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KROK 2 Medicine 2023 Questions | KROKEXAM
Browse 2023 KROK 2 Medicine exam questions with answers and explanations.
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A 51-year-old man was hit by a car. He complains of a pain in his pelvis on the left. Examination shows no disturbances of pelvic configuration, there is a swelling in the left inguinal region. Palpation of this region is sharply painful. The Larrey’s sign and Gabai’s sign are positive, the patient is unable to lift the extended leg, as if the heel was glued down. Make the provisional diagnosis:
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A 35-year-old man complains of rapidly increasing fatigue, palpitations,“visual snow”, dizziness. He has a history of peptic ulcer of the stomach, Objectively the skin is pale. Vesicular respiration is observed in the lungs. Systolic murmur is detected over the cardiac apex, heart rate is 100/min., BP is 100/70 mmHg. The epigastrium is slightly tender on palpation. Blood test: erythrocytes — 3.2• 1012/L, Hb — 100 g/L, color index — 0.94. What type of anemia is it?
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A 38-year-old patient has been delivered by an ambulance to a surgical department with complaints of general weakness, indisposition, black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Complete blood count: Hb — 108 g/L, thrombocytopenia. Anamnesis states that similar condition was observed 1 year ago. Make the diagnosis:
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A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to 38°C. Examination shows him to be in a moderately severe condition; there are small Pale pink non-merging spots on the skin of is back, abdomen, and extremities. Palpation reveals enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
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A 23-year-old woman with type 1 diabetes mellitus during the 2nd week of community-acquired pneumonia developed nausea and vomiting. In the evening she has lost her consciousness and was hospitalized. Objectively, the patient’s skin is pale and dry. Her respiration is loud, the tongue is dry, with brown deposit. Her heart rate is 129/min., blood pressure is 85/50 mm Hg. Palpation of the patient’s abdomen provokes no response. The liver is +3 cm. Acetone test is markedly positive, blood glucose is 26 mmol/L. Make the provisional 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 shows 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 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 43-year-old man complains of facial edema, dyspnea, and difficult swallowing that appeared 3 hours after he was stung by an insect. Objectively, the skin of his eyelids, cheeks, and lips is acutely hypcremic and edematous. What medicines should he be prescribed for emergency aid?
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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 aggression. On examination 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 48-year-old woman complains of disturbed menstrual cycle: her periods last for 7-9 days and arc excessively profuse throughout the last half-year. She notes occasional hot flashes in her head, insomnia, irritability, and headaches. Her skin is of normal color. Blood pressure — 150/90 mm Hg, pulse — 90/min., rhythmic. The abdomen is soft and painless. Bimanual examination shows no uterine enlargement, the appendages cannot be detected. The vaginal fornices are free. What is the most likely diagnosis?
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After the pregnant woman’s waters broke, it was noted that they are significantly contaminated with meconium. Upon birth, the baby is not breathing, remains inert, the skin is cyanotic and covered in meconium, heart rate is 98/min. What resuscitation measures should be taken after the baby is born?
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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. Objectively, on the skin of his abdomen there are isolated roseolas, his pulse is 78/min., the liver is enlarged by 2 cm. Make the diagnosis:
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A 34-year-old multipara was brought to the labor ward with regular labor activity. Her pelvic size 26-29-32-22 cm. Vaginal examination shows 6 cm cervical dilation, the amniotic sac is unbroken. The fetus is in the breech presentation, with buttocks pressed to the entrance into the lesser pelvis. The promontory cannot be reached, no exostoses. Feta heart rate is 140/min, expected fetal weight is 2800g. What labor tactics should be chosen?
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A 2.5-year-old child is ill for the second day. The onset of the disease was associated with the temperature up to 37.8°C, a single bout of vomiting, and watery diarrhea up to 5 times per day. During the second day, vomiting occurred twice, body temperature is 38.0°C, the child has low appetite, watery diarrhea continues. The treatment of the child should start with the following:
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A 35-year-old woman had acute onset of the disease that started with fever up to 39.0°C and cough. 3 days later her dyspnea at rest increased up to 35/min. Downward from her right shoulder-blade angle, percussion detects a dull sound. No vocal fremitus, respiratory sounds cannot be auscultated. What is the treatment tactics?
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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, over exposure 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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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. Cystoscopy detected hemiatrophy of the urinary bladder trigone, the right ureteral orifice is not detected. What pathology is it?
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A surgery unit received a person with an incised stab wound on the upper third of the right thigh. Examination detects an incised stab wound 3.0x0.5x2.0 cm in size on the inner surface of the upper third of the right thigh. Bright-red blood flows from deep within the wound in a pulsing stream. Characterize this type of bleeding:
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A 45-ycar-old woman complains of increasing body weight throughout the last year. Examination revealed moon face syndrome, brittle hair, hirsutism, stretch marks on the abdomen, and disproportionally thin limbs. The patient’s height is 162 cm, her body weight is 94 kg, her body mass index is 35.8 kg/m2. What type of obesity is it?
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A 45-year-old man came to the hematologist with complaints of general weakness, elevated body temperature, excessive sweating, enlarged cervical lymphnodes. Objectively, his body temperature is 375°C, the skin is pale and dry, the posterior cervical lymph nodes are dense and elastic, up to 2 cm in diameter, mobile. Hepatosplenomegaly was detected. What examination is necessary to determine the scope of the pathologic process?
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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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Preventive examination of a 75-year-old woman with a moderately active lifestyle shows total serum cholesterol of 5.1 mmol/L (208 mg/dL) and high-density lipoprotein levels of 70mg/dL. Her ECG is normal. What advise about her diet should be given to this woman?
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A 48-year-old man complains of stool 2-3 times a day, with a large amount of foul smelling feces, which is acconpanied by a pain in the umbilical region, hair loss, and paresthesias. Examination shows pale skin, ow body mass, and leg edema. Palpation of the umbilical region and intestine is painful. Blood test shows anemia; stool test shows steatorrhea, creatorrhea, amylorrhea. What syndrome can be observed in the patient?
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A 30-year-old woman complains of general weakness, difficult swallowing when eating, dry skin and brittle hair. Objectively, her body temperature is 36.6°C,respirations — 16/min., Ps — 92/min., blood pressure — 110/70 mm Hg. The skin and visible mucosae are pale. In the blood: Hb — 65 g/L, erythrocytes — 3.21012/L, color index — 0.6, reticulocytes — 3%, leucocytes — 6.7 ■ 109/L, eosinophils — 2%, stab neutrophils — 3%, segmented neutrophils — 64%,lymphocytes — 26%, monocytes — 5%, ESR — 17 mm/hour. Serum iron — 74mcmol/L, total protein — 78 g/L. What factor is deficient, causing this condition?
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A 20-year-old woman complains of headaches, vertigo, tearfulness, vomiting, pain in the area of the heart, and tachycardia. The signs appear 6-7 days before menstruation and disappear in the first days of menstruation. Make the diagnosis:
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A 45-year-old man underwent a cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively his body temperature is hectic. His cardiac borders arc expanded, apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?
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A 40-year-old patient presents with cough in the morning with production of mucopurulent sputum and elevated body temperature up to 376°C. He has been smoking since he was 17 years old. Objectively, auscultation detects coarse respirations and diffuse dry crackles in the lungs. Complete blood count:leukocytes — 12 • 109 /L, ESR — 19 mm/hour. Bronchoscopy shows purulent catarrhal endobronchitis. Make the diagnosis:
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A 35-year-old man, who for the last 3 years has been on hemodialysis due to chronic glomerulonephritis, developed disturbances of the cardiac performance, hypotension, progressing weakness, and dyspnea. ECG shows bradycardia, 1st degree atrioventricular block, tall and sharp T-waves. The day before he had a serious break from his solid and liquid diet. What biochemical changes are the most likely cause of the described clinical presentation?
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A 38-year-old man complains 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. Objectively, 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 diagnosis:
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A 32-year-old woman during an occupational medical examination underwent a colposcopy that revealed a punctuation area in zone 1 of the uterine cervix. Cytologically there was dysplasia of the 3rd degree detected. After additional examination, the patient was diagnosed with Carcinoma in situ of the uterine cervix. What treatment method should be chosen in this case?
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A premature newborn from the first pregnancy was born at 37 weeks of gestation, with the weight of 2400 g and the length of 51 cm. The infant is anxious, has limb tremor, does not suckle, exhibits respiratory disturbances and hepatosplenomegaly. At the end of the first day of life the child developed icteric skin and mucosa. On the second day, skin rashes appeared: both separate vesicles and clusters of vesicles located over the rib cage. Make the provisional diagnosis:
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A 28-year-old man, a teacher, after an emotional stress developed painful muscle spasms in his right hand that occur during writing; now he has to hold the pen between the second and third fingers. He has no problems with typing or writing on the black board; no other motor disturbances or neurological pathologies are detected. What is the most likely diagnosis?
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The body of a 24-year-old woman with probable signs of poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the Criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
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A 65-year-old woman for 5 weeks has been presenting with a progressing painless jaundice, skin itch, weight loss of 10 kg, and acholia. Palpation detects positive Courvoi-sier’s sign. Make the provisional diagnosis:
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A 47-year-old woman, who 2 days ago returned from Peru, complains of a pain and enlargement of the lymph nodes in her right inguinal region. She was diagnosed with bubonic plague. What medicine should be prescribed to the contact persons for urgent prevention of this disease?
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Forensic autopsy of the body of a 59-year-old man, who died suddenly at home without signs of violent death, shows pink skin and mucosa, liquid bright-red blood, and bright-red plethoric internal organs. Forensic toxicology testing detected 1.44% of ethanol in the blood and carboxyhemoglobin levels of 55%. What is the cause of death?
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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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A 55-year-old woman came to a doctor with complaints of a heavy sensation in her left shin and periodical cramps of the gastrocnemius muscles that occur at night. She has been suffering from this condition for 5 years, since the moment when these signs first appeared. Her condition has been remaining untreated all this time. Objectively, on the medial surface of the left shin and thigh there are dense subcutaneous varicose veins that are painless on palpation. Make the diagnosis:
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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 35-year-old woman came to the family doctor with complaints of profuse menstruations that last up to 10 days. Gynecological examination shows that the uterine cervix is without changes, the uterus is in anterflexio, has normal size, is mobile and painless. The uterine appendages on the both sides are without peculiarities. The family doctor made the provisional diagnosis of abnormal uterine bleeding. What instrumental method of examination needs to be performed first to diagnose this pathology?
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