KROK 2 MAY 2023 most probable answer ke’ "Unofficial student-compiled question paper sample." WN KROKPLANNER.COM eee ee ee TOP BF w a "Success is not final, failure is not fatal: It is the courage to continue that counts." - Winston Churchill2 @ etonecom “Message to All Final Year Students Who Took Exams in May" Our Support and Solidarity for Final Year Students who recently took the Krok 2 Exam! We stand by you, recognizing the challenges you faced during the recent Krok 2 exam. Let the facts speak: @ Less than 25 questions were direct repeats from past year papers and bases for foreign students. B Approximately 30 qui bases, Prekrok, and book foreign students typically do ni materials. peats from Ukrainian rn is highly unjust, as focus on these specific © There was a drastic change in the pattern and style of questions this year, with more clinical and lengthy questions. Many students found it difficult to complete all questions within the allocated 3 hours. We acknowledge the injustice faced by final year students, especially in these challenging times where their dedication and efforts to continue their studies and receive their diplomas have been extraordinary. Undoubtedly, this year’s Krok 2 paper was one of the toughest in the history of Krok 2 for foreign students (2004-2023). We offer our full support and solidarity to all affected students, and we hope that justice will prevail. Krokplanner.comMay this article provide some solace and assistance in your future endeavors. Stay strong and keep pursuing your dreams. Minimum Passing Score Vv Corey. um psig sO eat neem pgs sre 0 te itt Une fae heck eens am Ce catnip Krok 2. Medicine @ 1.0 Therapy (35-44%) © 20 surgery (18-23%) © 3.0 Pediatrics (13-179) @ 40 Obstetrics and mecology (11-14%) @ 5.0 Hygiene, Healthcare Management (11-14%) my Krokplanner.comAe inteineccom HOW YOU CAN FIND US OUR CONTACTS... 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We value your feedback and strive to provide you with the most accurate and up-to-date resources. my Krokplanner.comKROK 2 2023 MAY (For detailed explanations and practice, please visit www.krokplanner.com.") 1. Awoman with polycystic kidney disease observes an increase in her 24-hour urine output to 2-2.5 liters. Dynamic nephroscintigraphy shows the following: total glomerular filtration rate - 34 mL/min., serum creatinine - 84 mcmol/L, urea- 8.0 mmol/L. What stage of chronic kidney failure is it? + Compensated © Terminal * Polyuric © Intermittent + Latent a In the course of CRI 4 stages are distinguished (N. A. Lopat- kin, I. M. Kuchinsky, 1973); Latent CRI is characterized with minor subjective and objective symptoms. Glomerular filtration is reduced down to 50-60 ml/min, glucose excretion is raised, periodically proteinuria is revealed. On the isotope renogram there can be seen a decrease of the secre- tory function. Dysaminuria, periodical proteinuria may be ob- served Compensated CRI occurs in case of a great reduction of the re- nal function, still the urea and creatinine levels are not increased. The daily diuresis reached 2 Las a result of reduction of the tubular reabsorption. Glomerular filtration is reduced down to 30- 40 ml/min. Osmolarity of urine is low. Periodically dyselectro- lytemia may be revealed. Urea and creatinine are in the norm. 2. A 2-year-old child suffers from frequent and long- lasting respiratory diseases and pancreatogenic malabsorption. suspected. What study is necessary to confirm this diagnosis? + Sweat chloride ¢ = Immunogram test © Karyotyping Bronchoscopy © Chest X-ray my Krokplanner.com7 aoeecom 3. A 36-year-old woman complains of pain in her joints and muscles, loss of appetite, constipations, rapid fatigability, and a subfebrile body temperature.Objectively, she has dysphagia, symmetrical arthritis, skin atrophy and small ulcers on the fingertips, Raynaud's syndrome, telangiectasia. What disease is the cause of such a clinical presentation? + Systemie scleroderma * Dermatomyositis © Systemic lupus erythematosus © Rheumatoid arthritis * Raynaud's disease 4. A45-year-old man came to ai that last for ten days. The patient ulcerative colitis, is a smoker, and has been smoking one pacl per day for ten years. The patients fatherdied of{canceret thelaraetntestine at the axe ofs0! Physical examination shows the following: body temperature - 38.6°C, blood pressure - 130/80 mm Hg, pulse - 72/min., respiratory rate - 18/min. Examination of the oral cavity reveals erythematous pharynx and exudate in the tonsillar crypts. Antigen test for group A streptococcus was positive. What procedure that doctor can recommend for for this patient? * Colonoscopy © Low-dose CT scan of the lungs * PSA test and digital rectal examination © Fecal occult blood test jing of a sore throat and fever * Flexible sigmoidoscopy WM CU5. 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 [iii ac 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? + Bees @ Eczema © Contact dermatitis * Seborrheic dermatitis * Cat scratch disease #Points in favor of the answer Cat scratch disease is unlikely in this case because it typically presents with regional lymphadenopathy, fever, and malaise, which are not mentioned as symptoms in the patient's presentation. Additionally, the characteristic findings of dense erythematous plaques covered in silvery scales are more consistent with psoriasis. 6. It was found that for every 100 births, women with risk factors had 36 preterm births, while women without risk factors had 5 preterm births. What statistical method of data processing would be optimal for a doctor to use to estimate the validity of differences between the groups that are being compared? * Calculation of the Student's criterion Correlation analysis Calculation of relative values Calculation of average values Standardization method . . Krokplanner.com7. 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? * Excessive fluorine levels in water * Insufficient fluorine intake with tea © Insufficient fluorine levels in soil and water © Insufficient fluorine levels in animal products © Excessive fluorine levels in vegetable products 8. On the fourth day of life, a h started vomiting blood. Coagul ild developed melena and longed prothrombin time, What is the most likely disease in this case? * Disseminated intravascular coagulation syndrome Hemophilia A Neonatal sepsis Hemolytic disease of the newborn 9. 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 sign (costovertebral angle tenderness) on the left. General urinalysis detects pyuria and bacteriuria. What is the most likely diagnosis in this case? + Acute pyelonephritis © Acute cystitis © Renal colic * Acute glomerulonephritis © Paranephric abscess my Krokplanner.com10 ereiganercon 10. A pediatrician needs to analyze the infant mortality rates. What must be taken as the unit of observation for this purpose? + case of death of a child under one year of age © Acase of death of a child within the first month of life * Acase of death of a child after 28 days of life © Acase of death of a child within the first 7 days of life * case of the death of a child during childbirth 11. A 14-year-old girl developed morning fever, cheilitis, stomatitis, photosensitivity, leukocytosis of 24x109/L, and thrombocytopenia. Laboratory studies detect Make the provisional diagnosis. ‘© Juvenile idiopathic arth * systemic scleroderma © Sepsis * Dermatomyositis 12. The mother of a 4-year-old girl came to an endocrinologist with complaints about the the clitoris and an enlarged labia 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? © Measuring the ACTH levels in blood * Karyotyping © Measuring the TSH levels in blood Bone age assessment my Krokplanner.com11 ereigamercon 13. 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: 14. A pregnant woman suffers At 35 weeks of gestation, she d abdominal wall. Immunoglobulin G Immunoglobulin D Immunoglobulin M Immunoglobulin A ertension of the first degree. of the legs and anterior blood pressure increased to 170/120 mm Hg, She developed a headache and her vision became worse. Four hours of intensive treatment had no effect. What tactics would be necessary in this case? . . Labor induction Preparation of the cervix for preterm birth Continuation of the intensive therapy Conservative management of the delivery 15. A victim has a II-III degree burn injury that covers 15% of the body surface. On day 20 after the injury, the patient presents with a sharp increase in the blood pressure i 90/50 mm Hg. the pulses 112/min, What complication can be suspected in this case? . Acute intoxication Anaerobic infection. Purulent bronchitis Pneumonia Krokplanner.com32 ereiganercon 16. A 49-year-old man complains of angina pectoris attacks that occur when he walks up to 500 m. He has a many-year-long history of 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 - 160 g/L, leukocytes 6.4x109/L, ESR - 7 mm/hour. ECG shows hypertrophy of the left ventricle. What group of drugs is contraindicated in this case, taking into account the concomitant pathology? . Beta blockers © Angioprotectors * Antiplatelet drugs * Calcium antagonists © Long-acting nitrates #Points in favor of the answer Beta blockers are contraindicated in this case due to the patient's history of chronic bronchitis, as beta blockers can potentially worsen bronchoconstriction and exacerbate respiratory symptoms. 17. A.46-year-old patient complains of double vision and drooping of the eyelids that occur mainly in the second half of the day and almost completely disappear after a rest. Examination detects slight bilateral ptosis, reduced lateral movement of the eyeballs, diplopia, and test. Make the diagnosis. . © Oculopharyngeal muscular dystrophy © Kearns-Sayre syndrome * Olivopontocerebellar atrophy © Progressive supranuclear ophthalmoplegia my Krokplanner.com13 ereigamercon 18. 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 heard during auscultation. What is the most likely diagnosis in this case? . 19. A 34-year-old man fell ill 3 d complains of a fever of 39.2°C, . . 20. Forensic examination of the body of a baby detects the following: weight - 3500 g, body length 50 cm, the the lung float tests in this case? lips. Percussion reveals a dull sound nine oer 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? breathing cannot be Acute purulent pleurisy Total hemothorax on the right Open pneumothorax Pneumoperitoneum overexposure to cold. He eakness, sweating, and fe last 24 hours a small amount ination detects herpes on the Nosocomial pneumonia Community-acquired focal pneumonia Exudative pleurisy Lung abscess What is indicated by the results of Primary atelectasis Hyaline membrane disease The child was born dead Secondary atelectasis my Krokplanner.com14 ereiganercon 21. A 30-year-old woman came to a doctor with complaints of menstruations that have been missing for two years after her second childbirth. The childbirth was complicated by a massive bleeding. After giving birth, the woman started noticing hair loss and weight loss. Objectively, the woman's body type is asthenic, her external genitalia are hypoplastic, the cervix is cylindrical, the body of the uterus is small and painless, the uterine appendages cannot be detected. What is the most likely diagnosis in this case? * Pituitary amenorthea (Sheehan syndrome) Primary amenorrhea ‘* Uterine pregnancy * Pituitary tumor (Cushing disease) * Stein-Leventhal syndrome 22. An 18-year-old adolescent first time. The test for 1.0. What would be the optimal treatment plan in this case? th a duodenal ulcer for the © Quamatel (famotidine) + amoxicillin * De-nol (bismuth subcitrate) + trichopol (metronidazole) © Omeprazole + oxacillin © De-nol (bismuth subcitrate) + cimetidine WM CU35 ereigamercon 23. 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? * Ankylosing spondylitis ‘* systemic lupus erythematosus * Deforming spondyloarthrosis * Rheumatoid arthritis © Reiter's syndrome 24, Essential hypertension, as communicable disease, is the most common type of arterial hi ? hich 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? + Age (over 40 years), sex, hereditary predisposition Sensitivity to weather changes Excessive emotional and nervous strain * Obesity © Stress 25. A 26-year-old woman complains of cramping abdominal pain, diarrhea with a significant amount of mucus and blood, and fever of 37.5-38.0°C. Objectively, her skin and mucosa are pale, the body type is asthenic. Palpation detects pain along the large intestine. Colonofibroscopy reveals edematous wall of the lumen. What is the likely diagnosis in this case? + Nonspecii ulcerative colts * Chronic enteritis © Crohn's disease Dysentery © Cancer of the large intestine WM CU16 ereigamercon #Related Question ‘Awoman complains of frequent, liquid stool (up to 9-10 times per day) with mucus and blood admixtures, dull pain in the hypogastrium, weight loss of 4 kg within the last year. Objectively: malnutrition, dry skin, low turgor, aphthous stomatitis. The stomach is soft, the sigmoid colon is spastic and painful on palpation. Occult blood test is positive. Fibrocolonoscopy: edema, hyperemia, mucosal granulation, pseudopolyps, small ulcers, with irregular edges. Make the diagnosis: ANSWER Nonspecific ulcerative colitis 26. 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 wi wrapped once around the neck of the baby, the extractio was difficult. After the birth, the Apgar scale was used to ev: ‘ondition at the first minute of life: no breathing, the What would be the Apgar score in this case? © 2points © 4points © 3 points © Opoints APGAR SCORING SYSTEM 0 Points 1 Point Activity, ‘Arms and legs (manele tone Absent seo Pate Absent Below 100 bpm ‘Grimace Face! Some flexion of ceestex iertabitity) tai ‘Exiemitis ise Respiration Absent Stow, irregutar iy Blue, pate | extremitl Severely depressed 0-3 Moderately depressed 4-6 Excellent condition 7-10 my Krokplanner.com37 ereiganeecon 27. A 63-year-old man came to a doctor with complaints of marked general weakness, poor appetite, weight loss, joint pain, and heaviness in the right subcostal area. Complete blood count shows the following: erythrocytes - 3.4x 107/L, Hb - 102 g/L, color index - 0.9, platelets - 640x 10° /L, leukocytes promyelocytes - 2 %, myelocytes - 13 %, juvenile - 12 %, band neutrophils -16%, segmented neutrophils - 31 %, basophils - 3%, cosinophils - 8 %, lymphocytes — 9 %, monocytes - 5%, ESR-30 mm/hour. What is the provisional diagnosis? *+ Chronic myeloid leukemia © Erythremia (polycythemia vera) © Chronic lymphocytic leukemia * Acute leukemia © Leukemoid reaction #Related Question A 63-year-old man complains of unmotivated weakness and pressing and bursting sensation in the left subcostal area. According to him, these signs have been present for a year already. Previously he was healthy. He took part in containment measures during the accident at the Chornobyl Nuclear Power Plant. Objectively: the skin is pale, peripheral lymph nodes are not enlarged, the liver is +3 cm, the spleen is +10 cm. Complete blood count: erythrocytes - 3.1 - 1012/L, Hb- 100 g/L, leukocytes - 46 - 10*/L, blasts - 2%, promyelocytes - 10%, myelocytes 18%, band neutrophils - 27%, segmented neutrophils - 10%, lymphocytes - 12%, eosinophils - 6%, basocytes - 3%, monocytes - 2%, erythrocyte sedimentation rate - 20 mm/hour. What is the most likely diagnosis? ANSWER Chronic myeloleukemia 28. 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 . The woman has a severe form of diabetes mellitus. breech presentation, Cardiotocography detects fetal bradycardia of 90/min. No labor activity can be detected. What are the tactics of pregnancy management in this case? © Breech extraction © Labor stimulation * Childbirth through the natural birth canal * Continuation of pregnancy my Krokplanner.com18 ereiganercon 29. 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 What disease can be primarily suspected in this case? + Hypoplastic anemia * Acute leukemia Hemorrhagic vasculitis * Werlhof disease ‘* Acute agranulocytosis #Related Question 42 y.o. patient complains of weak I hemorrhages, cutaneous hemorrhages. His condition has been Worsening progressively for a month. Objectively: grave condition, the extremities and body skin has spotted and petechial hemorrhages, lymph nodes are not palpable, Ps- 116/min, liver is +2 cm enlarged, spleen is not palpable. Blood has evident pancytopenia. What disease should you think about first of all? Answer Hypoplastic anemia 30. The patient's son has filed a lawsuit after his mother died of breast cancer. Due to the fact that in the past she survived a stroke and had diabetes, aggressive cancer therapy was contraindicated for her. She was suffering from but doctors at the outpatient clinic were unable to obtain even 1 mg of morphine for her treatment. What kind of care should have been provided in this case by the primary care doctors to relieve the patient's condition? + Palliative medical care Emergency medical care © Tertiary medical care * Primary medical care ‘* Secondary medical care my Krokplanner.com19 ereiganercon 31. A 65-year-old woman came to a doctor with complaints of weakness in her left limbs. The 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 What is the most likely diagnosis in this case? + Ischemic stroke * Acute hypertensive encephalopathy © Hemorrhagic stroke © Multiple sclerosis © Dyscirculatory encephal 32. 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 Some hemorrhagic elements are with necrosis in the center. What disease is most likely present in this child? + Meningococcemia © Hemorrhagic vasculitis e Flu © Rubella © Scarlet fever WM CU20 ereiganercon 33. A man suddenly developed a sharp retrosternal pain that radiated into the left arm. Objectively, the patient was excited, his skin was pale, the respiration rate was 38/min., the blood pressure was 180/110 mm Hg. Later he lost his consciousness, fell What is the diagnosis in this case? * Clinical death © Cerebral circulation disorder © Heart attack * Coma * Agonal state 34, A'55-year-old woman com during movements. Objectivel surfaces of the to palpation. What are they call + Heberden's nodes © Tophi * Bouchard's nodes * Erythema nodosum * Rheumatoid nodules Heberden's — } node ; j/ finger joints and pain in them jony formations on the lateral formations are slightly painful Bouchard’ rode WM CU21 ereiganercon 35. A 20-year-old woman is being treated for anemia (hemoglobin -72 g/L). A year and a half ago, she had an involuntary miscarriage loss at 16 weeks of pregnancy, after which the woman developed memory deterioration, fatigability, loss of appetite, dry skin, brittle nails, and irregular menstrual cycles. Objectively, the following is observed: blood pressure - 80/55 mm Hg. pulse - 54/min., height - 168 cm, weight - 48 kg, What medicine would be the optimal choice for this patient? * Hydrocortisone * Methotrexate * Human normal immunoglobulin © Hydroxychloroquine © Infliximab 36. A'55-year-old woman complains pigmentation of the open areas of her body (neck, hands, and feet). Her history indicates that corn is one of the main components in her diet. The woman rarely cats other vegetables and legumes and does not eat meat or fish. What is the most likely diagnosis in this case? + PaRER * Psoriasis © Beriberi * Biotin-responsive dermatosis © Scurvy WM CU22 ereiganercon 37. 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 can be detected in the patient's urine. What is the most likely provisional diagnosis in this case? Mercury poisoning Food poisoning Aluminum poisoning Cadmium poisoning 38. A patient with epilepsy sud generalized seizures after self-discontinuation of antiepileptic drugs. What are the first-line drugs for the treatment of this condition? . . . Gabapentin, pregabalin, ethosuximide Levomepromazine, clozapine, quetiapine Topiramate, oxcarbazepine, carbamazepine Doxepin, amitriptyline, mianserin my Krokplanner.com23 ereiganercon 39. 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 singin laughing, reciting poems. She thinks she is "the healthiest" and "the happiest” 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?" . Delirium Attention deficit hyperactivity disorder Depressive syndrome Twilight state 40. A 12-year-old child has been diagnosed with bilateral pneumonia of with mild disease course. What drug must be prescribed for treatment in this case? Aminoglycosides Aminopenicillins Antifungal agents First generation cephalosporins 41. 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? Asbestosis. Siderosis Byssinosis Silicosis WM CU24 ereiganercon #Points in favor of the answer Anthracosis is the most likely disease to develop among workers in this industry due to the excessive concentration of dust in the air, specifically coal dust, which is associated with coal mining and coke production. The other options, such as asbestosis (related to asbestos exposure), siderosis (caused by iron dust exposure), byssinosis (caused by exposure to cotton dust), and silicosis (caused by inhalation of silica dust), are not directly related to the specific conditions mentioned in the scenario. 42. A 6-year-old child became acutely ill and developed fever, headache, and appeared on a hyperemic skin. The rash is more numerous on the lateral surfaces of the body and in the natural folds. ulent plaque on the tonsils. What disease can be suspected + SESTieRTENEt * Infectious mononucleosis * Measles © Rubella © Diphtheria 43. A 58-year-old man had a moderate ischemic stroke in the right hemisphere of the brain 10 days ago. At the time of hospitalization, the deficit score on the NIHSS scale was 9 points. He suffers from moderate arterial hypertension, atrial fibrillation, urolithiasis, and gout (remission). What must be prescribed to the patient for secondary prevention of stroke? . Oral anticoagulants (warfarin or NOACs - dabigatran, rivaroxaban, apixaban) © Aspirin, 100 mg per day Clopidogrel, 75 mg per day High doses of lipid-lowering agents (e.g., atorvastatin - 80 mg per day) Drugs that improve cerebral blood flow . my Krokplanner.com25 ereigamercon 44, For three weeks, a 29-year-old patient has been observing a painless ulcer on the skin of the vermilion border of the lower lip. The last week, the ulcer became accompanied by significant edema of the underlying and surrounding tissues. Examination shows an ulcer up to 2.5-3 em in diameter, with clear cartilaginous infiltrate. What laboratory test must be prescribed first in this case? . Treponema pallidum test © Smear for acantholytic cells * Eosinophil count ‘© Skin scraping for mycosis © Bacterial culture 45, A 45-year-old man complai into the lower jaw and During a pain attack, an be recorded on the ECG in leads V 3-4. What is the provisional diagnosis in this case? + Prinzmetal angina pectoris * Myocardial infarction ‘* Stable angina pectoris, functional class I! * Stable angina pectoris, functional class IV © Progressive angina pectoris a ee Activity level Generally very active. Can walk a few blocks and Can walk long distance and gets chest pain/pressure will not get any symptoms. and has to rest or take NTG trosternal pain that radiates When do symptoms occur Usually at rest and. Occurs with any exertion, presents like an MI, requires rest or NTG to crushing chest pain. relieve. Most commonly midnight Anytime they exert to3.am. themselves. EKG and no symptoms Normal sinus rhythm Normal sinus rhythm EKG and symptoms ST elevations ST depressions Cath findings Clean coronary arteries, _Blockages in the coronary might see an artery spasm. arteries. Treatment cco. my Krokplanner.com26 ereigamercon 46. A 30-year-old woman complains of menstruations missing for a year. She has a history of a 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? * Pituitary necrosis * Adrenocortical necrosis © Hypothalamic insufficiency © Ovarian insufficiency © Thyroid disorder 47. In a 70-year-old woman, ch heterogeneous structure over contrast detects What is the most likely diagnos! + Hiatal hernia © Benign esophageal tumor © Achalasia cardia ‘* Esophageal diverticulum * Esophagitis hows a shadow of a }e diaphragm. X-ray with 48. 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? . © Thermography ‘© Pneumogynecography © Pelvic X-ray © Metrosalpingography WM CU27 ereiganeecon 49. 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? + ERC * Rheopolyglucin (Dextran) * Phenylinum (Phenindione) Regular heparin © Acetylsalicylic acid 50. Within 2-3 hours, a 58-year-old man developed multiple spots in his vision, after which the vision in his rigl xxamination detects eccentric visual acuity of 0.02. The pupil ited, its direct response to light is reduced. Ophthalmoscopy di jorrhages of varying size and shape on the fundus [RRREEEERENNNNNN The patient has a history of essential hypertension of || B degree. What is the most likely diagnosis in this case? + Thrombosis ofthe central retinal vein Diabetic retinopathy Hypertensive angiopathy Embolism of the central retinal artery Hypertensive angioneuropathy . . #Related Question 57 year old patient abruptly lost the sight of one eye. Examination revealed that his sight made up 0.02 excentrically, eye fundus has haemorrhages of different forms and sizes ("squashed tomato” symptom). Disc of optic nerve is hyperemic. In anamnesis general vascular pathology is recorded. Direct-acting anticoagulants were administered. What is the most probable diagnosis? ANSWER Thrombosis of central vein of retina my Krokplanner.com28 creigamercon 51. A 37-year-old patient was repeatedly treated in a psychiatric hospital. The current hospitalization was due to behavioral disorders in the form of reticence, refusal to eat, periodical chaotic excitement with stereotyped movements. During the examination, the patient is sluggish, remains in bed, and no contact with him can be made. He does not answer any questions, his position is . This condition lasts for a week already. What is the provisional diagnosis in this case? + Catatonie schizophrenia ‘* Simple-type schizophrenia © Schizophrenia with paranoia © Reactive stupor © Hebephrenic schizophre! #Related Question ‘A 34-year-old man is being treated for schizophrenia exacerbation in a psychiatric unit. Objectively: the patient remains in bed, is sluggishly mobile, unresponsive, does not react to questions. His position is unvaried, hypomimic, snout reflex and Dupre’s symptom are present, muscles exhibit waxy flexibility. He has been remaining in this state for approximately a week. Feeding is parenteral. Determine the neuromotor disturbance: ANSWER Catatonic stupor 52. A 48-year-old woman complains that within the last 8-9 months she had very heavy periods that impair her ability to work. For 2 years, her health has been monitored by a gynecologist for uterine fibroids. Objectively, her cervix is cylindrical, clean, the cervical opening is closed; the body of the uterus is the appendages on both sides cannot be determined; the parametria are free; the fornices are deep; mucous discharge is being produced. What is the most likely diagnosis in this case? » Uterine fibroids Endometriosis that predominantly affects the body of the uterus Uterine fibroids and pregnancy Juvenile uterine bleeding Dysfunctional uterine bleeding . my Krokplanner.com29 ereigamercon 53. Two weeks after a case of tonsillitis, a 29-year- old patient noticed facial edema, weakness, and decreased work capacity. Gradually, he developed shortness of breath, leg edema, and lumbar edema. Objectively, his skin is pale, his heart sounds are weakened, he has hydrothorax, anasarca, and blood pressure of 150/100 mm Hg. Clinical urinalysis shows the following: specific the provisional diagnosis in this cas © Heart failure « Myxedema © Exacerbation of chronic glomerulonephritis * Acute pyelonephritis 54. During preventive medical doctors were determining, wh matches their calendar age. For doctors were using the following criteria: annual increase in body length, ossification of hand bones, number of permanent teeth. What additional developmental indicator should the doctors include, when examining children at this age? *+ Development of secondary sexual characteristics © Chest circumference © Body weight © Vital capacity of the lungs Hand muscle strength iddle and high school students, 55. After the birth of twins, the postparturient woman developed a massive hemorrhage from the natural birth canal. The placenta and birth canal are intact. The uterine fundus is located above the navel, the uterus is soft to palpation and does not respond to the administration of uterotonies. What is the most likely cause of the bleeding in this case? + Uterine atony * Uterine hypotonia © Retained placenta ‘© Damage to the uterine cervix © Uterine rupture Krokplanner.com30 ereigamercon A 26 year old woman had the second labour within the last 2 years with oxytocin application. The childs weight is 4080 g. After the placent birth there were massive bleeding, signs of hemorrhagic shock. Despite the injection of contractive agents, good contraction of the uterus and absence of any cervical and vaginal disorders, the bleeding proceeds. Choose the most probable cause of bleeding: ANSWER Atony of the uterus 56. A person has been hospitalized with the diagnosis of trichinellosis. What food product is the likely cause of this helminthiasis? + Be * Mutton © Poultry * Rabbit * Beef 57. A S-year-old child became acutely ill with the fever of 39.2°C, one episode of voriting, complaints of cramping pain in the abdomen, tenesmus, and amount of mucus with pus and blood streaks. Examination detects a dense sigmoid colon that is painful to palpation. Make the diagnosis. + Shigellosis * Cholera © Rotavirus infection * Acute appendicitis * Salmonellosis my Krokplanner.com31 ereigamercon 58. A 22-year-old pregnant woman was hospitalized in a severe condition. 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? | © Epilepsy © Hypertensive crisis * Diabetic coma * Chorea #Related Question eee ‘A 25-year-old woman at 34 weeks of pregnancy was hospitalized in a critical condition into the maternity clinic. She has complains of headache, vision impairment, and nausea. She has edemas, her blood pressure is 170/130 mm Hg. Suddenly, the woman developed fibrillar twitching of her facial muscles, tonic and clonic seizures, and respiratory arrest. One and a half minutes later her breathing resumed and blood-tinged foam appeared from her mouth. Her urinary protein levels are 3.5 g/L. Make the right diagnosis: a ANSWER Eclampsia 59. An 18-year-old adolescent bought at a store a salad with smoked fish, mushrooms, and mayonnaise. Six hours after eating the salad, he developed progressive weakness, vision impairment, "fog in the eyes", and problems with He was hospitalized. Examination detects the body temperature of 36.0°C and pale skin and mucosa. The patient is adynamic, answers questions sluggishly. The pupils are dilated, with reduced response to light. The patient's voice is hoarse, his oral mucosa is dry. What type of food poisoning can be suspected in this case? + Botulism * Salmonellosis * Staphylococcal intoxication * Mushroom poisoning © Fish poisoning my Krokplanner.com32 ereiganercon 60. A 6-year-old child developed a fever of 37.5°C, stuffed nose with a small amount of mucous discharge, and a scratchy sensation in the throat. On the fourth day after the onset of the disease, the temperature normalized but complaints of pain in the legs appeared. The child started limping and dragging What disease can be suspected in this case? © Diphtheritic polyneuritis © Botulism * Polyradiculoneuritis * Influenza with associated encephalopathy #Points in favor of the answer Paralytic poliomyelitis can be st se due to the combination of initial respiratory symptoms followed by the onset of limb pain, decreased muscle tone and reflexes, and retained sensitivity, which are characteristic of poliovirus infection. 15-year-old child fell ll acutely with high temperature 38°C, headache, fatigue. The temperature declined on the fifth day, muscular pain in the right leg occurred in the morning, there were no movements and tendon reflexes, sensitivity was reserved. What is the initial diagnosis? ANSWER Poliomyelitis 61. What is the type of joint action, where the overall effect on the human body is less than the sum of the individual effects of each separate substance included in the combination? Potentiation * Combined action * Isolated action © Complex action my Krokplanner.com33 ereigmmercon 62. 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 on the skin of his torso, scalp, and extensor surfaces of the limbs. What will be the provisional diagnosis in this case? . Pityriasis rosea Gibert Lichen ruber planus Seborrheic dermatitis Papular syphilide 63. A 14-year-old girl has short ulders, webbed neck, and no signs of puberty. Her intelligent sound of the lesser pelvis shows hypoplasia of the uterus, ‘of ovaries. Karyotype of the child is 45, X0. What pathologic: be suspected in this case? Patau syndrome Down syndrome Edwards syndrome Klinefelter syndrome 64. A food poisoning occurred in a canteen, affecting 15 people. The clinical presentation of the poisoning indicates its staphylococcal etiology. What biological materials, obtained from the patients, must be sent for laboratory testing to . Urine for clinical analysis Blood for clinical analysis Saliva Blood for hemoculture WM CU34 ereiganercon 65. After eating mushrooms, a 30-year- old person developed nausea, vomiting, and absence of urination. On the third day after the onset of the symptoms, this person sought medical aid. Laboratory tests show elevated creatinine levels of 700 memol/L and urea levels of 32 mmol/L. What treatment tactics should be chosen in this case? + Hemodialysis © Diuretics © Detoxification therapy * Peritoneal dialysis * Antidote therapy 66. A 24-year-old woman com The rash is painless, without it Two months ago, a rash on her external genitalia. rated from the healthy skin. . What is the likely diagnosis in this case? + Secondary syphilis © Toxidermia * Measles © Pityriasis versicolor © Typhus 67. 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 B2-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? * Bronchial asthma * Chronic obstructive bronchitis * Spontaneous pneumothorax * Cardiac asthma © Carcinoid syndrome Krokplanner.comMorphology of Asthma Curschmann spirals Charcot-Leyden © Coiled, basophilic crystals. plugs of mucus formed —» Eosinophilic needle- in the lower airways shaped crystalline and found in sputum structures. and tracheal washings 68. Among the population living near the number of congenital malformations that is dynamically increasing. Compounds of what chemical substance can cause the development of these pathologies? Cadmium Iron Chrome Strontium WM CUREPEAT QUESTIONS FROM UKRANIAN BASE & BOOKLETS 69. The mother of a 6-month-old boy came to a pediatrician. She is concerned that her child has not received any vaccinations. There are no health complaints. Objectively, the following is observed: body temperature 37.1°C, respiratory rate - 20/min., blood pressure - 100/70 mm Hg, the child's height and weight are within the range between the 50" and 75th percentile. What tactics must the doctor choose in the immunization of this child according to the regulatory documents issued by the Ministry of Health? © Administer BCG, MMR, and DPT vaccines © The child requires no va * Postpone the vaccinatio * Administer BCG vaccine pointment in a week NATIONAL VACCINATION SCHEDULE Py thie S 8 Sf FURAN cd by the Ministry 0 f Ukraine in Birth to 18 months 2to i6years Adults 13-5 2 4 6 2 1 6 14 16 sew bay “Oke MONTHS MONTHS. MOKS MONTAG MOS: YRS ARS EAS TOVEARS Pars, YY © wownse —er|? | MY vasxcn0ss- SUP mv remus | (PERTUSSIS) | (@) rovowreuns HAEMOPHILUS MFLUENZAE TPE (i) ‘The ur of combination vaccines reduces the number of iectons an visto the cle vacciadonarua | moegousa WM CU37 ereigameecon 70. For 12 hours, a woodcutter has been working outdoors in windy weather at the air temperature of +4-5°C. His shoes were compressing the distal parts of his feet, Now he complains of a pricking and burning pain in his toes 1-3 on both feet, pain in the interphalangeal joints, and decreased skin sensitivity in toes 1-3. Examination. detects slightly edematous toes, bluish skin, painful and reduced movements in the interphalangeal joints, slightly reduced skin feet. What is the provisional diagnosis in this case? © Critical ischemia of the feet * Acute interphalangeal joint arthritis * Obliterating endarteritis © Crush syndrome 71. A 45-year-old man with a hi dial 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 ) 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? * Paroxysmal ventricular tachycardia © Atrial fibrillation © Paroxysmal supraventricular tachycardia Frequent ventricular extrasystoles * Ventricular fibrillation WM CU72. A7-year-old boy after a fall from a height presents with rapid and shallow breathing and cyanotic face. The right half of his chest detects no breathing there. What pathology is the most likely cause of this clinical presentation? What be the most informative in this case? 73. During preventive medical lyceum shows signs of in the place where the lips closél Right-sided hemothorax. Survey X-ray of the chest Tension cyst of the right lung. Tracheobronchoscopy Mediastinitis. Survey X-ray of the chest Airway foreign body. Diagnostic and therapeutic bronchoscopy of the students at a technical maceration of the epithelium ight red, with isolated vertical fissures covered in red-brown scabs. These clinical signs are most likely caused by the insufficient intake of a certain substance with food. Name this substance. . . Calciferols Ascorbic acid Retinol Thiamine WM CU39 ereigamercon 74, A 54-year-old man was hospitalized with complaints of general weakness, fever of 38.6°C, shortness of breath during significant physical exertion, and frequent nosebleeds. He works in pi ijectively, his skin is pale and dry. Complete blood count shows the following: erythrocytes - 2.1x 10#/L, Hb 90 g/L, leukocytes -2.2x10°/L, eosinophils — 1% band neutrophils - 1%, segmented neutrophils 75 %, lymphocytes - 20 %, myelocytes - 3 %, platelets 30x10°/L, ESR-32 mm/hours. What is the most likely diagnosis in this case? * Chronic benzene intoxication * Chronic aniline intoxication © Chronic nitrobenzene intoxication © Chronic tetraethyllead intoxication * Chronic lead intoxication 75. A 16-year-old boy developer : ively, his heart rate is his blood pressure is 85/45 mm Hg, the heart borders are not enlarged, the heart sounds are loud and clear. ECG and ventricles are accompanied by varying location of P wave in relation to QRST complex. This presentation is most characteristic of the following disease: + Complete atrioventricular block (ll degree) * Extrasystole Atrioventricular block (II degree) © Sinus bradycardia © Atrioventricular dissociation WM CU40 ereiganercon 76. 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 Il heart sound 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 tight adrenal gland. What is the provisional diagnosis in this case? + Primary hyperaldosteronism Hypoparathyroidism Essential hypertension Glucosteroma Pheochromocytoma 77. A 64-year-old man is undergo a ‘treatment for ischemic heart disease, diffuse cardiosclerosis, persistent atrial fibrillation, and functional class lil 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 of the effectiveness and safety of the anticoagulant therapy? + International normalized ratio © Erythrocyte sedimentation rate * Lee-White clotting time © Fibrinogen levels * Platelet count my Krokplanner.com41 creigamercon 78. A baby with the gestation term of 30 weeks was born with the body weight of 1100.0 g. Three hours of breathing is observed, the heart rate is 98/min. The Silverman score is 9 points. Additional oxygenation did not improve the child's condition. What must the doctor do next? . Tracheal intubation Tactile stimulation External cardiac massage Artificial pulmonary ventilation the future? . . . 79. Screening detected week-old baby. What treatment must be prescribed vent severe complications in —— Hormone therapy Antibiotic therapy Vitamin therapy 80. A.46-year-old man came to a doctor with complaints of a rash on his hands that appeared one week ago and is accompanied by severe itching. The patient hasa story of and vesicles with serous contents, as well as areas of lichenification and excoriation, on the back of both hands. What is the most likely diagnosis in this case? Scabies Seborrheic dermatitis Psoriasis Contact dermatitis my Krokplanner.com42 creigamercon 81. A three-year-old boy has been suffering from stool retention since birth. Every 3-4 days, the mother gives her child enemas. The boy lags behind his peers in physical development. Objectively, he has pale skin and distended abdomen. What disease can be suspected in this child? + Hirschsprung's disease © Peritonitis Intestinal tumor Helminthiasis © Coprostasis 82. A 25-year-old woman was hospitalized at 11 weeks of pregnancy with complaints of pain in her lower jeeks ago, she had a severe exami formed cervix, the cervical Weeks of pregnancy, the uterine would be optimal in this case? appendages are normal. What. + Termination of pregnancy ¢ Administration of uterotonics ‘© Prolongation of pregnancy * Minor caesarean section * Administration of antispasmodics These symptoms have been observed for the last seven days. Physical examination shows the following: body temperature - 38.3°C, blood pressure - 130/70 mm Hg, heart rate - 79/min., respiratory rate 17/min., SpO2 - 95%. Auscultation detects moist crackles on the left. Survey X- ray of the chest reveals left lower lobe consolidations. What drug should be prescribed to the patient in this case? + Azithromycin © Trimethoprim/sulfamethoxazole © Ciprofloxacin * Gentamicin * Levofloxacin 83. A 22-year-old young man came to a doctor with complaints of fever and my Krokplanner.com43 creigmmercon 84, A 25-year-old woman had an abortion half a year ago. She complains of loss of appetite, weakness, and arthralgia. Two weeks later, she developed |. What marker of viral hepatitis is likely to be positive in the patient? * Anti-HBc IgM © Anti-HAV IgM © Anti-HBs © Anti-HEV IgM © Anti-CMV IgM iatrician, Objectively, she has a of the abdomen, blue sclera. 85. A 14-year-old girl is being e tall stature, asthenic body type, Cardiac ultrasound visualizes a mitral valve prolapse. What is the most likely cause of her tall stature? + Marfan syndrome * Noonan syndrome * Klinefelter syndrome * Ehlers-Danlos syndrome © Williams syndrome 86. A 42-year-old patient has been hospitalized into the trauma department. X- ray reveals a pelvic fracture. Objectively, unassisted urination is not possible, . Palpation detects an enlarged bladder and a painful swelling in the perineum. What is the provisional diagnosis in this case? + Urethral trauma * Perineal hematoma © Acute kidney failure © Reflex urinary retention * Bladder trauma WM CU