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KROK 2 Medicine 2021 Questions | KROKEXAM
Browse 2021 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 50-year-old man was hospitalized with complaints of blood in the urine. There are no pain or urination disorders. Hematuria is observed for the last 3 days. The kidneys are not palpable, the suprapubic area is normal, the external genitalia have no pathology. Rectal examination detects no prostatic enlargement. Cystoscopy detects no changes. What disease is suspected first?
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A 28-year-old patient complains of chills in his feet and fingers and pain in his legs during walking. The disease onset was one year ago. The skin of his legs is pale and cold; low turgor and hypotrichosis are observed. Pulsation over the femoral and popliteal arteries is weakened, on the pedal arteries it is palpable after a nitroglycerin test. Rheographic index is
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A 20-year-old woman complains of amenorrhea. She has hirsutism and obesity with predominant distribution of adipose tissue on the face, neck, and upper torso. On her face she has acne vulgaris, on her skin there are stretch marks. The blood pressure is 170/100 mm Hg. Her mental development and intelligence are not impaired. Gynecological status shows moderate hairiness of the external genitalia and acute hypoplasia of the vagina and uterus. Make the right diagnosis:
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A 48-year-old patient was hospitalized with complaints of headache, nausea, wet cough, problematic breathing, impaired vision, excessive sweating, and salivation. He worked in a team that treated gardens with organophosphorus pesticides. In his blood: erythrocytes – 4.1 · 1012/L, Hb – 136 g/L, color index – 0.9, leukocytes – 13.0 · 109/L, ESR – 17 mm/hour. He was diagnosed with acute intoxication caused by organophosphorus pesticides. What is the most important diagnostic criterion o this pathology?
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A 55-year-old man on the 3rd day after an acute anterior myocardial infarction complains of shortness of breath and a dull pain behind the sternum that decreases when he leans forward. His blood pressure is 140/80 mm Hg and his heart sounds are muffled. ECG has shown atrial fibrillation with the ventricular rate of 110/min., pathological Q wave, and ST segment elevation in the right-sided chest leads. Make the right diagnosis:
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The blood pressure and age were studied among 200 patients with essential hypertension. What statistical value can be used to measure the strength of the relationship between these characteristics?
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A 38-year-old woman, para 3, has a history of 5 artificial abortions. Five minutes after giving birth, she started bleeding from her genital tracts (350 mL). The patient’s condition is satisfactory, her pulse is 92/min., blood pressure is 100/60 mm Hg. There are no signs of placental expulsion, its manual removal has to be performed. In some spots the placenta is somewhat difficult to detach. Make the right diagnosis:
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A woman, who works at a pig farm, against the background of complete health developed sudden chills, fever of 39.9°C, intense headache, and nausea. The next day, she noticed a pain in her leg muscles and nosebleeds. On the 3rd day after the onset of the disease the woman’s condition is severe, her face is hyperemic, she has scleritis and subicteric sclerae. The liver is +3 cm. 24-hour urine output is 700 mL. Make the right diagnosis:
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A 38-year-old man lives in an area that is endemic for echinococcosis. For the last 6 months he has been suffering from pain in his right subcostal region and fever. Echinococcal liver damage was suspected. What study will be the most informative in this case?
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A 29-year-old woman was brought to the admission room with complaints of a sudden pain in her lower abdomen, weakness, and loss of consciousness. Her last menstruation was 6 weeks ago. Her pulse is 120/min., blood pressure – 80/50 mm Hg. There are pain and signs of peritoneal irritation low on the right side. In the blood: Hb – 106 g/L. Make the right diagnosis:
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A woman was hospitalized with complaints of periodical pain in the lower abdomen that intensifies during menstruation, as well as weakness, indisposition, nervousness, and smearing discharge of dark blood from the vagina before and after menstruation. Bimanual research has shown enlarged uterine body, the uterine appendages cannot be detected, the surface of the posteror fornix is tuberous. Laparoscopy detects cyanotic inclusions on the ovaries, in the rectouterine pouch of the peritoneal cavity, and on the paraproctium. Make the right diagnosis:
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A 31-year-old patient has been suffering from systemic scleroderma for 14 years. She underwent multiple inpatient treatment courses. She is complaining of intermittent dull pain in the area of her heart, palpitations, shortness of breath, headache, swollen eyelids, weight loss, and painful and deformed joints in her limbs. The prognosis of her condition will be worse if the following organ is affected:
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An ambulance team has brought a man diagnosed with acute respiratory viral infection into the inpatient department. The onset of the disease was acute, with fever of 39.9°C. The patient is complaining of a headache in his fronto-temporal regions, pain in the eyeballs, aches all over his body, stuffed nose, sore throat, and dry cough. At home, he had two episodes of nosebleeds. What type of acute respiratory viral infection does this patient have?
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An 28-year-old man was hospitalized on the 7th day of illness with complaints of headache, general weakness, fever, and sore throat. All the groups of lymph nodes are enlarged to 1–3 cm in diameter. Palpation shows dense, elastic, and slightly painless lymph nodes that are not matted together. Enlarged tonsils are covered with purulent plaque. The liver is +3 cm. In the blood: leukocytosis, relative lymphomonocytosis, virocytes – 15%. Make the right diagnosis:
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A 13-year-old girl is complaining of a febrile body temperature that is observed within the last month, pain in the joints, and periodical skin rash. Examination detects LE-cells and a persitent increase in ESR in the child’s blood. Make the right diagnosis:
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After manual repositioning of bone fragments and application of a plaster splint, a patient with forearm fractures developed edema, pain, and disturbed sensitivity in his hand and fingers. What tactics must the doctor choose?
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A 58-year-old woman developed profuse bleeding from a ruptured varicose node on her left calf. What first aid will you provide in this case?
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Two days ago a 28-year-old man has injured the distal phalanx of his right index finger with a needle. He complains of a sharp throbbing pain and edema in the area of this phalanx and markedly impaired finger mobility. His index finger is slightly bent, its distal phalanx is hyperemic and significantly enlarged. The probe clearly determines the point of maximum pain. The body temperature is 36.9°C. What treatment will be necessary in this case?
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A 28-year-old woman came to a doctor with complaints of facial edema, moderate leg edemas, and urine that periodically assumes the color of «meat slops». As a teenager, she had frequent tonsillitis. Her skin is pale, t° – 36.8°C, pulse – 68/min., rhythmic, blood pressure – 170/110 mm Hg. What changes in the patient’s urine are the most likely in this case?
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A 51-year-old woman has a 2.5- month-long menstruation delay. She is complaining of profuse bloody discharge from her vagina for the last 15 days, irritability, and disturbed sleep. She has a history of menstrual dysfunction observed within the last year. Ultrasound shows that her uterus is normal for her age, the uterine appendages are normal, endometrial thickness is 14 mm. What tactics will the doctor choose in this case?
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After an overexposure to cold, a 32-year-old patient developed general weakness, excessive sweating, fever, and cough. His overall condition is moderately severe, his skin is moist, his lips are cyanotic. His chest is symmetrically involved in the act of breathing. Under the shoulder blade on the right, the percussion sound is slightly dull; vesicular respiration there is weakend, with sonorous moist finely-vesicular crackles. Above the rest of the lung surface there is harsh breathing with scattered dry crackles. The heart sounds are intensified, the second heart sound is accentuated over the pulmonary artery. In the blood: leukocytes – 13.2 · 109/L, ESR – 21 mm/hour. Make the right diagnosis:
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A man complains of pain and skin redness in his right calf. He has a fever of 38.5°C and enlarged and painful inguinal lymph nodes on the right. The skin of the affected limb is edematous, hyperemic, and has rash elements in the form of vesicles filled with a dark liquid. Its palpation is painful. There is a clear margin between the red area and healthy skin. Make the right diagnosis:
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A 54-year-old patient was brought to a hospital with complaints of a sudden sharp pain in his chest that appeared when he was lifting a heavy object. The pain is localized in the center of his chest. It does not irradiate to other areas, nor does it intensify with changes in the position of the body. The pain was accompanied by nausea without vomiting. No respiratory symptoms are observed. The man has a history of essential hypertension and takes angiotensin-converting-enzyme inhibitors. Objectively, his skin is pale and moist. His pulse is 115/min., respiratory rate – 20/min. ECG shows sinus tachycardia. Chest Xray shows a darkening in the upper left and lower right segments. His cardiac enzyme levels are normal. Make the right diagnosis:
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When playing football, a 20-year-old man squatted sharply on his right leg with a simultaneous turn to the left. This movement resulted in a sharp pain in his right knee, after which he was brought to a first-aid station. The range of movements in the right knee joint is 100–150°, there is no lateral mobility in the knee. Make the right diagnosis:
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An 18-year-old young man was brought into to the hematology department with complaints of a headache, general weakness, loss of appetite, fever of 39°C, and a swelling on his neck. His, to – 38°C, the skin and mucosa are markedly pale, the cervical lymph nodes on both sides are up to 1 cm in size and painless. The liver is +1 cm and painless, the spleen is +0.5 cm. In the blood: Hb – 98 g/L, erythrocytes – 2.9 · 1012/L, leukocytes – 32 · 109/L, blast neutrophils – 0%, segmented neutrophils – 28%, monocytes – 2%, lymphocytes – 39%, blasts – 31%, reticulocytes – 31%, platelets – 120 · 109/L , ESR – 36 mm/hour. Specify the form of the patient’s leukemia:
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A 16-year-old teenager complains of weakness, dizziness, and heaviness in the left subcostal region. The skin and visible mucosa are icteric. The tower skull syndrome is observed. The liver is +2 cm. The lower edge of the spleen is at the level of the navel. The blood has: erythrocytes – 2.7 · 1012/L, Hb – 88 g/L, leukocytes – 5.6 · 109/L, ESR – 15 mm/hour. What is the most likely change in the bilirubin levels in this patient?
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A 58-year-old patient has undergone an urgent cholecystectomy and drainage of the abdominal cavity. In the postoperative period, she was prescribed heparin and developed hemorrhagic syndrome. What medicine must be used to eliminate the side effects of heparin in this case?
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A 20-year-old young man was brought to a clinic on the 7th day of his illness with complaints of icteric skin and sclerae, dark urine, one episode of vomiting, low appetite, and fever of 38°C throughout the last 2 days. Three weeks ago he went fishing with friends, during which they all shared the same tableware. He is inert, t° – 36.8°C, his skin and sclerae are icteric, the liver protrudes from under the edge of the costal arch by 3 cm and is tender on palpation; the spleen cannot be palpated. Patient’s urine is dark, his feces are partially acholic. Make the right diagnosis:
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A 30-year-old man is complaining of intense pain, skin redness, swollen ankle, and fever of 39°C. The onset of the disease was sudden. In the past, he had similar episodes that lasted 5–6 days without changes in the joint. The skin over the ankle joint is hyperemic, without clear margins or an infiltrative bank on the periphery. Make the right diagnosis:
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A 7-year-old boy has been receiving treatment for a month. At the time of hospitalization, he had marked edemas, proteinuria of 7.1 g/L, and daily urine protein of 4.2 g. Biochemical blood test has shown persistent hypoproteinemia (43.2 g/L) and hypercholesterolemia (9.2 mmol/L ). What leading glomerulonephritis syndrome is most likely in this patient?
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A 65-year-old man complains of asphyxia, cough with pink foaming sputum, sensation of lack of air, and fear of death. He has orthopnea, pale skin, and acrocyanosis and is covered in cold sticky sweat. His respiration is harsh, in the lower posterior segments there are wet finely vesicular and moderately vesicular crackles on both sides. His respiratory rate is 40/min. The heart sounds are markedly muffled. At the cardiac apex, the gallop rhythm is observed. Make the right diagnosis:
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In April, during medical examination of the population, 27% of the examined people were complaining of their decreased working ability and high fatigability. Examination revealed swollen loose gums that markedly bleed when pressed. On the skin, follicular hyperkeratosis is observed against the background of normal skin moisture. What pathology is most likely cause of this condition?
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A 37-year-old woman complains of shortness of breath and constricting retrosternal pain. One week ago she had a flu. She has acrocyanosis, her heart rate is 98/min., blood pressure – 90/75 mm Hg, respiratory rate – 26/min. The cardiac borders are expanded to the left and right by 3 cm. The heart sounds are muffled, above the cardiac apex there are a protodiastolic gallop rhythm and a systolic murmur. Hb – 100 g/L, ESR – 25 mm/hour. Make the right diagnosis:
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A 25-year-old multipara was hospitalized at the first period of labor with moderately strong contractions. This is her third pregnancy. She has a history of one cesarean section due to clinically narrow pelvis and one artificial abortion. Suddenly she developed severe abdominal pain and weakness. The blood pressure dropped to 90/50 mm Hg. Moderate bloody discharge appeared from the vagina. The fetal heartbeat cannot be auscultated. The labor activity has ceased. Make the right diagnosis:
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Examination of the corpse of a man, who died by hanging, reveals that the spots of livor mortis disappear when pressed and then reappear 50 seconds later. The rigor mortis is moderate and observed only in the masticatory muscles and muscles of neck and fingers. The body temperature is 31.0°C. What is the time of death is likely in this case?
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A child has suddenly developed a respiratory arrest, cyanotic skin, and pinpoint pupils. There is no pulse on the great blood vessels. What measures must be taken first in this case?
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For the last 2 years, a 51-year-old woman has been experiencing a dull pain with periodical exacerbations in her right subcostal region. The pain was associated with eating fatty foods. The woman is complaining of bitterness in her mouth in the morning, constipations, and flatulence. She is overeating, t° – 36.9°C, the tongue is coated near its root, the abdomen is moderately distended and painful at the point of gallbladder projection. What study would be the most useful for making a diagnosis?
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A 17-year-old girl was hospitalized into the gynecological department with complaints of profuse bloody discharge from her genital tracts and a cramping pain in her lower abdomen. The last menstruation was 10 weeks ago. Her blood pressure is 100/60 mm Hg, pulse is 90/min.. Vaginal examination has shown that the external orifice of the uterine cervix allows inserting one finger. The uterus is painless and enlarged to 6 weeks of pregnancy. The uterine appendages cannot be detected, the fornices are free. Make the right diagnosis:
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A 53-year-old woman complains of an aching pain in the lower abdomen, a significant abdominal distention within the last 5 months, weight loss, and weakness. The cervix is clean, the uterus is not enlarged, painless, and immobile. On the both sides, there are dense mildlymobile tumors 10x13 cm in size with an uneven surface. Abdominal percussion detects a fluctuation. Make the right diagnosis:
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In a 37-year-old primigravida the labor lasts for 10 hours already. Contractions last 20–25 seconds and occur every 6– 7 minutes. The fetus is in a longitudinal lie with cephalic presentation, the head is pressed against the entrance to the lesser pelvis. Vaginal examination has shown that the uterine cervix is up to 1 cm long and allows 2 finger-widths. The amniotic sac is absent. Make the right diagnosis:
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