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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 64-year-old man is undergoing outpatient treatment for ischemic heart disease, diffuse cardiosclerosis, persistent atrial fibrillation, and functional class III heart failure. The pharmacotherapy consists of cordarone (amiodarone) twice a day, torasemide every other day, and trimetazidine twice a day. The family physician recommended taking warfarin (3 mg per day) to prevent thrombus formation. What parameter should be measured in this case for optimal control the effectiveness and safety of the anti-coagulant therapy?
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Screening detected phenylketonuria in a two-week-old baby. What treatment must be prescribed for this child to prevent severe complications in the future
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A 25-year-old woman complains of pain in her right iliac region that lasts for 10-12 days already and a menstruation delay of 7-8 weeks. Palpation detects pain in the right iliac region. Gynecological examination detects pain in the right vaginal fornix, but no enlargement of the uterus or ovaries. A right sided ectopic pregnancy is suspected. What examination method would be optimal in this case?
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A worker at a workshop that produces car batteries came to a doctor with complaints of nausea, loss of appetite, sharp pain in the abdominal cavity, and constipations. Examination reveals elevated blood pressure, bradycardia, an enlarged liver, pain in the right subcostal region, a grayish blue stripe on the gums, and gray skin. Complete blood count indicates the presence of erythrocytes with basophilic stippling and reduced hemoglobin levels. Aminolevulinic acid and coproporphyrin can be detected in the patient's urine. What is the most likely provisional diagnosis in this case?
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A 16-year-old boy developed dizziness. Objectively, his heart rate is 35 / min., his blood pressure is 85/45 mm Hg, the heart borders are not enlarged, the heart sounds are loud and clear. ECG shows P waves disconnected from QRS complexes, dissociation, and different rhythm of atria and ventricles are accompanied by varying location of P wave in relation to QRS complex. This presentation is most characteristic of the following disease:
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For the last 3 months, a 68-year-old woman has been suffering from pain attacks in the heart that last for 10 minutes. The pain attacks occur in response to the slightest physical exertion. She does not take nitroglycerin because of severe headache. She was repeatedly treated for ischemic heart disease and had a myocardial infarction. Her blood pressure periodically rises to 160/80 mm Hg. ECG shows cicatricial changes in the posterior wall of the left ventricle. Auscultation reveals a systolic murmur over the aorta. What is the most likely diagnosis in this case?
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Essential hypertension, as an important non-communicable disease, is the most common type of arterial hypertension, in which there is a persistent increase in blood pressure up to 140/90 mm Hg and which is influenced by exogenous and endogenous risk factors. What factors are endogenous
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A 62-year-old man complains of constant pain in the epigastrium and weight loss of 12 kg. Physical and instrumental examinations (fibrogastroscopy with biopsy, abdominal ultrasound, and chest X-ray) detected cancer of the body of the stomach without signs of distant metastasis. Histology reveals moderately differentiated adenocarcinoma. What scope of surgical intervention is advised in this case?
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A 42-year-old man complains of weakness, palpitations, nosebleeds, and skin hemorrhages. His condition progressively deteriorates throughout the last month. Objectively, his condition is severe, he has petechial and spotted hemorrhages on the skin of his limbs and torso, lymph nodes and spleen are not palpable, the pulse is 116 / min., the liver is +2 cm. Complete blood count revels pancytopenia. What disease can be primarily suspected in this case?
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A man complains of red and sore skin on his right calf. Objectively, his body temperature is 38.5°C; his inguinal lymph nodes on the right are enlarged and painful; the skin is red, with clear boundaries between the redness and healthy skin; edema is observed; there are vesicles filled with a dark liquid; palpation is painful. What is the provisional diagnosis in this case?
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A 72-year-old patient came to a doctor with complaints of hand tremors, stiffness, slowness of walking and speech, and difficulties in performing routine household chores. Physical examination detects general bradykinesia, hypomimia, emprosthotonus," shuffling" gait, hand tremors at rest, D > S, plastic type of increased muscle tone, the" cogwheel rigidity" phenomenon, and marked postural instability. What medicines must be a primary part of the treatment regimen for this patient?
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A 32-year-old man came to a doctor with complaints of painless rashes that appeared on his knees 4 months ago and now start to appear on his elbows too. The rashes itch and bleed when scratched. The patient notes that on his elbows rash appeared after he had been scratched by a house cat. Physical examination detects dense erythematous plaques 2 to 3 cm in diameter on the knees and elbows. The plaques have a clear contour and are covered in silvery scales. What is the most likely diagnosis in this case?
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Examination of a victim of a traffic accident detects cyanosis and problems with breathing. The patient is in a severe condition, the right half of the chest lags behind in the act of breathing, the intercostal spaces are widened on the right, a bandbox resonance is observed during percussion, breathing cannot be heard during auscultation. What is the most likely diagnosis in this case?
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A 30-year-old woman complains of menstruations missing for a year. She has history of a massive postpartum hemorrhage. Objectively, her secondary sex organs are normally developed, the hair growth pattern is of the female type. Bimanual examination detects normal uterus and uterine appendages. What is a possible cause of amenorrhea in this case?
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In a 70-year-old woman, chest fluorography shows a shadow of a heterogeneous structure over the left dome of the diaphragm. X-ray with contrast detects the abdominal segment of the esophagus in the chest cavity. What is the most likely diagnosis is in this case
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A 54-year-old woman came to her family physician for a preventive checkup. Objectively, the following is observed: height 164 cm, weight-84 kg, blood pressure-130/80 mm Hg. The patient's history indicates the menopause for 5 years. The patient's mother died of breast cancer, the patient's younger sister suffers from mastopathy. Examination detects no lumps in the patient's breasts, the organs of her lesser pelvis are within the age norm. Her cervical cytology results are normal. What advice can be given to this woman
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A 48-year-old patient complains of frequent constricting retrosternal pain that radiates into the left shoulder and left scapula. Pain attacks occur at night, at complete rest, and last 10-15 minutes. During the visit to a polyclinic, no ECG abnormalities and no changes in the patient's general condition were detected. What examination would be most important for clarification of the diagnosis?
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A 20-year-old woman has been developing rhinitis and conjunctivitis in August September for the last 8 years. The last year during this period, attacks of bronchial asthma started occurring as well. Skin testing detects hypersensitivity to Ambrosia pollen, The antibodies that cause the exacerbation of this condition belong to the following class of immunoglobulins:
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A 19-year-old pregnant woman was hospitalized into the department of pregnancy pathology. Her term of gestation is 36 weeks, the fetus is large, with breech presentation. The woman has a severe form of diabetes mellitus. Cardiotocography detects fetal bradycardia of 90 / min. No labor activity can be detected. What are the tactics of pregnancy management in this case?
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A 49-year-old man complains of angina up pectoris attacks that occur when he walks up to 500 m. He has a many-year-long history of chronic bronchitis. Examination detects a small number of dry diffuse crackles in the lungs, the respiratory rate is 18/min The borders of the heart are expanded to the left, the heart sounds are muffled, the heart rate PS=86/min., the blood pressure is 160/100 mm Hg. Complete blood count shows the following: Hb –160g/L, leukocytes – 6.4*109/L, ESR–7mm/hour. ECG shows hypertrophy of the left ventricle. What group of drugs is contraindicated in this case, taking into account the concomitant pathology?
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A 40-year-old man complains of a rash all over his body and slight itching. He has been ill for 3 months and associates his rash with a neuropsychiatric trauma. Objectively, he has multiple pink papules covered with silvery scales on the skin of his torso, scalp, and extensor surfaces of the limbs. What will be the provisional diagnosis in this case?
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A 40-year-old man complains of impaired vision, rapid heartbeat, and an aching pain in the muscles of his back, lumbar region, and legs and in his shoulder and hip joints. Objectively, the signs of uveitis can be observed. X-ray detects blurring of the contours of the sacroiliac joints and single syndesmophytes between the vertebral bodies. Laboratory testing detects antibodies against HLA-B27 antigens, anemia, and ESR of 28 mm/hour. What disease causes such a clinical presentation?
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A full-term girl with chronic fetoplacental insufficiency was born from the second pregnancy that risked termination at 25-27 weeks. During the childbirth, the umbilical cord was revealed to be wrapped once around the neck of the baby, the extraction. of the shoulders was difficult. After the birth, the Apgar scale was used to evaluate the baby's condition at the first minute of life: no breathing, the heart rate of 50 /min., total cyanosis, atony, areflexia. What would be the Apgar score in this case?
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After the extraction of the second molar, the patient's body temperature increased. He developed pharyngeal pain on the left, infiltration, hyperemia of the lower part of the anterior palatine arch, and displacement of a tonsil towards the midline and upwards. Regional lymph nodes are painful to palpation. The otolaryngologist diagnosed the patient with paratonsillar abscess. What is the route of infection spread in this case?
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A 38-year-old woman made an appointment with a doctor. During her visit she talks a lot, speaks quickly, and rapidly switches from topic to topic, which makes it difficult to understand her speech. The patient cannot sit still on the chair, gesticulates, suddenly starts singing, laughing, reciting poems. She thinks she is "the healthiest" and claims that "everyone envies her good looks and beautiful voice". According to her relatives, she has not been sleeping at night for the past 5 days and her appetite has increased. Three years ago, she was treated by a psychiatrist for depression. What syndrome is most likely in this patient?"
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A 65-year-old woman came to a doctor with complaints of weakness in her left limbs. The weakness appeared in the morning and was gradually increasing throughout the day. Objectively, her consciousness is clear, her blood pressure is 190/100 mm Hg, her heart rate is 80 / min., rhythmic, a systolic murmur can be detected on the neck in the projection of the bifurcation of the right common carotid artery. Examination of the neurological status detects a smoothed-out nasolabial fold on the left, deviation of the tongue to the left, a decrease in the muscle strength of the left limbs to 3 points, tendon reflexes are S > D, the Babinski sign is positive on the left, left-sided hemihypersthesia is observed. What is the most likely diagnosis in this case?
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A 10-year-old boy was treated in the cardiology department for rheumatism, first attack, active phase, second degree activity. Discharged in a satisfactory condition. What drug should be prescribed in this case for prevention of secondary rheumatism?
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Approximately 40 % of patients with bacterial pneumonia develop concomitant pleural effusion. This diagnosis can be confirmed by chest X-ray in the direct vertical projection if there is at least:
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A four-month-old child suddenly became ill. The following symptoms has appeared: an increase of the body temperature to 38,5°C, one-time vomiting, lethargy. In 10 hours, on the buttocks and lower limbs appeared a rash in the form of petechie, spots and pustules. Some hemorrhagic elements are with necrosis in the center. What disease is most likely present in this child?
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A 22-year-old pregnant a severe condition was hospitalized in on. Throughout the past three days, she developed edemas, headache, nausea, and one episode of vomiting. Objectively, her consciousness is clouded, her blood pressure is 160/130 mm Hg. She presents with small fibrillar twitching of the facial muscles and problems with nasal breathing. During transportation, the woman's arms started twitching, her body stretched out, her spine curved, her jaws tightly clenched, and she stopped breathing. Then she developed clonic seizures and marked cyanosis. After that, the seizures stopped, a deep noisy inhale occurred, and blood-stained foam appeared on the patient's lips. What is the most likely diagnosis in this case?
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During coke production, the concentration of dust in the air of the working area has been for many years exceeding the maximum permissible concentration by 4-8 times. What disease is most likely to develop among the workers in this industry as a result?
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A 36-year-old patient complains of suffocation attacks with predominantly problematic exhalation. The attacks occur up to 2-3 times a day and can be relieved by inhalation of β2-adrenomimetics. This condition lasts for 10 years already. Objectively, the chest is expanded, percussion detects a bandbox resonance over the lungs, auscultation detects harsh respiration with prolonged exhalation. Laboratory analysis of sputum detects numerous eosinophils, Charcot-Leyden crystals, and Curschmann spirals. What is the provisional diagnosis in this case?
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A 45-year-old man with a history of myocardial infarction developed a brief attack of palpitations, accompanied by the sensations of lack of air, fear, and vertigo. His blood pressure is 90/60 mm Hg. ECG during the attack shows extended QRS complex (0.13 seconds) with the heart rate of 160 /min., discordant shift of ST segment and T wave, dissociation of atrial and ventricular rhythm. What disturbance of cardiac rhythm is it?
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Within 2-3 hours, a 58-year-old man developed multiple spots in his vision. after which the vision in his right eye darkened. Examination detects eccentric visual acuity of 0.02. The pupil is moderately dilated, its direct response to light is reduced. Ophthalmoscopy detects multiple hemorrhages of varying size and shape on the fundus of the eye ("squashed tomato" sign), the optic disc is edematous and hyperemic. The patient has a history of essential hypertension of II B degree. What is the most likely diagnosis in this case?
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A 34-year-old man fell ill 3 days ago after an overexposure to cold. He complains of a fever of 39.2°C, marked general weakness, sweating, and cough. The cough was initially dry, but within the last 24 hours a small amount of "rusty" sputum was produced. Objective examination detects herpes on the lips. Percussion reveals a dull sound in the lower pulmonary lobes. Auscultation detects bronchial breathing and tachycardia. No changes were detected in the organs of the abdominal cavity. What is the most likely diagnosis in this case
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A 34-year-old woman came to a doctor with complaints of muscle weakness, thirst, increased urination at night, paresthesias, and seizure attacks. Objectively, her general condition is satisfactory, her face and legs are doughy, her pulse is 80 /min., her blood pressure is 200/110 mm Hg, the II heart is accentuated over the aorta. Complete blood count shows K levels of 3.1 mmol /L and Na levels of 165 mmol /L. ECG shows inversion of T waves and depression of S-T segments. Ultrasound detects hyperplasia of the right adrenal gland. What is the provisional diagnosis in this case?
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A patient was hospitalized into the neurosurgery department with a closed craniocerebral injury, a fracture of the right temporal bone. Five hours later, the patient's condition sharply deteriorated, he developed respiratory disorders, periodical tonic seizures, and anisocoria (dilation of the right pupil). What complication can be suspected in this case?
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A 64-year-old man came to a doctor with complaints of edemas of the legs, lower back, and anterior abdominal wall. He has a history of chronic bronchitis with bronchiectasis. Physical examination shows the following: body temperature-372° C, blood pressure – 110/75 mm Hg, pulse – 82 /min., respiratory rate 19 /min. General urinalysis results are as follows: specific gravity- 1025. protein 9.9 g /L, leukocytes 2-3 in the-vision field, erythrocytes 1-2 in the vision. field, no casts. Daily proteinuria is 11.4 g per 24 hours. Blood biochemistry test shows the following: total protein-52 g/L, albumins -30 g /l, cholesterol-9.6 mmol /L. What type of kidney disorder is most likely inpatient?
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The mother of a 4-year-old girl came to an endocrinologist with complaints about the abnormal structure of the child's external genitalia: hypertrophy of the clitoris and an enlarged fabia that resembles a scrotum, Additionally, the child exhibits accelerated growth, as well as growth of axillary and pubic hair, and lowering of the vocal timbre. What examination is necessary to confirm the diagnosis in this case?
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A 38-year-old patient complains of pain in the area of the metatarsophalangeal joints of toes 1-2 on the right foot. Examination detects bluish-purple skin over the affected joints that is hot to the touch. There are nodular formations covered with thin shiny skin in the area of the auricles. What drug must be prescribed for this patient as a part of the urate-lowering therapy?
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