choose the obstetrical tactics necessary in this case:
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A 42-year-old man, a worker at the meat processing factory, developed an itching spot on his lower jaw, which gradually transformed into a slightly painful carbuncle 3 cm in diameter, surrounded by a painless swelling that reaches the clavicle. Temperature is subfebrile, under 37,8°C. The doctor suspects anthrax. What drug should this man be prescribed for treatment?
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The dermatologist has an appointment with a 30-year-old man that complains of severely itching rashes that especially disturb him at night. The rashes developed 2 weeks ago, after he had returned from a travel. Objectively on the lateral surfaces of his fingers, hands, wrists, elbows. lower abdomen, genitals, and thighs there are paired papulovesicles, single pustules, and scratch marks. What disease can be suspected?
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Clinical trials have proved the "Lipoflavon" drug to be effective for treatment of unstable angina pectoris in the control group and experimental group of patients. Neither patients nor researchers knew who belonged to which group. Name this type of study:
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A 39-year-old man suffers from chronic rheumatic heart disease. He complains of dyspnea during physical exertion, cough with expectoration, and palpitations. Auscultation detects intensified I heart sound and diastolic murmur; the sound of opening mitral valve can be auscultated at the cardiac apex. The II heart sound is accentuated over the pulmonary artery. The patient is cyanotic. X-ray shows dilated pulmonary root and enlargement of the right ventricle and left atrium. What is the most likely diagnosis?
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A 43-year-old man complains of a protrusion in the right inguinal region, that enlarges due to strain. He has been pre with this condition for 6 months. Within this period the protrusion has grown. Objectively in the right inguinal region an elastic protrusion 8×5 cm is visible. On palpation it disappears, leaving an empty space 4×4 cm between the pedicles of the Poupart ligament. "Cough push" sign is positive over this opening. Make the diagnosis:
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A 56-year-old woman was diagnosed with stage 2 hypertension of the 2nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is CONTRAINDICATED to this patient?
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In a rural health care area there is an increasing cervical cancer morbidity observed. The decision is made to conduct a medical examination of the women living in this locality. What type of medical examination is it?
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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 10x109/L, Hb- 37 g/L, color index – 1.1, leucocytes – 12 × 109/L. platelets - 86 × 109/L. What analysis would be the most advisable diagnosis-making in this case?
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A patient has gradually lost consciousness. The skin is pale and dry. There is a smell of ammonia from the mouth. Respirations are deep and noisy. Heart sounds are muffled, pericardial friction rub is present Blood pressure is 180/130 mm Hg. Blood test Hb- 80 g/L, leucocytes - 12 × 109/L, blood glucose – 6.4 mmol/L, urea – 50 mmol/L creatinine – 1200 mcmol/L, blood osmolarity – 350 mOsmol/L. No urinary excretion. Make the diagnosis:
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A 3-year-old child presents with dyspnea that abates in the sitting position. occasional loss of consciousness and seizures, delayed physical development, cyanosis, drumstick fingers. Echocardioscopy detects aortic dextroposition, ventricular septal defect, pulmonary artery stenosis, and right ventricular hypertrophy. What is the most likely diagnosis?
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Increased general morbidity of the local population is observed in the area near a factory, where the atmosphere is being intensively polluted with sulfurous gas. What effect does polluted air have on the human body in this case?
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A woman in her early- to mid-thirties lost consciousness 3-5 minutes ago. On examination: the skin is pale, no pulse over the carotid arteries, no spontaneous respiration, pupils are dilated; the patient is unresponsive, presents with atony. The patient’s condition can be determined as:
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During regular medical examination a lyceum student presents with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red, with single vertical cracks covered with brown red scabs. These clinical signs are most likely caused by insufficient content of the following in the diet:
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A 59-year-old man complains of pain in his left eye and left side of his head, significant vision impairment of the left eye, nausea, and vomiting. Visual acuity of the right eye is 1.0. Visual acuity of the left eye is 0.03. attempts at correction bring no improvement. Right eye intraocular pressure – 21 mm Hg, left eye intraocular pressure – 65 mm Hg. Congestive injection is observed on the sclera of the left eye. The cornea is thick and swollen. The anterior chamber is shallow, moist, and clear. The pupil is dilated and unresponsive to the light, the fundus of the eye is not visible. What is the most likely diagnosis?
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Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust-induced diseases. What is the main physical property of dust aerosols?
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A 13-year-old girl for a month has been complaining of fatigability, dull pain in her right subcostal area, abdominal distension, and constipations. Abdominal palpation reveals positive Kehr, Murphy, and Ortner signs, while Desjardins and Mayo-Robson points are painless. Total bilirubin is 14.7 mcmol/L. predominantly indirect, ALT- 20 U/L, AST- 40 U/L, amylase – 6.3 mmol/L. Echocholecystography shows practically no contraction of the gallbladder. Make the provisional diagnosis:
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A 35-year-old pregnant woman with degree 1 essential hypertension, developed edemas and headache at the 33 week of her pregnancy. Objectively her general condition is satisfactory, blood pressure – 160/100 mm Hg. normal uterine tone. Fetal heart rate is 140/min., rhythmic. She was diagnosed with daily proteinuria – 4 g/L, daily diuresis – 1100 mL. Creatinine – 80 mcmol/l, urea – 7 mmol/L, platelets – 100 × 109/L. What complication of pregnancy occurred?
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A 38-year-old woman complains of weakness, sleepiness, pain in the joints, weight gain despite low appetite, and constipations. She presents with dry and thickened skin. puffy and amimic face, narrowed palpebral fissures, thick tongue, and deep hoarse voice. Her heart sounds are weak, pulse is 56/min. Low levels of free T4 are observed. This patient needs to take the following on a regular basis:
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A 28-year-old man complains of skin rash and itching on both of his hands. The condition persists for 1.5 years. The exacerbation of his condition he ascribes to the occupational contact with formaldehyde resins. Objectively the lesion foci are symmetrically localized on both hands. Against the background of erythema with blurred margins there are papulae, vesicles, erosions, crusts, and scales. What is the most likely pathology?
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A 3-year-old child has been brought to a hospital with complaints of pain in the legs, fever, and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb- 88 g/L, color index – 1.3, platelets - 80 × 109/L, leucocytes - 25.8 × 109/L, lymphoblasts – 70%, ESR 52 mm/hour. Make the provisional diagnosis:
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A patient has the second and third degree burns of 15% of the body surface. On the 20th day after the trauma the patient presents with sharp increase of body temperature, general weakness, rapid vesicular respiration: facial features are sharpened, BP is 90/50 mm Hg, heart rate is 112/min. What complication is it?
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An 18-year-old girl was brought into the gynecology department with complaints of elevated body temperature up to 37,8°C, sharp pain in her lower abdomen, more intense on the right, and difficult defecation. Vaginal examination detected a painful dense elastic formation 5×6 cm in the area of her right ovary Pregnancy test is negative. What is the most likely diagnosis?
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On the 15th day after a small trauma of the right foot, the patient developed indisposition, fatigability, irritability, headache, elevated body temperature, and sensation of constriction. tension, and twitching in the muscles of the right shin, WL disease can be suspected?
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On the day 4 after the cesarean section a woman developed fever with body temperature up to 39°C and abdominal pain. Pulse – 104/min. She vomited twice. The patient is sluggish, her tongue is dry and has gray coating. The abdomen is distended. Signs of peritoneal irritation are positive in all segments. Peristalsis cannot be auscultated. No passage of gas occurs. Uterine fundus is located at the level of the navel. The uterus is painful on palpation. The discharge is moderate and contains blood and pus. What is the most likely diagnosis?
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A 51-year-old man complains of vomiting with blood. He has been drinking alcohol excessively. Health disorder has been observed since he was 40, when he first developed jaundice. On examination the skin and visible mucosa are icteric, with a stellate vascular pattern. The patient is malnourished and presents with abdominal distension, umbilical hernia, and ascites. The edge of the liver is tapered and painless, +3 cm, the spleen is +2 cm. Blood test: Hb- 80 g/L, leucocytes - 3 × 109/L. platelets – 85 × 109/L. What is the cause of portal hypertension in this patient?
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A 22-year-old postparturient woman on the 12th day after the normal childbirth informs of elevated body temperature up to 39°C for the last 3 days and pain in her right mammary gland. The right mammary gland is enlarged, hot to touch, tense, hyperemic, and painful. Palpation reveals there a dense infiltration 8×8 cm with a fluctuation in its center. What is the most likely diagnosis?
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A 45-year-old woman complains of intolerable paroxysmal facial pain on the left with attacks that last for 1-2 minutes. Attacks are provoked by chewing. The disease onset was two months ago after the overexposure to cold. Objectively: pain at the exit points of the trigeminal nerve on the left. Touching near the wing of the nose on the left induces a pain attack with tonic spasm of the facial muscles. What is the most likely diagnosis?
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