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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 36-year-old woman is complaining of epigastric pain that occurs after eating, nausea, belching, and loose stools. The disease gradually progresses over the course of the last 2 years. Her skin is pale and dry, her tongue is coated, moist, and has teeth imprints on its edges. Abdominal palpation detects diffuse epigastric pain. What study will be the most informative in this case?
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A 47-year-old woman is complaining of paroxysmal headaches that have been occurring for the past 5 years. The pain is unilateral, intense, and localized in the frontal area. It is accompanied by nausea and abdominal discomfort and begins suddenly. The headaches are preceded by blurred vision. The woman has a history of hypertension episodes, but currently takes no medicines. Between the headaches, her condition is satisfactory. She is overeating (body mass index is 29), her blood pressure is 170/95 mm Hg. Her neurological status is normal. Make the right diagnosis:
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A 38-year-old man is complaining of periodical problematic swallowing of both solid and liquid foods that is observed for many months. Sometimes he develops an intense retrosternal pain, especially after hot beverages. Asphyxia attacks are observed at night. He has no weight loss. His general condition is satisfactory, the skin is of normal color. Examination detects no changes in the gastrointestinal tract. Chest X-ray shows dilation of the esophagus with air-fluid levels in it. Make the right diagnosis:
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A 60-year-old man has complains of a heavy sensation in his scrotum. There is a scrotal edema on the left. The testicle is of normal size, but above it a soft edema is palpable. The edema is limited to the scrotum, can be compressed, and disappears when the patient lies down. Make the right diagnosis:
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A 42-year-old man, who has been suffering from a duodenal ulcer for 20 years, has developed a constant feeling of heaviness in the stomach after eating. His eructation carries the smell of decay and vomiting occurs with the food eaten the day before. He has lost weight. His condition is relatively satisfactory, tissue turgor is reduced. The abdomen is soft on palpation, there are no signs of peritoneal irritation, and a «sloshing sound» can be heard in the epigastrium. Defecation occurs once in 3 days. What complication most likely corresponds with the patient’s condition and the described clinical presentation?
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A district doctor was tasked with preparation of a plan for a complex of treatment and prevention measures among the population in his district. What measures for secondary disease prevention must be included in this plan?
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Preventive examination of a 75-yearold woman with a moderately active lifestyle has shown total serum cholesterol of 5.1 mmol/L (208 mg/dL) and highdensity lipoprotein levels of 70 mg/dL. Her ECG is normal. What advise about her diet can be given to this woman?
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A 46-year-old woman was awakened at 3 a.m. by a sharp pain in her right subcostal region, which irradiated into her right shoulder. The woman is anxious, had two episodes of vomiting, notes fever and excessive sweating. Her temperature is 39.0°C. Her abdominal muscles are tense in the right subcostal region. Make the right diagnosis:
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A 16-year-old patient throughout the last year presents with gradual changes in his behavior. He started preferring solitude and has lost interest in his friends and studies. He became indifferent to his family and rude without provocation, started speaking and laughing with himself. All the questions he answers laconically. He considers himself to be healthy, but tired, says that he thinks about writing a book titled «Projection of mankind onto the plane of the universe», and carries around a notebook with pages that are filled with numerous identical crosses. Make the right diagnosis:
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A 35-year-old woman has complains of pain in her left arm that progresses over the last 4 months and intensifies after physical exertion of the affected limb. Also, she notes a cold and «tingling» sensation in her arm. The pain decreases slightly at night, when the arm hangs down from the bed. The woman notes deteriorating vision and the weight loss of 4 kg. She does not smoke. She is undereating, the pulse on the left arm cannot be found. There is no pulsation over the left carotid artery, a murmur is heard above the right carotid artery. Make the right diagnosis:
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A person was hospitalized with a closed craniocerebral trauma 8 hours after a car accident. The patient is unconscious. There are anisocoria, a wound in the parietal area 3.0x1.0 cm in size, and neck muscles rigidity. The pulse is 58/min., hard. Convulsive syndrome was observed. What is the most important indication for an immediate surgery in this case?
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The inpatient care provided to the population of a certain district is being analyzed. What indicator could be used when deciding, whether to reduce the number of available hospital beds?
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A 32-year-old woman was treated in an inpatient department for an abscess of the right lung. After coughing, she suddenly developed labored breathing, cyanosis, and chest pain on the right. What complication is most likely in this case?
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A 42-year-old man was hospitalized 3 hours after an injury with marked subcutaneous emphysema of the upper torso, dyspnea, and tachycardia of 120/min. X-ray has detected no pneumothorax, but has shown a significant expansion of the mediastinum in both directions. What emergency aid must be provided in this case?
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In a city with the population of 400.000, per year 5,600 deaths are registered, including 3,300 deaths caused by diseases of the circulatory system and 730 cases of neoplasm-related mortality. What parameter will allow to characterize the circulatory-related mortality in this city?
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Palpation of the thyroid gland of a 40-year-old woman has detected a dense and moderately painful nodule in the left lobe. Ultrasound has shown the nodule to have high density, while scintigraphy with 131I shows it to be a «cold» nodule. What study would be the most useful for clarification of the diagnosis in this case?
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During medical examination, a port crane operator has complains of dizziness, nausea, a feeling of pressure in his eardrums, tremor, asphyxia, and cough. He is working at a high altitude associated with nervous and emotional strain. Also, the workers are exposed to vibration (general and local), noise, infrasound, and a microclimate that heats them in summer and cools them in winter. What factor is the most likely cause of the worker’s complaints?
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A pregnant woman was registered with a maternity consultancy at the term of 11 weeks and was monitored throughout the whole normal course of her pregnancy. What document will be given by the doctor to this woman for hospitalization to a maternity clinic?
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A 63-year-old man complains of weakness without an obvious cause, fatigability, loss of appetite, and a feeling of disgust towards meat products. Two weeks ago he had a gastric bleeding. Objectively, t° – 37.5°C, respiratory rate – 20/min., pulse – 96/min., blood pressure – 110/75 mm Hg. Epigastric palpation detects pain and muscle tension. In the blood: Hb – 82 g/L, ESR – 35 mm/hour. What study will be the most useful for making a diagnosis?
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A medical committee consists of a therapist, dermatologist, traumatologist, ophthalmologist, neurologist, immunologist, surgeon, otolaryngologist, and hematologist was called in for the regular medical examination of the workers at a chemical factory that produces chromium- and nickel-containing mineral compounds. Name the minimum composition of such a committee, taking into account the characteristics of the products manufactured by this factory:
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A 70-year-old patient complains of weakness, dizziness, brief episodes of nuconsciousneus, and pain in the cardiac region. His heart rate is 40/min., heart sounds are rhythmic, the first heart sound is muffled and significantly intensifies from time to time. Blood pressure is 180/90 mm Hg. What is most likely the cause of these hemodynamic disorders?
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A 76-year-old man has complains of epigastric pain and periodical vomiting throughout the past 2 months. He has no dysphagia or «coffee grounds» vomiting. During this period, he has lost 5 kg, his appetite is low. He does not smoke and is not a heavy drinker. Previously, due to gastric dyspepsia he was taking antacids and proton pump inhibitors, but recently these drugs have stopped bringing him relief. He is undereating, a lymph node can be palpated in his left supraclavicular fossa. The liver is not enlarged. Make the right diagnosis:
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For the last 2 months, a 29-year-old woman has been complaining of chest pain on the left, cough, shortness of breath, and fever of 39.6°C. The left half of her chest lags behind in the act of breathing, her vesicular respiration is weakened, and there is a shortening of the percussion sound on the left. X-ray has shown a round shadow in the lower lobe of the left lung. Make the right diagnosis:
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A 28-year-old man is undergoing a treatment for pulmonary tuberculosis. He has complains of shortness of breath and a sharp chest pain on the right that appeared suddenly. Percussion detects a bandbox resonance over the right lung, auscultation detects no breathing there. X-ray has shown that the right lung is collapsed to its root by 1/2 of its volume, the heart and mediastinal organs are shifted to the left. What complication has developed in this patient?
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A 76-year-old woman is complaining of a progressive swallowing disorder, predominantly when she eats solid foods. This sign is observed over the past 6 weeks. Sometimes she notes episodes of vomiting with solid vomitus. Swallowing is painless. She has lost 6 kg. Ten years ago she had a myocardial infarction. She permanently takes aspirin and long-acting nitrates, drinks alcohol in moderation, and smokes. Her skin is icteric, her neck is normal, the lymph nodes are not enlarged. The chest is normal. The cardiovascular system shows no marked changes. The liver is +3 cm. Make the right diagnosis:
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A girl was born with the weight of 3250 g and the body length of 52 cm. At the age of 1.5 months, the child’s actual body weight is sufficient (4350 g) and the psychophysical development corresponds with the child’s age. The child is on breastfeeding. Periodical regurgitation is observed. What may cause regurgitation in this child?
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A 12-year-old girl took two aspirin tablets. 4 hours later her body temperature increased to 39–40°C. She is complaining of general indisposition, dizziness, and spontaneous development of red spots and blisters on her skin. The skin lesions resemble burns of the second degree, in some places there are erosions or exfoliation of the epidermis. The Nikolsky sign is positive. Make the right diagnosis:
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On the fifth day after a full-term birth, a postparturient woman developed a fever of 38.8°C, abdominal pain, and general weakness. Her blood pressure is 120/80 mm Hg, pulse is 100/min. The breasts are moderately distended. The abdomen is soft and participates in the act of breathing. The uterine fundus is located three finger-widths below the navel. Vaginal examination shows that the cervix allows inserting one finger; the uterus is soft, painful, and enlarged to 13 weeks of pregnancy. There is a seropurulent foul-smelling discharge from the genital tracts. Make the right diagnosis:
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A surgical department has received a boy on the first day of his life. He produces a foaming discharge from his nose and mouth and has cyanosis attacks. X-ray has shown the esophagus that ends in a blind-ended pouch at the level of the Th2 vertebra and the gastric air bubble that is located under the left dome of the diaphragm. Make the right diagnosis:
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One year ago an 8-year-old boy had a case of hepatitis B. For the last two months he has been complaining of fatigability, disturbed sleep, loss of appetite, and nausea, especially in the morning. His skin is not icteric, the liver and spleen are painless and can be palpated 1 cm below the costal margin. His ALT levels are 220 units. How this condition can be interpreted?
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A 78-year-old woman complains of lumbar pain. The pain increases during movements, decreases at rest, and does not irradiate to other areas. Her temperature is normal, the body weight remains unchanged. Her peripheral joints are normal, she has moderate obesity, the mobility of the lumbar spine is limited. A local tension is observed in the soft tissues over the L2 vertebra. In the blood: Hb – 147 g/L, leukocytes – 8.8 · 109/L, platelets – 222 · 109/L, ESR – 5 mm/hour, Na+ – 140 mmol/L, K+ – 4.2 mmol/L, Ca2+ – 2.35 mmol/L. Make the right diagnosis:
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A 39-year-old patient undergoes treatment in the surgical department for acute cholecystitis. He was transferred to the therapy department due to an increase in blood pressure to 180/120 mm Hg, protein excretion with urine, and persistent fever. This persistent subfebrile body temperature was resistant to antibiotic therapy. 10 days after the treatment, the patient had an asphyxia attack with difficult expiration. Later, he developed arthralgias and erythematous skin lesions. Eosinophil levels in the blood are 18%. What disease might be suspected in this patient?
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A 74-year-old man has been suffering from benign prostate hyperplasia for the last 5 years. 4 days ago, after drinking alcohol, an acute urinary retention occurred. At the prehospital stage, his bladder was catheterized with a metallic catheter twice a day. The examination has shown enlarged, dense, and painful epididymis of the right testicle. There is purulent discharge from the urethra. What kind of emergency aid must be provided in this case?
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The people living in a radiationcontaminated area were recommended to include pectin in their diet for removal of radionuclides from the body. What products can be the main source of pectin?
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A 25-year-old woman is complaining of fever of 37°C, pain in her lower abdomen, and vaginal discharge. Three days ago, at 10 weeks of pregnancy, an artificial abortion was performed. The cervix is clean, the uterus is slightly enlarged and painful. The uterine appendages cannot be detected. The fornices are deep and painless. Sanguinopurulent discharge is being produced from the vagina. Make the right diagnosis:
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A 72-year-old woman has been hospitalized with a nosebleed. Within the last 6 years, her blood pressure had spikes up to 180/100 mm Hg. Her skin is pale, the heart sounds are quite sonorous, the second heart sound is accentuated over the aorta, there is an audible systolic murmur. Blood pressure – 150/80 mm Hg. In the blood: Hb – 92 g/L, erythrocytes – 2.7 · 1012/L. In the urine: specific gravity – 1022, leukocytes – 3–7 in the vision field, erythrocytes – 0–2 in the vision field. What is most likely the cause of hypertension in this case?
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Medical examination of the population has revealed and registered chronic diseases, various pathological conditions, and abmormalities. What type of morbidity is being studied in this case?
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A man has developed acute chills, headache, vomiting, and fever of 38.5°C. In the evening, nuchal rigidity and positive Kernig’s sign has appeared. Herpetic blisters are visible on the mucosa of his lips and nose. No focal neurological signs were detected. Make the right diagnosis:
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A 60-year-old woman is complaining of pain in the interphalangeal joints of her hands that exacerbates during work. The distal and proximal joints of her fingers II-IV are defigured, painful, have Heberden and Bouchard nodes, and their mobility is limited. X-ray of the joints has shown narrowed joint spaces, marginal osteophytes, and subchondral sclerosis. Make the right diagnosis:
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A 19-year-old young man was admitted to the surgical inpatient department with a closed abdominal injury. During the surgery, multiple ruptures of the spleen and small intestine were detected. The patient’s blood pressure is progressively decreasing. Blood transfusion is required. Who can determine the patient’s blood type and rhesus factor?
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