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KROK 2 Medicine 2023 Questions | KROKEXAM
Browse 2023 KROK 2 Medicine exam questions with answers and explanations.
Exam questions
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A 78-year-old man with a prostate adenoma underwent a herniotomy for a direct inguinal hernia. After the surgery he presents with absent urination. Enlarged urinary bladder is detectable above the patient’s pubis. What measures should be taken in this case?
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A 26-year-old woman, pregnancy I, 10 weeks of gestation, has been suffering from rheumatism since her childhood. With pregnancy her condition has deteriorated: her dyspnea increased and she developed edema in her lower extremities. Her pulse is 86/min., the lips are cyanotic, there are systolic and diastolic murmurs over the cardiac apex. The liver protrudes 4 cm from under the costal margin. The woman was diagnosed with III degree heart failure, her left ventricular ejection fraction is less than 40%. What are the tactics of the patient management in this case?
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An unconscious patient was delivered to a hospital by an ambulance. Objectively, his body temperature is 39°C, he presents with convulsions and red dry skin. It is known that the patient works as a stoker in the boiler room. What is the likely diagnosis?
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A 55-year-old woman complaints of pain and popping sounds in her left knee joint, which occur when she climbs the stairs. Occasionally during movements her joint becomes “stuck”, 5 years ago she suffered a trauma of her left knee. Complete blood count and biochemical blood analysis show normal results. X- ray shows marked osteosclerosis and osteophytes. The joint space is narrowed. Make the provisional diagnosis:
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A 45-year-old woman was hospitalized with complaints of periodical severe headaches against the background of elevated blood pressure up to 180/90 mm Hg, muscle weakness, and frequent urination (at night as well). Her anamnesis states that despite combining various antihypertensive drugs and adjusting their dosage her arterial hypertension cannot be corrected with drugs. The patient’s blood serum potassium levels are 2.0 mmol/L, blood serum sodium levels are 160.0 mmol/L. Ultrasound imaging detects three-dimensional formations approximately 1.0 cm in diameter in the both adrenal glands. Selective endovascular blood sampling from the suprarenal veins was performed, which revealed significant increase of cortisol and aldosterone levels. Make the diagnosis:
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In a certain region an increase in cardiovascular morbidity is observed in the population. A family doctor/gencral practitioner plans to take preventive measures against cardiovascular diseases. What measures can be classified as primary ones:
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A 21-year-old man was hospitalized on the 2nd day of the disease. His general condition is severe, body temperature is 39°C. On his skin there are numerous irregular shaped hemorrhagic elements. The diagnosis of meningococcemia was made. The next day his body temperature suddenly decreased, blood pressure was 80/40 mm Hg, pulse was 120/min. Acrocyanosis was detected. What complication did the patient develop?
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A 15-year-old patient presents with delayed physical development and periodically develops icteric skin. Objectively, the spleen is 16x12x10 cm, cholecystolithiasis is observed in the patient, there is a skin ulcer on the left calf in its lower third. In the blood: 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 would be optimal in this case?
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A 68-year-old woman with congestive heart failure and left ventricular ejection fraction of < 40% receives the following pharmacotherapy scheme: ramipril, torasemidc, bisoprolol, clopidogrcl, and digoxin. During one of her regular examinations, frequent polymorphic ventricular extrasystoles were detected in the patient. What medicine should be removed from her therapy scheme?
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A 60-year-old man complains of mild disturbances of memory, coordination, gait. Cerebral atherosclerosis was confirmed. Blood pressure is within the norm. Magnetic resonance imaging shows leukoaraiosis in the periventricular area. What is the most likley diagnosis?
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During the study of pulmonary tuberculosis morbidity, the data on socioeconomic living conditions and harmful habits of the patients were obtained. What method allows the assessment of the extent to which these factors influence the tuberculosis morbidity?
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During a regular examination, an 8-year-old girl with type I diabetes mellitus presents with a swelling on the anterior surface of her hip. The swelling is 3 cm in diameter, dense, painless on palpation. The skin over this formation has normal color and temperature. Localization of the swelling matches the place where the girl usually receives her insulin injections. What is the most likely cause of this clinical presentation?
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A 23-year-old woman came to the gynecological clinic. She complains of pain, itching, and burning in her vulva, general weakness, indisposition, elevated body temperature up to 37.2°C, and headache. On examination in the vulva there are multiple vesicles up to 2-3 mm in diameter with clear contents against the background of hyperemia and mucosal edema. Make the provisional diagnosis:
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A 48-year-old woman developed insomnia, depressive mood, anxiety, fears and suicidal thoughts after the death of her husband that occurred one month ago. During her stay in the hospital she speaks in a low voice, is depressed, anxious, avoids sleeping, refuses to eat. What medications should be prescribed in this case?
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During examination of a patient, the doctor detected in him disorders of the eyes (hemeralopia, Bitot’s spots), skin and skin appendages, mucosa, and gastrointestinal tract. He was provisionally diagnosed with Prasad’s syndrome. What causes the development of this pathology?
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A 43-year-old woman complains of persistent abdominal pain with recurrent pain attacks, nausea, repeated vomiting with stagnant bowel content, abdominal distension, and flatulence. She has been presenting with these signs for 7 hours. Pulse is 116/min. The tongue is dry and brown. The abdomen is symmetrically distended, soft, painful. Percussion reveals tympanitis. On auscultation there are bowel sounds with a metallic overtone, sounds of splashing and dripping. Make the diagnosis:
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A 17-year-old girl has height of 172 cm and weight of 40 kg. Nevertheless, she considers herself to be extremely overweight. For the last 2 years she has been keeping to a strict low-caloric diet, while simultaneously working out to exhaustion and tightly binding her waist with a cord. She often self-induccs vomiting. The girl complains of unpleasant sensations in her esophagus and amenorrhea. What is the most likely diagnosis?
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A 55-year-old man complains of a pain in the sternum, lumbar spine, and ribs. He has a history of bone fracture in his right shin. In the blood: total protein— 100 g/L, M-gradient is positive. In the urine there is Bence Jones protein. Make the diagnosis:
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Survey X-ray of the patient’s abdominal cavity shows severed hemispherical areas of lucency, located above well-defined horizontal levels. What is the cause of such an X-ray presentation?
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A 31-year-old woman complains of pain and swelling in her radiocarpal and metacarpophalangeal joints and morning stiffness for up to 1.5 hours. Two weeks ago she developed pain, swelling, and redness in her knee joints and fever of37.5°C. Examination of her internal organs shows no pathological changes. She was diagnosed with rheumatoid arthritis. What changes will most likely be visible on the X-ray scan of her joints?
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It is the 3rd day after the normal term labor; the infant is rooming-in with the mother and is on breastfeeding. Objectively: the mother’s general condition is satisfactory. Temperature is 36.4°C, heart rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless; lactation is moderate, unrestricted milk flow. The uterus is dense, the uterine fundus is located by 3 fingers width below the navel. Lochia are sanguino-serous, moderate in volume. Assess the dynamics of uterine involution:
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The dispatching department of the Center for Emergency Medical Care and Disaster Medicine received a call from a local citizen, who complained of retrosternal constricting pains irradiating to the left hand. The taking of nitroglycerine brings no relief. Specify the terms within which an emergency medical team should arrive in this case:
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A 10-year-old child, living in a large industrial city, presents with encephalopathy, polyneuritis, disturbed mental development, and reduced learning ability. In the blood: reticulocytosis, basophilic stippling of the erythrocytes. What poisoning can be suspected?
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A pregnant woman at 34 weeks of gestation underwent Doppler metry of umbilical circulation, which revealed a reverse diastolic component. Objectively, the height of the uterus is 27 cm above the pubic bone, the head of the fetus is mobile and located above the entrance to the lesser pelvis. Fetal heartbeat is 136/min. Vaginal examination shows that the uterine cervix is closed, its length is 3cm. What tactics should the obstetrician choose?
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For a week a 42-year-old patient has been suffering from fever attacks which occur every 48 hours. Body temperature raises up to 40°C and decreases in 3-4hours with excessive sweating. The patient presents with loss of appetite and general fatigue. The skin is pale and sallow. The liver and spleen are enlarged and dense on palpation. What method of diagnosis verification would be most efficient?
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A 3-ycar-old child was brought to the hospital by the mother with complaints of leg edema, dyspnea, cough, and abdominal pain. Heart murmurs were detected in the child at the early age, but back then the parents declined further examination. After a case of acute viral respiratory infection one month ago, the mother noticed that the child had become inert and periodically fussy and started developing edema of the shins. The child’s condition is severe. Respirations are 40/min. Foot and shin edema is observed. There are wet crackles in the lower posterior segments of the lungs. The left border of the relative cardiac dullness is located along the left anterior axillary line. Heart sounds are muffled and arrhythmic. The child’s heart rate is 120/min. The liver is +5 cm. Diuresis is decreased. Name the pathogenesis of the edema in this child:
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A 74-year-old woman complains of painful and distended abdomen and nausea. She suffers from postinfarction and atherosclerotic cardiosclerosis and ischemic heart disease. Objectively, she is in a severe condition, her abdomen is distended, the abdominal wall is barely involved in the act of breathing. Laparoscopy detects a small amount of turbid exudate in the abdominal cavity, one of the small intestine loops is dark blue. Make the diagnosis:
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A 46-year-old man, suffering from a constricting pain in the cardiac area, developed circulatory and respiratory arrest. ECG monitor shows a large-wave ventricular fibrillation. What would be done first in this case?
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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 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 in this case?
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A 38-year-old man complains of a spasmodic abdominal pain, frequent liquid stool with mucus and fresh blood admixtures. He has been suffering from this condition for 2 years, during which he has lost 12 kg. Objectively: Ps —92/min., blood pressure — 100/70 mm Hg, body temperature — 374 °C. The abdomen is soft and painful along the large intestine. The sigmoid colon is spastic. In the blood: erythrocytes — 3.2 × 1012/L, Hb — 92 g/L, leukocytes — 10.6 • 109/L, ESR — 32 mm/hour. Irrigoscopy shows narrowing of the large intestine, no haustra, blurred margins, "lead-pipe" sign. What is the most likely diagnosis?
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During agricultural work in the field, a tractor driver received an open trauma of the hand. The tractor driver has never completed the full course of planned antitetanus immunization. What should he be given for urgent specific prevention of tetanus in this case?
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A 23-year-old woman without visible cause developed a conflicting behavior at the workplace. She accused the management of underestimating her, claimed that she can be a deputy director, because she speaks four languages, is very attractive, and can make useful connections for the company. She has been dressing extravagantly, flirting with her colleges, and singing loudly in her office. In fact, she has only the training of a computer operator and speaks no foreign languages. What is the likely clinical diagnosis?
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A 60-year-old man complains of dyspnea, paresthesia, vertigo, and fatigability. He has a history of atrophic gastritis. Objectively, his skin and mucosa are pale and icteric. Lingual papillae are smoothed out. The liver and pancreas are not enlarged. Complete blood count shows the following: Hb — 77 g/L, erythrocytes — 1,65 •109/L, color index — 1.4, reticulocytes — 0.2%, leucocytes— 2.8 • 109/L; ESR — 22 mm/hour, macrocyte. What additional test can reveal the cause of anemia?
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On ultrasound of the thyroid gland, a 47-year-old woman presents with ahypoechoic node 1.6 cm in diameter with blurred margins and intranodular hypervascularization. The doctor suspects thyroid carcinoma. What method should be used to verify the diagnosis?
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A 14-year-old girl came to a general practitioner with complaints of weakness, loss of appetite, headache, rapid fatigability. Her last menstruation was profuse and lasted for 14 days after the previous delay of 2 months. Objectively, her skin is pale, heart rate is 90/min., BP is 110/70 mm Hg, Hb is 88 g/L. Rectal examination: the uterus and its appendages are without changes, no discharge from the genital tracts. What complication occurred in the patient?
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A 22-year-old woman with primary infertility complains of irregular menstruations and of colostrum being produced from her mammary glands. Ultrasound of the lesser pelvis shows hypoplastic uterus and ovaries without pecularities. MRI of the sella turcica detects no abnormalities. The patient’s prolactin is 3 times higher the normal level. The follicle-stimulating and luteinizing hormones are below the normal levels. The levels of cortisol and testosterone are within the normal range. What medicines should be chosen for the treatment of this pathology?
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A 45-year-old man developed constricting retrosternal pain that occursduring walks at the distance of 200 m. Objectively heart rate is 80/min., BP is 160/90 mm Hg. During cardiopulmonary exercise test at 50 W there is a depression of S-T segment by 3 mm below the isoline in V3-V4. What is the provisional diagnosis?
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A 58-year-old woman has type 2 diabetes mellitus that is compensated with diet and metformin. She prepares for cholecystectomy. Objectively, her height is 164 cm, weight is 90 kg, heart rate is 72/min., blood pressure is 130/80 mm Hg. Her abdomen is soft, painful in the right subcostal region. The liver is not enlarged. Fasting glucose — 6.2 mmol/L. Glycated hemoglobin — 6.5%. What further tactics of sugar-lowering therapy should be chosen in this case?
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A patient with complaints of disturbed gait and forced laughter was hospitalized into the neurological department. Objectively, he has a mask-like face and muscle hypersthenia. For a long time, he has been working at the various industrial objects, where, in violation of the hygienic norms, the high levels of exposure to the chemicals were registered. What harmful factor is the likely cause of this pathology?
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A patient has gradually lost his consciousness. The skin is pale and dry. There is smell of ammonia from the mouth. Respirations are deep and noisy. Heart sounds are muffled, pericardial friction rub is present. Blood pressure is 180/130mm Hg. Blood test: Hb — 80 g/L, leukocytes — 12 • 109/L, blood glucose — 6.4mmol/L, urea — 50 mmol/L, creatinine — 1200 mcmol/L, blood osmolarity —350 mOsmol/kg H20. No urinary excretion. Make the diagnosis:
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