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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 30-year-old man complains of pain in the lower legs of both legs, which worsens over time walk. The patient is forced to stop after 150-200 m. Intermittent claudication appeared a year therefore, the distance between stops was reduced. Both feet are pale, cool. Pulse on posterior arteries of the feet are absent. The skin is dry, hyperkeratosis on the soles, nails are thickened, easily breakable, matte color. On the legs - areas of alopecia. What stage obliterating endarteritis in this patient?
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A 68-year-old woman was hospitalized with complaints of a headache in the occipital region, severe shortness of breath at rest, which worsens in the supine position, and dry cough. Objectively established: orthopedic position, acrocyanosis. Above the lungs is listened toweakened vesicular respiration, medium and small-bubble wet rales in the lower departments. Heart tones are weakened, the rhythm of the gallop. Pulse - 102/min., AT - 210/110 mm Hg. Art. Liver protrudes 2 cm from the edge of the costal arch, sensitive to palpation. Swelling of the legs. What drugs should be prescribed first?
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An ambulance delivered a woman with a delay after menstruation cramping pain in the right iliac region, radiating to the rectum, bloody discharge from the genital tract. Objectively established: heart rate contractions - 100/min., blood pressure - 90/60 mm Hg. Art. The skin is pale. Stomach painful on palpation, a positive symptom of Shchotkin-Blumberg. During gynecological research is observed: shifts of a neck are painful, the right appendages are increased, painful, back vault overhanging, bloody discharge. Make a preliminary diagnosis:
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A girl of 8 months during the examination revealed a loud intense systolic murmur over the whole cardiac area with the epicenter in the III-IV intercostal space to the left of the sternum and systolictrembling; II tone over the pulmonary artery of increased volume. AT - 110/70 mm Hg. Art. Complaint no. During the X-ray examination, the size and shape of the heart shadow are not changed. What is the most likely diagnosis?
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A 42-year-old man, a miner, was released from the rubble 12 hours later. Objectively established: both legs and feet pale. There is no pulsation of peripheral vessels. Sensitivity and passive movements in the joints are absent. Delivered with harnesses on both extremities. What urgent first aid measures should be taken to prevent myoglobinuria and acute renal failure?
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A 3-year-old child was admitted to a 3-year-old house with hyperthermic syndrome influenza, tonic-clonic generalized seizures last for 50 minutes. Therapy is not was conducted. For immediate treatment of convulsive syndrome it is necessary:
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A 39-year-old man complains of shortness of breath and squeezing pain behind his chest calm. 10 days ago he had the flu. Objectively established: outside forced - sitting, leaning the torso forward, the face is swollen, cyanotic, swollen jugular veins. The boundaries of the heart are significant extended in both directions, deaf tones, rhythmic, heart rate - 104/min., respiratory rate - 28/min. The ECG revealed: decreased voltage of the teeth, concordant ST segment changes. On the radiograph: a spherical shadow of the heart, signs of stagnation in the lungs. IN blood revealed: erythrocyte sedimentation rate - 38 mm/h. What is the probable diagnosis?
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A 35-year-old man has shortness of breath during exercise, he periodically loses consciousness. Auscultation: systolic murmur in the III intercostal space to the left of sternum. Ultrasound of the heart revealed: symmetrical LV hypertrophy, its diastolic dysfunction with some reduction of the cavity. There is anterior systolic movement anterior mitral valve leaflet. What is the pathology of the patient?
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A 68-year-old woman was taken by ambulance with a nosebleed. From the anamnesis found that for 15 years she had hypertension, was not treated, AT - 210/120 mm Hg Art. Periodic nosebleeds bother for several years. Objectively found: in the nasal cavity blood clots, free breathing. During removal clots appeared bleeding from the nasal septum. What first aid should be provided by the funeral home?
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A 52-year-old man suffering from postcholecystectomy syndrome, during of retrograde cholecystopancreatography revealed stenosis of the sphincter of Oddi with moderate dilatation of the common bile duct and contrast reflux in the Virsung ducts. There are no concretions in the ducts. The diagnosis of chronic pancreatitis is undoubted. Which surgery is adequate to correct this pathology?
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The patient is 37 years old. Transferred to the ophthalmology department from the ENT department, in which was treated for purulent pansinusitis. Objectively established: general weakness,body temperature - 38.5°C. Visual acuity of the right eye - 0.6 (from the anamnesis of VIS OD = 1.0) Eyelids bluish, swollen, dense. Chemosis of the conjunctiva, Exophthalmos. Real estate of the eyeball. Repositioning of the eye is difficult. Diagnose:
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An 18-year-old girl complains of heaviness and distention in the right hypochondrium. State intensified after eating or taking no-spy. The abdomen is soft, painless, the liver is not enlarged. AsT - 35 OD, AlT - 40 OD. Blood test showed: leukocytes - 5.2 g/l, ESR - 7 mm/h. Ultrasound found: the liver is not enlarged. Gallbladder on an empty stomach 68 ml, after choleretic breakfast for 45 minutes - 64 ml. The wall is not thickened. What is the most likely diagnosis?
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A newborn with a gestational age of 31 weeks increases lethargy, muscular hypotension and depression of consciousness. Analysis of cerebrospinal fluid found: increased number of erythrocytes, protein and elevated glucose. What is the most likely diagnosis?
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A 48-year-old man went to the doctor with complaints of low back pain. Ill 3 days after hypothermia. After examination, the doctor diagnosed: acute lumbosacral sciatica. What drugs should be prescribed to the patient?
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The patient was taken to the department in serious condition: body temperature - 36.5°C, inhibited, facial features are pointed, the tongue is dry, the skin fold is not straightened. Tachypnea up to 28/min., Pulse - 126/min., AT - 60/40 mm Hg. art., the abdomen is painless. During hospitalization was observed: vomiting fountain, watery stools resembling rice broth. From the epidemiology it is known: a week ago he returned from Sudan (Africa). Choose a starting therapy for emergency care:
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The family ate canned vegetables (including mushrooms) and canned fruit preparation. Two days after the next meal, two family members complainedfor weakness, impaired vision, double vision and strabismus. A little later it arose difficulty speaking, swallowing disorders. After referring patients to the hospital hospitalized. What food poisoning occurred in this case?
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A 35-year-old patient complains of secretions from the nipple of the left breast. During the examination, palpation of the pathology was not detected. For what benign disease is there characteristic of this symptom?
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The girl was born from pregnancy and vaginal birth at 39 weeks of gestation (weight - 3350 g, body length - 53 cm). The 17-year-old mother of the child is HIV-positive. The child's condition after satisfactory birth. When can this child be vaccinated with BCG?
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A child of 11 years has periodic constipation from birth, bloating, decreased appetite, sometimes nausea, muscle wasting. Narrowing is observed on the irigogramin the area of the rectum with suprastenotic enlargement of the colon above this places. During anomanometry, the anorectal reflex is negative. What is the method of diagnosis will be the most informative to confirm the diagnosis?
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A 3-year-old child during the examination revealed: fever, intoxication, pale skin, hemorrhagic and necrotic elements of the rash on the skin and mucous membranes. In the general analysis of blood revealed: pancytopenia, agranulocytosis, reticulocytes are absent, ESR is significantly increased. What is the probable diagnosis?
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A 13-year-old child has a mitral valve defect with a predominance of insufficiency. Against the background of acute respiratory viral infection (ARI) increased shortness of breath and general weakness, a feeling of tightness in the chest, dry cough. In the lungs are listened to wet rales of various calibers. Liver at the edge of the costal arch. What an emergency developed in a child?
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A 67-year-old woman undergoing surgery for acute destructive cholecystitis the presence of purulent cholangitis was determined. No stones were found during the audit of the choledochus signs of duodenal nipple stenosis. Cholecystectomy was performed. How to finish operation?
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During the epidemiological investigation in the city according to the proposed hypothesis studied the cause-and-effect relationships of new cases depending on the identified risk factors. What kind of epidemiological study was used?
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A 52-year-old man suffers from severe shortness of breath during exercise, unproductive cough. Ill for 8 months. Smokes for 30 years. During auscultation in the lungs with creaking rales are heard on both sides - "cellophane crack". BP - 26 / min., SpO2 - 92%. During spirometry revealed: moderate dysfunction of external respirationrestrictive type. The interstitial process was suspected. What is the research method most effectively help verify diagnosis and prognosis?
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A 62-year-old man. Over the past 3 years for no apparent reason began to grow helplessness, memory loss. In a mental state it is established: correctly names the last name, first name, patronymic, date of birth; age can not say. Disoriented in terrain, in time. Memory is reduced to current and remote events. Intelligence is reduced. Violated higher cortical functions with the phenomena of aphasia, apraxia, agnosia. There is no criticism. Determine the leading pathogenetic mechanism of formation of the described condition:
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A 45-year-old man complains of pain in the inner surface of the lower leg and thigh. Ill for 5 days, when after exercise there was pain in the lower leg, which gradually spread to the thigh. Objectively established: in the projection of the large subcutaneous veins on the leg and thigh there is redness of the skin and swelling. On palpationrevealed: compaction and soreness. Edema of the right lower extremity is absent, pulsation arteries in the feet is determined. What is the most probable pathology that causes this the picture?
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A 65-year-old woman was hospitalized in the intensive care unit in a coma. Has been suffering from type II diabetes for 10 years. The last 2 weeks were observed pronounced polyuria, polydipsia. Serum glucose - 30 mmol/l, arterial blood pH - 7.3. Blood plasma osmolarity is 350 mOsm / l. The patient was diagnosed with diabetic hyperosmolar coma. What is the main pathogenetic mechanism of coma?
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A 25-year-old woman applied to the gynecology department with complaints of promotion body temperature up to 38.6°C, lower abdominal pain, dysuric disorders. Ill 3 days ago, when these symptoms appeared after an abortion. During gynecological the study revealed: the cervix is cylindrical, the eye is closed. The body of the uterus is somewhat enlarged, painful, soft. Uterine appendages are not palpable. Purulent-bloody discharge. Bythe results of blood tests revealed: leukocytosis with a shift of the blood formula to the left, accelerated ESR. Which diagnosis is most likely?
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A 54-year-old man complained to his family doctor about breathing difficulties, weakness. For the past two weeks, he has been concerned about pain and swelling in his right lower limb. These symptoms feels for the first time in a life, was not registered at the doctor earlier. AT - 110/70 mm Hg. st, heart rate - 96 / min Which diagnostic method is crucial?
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In the woman in labor on the 12th day of the postpartum period, the temperature suddenly rose body up to 38.2°C, There is a general weakness, pain in the right breast for 1 day. During the examination it was found: the breast is tense, hot, y the right upper quadrant is palpated infiltrate, painful, dense. Which the diagnosis is most likely?
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A 61-year-old man underwent cholecystectomy 7 days ago. Concomitant disease diabetes. What diet should be prescribed to the patient?
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The child was born at 8 months of pregnancy. She was diagnosed with: microcephaly, cataracts, heart defect. The mother of the child in the 2nd month of pregnancy was ill; there was a brief increase body temperature up to 37.5°C, enlarged lymph nodes and small-spotted rash on face, torso and limbs, which passed without residual effects. Which is most likely preliminary diagnosis in the child and mother?
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Pregnant at 35 weeks, serious condition. Complains of headache, impaired vision, flickering "flies" in front of the eyes. Examination revealed: general edema, AT - 180/120 mm Hg Art. Suddenly there were fibrillar twitching of facial muscles, tonic convulsions. Breathing stopped. In 1 minute breathing was restored. From the mouth came out a lot the amount of foam. Amnesia. Proteinuria - 7 g/l. What is the probable diagnosis?
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A 69-year-old man underwent a right-sided nephrectomy. Intraoperative one-time blood loss - 800 ml, after which hypotension was observed for 40 minutes. Later anuria developed. Specify the probable cause of anuria:
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A 58-year-old man complains of pain in the right iliac region, infrequent up to 4-6 times on day, bowel movements, fever up to 37.5-38°C. Objectively established: moderate condition of malnutrition, pale skin and mucous membranes. AT - 100/60 mm Hg st., PS - 98/min. Painful infiltrate is palpated in the right iliac region. Blood tests showed: erythrocytes - 2.5 × 1012/ l, Hb - 80 g/l, leukocytes - 11.2 × 10 ^ g/l, eosinophils - 3%, rod - 6%, segmental - 68%, monocytes - 7%, lymphocytes - 14%, total protein - 61 g/l, albumin - 47%, globulins - 53%, C-reactive protein - 24. During X-ray examination with a passage of barium through the small intestine inflammatory stenosis of the terminal part of the small intestine with barium deposition was detected dilated loop of the small intestine. Diagnosed with Crohn's disease with lesionterminal small intestine, stenotic form of moderate severity. What a group drugs should be prescribed first?
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A 65-year-old woman who drank water from a well gradually developed a fever to 39.9°C. Objectively established: inhibited, the tongue is covered with a gray-brown plaque with imprints of teeth on the edges, on the skin of the abdomen single roseola, bloated abdomen. Vidal's reaction - 1: 400. Which of the etiotropic chemotherapy drugs should be prescribed?
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A 20-year-old patient is being treated for anemia (hemoglobin - 72 g/l). One and a half years ago after a miscarriage at 16 weeks and blood loss is observed memory loss, fatigue, loss of appetite, dry skin, brittle nails, swelling, menstrual disorders. Objectively established: blood pressure - 80/55 mm rt. Art., pulse - 54/min., height - 168 cm, weight - 48 kg, genital hypoplasia. Appointment which of the following drugs will be most appropriate?
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The driver during the clinical examination in the urine revealed an increased content of calcium salts of phosphoric acid. His diet includes rye and wheat bread, pasta, butter, oil, mashed potatoes, milk, cheese, coffee, tea, broth rose hips, currant jelly. The energy value of the diet corresponds to energy consumption. What should be limited in the diet?
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A 35-year-old woman went to a doctor in OKL with complaints of chest pain, difficulty passage of solid and liquid food through the esophagus, increased salivation, vomiting, weight loss. Such symptoms are disturbing about a year after the psycho-emotional stress. What is the previous diagnosis?
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During the medical examination of middle and high school students doctors determined the correspondence between biological development and calendar age by the following criteria: annual increase in body length, ossification of the bones of the hand, the number of permanent teeth. What additional indicator of development in this age period is most likely should doctors include?
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