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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 15-year-old boy complains of periodical headaches and fatigability. On examination, the boy is active, his psychoemotional development corresponds with his age, his skin is pale and clammy. No abnormalities of the internal organs were detected. Blood pressure is 120/80 mm Hg. Noticeable is the excessive subcutaneous fat that is evenly distributed throughout the body. The doctor suspects obesity in the child. What parameter should be measured first to confirm his diagnosis?
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On the 3rd day after the artificial abortion the woman was hospitalized into the gynecological department in a severe condition with signs of intoxication, abdominal pain, and purulent discharge from the vagina. Objectively, the patient’s condition is severe, her body temperature is 38.8°C, pulse is 100/min., blood pressure is 110/70 mm Hg, the uterus is soft, the uterine fundus is located at the level of the navel, there are positive signs of peritoneal irritation. What is the most likely diagnosis?
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A 22-year-old post parturient woman on the 12th day after the normal childbirth informs of fever up to 39°C for the last 3 days and pain in her right mammary gland. The right mammary gland is enlarged, hot to touch, tense, hyperemic, and painful. Palpation reveals there is a dense infiltration 8x8 cm with a fluctuation in its center. What is the most likely diagnosis?
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Amortization costs for CT scan are included into its price and annually amount to 10% of its original cost. When can the CT scan be replaced?
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A 12-year-old girl after a case of respiratory infection developed dyspnea at rest, paleness of skin. Heart rate is 110/min., BP is 90/55 mm Hg. Heart sounds are muffled. Borders of relative heart dullness: right — the parasternal line, upper —the III rib, left — 1,0 cm outwards from the midclavicular line. Make the provisional diagnosis:
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A 10-year-old boy came to the polyclinic with complaints of stuffy nose. It is known that these signs occur in the child periodically (in spring and autumn). He has a history of atopic dermatitis. The father of the child has bronchial asthma. Objectively, the boy’s face is pale and slightly swollen. Respirations are 22/min. Auscultation detects vesicular respiration over the lungs. Rhinoscopy shows swollen and pale nasal mucosa. What disease can be suspected?
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A 34-year-old woman after rapidly changing her position from horizontal to vertical suddenly paled, fell down, her skin became moist, her limbs are cold, her pupils are dilated. The pulse is rapid and blood pressure is 50/25 mm Hg. What condition has likely developed in the patient?
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The patient’s respirations are 28/min., tachycardia is up to 100/min., there are signs of intoxication. In the area of the right scapula the percussion sound is dull, the respiration is bronchial, with single fine vesicular crackles and crepitation sounds. X-ray shows a massive inflammatory infiltration in the middle pulmonary field. Three days later, against the background of treatment, the patient developed a cough attack, during which he expectorated 200 mL of purulent sputum. After that his body temperature dropped to subfebrile values and his overall condition improved. At the level of the scapular angle, against the background of the pulmonary infiltration, there is a round area of radiolucency with the horizontal level of liquid. Make the diagnosis:
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A child is 8 months old. One week ago, the child had a case of acute viral respiratory infection. The child’s physical and mental development corresponds with the age. There are complaints of inertness, loss of appetite, unmotivated recurrent vomiting, temperature up to 38°C within the last 24 hours, pallor, frequent urination with low urine output, tachycardia. Urinalysis: protein —0.099g/L, leukocytes — 15-20 in the vision field, bactcriuria: +++, mucus: +++. What disease can be suspected?
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In the demographic structure of a region, the persons aged from 0 to 14make up 31% of the population, while the 50+ age group makes up 20% of the population. What population structure characterizes this demographic situationmost accurately?
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A 16-year-old teenager complains of weakness, dizziness, and heaviness in the left subcostal region. Objectively, 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. In the complete blood count: 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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During examination a 4-month-old child with meningococcemia presents with acrocyanosis, cold extremities, tachypnea, and thready pulse, blood pressure of 30/0 mm Hg, anuria, and sopor. What clinical syndrome is it?
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A 58-year-old man complains of weakness, edema of the face, legs, and lumbar region, dyspnea, and wet cough. For many years he has been suffering from chronic obstructive pulmonary disease. Within the last 5 years he has been noting increased production of sputum that often is purulent. Objectively, his heart rate is80/min., blood pressure is 120/80 mm Hg. He has pale and dry skin with poor turgor and diffuse edema. Daily proteinuria is 6.6 g/L. In the blood:hypoalbumincmia, increased levels of «2-and 7-globulins, ESR is 50 mm/hour. Blood creatinine is 188 mcmol/L. Which is the correct diagnosis?
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A 26-year-old man has an external bleeding from a lacerated wound of the shin. Dark-red blood flows from the wound in a steady stream. The total blood loss is approximately 400 mL. What method should be used to stop the blood loss during the preadmission stage?
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Throughout the last year a 27-year-old man notes fatigue, excessive sweating, and heaviness in his left subcostal region, especially after eating. Objectively, his spleen and liver are enlarged. In clinical blood test: erythrocytes —3.2 * 1012/L, Hb — 100 g/L, color index — 0.87, leukocytes — 100 * 109/L, basophils — 7%, eosinophils — 5%, monocytes — 15%, juvenile — 16%, bandneutrophils — 10%, segmented neutrophils — 45%, lymphocytes — 2%,monocytes — 0%, reticulocytes — 0.3%, platelets — 400 * 109/L, ESR — 25 mm/hour. Make the diagnosis:
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A 19-year-old young man was diving and hit his head on the bottom of the pool. He complains of pain in the neck, his head movements are limited and painful. During examination his head is bowed forward and to the right and the patient supports it with his hands. Palpation detects tense neck muscles and protruding spinous process of the IV cervical vertebra (C4). When pressure is applied to this process and to the head (axial load), the pain intensifies. Make the provisional diagnosis:
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A 29-year-old woman complains of no menstruations within a year. She has a history of two abortions. Objectively, her secondary sexual characters are developed normally, she has adult woman pattern of hair distribution, galactorrhea from the mammary glands is observed. Her prolactin levels are high. What additional examination is necessary for diagnosis verification?
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The region at the Carpathian foothills is characterized by constant high atmospheric humidity (over 80%). In the cold season, while the air temperature is moderately low, the population of this region feels extreme cold. What type of heat transfer increases in such conditions?
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A 15-year-old boy complains of pain attacks in his abdomen during defecation, diarrhea up to 6 times in 24 hours with pus and dark blood in the feces. Objectively, his physical and sexual development is delayed. The skin is pale and dry. The abdomen is distended and painful in the umbilical region and in the right iliac region. Crohn’s disease is suspected. What examination is necessary to confirm the diagnosis?
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The patient complains of an inflammatory infiltration in the middle third of the left forearm. It is the first occurrence of this condition in the patient. In the middle third of the left forearm there is an inflammatory infiltration up to 3 cm in diameter that protrudes in a cone-like shape above the surface of the skin. The skin over the infiltration is hyperemic, edematous, its palpation is sharply painful. On the infiltration apex there is a small accumulation of pus with a black dot in the center. Body temperature is 37.6°C. What disease is described?
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For 2 weeks a 37-year-old HIV-positive man has been presenting with progressing dyspnea and body temperature up to 37.7 °C. He was diagnosed with pneumocystic pneumonia. What etiotropic drug is indicated in this case?
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A 19-year-old girl complains of moderate itching and hair loss on her head. Objectively, on the skin of her occipital region there is a single round erythematous focus 3 cm in diameter with clear margins. Asbestos-like scales can be observed on the surface of the lesion. The hair in the focus of the lesion is broken off at the length of 6-8 mm. What is the most likely diagnosis?
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An employee has been sick for 4 months, further treatment is necessary, the patient is unable to work. Who is authorized to provide further disability examination of this patient?
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A 28-year-old pregnant woman was hospitalized into the inpatient department. Her diagnosis is as follows: pregnancy III, 7-8 weeks of gestation; rheumatism, inactive phase, III degree mitral stenosis. What is the management plan for this patient?
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A 37-year-old woman complains of marked general weakness, edema of the face and hands, rapid fatigability when walking, difficult swallowing, disturbances of the cardiac performance. These signs appeared 11 days after a vacation at the sea side. Objectively, the patient has face erythema, "glasses" sign, edema of the lower leg muscles. Heart sounds are muffled, blood pressure is 100/70 mm Hg. In the blood: ASAT -95U, ALAT -130U, increased activity of aldolase and creatine phosphokinase. What examination will be the most informative in this case?
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A 22-day-old infant developed subcutaneous red nodes from 1.0 to 1.5 cm in size on the scalp; later the nodes suppurated. Temperature increased up to 37.7°C, intoxication symptoms appeared, regional lymph nodes enlarged. Complete blood count: anemia, leukocytosis, ncutrocytosis, raised ESR. What diagnosis will you make?
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A 31-year-old woman has been suffering from systemic scleroderma for 14 years. She underwent multiple inpatient treatment courses. She complains 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 which of the following organs is affected?
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A patient with chronic pancreatitis complains of diarrhea occurring up to 5 times per day (no blood traces), loss of body weight, abdominal distension, drynessof skin, loss of hair, thirst, bleeding gums, convulsions. Complete blood count: leukocytes — 5.8 ■ 109/L; Hb — 86 g/L; ESR — 15 mm/g; Blood protein test: protein — 48 g/L; albumins — 28 g/L. What indicators of coprological analysis would accompany this syndrome?
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A man works in casting of non-ferrous metals and alloys for 12 years. In the air of working area there was registered high content of heavy metals, carbonmonoxide, and nitrogen. During periodic health examination the patient presents with as the no vegetative syndrome, sharp abdominal pains, constipations, pain in the hepatic area. In the laboratory analysis of urine: aminolevulinic acid and coproporphyrin are detected. In the laboratory analysis of blood: reticulocytosis, low hemoglobin level. Such intoxication is caused by:
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A 7-year-old boy suddenly developed pain and edema in his right knee. The day before, at school, he took part in crosscountry skiing. There is no family history of hemophilia or susceptibility to bleeding. Objectively, his body temperature is 37.5°C. The knee is painful on palpation, hot to the touch, and has edema with local tissue tension above it. Incomplete blood count: Hb — 123 g/L, leukocytes — 5.6 • 109/L, platelets — 354 •109/L, prothrombin time — 12 seconds (normal range is 10-15 seconds), activated partial thromboplastin time —72 seconds (normal range is 35^15 seconds). Bleeding time is normal, the factor VIII levels constitute 5% of normal value. Make the diagnosis:
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A 17-year-old girl has been suffering from hepatic cirrhosis for 3 years. Lately her periods of excitation have been intermittent with depression, she does not sleep enough. Objectively, her condition is severe, the girl is sluggish, gives one-word responses, has tremor in her extremities, her skin is icteric, with single hemorrhagic rashes. Name the likely complication of her disease:
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A 30-year-old woman complains of itching skin, predominantly in the evening and at night. The condition lasts for 2 weeks already. On the skin of the interdigital folds, mammary glands, abdomen, buttocks, and thighs there are numerous fine papular and papulovesicular rashes located in pairs, excoriations. There is no rash on the face and neck. Similar rash is observed in the husband of the patient. What is the most likely diagnosis?
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Before her discharge from a hospital, a full-term newborn girl on the 3rd day of her life developed a recurrent vomiting with blood and stool resembling "raspberry jelly". It is known that her mother refused to let her child receive any intramuscular injections. What laboratory test will be the most informative for confirmation of the diagnosis?
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A pregnant woman at 32 weeks of gestation with the risk of preterm labor undergoes a treatment to prevent fetal respiratory distress syndrome. What medicine was she prescribed?
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A 3-year-old child has been brought to a hospital with complaints of pain in the legs, fever, and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb — 88 g/L, color index — 1.3, platelets — 80 • 109/L, leukocytes — 25.8 •109/L, lymphoblasts — 70%, ESR — 52 mm/hour. Make the provisional diagnosis:
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Disease onset was acute. A child developed general weakness, pain in the joints, and fever. Later these signs became accompanied by itching skin rash manifested as erythematous spots 2-5 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen; pain attacks periodically occur in the paraumbilical area; there are signs of intestinal hemorrhage. What is the most likely diagnosis?
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A 17-year-old girl complains of a pain in her knee and ankle joints and body temperature up to 39°C. 2 weeks ago, she had a case of acute tonsillitis. Objectively, her joints are swollen, sharply painful, and their mobility is reduced. On the skin of her trunk and limbs there are barely visible circle-shaped pale pink spots. Heart rate is 95/min., blood pressure is 90/60 mm Hg, heart sounds are weakened, there is a soft systolic noise over the apex. Make the provisional diagnosis:
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A 60-year-old woman complains of pain in the interphalangeal joints of her hands that exacerbates during work. Objectively, 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 shows narrowed joint spaces, marginal osteophytes, and subchondral sclerosis. Make the diagnosis:
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A 5-day-old girl from the first pregnancy was born with the weight of 3100g and the length of 51 cm. Her Apgar score was 8/9. On the 3rd day she developed icteric skin. On the 4th day of life her condition is satisfactory, she suckles well,her voice is loud. The umbilical wound is clean. In the lungs there is a puerile respiration, heart sounds are sonorous. The abdomen is soft, the liver is +1 cm, the spleen is The feces are yellow. The blood group of the mother is A (II) Rh+. The blood group of the child is 0 (I) Rh+. Bilirubin levels on the 4th day are as follows: indirect — 140 mc mol/L, direct — 0, ALT — 25 mmol/L, AST — 18 mmol/L. Make the diagnosis:
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The left hand of a newborn is extended in all its joints, stretched along the torso, and pronated in the forearm. Active movements of the shoulder joint are retained. The hand is flattened, atrophied, cold to touch, hangs passively. Grasping and palmomental reflexes are absent at the affected side. Hemogram indicators are normal. Make the most likely diagnosis:
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