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Exam Review

Key Facts: KROK 2 Pediatrics Exam

150

Exam Questions

Testing Center MOH Ukraine

150 / 180 min

Test Duration

Testing Center: Ukrainian / foreign citizens

64.0%

Passing Criterion

MOH Order No. 1898

KROK 2 Pediatrics is the 150-question clinical licensing examination administered by the Testing Center of the Ministry of Health of Ukraine for graduating sixth-year pediatric students, requiring a 64.0% passing score.

Sample KROK 2 Pediatrics Practice Questions

Try these sample questions to review concepts for the KROK 2 Pediatrics exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 95+ question experience with AI tutoring.

1A preterm male infant born at 30 weeks of gestation (birth weight 1,350 g) develops rapid, shallow breathing, expiratory grunting, prominent intercostal and subcostal retractions, and nasal flaring within 30 minutes after delivery. Room-air pulse oximetry shows an oxygen saturation of 78%. A chest radiograph demonstrates diffuse reticulogranular 'ground-glass' opacities with prominent air bronchograms and reduced lung volume. What is the fundamental pathophysiology and the most appropriate definitive therapy for this condition?
A.Deficiency of pulmonary surfactant; administration of exogenous surfactant via the trachea alongside respiratory support
B.Delayed clearance of fetal alveolar fluid; fluid restriction and intravenous furosemide
C.Congenital malformation of the tracheobronchial tree; emergency surgical bronchoplasty
D.Bacterial aspiration pneumonia; empiric intravenous broad-spectrum vancomycin monotherapy
Explanation: This clinical and radiographic presentation is classic for neonatal respiratory distress syndrome (NRDS, formerly hyaline membrane disease), caused by a deficiency of pulmonary surfactant produced by type II pneumocytes in premature infants (< 32-34 weeks). Surfactant deficiency leads to high alveolar surface tension, diffuse microatelectasis, ventilation-perfusion mismatch, and hypoxemia. Definitive management includes non-invasive CPAP support and timely administration of exogenous natural surfactant (e.g., poractant alfa, beractant) via endotracheal tube or minimally invasive surfactant therapy (LISA/MIST).
2A full-term male neonate born at 39 weeks of gestation via elective cesarean section without labor develops tachypnea (respiratory rate 76 breaths/min) and mild intercostal retractions at 1 hour of life. Auscultation reveals clear breath sounds bilaterally without crackles or grunting. Pulse oximetry is 91% on room air and improves to 97% on minimal supplemental blow-by oxygen. A chest radiograph reveals hyperexpansion, prominent perihilar streaking, and fluid tracking within the horizontal interlobar fissure. Which of the following is the most likely diagnosis?
A.Transient tachypnea of the newborn (TTN)
B.Meconium aspiration syndrome
C.Neonatal respiratory distress syndrome
D.Spontaneous tension pneumothorax
Explanation: Transient tachypnea of the newborn (TTN, or 'wet lung') results from delayed resorption and clearance of fetal alveolar lung fluid by pulmonary lymphatic and venous channels. The absence of labor and delivery via elective cesarean section deprives the infant of catecholamine-mediated sodium and water resorption mechanisms across the alveolar epithelium. Chest radiograph classically displays hyperinflation, prominent perihilar vascular markings, and fluid in the interlobar fissures. TTN is typically a benign, self-limited condition resolving within 24 to 72 hours with supportive care.
3A 12-hour-old full-term infant is noted to have marked jaundice of the face, trunk, and proximal extremities. The mother is a 28-year-old Rh-negative (O, Rh-) woman who did not receive anti-D immunoglobulin during pregnancy; the infant's blood group is A, Rh-positive (Rh+). Laboratory testing reveals total serum bilirubin of 220 mcmol/L (predominantly indirect/unconjugated), hemoglobin of 115 g/L, reticulocyte count of 12%, and a strongly positive direct antiglobulin (Coombs) test. What is the definitive diagnosis and primary mechanism of hemolysis?
A.Hemolytic disease of the fetus and newborn due to Rh(D) alloimmunization; transplacental maternal IgG antibodies destroying fetal Rh-positive erythrocytes
B.Physiological jaundice of the newborn; immature hepatic glucuronosyltransferase activity
C.ABO incompatibility hemolysis; natural maternal IgM antibodies directly crossing the placenta
D.Hereditary spherocytosis; congenital erythrocyte membrane skeletal protein mutation
Explanation: This neonate displays severe early-onset hemolytic jaundice occurring within the first 24 hours of life due to Rh(D) incompatibility. An unsensitized Rh-negative mother carrying an Rh-positive fetus produces anti-D IgG antibodies upon exposure to fetal erythrocytes. These maternal IgG antibodies cross the placenta and target fetal Rh-D antigens, leading to extravascular hemolysis by reticuloendothelial macrophages. Marked reticulocytosis, anemia, and a positive direct Coombs test confirm immune hemolysis, requiring urgent intensive phototherapy and preparation for possible exchange transfusion to prevent bilirubin encephalopathy (kernicterus).
4A 36-hour-old term neonate with blood group B, Rh-positive born to a mother with blood group O, Rh-positive develops mild scleral and cutaneous jaundice extending to the umbilicus. Serum total bilirubin is 195 mcmol/L (indirect fraction 185 mcmol/L). Hemoglobin is 148 g/L, and peripheral blood smear reveals spherocytes. The direct antiglobulin (Coombs) test is weakly positive. What is the most appropriate initial management for this infant?
A.Initiate phototherapy and recheck serum bilirubin in 4-6 hours, adjusting further monitoring to the response
B.Immediate double-volume exchange transfusion via umbilical venous catheter
C.Administer oral phenobarbital to induce hepatic glucuronosyltransferase
D.Discontinue all feedings and initiate total parenteral nutrition
Explanation: This scenario describes mild-to-moderate hemolytic disease of the newborn due to ABO incompatibility (mother group O, infant group B). Maternal anti-B IgG antibodies cross the placenta, causing mild extravascular hemolysis, spherocytosis, and unconjugated hyperbilirubinemia. For this bilirubin level, age and hemolysis risk, phototherapy (converting unconjugated bilirubin into water-soluble structural isomers like lumirubin that are excreted in bile and urine without conjugation) is the established first-line intervention. Exchange transfusion is used for acute bilirubin encephalopathy or bilirubin at the age- and risk-specific exchange threshold despite urgent intensive phototherapy.
5A 2-day-old male infant born at 38 weeks of gestation following a 22-hour duration of membrane rupture presents with hypothermia (axillary temperature 35.8°C), lethargy, poor feeding, weak cry, and tachypnea with mild grunting. Physical examination reveals mottled skin, cold extremities, and a capillary refill time of 4 seconds. Heart rate is 172 beats/min, and blood pressure is 52/30 mmHg. Complete blood count shows a total leukocyte count of 4.2 x 10^9/L with 28% band forms (immature-to-total neutrophil ratio > 0.25). Which of the following is the most appropriate empiric antimicrobial therapy after blood and urine cultures are obtained?
A.Intravenous ampicillin plus gentamicin
B.Oral amoxicillin-clavulanate monotherapy
C.Intravenous vancomycin plus oral fluconazole
D.Intravenous ceftriaxone monotherapy
Explanation: This neonate presents with early-onset neonatal sepsis and septic shock, with risk factors including prolonged rupture of membranes (> 18 hours). The predominant causative pathogens for early-onset neonatal sepsis (< 72 hours of life) are Group B Streptococcus (Streptococcus agalactiae) and Escherichia coli, followed by Listeria monocytogenes. The standard guideline-recommended empiric antimicrobial regimen is intravenous ampicillin (covering GBS and Listeria) combined with an aminoglycoside such as gentamicin (providing synergistic bactericidal coverage against Gram-negative enteric bacilli including E. coli).
6A term female neonate (40 weeks) is born via emergent cesarean section for non-reassuring fetal status and placental abruption. Apgar scores are 1 at 1 minute, 3 at 5 minutes, and 5 at 10 minutes. Umbilical arterial blood gas analysis reveals a pH of 6.90 and a base deficit of 18 mmol/L. At 3 hours of life, the infant exhibits lethargy, profound hypotonia with diminished primitive reflexes, and focal clonic seizures. Amplitude-integrated EEG demonstrates a severely abnormal discontinuous pattern. Which of the following interventions has been proven to significantly reduce death and long-term neurodevelopmental disability when initiated within 6 hours of birth?
A.Therapeutic whole-body hypothermia maintaining a core temperature of 33.5°C for 72 hours
B.High-dose intravenous methylprednisolone pulse therapy for 5 days
C.Aggressive hyperventilation to induce hypocapnia with target PaCO2 < 25 mmHg
D.Continuous intravenous sodium bicarbonate infusion to normalize base deficit
Explanation: Therapeutic hypothermia (cooling to a core temperature of 33.0°C-34.0°C, typically 33.5°C, for 72 hours followed by slow rewarming) is the standard evidence-based neuroprotective treatment for moderate-to-severe hypoxic-ischemic encephalopathy (HIE) in infants >= 36 weeks of gestation. To be effective, cooling must be initiated within the 6-hour therapeutic window before secondary neuronal energy failure and apoptosis peak. Large randomized trials have conclusively proven that therapeutic hypothermia significantly reduces mortality and cerebral palsy without increasing severe adverse effects.
7A 24-hour-old term infant delivered via vacuum-assisted extraction is evaluated for a localized scalp mass. Examination reveals a firm, fluctuant, non-pulsatile swelling over the right parietal bone that is strictly bounded by cranial suture lines and does not cross the sagittal or coronal sutures. The infant is alert, feeds well, and has a normal neurological examination with a stable hematocrit. What is the most likely diagnosis and appropriate clinical management?
A.Cephalohematoma; clinical observation and parental reassurance without needle aspiration
B.Caput succedaneum; immediate needle drainage to relieve intracranial pressure
C.Subgaleal hemorrhage; urgent surgical evacuation through craniotomy
D.Epidural hematoma; emergency decompressive burr hole placement
Explanation: A cephalohematoma is a traumatic subperiosteal collection of blood resulting from rupture of blood vessels between the skull bone and the periosteum, commonly associated with prolonged labor or instrumented deliveries (vacuum or forceps). Because the bleeding is beneath the periosteum, it is strictly confined by cranial suture lines. Management is conservative observation and reassurance, as the hematoma spontaneously absorbs over several weeks to months. Needle aspiration or incision is contraindicated due to the high risk of introducing bacterial infection.
8A post-term female neonate (gestational age 42 weeks) is born through thick, 'pea-soup' meconium-stained amniotic fluid. Immediately after delivery, the infant is tachypneic (respiratory rate 82 breaths/min) with prominent expiratory grunting, sternal retractions, cyanosis, and a barrel-shaped chest. Auscultation reveals coarse rhonchi and crackles bilaterally. A chest radiograph demonstrates hyperinflation with flattening of the diaphragms, coarse, asymmetric patchy infiltrates, and areas of consolidation interspersed with atelectasis. What is the primary pathophysiology of this disease?
A.Airway obstruction, chemical pneumonitis, and secondary surfactant inactivation caused by aspirated meconium
B.Congenital absence of bronchial cartilage rings leading to widespread dynamic airway collapse
C.Primary pulmonary hypoplasia secondary to severe prolonged oligohydramnios
D.Persistent pulmonary venous hypertension due to total anomalous pulmonary venous connection
Explanation: Meconium aspiration syndrome (MAS) occurs primarily in post-term or growth-restricted infants experiencing intrapartum hypoxia that triggers in-utero passage of meconium and gasping respirations. Inhaled meconium causes a triad of pathophysiologic insults: (1) mechanical obstruction of small airways producing a 'ball-valve' effect with air trapping and alveolar hyperinflation; (2) acute chemical pneumonitis with inflammatory exudation; and (3) direct inhibition and breakdown of pulmonary surfactant, leading to secondary alveolar collapse and severe ventilation-perfusion mismatch.
9A 4-month-old infant is brought to the pediatric clinic during winter with a 3-day history of clear rhinorrhea, sneezing, and low-grade fever (37.9°C), followed today by poor feeding, rapid breathing, and audible wheezing. Physical examination reveals an alert infant with a respiratory rate of 58 breaths/min, intercostal retractions, prolonged expiratory phase, and diffuse bilateral fine inspiratory crackles and high-pitched expiratory wheezes. Oxygen saturation on room air is 93%. Nasopharyngeal swab is positive for respiratory syncytial virus (RSV). What is the primary evidence-based management strategy for this infant?
A.Supportive care with gentle nasal suctioning, maintenance of hydration, and supplemental oxygen if saturation drops below 90-92%
B.Immediate oral azithromycin for 5 days to eradicate atypical secondary pathogens
C.Routine administration of nebulized salbutamol and oral prednisolone every 4 hours
D.Intravenous aminophylline infusion and prophylactic broad-spectrum antibiotics
Explanation: Acute bronchiolitis is the most common lower respiratory tract infection in infants, predominantly caused by RSV. Clinical practice guidelines (AAP and international pediatric guidelines) emphasize supportive care as the cornerstone of management: maintaining upper airway patency through gentle nasal suctioning, ensuring adequate hydration and nutrition, and providing humidified supplemental oxygen when saturation drops below 90-92%. Clinical trials have consistently shown that routine bronchodilators, systemic corticosteroids, and antibiotics do not shorten hospital stay, reduce admission rates, or alter clinical outcomes in viral bronchiolitis.
10A previously healthy 3-year-old boy presents with high fever (39.2°C), productive cough, and tachypnea of 2 days' duration. On examination, his respiratory rate is 46 breaths/min (elevated for age), pulse is 128 bpm, and SpO2 is 96% on room air. Auscultation reveals bronchial breath sounds and crackles localized to the right lower lung field, with dullness to percussion in the same area. The child is drinking fluids and has no vomiting or signs of lethargy. A diagnosis of non-severe community-acquired pneumonia is made. Which of the following is the first-line oral antimicrobial treatment according to pediatric guidelines?
A.Oral amoxicillin (50-90 mg/kg/day divided into 2 or 3 doses)
B.Oral ciprofloxacin (20 mg/kg/day divided twice daily)
C.Oral erythromycin (40 mg/kg/day divided four times daily)
D.Oral trimethoprim-sulfamethoxazole (8 mg/kg/day trimethoprim equivalent)
Explanation: Streptococcus pneumoniae is an important cause of bacterial community-acquired pneumonia in children. Ukraine's 2022 pediatric pneumonia standard recommends oral amoxicillin as first-choice treatment for non-severe CAP, at 50-90 mg/kg/day in two or three divided doses. Amoxicillin provides pneumococcal coverage without unnecessarily broad antimicrobial therapy.

About the KROK 2 Pediatrics Exam

Independent practice questions for KROK 2 Pediatrics, the clinical-stage licensing exam for sixth-year pediatric students in Ukraine.

Exam sponsor: ДНТ «Центр якості освіти МОЗ» (Testing Center of the Ministry of Health of Ukraine). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Stage 2 Unified State Qualification Examination (ЄДКІ) integrated test comprising 150 single-best-answer MCQs; university graduation also entails the Objective Structured Practical (Clinical) Examination (OSCE / ОСП(К)І) in the sixth year.

Time Limit

150 min (180 min for foreign students)

Passing Score

64.0%

Exam / Certification Fees

Ordinary exam costs are covered by state funding for state-funded students or included in tuition for fee-paying students. Universities arrange payment to the Testing Center. During martial law, up to two retakes are allowed at the learner's expense. Overseas certification centres set their own sitting charges, payable by the learner. Confirm the applicable amount with your university and test centre.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

60%

Diseases of Organs and Systems / Clinical Protocols

Pediatric respiratory, cardiovascular, gastrointestinal, nephrological, hematological, endocrine, neonatal, and surgical pathologies.

20%

Diagnostics of Emergencies and Urgent Care

Recognition and urgent management of pediatric resuscitation, status epilepticus, anaphylaxis, severe dehydration, respiratory failure, acute poisonings, and trauma.

18%

Infectious and Parasitic Diseases, and Immunoprophylaxis

Childhood exanthematous infections, meningococcal infection, purulent meningitis, whooping cough, intestinal infections, parasites, and the National Immunization Calendar.

2%

Related Issues

Pregnancy and childbirth, including labor disorders, fetal hypoxia, placental complications, and obstetric hemorrhage.

Preparing for the KROK 2 Pediatrics Exam

What You Need to Know

  • Passing score: 64.0%
  • Assessment: Stage 2 Unified State Qualification Examination (ЄДКІ) integrated test comprising 150 single-best-answer MCQs; university graduation also entails the Objective Structured Practical (Clinical) Examination (OSCE / ОСП(К)І) in the sixth year.
  • Time limit: 150 min (180 min for foreign students)
  • Exam / certification fees: Ordinary exam costs are covered by state funding for state-funded students or included in tuition for fee-paying students. Universities arrange payment to the Testing Center. During martial law, up to two retakes are allowed at the learner's expense. Overseas certification centres set their own sitting charges, payable by the learner. Confirm the applicable amount with your university and test centre. Official sources

Using Our Practice Resources

  • Work through all 95 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

KROK 2 Pediatrics: Suggested Study Strategy

1Master neonatal assessment, respiratory distress syndrome, neonatal jaundice phototherapy criteria, and hypoxic-ischemic encephalopathy management.
2Review childhood infectious exanthems, distinctive rash morphology, Koplik spots, strawberry tongue, and Ukrainian vaccination calendar schedules.
3Know pediatric emergency protocols by heart: PALS algorithms, intramuscular adrenaline dosing for anaphylaxis, and status epilepticus management.
4Understand differential diagnoses and urgent surgical interventions for acute abdomen in children, including intussusception and hypertrophic pyloric stenosis.

Frequently Asked Questions

What is KROK 2 Pediatrics in Ukraine?

KROK 2 Pediatrics is the clinical disciplines test component of Stage 2 of the Unified State Qualification Examination (ЄДКІ), taken in the sixth year of medical school for the specialty 'Pediatrics' (228 Педіатрія). Graduation also requires passing the practical clinical OSCE examination.

What is the passing score for KROK 2 Pediatrics?

The Testing Center of the Ministry of Health of Ukraine establishes a passing criterion of 64.0% correct answers.

How long is the KROK 2 Pediatrics examination?

The official exam duration is 150 minutes for Ukrainian citizens (1 minute per question for 150 questions) and 180 minutes for foreign students.

Is this practice resource an official KROK translation?

This is an independent English-language MCQ study adaptation on tested topics, with four options per practice question. It is not an official translation or format simulation and does not replace university clinical rotations or the practical clinical OSCE examination.

What fees apply to the KROK 2 Pediatrics examination?

Under CMU Resolution No. 334, ordinary exam costs for state-funded students are covered within the state budget; costs for fee-paying students are included in tuition. Universities pay the Testing Center under institutional contracts. During martial law, Resolution No. 1327 of 22 October 2025 allows up to two learner-funded retakes. Candidates sitting abroad also pay the charge set by their certification centre. Confirm your applicable amount with your university and test centre; there is no single amount stated here for every cohort and location.