Welcome Young Doctor,
You are about to start KROK 2 - 2009
It has a total of 200 Questions.
GOOD LUCK!!
1.
Female 45 year old patient was admitted to the traumatological ward with the closed fracture of the medial malleolus with its displacement up to 3 mm. The foot is to be fixed with a plaster cast in the following position:
2.
A female patient has been suffering from pain in the right subcostal area, bitter taste in the mouth, periodical bile vomiting for a month. The patient put off 12 kg. Body temperature in the evening is 37,6oC. Sonography revealed that bile bladder was 5,5х2,7 cm large, its wall 0,4 cm, choledochus - 0,8 cm in diameter. Anterior liver segment contains a roundish hypoechoic formation up to 5 cm in diameter and another two up to 1,5 cm each, walls of these formations are up to 0,3 cm thick. What is the most probable diagnosis?
3.
A 40 year old woman has a selfdetectedhard breast mass. The procedure of choice for confirming the diagnosis is:
4.
A 22 year old woman complained of right subcostal aching pain, nausea, and decreased appetite. She fell ill 2 months after appendectomy when jaundice appeared. She was treated in an infectious hospital. 1 year later above mentioned symptoms developed. On exam: the subicteric sclerae, enlarged firm liver. Your preliminary diagnosis:
5.
A 52 year old patient was admitted to a hospital because of high hemorrhagic diathesis of mucous membranes, massive skin haemorrhages in form of ecchymoses and spots, nasal and stomachal haemorrhages. After clinical examinations her illness was diagnosed as thrombocytopenic purpura. What is the most probable cause of this disease?
6.
A woman 26 years old has abused alcohol for 7 years. She has psychological dependence on alcohol, but no withdrawal syndrome. Drinks almost every day approximately 50-100 g of wine. She is in her 4-th week of pregnancy. Primary prevention of fetal alcohol syndrome requires:
7.
A 28 year old patient was admitted to the clinic with complaints of the temperature rise up to 39,0oC, headache, weakness, constipation on the 9th day of the disease. On examination: single roseolas on the skin of the abdomen are present. The pulse rate is 78 bpm. The liver is enlarged by 2 cm. What is the most probable diagnosis?
8.
A 62 year old patient complains of rest dyspnea, heart pains. 3 years ago he had myocardial infarction. Physical examination: orthopnea, acrocyanosis, swollen cervical veins. Ps - 92, total heart enlargement, the liver is enlarged by 7 cm, shin edema. What is the stage of chronic heart failure (CHF)?
9.
. A patient has been in a hospital. The beginning of the disease was gradual: nausea, vomiting, dark urine, аcholic stools, yellowness of the skin and scleras. The liver is protruded by 3 cm. Jaundice progressed on the 14th day of the disease. The liver diminished in size. What complication of viral hepatitis caused deterioration of the patient’s condition?
10.
Which of the following symptoms would occur only if a total-body acute radiation exposure exceeded 5.000 rad (50 Gy)
11.
A male patient, 60 years old, tobacco smoker for 30 years, alcoholic, has dysphagia and weight loss since 4 months. Suggested diagnosis?
12.
1,5 hour after start of gullet bougienage a 48 year old patient suffering from corrosive stricture felt acute abdominal pain. Previously he had been suffering from duodenal ulcer. Examination revealed that abdomen was very tense and painful; Ps- 110 bpm, painful sialophagia, skin pallor. What is the most probable diagnosis?
13.
A 4 year old girl was playing with her toys and suddenly she got an attack of cough, dyspnea. Objectively: respiration rate - 45/min, heart rate - 130/min. Percussion revealed dullness of percutory sound on the right in the lower parts. Auscultation revealed diminished breath sounds with bronchial resonance on the right. X-ray pictue showed shadowing of the lower part of lungs on the right. Blood analysis revealed no signs of inflammation. The child was diagnosed with foreign body in the right bronchus. What complication caused such clinical presentations?
14.
Examination of a 9 month old girl revealed skin pallor, cyanosis during excitement. Percussion revealed transverse dilatation of cardiac borders. Auscultation revealed continuous systolic murmur on the left from the breastbone in the 3-4 intercostal space. This murmur is conducted above the whole cardiac region to the back. What congenital cardiac pathology can be suspected?
15.
A 28 year old parturient complains about headache, vision impairment, psychic inhibition. Objectively: AP200/110 mm Hg, evident edemata of legs and anterior abdominal wall. Fetus head is in the area of small pelvis. Fetal heartbeats is clear, rhythmic, 190/min. Internal investigation revealed complete cervical dilatation, fetus head was in the area of small pelvis. What tactics of labor management should be chosen?
16.
A 26 year old manual worker complained of 3 weeks history of fevers and fatigue, weight loss with no other symptoms. Physical findings: Temperature 37,6oC, Ps- 88 bpm, blood pressure 115/70 mm Hg, superficial lymph nodes (occipital, submental, cervical, axillary) are enlarged, neither tender nor painful. Rubella-like rash on the trunk and extremities. Herpes simplex lesions on the lips. Candidosis of oral cavity. What infectious disease would you suspect?
17.
A 60 year old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta adrenegic blockers and calcium channel antagonist. The best management includes:
18.
An 8 year old boy suffering from haemophilia was undergoing transfusion of packed red cells. Suddenly he got pain behind the breastbone and in the lumbar area, dyspnea, cold sweat. Objectively: pale skin, heart rate - 100/min, AP- 60/40 Hg; oliguria, brown urine. For treatment of this complication the following drug should be administered:
19.
The student has the following devices: Geiger counter, Ebert counter, Krotov’s apparatus, Mischuk device, Ebert device. What device can he use to assess air germ pollution?
20.
Infant is 6,5 months now and is given natural feeding since birth. Body mass was 3,5 kg, with length 52 cm at birth. How many times per day the supplement (up feeding) should be given?
21.
A parturient complains about pain in the mammary gland. Palpation revealed a 3х4 cm large infiltration, soft in the centre. Body temperature is 38,5oC. What is the most probable diagnosis?
22.
A 27 year old man complains of pains in epigastrium which are relieved by food intake. EGDFS shows antral erosive gastritis, biopsy of antral mucous presents Hеlicobacter Pylori. Diagnosis is:
23.
A 14 year old girl complains of profuse bloody discharges from genital tracts during 10 days after suppresion of menses for 1,5 month. Similiar bleedings recur since 12 years on the background of disordered menstrual cycle. On rectal examination: no pathology of the internal genitalia. In blood: Нb - 70 g/l, RBC- 2,3 · 1012/l, Ht - 20. What is the most probable diagnosis?
24.
A patient complained about problems with pain and tactile sensitivity, pain in the nail bones at the end of the working day. He works at a plant with mechanical devices. What pathology can be suspected?
25.
In the 43rd week of gestation a long, thin infant was delivered. He is apneic, limp, pale, and covered with "pea soup"amniotic fluid. The first step in the resuscitation of this infant at delivery should be:
26.
A 32 year old welder complains of weakness and fever. His illness started as tonsillitis a month before. On exam, BT of 38,9oC, RR of 24/min, HR of 100/min, BP of 100/70 mm Hg, hemorrhages on the legs, enlargement of the lymph nodes. CBC shows Hb of 70 g/l, RBC of 2,2·1012/l, WBC of 3,0·109/l with 32% of blasts, 1% of eosinophiles, 3% of bands, 36% of segments, 20% of lymphocytes, and 8% of monocytes, ESR of 47 mm/h. What is the cause of anemia?
27.
Which of the methods of examination is the most informative in the diagnostics of a tube infertility?
28.
A patient has got pain in the axillary area, rise of temperature developed 10 hours ago. On examination: shaky gait is evident, the tongue is coated with white deposit. The pulse is frequent. The painful lymphatic nodes are revealed in the axillary area. The skin over the lymph nodes is erythematous and glistering. What is the most probable diagnosis?
29.
A 68 year old female patient complains about temperature rise up to 38,3oC, haematuria. ESR- 55 mm/h. Antibacterial therapy turned out to be ineffective. What diagnosis might be suspected?
30.
A 37 year old patient applied to a local therapeutist. As a result of exacerbation of chronic obstructive bronchitis the patient had been temporarily disabled for 117 days within 1 year. What tactics will be legally correct?
31.
A 10 year old boy complains about pain in his left eye and strong photophobia after he had injured his left eye with a pencil at school. Left eye examination: blepharospasm, ciliary and conjunctival congestion, cornea is transparent, other parts of eyeball have no changes. Visus 0,9. Right eye is healthy, Visus 1,0. What additional method would you choose first of all?
32.
A 25 year old woman complained of edema on her face and legs, rise of blood pressure up to 160/100 mm Hg and weakness. She fell ill 3 weeks after recovering from angina. Urinalysis data: protein of 0,5 g/l, erythrocytes of 17-20/field, leukocytes of 2-3/field, erythrocyte casts. What treatment should be initiated after specifying the diagnosis?
33.
An 18 year old patient was admitted to a hospital with complaints of headache, weakness, high temperature, sore throat. Objectively: enlargement of all groups of lymph nodes was revealed. The liver is enlarged by 3 cm, spleen - by 1 cm. In blood: leukocytosis, atypical lymphocytes - 15%. What is the most probable diagnosis?
34.
The man, aged 42, applied to the therapeutist with complaints of pricking pains in scapulas area, dyspnea on physical exertion, cough with discharge of small amount of sputum. During 10 years he works in coal mining. On percussionbox-note sound in the lower parts, on auscultation- a harsh breathing. There were no changes in the heart. Possible diagnosis?
35.
A 3 year old boy fell ill abruptly: fever up to 39oC, weakness, vomitng. Haemorrhagic rash of various size appeared on his lower limbs within 5 hours. Meningococcemia with infective - toxic shock of the 1 degree was diagnosed. What medications should be administered?
36.
A healthy 75 year old woman who leads a moderately active way of life went through a preventive examination that revealed serum concentration of common cholesterol at the rate of 5,1 millimole/l and HDL (high-density lipoproteins) cholesterol at the rate of 70 mg/dl. ECG reveals no pathology. What dietary recommendation is the most adequate?
37.
A 2 year old girl has been ill for 3 days. Today she has low grade fever, severe catarrhal presentations, slight maculopapular rash on her buttocks and enlarged occipital lymph nodes. What is your diagnosis?
38.
A pregnant woman in her 40th week of pregnancy undergoes obstetric examination: the cervix of uterus is undeveloped. The oxytocin test is negative. Examination at 32 weeks revealed: AP 140/90 mm Hg, proteinuria 1 g/l, peripheral edemata. Reflexes are normal. Choose the most correct tactics:
39.
A 3 year old child with weight deficiency suffers from permanent moist cough. In history there are some pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 millimol/l. What is the most probable diagnosis?
40.
A 25 year old patient complains about weakness, dizziness, haemorrhagic skin rash. She has been suffering from this for a month. Blood count: erythrocytes: 1,0 · 1012/l, Hb- 37 g/l, colour index - 0,9, leukocytes - 1,2 · 109/l, thrombocytes - 42 · 109/l. What diagnostic method will be the most effective?
41.
25 children at the age of 2-3 years who don’t attend any child welfare institutions should be observed by a district pediatrician within the current year. How many initial visits of this group of children should be planned?
42.
A patient with acute purulent otitis media complicated by mastoiditis was admitted to a hospital. Roentgenogram of mastoid processes showed the shadiowing of the cellular system on the lesion, absence of bone septa was present. What are the necessary therapeutic actions at the second stage of mastoiditis?
43.
A 54 year old male patient complains about permanent dull pain in the mesogastral region, weight loss, dark blood admixtures in the feces, constipations. He put off 10 kg within a year. In blood: erythrocytes: 3,5·1012/l, Hb- 87 g/l, leukocytes - 12,6 · 109/l, stab neutrophil shift, ESR- 43 mm/h. What is the most probable diagnosis?
44.
A 3 year old child has been suffering from fever, cough, coryza, conjunctivitis for 4 days. He has been taking sulfadimethoxine. Today it has fever up to 39oC and maculopapular rash on its face. Except of rash the child’s skin has no changes. What is your diagnosis?
45.
A 48 year old female patient complains about contact haemorrhage. Speculum examination revealed hypertrophy of uterus cervix. It resembles of cauliflower, it is dense and can be easily injured. Bimanual examination revealed that fornices were shortened, uterine body was nonmobile. What is the most probable diagnosis?
46.
At year-end hospital administration has obtained the following data: annual number of treated patients and average annual number of beds used for patients’ treatment. What index of hospital work can be calculated on the base of this data?
47.
A nine year old child is at a hospital with acute glomerulonephritis. Clinical and laboratory examinations show acute condition. What nutrients must not be limited during the acute period of glomerulonephritis?
48.
What guarantees against the preconceived attitude to the physician in cases of professional law violations do you know?
49.
A 34 year old female patient has been suffering from anxious depression accompanied by panic attacks for 2 years. She has been a patient of a psychotherapist. Treatment resulted in incomplete remission. The patient had to break off psychotherapy because of moving to a new place of residence. Soon after this her condition grew significantly worse, she was almost permanently anxious, panic attacks turned up 5-6 times a day and were accompanied by palpitation, dyspnea, cold sweat, thanatophobia. What drug group is the most appropriate for medicamental therapy?
50.
A 39 year old patient complained about morning headache, appetite loss, nausea, morning vomiting, periodic nasal haemorrhages. The patient had acute glomerulonephritis at the age of 15. Examination revealed rise of arterial pressure up to 220/130 mm Hg, skin haemorrhages on his arms and legs, pallor of skin and mucous membranes. What biochemical index has the greatest diagnostic importance in this case?
51.
A man, aged 37, working on the collective farm on sowing, was admitted to the infectious hospital with the clinical symptoms: miosis, labored breathing, sweating.What kind of poisoning is it and what is the first aid?
52.
The 25 year old patient was admitted on the 1st day of the disease with complaints of double vision in the eyes, difficult respiration. The day before the patient ate home-made mushrooms. On objective examination: paleness, widened pupils, disorder of swallowing, bradycardia, constipation are marked. What is the diagnosis?
53.
A 52 year old patient with history of functional Class II angina complains of having intense and prolonged retrosternal pains, decreased exercise tolerance for 5 days. Angina is less responsive to nitroglycerine. What is the most probable diagnosis?
54.
Indicate the registration medical document for the patient, who 21.02. was addressed to the doctor with diagnosis ARVD for the first time in this year:
55.
A 32 year old patient complains about cardiac irregularities, dizziness, dyspnea at physical stress. He has never suffered from this before. Objectively: Ps- 74 bpm, rhythmic. AP- 130/80 mm Hg. Auscultation revealed systolic murmur above aorta, the first heart sound was normal. ECG showed hypertrophy of the left ventricle, signs of repolarization disturbance in the I, V5 and V6 leads. Echocardiogram revealed that interventricular septum was 2 cm. What is the most probable diagnosis?
56.
A 46 year old patient is to be prepared to the operation on account of stomach cancer. Preoperative preparation involves infusion therapy. It was injected up to 3 l of solutions into his right lunar vein. On the next day he got tensive pain in the region of his right shoulder. Examination of interior brachial surface revealed an oblong area of hyperemia, skin edema and painful cord. What complication is it?
57.
A 20 year old patient was delivered to the hospital in summer from the street with haemorrage from the brachial artery. First medical aid involved aplication of a tourniquet for provisional arrest of bleeding. What is the maximal exposure of the tourniquet?
58.
A 50 year old locksmith was diagnosed with typhoid fever. The patient lives in a separate apartment with all facilities. Apart of him there are also 2 adults in his family. What actions should be taken about persons communicating with the patient?
59.
A 36 year old patient was diagnosed with right-sided pneumothorax. What method of treatment is indicated to the patient?
60.
A woman delivered a child. It was her fifth pregnancy but the first delivery. Mother’s blood group is A(II)Rh−, newborn’s - A(II)Rh+. The level of indirect bilirubin in umbilical blood was 58 micromole/l, haemoglobin - 140 g/l, RBC3,8 · 1012/l. In 2 hours the level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn (ictericanemic type, Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:
61.
A 75 year old man who has been suffering from diabetes for the last six months was found to be jaundiced. He was asymptomatic except for weight loss at the rate of 10 pounds in 6 months. Physical examination revealed a hard, globular, right upper quadrant mass that moves during respiration. A CT scan shows enlargement of the head of the pancreas, with no filling defects in the liver. The most likely diagnosis is:
62.
A 58 year old female patient complains about periodical headache, dizziness and ear noise. She has been suffering from diabetes mellitus for 15 years. Objectively: heart sounds are rhythmic, heart rate is 76/min, there is diastolic shock above aorta, AP is 180/110 mm Hg. In urine: OD- 1,014. Daily loss of protein with urine is 1,5 g. What drug should be chosen for treatment of arterial hypertension?
63.
It is suspected that a 34 year old patient has an abscess of Douglas pouches. What diagnostic method is to be chosen?
64.
Student В. lives in the canalized house in the flat with complete set of sanitary equipment (WC, bath, shower, local water heater). How much water consumption has he got?
65.
. A 42 year old woman complains of dyspnea, edema of the legs and tachycardia during minor physical exertion. Heart borders are displaced to the left and S1 is accentuated, there is diastolic murmur on apex. The liver is enlarged by 5 cm. What is the cause of heart failure?
66.
After objective clinical examination a 12 year old child was diagnosed with mitral valve prolapse. What complementary instrumental method of examination should be applied for the diagnosis confirmation?
67.
A 12 year old child has the ulcer disease of stomach. What is the etiology of this disease?
68.
In the woman of 24 years about earlier normal menstrual function, cycles became irregular, according to tests of function diagnostics - anovulatory. The contents of prolactin in blood is boosted. Choose the most suitable investigation:
69.
Examination of a 22 year old man suffering from polyarthralgia and high fever revealed right-sided exudative pleuritis. X-ray picture showed a homogenous shadow below the IV rib on the right. In the II segment there were single dense focal shadows. Mantoux test with 2 TU resulted in formation of a papula 16 mm large. Pleural liquid has increased protein concentration, Rivalta’s reaction is positive, there was also increased number of leukocytes with prevailing lymphocytes. What is the most probable etiology of pleuritis?
70.
A patient complains about strong dyspnea that is getting worse during physical activity. Presentations appeared suddenly 2 hours ago at work: acute chest pain on the left, cough. The pain was abating, but dyspnea, dizziness, pallor, cold sweat and cyanosis were progressing. Vesicular respiration is absent, X-ray picture shows a shadow on the left. What pathology might be suspected?
71.
The observed patient’s movements are retarded, she answers no questions. Sometimes she spontaneously stiffens in strange postures. It is possible to set her body and limbs into different positions artificially. If the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such a position for quite a long time. Name the probable disorder:
72.
Five days after a total hip joint replacement a 72 year old woman becomes acutely short of breath, diaphoretic and hypotensive. Both lung fields are clear to auscultation and percussion, but examination of the neck reveals mild jugular venous distension with prominent A waves. Heart sounds are normal. ECG shows sinus tachycardia with a new right bundle branch block and minor nonspecific ST − T wave changes. The most likely diagnosis is:
73.
A patient who takes diuretics has developed arrhythmia as a result of cardiac glycoside overdose. What is the treatment tactics in this case?
74.
Examination of a 3-month-old child revealed scrotum growth on the right. This formation has elastic consistency, its size decreases during sleep and increases when the child is crying. What examination will be helpful for making a correct diagnosis?
75.
A woman complains of having slight dark bloody discharges and mild pains in the lower part of abdomen for several days. Last menses were 7 weeks ago. The pregnancy test is positive. Bimanual investigation: the body of the uterus indicates for about 5-6 weeks of pregnancy, it is soft, painless. In the left appendage there is a retort-like formation, 7х5 cm large, mobile, painless. What examination is necessary for detection of fetus localization?
76.
A 26 year old woman had the second labour within the last 2 years with oxytocin application. The child’s 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:
77.
A fitter of a metallurgic factory with occupational exposure to high concentrations of mercury fumes for 16 years presents instability of pulse and blood pressure, general hyperhydrosis, asymmetric innervations of facial muscles and tongue, positive subcortical reflexes, hand tremor on physical examination. A dentist revealed paradontosis and chronic stomatitis. What is the most probable diagnosis?
78.
Prophylactic photoroentgenography examination of a 25 year old man revealed focal shadowings of small and medium intensity with irregular contours in the 1st and 2nd segments of the right lung. Which clinical form can be suspected?
79.
A 63 year old patient was diagnosed with purulent mediastinitis. What of the below listed diseases are NOT the cause of purulent mediastinitis?
80.
A 38 year old man worked at roofing and drain pipes production for 15 years. He seeks medical help for expiratory breathlessness on exertion, and dry cough. On exam, wheezes above both lungs, grayish warts on fingers are seen. Factory physician has diagnosed asbestosis. What method is the most important for this diagnosis?
81.
A 25 year old patient had pharyngitis 2 weeks ago. Now he complains about body temperature rise up to 38oC, general weakness, dyspnea during walking, swelling and shifting pain in the articulations. Objectively: cyanosis of lips, rhythmic pulse of poor volume - 100 bpm. Left cardiac border deviates outwards from the mediaclavicular line by 1 cm. The first heart sound is weakened on the apex, auscultation revealed systolic souffle. What is the most probable aetiological factor that caused this pathological process?
82.
A 25 year old patient complains of pain in the I finger on his right hand. On examination: the finger is homogeneously hydropic, in bent position. On attempt to unbend the finger the pain is getting worse. Acute pain appears during the probe in ligament projection. What decease is the most likely?
83.
A patient was delivered to a surgical department after a road accident with a closed trauma of chest and right-sided rib fracture. The patient was diagnosed with right-sided pneumothorax, it is indicated to perform drainage of pleural cavity. Pleural puncture should be made in:
84.
A 10 month old boy has been ill for 5 days after consumption of unboiled milk. Body temperature is 38 − 39oC, there is vomiting, liquid stool. The child is pale and inert. His tongue is covered with white deposition. Heart sounds are muffled. Abdomen is swollen, there is borborygmus in the region of ubbilicus, liver is enlarged by 3 cm. Stool is liquid, dark-green, with admixtures of mucus, 5 times a day. What is the most probable diagnosis?
85.
A 52 year old patient has hypervolaemic type of essential hypertension. Which of the following medications is to be prescribed either as monotherapy or in complex with other antihypertensive drugs?
86.
The most available and informative diagnostic method for closed trauma of the urinary bladder is:
87.
A 3 month old infant suffering from acute segmental pneumonia has dyspnea (respiration rate - 80 per minute), paradoxical breathing, tachycardia, total cyanosis. Respiration and pulse - ratio is 1:2. The heart dullness under normal size. Such signs characterise:
88.
A 38 year old man, previously in good health, suddenly develops severe abdominal pain radiating from the left loin to groin and accompanied by nausea, perspiration and the need for frequent urination. He is restless, tossing in bed but has no abnormal findings. The most likely diagnosis is:
89.
A patient has restrained umbilateral hernia complicated by phlegmon hernia, it is necessary to take following actions:
90.
A woman of a high-risk group (chronic pyelonephritis in anamnesis) had vaginal delivery. The day after labour she complained of fever and loin pains, frequent urodynia. Specify the most probable complication:
91.
The average body lenth of newborn boys is 50,9 cm at a sigma 1,66; and average mass - 3432 at a sigma 5,00. What criterion is necessary in order to compare degree of variability of these signs?
92.
What is the maximum duration of medical certificate in case of tuberculosis?
93.
A maternity hospital registered 616 live births, 1 stillbirth, 1 death on the 5th day of life over a 1 year period. What index allows the most precise estimation of this situation?
