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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 19-year-old young man complains of cough with expectoration of purulent sputum in amount of 100 mL per day, hemoptysis, dyspnea, increased body temperature up to 37.8°C, general weakness, weight loss. The patient’s condition lasts for 4 years. Exacerbations occur 2-3 times a year. The patient presents with malnutrition, pale skin, cyanosis of the lips, drumstick (clubbed) fingers. Tympanic percussion sound in the lungs, weakened respiration, and various numerous moist crackles in the lower pulmonary segments on the left can be observed in this patient. Complete blood count: erythrocytes — 3.2 • 1012/L, leukocytes — 8.4 • 109/L, ESR — 56 mm/hour. On X-ray: lung fields are emphysematous, the left pulmonary root is deformed and dilated. What is the most likely diagnosis?
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Examination detected vesicles with seropurulent content on the neck, back of the head, and buttocks of an infant on the 4th day of life. The patient’s conditionis satisfactory, the child is active, all newborn reflexes can be fully induced, the umbilical cord is at the stage of mummification, the umbilical area is without any peculiarities. What disease can be suspected?
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A 48-year-old woman was delivered in to the surgical unit with wounds in her thigh. On examination the wound surface has a dirty-gray coating with unpleasant sweet smell. The wound content resembles a raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What bacteria is the most likely to cause such inflammation?
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A patient 1 year ago had a Q wave myocardial infarction of the posterior wall of the left ventricle. For the last 2 weeks he has been suffering from daily attacks of atrial fibrillation and bradycardia episodes, accompanied by bouts of vertigo. What tactics is the most advisable in this case?
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A 34-year-old man undergoes treatment in a psychiatry unit for exacerbation of his schizophrenia. Objectively, he stays in bed, his movements are inhibited, no contact. The patient does not respond to the questions. The position remains unchanged, the patient is hypomimic, such signs as puckering of the lips, waxy flexibility, “psychological pillow” are present. The patient has been remaining in this condition for a week. He is being fed parenterally. What psychomotor disorder is it?
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A 30-year-old woman complains of subfebrile body temperature that persists for the last 3 weeks, loss of appetite and working ability, excessive sweating especially at night, malaise. Objectively, her pulmonary percussion indicates no changes in the lungs, auscultation detects crackles in the projection of the upper lobe of the right lung. X-ray shows a dense focus of moderate intensity, 6 mm in diameter, in segment S2. Make the provisional diagnosis:
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What should be prescribed as secondary revention drugs for a patient with atrial firillation after an ischemic stroke caused by cardiac embolism?
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The overall condition of a 24-year-old man, who was being treated for meningococcemia, took a turn for the worse. Objectively, he has acrocyanosis, anuria, his limbs arc cold, his respiration is 30/min., heart rate is140/min., blood pressure is 40/0 mm Hg. What emergency medical condition did the patient develop?
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A 25-year-old woman has been suffering from diabetes mellitus since she was 9 years of old. She was admitted into the nephrology unit with significant edemas of the face, upper and lower extremities. Blood pressure — 200/110 mmHg. In the laboratory analysis of the blood: Hb — 90 g/L, blood creatinine — 850mcmol/L, urine proteins — 1.0 g/L, leukocytes — 10-15 in the vision field. Glomerular filtration rate — 10 mL/min. What tactics should the doctor choose?
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A 66-year-old man complains of marked weakness. The onset of the disease was acute: he developed fever and pain in the joints and along the muscles of his legs. Objectively, he has a violet-cyanotic erythema around his eyes and over the knee joints. His heart rate is 120/min., heart sounds are weakened. Blood test: leukocytes — 12 • 109/L, ESR — 40 mm/hour. Make the diagnosis.
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During the analysis of morbidity in the city, it was determined that the age structure of population is different in each district. What statistical method allows to exclude this factor, so that it would not skew the morbidity data?
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A multigravida, labor II, 36-37 weeks of gestation, has gone into labor. Her waters broke 8 hours ago, the labor activity continues for the last 4 hours, it is regular, with contractions that last 35 seconds and occur every 3-4 minutes. The child is in the cephalic presentation, with the head pressed to the entrance into the lesser pelvis. The parturient woman complains of a sudden sharp abdominal pain. Her pulse is 100/min., blood pressure is 110/70 — 100/70 mm Hg. The uterus is tense and does not relax between the contractions. Fetal heartbeat is muffled —100/min. The amniotic fluid is blood-colored and continues to leak. What is the most likely diagnosis?
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A 7-year-old boy has been receiving treatment for a month. At the time of hospitalization, he had marked edemas, and daily urine protein of 4.2 g. Biochemical blood test shows persistent hypoproteinemia (43.2 g/L) and hypercholesterolemia (9.2 mmol/L). What leading glomerulonephritis syndrome is most likely in this patient?
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The people living in a radiation-contaminated area are recommended to include pectin in their diet for removal of radionuclides from the body. What products are the main source of pectin?
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A 73-year-old woman came to the family physician for one of her regular followup examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to ner diet and exercise plan and taking phyton preparations. On examination her fasting glucose was within the range of78-8.6 mmol/L, HbAlc — 79%. Height — 164 cm, weight — 83 kg. What blood glucose-controlling medicine should she be prescribed first in the course of her pharmacological therapy?
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A multigravida on the 38th week of her pregnancy complains of increased BP up to 140/90 mm Hg, edema of the shins for 2 weeks. In the last month she gained 3.5 kg of weight. Urine analysis: protein — 0.33 g/L. What is the most likely diagnosis:
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A 25-year-old man suffers from a disease that manifests with fever and vesicular rash that appears mostly on the trunk and scalp. On the 10th day after the onset of the disease, he developed an intense headache, vomiting, ataxia, sluggishness, discoordination of movements, limb tremor. He was diagnosed with encephalitis. This condition is the complication of the following disease:
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A 55-year-old woman complains of a tumor-like formation that can be palpated in the kidney area on the left, moderate dull in her left side, periodical discharge of right-red blood during urination. Objectively, the patient has lost weight, her skin is pale and dry. Palpation of the abdomen detects an clastic formation in the left renal region. The formation is mobile and painless. Urinalysis detects macrohematuria and atypical cells. Blood Hb is 82 g/L, ESR is 70mm/hour. What is the most likely pathology, causing this clinical presentation?
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A district doctor has been 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 should be included in this plan?
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A 38-year-old woman complains of weakness, sleepiness, pain in the joints, weight gain despite low appetite, and constipations. She presents with dry and thickened skin, puffy and amimic face, narrowed palpebral fissures, thick tongue, and deep hoarse voice. Her heart sounds are weak, pulse is 56/min. Low levels of free T4 are observed. This patient needs to take the following on a regular basis:
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After playing with "mosaics", a 2-year-old child suddenly developed cough, stridorous respirations, urges to vomit, and cyanosis against the background of relative somatic health. What should the doctor suspect first when examining this child?
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An ambulance was called to a 45-year-old man. According to his family, the onset of the disease was sudden, after he returned from a ski resort. His body temperature increased up to 38.7 °C, he developed headache and vomiting. Objectively, his skin is pale with a cyanotic tint, there is a thick hemorrhagic rash all over the body, sometimes with necrosis in the center. Blood pressure is 45/0 mm Hg, pulse is 126/min., low volume. The patient has marked nuchal rigidity and positive Kernig’s sign. Make the provisional diagnosis:
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A woman came to the gynecologist to plan her pregnancy. She was advised to increase her intake of the products rich in folic acid, particularly soy beans, bread made of coarsely ground flour, fruits, leafy green vegetables. Such changes in her diet will work toward the prevention of:
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A 55-year-old woman complains of thyroid gland enlargement that can be observed throughout the last 2 years and a discomfort during swallowing. Objectively, she has signs of hypothyroidism. The thyroid gland on palpation is dense, non-fused with the surrounding tissues and mobile on swallowing. The regional lymph nodes are not enlarged. In the serum there are antithyroid antibodies detected. What is the most likely diagnosis?
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A 16-year-old patient has made an appointment with an otolaryngologist. He complains of fever and sore throat. The disease onset was 2 days ago, after the patient ate two portions of ice-cream. Pharyngoscopy shows hyperemic mucosa of the palatine tonsils, with purulent exudate in the lacunae. Make the provisional diagnosis:
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A 62-year-old woman was brought into the admission room with complaints of severe burning retrosternal pain and asphyxia. She has a 10-year-long history of essential hypertension. Objectively her condition is moderately severe. She presents with skin pallor, cyanotic lips, and vesicular respiration over her lungs. The II heart sound is accentuated over the aorta. Blood pressure — 210/120 mmHg, heart rate (pulse) — 76/min. ECG shows elevation of ST segment in the leads I, aVL, and V5-V6. What is the most likely diagnosis?
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On the 5th day after giving birth a postparturient woman complains of a pain in her left mammary gland and body temperature up to 38.
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A family doctor performed an external obstetrical examination of a pregnant woman and determined that her uterine fundus is located at the level of the navel. What is the most likely term of pregnancy in this woman?
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A 3-year-old child presents with sharp deterioration of his general condition. He has a history of purulent otitis. His temperature is now 38.5°C'. The left leg is pressed to the torso, active movements are absent, the lower third of the thigh and knee joint are thickened, hyperemic, with localized fever. Axial load leads to acute discomfort of the patient. What is the most likely diagnosis?
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A 19-year-old student was urgently hospitalized due to a marked dyspnea and chest pain on the left. Her body temperature is 38.8°C. She has been presenting with these signs for 3 days. Respiratory rate is 42/min., shallow. Percussion sound is dull to the left from the center of the scapula, no respiration can be auscultated. The left heart border is displaced outwards by 3 cm. Embryocardia and heart rate of 110/min are observed. Palpation of the right subcostal area is painful. What urgent measures should be taken in this case?
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For intensive infusion therapy, a patient with acute respiratory failure underwent subclavian vein catheterization using the Seldinger technique. After administration of 600 mL of the infusion solution, the patient's condition sharply deteriorated, tachypnea increased from 26 / min. to 40 / min., tidal volume decreased from 400 ml. to 250 ml. Auscultation detects sharply weakened respiration on the right. Percussion detects a dull sound. What complication developed in this patient?
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A 27-year-old patient developed a fever of 38.7°C, lumbar pain, weakness, and headache after an overexposure to cold. Examination detects a positive Pasternacki. What is the provisional diagnosis in this case?
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Examination of a newborn girl detects a hemorrhage on the child's head. The hemorrhage is limited to one cranial bone, does not pulsate, and is painless. What condition did the child develop
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A 14-year-old girl developed morning fever, cheilitis, stomatitis, photosensitivity, leukocytosis of 24 x 10%/L, and thrombocytopenia. Laboratory studies detect antinuclear antibodies in a high titer. Make the provisional diagnosis.
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Potatoes that became green or started sprouting, as a result of incorrect storage, taste slightly bitter. What toxic substance contained in such potatoes can cause food poisoning?
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A 27-year-old woman, gravida 1, para 1, was hospitalized into the maternity ward. She had a 3-year-long history of primary infertility Contractions started 9 hours ago, occur every 4-5 minutes, and last 20-25 seconds The waters broke 2.5 hours ago. The fetal heartbeat is 136 / min. The small segment of the fetal head lies in the plane of the inlet into the lesser pelvis. The cervix is smoothed out, its opening is 4 cm. The amniotic sac is absent. What complication occurred during the childbirth?
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Preventive examination of the population of one of the Ukrainian cities detected spotted tooth enamel and generalized osteosclerosis with calcification of the intervertebral ligaments in 25% of the residents. What is the most likely cause of these symptoms?
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A 64-year-old patient with a tumor of the sigmoid colon and chronic thrombophlebitis of the deep veins of the right leg is scheduled for a surgery. What is the optimal medicine for prevention of deep vein thrombosis in this patient
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A 19-year-old patient complains of a dry cough, muscle pain, and a fever of 39°C. A sore throat and subfebrile body temperature were observed for the last week. Objectively, the respiration is harsh. Complete blood count shows the following: leukocytes 10.0 10 % / L, leukocyte left shift, ESR-26 mm / hour. Chest X-ray shows an intensified pulmonary pattern, low-intensity focal shadows in the lower segments of the right lung. What medicines should be prescribed in this case?
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A 30-year-old woman came to a doctor with complaints of milk discharge from her breasts and no menstruation for the last 5 months. She had one physiological childbirth four years ago. The development of her breasts is normal. Bimanual examination detects a reduced in size uterus and normal size of the ovaries. MRI detects no cerebral pathology. Thyrotropin levels are within the normal range, prolactin levels in blood serum are elevated. What is the most likely diagnosis in this case?
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