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KROK 2 Medicine 2021 Questions | KROKEXAM
Browse 2021 KROK 2 Medicine exam questions with answers and explanations.
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A 27-year-old man received an electrical injury, when he touched an exposed electrical wire with his hand, after which he developed circulatory and respiratory arrest. Resuscitation measures restored his cardiac activity after 5 minutes. What complications are possible in a few hours or even days after the electrical injury?
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Survey X-ray of the patient’s abdominal cavity has shown several hemispherical areas of lucency, located above welldefined horizontal levels. What might be the cause of such an X-ray presentation?
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A patient has visited the doctor at a rural outpatient clinic twice during the calendar year (in March and in November). In both cases, he was diagnosed with acute respiratory viral infection. How to fill in the statistical forms for registration of final (clarified) diagnoses, to account for these morbidity cases?
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A 55-year-old man is complaining of general weakness, decreased fluid excretion, and an aching pain in his heart. For the last 15 years he has been suffering from chronic pyelonephritis and undergoing an inpatient treatment. His skin is dry and has a yellowish tinge. His pulse is 80/min., rhythmic, blood pressure – 100/70 mm Hg. Cardiac auscultation detects muffled heart sounds and a friction rub in the pericardium. Laboratory results: creatinine – 1.1 mmol/L, glomerular filtration – 5 mL/min. What treatment is indicated for this patient?
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After lifting a heavy object, a 41-yearold man felt a sharp pain in his chest on the right and developed progressing shortness of breath. The man’s condition is severe. His lips and mucosa are cyanotic, respiratory rate – 28/min., pulse – 122/min. Over the right half of the chest, percussion shows tympanitis, while auscultation detects sharply weakened breathing. The II heart sound is accentuated over the pulmonary artery. His blood pressure is 80/40 mm Hg. What primary emergency measure must be taken at the prehospital stage in this case?
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For a month a 60-year-old patient had short-term episodes of decreased strength in his limbs on the left. Later, after waking up in the morning, he developed a persistent weakness in his extremities. His blood pressure is 140/90 mm Hg. He is conscious and has central paresis of VII and XII pairs of cranial nerves on the left. On the same side, he presents with central hemiparesis and hemihyperesthesia. What group of drugs must be chosen for the differentiated treatment of this patient?
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A 45-year-old woman with a normal body weight was diagnosed with diabetes mellitus for the first time. Attempts to correct his blood glucose levels by means of a diet were unsuccessful. Her 24- hour glycemia varies between 10 and 15 mmol/L. Which medicine would be optimal in this case?
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Fluorography of a 45-year-old patient detects a few foci of low intensity with blurred margins on the apex of his right lung. This sign is observed for the first time. Such condition causes him no discomfort. He has a many-year history of smoking. Objectively, percussion produces a pulmonary sound above the lungs, the respiration is vesicular, auscultation detects no wheezing. Blood test findings are normal. Make the right diagnosis:
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A 54-year-old patient has been suffering from femoral osteomyelitis for over 20 years. In the last month she developed gradually progressing leg edemas. In the urine: proteinuria – 6.6 g/L. In the blood: dysproteinemia in the form of hypoalbuminemia, increased α2- and γ-globulin levels, ESR – 50 mm/hour. Make the right diagnosis:
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A 28-year-old man was hospitalized on the 9th day of illness with complaints of fever of 39°C, headache, general weakness, constipation, and disturbed sleep. On the skin of his abdomen there were isolated roseolas, his pulse is 78/min., the liver is enlarged by 2 cm. Make the right diagnosis:
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A well was dug on a rural land plot. It is located at the distance of 20 meters from the house, 10 meters from the toilet, and 15 meters from the neighbor’s house. What is the minimum permissible distance between the well and the source of possible water pollution, according to the sanitary norms?
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The ambulance has brought in the victim of an accident, who has fallen from a height. This patient has clinical signs of multiple fractures in both legs. The patient’s condition is severe; the patient is conscious, but mentally sluggish; the skin is pale gray; the forehead is covered in a cold sweat. The patient’s breathing is shallow, with respiratory rate of 30/min., blood pressure – 80/60 mm Hg, pulse – 120/min., shallow. What complication has occurred in this person?
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A 30-year-old patient after an emotional upset developed tonic seizure that later gave place to clonic seizures. This condition was accompanied by loss of consciousness, foaming at the mouth, and involuntary urination. No focal signs were detected. Blood pressure is 120/60 mm Hg. Make the right diagnosis:
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A full-term delivery has resulted in the birth of a live full-term girl without asphyxia. The baby is inert, her skin is pale with an icteric tinge, she has no edemas. The abdomen is soft, the liver and spleen are enlarged. The blood tests show that the mother’s blood type is A(II) Rh(–), while the child’s blood type is A(II) Rh(+). Make the right diagnosis:
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The region in the Carpathian foothills is characterized with constant high atmospheric humidity (over 80%). In the cold season, while the air temperature is moderately low, the population of this region feels extreme cold. What type of heat transfer increases in such conditions?
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A 58-year-old patient complains of an inguinal tumor that increases during straining and coughing. There is a pulsating tumor-like formation located below and laterally to the Poupart’s ligament. The formation does not diminish during palpation. Make the right diagnosis:
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A variety of lighting fixtures have been used to illuminate classrooms. What kind of lighting fixtures creates the most hygienically acceptable lighting?
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A victim of a car accident received multiple fractures of the limbs and pelvic bones. He has a history of hemophilia A. Objectively, hematomas form at the sites of injury. The patient’s condition is deteriorating. The blood pressure is 90/50 mm Hg. What is the optimal combination of infusion agents that should be given to the patient for treatment after polyglucin (dextran) and saline solutions are administered?
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A 40-year-old woman, gravida 6, para 3, at the 40 weeks of her pathological pregnancy (threatened miscarriage, type I gestosis of the second half of her pregnancy), gave birth to a girl with asphyxia. The baby’s condition is severe, the weight is 2 kg, there are signs of immaturity and hydrocephalus. The baby’s skin is pale, icteric, and has acrocyanosis. Heart sounds are muffled, there is a harsh systolic murmur at all points of auscultation. Abdomen is enlarged, the liver is +3 cm. The urine is saturated, the stool is light-colored. An ophthalmologist has detected chorioretinitis in the baby. Make the right diagnosis:
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A woman at 12 weeks of her pregnancy developed a pain in her lower abdomen and mild bloody Discharge, which occurred with no apparent reason. Vaginal examination shows well-formed cervix with closed external orifice. The body of the uterus is enlarged according to her term of pregnancy. Make the right diagnosis:
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In the demographic structure of a region, the people aged from 0 to 14 make up 31% of the population, while the 50+ age group makes up 20% of the population. What population structure characterizes such demographic situation most accurately?
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A 13-year-old boy is complaining of a dry cough and shortness of breath. The onset of the disease was one year ago. He has brief asphyxia attacks that occur 1–2 times per month. Objectively, the child is anxious and has expiratory dyspnea, his skin is pale, his nasolabial triangle is cyanotic. His respiratory rate is 48/min. Percussion produces a banbox resonance over the lungs; auscultation detects weakened breathing with bilateral dry wheezing. Forced expiratory volume is 80% of the normal. What medicine should be prescribed to this boy?
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A patient with rheumatism presents with diastolic tremor of the chest wall («cat’s purr»), heart sound I that is amplified at the apex, diastolic murmur with presystolic amplification, a mitral opening sound, and an accent of the II heart sound over the pulmonary artery. What heart defect was observed in this patient?
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At a factory with harmful working conditions, a complex of measures was being taken to reduce the morbidity among the workers. For better effect, the factory doctor was separately monitoring a group of people, who fall ill frequently and for a long time. What type of morbidity requires distinguishing such a group of people?
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A 38-year-old patient has episodes of paroxysmal hypertension that reaches 240/120 mm Hg and is accompanied by nausea, vomiting, tachycardia, and excessive sweating. Hyperglycemia is observed in the blood during such episodes. After the episode, profuse urination occurs. Renal sonography has shown a new formation adjacent to the upper pole of the right kidney that might belong to the adrenal gland. What laboratory test will help clarify the diagnosis?
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During physical exertion, a man with a cerebral artery aneurysm suddenly developed severe headache and vomiting and fainted. The patient is agitated and wants to run somewhere. His pulse is 62/min., rhythmic, blood pressure – 140/90 mm Hg, the body temperature is 37.5°C. He has nuchal rigidity and positive Kernig’s sign. Focal neurological signs are absent. Make the provisional diagnosis:
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A 14-year-old boy developed a sympatho-adrenal crisis. What medicine was indicated for crisis relief in this case?
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In the morning, an 8-year-old child started complaining of general weakness and pain during swallowing. At noon, her parents called for a doctor, because the girl’s weakness was progressing and she developed a bilateral swelling slightly below and in front of her ears. Make the right diagnosis:
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A 58-year-old patient, a heavy drinker and smoker, came to a hospital with complaints of constant coughing and shortness of breath. Lately, he has been losing weight. His cervical lymph nodes are enlarged and dense, the tissues above them exhibit no tension. Chest X-ray has shown fibrosis of an upper pulmonary lobe and left-sided pleurisy. The pleural fluid is straw-colored, with protein levels of 52 g/L and a high lymphocyte count. Malignant cells were not detected. Inoculation of the pleural fluid produced no microbial growth one week later. Make the right diagnosis:
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A laboratory has received a milk sample for analysis. The findings are as follows: color is whitish, smell is normal, taste is normal for milk, specific gravity is 1,038, acidity is 35°T (degrees Turner), fats is 3.2%. What is the milk quality?
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A 7-year-old child fell ill 2 weeks ago, when he developed a runny nose. An otolaryngologist was consulted about sanguinopurulent discharge from the child’s nose and maceration of his wings of the nose and upper lip. Rhinoscopy has detected whitish-gray foci on the nasal septum. The oropharyngeal mucosa is without changes. Make the right diagnosis:
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An 18-year-old young man complains of pain in his knee and ankle joints and a fever of 39.5°C. A week and a half before, he had a case of respiratory disease. His body temperature is 38.5°C, his knee and ankle joints are swollen. His pulse is 106/min., rhythmic. His blood pressure is 90/60 mm Hg. The heart borders are normal, the heart sounds are weakened, and there is a soft systolic murmur at the apex. What parameter was most closely associated with the possible etiology of this process?
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A postparturient woman came to a doctor on the 14th day after giving birth. She complained of a sudden pain, hyperemia, and induration in her left breast, fever of 39°C, headache, and indisposition. There is a fissure in the nipple, the left breast is enlarged, during its palpation the pain intensifies. What pathology is suspected in this case?
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A 15-year-old patient presents with delayed physical development and periodically develops icteric skin. Spleen is 16x12x10 cm, cholecystolithiasis is observed in the patient, there is a skin ulcer on the left calf in its lower third. The blood has: erythrocytes – 3.0 · 1012/L, Hb – 90 g/L, color index – 1.0, microspherocytosis, reticulocytosis. Total serum bilirubin – 56 mcmol/L, indirect bilirubin – 38 mcmol/L. What treatment method is optimal in this case?
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A 22-year-old woman at 11–12 weeks of pregnancy came to a maternity clinic. Examination has shown a positive Wasserman reaction. A dermatologist diagnosed her with secondary latent syphilis. What are the tactics of pregnancy management in such case?
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A lumbar puncture was made for a newborn with a suspected intracranial birth injury. Bloody cerebrospinal fluid was obtained. What type of hemorrhage was observed in this case?
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The mother of a newborn child is suffering from chronic pyelonephritis and had a case of acute respiratory viral infection before giving birth. The delivery is full-term, the waters did not break for a long time. On the 2nd day of life the baby developed an erythematous rash. Blisters of about 1 cm in size appeared. They are filled with seropurulent contents and their lancing results in formation of erosions. The Nikolsky’s sign is positive. The baby is inert and has a subfebrile body temperature. Make the diagnosis:
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A 34-year-old patient has been suffering from pulmonary tuberculosis for the last 7 years. He complains of muscle weakness, weight loss, diarrhea, and frequent urination. His skin, gums, and buccal mucosa are hyperpigmented. His blood pressure is 90/58 mm Hg. In the blood: erythrocytes – 3.1 · 1012/L, Hb – 95 g/L, color index – 0.92; leukocytes – 9.4 · 109/L, eosinophils – 7%, segmented neutrophils – 45%, band neutrophils – 1%, lymphocytes – 40%, monocytes – 7%, Na+ – 115 mmol/L, K+ – 7.3 mmol/L. Make the diagnosis:
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A 35-year-old woman has red swollen areas on the dorsal surface of her hands after a severe nervous strain, which was followed by formation of small inflamed nodules, vesicles, and later erosions with significant discharge of a serous fluid. This process was accompanied by severe itching. Make the right diagnosis:
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A 48-year-old patient, whose blood test has resulted in positive Wasseman and sedimentation reactions thrice, came to a doctor. His treponema pallidum immobilization test was positive as well. Examination has shown no clinical manifestations of syphilis in the patient’s skin, internal organs or nervous system. Make the right diagnosis:
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