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KROK 2 Medicine 2020 Questions | KROKEXAM
Browse 2020 KROK 2 Medicine exam questions with answers and explanations.
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A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for the past month. On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On physical examination, she is a tiredappearing thin woman. Hyperpigmentation is present over many areas of her body, most prominently over the face, neck and back of hands (areas exposed to light). Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient?
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A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth. On physical examination, her vital signs are stable. She does not have pubic hair and her breast is slightly elevated with areola remaining in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?
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A 43-year-old man seeks evaluation at an emergency department with complaints of fever with chills, malaise, diffuse abdominal pain for over a week, diarrhea and loss of appetite. He says that his symptoms are progressively getting worse. He recalls that the fever began slowly and climbed its way up stepwise to the current 39.8°C. His blood pressure is 110/70 mm Hg. A physical exam reveals a coated tongue, enlarged spleen and rose spots on the abdomen. Serologic study shows the agglutinin O titre of 1:200 by the Widal test. Which of the following is the most likely causative organism for this patient’s condition?
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A 6-year-old boy is brought to the pediatrician by his mother, who complains of low-grade fever, chronic cough and night sweats in her child. She describes the cough as productive, producing white sputum that is sometimes streaked with blood. She also says that her son has lost some weight in the last month. His vital signs include blood pressure of 115/75 mm Hg, heart rate of 110/min., respiratory rate of 18/min, and temperature of 36.6°C. On physical examination, the patient is ill looking. Pulmonary auscultation reveals some fine crackles in the right upper lobe. The pediatrician suspects an active infection and performs Mantoux test. Intradermal injection of which of the following substances has been most likely used by pediatrician for screening test in this clinical case?
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A 14-year-old girl presents to the emergency department for evaluation of an "infected leg". She states there is no history of trauma but mentions she had a history of sickle cell disease. On physical examination, her upper part of right shin is very painful, red, swollen and hot. Her temperature is 39.2°C. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia. Increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?
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A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the Trousseau’s sign and Chvostek’s sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The surgeon suggests surgical destruction of parathyroid glands. Which of the following is the most likely cause of this patient’s neurologic abnormality?
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On your physiology class, the professor asks you to report about the effects of various body hormones and neurotransmitters on the metabolism of glucose. You begin your report with the statement that the use of glucose by the cell is preceded by absorption through the plasma membrane from the extracellular matrix into the cell. Which of the following hormones is most likely responsible for the glucose uptake by the cell?
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A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
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A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c) - 8.0%, Fasting Blood Glucose - 12 mmol/L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug’s action?
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A group of researchers aimed to study cardiac physiology found that overstretching of atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause of physiologic effects discovered by researchers?
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An 11-year-old girl is brought to the doctor’s office by her mother who states her daughter has been weak with swollen face for 3 days. The mother states her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria and microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?
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A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse - 91/min., temperature - 36.8°C and respiratory rate - 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypercholesterolemia, hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE’s complication in this patient?
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A 40-year-old woman dies of intracerebral hemorrhage after the hypertensive emergency. During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini populated by a homogenous cluster of deeply basophilic cells. Which of the following was the most likely underlying disease?
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An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The organ can be subdivided into two regions: a cortex with lymphoid nodules and medulla with medullary cords populated by plasma cells, B-cells and T-cells. Which of the following structures is most likely the origin of this surgical specimen?
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A 46-year-old man presents with fatigue and joint pain in his lingers and wrists for the last 2 months. The pain is present in both hands and the wrists are swollen. Furthermore, he describes morning stiffness in his joints lasting about 2 hours, which improves with use. His past medical history reveals he has been successfully treated for H. pylori related ulcers last year. He denies smoking and stopped drinking when his gastric symptoms started. Which of the following drugs is the best choice for his joints pain management?
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A 60-year-old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient’s death?
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A team of medical students is performing research on phases of cell cycle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely takes place in the cell?
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A mother of a 4-month-old male infant brought him to pediatrician with complaints of food rejection and weight loss. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomegaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he continues to reject food. Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
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After dehelmintization, a 35-year-old man passed a 3.5 m tapeworm during a bowel movement. A stool examination reveals scolex with four suckers and hooks. Mature proglottids are static with up to 12 primary uterine branches. Which of the following is the most likely diagnosis?
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A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for "many years", but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is afebrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination. There is a "pillrolling" resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by fingernose testing. When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug?
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A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision. Her doctor reveals loss of vision in the lateral halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?
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A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination reveals the organ encased by thin connective tissue capsule that enters the substance of the lobes to further subdivide the organ into irregular lobular units. Each lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity of the follicle. Which of the following organs does this tissue most likely belong to?
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A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wife reports he became more irritable and forgetful in the past year. In addition, she notes that he became a vegan a year ago, and currently, his diet consists of starchy foods like potatoes, corn, and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczema-like lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a "gloves and socks" distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?
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A 37-year-old female presents to the clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or take ibuprofen but now the pain is much worse and wakes her up at night. She works as a typist and her pain mostly increases after typing all day. Her right wrist and fingers are fine. Nerve conduction studies reveal nerve compression. Which of the following nerves is most likely compressed in this patient?
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A 68-year-old man comes to his physician with complaints of severe fatigue and altered sensations in his extremities. Past medical history is remarkable for chronic gastritis. He drinks alcohol almost every day. His blood pressure is 130/80 mm Hg, heart rate is 95/min., respiratory rate - 14/min, and temperature of 37.1°C. His heart has a regular rate and rhythm, his lungs are clear to auscultation bilaterally. Neurologic examination reveals loss of touch and vibration sense in both upper and lower limbs. Laboratory investigation results include a hemoglobin of 80 g/L, Mean Corpuscular Volume (MCV) of 115 fL (the reference range is 80-100 fL) and White Blood Cells (WBC) of 3.0 × 109/L. Which of the following is the most likely diagnosis?
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A 34-year-old man visits his dentist complaining of toothache. After a dental procedure that involved extraction of several teeth, he develops severe bleeding lasting more than 15 minutes. He has a history of chronic hepatitis C. Which of the following is the most likely cause of prolonged bleeding in this patient?
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A 23-year-old woman presents to the emergency department complaining of bloody diarrhea, fatigue and confusion. A few days earlier, she went to a fast food restaurant for a birthday party. Her friends are experiencing similar symptoms. Laboratory studies show anemia. Which of the following would you most likely obtain for microbiologic testing?
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An 18-year-old girl comes to her physician with concern about her health because she has not achieved menarche. She denies any significant weight loss, changes in mood, or changes in her appetite. She mentions that her mother told her about mild birth defects, but she cannot recall the specifics. Past medical history and family history are benign. On physical examination, the patient is short in stature, has a short and webbed neck and wide chest. Staining of buccal smear reveals absence of Barr bodies in the nucleus of epithelial cells. A urine pregnancy test is negative. Which of the following genetic disorders is the most likely cause of this patient’s condition?
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During examination of a patient, the doctor detected in him disorders of the eyes (hemeralopia, Bitot's spots), skin and skin appendages, mucosa, and gastrointestinal tract. He was provisionally diagnosed with Prasad's syndrome. What causes the development of this pathology?
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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, his heart rate is 120/min., the electrical axis of the heart deviates to the right, S1-Q111. What is the most likely diagnosis?
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A 37-year-old woman received an occupational trauma that resulted in a severe vision impairment. Now she needs to be trained for another occupation. What type of rehabilitation should the doctor choose for the patient in this case?
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A 22-year-old postparturient woman on the 12th day after the normal childbirth informs of fever 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 8x8 cm with a fluctuation in its center. What is the most likely diagnosis?
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A 38-year-old woman has been suffering from glomerulonephritis for 20 years. For approximately 16 years she has been presenting with progressing renal parenchymal arterial hypertension that became refractory and accompanied by leg edemas. She receives a combination of 100 mg Losartan and 20 mg Lercanidipine with insufficient antihypertensive effect. What medicine can she be recommended for intensification of the antihypertensive effect of her therapy?
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A 45-year-old man has been suffering from ankylosing spondylitis for 15 years. For the last 3 years he has been noticing facial swelling and edemas of the limbs. Objectively, he assumes a "beggar's" position. X-ray shows "bamboo spine" changes in the thoracic and lumbar segnients. Heart ultrasound shows aortic regurgitation. Complete blood count: Hb-106 g/L; leukocytes - 8.9 × 109/L; ESR - 40 mm/hour. Daily proteinuria 9.6 grams per 24 hours. Blood creatinine -230 mcmol/L. What is the cause of kidney failure in this case?
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A patient was brought into the pulmonology department with complaints of inspiratory dyspnea and dry cough at the highest point of inhalation. On examination the following is observed: pale skin, cyanotic lips, "Hippocratic fingers". Auscultation detects Velcro-type crackles (like opening a Velcro fastener). X-ray shows a "ground glass opacity" pattern. What is the most likely diagnosis?
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A 45-year-old man came to the hematologist with complaints of general weakness, elevated body temperature, excessive sweating, enlarged cervical lymph nodes. Objectively, his body temperature is 37.5°C, the skin is palezand dry, the posterior cervical lymph nodes are dense and elastic, up to 2 cm in diameter, mobile. There are no peculiarities in the patient's heart and lungs. Hepatosplenomegaly was detected. What examination is necessary to determine the scope of the pathologic process?
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A 65-year-old man underwent a left hemicolectomy due to a malignant tumor in the descending colon. On the 4th day after the surgery he developed pain and edema in his left shin. The Homans sign is positive on the left. What postoperative complication developed in this patient?
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A 35-year-old forestry officer was delivered to the hospital on the 7th day after the onset of the disease. He complains of chills, elevated body temperature up to 40.0°C, sharp headache, and myalgias. On examination his face is puffy and hyperemic, the tongue is dry, "chalk-dusted": In the left inguinal area, a sharply painful conglomeration of enlarged lymph nodes can be palpated. The skin over the conglomeration is hyperemic and tense. What etiotropic therapy should be prescribed to this patient?
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Examination detected vesicles with seropurulent content on the neck, back of the head, and buttocks of an infant on the 4th day of life. The patient's condition is satisfactory, the child is active, all newborn reflexes can be fully induced, the umbilical cord is at the stage of mummification, the umbilical area is without any peculiarities. What disease can be suspected?
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A 65-year-old man with acute anterior myocardial infarction developed an asphyxia attack. Examination detected diffuse cyanosis. In the lungs there are numerous heterogeneous wet crackles. Heart rate is 100/min. Blood pressure is 120/100 mm Hg. What complication occurred in this patient?
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