Krok 2- 2020 (General Medicine) (t.

me/krok2GeneralMedicine) - 1

not sleep enough. Objectively her condition is

Krok 2 – 2020 (General Medicine) severe, the girl is sluggish, gives one-word
responses, has tremor in her extremities, her skin is
1. A patient has gradually lost his consciousness. icteric, with single hemorrhagic rashes. Name the
The skin is pale and dry. There is smell of ammonia likely complication of her disease:
from the mouth. Respiration is deep and noisy. Heart 1. Bipolar affective disorder
sound muffled, pericardial friction rub are present, 2. Hepatic encephalopathy
blood pressure is 180/130mmHg. Blood test : Hb – 3. Reye syndrome
80g/l, leukocytes- 12 x 109/l , blood glucose- 4. Sepsis
6.4mmol/l ,urea – 50mmol/l, creatine- 1200mmol/l, 5. Kidney failure
blood osmolarity – 350 mOsmol/kg H2O.No urinary
excretion. Make the diagnosis: 5. A 35-year-old woman came to the family doctor
1. Acute disturbance of cerebral circulation with complaints of profuse menstruations that last
2. Uremic coma up to 10 days. Gynecological examinations shows
3. Hyperglycemic coma that the uterine cervix is without changes, the uterus
4. Hyperosmolar coma is in anterflexio, has normal size , is mobile and
5. Acute renal failure painless. The uterine appendages on the both sides
are without peculiarities. The family doctor made the
2. A man works in casting of nonferrous metals and provisional diagnosis of the abnormal uterine
alloys for 12 years. In the air of working area there bleeding. What instrumental method of examination
was registered high content of heavy metals, carbon needs to be performed first to diagnose this
monoxide, and nitrogen. During periodic health pathology?
examination the patient presents with 1. Laparoscopy
asthenovegetative syndrome, sharp abdominal 2. Transvaginal ultrasound
pains, constipations, pain in the hepatic area. In 3. Culdoscopy
urine: aminolaevulinic acid and coproporphyrin are 4. Transabdominal ultrasound
detected. In blood: reticulocytosis, low hemoglobin 5. Colposcopy
level. Such intoxication is caused by:
1. Lead and lead salts 6. A child was born at 40 weeks of gestation with the
2. Zinc weight of 3700g. The child’s Apgar score is 7/9. The
3. Nitric oxide baby was put to breast immediately after birth and
4. Carbon monoxide suckled actively. On the 3rd day of life, the child’s
5. Tin weight decreased to 3600g. What transitory
condition is observed in this child?
3. A 23-year old woman without visible cause 1. Uric acid infarction
developed a conflicting behavior at the work place. 2. Transient dysbiosis
She accused the management of underestimating 3. Physiological jaundice
her, claimed that she can be a deputy director, 4. Physiological weight loss
because she speaks four languages, is very 5. Toxic erythema
attractive, and can make useful connections for the
company. She has been dressing extravagantly, 7. An 8-day-old boy was delivered to the hospital on
flirting with her colleges, and singing loudly in her the second day after the onset of the disease. His
office. Infact, she has only the training of a computer parents complain of his fussiness, regurgitation,
operator and speaks no foreign languages. What is body temperature up to 38.5 C, red skin with
the likely clinical diagnosis? infiltration in the lumbar area. His medical history
1. Mild mental retardation has no peculiarities. The child is in the severe
2. Depressive disorder condition, inert, pale, suckles poorly. In the lumbar
3. Manic episode area, on the sacrum and buttocks there is a tense
4. Epilepsy infiltration with hyperemic and cyanotic areas and
5. Schizophrenia with a soft spot 8×7 cm in its center. the stool is 10
times in 24 hours, with green and mucous
4. A 17-year old girl has been suffering from hepatic admixtures. What is the most likely diagnosis?
cirrhosis for 3 years. Lately her periods of excitation 1. Erysipelas
have been intermittent with depression, she does 2. Congenital soft-tissue tumor
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 2

3. Phlegmon of the newborn burning pain in his left subcostal region that
4. Adiponecrosis irradiates to the left lumbar region. These signs
5. Hemangioma appeared after a meal. The Ortner’s and Mayo-
Robson’s signs are positive. In the blood;
8. A 35-year old forestry officer was delivered to the leukocytosis and increased ESR. In the urine;
hospital on the 7th day after the onset of the elevated diastase levels. Make the diagnosis:
disease. He complains of chills, elevated body 1. Chronic cholecystitis in the exacerbation stage
temperature up to 40.0 C, sharp headache, and 2. Chronic pancreatitis in the exacerbation stage
myalgias. On examination his face is puffy and 3. Gastric ulcer Performation
hyperemic, the tongue is dry, “chalk-dusted”. In the 4. Chronic gastritis in the exacerbation stage
left inguinal area, a sharply painful conglomeration 5. Renal colic
of enlarged lymph nodes can be palpated. The skin
over the conglomeration is hyperemic and tense. 12. A 25-year old man was hospitalized with
What etiotropic therapy should be prescribed to this complaints of pain in his lower abdomen and right
patient? lumbar area that appeared one hour ago. The
1. Human immunoglobulin intravenously patients general state is moderately severe. Body
2. Ribavirin temperature- 38.2C, heart rate-102/min. The tongue
3. Streptomycin is dry. The abdomen is painful on deep palpation j
4. Administration of heterologous serum the right iliac area and in the petit triangle. Aure-
5. Ketoconazole Rozanov and Gabay signs are positive. Make the
provisional diagnosis:
9. A woman complains of a severe pain in her throat 1. Acute appendicitis
on the left, difficult swallowing and mouth opening, 2. Cecal tumor
elevated body temperature, and general malaise. The 3. Acute cholecystitis
onset of the disease was 4 days ago after a case of 4. Right-sided renal colic
tonsillitis. Examination detects a trismus of the 5. Intestinal obstruction
masticatory muscles; the left tonsil is displaced
toward the midline; the anterior palatal arch is 13. A 45-year old woman was hospitalized with
infiltrated and protruding. The regional lymph nodes complaints of periodical severe headaches against
on the right are enlarged and painful on palpation. the background of elevated blood pressure up to
Make the diagnosis: 180/90 mmHg, muscle weakness, and frequent
1. Lacunar tonsillitis urination (at night as well). Her anamnesis states
2. Infectious mononucleosis that despite combining various antihypertensive
3. Tonsillar tumor drugs and adjusting the dosage her arterial
4. Peritonsillar abscess hypertension cannot be corrected with drugs. The
5. Acute pharyngitis patient’s blood serum potassium levels are 2.0
mmmol/L, blood serum sodium level are
10. A 30-year old woman complains of itching skin, 160mmmol/L. Ultrasound imaging detects three
predominantly in the evening and at night. The dimensional formations approximately 1.0 cm in
condition lasts for 2 weeks already. On the skin of diameter in the both adrenal glands. Selective
interdigital folds, mammary glands, abdomen, endovascular blood sampling from the suprarenal
buttocks, and thighs there are numerous fine vein was performed which revealed significant
papular and papulovesicular rashes located in pairs, increase of cortisol and aldosterone levels. Make the
excoriations. There is no rash on the face and neck. diagnosis:
Similar rash is observed in the husband of the 1. Pheochromocytoma
patient. What is the most likely diagnosis? 2. Cushing's disease
1. Eczema 3. Androsteroma
2. Scabies 4. Aldosteroma
3. Epidermophytosis 5. Cushing's syndrome
4. Neurodermatitis
5. Herpes 14. During winter epidemics of influenza caused
predominantly by virus A/California/04/2009 (H1N1),
11. A 48-year-old man came to a doctor with on the 2nd day after the disease onset a 30-year old
complaints of vomiting that brings no relief and a hospitalized man presented with high fever, dry
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 3

cough, myalgia, headache, and general weakness. 1. Hemostatic therapy

What should be prescribed as an etiotropic 2. Surgical intervention
treatment in this case? 3. Anti-inflammatory therapy
1. Immunoglobulin 4. Complex conservative treatment
2. Antibiotics 5. Lumbar puncture to relieve the pressure
3. Neuraminidase inhibitors (oseltamivir)
4. Acyclovir 19.A 34-year-old woman after rapidly changing her
5. Interferon inducers position from horizontal to vertical suddenly paled,
fell down, her skin became moist, her limbs are cold,
15. A 75-year-old man in a severe condition suffers her pupils are dilated. The pulse is rapid and
from dyspnea at rest, marked weakness, and thready, blood pressure is 50/25 mmHg. What
arrhythmia. Abdominal aortic pulsation is observed, condition has likely developed in the patient?
further on is a systolic murmur detected. Palpation 1. Morgagni-Adams-stokes syndrome
reveals a volumetric formation in the mesogastrium. 2. Ventricular fibrillation
Blood pressure is 70/40mmHg. There is no pulsation 3. Shock
over the femoral arteries. Oliguria is detected. Which 4. Coma
diagnosis is the correct one? 5. Collapse
1. Pancreatic cyst
2. Acute pericarditis 20. A 6-year-old girl complains of body temperature
3. Cardio sclerotic aneurysm up to 39 C, rhinitis, dry cough, dyspnea. She has
4. Dissecting aortic aneurysm been presenting with these signs for 5 days already.
5. Acute cardiac aneurysm On examination her condition is of moderate
severity. Her dyspnea is of mixed genesis.
16. A 56-year old woman was diagnosed with stage 2 Respirations are 28/min. Percussion produces a dull
hypertension of the 2nd degree. She belongs to the sound in the right lower segments; in the same area
group of moderate risk and has bronchial asthma. auscultation detects weakened respiration and fine
What group of drugs is CONTRAINDICATED to this vesicular wet crackles; coarse respiration can be
patient? detected on the left. Make the provisional diagnosis:
1. Imidazoline receptor antagonist 1. Acute simple bronchitis
2. Calcium antagonists 2. Stenosing laryngotracheitis
3. Beta blockers 3. Acute obstructive bronchitis
4. Angiotensin converting enzyme inhibitors 4. Acute bronchiolitis
5. Diuretics 5. Right-sided community acquired pneumonia

17. A dweller of the northern Dnieper area, a 21. A 37-year old woman received an occupational
fisherman, for the last several days has been trauma that resulted in a severe vision impairment.
complaining of a discomfort in his right subcostal Now she needs to be trained for another occupation.
region, periodical episodes of diahhrea, intermittent What type of rehabilitation should be doctor choose
with constipation, frequent skin rashes. Abdominal for the patient in this case?
ultrasound shows enlarged liver and pancreatic 1. Occupational rehabilitation
head. Make the provisional diagnosis: 2. Target rehabilitation
1. Onchocerciasis 3. Psychological rehabilitation
2. Ornithosis 4. Social rehabilitation
3. Trichinellosis 5. Medical rehabilitation
4. Taeniasis
5. Opisthrochiasis 22. A 45-year old man has been suffering from
ankylosing spondylitis for 15 years. For the last 3
18. A 9-year-old boy fell off a tree and hit the back of years he has been noticing facial swelling and
his head. A brief loss of consciousness was edemas of the limbs. Objectively he assumes a
observed. The child’s condition is satisfactory, he “beggar’s” position. X-ray shows “bamboo spine”
has a headache and vertigo. Skull X-ray scans changes in the thoracic and lumbar segments. Heart
shows depressed fracture of the occipital bone in ultrasound shows aortic regurgitation. Complete
the area of the external occipital protuberance. What blood count: Hb-106g/L; leukocytes- 8.9 x 109 /L;
treatment tactics is indicated for this patient? ESR-40mm/hour. Daily proteinuria-9.6 grams per 24
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 4

hours. Blood creatinine-230 mcmol/L. What is the cough. 3days later a dyspnea at rest increased to
cause of kidney failure in this case? 35/minute. Downward from her right shoulder blade
1. Concomitant heart disease angle, percussion detects a dull sound. No vocal
2. Pyelonephritis fremitus, respiratory sounds cannot be auscultated.
3. Renal amyloidosis What is the treatment tactics?
4. Urolithiasis 1. Artificial lung ventilation
5. Medicine side effects 2. Antibiotic therapy
3. Pleural tap
23. A 72-year-old man with pneumonia complains of 4. Oxygen therapy
marked dyspnea, chest pain, severe cough with 5. Physiotherapy
expectoration, temperature is 39.5-40 C, no urination
for the last 24 hours. Objectively, the patient is 27. Disease onset was acute. A child developed
conscious. Respiratory rate is 36/min. Percussion general weakness, pain in the joints, and fever. Later
sound is dull over the right lower pulmonary lobe; these signs became accompanied by itching skin
on auscultation there is bronchial respiration and rash manifested as erythematous spots 2-5 mm in
numerous moist crackles. Blood pressure is 80/60 size. The rash gradually turned hemorrhagic. Large
mmHg. Heart rate is 120/min. Heart sounds are joints are painful and swollen ;pain attacks
muffled, there is tachycardia. What tactics should periodically occur in paraumbilical area; there are
the family doctor choose for the management for signs of intestinal hemorrhage. What is the most
this patient? likely diagnosis?
1. Hospitalization into the neurology unit 1. Scarlet fever
2. Hospitalization into the intensive care unit 2. Hemorrhagic meningoencephalitis
3. Outpatient treatment 3. Hemorrhagic vasculitis (Henoch-Schonlein
4. Hospitalization into the pulmonary unit purpura)
5. Treatment in the day patient facility 4. Rheumatism
5. Streptococcal impetigo
24. A 3-month-old child with sighs of rickets
presents with positive Chvostek, Trousseau, and 28. A 16-year-old boy developed dizziness. His heart
Maslov signs. One days ago, the parents witnessed rate is 35/min, blood pressure is 85/45mmHg, heart
a cyanotic attack in their child- the child broke into a borders are not enlarged. Heart sounds are loud and
cold sweat, the eyes bulged, and respiratory arrest clear. ECG shows P waves disconnected from QRS
occurred. One minute later the child drew in a loud complex, dissociation and different rhythm of atria
breath and child’s condition normalized again. What and ventricles is accompanied by varying location of
is the cause the described signs of the disease? P wave in relation to QRST complex. This
1. Increase of blood phosphorus levels presentation is the most characteristic of the
2. Increase of blood calcium levels following disease:
3. Decrease of blood calcium levels 1. Atrioventricular block (II degree)
4. Metabolic acidosis 2. Extrasystole
5. Decrease of blood phosphorus levels 3. Complete atrioventricular block (III block)
4. Atrioventricular dissociation
25. For 20 years the role of excessive weight in 5. Sinus bradycardia
ischemic heart disease development among the
working age male production over 40 was studied. It 29. 40% of workers who, who polish the art glass,
was determined that overweight men developed using an abrasive disk, and have a long record of
ischemic heart disease more often. What type of employment, are diagnosed with ulnar neuritis, 21%-
epidemiological study is it? with vegetative polyneuritis, and 12% – with
1. Cohort study vegetomyofascitis of the upper limbs. These
2. Experimental study pathologies are associated with the following
3. Case report harmful factor:
4. Case-control study 1. Noise
5. Vase series report 2. Vibration
3. Electromagnetic field
26. A 35-year old woman had acute onset of the 4. Dust
disease that started with fever up to 39.0C and 5. Microclimate
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 5

30. A 45-year old woman undergoes an inpatient 2. Markedly accentuated personality

treatment. She complains of elevated body 3. Anankastic personality disorder
temperature up to 39.0 C, pain in her right lumbar 4. Psychopathy-like state
area, turbid urine with blood. CT scan shows an area 5. Anxiety (avoidant) personality disorder
of low density within the parenchyma, no difference
between the cortical and medullary layers, an 34. A 22-year old post parturient woman on the 12th
increased density of the perinephric fat due to day after the normal childbirth informs of fever up to
edema. What is the diagnosis? 39 degree C for the last three days and pain in her
1. Renal abscess right mammary gland. The right mammary gland is
2. Para nephritis enlarged, hot to touch, tense, hyperemic, and
3. Glomerulonephritis painful. Palpation reveals there a dense infiltration
4. Renal carcinoma 8*8 cm with a fluctuation in its center. What is the
5. Pyelonephritis most likely diagnosis?
1. Postpartum period, day 12. Right sided lactostasis
31. A patient is 45 year old. He was referred for a 2. Postpartum period, day 12. Right sided phlegmonous
consultation with a psychiatrist due to complains of mastitis
abdominal pain and discomfort that occur in 3. Postpartum period, day 12. Right sided serous
emotional staining situation. Objectively, no mastitis
changes of the gastrointestinal tract was detected. 4. Postpartum period, day 12. Right sided gangrenous
The complaints emerged over 10 years ago against mastitis
the background of severe alcohol poisoning. The 5. Postpartum period, day 12. Right sided
patient has been repeatedly visiting infiltrative-purulent mastitis
gastroenterologists, who were unable to find any
significant changes in the patient. The prescribed 35. A woman complains of frequent watery stool (up
therapy was ineffective. What is the likely to 9-10 times per day) with mucus and blood
conclusion? admixtures, dull pain in the hypogastrium, weight
1. Organic brain disorder loss of 4kg within the last year. Objectively,
2. Chronic alcoholism malnutrition, dry skin, low turgor, aphthous
3. No disorder stomatitis. The abdomen is soft, the sigmoid colon
4. Somatoform autonomic dysfunction is spastic and painful on palpation. Occult blood test
5. Functional dyspepsia is positive. Fibro colonoscopy; edema, hyperemia,
mucosal granulation, pseudopolyps, small ulcers
32. An unconscious patient was delivered to a with irregular edged. Make the diagnosis:
hospital by an ambulance. Objectively, his body 1. Nonspecific ulcerative colitis
temperature is 39 C, he presents with convulsion 2. Chronic enterocolitis
and red dry skin. It is known that the patient works 3. Colon cancer
as a stoker in the boiler room. What is the likely 4. Crohn's disease (regional enteritis)
diagnosis? 5. Irritable bowel syndrome
1. CO poisoning
2. Heat stroke 36. A 38-year-old patient has been delivered by an
3. food poisoning ambulance toa surgical department with complaints
4. Hypertensive urgency of general weakness, indisposition, black stool. On
5. Acute viral respiratory infection examination the patient is pale, there are dotted
hemorrhages on the skin of his torso and
33. An 18-year old patient always obeys others and extremities. On digital investigation there are black
adapts his needs to the demands of the people on feces on the glove. Blood test: Hb-108g/L,
whom he depends. He excessively defers to their thrombocytopenia. Anamnesis states that similar
wishes and makes them responsible for his condition was observed I year ago. Make the
wellbeing, cannot defend his interests and needs diagnosis:
support from other people. Such psychic profile has 1. Hemophilia
been formed in the childhood, remains unchanged, 2. Ulcerative bleeding
and hinders adaptation. What psychic disorder is 3. Rectal tumor
observed in this patient? 4. Nonspecific ulcerative colitis
1. Dependent personality disorder 5. Thrombocytopenic purpura
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 6

37. When planning treatment of a patient, it was 41. A 48-year-old woman complains of disturbed
decided to use a medicine with evidence level A. menstrual cycle; her periods last for 7-9 days and
what trials produce the evidence that allows to are excessively profuse throughout the last half-
classify the medicine level as A? year. She notes occasional hot flashes in her head,
1. Case-control studies insomnia, irritability, and headaches. Her skin is of
2. Expert consensus normal color. Blood pressure – 150/90mmHg, pulse
3. Data obtained from one randomized clinical trial –90/min, rhythmic. The abdomen is soft and
4. Data obtained from several randomized clinical painless. Bimanual examination shows no uterine
trials enlargement, the appendages cannot be detected.
5. Data obtained from many non-randomized trials The vaginal fornixes are free. What is the most likely
diagnosis?
38. You witnessed a car accident. When examining 1. Adrenogenital syndrome
the place of the accident you noticed a man of about 2. Climacteric syndrome
30 years, who was hit by the car. He is unconscious. 3. Premenstrual syndrome
On his neck on the left there is a profuse 4. Uterine myoma
hemorrhage with bright-red blood. How to stop this 5. Stein- leventhal syndrome (polycystic ovary
hemorrhage? syndrome)
1. Maximal hyperextension of the neck
2. Digital occlusion, Mikulich method 42. The body of a citizen was found at the place of
3. Apply a plaster cast his dwelling. On his face, neck, and hands there
4. Apply a neck brace were detected irregular-shaped wounds, varying
5. Put him in a stable position from 2×3 cm to 4×5 cm in size. The skin and
underlying tissues are absent in the wounds. The
39. A patient was brought into the pulmonology margins of the wounds are uneven, with major and
department with complaints of inspiratory dyspnea minor scalloping along the edges and no signs of
and dry cough at the highest point of inhalation. On bleeding. What is the initiating mechanism of these
the examination the following is observed: pale skin, wounds?
cyanotic lips, “Hippocratic fingers”. Auscultation 1. Blast injury
detects Velcro-type crackles (like opening a Velcro 2. Animal bite wounds
fastener). X- ray shows a “ground glass opacity” 3. Multiple stab and incised wounds
pattern. What is the most likely diagnosis? 4. Local effect of cold
1. Hand-Schuller-Christian disease 5. Pellet gunshot wound
2. Exogenous allergic alveolitis
3. Idiopathic pulmonary hemosiderosis 43. A family doctor performed an external obstetrical
4. Idiopathic pulmonary fibrosis examination on a pregnant woman and determined
5. Pulmonary histiocytosis X that her uterine fundus is located at the level of the
navel. What is the most likely term of pregnancy in
40. A 31-year-old drug-addicted person complains of this woman?
a cough with bloody expectorations, dyspnea, 1. 24 weeks
persistent fever, and leg edemas. The jugular veins 2. 8 weeks
are distended. There is a coarse pansystolic murmur 3. 16 weeks
detected above the base of the xiphoid process and 4. 40 weeks
in the second intercostal space on the left, close to 5. 32 weeks
the edge of the sternum. Heart sounds are clear,
arrythmia is detected, heart rate is 128/min, pulse- 44. A 19-year-old young man complains of cough
82/min, blood pressure is 100/70 mmHg. What is the with expectoration of purulent sputum in amount of
most likely diagnosis? 100 ml per day, hemoptysis, dyspnea, increased
1. Infective endocarditis body temperature up to 37.8 C, general weakness,
2. Lutembacher syndrome weight loss. The patients condition lasts for 4 years.
3. Coarctation of the aorta Exacerbations occur 2-3 times a year. The patient
4. Community acquired pneumonia presents with malnutrition, pale skin, cyanosis of the
5. Pulmonary embolism lips, drumstick (clubbed fingers). Tympanic
percussion sound in the lungs, weakened
respiration, and various numerous moist crackles in
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 7

the lower pulmonary segments on the left can be 2. Performation of gastric ulcer
observed in this patient. in blood: erythrocytes-3.2 x 3. Saturnism (lead poisoning)
1012/L, leukocytes- 8.4 x 109/L, ESR-56 mm/hour. On 4. Acute appendicitis
X-ray: lung fields are emphysematous, the left 5. Acute cholecystitis
pulmonary root is deformed and dilated. What is the
most likely diagnosis? 48. A 28-year old man, a teacher, after an emotional
1. Multiple bronchiectasis of the left lung stress developed painful muscle spasms in his right
2. Left-sided pulmonary cystic dysplasia hand that occur during writing; now he has to hold
3. Chronic left-sided pneumonia the pen between the second and the third fingers. He
4. Chronic abscess of the left lung has no problems with typing or writing on the black
5. Suppuration of the cyst in the left lung board, no other motor disturbances or neurological
pathologies are detected. What is the most likely
45. A 5-year-old child had acute onset of the disease diagnosis?
that manifested in body temperature up to 39.5 C, 1. neuropathy of the right ulnar nerve
marked chills, weakness, inertness, skin pallor, and 2. Writer's cramp
headache. 8 hours later a hemorrhagic rash 3. Parkinsonism
developed on the skin of the buttocks and les. The 4. Neuropathy of the right radial nerve
child is sluggish, the body temperature has dropped, 5. Cortical agraphia
blood pressure is 80/40, respirations are 28-30/min,
diuresis is decreased. Make the provisional 49. An 18-year-old patient complains of skin rash.
diagnosis: The patient has been suffering from this condition
1. thrombocytopenic purpura for 5 years. The first instance of this disease
2. Hemorrhagic vasculitis (Henoch-Schonlein purpura) occurred after a car accident. Objectively, the patient
3. Measles presents with a papular rash covered in silvery
4. Meningococcemia scales, “thimble” sign (small pits on the nails)
5. Reye syndrome affected joints. What is the most likely diagnosis?
1. Panaritium
46. A 45-year old man came to the hematologist with 2. Rheumatism
complaints of general weakness, elevated body 3. Onychomycosis
temperature, excessive sweating, enlarged cervical 4. Psoriasis
lymph nodes. Objectively, his body temperature is 5. Lupus erythematosus
37.5 C, the skin is pale and dry, the posterior
cervical lymph nodes are dense and elastic, upto 2 50. A 26-year-old woman was hospitalized into the
cm in diameter, mobile. There are no peculiarities in gynecological department with the complains of
the patient’s heart and lungs. Hepatosplenomegaly body temperature up to 38.2 C, fever, general
was detected. What examination is necessary to weakness, and dirty-red blood discharge from her
determine the scope of pathologic process? genital tracts. She is hemodynamically stable. Two
1. Bone scintigraphy days ago, she underwent a medical abortion on the
2. Abdominal X-ray 8th week of pregnancy. Ultrasound detects the
3. Complete blood count remains of the fertilized egg in her uterine cavity.
4. Ultrasound of the cervical lymph nodes What are the tactics of the patient management in
5. Computed tomography this case?
1. Pipelle biopsy
47. A 39-year-old man, a battery attendant suddenly 2. Uterine cavity treatment with antibiotic solutions
developed weakness, loss of appetite, nonlocalized 3. Revision of the uterine cavity with vacuum
colicky abdominal pains, and nausea. Objectively, aspirator. Antibiotic therapy
his skin, its grey, there is pink-gray stripe on his 4. Laparotomy, extirpation of the uterus and tubes.
gums; the abdomen is soft and sharply painful. Abdominal drainage
Blood test detected erythrocytes with basophilic 5. Laparotomy, supravaginal uterine amputation.
stippling and anemia. The patient has a history of Abdominal drainage
peptic ulcer disease of the stomach. Constipations
occur each 3-4 days. What is the most likely 51. A 32-year-old woman complains of general
provisional diagnosis? weakness, low-grade, fever persisting for 4 months,
1. Chronic alcoholism lumbar pain, and dysuria. Anamnesis includes
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 8

frequent acute respiratory diseases, overexposure 55. A 73-year-old woman came to the family
to cold, low-calorie diet, a case of pulmonary physician for one of her regular follow-up
tuberculosis in childhood. Clinical urine analysis; pH examinations. Three months ago she was found to
4.8 leukocytosis, hematuria. Complete blood count: have type 2 diabetes mellitus. She was keeping to
leukocytosis, lymphocytosis, raised ESR, urography her diet and exercise plan and taking Phyto
concludes; dilation of renal pelvis and calyceal preparations. On examination her fasting glucose
system of both kidneys, foci of the calcification in was within the range of 7.8-8.6mmol/L,HbA1c- 7.9%.
the projection of right kidney parenchyma. What is height –164cm, weight –83kg. What blood glucose
the most likely diagnosis? controlling medicine should be prescribed first in
1. Right renal cyst the course of her pharmacological therapy?
2. Acute glomerulonephritis 1. Glibenclamide
3. Nephrotuberculosis 2. Glimepiride
4. Right renal carcinoma 3. Gliclazide
5. Chronic pyelonephritis 4. Insulin
5. metformin
52. A woman with the pregnancy term of 8 weeks
complains of elevated temperature up to 37.6 C, skin 56. A 23-year-old woman came to the gynecological
rash that can be characterized as macular clinic. she complains of pain, itching, and burning in
exanthema, enlargement of posterior cervical and her vulva, general weakness, indisposition, elevated
occipital lymph nodes, small amount of bloody body temperature up to37.2 C, and headache. On
discharge from the genital tracts. She was examined examination in the vulva there are multiple vesicles
by the infectious diseases specialist and diagnosed up to 2-3 mm in diameter with clear contents against
with rubella. What tactics should be obstetrician- the background of hyperemia and mucosal edema.
gynecologist choose? Make the provisional diagnosis:
1. Abortion 1. Genital herpes infection
2. Prescription of antibacterial therapy 2. Primary syphilis
3. Treatment of insipient abortion 3. Cytomegalovirus infection
4. Prescription of hemostatic therapy 4. Vulvar cancer
5. Prescription of antiviral therapy 5. Papillomavirus infection

53. Forensic autopsy of a body of a 59-year-old man, 57. On ultrasound of the thyroid gland. A 47-year-old
who died suddenly at home without signs of violent woman presents with a hypoechoic node 1.6 cm in
death, shows pink skin and mucosa, liquid bright- diameter with blurred margins and intranodular
red blood, and bright-red plethoric internal organs. hypervascularization. The doctor suspects thyroid
Forensic toxicology testing detected 1.44% of carcinoma. What method should be used to verify
ethanol in the blood and carboxyhemoglobin levels the diagnosis?
of 55%. What is the cause of death? 1. Determine TSH levels in the blood
1. Carbon monoxide poisoning 2. Case monitoring
2. Alcohol poisoning 3. Position emission tomography (PET)
3. Arsenic poisoning 4. Fine-needle aspiration biopsy
4. Aniline poisoning 5. Thyroid scintigraphy
5. Potassium cyanide poisoning
58. A 34-year-old multipara was brought to the labor
54. A patient underwent suture plication of the ward with regular labor activity. Her pelvic size 26-
perforated duodenal ulcer. On the 3rd day after the 29-32-22 cm. Vaginal examination shows 6 cm
operation he started producing a large amount of cervical dilation, the amniotic sac is unbroken. The
discharge from the abdominal drain tube. The fetus is in the breech presentation, with buttocks
discharge contains bile and has high amylase levels. pressed to the entrance into the lesser pelvis. The
What complication occurred in the patient? promontory cannot be reached, no exostoses. Feta
1. Hemorrhage from the ulcer heart rate is 140/min, expected fetal weight is 2800g.
2. Suture incompetence of the ulcerative defect What labor tactics should be chosen?
3. Acute postoperative pancreatitis 1. External obstetric version of fetus
4. Early postoperative adhesive obstruction 2. Fetal extraction from the pelvic end
5. Acute cholecystitis 3. Classic combined external-internal version of the
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 9

fetus 63. A 45-year-old woman complains of increasing

4. Delivery through the natural birth canal body weight throughout the last year. Examination
5. Urgent cesarean section revealed moon face syndrome, brittle hair, hirsutism,
stretch marks on the abdomen, and
59. After the pregnant woman’s water broke, it was disproportionally thin limbs. The patient’s height is
noted that they are significantly contaminated with 162 cm, her body weight is 94 kg, her body mass
meconium. Upon birth, the baby is not breathing, index is 35.8 kg/m2. What type of obesity it?
remains inert, the skin is cyanotic and covered in 1. Alimentary-constitutive
meconium, heart rate is 98/min. What resuscitation 2. Gynoid
measures should be taken after the baby is born? 3. Dysplastic
1. Tactile stimulation of the newborn 4. Cerebral
2. Give adrenaline intravenously 5. Android
3. Artificial pulmonary ventilation with a mask and Ambu
bag 64. A woman came to the gynecologist to plan her
4. Direct laryngoscopy, intubation, sanation of the pregnancy. She was advised to increase her intake
trachea of the products rich in folic acid, particularly soy
5. Sanation of the upper respiratory tracts with a rubber beans, bread made of coarsely ground flour, fruits,
balloon leafy green vegetables. Such changes in her diet will
work toward the prevention of:
60. A 27-year-old man complains of pain in his leg 1. Rickets
joints, purulent discharge from the eyes, and painful 2. Polyhydramnios
burning sensations during urination. The disease 3. Non- closure of the neural tube in the fetus
onset was acute. He has a history of influenza. The 4. Iron- deficiency anemia in the pregnant woman
patient smokes and drinks alcohol in excess. In his 5. Non-closure of the fontanel
line of work, he is often away on business trips.
What is the most likely etiological factor of this 65. During examination of a patient, the doctor
disease? detected in him disorders of the eyes (hemeralopia,
1. Candida Bitot’s spots), skin and skin appendages, mucosa,
2. Streptococci ang gastrointestinal tract. He was provisionally
3. Chlamydia diagnosed with Prasad’s syndrome. What causes
4. Adenovirus the development of this pathology?
5. Staphylococci 1. Manganese deficiency
2. Vanadium deficiency
61. A 22-year-old infant developed subcutaneous red 3. Zinc deficiency
nodes from 1.0 to 1.5 cm in size on the scalp; later 4. Iron deficiency
the nodes enlarged. Complete blood count: anemia, 5. Copper deficiency
leukocytosis, neutrocytosis, raised ESR. What
diagnosis will you make? 66. What should be prescribed as secondary
1. Pseudo furunculosis prevention drugs for a patient with atrial fibrillation
2. Vesiculopustulosis after an ischemic stroke caused by cardiac
3. Pemphigus embolism?
4. Scalp phlegmon 1. Oral anticoagulants
2. Aspirin or clopidogrel
62. After playing with” mosaics”, a two-year-old 3. Beta blockers
child suddenly developed cough, stridorous 4. Nootropics
respiration, urges to vomit, and cyanosis against the 5. Calcium antagonists
background of relative stomatic health. What should
the doctor suspect first when examining the child? 67. During regular medical examination a lyceum
1. Pertussis student present with signs of cheilitis that manifests
2. Acute laryngotracheitis as epithelial maceration in the area of lip seal. The
3. Pneumonia lips are bright-red with single vertical cracks
4. Foreign body aspiration covered with brown-red scabs. These clinical signs
5. Acute obstructive bronchitis are mostly likely caused by insufficient content of
the following in the diet:
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 10

1. Retinol 2. Ramipril
2. Riboflavin 3. Torasemide
3. Ascorbic acid 4. Digoxin
4. Thiamine 5. Bisoprolol
5. Calciferol
71. A 35-year old woman complaints of a pain in her
68. A 25-year-old woman was brought into the right axillary region. She has been suffering from
gynecological department with profuse bloody this condition for a week. Her body temperature is 38
discharge from her genital tracts. She is 12 weeks C. in the right axillary region there are 2 formations,
pregnant, the pregnancy is planned. Within the last 3 2 cm in size each. The skin over the formations is
days she was experiencing pains in her lower dark red and thin, palpation produces a yellow-white
abdomen that eventually started resembling cramps, discharge from the fistular openings. What is the
ahe developed bleeding. Her skin is pale, pulse- most likely diagnosis?
88/min, blood pressure-100/60mmHg, body 1. Hydradenitis
temperature –36.8C. Vaginal examination; the uterus 2. Lymphadenitis
size corresponds to 11 weeks of gestation, the 3. Carbuncle
cervical canal allows inserting 1 finger and contains 4. Folliculitis
fragments of the fertilized ovum, the discharge is 5. Furuncle
bloody and profuse. What is the most likely
diagnosis? 72. A newborn has a round red formation in the
1. Disturbed menstrual cycle, hyperpolymenorrhea suprapubic region. Examination shows that urine is
2. 12-week pregnancy, spontaneous abortion in being discharged in pulses from the two orifices
progress located in the lower part of this formation. Name this
3. 12-week pregnancy, threatened spontaneous developmental anomaly:
abortion 1. Bladder agenesis
4. Full-term pregnancy, term labor 2. Urachal cyst
5. Disturbed menstrual cycle, amenorrhea 3. Vesico-umbilical fistula
4. Bladder diverticulum
69. A 38-year-old woman has been suffering from 5. Bladder exstrophy
glomerulonephritis for 20 years. For approximately
16 years she has been presenting with progressing 73. A 12-year-old girl after a case of respiratory
renal parenchymal arterial hypertension that became infection developed dyspnea at rest, paleness of
refractory and accompanied by leg edemas. She skin. Heart rate is 110/min, BP is 90/55 mmHg. Heart
receives a combination of 100mg losartan and 20mg sounds are muffled. Borders of relative heart
lercanidipine with insufficient antihypertensive dullness: right- the left parasternal line, upper- the III
effect. What medicine can she be recommended for rib, left- 1,0 cm outwards from the midclavicular line.
intensification of the antihypertensive effect of her Make the provisional diagnosis:
therapy? 1. Functional cardiomyopathy
1. Doxazosin 2. Somatoform autonomic dysfunction
2. Bisoprolol 3. Exudative pericarditis
3. Torasemide 4. Infectious myocarditis
4. Lisinopril 5. Hypertrophic cardiopathy
5. Urapidil
74. A 20-year old man suffers from headache,
70. A 68-year old woman with congestive heart general weakness, and face edema that appears in
failure and left ventricular ejection fraction of less the morning. 18 days earlier he had a case of
than 40% receives the following pharmacotherapy tonsillitis. Objectively, his skin is pale, there are
scheme: ramipril, torasemide, bisoprolol, edema under his eyes. Hear rate is 60/min, blood
clopidogrel and digoxin. During one of her regular pressure is 185/100 mmHg. The sign of
examination, frequent polymorphic ventricular costovertebral angle tenderness (punch sign in the
extrasystole were detected in the patient. What lumbar region) is negative. Urinalysis: color of “meat
medicine should be removed from her therapy slops”, protein-4.5 g/, altered erythrocytes- 40-45 in
scheme? the vision field, leukocytes- 5-6 in the vision field.
1. Clopidogrel 24-hour diuresis is 400 mL. What is the most likely
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 11

diagnosis? Homans sign is positive on the left. What

1. Acute pyelonephritis postoperative complication developed in this
2. Renal amyloidosis patient?
3. Acute glomerulonephritis 1. Acute postoperative thrombosis of the deep veins
4. Systemic lupus erythematosus in the left shin
5. Urolithiasis 2. Postoperative allergic reaction
3. Acute postoperative lymphangitis of the left shin
75. A patient 1 year had a Q wave myocardial 4. Acute disturbance of the cerebral blood flow
infarction of the posterior wall of the left ventricle. 5. Acute postoperative thrombosis of the popliteal artery
For the last 2 weeks he has been suffering from daily on the left
attacks of atrial fibrillation and bradycardia
episodes, accompanied by bouts of vertigo. What 79. A 19-year-old young man was diving and hit his
tactics is the most advisable in this case? head on the bottom of the pool. He complains of
1. Prescription of amiodarone pain in the neck, head movements are limited and
2. Prescription of procainamide painful. During examination his head is bowed
3. Prescription of bisoprolol forward and to the right and the patient supports it
4. Pacemaker implantation with his hands. Palpation detects tense neck
5. Prescription of digoxin muscles and protruding spinous process of the IV
cervical vertebra(C4). When pressure is applied to
76. On the 5th day after giving birth a post parturient this process and to the head (axial load), the pain
woman complains of a pain in her left mammary intensifies. Make the provisional diagnosis:
gland and body temperature up to 38.1C. 1. Cervical contusion
Examination shows that her mammary gland is 2. Uncomplicated cervical fracture
enlarged and painful on palpation, the nipple is 3. Neck muscle injury
edematous and has fissures, the upper external 4. Spinal root injury
quadrant of the gland is hyperemic. Name the 5. Complicated cervical fracture
measures that would have prevented the
development of this complication in the patient 80. A 58-year old woman has type2 diabetes mellitus
1. Feeding on demand, expression of breast milk, that is compensated with diet and metformin. She
prevention of nipple fissures prepares for cholecystectomy. Objectively, her
2. Stop breastfeeding when fissures appear height is 164 cm, weight is 90 kg, heart rate is
3. Feeding no longer that 10 minutes through an overlay 72/min, blood pressure is 130/80 mmHg. Her
4. Constant expression of breast milk abdomen is soft, painful in the right subcostal
5. Feeding on schedule region. The liver is not enlarged. Fasting glucose-6.2
mmol/L. Glycated hemoglobin- 6.5%. what further
77. A 55-year old woman complaints of thyroid gland tactics of sugar lowering therapy should be chosen
enlargement that can be observed throughout the in this case?
last two years and a discomfort during swallowing. 1. Prescription of a short-acting insulin
Objectively, she has signs of hypothyroidism. The 2. Prescription of an insulin mixture
thyroid gland on palpation is dense, non-fused with 3. Continue the present scheme of therapy
the surrounding tissues and mobile on swallowing. 4. Prescription of a long-acting insulin
The regional lymph nodes are not enlarged. In the 5. Prescription of glurenorm (gliquidone)
serum there are antithyroid antibodies detected.
What is the most likely diagnosis? 81. 2 hours after eating unknown mushrooms, a 28-
1. Hashimoto’s thyroiditis year-old man sensed a decrease in his mobility and
2. Acute thyroiditis deterioration of his ability to focus. This condition
3. Thyroid cancer was then followed by a state of agitation and
4. Endemic goiter aggression. On examination, he is disoriented and
5. Midline cervical cyst his speech is illegible. 4 hours later he developed
fetor hepaticus and lost his consciousness. What
78. A 65-year old man underwent a left syndrome can be observed in this patient?
hemicolectomy due to a malignant tumor in the 1. Cytolytic syndrome
descending colon. On the 4th day after the surgery 2. Cholestatic syndrome
he developed pain and edema in his left shin. The 3. Portal hypertension
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 12

4. Hepatolienal syndrome year-old child. What type of healthcare provides

5. Acute hepatic failure such medical services?
1. Emergency aid
82. On the 3rd day after the artificial abortion the 2. Tertiary healthcare
woman was hospitalized into the gynecological 3. Palliative care
department in a severe condition with signs of 4. Secondary healthcare
intoxication, abdominal pain, and purulent discharge 5. Primary healthcare
from the vagina. Objectively, the patient’s condition
is severe, her body temperature is 38.8 C, pulse is 86. A 45-year-old man with a history of myocardial
100/min, blood pressure is 110/70 mmHg, the uterus infarction developed a brief attack of palpitation,
is soft, the uterine fundus is located at the level of accompanied by the sensations of lack of air, fear,
navel, there are positive signs of peritoneal irritation. and vertigo. His blood pressure is 90/60mmHg. ECG
What is the most likely diagnosis? during the attack shows extended QRS complex
1. Uterine perforation (0.13 seconds) with heart rate of 160/min, discordant
2. Acute metro endometritis shift of ST segment and T wave, dissociation of
3. Ectopic pregnancy atrial and ventricular rhythm. What disturbances of
4. Pelviperitonitis cardiac rhythm it is?
5. Acute suppurative salpingo-oophoritis 1. Paroxysmal supraventricular tachycardia
2. Ventricular fibrillation
83. A full-term newborn (born with the body weight 3. Frequent ventricular extrasystole
of 3900 g at gestational age of 39 weeks) on the first 4. Atrial fibrillation
day of his life developed respiratory disturbances: 5. Paroxysmal ventricular tachycardia
dyspnea, arrhythmic respiration, cyanosis attacks.
On examination there is paradoxical respiration 87. A 20-year old woman, gravida 2, para1 has been
observed and left side of the chest lags behind in in labor for 4 hours. Her condition is satisfactory.
the act of breathing. On auscultation the respiration Moderately painful contractions occur every 3
is weakened in the lungs on the left. Neurologist minutes and last for 35-40 seconds. The waters have
diagnosed the patient with left- sided Erb-Duchenne not burst yet. The fetus is in longitudinal position.
palsy. Complete blood count shows no changes. Fetal heartbeats are 136/min., clear and rhythmic.
What is the most likely diagnosis? Major segment of the fetal head is engaged to the
1. Left-sided diaphragm paresis pelvic inlet. Vaginal examination shows smooth
2. Respiratory distress syndrome cervix of 6 cm, amniotic sac is intact, sagital suture
3. Transient tachypnea of the newborn is in the left oblique diameter, occipital fontanel is
4. Congenital pneumonia on the right near the symphasis pubis. What stage of
5. Left-sided pneumonia labor is it?
1. Precursors of childbirth
84. A 17-year-old girl complains of a pain in her knee 2. Preliminary stage
and ankle joints and body temperature up to 39c . 2 3. The second stage of normal labor
weeks ago, she had a case of acute tonsillitis. 4. Latent phase of the first stage of normal labor
Objectively, her joints are swollen, sharply painful 5. Active phase of the first stage of normal labor
and their mobility is reduced. On the skin of her
truck and limbs there are barely visible circle- 88. The 5-year old child has been ill for 2 weeks.
shaped pale pink spots. Heart rate is 95/min, blood Cough attacks developed first and were then
pressure is 90/60 mmHg, heart sounds are followed by reprises. During coughing the child’s
weakened, there is a soft systolic noise over the face turns red and cervical veins bulge. The cough
apex. Make the provisional diagnosis: attacks induce vomiting. X-ray shows intensified
1. Acute rheumatic fever bronchial pattern. Blood test: leukocytes-16 x 109/L,
2. Rheumatoid arthritis lymphocytes-72%, erythrocyte sedimentation rate-
3. Systemic scleroderma 4mm/hour. What is the most likely diagnosis?
4. Erythema nodosum 1. Pneumonia
5. Reactive arthritis 2. Foreign body
3. Pertussis
85. A 30-year-old woman made an appointment with 4. Obstructive bronchitis
the family doctor for scheduled vaccination of her 2- 5. Adenovirus infection
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 13

89. During a regular examination, an 8-year old girl fatty acids. What is the most likely diagnosis?.
with type 1 diabetes mellitus presents with a 1. Celiac disease
swelling on the anterior surface of her hip. The 2. Lactase deficiency
swelling is 3 cm in diameter, dense, painless on 3. Functional diahhrea
palpation. The skin over this formation has normal 4. Irritable bowel syndrome
color and temperature. Localization of the swelling 5. Mucoviscidosis
matches the place where the girl usually receives
her insulin injections. What is the most likely cause 94. In a pediatric clinic, located in a rural area, there
of this clinical presentation? are 9 children, who simultaneously fell ill. The
1. Development of atrophic lipodystrophy following signs were detected: low physical activity,
2. Development of hypertrophic lipodystrophy acrocyanosis of the nasolabial triangle and
3. Formation of post-injection abscess fingertips, mucosal cyanosis, tachycardia, dyspnea.
4. Allergic response It was determined that all the sick children were fed
5. Formation of post-injection infiltration with a formula that was dissolved in the water taken
from a dug well. Laboratory analysis revealed high
90. A district doctor has diagnosed one of his levels of methemoglobin in the blood of the children.
patients with dysentery. What accounting document These signs can be caused by increased content of
reflects this type of morbidity? a certain element in the water. Name this element:
1. Control card of a patient registered for regular check- 1. Selenium
ups 2. Sulfates
2. Certificate of temporary disability 3. Methyl mercury
3. Urgent report 4. Nitrates
4. Statistical report 5. Lead
5. Report on a major non-epidemic disease
95. A 48-year old woman was delivered into the
91. A 48-year old woman has been hospitalized due surgical unit with wounds in her thigh. On
to development of tachysystolic atrial fibrillation. examination the wound surface has a dirty-gray
She has lost 5 kg of body weight within 2 months. coating with unpleasant sweet smell. The wound
On palpation there is a node in the left lobe of the content resembles a raspberry jelly. Skin tissues
thyroid gland. What pathology resulted in the around the wound are glossy and turgid. Palpation
development of this condition? reveals moderate crepitation in the tissues. What
1. Atherosclerotic cardiosclerosis bacteria is the most likely to cause such
2. Nontoxic nodular goiter inflammation?
3. Chronic thyroiditis 1. Blue pus bacillus
4. Autoimmune thyroiditis 2. Streptococci
5. Toxic nodular goiter 3. Staphylococci
4. Anaerobic non-clostridial
92. A pregnant woman at 32 weeks of gestation with 5. Anaerobic clostridial
the risk of preterm labor undergoes a treatment to
prevent fetal respiratory distress syndrome. What 96. A 45-year old man underwent a cardiac surgery
medicine was she prescribed? one week ago. His general state has been
1. Dexamethasone deteriorating since then: dyspnea at rest,
2. Misoprostol retrosternal pain that irradiates to the neck, marked
3. Gynipral ( hexoprenaline) weakness. Objectively, his body temperature is
4. Oxytocin hectic. His cardiac borders are expanded, apical
5. Progesterone beat is weakened. Auscultation detects pericardial
friction rub. What is the most likely diagnosis?
93. After semolina was introduced into the diet, a1- 1. Pulmonary embolism
year old child for 2 months has been presenting with 2. Acute cardiac aneurism
loss of appetite, irritability, loss of body mass, and 3. Myocardial infarction
loss of previously learned skills. The feces are 4. Acute myogenic dilation of the heart
copious and foul smelling. The skin is pale and dry, 5. Acute pericarditis
the hair is brittle. The abdomen is distended, while
the limbs are thin. Stool test shows high levels of
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 14

97. A 23-year-old woman with type 1 diabetes father of the child had bronchial asthma. Objectively,
mellitus during the 2nd week of community-acquired the boy’s face is pale and slightly swollen.
pneumonia developed nausea and vomiting. In the Respirations are 22/min. Auscultation detects
evening she has lost her consciousness and was vesicular respiration over the lungs. Rhinoscopy
hospitalized. Objectively, the patient’s skin is pale shows swollen and pale nasal mucosa. What
and dry. Her respiration is long, the tongue is dry, disease can be suspected?
with brown deposit. Her heart rate is 129/min, blood 1. Allergic rhinitis
pressure is 85/50mmHg. Palpation of the patient’s 2. Recurrent respiratory disease
abdomen provokes no response. the liver is +3 cm. 3. Acute rhinitis
Acetone test is markedly positive, blood glucose is 4. Acute adenoiditis
26 mmol/l. Make the provisional diagnosis: 5. Acute maxillary sinusitis
1. Hyperosmolar coma
2. Infectious toxic shock 101. After a long drive with the window open a man
3. Hepatic coma developed a facial asymmetry; he cannot close his
4. Lacticaemic coma right eye, his right nasolabial fold is smoothed out,
5. Ketoacidotic coma movements of expression are absent on the right,
there is a disturbance of taste sensation in the
98. A 54-year-old woman complains of fogged vision tongue on the right. No other neurological
in her right eye, rainbow circles in her vision, abnormalities were detected. What disease can be
headache, and nausea. Within the last month she provisionally diagnosed in this case?
twice experienced a similar condition, but back the 1. Neuropathy of the oculomotor nerve
all the signs eventually disappeared and her sight 2. Neuropathy of the facial nerve
was restored. Currently, all the signs have beed 3. Trigeminal ganglionitis
persisting for over 2 days. Objectively, the patient 4. Ischemic stroke
has eyelid edema, congestive injection of the 5. Neuropathy of the trigeminal nerve
eyeball, corneal opacity, shallow anterior chamber of
the eye, and dilated pupil that is unresponsive to the 102. A 45-year old man with thrombophlebitis of the
light. Her intraocular pressure is 48mmHg. Make the deep veins in his legs suddenly after physical
diagnosis: exertion developed sharp pain in his thorax on the
1. Cyclitis right, dyspnea, and hemoptysis. Objectively his
2. Iridocyclitis condition is severe; he presents with acrocyanosis,
3. Keratitis shortening of pulmonary percussion sound on the
4. Iritis right, and weakened respiration. Respiration is
5. Glaucoma 30/min, blood pressure is 110/80mm Hg. ECG shows
sinus tachycardia, his heart rate is 120/min, the
99. A pregnant woman of 34 weeks of gestation electrical axis of the heart deviates to the right. S1-
underwent dopperometry of umbilical circulation, Q3. What is the most likely diagnosis?
which revealed a reverse diastolic component. 1. Right-sided exudative pleurisy
Objectively, the height of the uterus is 27 cm above 2. Pulmonary embolism
the pubic bone, head of the fetus is mobile and 3. Community acquires right sided pneumonia
located above the entrance to the lesser pelvis. Fetal 4. Spontaneous pneumothorax
heartbeat is 136/min. Vaginal examination shows 5. Cancer of the right lung
that the uterine cervix is closed, its length is 3 cm.
What tactics should the obstetrician choose? 103. On laboratory investigation of a pork sample
1. Repeated dopplerometry next day there is 1 dead trichinella detected in 24 sections.
2. Urgent cesarean section This meat should be:
3. Labor induction with oxytocin 1. Processed and sold through public catering network
4. Fetal biophysical profile 2. Allowed for sale with no restrictions
5. Ultrasound photometry of the fetus 3. Processed for boiled sausage production
4. Handed over for technical disposal
100. A 10-year-old boy came to the polyclinic with 5. Frozen until the temperature of -10 degree C is
complaints of stuffy nose. It is known that these reached in the deep layers, with subsequent exposure to
signs occur in the child periodically (in spring and cold for 15 days
autumn). He has a history of atopic dermatitis. The
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 15

104. A surgery unit received a person with an 3. Tuberculosis of the right lung
incised stab wound on the upper third of the right 4. Cancer of the right lung
thigh. Examination detects an incised stab wound 5. Chronic bronchitis
3.0×0.5×2.0 cm in size on the inner surface of the
upper third of the right thigh. Bright red blood flow 108. A 43-year old man complains of facial edema,
from deep within the wound in a pulsing stream. dyspnea, and difficult swallowing that appeared 3
Characterize this type of bleeding: hours after he was stung by an insect. Objectively,
1. Venous the skin of his eyelids, cheeks and lips is acutely
2. Capillary hyperemic and edematous. What medicines should
3. Arterial he be prescribed for emergency aid?
4. Mixed 1. Nonsteroidal anti-inflammatory drugs
5. Parenchymatous 2. Diuretics
3. Muscle relaxants
105. During regular examination of a 2-year old boy, 4. Antihistamines
he presents with enlarged left kidney, painless on 5. Glucocorticoids - (Glucocorticosteroids)
palpation. The right kidney was undetectable on
palpation. Excretory urography shows no contrast 109. A 19-year-old girl complains of moderate,
on the right. Cytoscopy detected hemi atrophy of the itching and hair loss on her head. Objectively, on the
urinary bladder trigone, the right ureteral orifice is skin of her occipital region there is a single round
not detected. What pathology is it? erythematous focus 3 cm in diameter with clear
1. Agenesis of the right ureter margins. Asbestos- like scales can be observed on
2. Agenesis of the right kidney the surface of the lesion. The hair in the focus of the
3. Dystopia of the right kidney lesion is broken off at the length of 6-8 cm. What is
4. Ectopic right ureteral orifice the most likely diagnosis?
5. Hypoplasia of the right kidney 1. Psoriasis
2. Seborrhea
106. A 56-year-old woman has been working as a 3. Microsporia
disinfector for 19 years. She complains of general 4. Scabies
weakness, nausea, bitter taste in her mouth, heavy 5. Trichophytosis
sensation in her right subcostal area, and rapid
fatigability. Objectively, her body temperature is 37.1 110. A 26-year-old man complains of chills, rhinitis,
C, the sclerae are icteric, and the liver is enlarged. dry cough, and fever up to 38C. Examination shows
Total bilirubin is 40 mcmol/L. What is the likely him to be in a moderately severe condition; there are
diagnosis? small pale pink non-merging spots on the skin of his
1. Chronic cholecystitis back, abdomen, and extremities. Palpation reveals
2. Biliary dyskinesia enlarged occipital and axillary lymph nodes. No
3. Occupational toxic hepatitis information about vaccination history could be
4. Chronic pancreatitis obtained. What is the likely etiology of this disease?
5. Acute cholecystitis 1. Epstein-Barr virus
2. Meningococcus
107. A 57-year-old man, a miner, complaints of a 3. Streptococcus
pain in his chest, dyspnea on physical exertion, 4. Rubella virus
excessive sweating, constant sub febrile 5. Mumps virus
temperature, and cough that produces blood-
steaked sputum. He has been smoking for 111. A 3-year-old child has been brought to a
approximately 40 years (2 packs a day) and hospital with pain in the legs, fever, and loss of
frequently has ”pneumonias”. Survey chest X-ray appetite. Objectively: pale skin and mucosa,
shows a triangular shadow in the middle lobe of the hemorrhagic rash. Lymph nodes are enlarged,
right lung. One of the apices of the shadow points to painless, dense and elastic, not matted together.
the lung root. Cardiac and mediastinal shadows are Bones, joints and abdomen are painful. The liver and
displaced toward the affected area. Make the spleen are enlarged. Hemogram: Hb-88g/L, color
provisional diagnosis: index- 1.3, platelets- 80 x 109/L, leukocytes- 25.8 x
1. Right-sided pleuropneumonia 109/L, lymphoblasts- 70%, ESR-52 mm/hour. Make
2. Pneumoconiosis the provisional diagnosis:
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 16

1. Infectious mononucleosis 4. Head CT

2. Hemorrhagic vasculitis (Henoch-Schonlein purpura) 5. Echoencephalography
3. Acute leukemia
4. Acute rheumatic fever 116. A 40-year-old victim of a traffic accident
5. Thrombocytopenic purpura sustained the following injuries: closed diaphyseal
femur fracture, brain concussion, multiple rib
112. A 13-year- old girl for a month has been fractures, hemopneumothorax, degloving shin
complaining of fatigability, dull pain in her right injuries. What injuries require the most urgent
subcostal area, abdominal distension, and attention?
constipations. Abdominal palpation reveals positive 1. Brain concussion
Kehr, Murphy, and Ortner signs, while Desjardins 2. Closed diaphyseal femur fracture
and Mayo-Robson points are painless. Total bilirubin 3. Degloving shin injuries
is 14.7 mcmol/L, predominantly indirect, ALT-20 U/L, 4. Multiple rib fractures, hemopneumothorax
AST- 40 U/L, amylase – 6.3 mmol/L. Echo 5. All injuries are equivalent
cholecystography shows practically no contraction
of the gallbladder. Make the provisional diagnosis: 117. After eating shrimps, a 25-year old man
1. Chronic pancreatitis suddenly developed skin itching, some areas of his
2. Chronic hepatitis skin became hyperemic or erupted into vesicles.
3. Hypokinetic biliary dyskinesia Make the diagnosis:
4. Hyperkinetic biliary dyskinesia 1. Hemorrhagic vasculitis (Henoch-Schonlein purpura)
5. Acute pancreatitis 2. Psoriasis
3. Acute urticaria
113. A 20-year-old woman complains of headaches, 4. Scabies
vertigo, tearfulness, vomiting, pain in the area of the 5. Urticaria pigmentosa
heart, and tachycardia. The signs appear 6-7 days
before menstruation and disappear in the first days 118. Employees work in conditions of high dust
of menstruation. Make the diagnosis concentration. Certain chemical (silicon dioxide
1. Diencephalic syndrome content) and physical properties of dust aerosols
2. Algomenorrhea contribute to the development of occupational dust-
3. Metabolic craniopathy induced diseases. What is the main physical
4. Stein-leventhal syndrome property of dust aerosols?
5. Premenstrual syndrome 1. Magnetization
2. Electric charge
114. What modern organizational method can 3. Solubility
provide the patients in the remote settlements with 4. Ionization
timely access to quality medical aid and such 5. Dispersion
medical services as consulting, diagnostics, and
treatment, especially in the situations when time and 119. The director of a medical facility draws up a
distance are crucial? financial plan for the next year. To improve the
1. Telemedicine economic well-being of his establishment, he
2. Field medical services decided to increase the amount of medical services
3. Mobile communication provided. How will it change the fixed cost per unit
4. Ambulance services of service?
5. Air medical services 1. Fluctuate
2. Decrease
115. 3 hours after a trauma, a young man developed 3. No changes
bradycardia of 46/min, anisocoria D >S, hemi- 4. There is no correlation between these variables
hyperreflexia S >D, hemi hypesthesia on the left, and 5. Increase
a convulsive disorder. The character of this process
needs to be clarified. What method of examination 120. A 55-year-old woman came to a gynecologist
will be the most accurate for this purpose? with complaints of leukorrhea and bloody discharge
1. Lumbar puncture from the vagina after 5 years of menopause.
2. Skull X-ray Anamnesis states no pregnancies. Bimanual
3. Electroencephalography examination: the uterus and uterine appendages are
without changes. During diagnostic curettage of the
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 17

uterine cavity the physician scrapped off a sample of margin, the lower splenic pole is at the umbilical
encephaloid matter. What is the most likely level. In blood: erythrocytes- 3.5 x 1012/L, Hb- 88 g/L,
diagnosis in this case? leukocytes- 86 x 109/L, band neutrophils- 1%,
1. Endometrial carcinoma segmented neutrophils-10%, lymphocytes- 85%,
2. Subserous uterine myoma eosinophils-2%, basophils-0%, monocytes-2%,
3. Adenomyosis erythrocyte sedimentation rate- 15 mm/hour,
4. Cervical carcinoma Gumprecht shadows. What is the most likely
5. Ovarian carcinoma diagnosis?
1. Acute leukemia
121. Children from a certain township presents with 2. Chronic lymphocytic leukemia
brittle teeth, malocclusion, dental enamel erosions, 3. Lymphogranulomatosis
and dental pigmentation that looks like yellow- 4. Chronic myeloid leukemia
brown spots. What is the likely cause of this 5. Lymphocytic leukemoid reaction
presentation?
1. High levels of sulfates in water 125. A multigravida, labor II, 36-37 weeks of
2. High levels of nitrates gestation, has gone into labor. Her waters broke 8
3. High levels if fluorine in water hours ago, the labor activity continues for the last 4
4. Low levels of fluorine in water hours, it is regular, with contractions that last 35
5. Low levels of sulfates in water seconds and occur every 3 –4 minutes. The child is
in the cephalic presentation, with the head pressed
122. A 65-year old man with acute anterior to the entrance into the lesser pelvis. The parturient
myocardial infarction developed an asphyxia attack. woman complains of a sudden sharp abdominal
Examination detected diffuse cyanosis. In the lungs pain. Her pulse is100/min, blood pressure is 110/70-
there are numerous heterogenous wet crackles. 100/70 mmHg. The uterus is tense and does not
Heart rate is 100/min. Blood pressure is 120/100 mm relax between the contractions. Fetal heartbeat is
Hg. What complication occurred in this patient? muffled- 100/min. The amniotic fluid is blood-colored
1. Cardiogenic shock and continues to leak. What is the most likely
2. Ventricular septal rupture diagnosis?
3. Pulmonary edema 1. Uterine rupture
4. Hypertensive crisis 2. Cervical rupture
5. Pulmonary embolism 3. Rupture of the umbilical vessels
4. Premature detachment of the normally positioned
123. A 7-year-old boy after a fall from a height placenta
presents with rapid and shallow breathing and 5. Partial placenta previa
cyanotic face. The right half of his thorax is
distended and takes no part in the respiration. 126. A 52-year-old woman has been suffering for 2
Percussion detects tympanitis in the affected area, years from dull, occassionally exacerbating pain in
while auscultation detects no breathing there. What her right subcostal area, occuring after eating high-
pathology is the most likely cause of this clinical fat foods, bitter taste in her mouthin the morning,
presentation? What instrumental examination would constipations, and flatulence. Objectively, she is
be most informative in this case? obese, her body temperature is 36.9 C; there is a
1. Tension cyst of the right lung. Tracheobronchoscopy coating on the root of her tongue; abdomen is
2. Right-sided tension pneumothorax. Chest X-ray moderately distended and painful in the area of the
3. Right-sided hemothorax. Survey X-ray of the chest gallbladder projection. What examination would be
4. Airway foreign body. Diagnostic therapeutic most helpful for diagnosis making?
bronchoscopy 1. Ultrasound
5. Mediastinitis. Survey X-ray of the chest 2. Duodenoscopy
3. Liver scanning
124. A 58-year old man complains of weakness and 4. Cholecystography
tumor-like formations that appeared on the anterior 5. Duodenal probe
surface of his neck and in the inguinal region.
Palpation detects soft painless mobile cervical and 127. A 21-year-old man was hospitalized on the 2nd
inguinal lymph nodes up to 2cm in diameter. The day of the disease. His general condition is severe,
liver protrudes by 2cm from the edge of the costal body temperature is 39C. On his skin there are
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 18

numerous irregular-shaped hemorrhghic elements. 3. Lymphocytic (Armstrong’s) meningitis

The diagnosis of meningococcemia was made. The 4. Syphilitic meningitis
next day his body temperature suddenly decreased, 5. Tuberculous meningitis
blood pressure was 80/40mmHg, pulse was 120/min.
Acrocyanosis was detected. What complication did
the patient develop?
1. Acute hemorrhage
2. Acute liver failure
3. Acute heart failure
4. Acute adrenal insufficiency
5. Cerebral coma

128. A 2.5-year –old child is ill for the second day.

The onset of the disease was associated with the
temperature up to 37.8 C, a single bout of vomiting,
a watery diarrhea up to 5 times per day. During the
second day, vomiting occurred twice, body
temperature is 38.0C, the child has low appetite,
watery diarrhea continues. The treatment of the child
should start with the following:
1. Prescribe nifuroxazide
2. Prescribe polymyxin
3. Prescribe loperamide
4. Prescribe ceftriaxone
5. Prescribe oral rehydration

129. Examination detected vesicles with

seropurulent content on the neck, back of the head,
and buttocks of an infant on the 4th day of life. The
patient’s condition is satisfactory, the child is active,
all newborn reflexes can be fully induced, the
umbilical cord is at the stage of mummification, the
umbilical area is without any peculiarities. What
disease can be suspected?
1. Epidermolysis bullosa
2. Phlegmon
3. Vesiculopustulosis
4. Miliaria
5. Neonatal pemphigus

130. A 20-year old patient complains of a severe

headache, double vision, weakness, fever,
irritability. Objectively: body temperature is 38.1 C,
the patient is reluctant to contact, sensitive to
stimuli. There is ptosis of the left eyelid, exotropia,
anisocoria S >D, and pronounced meningeal
syndrome. On the lumbar puncture the
cerebrospinal fluid flowed out under a pressure of
300 mmHg, the fluid is clear, slightly opalescent. 24
hours later there appeared a fibrin film. Protein- 1.4
g/L, lymphocytes- 600 per mm^3, glucose- 0.3
mmol/L. What is the provisional diagnosis?
1. Meningococcal meningitis
2. Mumps meningitis
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 19

Krok 2 - 2020 (General Medicine) Answer Key

01.(2) 21.(1) 41.(2) 61.(1) 81.(5) 101.(2) 121.(3)
02.(1) 22.(3) 42.(2) 62.(4) 82.(4) 102.(2) 122.(3)
03.(3) 23.(2) 43.(1) 63.(3) 83.(1) 103.(4) 123.(2)
04.(2) 24.(3) 44.(1) 64.(3) 84.(1) 104.(3) 124.(2)
05.(2) 25.(1) 45.(4) 65.(3) 85.(5) 105.(2) 125.(4)
06.(4) 26.(3) 46.(5) 66.(1) 86.(5) 106.(3) 126.(1)
07.(3) 27.(3) 47.(3) 67.(2) 87.(5) 107.(4) 127.(4)
08.(3) 28.(3) 48.(2) 68.(2) 88.(3) 108.(5) 128.(5)
09.(4) 29.(2) 49.(4) 69.(3) 89.(2) 109.(3) 129.(3)
10.(2) 30.(5) 50.(3) 70.(4) 90.(3) 110.(4) 130.(5)
11.(2) 31.(4) 51.(3) 71.(1) 91.(5) 111.(3)
12.(1) 32.(2) 52.(1) 72.(5) 92.(1) 112.(3)
13.(4) 33.(1) 53.(1) 73.(4) 93.(1) 113.(5)
14.(3) 34.(5) 54.(2) 74.(3) 94.(4) 114.(1)
15.(4) 35.(1) 55.(5) 75.(4) 95.(5) 115.(4)
16.(3) 36.(5) 56.(1) 76.(1) 96.(5) 116.(4)
17.(5) 37.(4) 57.(4) 77.(1) 97.(5) 117.(3)
18.(2) 38.(2) 58.(4) 78.(1) 98.(5) 118.(5)
19.(5) 39.(4) 59.(4) 79.(2) 99.(2) 119.(2)
20.(5) 40.(1) 60.(3) 80.(1) 100.(1) 120.(1)
Krok 2- 2020 (General Medicine) (t.me/krok2GeneralMedicine) - 1