2019 Krok Booklet From variant 52, Questions 151-200
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- 2019 booklet Questions 151-200 (You are Here)
Answers contain an “*” on the answer.
151. A 73-year-old woman came to the family physician for one of her regular follow-up examinations. Three months ago she was found to have type 2 diabetes mellitus. She was keeping to her diet and exercise plan and taking phytopreparations. On examination her fasting glucose was within the range of 7.8 – 8.6 mmol/L, HbAlc – 79%. Height – 134 cm, weight – 83 kg. What blood sugar-controlling medicine should she be prescribed first in the course of her pharmacological therapy?
152. A newborn girl has an Apgar score of 7-8 points at the 1-5 minutes after birth. During the labor there was a brief difficulty with extraction of the shoulder girdle. After birth the baby presents with disturbed function of the proximal segment and forced position of the right arm. The shoulder is inwards, the elbow is extended, the forearm pronated, and the whole upper limb resembles the arm of a doll. What is the most likely clinical diagnosis in this case?
A. Thoracic spine trauma
B. *Erb-Duchenne palsy
C. Intracranial hemorrhage
D. Soft tissue injury of the right arm
E. Osteomyelitis of the right arm
153. 2 hours after eating unknown mushrooms a 28-year-old man sensed a decrease in his mobility and deterioration of his ability to focus. This condition was then followed by a state of agitation and aggression. On examination he is disoriented and his speech is illegible. 4 hours later he developed fetor hepaticus and lost his consciousness. What syndrome can be observed in this patient?
A. *Acute hepatic failure
B. Cholestatic syndrome
C. Hepatolienal syndrome
D. Cytolytic syndrome
E. Portal hypertension
154. A 45-year-old woman came to the maternity clinic with complaints of periodical pains in her mammary glands that start 1 day before menstruation and stop after the menstruation begins. Palpation of the mammary glands detects diffuse nodes predominantly in the upper outer quadrants What is the most likely diagnosis?
A. Breast cyst
B. *Fibrocystic mastopathy
E. Breast cancer
155. A 32-year-old man complains of pain in his legs that intensifies during walking was intermittent claudication, numbness of his toes, extremity coldness, and inability to walk more than 100 meters. When he sleeps his leg usually hangs down. The patient has been smoking since he was 16. He drinks alcohol in excess. The left leg is colder than the right one; the skin of the extremities is dry. No pulse can be detected on the pedal arteries, while pulsation of the femoral arteries is retained. What is the most likely diagnosis?
A. *Obliterating endarteritis
B. Raynaud disease
C. Deep thrombophlebitis
D. Leriche syndrome (aortoiliac occlusive disease)
E. Diabetic angiopathy
156. A 46-year-old woman came to the maternity clinic with complaints of moderate blood discharge from the vagina, which developed after the menstruation delay of 1.5 months. On vaginal examination: the cervix is clean; the uterus is not enlarged, mobile, painless; appendages without changes. Make the diagnosis:
A. Cancer of the uterine body
B. Ectopic pregnancy
D. *Dysfunctional uterine bleeding
E. Submucous uterine myoma
157. A woman undergoing in-patient treatment for viral hepatitis type B developed a headache. nausea. recurrent vomiting, memory lapses, flapping tremor of her hands. and rapid pulse. Sweet smell from her mouth is detected. Body temperature is 376°C and the heart rate is 89/min. What complication developed in the patient?
A. Ischemic stroke
B. Hypoglycemic shock
C. *Acute liver failure
E. Gastrointestinal hemorrhage
158. An 18-year-old patient always obeys others and adapts his needs to the demands of the people on whom he depends. He excessively defers to their wishes and makes them responsible for his well being, cannot defend his interests and needs support from other people. Such a psychic profile has been formed in childhood, and remains unchanged. and hinders adaptation. What psychic disorder is observed in this patient?
A. Anxiety (avoidant) personality disorder
B. Anankastic personality disorder
C. Psychopathy-like state
D. *Dependent personality disorder
E. Markedly accentuated personality
159. It is the 3rd day after the first normal term labor; the infant is rooming-in with the mother and is on breastfeeding. Objectively: the mother’s general condition is satisfactory Temperature is 36.4°C, heart rate is 80/min., BP is 120/80 mm Hg. Mammary glands are soft and painless, lactation is moderate, unrestricted milk flow. The uterus is dense, the uterine fundus is located 3 finger widths below the navel. Lochia are sanguino-serous. moderate in volume. Assess the dynamics of uterine involution:
C. *Physiological involution
D. Pathologic involution
160. A boy had a foreign body removed from under his nail plate. 3 days later he developed a sharp throbbing pain at the end of his distal phalanx, which intensifies when the phalanx is pressed, hyperemia of the nail fold, elevated body temperature up to 38.5°C, and nail plate discoloration. Make the diagnosis:
A. *Subungual panaritium
161. A 42-year-old man, a dispatcher, suffers from peptic ulcer disease of the duodenum. The disease is of moderate severity. He wants to be assigned a disability group. Make the conclusion regarding his working ability:
A. Capable of working, non-employable
B. Second group of disability
C. Third group of disability
D. First group of disability
E. *Capable of working, employable
162. A 48-year-old woman has arrived to the surgical unit with wounds in her thigh. On examination the wound surface has dirty-gray coating with unpleasant sweet smell. Wound content resembles raspberry jelly. Skin tissues around the wound are glossy and turgid. Palpation reveals moderate crepitation in the tissues. What microflora is the most likely to cause such inflammation?
A. Blue pus bacillus
D. *Anaerobic clostridial
E. Anaerobic non-clostridial
163. A 10-year-old girl exhibits a high level of physical development (M + 30). her body length increased by 10 cm within a year (which is double the norm for her age group), the number of permanent teeth corresponds with the age norm (20), the development of her secondary sex characteristics is three years ahead of her age (Ma, P, Ax, Menarche). Development rate ahead of her biological age can occur due to:
A. Sports training
C. Deficient hygienic education
D. *Endocrine disorders
E. Certain components of her diet
164. In the inpatient gynecological unit within a year 6500 women underwent treatment. They spent there a total of 102000 bed-days there. What indicator of the gynecological unit work can be calculated based on this data?
A. Bed turnover rate
B. Average bed occupancy rate per year
C. Number of beds by hospital department
D. Planned bed occupancy rate per year
E. *Average length of inpatient stay
165. A 57-year-old woman complains of weakness, dyspnea, loss of appetite, and liquid feces. She has been suffering from this condition for 2 years. Objectively she presents with pale skin, subicteric sclerae, and bright red fissured tongue. Lymph nodes are not enlarged. Pulse – 100/min. BP- 105/70 mm Hg. Liver +3 cm, the spleen cannot be palpated. Blood test: erythrocytes – 1.2.102/L, Hb- 56 g/L, color index – 1.4. macrocytes, leukocytes – 2,5 . 10°/L, eosinophils – 1%, juvenile – 1%. metamyelocytes – 1%, band neutrophils – 8%, segmented neutrophils – 47%, lymphocytes – 38%, monocytes – 4%, reticulocytes – 0.1% platelets – 10010°/L, ESR- 30 mm/hour, indirect bilirubin – 26 mmol/L. What changes can be expected in the bone marrow puncture material?
A. *Prevalence of megaloblasts
B. Presence of blast cells
C. Increased number of sideroblasts
D. Prevalence of lymphoid tissue
E. Erythroid hyperplasia
166. The burns unit received a patient, who 6 hours ago during a fire received flame burns. On the patient’s body there is a gray brown area of necrosis that covers 3/4 of the body perimeter. Occasionally there are small blisters with hemorrhagic contents and patches of shredded epidermis. What local therapy is necessary in this case?
A. Chemical necrolysis
B. *Decompression necrectomy
C Necrectomy with dermal autograft
D. Necrectomy with xenotransplantation
E. Blister puncture
167. A 45-year-old woman is registered for regular check-ups due to Werlhof disease (immune thrombocytopenia). Complete blood count: Hb- 100 g/L. erythrocytes – 2.8. 109/L. platelets – 90.0 . 10°/L, leukocytes – 8.4 -10°/L. erythrocyte sedimentation rate – 13 mm/hour. Examination detects a single small hematoma on the anterior surface of the thigh, developed after the patient accidentally stumbled on a table. What treatment tactics should be chosen in this case?
A. Administer thrombocytic mass, continue the treatment in the hematology unit
B. *Continue the supervision by the hospital hematologist
C. Urgent hospitalization into the general care unit
D. Urgently start a hemostatic therapy followed by a planned hospitalization into the hematology unit
E. Urgent hospitalization into the hematology unit
168. In the process of hiring, a prospective employee has undergone preventive medical examination and was declared fit to work in this manufacturing environment. What type of preventive medical examination was it?
169. A 27-year-old woman, a teacher in the elementary school, complains of frequent stools, up to 3 times per day, with lumpy feces and large amount of mucus, abdominal pain that gradually abates after a defecation. irritability. Her skin is pale and icteric. Pulse IS 74/min, rhythmic, can be characterized as satisfactory. Blood pressure is 115/70 mm Hg. The abdomen is soft, moderately tender along the colon on palpation. Fiberoptic colonoscopy detects no changes. What disease can be suspected?
A. Whipple disease
B. Chronic enteritis
C. Crohn disease (regional enteritis)
D. Chronic non-ulcerative colitis
E. *Irritable bowel syndrome
170. A 6-month-old child on breastfeeding is hospitalized in the inpatient department. After the child recovers, the doctor recommends the mother to start introducing solid food to the child’s diet. What products should be introduced to the child’s diet first?
A. Buckwheat porridge
B. Semolina porridge
C. Fermented dairy products
D. Grated apple
E. *Vegetable puree
171. 10 hours after birth a child developed jaundice, hypotonia, hyporeflexia, and moderate hepatosplenomegaly. Feces and urine are of normal color. Umbilical cord blood bilirubin is 51 mcmol/L due to unconjugated bilirubin levels. In venous blood: erythrocytes – 3.5 . 1012/L, Hb- 140 g/L. reticulocytes – 1.5%, bilirubin – 111 mcmol/L, conjugated – 11 mcmol/L, ALT-40 U/L, AST- 30 U/L. Mother’s blood group is A(II) Rh(-), child’s blood group is A(II) Rh(+). What laboratory test can confirm the diagnosis?
A. Viral hepatitis markers analysis
B. *Coombs test
D. Measurement of erythrocyte osmotic resistance
E. Measurement of glucose 6-phosphate dehydrogenase levels in erythrocytes
172. The body of a 24-year-old woman with suspected poisoning has been found on the street. Forensic medical examination was requested by an investigator during examination of the site and the body. According to the Criminal Procedure Code currently in force in Ukraine, forensic medical examination is required when it is necessary to determine the:
A. *Cause of death
B. Mode of death
C. Manner of death
D. Mechanism of death
E. Time of death
173. During regular preventive gynecological examination a 30-year-old woman was detected to have dark blue punctulated “perforations on the vaginal portion of the uterine cervix. The doctor suspects endometriosis of the vaginal portion of the uterine cervix. What investigation method would be most informative for diagnosis confirmation?
A. Hormone testing
B. *Colposcopy, target biopsy of the cervix
C. US of the lesser pelvis
E. Curettage of the uterine cavity
174. A 72-year-old man with pneumonia complains of marked dyspnea, chest pain, severe cough with expectoration, is 39.5-40°C, no urination for a whole day. Objectively the patient is conscious. Respiratory rate is 36/min. Over the right lower pulmonary lobe percussion sound is dull: on auscultation there is bronchial respiration and numerous moist crackles. Blood pressure is 80/60 mm Hg. Heart rate is 120/min. Heart sounds are muffled, there is tachycardia. What tactics should the family doctor choose in the management of this patient?
A. Treatment in the day patient facility
B. *Hospitalization into the intensive care unit
C. Hospitalization into the pulmonology unit
D. Outpatient treatment
E. Hospitalization into the neurology unit
175. A parturient woman is 30 years old, Stage 1 of the labor is ongoing. The fetus is in the cephalic presentation. Auscultation of the fetal heart sounds detects bradycardia. Evaluation of cardiotocogram yielded the following data: decrease of basal heart rate down to 90/min., variability – monotonous (2 and less): late decelerations with amplitude of 50/min. Make the diagnosis and choose the obstetrical tactics necessary in this case:
A. Fetal distress. Stimulation of uterine contractions
B. Fetal distress. Vacuum extraction delivery
C. *Fetal distress. Urgent cesarean section delivery
D. Fetal distress. Forceps delivery
E. Normal condition of the fetus. Vaginal birth
176. A 42-year-old man, a worker at the meat processing factory, developed an itching spot on his lower jaw, which gradually transformed into a slightly painful carbuncle 3 cm in diameter, surrounded by a painless swelling that reaches the clavicle. Temperature is subfebrile, under 37.8°C. The doctor suspects anthrax. What drug should this man be prescribed for treatment?
A. Interferon alpha
B. Biseptol (Co-trimoxazole)
D. Azidothymidin (Zidovudine)
E. Levomycetin (Chloramphenicol)
177. The dermatologist has an appointment with a 30-year-old man that complains of severely itching rashes that especially disturb him at night. The rashes developed 2 weeks ago, after he had returned from a travel. Objectively on the lateral surfaces of his fingers, hands, wrists, elbows. lower abdomen, genitals, and thighs there are paired papulovesicles, single pustules, and scratch marks. What disease can be suspected?
178. Clinical trials have proved the “Lipoflavon” drug to be effective for treatment of unstable angina pectoris in the control group and experimental group of patients. Neither patients nor researchers knew who belonged to which group. Name this type of study:
A. *Double blind study
B. Simple blind study
C. Total-blind study
D. Multicenter study
E. Triple-blind study
179. A 39-year-old man suffers from chronic rheumatic heart disease. He complains of dyspnea during physical exertion, cough with expectoration, and palpitations. Auscultation detects intensified I heart sound and diastolic murmur; the sound of opening mitral valve can be auscultated at the cardiac apex. The II heart sound is accentuated over the pulmonary artery. The patient is cyanotic. X-ray shows dilated pulmonary root and enlargement of the right ventricle and left atrium. What is the most likely diagnosis?
A. *Patent ductus arteriosus
B. Pulmonary artery stenosis
C. Mitral stenosis
D. Aortic stenosis
E. Coarctation of the aorta
180. A 43-year-old man complains of a protrusion in the right inguinal region, that enlarges due to strain. He has been pre with this condition for 6 months. Within this period the protrusion has grown. Objectively in the right inguinal region an elastic protrusion 8×5 cm is visible. On palpation it disappears, leaving an empty space 4×4 cm between the pedicles of the Poupart ligament. “Cough push” sign is positive over this opening. Make the diagnosis:
A. *Right-sided reducible inguinal hernia
B. Right-sided inguinal lymphadenitis
C. Cyst of the right spermatic cord
D. Right-sided reducible femoral hernia
E. Right-sided reducible arcuate line hernia
181. A 56-year-old woman was diagnosed with stage 2 hypertension of the 2nd degree. She belongs to the group of moderate risk and has bronchial asthma. What group of drugs is CONTRAINDICATED to this patient?
A. Calcium antagonists
C. Imidazoline receptor antagonists
E. Angiotensin-converting enzyme inhibitors
182. In a rural health care area there is an increasing cervical cancer morbidity observed. The decision is made to conduct a medical examination of the women living in this locality. What type of medical examination is it?
183. A 25-year-old woman complains of fatigue, dizziness, hemorrhagic rashes on the skin. She has been presenting with these signs for a month. Blood test: erythrocytes 10 109/L, Hb- 37 g/L, color index – 1.1, leukocytes – 12. 109/L. platelets – 42 . 10°/L. What analysis would be the most advisable diagnosis-making in this case?
A. Splenic biopsy
B. Coagulation studies
C. US of the gastrointestinal tract
D. *Sternal puncture (bone marrow biopsy)
E. Liver biopsy
184. A patient has gradually lost consciousness. The skin is pale and dry. There is a smell of ammonia from the mouth. Respirations are deep and noisy. Heart sounds are muffled, pericardial friction rub is present Blood pressure is 180/130 mm Hg. Blood test Hb- 80 g/L, leukocytes – 12 . 10°/L, blood glucose – 6.4 mmol/L, urea – 50 mmol/L creatinine – 1200 mcmol/L, blood osmolarity – 350 mOsmol/L. No urinary excretion. Mak the diagnosis:
A. Acute renal failure
B. Acute disturbance of cerebral circulation
C. *Uremic coma
D. Hyperglycemic coma
E. Hyperosmolar coma
185. A 3-year-old child presents with dyspnea that abates in the sitting position. occasional loss of consciousness and seizures, delayed physical development, cyanosis, drumstick fingers. Echocardioscopy detects aortic dextroposition, ventricular septal defect, pulmonary artery stenosis, and right ventricular hypertrophy. What is the most likely diagnosis?
A. Coarctation of the aorta
B. Ventricular septal defect
C. Transposition of the great vessels
D. Acquired valvular disease
E. *Tetrad of Fallot
186. Increased general morbidity of the local population is observed in the area near a factory, where the atmosphere is being intensively polluted with sulfurous gas. What effect does polluted air have on the human body in this case?
B. *Chronic nonspecific
C. Acute specific
D. Acute nonspecific
E. Chronic specific
187. A woman in her early- to mid-thirties lost consciousness 3-5 minutes ago. On examination: the skin is pale, no pulse over the carotid arteries, no spontaneous respiration, pupils are dilated; the patient is unresponsive, presents with atony. The patient’s condition can be determined as:
B. Comatose state
C. Brain death
D. *Clinical death
E. Natural death
188. During regular medical examination a lyceum student presents with signs of cheilitis that manifests as epithelial maceration in the area of lip seal. The lips are bright-red, with single vertical cracks covered with brown red scabs. These clinical signs are most likely caused by insufficient content of the following in the diet:
A. Ascorbic acid
189. A 59-year-old man complains of pain in his left eye and left side of his head, significant vision impairment of the left eye, nausea, and vomiting. Visual acuity of the right eye is 1.0. Visual acuity of the left eye is 0.03. attempts at correction bring no improvement. Right eye intraocular pressure – 21 mm Hg, left eye intraocular pressure – 65 mm Hg. Congestive injection is observed on the sclera of the left eye. The cornea is thick and swollen. The anterior chamber is shallow, moist, and clear. The pupil is dilated and unresponsive to the light, the fundus of the eye is not visible. What is the most likely diagnosis?
A. Endophthalmitis of the left eye
B. Acute iridocyclitis of the left eye
C. Panophthalmitis of the left eye
D. *Acute attack of glaucoma of the left eye
E. Stage II intraocular tumor of the left eye
190. Employees work in conditions of high dust concentration. Certain chemical (silicon dioxide content) and physical properties of dust aerosols contribute to the development of occupational dust-induced diseases. What is the main physical property of dust aerosols?
B. Electric charge
191. A 13-year-old girl for a month has been complaining of fatigability, dull pain in her right subcostal area, abdominal distension, and constipations. Abdominal palpation reveals positive Kehr, Murphy, and Ortner signs, while Desjardins and Mayo-Robson points are painless. Total bilirubin is 14.7 mcmol/L. predominantly indirect, ALT- 20 U/L, AST- 40 U/L, amylase – 6.3 mmol/L. Echocholecystography shows practically no contraction of the gallbladder. Make the provisional diagnosis:
A. Chronic hepatitis
B. Acute pancreatitis
C. *Hypokinetic biliary dyskinesia
D. Chronic pancreatitis
E. Hyperkinetic biliary dyskinesia
192. A 35-year-old pregnant woman with degree 1 essential hypertension, developed edemas and headache at the 33 week of her pregnancy. Objectively her general condition is satisfactory, blood pressure – 160/100 mm Hg. normal uterine tone. Fetal heart rate is 140/min., rhythmic. She was diagnosed with daily proteinuria – 4 g/L, daily diuresis – 1100 mL. Creatinine – 80 mcmol/l, urea – 7 mmol/L platelets – 100. 10°/L. What complication of pregnancy occurred?
A. Severe preeclampsia
B. Renal failure
C. Mild preeclampsia
D. Hypertensive crisis
E. *Moderate preeclampsia
193. A 38-year-old woman complains of weakness, sleepiness, pain in the joints, weight gain despite low appetite, and constipations. She presents with dry and thickened skin. puffy and amimic face, narrowed palpebral fissures, thick tongue, and deep hoarse voice. Her heart sounds are weak, pulse is 56/min. Low levels of free T4 are observed. This patient needs to take the following on a regular basis:
B. Mercazolil (Thiamazole)
C. Lithium carbonate
E. Calcium gluconate
194. A 28-year-old man complains of skin rash and itching on both of his hands. The condition persists for 1.5 years. The exacerbation of his condition he ascribes to the occupational contact with formaldehyde resins. Objectively the lesion foci are symmetrically localized on both hands. Against the background of erythema with blurred margins there are papulae, vesicles, erosions, crusts, and scales. What is the most likely pathology?
A. Allergic dermatitis
B. Simple contact dermatitis
C. Erythema multiforme
D. *Occupational eczema
E. Idiopathic eczema
195. A 3-year-old child has been brought to a hospital with complaints of pain in the legs, fever, and loss of appetite. Objectively: pale skin and mucosa, hemorrhagic rash. Lymph nodes are enlarged, painless, dense and elastic, not matted together. Bones, joints, and abdomen are painful. The liver and spleen are enlarged. Hemogram: Hb- 88 g/L, color index – 1.3. platelets – 80 – 10°/L, leukocytes – 25.8. 10°/L, lymphoblasts – 70%, ESR 52 mm/hour. Make the provisional diagnosis:
A. *Acute leukemia
B. Acute rheumatic fever
C. Infectious mononucleosis
D. Hemorrhagic vasculitis (Henoch-Schonlein purpura)
E. Thrombocytopenic purpura
196. A patient has the second and third degree burns of 15% of the body surface. On the 20th day after the trauma the patient presents with sharp increase of body temperature, general weakness, rapid vesicular respiration: facial features are sharpened, BP is 90/50 mm Hg, heart rate is 112/min. What complication is it?
B. Purulent bronchitis
D. Acute intoxication
E. Anaerobic infection
197. An 18-year-old girl was brought into the gynecology department with complaints of elevated body temperature up to 37.8°C, sharp pain in her lower abdomen, more intense on the right, and difficult defecation. Vaginal examination detected a painful dense elastic formation 5×6 cm in the area of her right ovary Pregnancy test is negative. What is the most likely diagnosis?
A. Ovarian apoplexy
B. Ectopic pregnancy
D. Ovarian cyst rupture
E. *Torsion of ovarian tumor pedicle
198. On the 15th day after a small trauma of the right foot, the patient developed indisposition, fatigability, irritability, headache, elevated body temperature, and sensation of constriction. tension, and twitching in the muscles of the right shin, WL disease can be suspected?
C. Thrombophlebitis of the popliteal artery
D. Anaerobic gas gangrene
E. Acute thrombophlebitis
199. On the day 4 after the cesarean section a woman developed fever with body temperature up to 39°C and abdominal pa Pulse – 104/min. She vomited twice. The patient is sluggish, her tongue is dry and has gray coating. The abdomen is distended Signs of peritoneal irritation are positive in all segments. Peristalsis cannot be auscultated. No passage of gas occurs. Uterine fundus is located at the level of the navel. The uterus is painful on palpation. The discharge is moderate and contains blood and pus. What is the most likely diagnosis?
B. Pelvic peritonitis
C. Progressive thrombophlebitis
E. *Diffuse peritonitis
200. A 51-year-old man complains of vomiting with blood. He has been drinking alcohol excessively. Health disorder has been observed since he was 40, when he first developed jaundice. On examination the skin and visible mucosa are icteric, with a stellate vascular pattern. The patient is malnourished and presents with abdominal distension, umbilical hernia, and ascites. The edge of the liver is tapered and painless. +3 cm, the spleen is +2 cm. Blood test: Hb- 80 g/L, leukocytes – 3. 10°/L. platelets – 85 . 10°/L. What is the cause of portal hypertension in this patient?
A. Budd-Chiari syndrome
C. Constrictive pericarditis
D. Thrombosis of the splenic vein
E. *Hepatic cirrhosis
- 2019 booklet Questions 151-200 with Explanations and highlights
- 2019 Hygiene & Ecology Bases with Explanations and highlights