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KROK 2 Medicine 2020 Questions | KROKEXAM
Browse 2020 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 20-year-old woman complains of headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia. The signs appear 6-7 days before menstruation and disappear in the first days of menstruation. Make the diagnosis:
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A woman came to the gynecologist to plan her pregnancy. She was advised to increase her intake of the products rich in folic acid, particularly soy beans, bread made of coarsely ground flour, fruits, leafy green vegetables. Such changes in her diet will work toward the prevention of:
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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 pregnant woman at 34 weeks of gestation underwent dopplerometry of umbilical circulation, which revealed a reverse diastolic component. Objectively, the height of the uterus is 27 cm above the pubic bone, the head of the fetus is mobile and located above the entrance to the lesser pelvis. Fetal heartbeat is 136/min. Vaginal examination shows that the uterine cervix is closed, its length is 3 cm. What tactics should the obstetrician choose?
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A 26-year-old woman was hospitalized into the gynecological department with complaints of body temperature up to 38.2°C, fever, general weakness, and dirty-red blood discharge from her genital tracts. She is hemodynamically stable. Two days ago she underwent a medical abortion on the 8th week of pregnancy. Ultrasound detects the remains of the fertilized egg in her uterine cavity. What are the tactics of the patient management in this case?
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A 23-year-old woman with type 1 diabetes mellitus during the 2nd week of community-acquired pneumonia developed nausea and vomiting. In the evening she has lost her consciousness and was hospitalized. Objectively, the patient's skin is pale and dry. Her respiration is loud, the tongue is dry, with brown deposit. Her heart rate is 129/min., blood pressure is 85/50 mm Hg. Palpation of the patient's abdomen provokes no response. The liver is +3 cm. Acetone test is markedly positive, blood glucose is 26 mmol/L. Make the provisional diagnosis:
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On the 5th day after giving birth a postparturient woman complains of a pain in her left mammary gland and body temperature up to 38.1°C. Examination shows that her mammary gland is enlarged and painful on palpation, the nipple is edematous and has fissures, the upper external quadrant of the gland is hyperemic. Name the measures that would have prevented the development of this complication in the patient:
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On ultrasound of the thyroid gland, a 47-year-old woman presents with a hypoechoic node 1.6 cm in diameter with blurred margini and intranodular hypervascularization. The doctor suspects thyroid carcinoma. What method should be used to verify the diagnosis?
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In a pediatric clinic, located in a rural area, there are 9 children, who simultaneously fell ill. The following signs were detected: low physical activity, acrocyanosis of the nasolabial triangle and fingertips, mucosal cyanosis, tachycardia, dyspnea. It was determined that all the sick - children were fed with a formula that was dissolved in the water taken from a dug well. Laboratory analysis revealed high levels of methemoglobin in the blood of the children. These signs can be caused by increased content of a certain element in the water. Name this element:
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A 20-year-old man suffers from headache, general weakness, and face edema that appears in the morning. 18 days earlier he had a case of tonsillitis. Objectively, his skin is pale, there are edema under his eyes. Heart rate is 60/min., blood pressure is 185/100 mm Hg. The sign of costovertebral angle tenderness (punch sign in the lumbar region) is negative. Urinalysis: color of "meat slops": protein - 4.5 g/L, altered erythrocytes - 40-45 in the vision field, leukocytes - 5-6 in the vision field. 24-hour diuresis is 400 mL. What is the most likely diagnosis?
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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 wellbeing, cannot defend his interests and needs support from other people. Such psychic profile has been formed in the childhood, remains unchanged, and hinders adaptation. What psychic disorder is observed in this patient?
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A 35-year-old woman complains of a pain in her right axillary region. She has been suffering from this condition for a week. Her body temperature is 38°C. In the right axillary region there are 2 formations, cm in size each. The skin over the formations is dark red and thin. Palpation produces a yellow-white discharge from the fistular openings. What is the most likely diagnosis?
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During a regular examination, an 8-year-old girl with type I diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?
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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 is obese, 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 family doctor performed an external obsterical examination of a pregnant woman and determined that her uterine fundus is located at the level of the navel. What is the most likely term of pregnancy in this woman?
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What should be prescribed as secondary prevention drugs for a patient with atrial fibrillation after an ischemic stroke caused by cardiac embolism?
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A 55-year-old woman complains of thyroid gland enlargement that can be observed throughouth the last 2 years and a discomfort during swallowing. Objectively, she has signs of hypothyroidism. The thyroid gland on palpation is dense, non-fused with the surrounding tissues and mobile on swallowing. The regional lymph nodes are not enlarged. In the serum there are antithyroid antibodies detected. What is the most likely diagnosis?
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A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart dullness: right - the parasternal line, upper - the III rib, left - 1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
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A 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37,8°C, general weakness, weight loss. The patient's condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, and various numerous moist crackles in the lower pulmonary segments on the left can be observed in this patient. In blood: erythrocytes - 3.2 × 1012/L, leukocytes - 8.4 × 109/L, ESR - 56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?
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A patient 1 year ago had a Q wave myocardial infarction of the posterior wall of the left ventricle. For the last 2 weeks he has been suffering from daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo. What tactics is the most advisable in this case?
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A 58-year; old woman has type 2 diabetes mellitus that is compensated with diet and metformin. She prepares for cholecystectomy. Objectively, her height is 164 cm, weight is 90 kg, heart rate is 72/min., blood pressure is 130/80 mm Hg. Her abdomen is soft, painful in the right subcostal region. The liver is not enlarged. Fasting glucose - 6.2 mmol/L. Glycated hemoglobin - 6.5%. What further tactics of sugar-lowering therapy should be chosen in this case?
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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 5-year-old child had acute onset of the disease that manifested in body temperature up to 39.5°C, marked chills, weakness, inertness, skin pallor, and headache. 8 hours later a hemorrhagic rash developed on the skin of the buttocks and legs. The child is sluggish, the body temperature has dropped, blood pressure is 80/40 mm Hg, respirations are 28-30/min., diuresis is decreased. Make the provisional diagnosis:
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A 43-year-old man complains of facial edema, dyspnea, and difficult swallowing that appeared 3 hours after he was stung by an insect. Objectively, the skin of his eyelids, cheeks, and lips is acutely hyperemic and edematous. What medicines should he be prescribed for emergency aid?
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When planning treatment of a patient, it was decided to use a medicine with evidence level A. What trials produce the evidence that allows to, classify the medicine as level A?
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After the pregnant woman's waters broke, it was noted that they are significantly contaminated with meconium. Upon birth, the baby is not breathing, remains inert, the skin is cyanotic and covered in meconium, heart rate is 98/min. What resuscitation measures should be taken after the baby is born?
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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 × 109/L, lymphocytes - 72%, erythrocyte sedimentation rate - 4 mm/hour. What is the most likely diagnosis?
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A 48-year-old woman was delivered into the surgical unit with wounds in her thigh. On examination the wound surface has a dirty-gray coating with unpleasant sweet smell. The wound content resembles a raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What bacteria is the most likely to cause such inflammation?
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A patient underwent suture plication of the perforated duodenal ulcer. On the 3rd day after the operation he started producing a large amount of discharge from the abdominal drain tube. The discharge contains bile and has high amylase levels. What complication occurred in the patient?
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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 require the most urgent attention?
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A 20-year-old woman, gravida 2, para 1 has been in labor for 4 hours. Her condition is satisfactory. Moderately painful contractions occur every 3 minutes and last for 35-40 seconds. The waters have not burst yet. The fetus is in longitudinal position. Fetal heartbeats are 136/min., clear and rhytmic. Major segment of the fetal head is engaged to the pelvic inlet. Vaginal examination shows smooth cervix of 6 cm, amniotic sac is intact, sagittal suture is in the left oblique diameter, occipital fontanel is on the right near the symphysis pubis. What stage of the labor is it?
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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 37.7°C, intoxication symptoms appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, neutrocytosis, raised ESR. What diagnosis will you make?
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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 back, abdomen, and extremities. Palpation reveals 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 38-year-old patient has been delivered by an ambulance to a 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 similar condition was observed 1 year ago. Make the diagnosis:
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The body of a citizen was found at the place of his dwelling. On his face, neck, and hands there were detected irregular-shaped wounds, varying from 2x3 cm to 4x5 cm in size. The skin and underlying tissues are absent in the wounds. The margins of the wounds are uneven, with major and minor scalloping along the edges and no signs of bleeding. What is the initiating mechanism of these wounds?
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A multigravida, labor II, 36-37 weeks of gestation, has gone into labor. Her waters broke 8 hours ago, the labor activity continues for the last 4 hours, it is regular, with contractions that last 35 seconds and occur every 3-4 minutes. The child is in the cephalic presentation, with the head pressed to the entrance into the lesser pelvis. The parturient woman complains of a sudden sharp abdominal pain. Her pulse is 100/min., blood pressure is 110/70 - 100/70 mm Hg. The uterus is tense and does not relax between the contractions. Fetal heartbeat is muffled - 100/min. The amniotic fluid is blood-colored and continues to leak. What is the most likely diagnosis?
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A 45-year-old woman complains of increasing body weight throughout the last year. Examination revealed moon face syndrome, brittle hair, hirsutism, stretch marks on the abdomen, and disproportionally thin limbs. The patient's height is 162 cm, her body weight is 94 kg, her body mass index is 35.8 kg/m2. What type of obesity is it?
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A 2.5-year-old child is ill for the second day. The onset of the disease was associated with the temperature up to 37,8°C, a single bout of vomiting, and watery diarrhea up to 5 times per day. During the second day, vomiting occurred twice, body temperature is 38.0°C, the child has low appetite, watery diarrhea continues. The treatment of the child should start with the following:
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On the 3rd day after the artificial abortion the woman was hospitalized into the gynecological department in a severe condition with signs of intoxication, abdominal pain, and purulent discharge from the vagina. Objectively, the patient's condition is severe, her body temperature is 38.8°C, pulse is 100/min., blood pressure is 110/70 mm Hg, the uterus is soft, the uterine fundus is located at the level of the navel, there are positive signs of peritoneal irritation. What is the most likely diagnosis?
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You witnessed a car accident. When examining the place of the accident you noticed a man of about 30 years, who was hit by the car. He is unconscious. On his neck on the left there is a profuse hemorrhage with bright-red blood. How to stop this hemorrhage?
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