2019 Krok Booklet From variant 52, Questions 101-150
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- 2019 booklet Questions 1-50
- 2019 booklet Questions 51-100
- 2019 booklet Questions 101-150 (You are Here)
- 2019 booklet Questions 151-200
Answers contain an “*” on the answer.
101. A 3-month-old child with signs of ricketspresents with positive Chvostek, Trousseau, and Maslov signs. One day ago the parents witnessed a cyanotic attack in their child – the child broke into a cold sweat, the eyes bulged, and respiratory arrest occurred. One minute later the child drew in a loud breath and the child’s condition normalized again. What is the cause of the described signs of the disease?
A. Increase of blood calcium levels
B. Increase of blood phosphorus levels
C. *Decrease of blood calcium levels
D. Decrease of blood phosphorus levels
E. Metabolic acidosis
102. A 25-year-old man was hospitalized with complaints of pain in his lower abdomen and right lumbar area that appeared one hour ago. Patient’s general state is moderately severe. Body temperature – 38.2°C, heart rate – 102/min. The tongue is dry. The abdomen is painful on deep palpation in the right iliac area and in the Petit triangle. Aure-Rozanov and Gabay signs are positive. Make the provisional diagnosis:
A. Intestinal obstruction
B. *Acute appendicitis
C. Cecal tumor
D. Acute cholecystitis
E. Right-sided renal colic
103. Clinical statistical investigation was performed to determine effectiveness of a new pharmacological preparation for patients with ischemic heart disease. What parametric test (coefficient can be used to estimate the reliability of the results?
A. *Student’s t-distribution
B. Kolmogorov-Smirnov test
C. Matching factor
D. Sign test
E. Wilcoxon signed-rank test
104. A 45-year-old man underwent cardiac surgery one week ago. His general state has been deteriorating since then: dyspnea at rest, retrosternal pain that irradiates to the neck, marked weakness. Objectively his body temperature is hectic. His cardiac borders are expanded. apical beat is weakened. Auscultation detects pericardial friction rub. What is the most likely diagnosis?
A. Acute myogenic dilatation of the heart
B. Acute cardiac aneurysm
C. *Acute pericarditis
D. Myocardial infarction
E. Pulmonary embolism
105. A surgery unit received a person with an incised stab wound on the upper third of the right thigh. Examination detects an incised stab wound 3.0×0.5×2.0 cm in size on the inner surface of the upper third of the right thigh. Bright-red blood flows from deep within the wound in a pulsing stream. Characterize this type of bleeding:
106. A 33-year-old man developed multiple rashes on the skin of his torso and extensor surfaces of his upper and lower limbs. The rashes itch and occasionally fuse together and form plaques. The elements of rash are covered with silver-white fine scales that easily flake off when scratched. Grattage test results in three sequential phenomena: stearin spot, terminal film, and punctate hemorrhage. What diagnosis can be suspected?
C. Lichen ruber planus
D. Secondary papular syphilid
107. A 22-year-old postparturient woman on the 12th day after the normal childbirth informs of elevated body temperature up to 39°C for the last 3 days and pain in her right mammary gland. The right mammary gland is enlarged, hot to touch, tense, hyperemic, and painful. Palpation reveals there a dense infiltration 8×8 cm with a fluctuation in its center. What is the most likely diagnosis?
A. *Postpartum period, day 12. Right-sided infiltrative-purulent mastitis
B. Postpartum period, day 12. Right-sided serous mastitis
C. Postpartum period, day 12. Right-sided gangrenous mastitis
D. Postpartum period, day 12. Right-sided phlegmonous mastitis
E. Postpartum period, day 12. Right-sided lactostasis
108. A 45-year-old woman complains of intolerable paroxysmal facial pain on the left with attacks that last for 1-2 minutes. Attacks are provoked by chewing. The disease onset was two months ago after the overexposure to cold. Objectively: pain at the exit points of the trigeminal nerve on the left. Touching near the wing of the nose on the left induces a pain attack with tonic spasm of the facial muscles. What is the most likely diagnosis?
A. Glossopharyngeal neuralgia
B. Maxillary sinusitis
C. *Trigeminal neuralgia
D. Temporomandibular joint arthritis
E. Facial migraine
109. A 15-year-old girl complains of dizziness and sensation of lack of air that she develops in emotionally straining situations. Relief occurs after she takes corvalol. Objectively hyperhidrosis and marble-like pattern of the skin of her palms and feet. Clinical and instrumental examination revealed no organic changes in the central nervous, cardiovascular, and respiratory systems. What provisional diagnosis can be made?
A. *Somatoform autonomic dysfunction
B. Acute epiglottitis
C. Stenosing laryngotracheitis
D. Obstructive bronchitis
E. Bronchial asthma
110. A 32-year-old woman complains of tumor-like formation on the anterior surface of her neck that appeared 2 years ago. Within the last 3 months the tumor has been rapidly growing. It hinders swallowing and impairs speech; the tumor causes a sensation of pressure. Objectively the skin moisture is normal, pulse is 80/min., rhythmic, blood pressure is 130/80 mm Hg. In the right lobe of the thyroid gland there is a dense lumpy node 3.0×3.5 cm that moves during swallowing. Scanning image shows a “cold nodule” in the thyroid gland. Make the provisional diagnosis:
A. Autoimmune thyroiditis
B. Thyroid adenoma
C. Thyroid cyst
D. Nodular goiter
E. *Thyroid cancer
111. A 3-week-old infant developed large, flaccid vesicles with purulent contents on the skin of chest and abdomen. The vesicles rupture quickly. Make the provisional diagnosis:
A. Toxic erythema
B. *Pemphigus neonatorum
C. Pseudo Furunculosis
D. Vesiculo Pustulosis
E. Pemphigus syphiliticus
112. Disease onset was acute. A developed general weakness, pain in the joints, and elevated temperature. Later these signs became accompanied by itching skin rash manifested as erythematous spots 25 mm in size. The rash gradually turned hemorrhagic. Large joints are painful and swollen: pain attacks periodically occur in the periumbilical area; there are signs of intestinal hemorrhage. What is the most likely diagnosis?
A. Scarlet fever
B. *Hemorrhagic vasculitis (Henoch-Schonlein purpura)
C. Hemorrhagic meningoencephalitis
D. Streptococcal impetigo
113. A 23-year-old woman came to the gynecological clinic. She complains of pain, itching and burning in her vulva, general weakness, indisposition, elevated body temperature up to 322°C, and headache. On examination in the vulva there are multiple vesicles up to 2-3 mm in diameter with clear contents against the background of hyperemia and mucosal edema. Make the provisional diagnosis:
A. Papillomavirus infection
B. Cytomegalovirus infection
C. Vulvar cancer
D. *Genital herpes infection
E. Primary syphilis
114. A 72-year-old man complains of lower extremity edema, sensation of heaviness in the right subcostal area, dyspnea at rest. For over 25 years he has been suffering from COPD. Objectively: orthopnea, jugular venous distention, diffuse cyanosis, acrocyanosis. Barrel chest is observed, on percussion there is a vesicular tympanitic (bandbox) resonance, sharply weakened vesicular respiration on both sides, moist crepitant crackles in the lower segments of the lungs. Heart sounds are weakened, the II heart sound is accentuated over the pulmonary artery. The liver is +3 cm. What complicated the clinical course of COPD in this patient?
A. Pulmonary embolism
B. Diffuse pneumosclerosis
C. Acute left ventricular failure
D. Community-acquired pneumonia
E. *Chronic pulmonary heart
115. A woman is 40 weeks pregnant. The fetus is in the longitudinal lie and cephalic presentation. Pelvic size: 26-29-31-20. Expected weight of the fetus is 4800 gram. The labor contractions have been lasting for 12 hours, within the last 2 hours they were extremely painful. The parturient woman is anxious. The waters broke 4 hours ago. On external examination the contraction ring is located 2 finger widths above the navel, Henkel-Vasten sign is positive. Fetal heart rate is 160/min., muffled. On internal examination the uterine cervix is fully open, the head is engaged and pressed to the entrance into the lesser pelvis. What is the most likely diagnosis?
A. Anatomically contracted pelvis
B. Hyperactive uterine contractions
C. *Threatened uterine rupture
D. Abruption of the normally positioned
E. Complete uterine rupture
116. A 17-year-old girl has made an appointment with the doctor. She plans to begin her sex life. No signs of gynecological pathology were detected. In the family history the patient’s grandmother had cervical cancer. The patient was consulted about the maintenance of her reproductive health. What recommendation will be the most helpful for prevention of invasive cervical cancer?
A. Timely treatment of sexually transmitted diseases
B. *Vaccination against human papillomavirus (HPV)
C. Antiviral and antibacterial drugs
E. Vitamins, calcium, omega-3
117. A 52-year-old man for the last 3 years has been suffering from difficult swallowing of solid food, burning retrosternal pain that aggravated during eating, loss of body mass, and occasional vomiting with undigested food. Esophageal X-ray shows S-shaped deformation of the esophagus and its dilation; at the cardiac orifice the esophagus is constricted: esophageal mucosa is smooth, without signs of peristalsis. Make the provisional diagnosis
A. Diaphragmatic hernia
B. Reflux esophagitis
C. Esophageal achalasia
D. Esophageal diverticulum
E. *Esophageal carcinoma
118. A 30-year-old man was brought to the neurosurgical department with complaints of constant headaches, nausea, vomiting, fever, and weakness of the right-side limbs. Anamnesis states that one month ago the patient had surgery for left-sided suppurative otitis and mastoiditis. He has been undergoing treatment in an ENT department. Approximately 2 weeks ago the temperature increased, and the patient developed headaches. Objectively: heart rate – 98/min., BP-140/90 mm Hg, temperature – 38.3°C. Neurologically manifested stiff neck: bilateral Kernig’s symptom. unsteadiness during the Romberg’s maneuver. Computer tomography of the brain revealed a three dimensional growth with a capsule in the left hemisphere. Make the diagnosis:
A. Arnold-Chiari malformation
C *Cerebral abscess
119. A 65-year-old man complains of dyspnea, severe cough with expectoration of small amounts of blood-streaked sputum, weight loss, body temperature 37.2°C. loss of appetite, and weakness. He has been suffering from this condition for years. The patient’s condition deteriorated one year ago, dyspnea developed 3 weeks ago. The patient is a lifelong smoker. He is a carpenter by occupation. Objectively he is of normal body type but emaciated. Right side of the chest is retracted, excursions are limited, accessory muscles take part in the respiration, respiratory rate is 22 /min percusion detects dull sound over the upper segment. Chest X-ray shows shrunken right upper lobe with homogenous shadow connected to the root of the lung: the root is deformed: mediastinal organs are displaced to the right. What is the most likely diagnosis?
A. Pulmonary tuberculosis
B. Pulmonary sarcoidosis
C. Complete right-sided pneumothorax
D. Fibrosing alveolitis
E. *Obstructive atelectasis
120. A 20-year-old student after failing an exam developed complaints of a sensation of a round foreign body in her throat, difficult swallowing. She fixates on her condition, limits her diet, often cries, seeks attention, exhibits demonstrative attitude. She is highly susceptible to psychotherapeutic suggestions. What psychiatric diagnosis can be made in this case?
A. *Hysterical neurosis
B. Depressive neurosis
C. Paranoid personality disorder
D. Hypochondriacal neurosis
E. Obsessive neurosis
121. Having studied the relationship between the distance from villages to the local outpatient clinics and frequency of visits to the clinics among the rural population of this area it was determined that the rank correlation coefficient in this case equals -0.9. How can this relationship be characterized?
A. Moderate inverse relationship
C. *Strong inverse relationship
D. Moderate direct relationship
E. Strong direct relationship
122. A 39-year-old man suffers from chronic adrenal insufficiency and receives replacement glucocorticoid therapy (hydrocortisone – 15 mg/day). He is to undergo elective surgery for calculous cholecystitis. What medication adjustment should be made on the day of the surgery to prevent the development of acute adrenal insufficiency?
A. Add an antibiotic
B. *Increase the dosage by 2-3 times
C. Add a mineralocorticoid
D. Prescribe a large volume intravenous fluid infusion
E. Cancel the drug for the day of the surgery
123. After a pain attack in the right subcostal area, a 38-year-old woman with overnutrition developed icteric skin and sclera, light colored feces, and dark urine. Her abdomen is distended and painful on palpation in the right subcostal area. Palpation detects liver enlargement by 2-3 cm. Blood test: total bilirubin – 90 mcmol/l, conjugated bilirubin60 mcmol/L, What method of examination will be the most informative for diagnosis clarification?
A. Intravenous cholegraphy
B. *Retrograde cholangiopancreatography
C. Infusion cholegraphy
D. Percutaneous transhepatic cholegraphy
E. US of the hepatopancreatobiliary zone
124. A 65-year-old woman on abdominal palpation presents with a tumor in the umbilical region and above it; the tumor is 13×8 cm in size, moderately painful, nonmobile, pulsing. On auscultation systolic murmur can be observed. What is the most likely diagnosis?
A. Bicuspid insufficiency
B. Tricuspid insufficiency
C. *Abdominal aortic aneurysm
D. Arteriovenous aneurysm
E. Gastric tumor
125. A woman has been provisionally diagnosed with pheochromocytoma. At the stage of intermission her BP is within norm: there is a tendency towards tachycardia. No urine pathologies. The decision has been made to perform a provocative test with histamine. What drug should be kept close at hand for emergency aid in case of a positive test result?
D. Pipolphen (Promethazine)
E. Mesaton (Phenylephrine)
126. A middle school teacher with a 4-year long record of work was issued a medical certificate for pregnancy and childbirth leave. What amount of pay will she receive for the duration of her leave in this case?
A. 50% of average salary
B. 70% of average salary
C. 60% of average salary
D. 80% of average salary
E. *100% of average salary
127. A 38-year-old woman developed a medical condition 7 days after her return from Bangladesh. Periodical elevation of temperature was accompanied by chills and excessive sweating. She was diagnosed with tropical malaria. Next day her condition further deteriorated: body temperature – 38°C. inertness, periodical loss of consciousness, generalized seizures, tachycardia. hypotension, and icteric skin. What complication can be suspected in this case?
A. Serous meningitis
B. Purulent meningitis
C. Acute hepatic failure
D. Acute heart failure
E. *Cerebral coma
128. A 45-year-old man was brought by an ambulance into the emergency hospital. He complains of sudden pain in the lumbar area frequent painful urination, and vomiting Examination detects pain in the lumbar area. costovertebral angle tenderness, pain on palpation of kidneys and along the ureter on the right. Urine test: proteins, fresh erythrocytes, leukocytes. Make the provisional diagnosis:
A. Polycystic kidney disease
B. Acute glomerulonephritis
C. Acute pyelonephritis
D. *Urolithiasis, renal colic
E. Acute renal failure
129. An 8-year-old girl complains of frequent painful urination in small amounts and urinary incontinence. The signs have been present for 2 days already. She explains her disease by overexposure to cold. Costovertebral angle tenderness is absent. Complete blood count is without pathologies. Urine test: leukocytes – 20-30 in the vision field, erythrocytes – 40-50 in the vision field, unchanged, bacteriuria. What is the most likely diagnosis?
130. After a surgery for a left thigh phlegmon the disease progression was complicated by sepsis. On the 7th day after the surgery there are marked signs of a generalized inflammatory reaction, in blood there are signs of toxic anemia and progressing hypoproteinemia, bilirubin levels are 40 mcmol/L, AST and ALT exceed the norm by 2.5 times. Oliguria persists (700 mL of urine per day). Name the phase of sepsis progression:
A. Mixed phase
B. Stress phase
C. *Catabolic phase
D. Recovery phase
E. Anabolic phase
131. 3 hours after a trauma, a young man developed bradycardia of 46/min., anisocoria D>s, hemi-hyperreflexia S>D, hemihypesthesia on the left, and a convulsive disorder. The character of this process needs to be clarified. What method of examination will be the most accurate for this purpose?
B. *Brain CT
D. Skull X-ray
E. Lumbar puncture
132. Having examined a 52-year-old patient, the doctor diagnosed him with obesity (body mass index – 34 kg/m2. waist circumference – 112 cm) and arterial hypertension (170/105 mm Hg). 2-hour postprandial blood sugar is 10.8 mmol/L. What biochemical blood analysis needs to be conducted to diagnose the patient with metabolic syndrome X?
B. Creatinine and urea
C. Calcium and phosphorus
E. *Lipid profile
133. Mother of a 5-year-old child noticed on the head of her child a round “bald” spot 3 cm in diameter. All the hairs in the focus are broken off at the length of 5-6 mm. The day before the child was petting a stray cat. Make the diagnosis:
A. Superficial trichophytosis
C. Alopecia areata
D. Deep trichophytosis
134. A 23-year-old man complains of facial edemas, headache, dizziness, low urinary output, and urine discoloration (dark red). These complaints arose after a case of acute tonsillitis. On examination there are facial edemas, the skin is pale, temperature is 374°C; heart rate is 86/min., blood pressure is 170/110 mm Hg. Heart sounds are muffled, the II heart sound is accentuated over the aorta. What etiological factor is the most likely in this case?
A. Streptococcus pyogenes
B. Streptococcus viridans
C. Staphylococcus aureus –
D. *Beta-hemolytic streptococcus
E. Staphylococcus saprophyticus
135. A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset. What is the most likely diagnosis?
A. Acute bronchitis
B. *Stenosing laryngotracheobronchitis
C. Acute pulmonary inflammation
D. Bronchial asthma
E. Acute bronchiolitis
136. A 35-year-old patient developed an epileptic attack with tonic clonic spasms that lasted for 3 minutes. After the attack the patient fell asleep but in 5 minutes the second attack occurred. The first step of emergency aid would be to:
A. Introduce diazepam intravenously
B. Prescribe antiepileptic drugs
C. *Ensure patency of airways
D. Take blood from the vein for analysis
E. Administer chloral hydrate via an enema
137. A young man has made an appointment with the dermatologist. He complains of a painful facial rash in the beard and mustache area. This condition has been persisting for several weeks already. After shaving, the patient’s condition aggravates. The diagnosis of sycosis is made. What primary morphological elements can be observed in the rash in this case?
A. Maculae, nodes
B. Pustules, bumps
C. Phlyctenae, maculae
D. Nodes, nodules
E. *Pustules, papulae
138. A 26-year-old man complains of chills, rhinitis, dry cough, and fever up to Examination shows him to be in a moderately severe condition, there are small pale pink non-merging spots on the skin of his abdomen, and extremities. Palpation revealed enlarged occipital and axillary lymph nodes. No information about vaccination history could be obtained. What is the likely etiology of this disease?
A. Mumps virus
C. Epstein-Barr virus
D. Neisseria meningitis
E. *Rubella virus
139. A 37-year-old man suddenly developed an acute headache accompanied by nausea. vomiting, and impaired consciousness. Objectively blood pressure is 190/120 mm Hg. The face is hyperemic. Patient’s consciousness is clouded, his answers to the questions are short, monosyllabic. Movement and sensory disturbances are absent. Meningeal signs are positive. Cerebrospinal fluid contains blood. What provisional diagnosis can be made?
A. *Subarachnoid hemorrhage
D. Ischemic stroke
E. Cerebral vascular embolism
140. A 45-year-old man diagnosed with acute pulmonary abscess suddenly developed sharp pain in his chest on the right and dyspnea up to 30/min. Examination detects facial cyanosis and shallow rapid respiration. Auscultation reveals acutely weakened respiration throughout the whole right lung percussion reveals a vesicular tympanitic (bandbox) resonance at the lung apex and dullness in the lower lobe. What complication developed in this patient?
C. Acute mediastinitis
E. Esophageal perforation
141. 2 hours after a traffic accident a 28-year old man in a grave condition was brought to a hospital. The patient complains of abdominal pain. He received a blow to the abdomen with the steering wheel. Objective examination revealed the following: the abdomen does not participate in respiration, is tense and acutely painful on palpation: the abdominal muscles are defensively tense, peritoneal irritation signs are positive, hepatic dullness is absent. BP is 90/60 mm Hg, heart rate is 120/min. What further treatment tactics should be chosen?
B. Ultrasound investigation
D. Cold to the abdomen
142. A 48-year-old woman developed insomnia, depressive mood, anxiety, fears and suicidal thoughts after the death of her husband that occurred one month ago. During her stay in the hospital she speaks in a low voice, is depressed, anxious, avoids sleeping, refuses to eat. What medications should be prescribed in this case?
B. Group B vitamins
143. A woman has been working as a polisher for a year and a half. Her workstation is equipped with a grinding machine (grinding wheels). She complains of white discoloration of her fingers and toes that appears when she is nervous. Objectively there are no changes in the coloration of the distal segments of her limbs. Grip strength measured with a dynamometer is 25 kg, algesimetry findings are 0.1; 0.3; 0.5. Cold stimulus is extremely positive on the upper and lower limbs. Internal organs are without pathologies. Make the diagnosis:
B. Raynaud disease
C. Raynaud syndrome
E. *Vibration disease
144. In April during the medical examination of various population groups, 27% of individuals presented with low working ability and rapid fatigability. The following symptoms were observed in the affected individuals swollen friable gingiva that bleeds when pressed, hyperkeratosis follicularis not accompanied by skin dryness. These symptoms most likely result from the following pathology
A. Poly Hypovitaminosis
145. A 39-year-old man, a battery attendant, suddenly developed weakness, loss of appetite, non localized colicky abdominal pains, and nausea. Objectively his skin is gray. there is a pink-gray stripe on his gums, the stomach is soft and sharply painful. Blood test detected erythrocytes with basophilic stippling and anemia. The patient has a history of peptic ulcer disease of the stomach. Constipation tends to occur every 3-4 days. What is the most likely provisional diagnosis?
A. Acute appendicitis
B. Acute cholecystitis
C. Perforation of gastric ulcer
D. *Saturnism (lead poisoning)
E. Chronic alcoholism
146. A 62-year-old patient has been hospitalized with complaints of pain in the thorax on the right during breathing, dyspnea, and dry cough. Ten days ago he slipped and fell hitting his right side. On examination: the patient lies on the left side. The right side of the thorax lags during breathing. On the right there is crepitation and pain in the III-IV ribs. Dullness of percussion sound and sharply diminished breath sounds can be observed. On X-ray: signs of exudate, fracture of the IIIIV ribs. On pleurocentesis: blood is detected. Choose the further tactics.
A. *Transfer to a thoracic surgery department
B. Prescribe conservative therapy
C. Perform repeated pleural taps
D. Apply a fixation bandage to the rib cage
E. Refer to a traumatologist
147. A 38-year-old patient has been brought by an ambulance to the surgical department with complaints of general weakness, indisposition. black stool. On examination the patient is pale, there are dotted hemorrhages on the skin of his torso and extremities. On digital investigation there are black feces on the glove. Blood test: Hb. 108 g/L thrombocytopenia. Anamnesis states that a similar condition was observed 1 year ago. Make the diagnosis:
B. Ulcerative bleeding
C. *Thrombocytopenic purpura
D. Rectal tumor
E. Nonspecific ulcerative colitis
148. A 10-year-old boy, who was outdoors in Windy and cold weather, developed pain and tingling in his fingers and toes when he returned home. His parents noticed that the tips of his fingers and toes were white and their sensitivity was lost. As the affected areas were warming up the fingers and toes developed tingling and painful sensations. Skin pallur changed into redness, tingling stopped. Mild itching and swelling of the fingers appeared. Determine the frostbite degree in this child!
A. Frostbite of the III degree
B. Frostbite of the IV degree
C. Frostbite of the II degree
D. *Frostbite of the I degree
149. A 24-year-old woman, a kindergarten teacher, has been sick for 2 days already Disease onset was acute. She presents with elevated body temperature up to 38.0°C, pain attacks in her lower left abdomen, liquid stool in small amounts with blood and mucus admixtures 10 times a day. Pulse – 98/min.. blood pressure – 110/70 mm Hg. Her tongue is moist and coated with white deposits. The abdomen is soft, the sigmoid colon is painful and spastic. Make the provisional diagnosis
E. Rotavirus infection
150. A 36-year-old man complains of marked dyspnea and cardiac pain. He ascribes his disease to the case of influenza that he had 2 weeks ago. Objectively he leans forward when sitting. The face is swollen. cyanotic, cervical veins are distended. Heart borders are extended on both sides, heart sounds are muffled, heart rate = Ps = 118/min., BP is 90/60 mm Hg. Blood test: ESR is 46 mm/hour. ECG shows low voltage. X-ray shows trapezoidal cardiac silhouette and signs of pulmonary congestion. Choose the treatment tactics:
C. *Pericardial puncture (pericardiocentesis)
- 2019 booklet Questions 101-150 with Explanations and highlights
- 2019 booklet Questions 151-200