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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 27-year-old man complains of pain in his leg joints, purulent discharge from the eyes, and painful burning sensations during urination. The disease onset was acute. He has a history of influenza. The patient smokes and drinks alcohol in excess. In his line of work he is often away on business trips. What is the most likely etiological factor of this disease?
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A 57-year-old man, a miner, complains of a pain in his chest, dyspnea on physical exertion, excessive sweating, constant subfebrile tempeature, and cough that produces blood-streaked sputum. He has been smoking for approximately 40 years (2 packs a day) and frequently has "pneumonia': Survey chest X-ray shows a triangular shadow in the middle lobe of the right lung. One of the apices of the shadow points to the lung root. Cardiac and mediastinal shadows are displaced toward the affected area. Make the provisional diagnosis:
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A district doctor has diagnosed one of his patients with dysentery. What accounting document reflects this type of morbidity?
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A 31-year-old drug-addicted person complains of a cough with bloody expectorations, dyspnea, persistent fever, and leg edemas. The jugular veins are distended. There is a coarse pansystolic murmur detected above the base of the xiphoid process and in the second intercostal space on the left, close to the edge of the sternum. Heart sounds are clear, arrhythmia is detected, heart rate is 128/min., pulse - 82/min., blood pressure is 100/70 mm Hg. What is the most likely diagnosis?
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A 7-year-old boy after a fall from a height presents with rapid and shallow breathing and cyanotic face. The right half of his thorax is distended and takes no part in the respiration. Percussion detects tympanitis in the affected area, while auscultation detects no breathing there. What pathology is the most likely cause of this clinical presentation? What instrumental examination would be the most informative in this case?
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A 55-year-old woman came to a gynecologist with complaints of leukorrhea and bloody discharge from the vagina after 5 years of menopause. Anamnesis states no pregnancies. Bimanual examination: the uterus and uterine appendages are without changes. During diagnostic curettage of the uterine cavity the physician scraped off a sample of enchephaloid matter. What is the most likely diagnosis in this case?
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What modern organizational method can provide the patients in the remote settlements with timely access to quality medical aid and such medical services as consulting, diagnostics, and treatment, especially in the situations when time and distance are crucial?
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A 17-year-old girl has been suffering from hepatic cirrhosis for 3 years. Lately her periods of excitation have been intermittent with depression, she does not sleep enough. Objectively, her condition is severe, the girl is sluggish, gives one-word responses, has tremor in her extremities, her skin is icteric, with single hemorrhagic rashes. Name the likely complication of her disease:
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A man works in casting of nonferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbon monoxide, and nitrogen. During periodic health examination the patient presents with asthenovegetative syndrome, sharp abdominal pains, constipations, pain in the hepatic area. In urine: aminolevulinic acid and coproporphyrin are detected. In blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
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During regular examination of a 2-year-old boy, he presents with enlarged left kidney, painless on palpation. The right kidney was undetectable on palpation. Excretory urography shows no contrast on the right. Cytoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
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A 34-year-old woman after rapidly changing her position from horizontal to vertical suddenly paled, fell down, her skin became moist, her limbs are cold, her pupils are dilated. The pulse is rapid and thready, blood pressure is 50/25 mm Hg. What condition has likely developed in the patient?
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On laboratory investigation of a pork sample there is 1 dead trichinella detected in 24 sections. This meat should be:
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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 woman complains of a severe pain in her throat on the left, difficult swallowing and mouth opening, elevated body temperature, and general malaise. The onset of the disease was 4 days ago after a case of tonsillitis. Examination detects a trismus of the masticatory muscles, the left tonsil is displaced toward the midline, the anterior palatal arch is infiltrated and protruding. The regional lymph nodes on the right are enlarged and painful on palpation. Make the diagnosis:
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During winter epidemics of influenza caused predominantly by virus A/California/04/2009 (H1N1), on the 2nd day after the disease onset a 30-year-old hospitalized man presented with high fever, dry cough, myalgia, headache, and general weakness. What should be prescribed as an etiotropic treatment in this case?
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A 30-year-old woman complains of itching skin, predominantly in the evening and at night. The condition lasts for 2 weeks already. On the skin of the interdigital folds, mammary glands, abdomen, buttocks, and thighs there are numerous fine papular and papulovesicular rashes located in pairs, excoriations. There is no rash on the face and neck. Similar rash is observed in the husband of the patient. What is the most likely diagnosis?
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A 20-year-old patient complains of a severe headache, double vision, weakness, fever, irritability. Objectively: body temperature is 38.1°C, the patient is reluctant to contact, sensitive to stimuli. There are ptosis of the left eyelid, exotropia, anisocoria S>D, and pronounced meningeal syndrome. On lumbar puncture the cerebrospinal fluid flowed out under a pressure of 300 mm Hg, the fluid is clear, slightly opalescent. 24 hours later there appeared a fibrin film. Protein - 1.4 g/L, lymphocytes - 600 per me, glucose - 0.3 mmol/L. What is the provisional diagnosis?
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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 proiess needs to be clarified. What method of examination will be the most accurate for this purpose?
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A 75-year-old man in a severe condition suffers from dyspnea at rest, marked weakness, and arrhythmia. Abdominal aortic pulsation is observed, further on there is a systolic murmur detected. Palpation reveals a volumetric formation in the mesogastrium. Blood pressure is 70/40 mm Hg. There is no pulsation over the femoral arteries. Oliguria is detected. Which diagnosis is the correct one?
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A dweller of the northern Dnieper area, a fisherman, for the last several days has been complaining of a discomfort in his right subcostal region, periodical episodes of diarrhea, intermittent with constipations, frequent skin rashes. Abdominal ultrasound shows enlarged liver and pancreatic head. Make the provisional diagnosis:
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A 25-year-old woman was brought into the gynecological department with profuse bloody discharge from her genital tracts. She is 12 weeks pregnant, the pregnancy is planned. Within the last 3 days she was experiencing pains in her lower abdomen that eventually started resembling cramps, she developed bleeding. Her skin is pale, pulse - 88/min., blood pressure - 100/60 mm Hg, body temperature - 36.8°C. Vaginal examination: the uterus size corresponds to 11 weeks of gestation, the cervical canal allows inserting 1 finger and contains fragments of the fertilized ovum, the discharge is bloody and profuse. What is the most likely diagnosis?
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A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, nonlocalized colicky abdominal pains, and nausea. Objectively, his skin is gray; there is a pink-gray stripe on his gums; the abdomen 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. Constipations occur each 3-4 days. What is the most likely provisional diagnosis?
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An 18-year-old patient complains of skin rash. The patient has been suffering from this condition for 5 years. The first instance of this disease occurred after a car accident. Objectively: the patient presents with a papular rash covered in silvery scales, "thimble" sign (small pits on the nails), affected joints. What is the most likely diagnosis?
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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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Children from a certain township present with brittle teeth, malocclusion, dental enamel erosions, and dental pigmentation that looks like yellow-brown spots. What is the likely cause of this presentation?
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An 8-day-old boy was delivered to the hospital on the second day after the onset of the disease. His parents complain of his fussiness, regurgitation, body temperature up to 38.5°C, red skin with infiltration in the lumbar area. His medical history has no peculiarities. The child is in the severe condition, inert, pale, suckles poorly. In the lumbar area, on the sacrum and buttocks there is a tense infiltration with hyperemic and cyanotic areas and with a soft spot 8x7 cm in its center. The stool is 10 times in 24 hours, with green and mucous admixtures. What is the most likely diagnosis?
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A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, t° is 39.5-40°C, no urination for the last 24 hours. Objectively the patient is conscious. Respiratory rate is 36/min. Percussion sound is dull over the right lower pulmonary lobe; 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 for the management of this patient?
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A 48-year-old man came to a doctor with complaints of vomiting that brings no relief and a burning pain in his left subcostal region that irradiates to the left lumbar region. These signs appeared after a meal. The Ortner's and Mayo-Robson's signs are positive. In the blood: leukocytosis and increased ESR. In the urine: elevated diastase levels. Make the diagnosis:
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A 32-year-old woman complains of general weakness, low-grade fever persisting for 4 months, lumbar pain, and dysuria. Anamnesis includes frequent acute respiratory diseases, overexposure to cold, low-calorie diet, a case of pulmonary tuberculosis in childhood. Clinical urine analysis: pH- 4.8, leukocyturia, hematuria. Complete blood count: leukocytosis, lymphocytosis, raised ESR. Urography concludes: dilatation of renal pelvis and calyceal system of both kidneys, foci of calcification in the projection of right kidney parenchyma. What is the most likely diagnosis?
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An unconscious patient was delivered to a hospital by an ambulance. Objectively, his body temperature is 39°C, he presents with convulsions and red dry skin. It is known that the patient works as a stoker in the boiler room. What is the likely diagnosis?
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A child was born at 40 weeks of gestation with the weight of 3700 g. The child's Apgar score is 7/9. The baby was put to breast immediately after birth and suckled actively. On the 3rd day of life the child's weight decreased to 3600 g. What transitory condition is observed in this child?
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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 agression. On examiantion 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 17-year-old girl complains of a pain in her knee and ankle joints and body temperature up to 39°C. 2 weeks ago she had a case of acute tonsillitis. Objectively, her joints are swollen, sharply painful, and their mobility is reduced. On the skin of her trunk and limbs there are barely visible circle-shaped pale pink spots. Heart rate is 95/min., blood pressure is 90/60 mm Hg, heart sounds are weakened, there is a soft systolic noise over the apex. Make the provisional diagnosis:
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A 19-year-old girl complains of moderate itching and hair loss on her head. Objectively, on the skin of her occipital region there is a single round erythematous focus 3 cm in diameter with clear margins. Asbestos-like scales can be observed on the surface of the lesion. The hair in the focus of the lesion is broken off at the length of 6-8 mm. What is the most likely diagnosis?
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A woman complains of frequent watery stool (up to 9-10 times per day) with mucus and blood admixtures, dull pain in the hypogastrium, weight loss of 4 kg within the last year. Objectively: malnutrition, dry skin, low turgor, aphthous stomatitis. The abdomen is soft, the sigmoid colon is spastic and painful on palpation. Occult blood test is positive. Fibrocolonoscopy: edema, hyperemia, mucosal granulation, pseudopolyps, small ulcers with irregular edges. Make the diagnosis:
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A 9-year-old boy fell off a tree and hit the back of his head. A brief loss of consciousness was observed. The child's condition is satisfactory, he has a headache and vertigo. Skull X-ray scans show a depressed fracture of the occipital bone in the area of the external occipital protuberance. What treatment tactics is indicated for this patient?
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A 16-year-old boy developed dizziness. His heart rate is 35/min. blood pressure is 85/45 mm Hg. Heart borders are not enlarged. Heart sounds are loud and clear ECG shows P waves disconnected from QRS complexes, dissociation and different rhythm of atria and ventricles is accompanied by varying location of P wave in relation to QRST complex. This presentation is the most characteristic of the following disease:
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A 56-year-old woman has been working as a disinfector for 19 years. She complains of general weakness, nausea, bitter taste in her mouth, heavy sensation in her right subcostal area, and rapid fatigability. Objectively, her body temperature is 37.1°C, the sclerae are icteric, and the liver is enlarged. Total bilirubin is 40 mcmol/L. What is the likely diagnosis?
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