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LEKEXAM / 2008 autumn

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Question distribution — 2008 autumn session

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Internal medicinePediatricsSurgeryGynecology and obstetricsFamily medicineEmergency medicine, AnaesthesiologyPsychiatryMedical law and bioethicsPublic healthMedical certification

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Question 1

A patient with a long-standing history of severe COPD is admitted to hospital with increased shortness of breath and changes in the character of the cough and the sputum. Arterialized capillary blood gas analysis (ABG) showed: PaO2=45mmHg, PaCO2=55mmHg, SaO2=88%. Apart from intravenous drugs the patient was given oxygen via a nasal cannula with the flow rate of 2 litres per minute. Two hours later the patient started complaining of a headache and general malaise. Control ABG demonstrated PaO2=48mmHg, PaCO2=60mmHg, SaO2=90%. In this patient the next step should be:

Aincreasing the oxygen flow rate.
Bdecreasing the oxygen flow rate.
Cleaving the oxygen flow rate at 2l/min.
Dcarrying out the blood culture test.
Ereplacing the nasal cannula with an oxygen mask to increase oxygen concentration in the gases delivered to the airways.

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Question 2

(1) A patient with implanted pacemaker requires routine antibiotic prophylaxis against infective endocarditis before having a dental plaque removal procedure because (2) dental procedures involving parodontium increase the risk of infective endocarditis development.

Astatement (1) is true, statement (2) is false.
Bboth statements are true with a logical connection.
Cboth statements are true without a logical connection.
Dstatement (1) is false, statement (2) is true.
Eboth statements are false.

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Question 3

A common complication of inferior myocardial infarction resulting in acute pulmonary oedema and cardiogenic shock presenting with pansystolic murmur and third heart sound is:

Apost-infarction angina.
Bmitral stenosis.
Cacute mitral regurgitation.
Dpapillary muscle rupture.
EC and D.

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Question 4

Impaired glucose tolerance is defined as:

Afasting plasma glucose ≥200 mg/dl.
Brandom plasma glucose ≥ 200 mg/dl.
Cplasma glucose of 140-199 mg/dl 2hrs after a 75g oral glucose load.
Dfasting plasma glucose ≥126 mg/dl from two samples.
Eplasma glucose ≥ 200 mg/dl 2hrs after a 75g oral glucose load.

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Question 5

The following values were obtained in a prebronchodilator spirometry: FEV1=2,5l, FVC=4l. Such results justify the diagnosis of:

Aasthma.
BCOPD.
Cvolume restriction.
Dairflow obstruction.
Einterstitial lung disease.

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Question 6

The following parameters are included in the SCORE risk charts except for:

Awaist circumference.
Bgender.
Cage.
Dsystolic blood pressure.
Esmoking.

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Question 7

The four limb electrodes in a standard 12-lead electrocardiogram should be placed in the following order (B stands for black, R - red, G - green, Y- yellow):

AB – left lower limb, R – left upper limb, G – right upper limb, Y – right lower limb
BB – left lower limb, R – left upper limb, Y – right upper limb, G – right lower limb
CB – right lower limb, R – left lower limb, Y – right upper limb, G – left upper limb
DB – right lower limb, R – right upper limb, G – left upper limb, Y – left lower limb
EB – right lower limb, R – right upper limb, Y – left upper limb, G – left lower limb

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Question 8

The following results of serological assay:
HBs Ag (-)
anti-HBc IgM (-)
anti-HBc IgG (+)
anti-HBs IgG (+)
indicate:

Aacute hepatitis C, early phase.
Bacute hepatitis B, early phase.
Cprevious HBV infection and immune due to natural-infection.
Dhepatitis B immunization without infection (vaccination against hepatitis B).
Eacute hepatitis C, late phase.

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Question 9

The first choice treatment of acute bacterial bladder infection is:

Atrimethoprim-sulfamethoxazole.
Bpenicillin.
Cgentamicin.
Dmacrolide.
Evancomycin

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Question 10

Electrolyte and acid-base disorders observed in the 5th stage of chronic kidney disease are:

Ahypophosphatemia and metabolic acidosis.
Bhypophosphatemia and metabolic alkalosis.
Chyperphosphatemia and metabolic acidosis.
Dhyperphosphatemia and metabolic alkalosis.
Eall of the above are wrong.

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Question 11

Antihypertensive agents used to treat hypertension in pregnancy are:
1) methyldopa;
2) ACE inhibitors;
3) angiotensin receptor blockers;
4) hydralazine;
5) nitroprusside sodium.
The correct answer is:

A1,2,3.
B1,3.
C1,4.
Dall.
Eonly 1.

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Question 12

Immediate electrical cardioversion in patients with WPW syndrome is indicated in the case of:

Avery fast heart rate (ventricular rhythm).
Bdocumented several accessory pathways.
Chypokalemia.
Deach of the above.
Enone of the above.

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Question 13

Which method is recommended for detection of chronic changes in sacroiliac joints and spine in patients with ankylosing spondylitis?

ACT.
BMRI.
Cconventional radiography.
Ddensitometry.
EA or B.

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Question 14

Nitrates are contraindicated in patients with acute coronary syndrome in the case of:

Asystolic arterial pressure below 90 mmHg.
Bright ventricle infarction.
CAV block.
DA and B.
EA, B and C.

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Question 15

A 56-year old male complains of strong pain, swelling, warmth and redness around the right toe. All the symptoms occurred early in the morning and made it difficult for him to walk. For a week the patient has had a pain in the left knee, where physical examination showed effusion. The laboratory results: CRP 25 mg/l, uric acid serum concentration: 4,5 mg/dl. Which of the following would be useful for confirmation of gout diagnosis?

Aurate monosodium crystals presence in the synovial fluid.
Brapid response to colchicine trial.
Cno improvement after NSAIDs (nonsteroidal drugs) in maximal doses.
Dbecause of normal serum uric acid concentration in presented case diagnosis of gout is highly unlikely.
EA and B.

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Question 16

Which of the following is false with reference to Raynaud’s phenomenon description?

Ait consists in color changes: paleness, followed by cyanosis and then redness of the fingers (in hands and/or feet), lips or ears.
Bit is painful.
Cit occurs in stress or after exposure to cold.
Dit may precede other symptoms of systemic scleroderma.
Eone of the treatment methods is cryotherapy (local or general).

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Question 17

43-year old female presented with pain in hands and feet, morning stiffness lasting two hours, constant feeling of fatigue and elevated temperature. The physical examination: showed swelling of wrist, metacarpophalangeal and proximal interphalangeal joints on both hands, tenderness in metatarsophalangeal joints in both feet. Laboratory findings: ESR 58 mm/h, Hgb 10,5 g/dl, rheumatoid factor negative, anti-cyclic citrullinated peptide antibodies 250 RU/ml (normal range up to 5 RU/ml). The most likely diagnosis in this case is:

Asystemic lupus erythematosus (SLE).
Berosive type of osteoarthritis.
Crheumatoid arthritis.
DStill’s disease.
Epsoriatic arthritis without psoriasis.

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Question 18

Choose symptoms associated with pneumothorax:
1) mediastinum shifted contralaterally;
2) hyperresonance;
3) bradycardia;
4) diminished or absent breath sounds;
5) wheezes;
6) cyanosis.
The correct answer is:

A1,2,3,5.
B1,2,3,6.
C2,3,4,6.
D1,2,4,5.
E1,2,4,6.

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Question 19

50-year-old patient complains of: nocturia, ankle region edema particularly in the evenings, pain in the right subcostal area, worsening of physical activity tolerance. The most probable reason of his condition is:

Aviral hepatitis C.
Bhemochromatosis.
Cright sided heart failure.
Dhypertension.
Echronic renal failure.

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Question 20

46-year-old female patient complains of typical stenocardial chest pain that occurs at rest or after wakening up. It is usually accompanied by dyspnea and heart palpitations. Performed coronarography revealed no changes in the coronary arteries. The most probable reason of this condition is:

Astable cardiac angina.
Bunstable cardiac angina.
CPrinzmetal’s angina.
Dacute myocardial infarction.
Ehiatus hernia.

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Question 21

Which statement concerning the measurement of blood pressure is false?

Awhile using a mercury sphygmomanometer one should keep the manometer vertical and take all readings at eye level.
Bif a patient has an obese arm one should use an appropriate larger cuff.
Cif an adult patient is very thin (for example a patient with anorexia), a paediatric cuff may be necessary.
Dif repeated measurements are needed wait at least 10 minutes between readings with the cuff fully deflated.
Ea patient should be sitting.

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Question 22

A 30-year-old patient complains of chronic cough (lasting for 3 months), hemoptysis, 37˚C temperature in random measurements, 5 kg weight loss for the last month, fatigue. Which test will you order as first?

Alung scintigraphy.
Bmicrobiologic sputum analysis.
Cchest X-ray.
Dspirometry.
Etuberculosis skin test.

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Question 23

A 35-year-old white woman enters the emergency room complaining of chest pain. The pain is episodic and usually lasts for 5-10 minutes. Sometimes it is related to exercise, but on other occasions, it occurs at rest. The pain does not radiate. The patient is nonsmoker and has no history of hypertension. Two other family members have died of heart disease, one at 50 and the other at 56. Physical examination shows the patient is in no acute distress. Her blood pressure is 120/70 mmHg and her pulse is 70. Examination of the precordium finds that the point of maximal impulse is forceful. There is a II/VI systolic ejection murmur heard along the left sternal border. The murmur increases in intensity when the patient stands up. The ECG shows non specific S-T segment and T-wave abnormalities. Which of the following is the most likely diagnosis?

Ainnocent flow murmur
Baortic stenosis
Chypertrophic cardiomiopathy
Dmitral stenosis
Epulmonic stenosis

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Question 24

Which of the following procedures would be best to use when diagnosing the above patient? (A 35-year-old white woman enters the emergency room complaining of chest pain. The pain is episodic and usually lasts for 5-10 minutes. Sometimes it is related to exercise, but on other occasions, it occurs at rest. The pain does not radiate. The patient is nonsmoker and has no history of hypertension. Two other family members have died of heart disease, one at 50 and the other at 56. Physical examination shows the patient is in no acute distress. Her blood pressure is 120/70 mmHg and her pulse is 70. Examination of the precordium finds that the point of maximal impulse is forceful. There is a II/VI systolic ejection murmur heard along the left sternal border. The murmur increases in intensity when the patient stands up. The ECG shows non specific S-T segment and T-wave abnormalities. Which of the following is the most likely diagnosis?)

Achest x-ray.
Bcardiac catheterization.
Ctallium scanning.
Dechocardiography.
Emyocardial biopsy.

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Question 25

Match the following physical or laboratory finding with the appropriate valve lesion:
a) aortic stenosis;
b) aortic regurgitation;
c) mitral stenosis;
d) mitral regurgitation;
1) harsh murmur transmitted to the carotids;
2) loud S1;
3) apical holosystolic murmur with radiation to the axilla;
4) Marfanoid body habitus.
The correct answer is:

Aa3,b1,c4,d2.
Ba3,b2,c1,d4.
Ca1,b4,c2,d3.
Da3,b1,c2,d4.
Ea2,b4,c1,d3.

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Question 26

ECG curve presents:

Alateral wall acute infarction.
Banterolateral wall infarction.
Cleft ventricular hypertrophy.
Dright ventricular hypertrophy.
Eleft bundle branch block.

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Question 27

Which of the following characterizes the nephrotic syndrome:
1) edema;
2) hypoalbuminemia;
3) hematuria;
4) proteinuria (>3.5g/day);
5) hyperlipidemia;
6) proteinuria (>2.0g/day).
The correct answer is:

A1,3,4,6.
B1,2,4,5.
C2,3,4.
D1,2,5,6.
E1,2,6.

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Question 28

/1/Glicocorticosteroids are the most important group of drugs causing gastric and duodenal ulcers, for /2/it has been proven that concomitant treatment using glicocorticosteroids and non-steroid anti-inflammatory drugs at the same time can increase the risk of ulcerative disease by about fifteenth times.

Aboth sentences are true and logically related.
Bboth sentences are true but not logically related.
Cthe first sentence is true, the second false.
Dthe first sentence is false, the second is true.
Eboth sentences are false.

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Question 29

The risk of gastric cancer increases in patients with:

Agastric adenomatous polyps.
Bgastritis coexisting with Helicobacter pylori infection.
CMenetriere’s disease.
Dafter partial gastric resection.
Eall the above.

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Question 30

In an 18-year-old patient with chronic diarrhea and syderopenic anemia a jejunal biopsy has been performed, which revealed atrophy of villi and lymphocytes infiltration in lamina propria of the mucosa. In this patient we can suspect:

Aintestinal lipodystrophy.
Blactase deficit.
Cafter antibiotic therapy diarrhea.
DCrohn’s disease.
Egluten enteropathy.

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Question 31

A 30-year-old cachectic patient has been admitted to the hospital with small intestinal occlusion. One year ago he had a partial resection of ileum terminale. He suffered from perianal fistulas, anaemia and erythema nodosum. The most probable diagnosis in this patient is:

Asmall intestine cancer.
BWhipple’s disease.
CGiardia lamblia infection.
DCrohn’s disease.
Eulcerative colitis.

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Question 32

/1/ Most patients with non-symptomatic cholecystolithiasis will suffer from the disease complications during their life, /2/ therefore, in every patients with cholecystolithiasis cholecystectomy should be considered.

Aboth sentences are true and logically related.
Bboth sentences are true but not logically related.
Cthe first sentence is true, the second false.
Dthe first sentence is false, the second is true.
Eboth sentences are false.

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Question 33

Metastatic tumors in the liver are:

Aless frequent than primary hepatocellular carcinoma.
Bmostly of colorectal cancer origin.
Csupplied with blood from portal system vessels.
DB and C.
EA, B and C.

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Question 34

According to current knowledge population-oriented screening programmes are justified in early detection of:

1) breast cancer;

2) lung cancer;

3) cervical cancer;

4) colorectal cancer;

5) stomach cancer.

The correct answer is:

A1, 2
B1, 3, 5
C2, 3, 4
D1, 3, 4
E1, 2, 3, 4

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Question 35

Among the neoplasms listed below the most frequently observed one in acquired immunodeficiency syndrome (AIDS) is:

AKaposi sarcoma.
Bmelanoma.
Clung cancer.
DEwing sarcoma.
Eplasmocytic myeloma.

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Question 36

Normal findings on conventional chest radiography in a 65-year-old male patient (history – cigarette smoking for 45 years) presenting with general weakness and dyspnea as well as shoulder pain do not exclude lung cancer, because malignant process may be situated in the area of limited access for radiography. The statements presented are:

Aboth true with causal association.
Bboth true without causal association.
Cfirst false, second true.
Dfirst true, second false.
Eboth false.

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Question 37

In adult males anterior hypopituarism does not cause:

Ahypothyroidism.
Binfertility.
Creduced secretion of TSH.
Dreduced secretion of cortisol.
Ereduced secretion of aldosterone.

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Question 38

Mark the least typical symptom of thyrotoxicosis:

Asweating.
Bweight loss.
Ctachycardia.
Dconstipation.
Emenstrual irregularity.

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Question 39

Which of the following referring to thyroid nodules is correct?

Athey are more frequent in males.
Bthey are less common in iodine-deficient areas.
Cthey usually occur in euthyroid patients.
Dthe risk of malignancy of the nodule is not related to the size of the nodule.
Ethe risk of malignancy of the nodule is not related to the patient’s age.

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Question 40

A 6-year-old boy presents the following symptoms: fever for the last few days, rhinitis, erythema across the cheeks, "lace-like" rashes on the arms, legs, torso, and back. In laboratory results you observe: leukopenia , lymphocytosis, mild eosinophilia. The symptoms mentioned above are typical for:

AParvovirus B 19.
BEpstein- Barr virus.
CCytomegalovirus.
DChicken-pox virus.
ERubeola.

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Question 41

In the hospital ward you recognize oxyuriasis. Which of the following drugs can you prescribe?
1) mebendazole;
2) albendazole;
3) amoxicillin;
4) erythromycin;
5) pyrantel.
The correct answer is:

A1,3,5.
B1,2,5.
C3,4,5.
D1,4,5.
E4,5.

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Question 42

Which of the mentioned below is not a sign of tetany?

1) Chwostek’s;

2) Stellwag’s;

3) Trousseau’s;

4) Lust’s;

5) Oppenheim’s.

The correct answer is:

A1,5.
B2,5.
C3,4.
D4,5.
E3,4,5.

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Question 43

Malformations connected with Wilms’ tumour are:
1) kidneys hypoplasia, double kidney, horseshoe kidney, hypospadias;
2) Hemihyperplasia, aniridia, bone and joints malformations, circulatory system diseases;
3) CNS malformations, spina bifida, hypoplasia of the liver;
4) acute lymphoblastic leukemia, cancers, lymphoma;
5) Hepatoblastoma, retinoblastoma, bone tumours, cancers.
The correct answer is:

A1,2.
B2,4.
C3,5.
D1,4.
E1,5.

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Question 44

Choose the right description of Ewing’s sarcoma:
1) more common in females, during their pre-school years, more often in black race;
2) more common in males, teenagers, rarely in black race;
3) is an undifferentiated tumour;
4) the invasion of the soft tissues and the spreading of the tumour proceed slowly;
5) the invasion of the soft tissues and the spreading of the tumour proceed fast.
The correct answer is:

A1,3,4.
B2,3,5.
C2,3,4.
D1,2,4.
E1,5.

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Question 45

The rarest type of leukemia among children is:

ACML.
BAML.
CALL.
DMDS.
ECLL.

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Question 46

The infant whose breastfeeding mother took Vit. D3 in the last trimester of pregnancy:

Ashould be given 400 j.m./24h Vit. D3 per day starting from his birthday.
Bshould be given 400 j.m./24h Vit. D3 per day starting from the third week of his life.
Cshould be given 800 j.m./24h Vit. D3 per day starting from his birthday.
Ddoes not require supplementation of Vit. D3.
Erequires supplementation of Vit. D3 starting from the third month of his life.

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Question 47

Non-pharmacological treatment of hypertension in children includes:

Abody mass normalization.
Bsalt restricted diet.
Cphysical activity.
Dreduction of the consumption of saturated fatty acids.
Eall of the above.

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Question 48

The utter contraindication for living culture vaccination is:

Aimmunosuppressive therapy.
Bdiabetes.
Cpremature birth.
DDown syndrome.
Esplenectomy.

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Question 49

An 18-year-old girl reports to the Family doctor, complaining of a few day fever reaching 39°C and a pain in the neck. Medical examination shows: pharyngitis and enlarged neck lymph nodes. Laboratory results: higher CRP activity, leukocytosis, atypical lymphocytes. The most probable diagnosis is:

Aacute lymphoblastic leukemia.
BHodgkin’s lymphoma.
Cdiphtheria.
Dinfectious mononucleosis.
Escarlet fever.

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Question 50

The vaccination against tuberculosis is done once in newborn period without another revaccination, because next vaccinations do not protect against primary infections such as: lungs tuberculosis, reactivation of the latent infection.

Aboth sentences are true and there is a cause-and-effect relationship between them.
Bboth sentences are true and there is no cause-and-effect relationship between them.
Cboth sentences are false.
Dthe first sentence is true, the second one is false.
Ethe first sentence is false, the second one is true.

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Question 51

Which of the following symptoms can suggest adrenocortical insufficiency?

Ahypoglycaemia, hyponatraemia, hypokalaemia, hyperchloraemia, metabolic alkalosis.
Bhypoglycaemia, hyponatraemia, hyperkalaemia, hyperchloraemia, metabolic acidosis.
Chypoglycaemia, hypernatraemia, hypokalaemia, hyperchloraemia, metabolic alkalosis.
Dhyperglycaemia, hyponatraemia, hypokalaemia, hyperchloraemia, respiratory alkalosis.
Ehypoglycaemia, hyponatraemia, hyperkalaemia, hypochloraemia, metabolic acidosis.

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Question 52

A 2-year-old child, so far healthy, swallowed unknown number of Furosemide tablets. The child appears very weak with the limited contact with the surrounding. Which of the mentioned below symptoms are unlikely to be observed in this patient?
1) excessive sweating;
2) pulmonary oedema;
3) skin hyperaemia and reddening of the whole body;
4) tachycardia;
5) cardiac arrhythmia.
The correct answer is:

A1,2,3,5.
B1,2,3.
C2,4,5.
D2,4.
E3,5.

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Question 53

Which of the following groups of pharmacotherapeutic agents predispose to secondary hyperlipidemia?
1) beta-blockers;
2) thiazide diuretics;
3) oral estrogens;
4) fibric acid derivatives (fibrates);
5) corticosteroids.
The correct answer is:

A1,2,4,5.
B1,2,3,5.
C1,3,4,5.
D2,3,4.
Eall of them.

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Question 54

Which of the following situations is not an indication for karyotype analysis?

Amental retardation of unknown cause.
Bmental retardation and dysmorphic features
Ca child with clinically apparent features of Down’s syndrome.
Da newborn with isolated cleft of secondary palate.
Ea couple with recurrent miscarriages.

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Question 55

A six-month-old girl has been suffering from recurrent pulmonary infections for three months, with bronchial obturation with wheezing and persistent cough. In spite of good appetite the child shows weight deficiency. Neonatal history reveals prolonged cholestatic jaundice. Which disease should be considered in preliminary diagnosis?

Aalpha 1 antitrypsine deficiency.
Bcongenital bronchiectases.
Cidiopathic pulmonary fibrosis.
Dcystic fibrosis.
Epulmonary hemosiderosis.

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Question 56

Parents are coming to the outpatient department with eighteen-month-old child suffering from fever of 39°C for 5 days. On physical exam the child presents: non purulent conjunctivitis, dry and cracked lips, red pharynx. Submandibular lymph nodes are enlarged above 1,5 cm. This clinical picture is typical of:

Aerythema infectiosum.
BKawasaki disease.
Cexanthema subitum.
Drubella.
Emononucleosis.

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Question 57

The diagnostic hallmark of Juvenile Chronic Arthritis of systemic onset is:

Amultiple small joints involvement with joints deformations.
Bbilateral uveitis.
Chectic fever of quotidian pattern.
Dall the above.
Enone of the above.

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Question 58

In severe exacerbation of bronchial asthma the basic treatments are:

1) beta2-mimetics in inhalation;

2) oxygen;

3) corticosteroids i.v.;

4) beta2-mimetics i.v.;

5) aminophyllinum.

The correct answer is:

A1,2,3.
B1,2,5.
C2,3,4.
D1,2,3,5.
Eall of them.

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Question 59

An anxious mother reports symptoms that according to her and a parents' website require immunological diagnostics. She asks you to clarify which of the following could indicate primary immunodeficiency in her 1-year-old son: 1) three upper respiratory tract viral infections;

2) otitis media;

3) pneumonia;

4) recurrent oral aphthae;

5) persistent cradle cap;

6) lack of weight gain and the inhibition of normal development.

The correct answer is:

Aall the above.
B1,2,3
C2,3,6.
D2,3.
Eonly 6.

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Question 60

Which of these symptoms can occur in anaphylactic shock:
1) hypotonia;
2) urticaria;
3) dyspnoe;
4) tachycardia;
5) vomiting.
The correct answer is:

A1,2,3.
B1,2,4.
C1,2,5.
D1,2,3,4.
Eall of them.

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Question 61

In the course of cystic fibrosis the following symptoms may occur:

1) diabetes;

2) infertility;

3) osteoporosis;

4) pancreatitis;

5) liver cirrhosis.

The correct answer is:

A1,2,3.
B1,2,4.
C1,2,5.
D1,2,3,4.
Eall of them.

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Question 62

The first choice treatment in croup is:

Aantibiotic.
Bantiviral treatment.
Csystemic corticosteroid.
Dmucolytic.
Einhaled beta2-mimetic.

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Question 63

A child 4 y.o. arrives to the doctor's office with the following complaints: recurrent respiratory tract infections, snoring and a hearing defect. In a physical examination: pale skin, breathing through the mouth, discharge from the nose and a bite defect. The most probable diagnosis is:

Achronic sinusitis.
Bchronic rhinitis.
Cadenoid hypertrophy.
Dtonsils hypertrophy.
Echronic otitis media.

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Question 64

The diagnosis of giant cell osteosarcoma is based on:

Aradiography.
Bhistopathology of the tumour bioptate.
CCT-scan.
Dmagnetic resonance imaging (MRI).
Ephysical examination.

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Question 65

Which of the following examinations has the highest diagnostic value in nephroblastoma?

Aultrasonography with measuring 3 dimensions of the tumour + alternatively CT-scan.
Bevaluation of urine metoxycatecholamines.
Cevaluation of neoplastic markers.
Dbone scyntygraphy.
Echest X-ray.

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Question 66

The characteristic features of bone malignant neoplasms comprise:
1) osteoscarcoma spur (Codman’s triangle);
2) periosteal lesion (breaking the continuity of periosteum);
3) bone ectasia;
4) bone destruction lesion;
5) periosteal reactions;
6) tumour in soft tissues.
The correct answer is:

A1,2,3.
B1,2.
Call of them.
D4,5.
Eonly 6.

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Question 67

The gold standard in the diagnosis of food allergy is:

Aevaluation of skin tests.
Bconcentration of specific IgE.
Cfood elimination and provocation (challenge) testing.
Devaluation of protein loss in stools.
Egastroscopy with biopsies.

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Question 68

The treatment of food allergy includes:
1) elimination of certain food or the compound responsible for allergy;
2) replacing cow’s milk with goat’s milk;
3) using low-grade protein hydrolysates;
4) using high-grade casein and whey hydrolysates (hypoallergic);
5) total parenteral nutrition.
The correct answer is:

A1,2,3.
B1,4.
C2,3.
D1,5.
Eall of them.

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Question 69

A 21-year-old man with a cut wound on the hand presents to the Emergency Room. He cut himself working in the garden. He presented a record confirming he had received all mandatory vaccinations – the last Td dose 3 years ago. Choose the recommended tetanus prevention:

Aneither vaccine nor specific immunoglobulin is needed.
Bone dose of Td or T vaccine is recommended.
Cgive one dose of Td or T vaccine and fix the date for two consecutive doses (after 1 month and 6 months).
Done dose of Td or T vaccine and one dose of a specific immunoglobulin are recommended.
Eone dose of Td or T vaccine and one dose of a specific immunoglobulin are recommended; fix the date for two consecutive doses of the vaccine (after 1 month and 6 months).

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Question 70

The risk factors of endometrial carcinoma include:

Acigarette smoking, hypertension, obesity.
Bdiabetes mellitus, hypertension, obesity.
Coral contraception, hypertension, obesity.
Dtalc exposure, cigarette smoking, obesity.
Emutation in BRC-A1 and BRC-A2 genes, diabetes mellitus, obesity.

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Question 71

Choose the HPV types with high oncogenic potential:

A16,18,39,45.
B16,6,11,34.
C16,18,6,11.
D6,11,34,42.
E16,11,34,44.

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Question 72

Cardiotocography (CTG), the diagnostic method used in obstetrics:
1) concurrently records fetal heart tones and uterine contractions;
2) which assessment criteria include evaluation of accelerations and decelerations;
3) is helpful in diagnosis of fetal distress;
4) is used in challenge tests.
The correct answer is:

A1,2.
B2,3,4.
C1,4.
D1,2,3.
Eall of them.

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Question 73

Ultrasound examination in the first trimester of a pregnancy includes:
1) evaluation of crown-rump length;
2) fetal heart rate and biophysical profile;
3) evaluation of gestational age;
4) detection of fetal gender in multiple gestations.
The correct answer is:

A1,3.
B2,3,4.
C2,4.
D1,4.
Eall of them.

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Question 74

Doppler examination in pregnancy includes assessment of blood flow in:
1) uterine arteries;
2) spiral arteries;
3) umbilical arteries;
4) ductus venosus.
The correct answer is:

A1,3.
B1,3,4.
C2,4.
D1,4.
Eall of them.

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Question 75

Prenatal screening of chromosomal abnormalities is based also on biochemical tests. The so-called triple test includes evaluation of:
1) AFP;
2) hCG;
3) E3;
4) PAPP-A;
5) Inhibin A.
The correct answer is:

A1,2,3.
B1,3,5.
C1,2,4.
D1,3,4.
Eall of them.

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Question 76

Corticosteroids used to accelerate fetal lung maturity:
1) should be administered to every pregnant women;
2) are administered to pregnant women between 24-34 wks;
3) are indicated for use by symptoms of preterm labor;
4) make use of bethametasone due to its ability to cross the placenta;
5) include injections of prednisone or prednisolone b.d. as a preferred method.
The correct answer is:

A1,3,5.
B1,2,4.
Call of them.
D2,3,4.
E1,2,3,5.

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Question 77

The positive feedback during menstrual cycle takes place between:

Athe mid-cycle level of testosterone and the secretion of luteinizing hormone (LH).
Bthe level of estradiol produced by maturing follicle and both FSH and LH secretion.
Cthe level of progesterone in the luteal phase and the secretion of FSH.
Dthe level of progesterone in the luteal phase and the secretion of LH.
Ethe level of estradiol in the early follicular phase and FSH secretion.

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Question 78

Which of the following symptoms least suggests endometriosis:

Anodularity of the uterosacral ligaments.
Btenderness of the retroverted uterus during palpation.
Ctenderness in the cicatrix post cesarean section.
Dbilateral enlargement of the inguinal lymph nodes.
Etender, enlarged and fixed left ovary.

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Question 79

Which of the following behaviours is not associated with hyperprolactinemia:

Aextensive weight loss.
Bpregnancy.
Csexual intercourse.
Dstress.
Enipple stimulation.

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Question 80

In the physiological delivery the proper presentation of fetal head is:

Aneutral (slightly extended).
Bface.
Cbrow.
Docciput.
Easynclitic.

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Question 81

The proper sequence of cardinal movement is:

Aflexion, extension, internal rotation, external rotation.
Bextension, internal rotation, flexion, external rotation.
Cflexion, internal rotation, external rotation, extension.
Dflexion, internal rotation, extension, external rotation.
Einternal rotation, flexion, external rotation, extension.

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Question 82

The risk factors of ectopic pregnancy include:
1) history of previous ectopic pregnancy;
2) infertility treatment;
3) PID;
4) tubal surgery;
5) alcohol abuse.
The correct answer is:

A1,2,3,4.
Ball of them.
C2,3,4.
D1,2,3.
E3,4,5.

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Question 83

The management plan for placenta previa is based on:
1) degree of hemorrhage and total blood loss;
2) general condition of a patient;
3) gestational age and fetal maturity;
4) the advance of labor;
5) fetal welfare.
The correct answer is:

A2,3,4.
B1,2,4,5.
C1,2,3,5.
Dall of them.
E2,3,4,5.

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Question 84

The proper management of Pap smear grade 3 is:

Aelectroconization of the cervix.
Bsurgical conization of the cervix.
Ctreatment of vaginal infection and re-Pap.
Dcervical biopsy.
Ecervical biopsy and curettage of the cervical canal.

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Question 85

The term „sterilitas primaria” describes:

Amale infertility.
Bincomplete Mullerian fusion (double uterus).
Cinability to achieve pregnancy.
Drecurrent pregnancy loss.
Eiatrogenic intrauterine adhesions.

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Question 86

Choose the main risk factors for cervical cancer:

AHPV 16/18 infection, multiple sexual partners, multiparity.
BHPV 16/18 infection, CMV infection, low socioeconomic status.
Chistory of CIN-2, vaginal infection caused by chlamydia trachomatis, low antioxidant diet.
Dcigarette smoking, a history of CIN-1, EBV infection.
Eoral contraceptive use, HSV-2 infection, early sexual initiation.

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Question 87

The screening and/or diagnostic test for gestational diabetes is performed during pregnancy at:

A10-12 wks.
B14-18 wks.
C18-22 wks.
D24-28 wks.
E32-36 wks.

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Question 88

The assessment of early pregnancy (8-10 wks) with vaginal bleeding and closed cervical canal includes:

Athe thorough vaginal examination every 1-2 days.
Bultrasound examination of the fetal heart rate (FHR) every 3 days.
Cthe cyclical measurement of serum progesterone every 2-3 days.
Dthe cyclical measurement of serum β-HCG every 2-3 days.
Eboth A and D.

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Question 89

The proper differential diagnosis of seizures in pregnancy does not require the assessment of:

Ablood glucose level.
Bblood pressure.
Cproteinuria.
Dplatelets count.
Eall above are required.

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Question 90

An increased level of β-HCG is detected in:
1) persistent trophoblastic disease;
2) pregnancy complicated by trisomy 21;
3) testicular tumor;
4) gestational diabetes;
5) yolk sac carcinoma.
The correct answer is:

A1,4,5.
B1,2,4.
C1,2,5.
D1,2,3,5.
E1,2,3.

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Question 91

The basic therapy in the management of vaginal cancer includes:

A5-fuorouracil chemotherapy.
Bcisplatin chemotherapy.
Cradiotherapy.
Dsurgical therapy.
Echemoradiotherapy.

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Question 92

The cervical cancer with stromal invasion in depth <= 3mm and linear extent <7 mm is classified as FIGO:

Astage 0.
Bstage Ia1.
Cstage Ia2.
Dstage Ib1.
Estage Ib2.

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Question 93

The calculation of EDC with Naegele’s rule is based on:
1) the last day of LMP;
2) the first day of LMP;
3) the date of conception;
4) the date of quickening;
5) the date of the first missed menstrual period.
The correct answer is:

A1,2,3.
B1,4.
Conly 3.
Donly 2.
E1,3,5.

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Question 94

Typical signs and symptoms of vaginal fungal infections include:

1) vaginal pH > 4.5;

2) white, white, cottage cheese-like vaginal discharge;

3) clue cells;

4) hyphae in microscopic examination;

5) itching and burning sensation.

The correct answer is:

A1,3,5.
B2,4,5.
Call of the above.
D1,2,3.
E2,3,4.

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Question 95

Which of the following does not belong to the disturbances of cognition?

Adisturbances of attention.
Bdisturbances of memory.
Cdisturbances of perception.
Ddisturbances of thinking.
Edisturbances of impulsivity.

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Question 96

The disturbance of memory which pertains to the loss of the possibility to recall the memories from a certain period of time is called:

Ahypomnesia.
Bamnesia.
Cretrograde amnesia.
Danterograde amnesia.
Ehypermnesia.

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Question 97

Which of the following is the most severe quantitative disturbance of consciousness:

Acoma
Bsomnolence
Csopor
Dclouding
Edelirium

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Question 98

The typical clinical picture of mania does not include:

Agrandiose delusions.
Bmood elevations.
Ccommenting voices.
Dincrease of psychomotor drive.
Edisregarding of the somatic symptoms.

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Question 99

The lack of verbal response to the questions or instructions given to the patent, is called:

Astupor.
Bmutism.
Cparagnomen.
Daphasia.
Eautism.

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Question 100

The symptoms called deja vu or deja vecu belong to:

Athe disturbances of attention.
Bdelirium.
Cthe disturbances of memory.
Dthe disturbances of perception.
Ethe disturbances of affect.

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Question 101

At present, the term „epileptic psychoses” means:

Acharacteropathy.
Bdisturbance of the consciousness during an epileptic fit.
Cthe patients with such diagnosis require the treatment with chlorpromazine.
Dalways justifies the diagnosis of the disability.
Ehas only a historical meaning.

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Question 102

In the case of pitiutary hypoactivity (the syndrome of Glinski and Simmonds), the mental disorders are most frequently similar to:

Aschizophrenia.
Bmania.
Cbulimia.
Ddepression.
Eobsessive-compulsive syndrome.

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Question 103

The group of substances which are found naturally in Cannabis indica, are:

Ametamphetamins.
Bbenzodiazepins.
Cephedrins.
Dcannabinoles.
Epsylocybines.

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Question 104

According to E. Bleuler basic symptoms of schizophrenia (so called “4 As”) do not include:

Aautism.
Bdisturbance of attention.
Cdisturbance of affect.
Dambivalence.
Edisturbance of association.

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Question 105

Delusions in schizophrenia usually are not the delusions of:

Athought insertion.
Binfluence.
Cthought loudness.
Dgrandiose.
Eunusual thought content.

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Question 106

Among reactive disorders, so called „situation-caused syndrome” includes:

Aan acute reaction to stress.
Badaptation disorders.
Cthe Ganser’s syndrome.
Dreactive depression.
Eselective mutism.

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Question 107

Somnambulism belongs to:

Aprimary insomnias.
Bparasomnias.
Cdisturbances of sleep caused by somatic conditions.
Ddisturbances of sleep characteristic for depression.
Eit does not belong to pathology (it is a physiological phenomenon).

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Question 108

The probable risk factors for Alzheimer’s disease do not include:

Ahead trauma.
Bhistory of depression.
Cviral infections.
Dmother’s old age.
Emother’s young age.

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Question 109

„Open surgical debridgement” – the operative method, which consists of several scheduled repeated laparotomies connected with necrectomy, debridement and lavage is the golden standard in:

Amechanical ileus.
Bacute necrotic pancreatitis.
Cchronic pancreatitis.
Dpancreatic cancer.
Eacute appendicitis.

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Question 110

An 8 month-old girl has been suffering from sharp attacks of uneasiness and cry for 4 hours. During the attacks she raises her legs upwards. Between the episodes the infant is apathetic, sleepy and pale. She vomited several times and expelled one stool looking like „raspberry jelly”. On physical exam flatulence and a mass in right upper quadrant were found. On rectal exam small amounts of blood and mucus were found. Radiograms revealed asymmetric bowel gases and fluid levels. In ultrasound a „sign of a shield” was seen. What’s the most probable diagnosis?

Aacute appendicitis
Bincarcerated umbilical hernia
Cintestinal invagination
Dacute Meckel’s diverticulum inflammation
Eacute mesenterial lymphadenitis

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Question 111

In a patient with cholecystolithiasis and choledocholithiasis the correct combination of treatment is:

Aonly endoscopic removal of the deposits.
Blaparoscopic cholecystectomy and after a few days endoscopic removal of the deposits.
Cendoscopic removal of the deposits and after a few days laparoscopic cholecystectomy.
Donly laparoscopic cholecystectomy.
Eonly open cholecystectomy.

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Question 112

In a patient with paroxysmal atrial fibrillation there was a sudden cooling, livedo and weakness of lower limb. There was no previous lower limb ischemia. Taking into consideration the most probable reason the best treatment is:

Avasodilatation drugs.
Bintra-arterial heparin administration (to femoral artery).
Cintra-arterial streptokinase administration (to femoral artery).
Dintra-arterial tissue plasminogen activator administration (to femoral artery).
Elower-limb arteries embolectomy.

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Question 113

In the case of surgeon’s intraoperative injury the proper behavior is:
1) HIV and HCV examination in the surgeon;
2) HIV and HCV examination in the patient;
3) in every case surgeon’s anti-retrovirus treatment.
The correct answer is:

Aonly 1.
Bonly 2.
C1,2.
D2,3.
E1,2,3.

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Question 114

The drainage of the pleural cavity for fluid evacuation should be made in:

A3rd – 4th intercostal space in posterior axillary line.
B5th – 6th intercostal space in posterior axillary line.
C3rd – 4th intercostal space in anterior axillary line.
D5th – 6th intercostal space in anterior axillary line.
E7th – 8th intercostal space in posterior axillary line.

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Question 115

In an 80-years old woman prepared to elective surgery for an abdominal aortic aneurysm of 85 mm in diameter without iliac arteries dilatation, you discovered heart insufficiency with ejection fraction 30%. In this case the best method of aneurysm treatment is:

Aopen surgery with straight tube implantation.
Bopen surgery with bifurcated tube implantation.
Cendovascular surgery.
Daneurysm of 85 mm in diameter is not the indication for surgery.
E30% ejection fraction is absolute contraindication for any type of surgery.

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Question 116

A 71-years old patient was admitted to hospital due to severe hematemesis. For the last week he has used a lot of non-steroid anti-inflammatory drugs. He is also on long-term acetylsalicylic acid treatment. Taking into consideration the most probable reason of bleeding the routine procedure includes:
1) recombinant factor VII;
2) gastroscopy;
3) laparotomy and surgical closure of the bleeding site;
4) thrombocyte concentrate transfusion.
The correct answer is:

Aonly 2.
B1,2.
C2,3.
D2,4.
Eonly 4.

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Question 117

In a patient with abdominal trauma, an examination revealed splenic rupture. The proper treatment is:
1) leaving the rupture – hematoma surrounding the ruptured spleen will stop the bleeding;
2) attempting to stop the bleeding (capsule suture, glue of the spleen);
3) splenectomy if the attempt to stop the bleeding is unsuccessful;
4) leaving small pieces of the removed spleen in the greater omentum.
The correct answer is:

Aonly 1.
B1,2.
C2,3.
D3,4.
E2,3,4.

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Question 118

The optimal time of creation (point 1-3) and the site of the primary arteriovenous fistula for hemodialysis (point 4-5) is:
1) few months before dialysis;
2) few days before dialysis;
3) after the beginning of the dialysotherapy – first dialysis should be made with central catheter;
4) on forearm;
5) on arm.
The correct answer is:

A1 and 4.
B1 and 5.
C2 and 4.
D2 and 5.
E3 and 4.

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Question 119

In the case of neoplasmatic oesophagostenosis the best method of persistent nutrition could be:

Aintravenous glucose solution.
Bperipheral vein intravenous nutritional mixture.
Ccentral vein intravenous nutritional mixture.
Dnutritional mixture through gastrostomy.
Eanal feeding with nutritional mixture.

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Question 120

A patient was admitted to hospital due to chest trauma. In x-ray a rupture of 7- th and 8-th rib was found (on the right side). The correct management is:

Asurgical anastomosis of broken ribs.
Brelaxation and intubation of the patient.
Cchest bandage.
Danalgetic drugs.
Epleural cavity drainage.

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Question 121

Portal hypertension may present with the following conditions except for:

AHorner’s syndrome.
Besophageal varices.
Chepatorenal syndrome.
Djaundice.
Eascites.

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Question 122

Which of the statements related to paronychia are true?
1) it is inflammation of the tissues surrounding nail;
2) ingrown nail is the source of infection;
3) infection results in subcutaneous abscess formation at the base of the nail;
4) generalized symptoms of infection are always present;
5) incision of the abscess is the proper treatment.
The correct answer is:

A1,2,3,5.
B1,2.
C1,4,5.
D1,2,5.
E1,2,3,4.

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Question 123

Which of the following procedures can be performed laparoscopically?
1) cholecystectomy;
2) appendectomy;
3) adrenalectomy;
4) nephrectomy;
5) inguinal hernia repair.
The correct answer is:

A1,2.
B1,2,3.
C1,2,3,4.
D1,2,4.
Eall of them.

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Question 124

The most characteristic clinical symptoms of cholangitis inducted by E. coli are:
1) fever;
2) pruritius;
3) jaundice;
4) hypotension;
5) pain in the upper right quadrant of the abdomen.
The correct answer is:

Aall of them.
B1,2,3,4.
C1,3,5.
D1,3,4.
Enone.

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Question 125

The most typical symptoms of Crohn’s disease include:
1) disease localizes only in the terminal ileum and right colon;
2) inflammatory process involves all layers of the intestinal wall and mesentery;
3) disease is frequently complicated with intraabdominal abscesses;
4) surgical treatment includes resection of the terminal ileum and colon.
The correct answer is:

A1,4.
B1,2,3.
C2,3.
D1,3,4.
Eall of them.

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Question 126

Melaena is the symptom of:
1) gastric carcinoma;
2) duodenal ulcer;
3) tumor of the small intestine;
4) right colon carcinoma;
5) left colon carcinoma.
The correct answer is:

Aonly 5.
B1,2.
C1,2,3.
D4,5.
Eall of them.

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Question 127

Hospital treatment of cold injury includes:
1) rewarming of the frostbiten parts and the body;
2) tetanus prophylaxis;
3) pain management;
4) broad-spectrum antibiotic therapy;
5) vasodilatants administration.
The correct answer is:

A1,2,3.
B3,4,5.
C1,3,5.
D2,3,5.
Eall of them.

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Question 128

After the reduction of a dislocated elbow the immobilization should last:

A1 week.
B2-3 weeks.
C6 weeks.
Ddepending of the type of dislocation.
Eimmobilization is not necessary.

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Question 129

For the third degree burns typical finding is not:

Atissue necrosis.
Ba ring of the second and first degree burn around the site of the third degree burn.
Cthromboembolic changes in the vessels of the burn site.
Dabsent or insignificant pain.
Eno damage to the tissues below third degree site.

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Question 130

A medical emergency team should be called when you find:
1) a sudden onset of bradycardia (below 40/min) or tachycardia (above 130/min);
2) systolic pressure decrease below 90 mm Hg;
3) sudden fluctuations in respiratory rate, below 8/min and above 30/min;
4) sudden decrease in oxygen saturation level below 90% despite normobaric oxygen therapy;
5) sudden consciousness disturbances – no motor response to painfull stimuli, no verbal response.
The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
Dall of them.
E1,3,5.

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Question 131

The most common localization of the aneurysms of the peripheral arteries is:

Athe internal carotid artery.
Bthe basilar artery.
Cthe internal iliac artery.
Dthe brachial artery.
Ethe popliteal artery.

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Question 132

The posterior wall (floor) of the inguinal canal is formed by:

Athe lower border of the internal obliqe abdominis muscle.
Bthe lower border of the transversus abdominis muscle.
Ctransversalis fascia.
Dthe inguinal ligament.
Ethe aponeurosis of the external oblique abdominis muscle.

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Question 133

Ranson's criterion is a clinical prediction rule for the prediction of the severity of:

Acarcinoma of the cervix.
BCrohn's disease.
Ccirrhosis of the liver.
Dacute pancreatitis.
Estomach carcinoma.

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Question 134

The criteria of a right bundle-branch block include:

AQRS duration >0.12s.
Bventrical complex in „M” shape in lead V5,V6.
Cventrical complex in „M” shape in lead V1,V2.
DQRS duration <0.12s.
EA and C.

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Question 135

Diabetes should be diagnosed if:

1) blood glucose level above 11.1 mmol/L (200 mg/dL) is found twice when taken at any time

2) blood glucose level above 7 mmol/L (126 mg/dL) is found twice when taken without bite and sip

3) blood glucose level above 11.1 mmol/L (200 mg/dL) is found when taken 2 hours after drinking 75 g of glucose

4) blood glucose level above 7.8 mmol/L (140 mg/dL) is found twice when taken at any time

5) blood glucose level above 6.1 mmol/L (110 mg/dL) is found twice when taken without bite and sip

The correct answer is:

A1, 2, 3
B4, 5
C2,3
D3, 4
E1, 5

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Question 136

A proper surgical management of a wound involves procedures listed below, except for:

Aputting on a pressing binder above the wound.
Bwashing edges of the wound.
Cflushing the wound and smoothing out clots from it.
Dcontrolling of the bottom of the wound.
Eexcision of the necrotic tissues.

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Question 137

In wounded patients (even when it is more than 1 year after last recalling vaccine dose against tetanus) there is no need for tetanus prevention, because thanks to all world vaccinations against tetanus Clostridium tetani bacteria have been practically eliminated from the environment.

Aboth sentences are true and there is a causal relationship between them.
Bboth sentences are true but there is no causal relationship between them.
Cthe first sentence is true but the second is false.
Dthe first sentence is false and the second is true.
Eboth sentences are false.

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Question 138

When removing ear wax from external auditory duct:

Ain order to see better the duct one should pull downwards the patient’s ear-lap.
Bduring irrigation the ear a water stream should be directed to the fronto-inferior wall of the duct.
Cthe easiest way to remove a wax plug is by using forceps.
Dirrigation must not be conducted if the patient has a story of an operation of the middle ear.
Eguts containing fat must be avoided before irrigation of the duct.

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Question 139

A patient asking for a certificate stating on his ability to be employed came to a young non-specialist physician:

Athe physician should refer the patient to a physician authorized for such certification.
Bthe physician can certify if the job is free of noisome factors.
Cthe physician can certify if the job is free of burdensome factors.
Dthe physician can certify but for a period not longer than 1 year.
Ethe physician can fulfill his/her patient’s request.

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Question 140

In patients with diagnosed gout the hypertension treatment should not include:

Athiazide diuretics.
Bangiotensin-converting enzyme inhibitors.
Ccalcium channel blockers.
Dangiotensin receptor blockers.
Ealphablockers.

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Question 141

Hypotensive medications preferred in patients with diagnosed metabolic syndrome are:

1) thiazide diuretics;

2) betablockers;

3) calcium channel blockers;

4) angiotensin-converting enzyme inhibitors;

5) angiotensin receptor blockers;

6) loop diuretics.

The correct answer is:

A1,2.
B2,3,4.
C3,4,5.
D1,2,4,5.
E1,2,5,6.

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Question 142

The decision to start pharmacotherapy in patients with hypertension should be based on:

Asystolic and diastolic blood pressure results.
Btotal cardiovascular risk assessment.
Cpatient preferences.
DA and B.
EA, B and C.

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Question 143

The most effective screening procedure for colorectal cancer is:

Acolonoscopy.
Boccult blood in the feces test.
Cfiber sigmoidoscopy.
Drectoscopy.
Ethe screening for a colorectal cancer is not performed.

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Question 144

To assess the effectiveness of eradiction treatment of Helicobacter pylori one should perform:

Aurease test.
Burea breath test.
Chydrogen test.
DA or B.
EA, B or C.

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Question 145

The sign of heavy dehydration in the case of diarrhoea in a child, prompting to an urgent hospitalization is:

Aavid fluid intake.
Bchild anxiety.
Clack of a diuresis.
Dsudden scream.
Edry mucosa.

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Question 146

The most frequent and clinically significant risk factor of obstructive sleep apnoea is:

Aobesity.
Balcohol consumption before going to bed.
Chypnotic medication use.
Dsupine sleeping position habit.
Etonsils enlargement.

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Question 147

A 55-year-old female with T-score-1,5 in DEXA scan should be advised:

Acalcium rich diet and vitamin D3 supplementation.
Badequate physical activity.
Cto quit smoking.
Dbiophosphonates.
EA, B and C.

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Question 148

In the management of venous ulceration the most relevant is:

Asurgical debridement of ulceration.
Bpressure therapy.
Cdrying ointments application.
Dantibiotic therapy.
Etreatment of crural varicose veins.

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Question 149

A fresh red optical disc with vague borders, elevated above the surrounding retina is an ophtalmoscopic sign of:

Aoptic nerve dystrophy.
Bcentral retinal vein thrombosis.
Cintraocular inflammation.
Doptic disc oedema.
Eproliferative retinopathy.

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Question 150

It is not true that epinephrine causes:

Adecrease in vascular resistance.
Bdiastolic pressure increase in aorta.
Cincreased myocardial contraction.
Dimproved conduction in a conducting system of heart.
Eincrease in amplitude of a ventricle fibrillation.

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Question 151

The integral part of management in plasmocytic myeloma is:

Aprevention of renal failure.
Bprevention of osteolysis.
Ctreatment of hypocalcaemia.
DA and B.
EA, B and C.

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Question 152

The use of low-leucocyte concentrate of red blood cells is contraindicated in cancer patients with anaemia, because transfusion-related immunity may produce progression of the neoplasm. The statements presented are:

Aboth true with causal association.
Bboth true without causal association.
Cthe first is false, the second is true.
Dthe first is true, the second is false.
Eboth are false.

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Question 153

In the case of the death of a patient caused by a body injury or poisoning the personal medical records should be stored in the archive of the family physician practice for:

A10 years.
B20 years.
C30 years.
D40 years.
E50 years.

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Question 154

The level of consciousness in patient after multiregional trauma who neither opens his eyes to a painful stimulus nor responds verbally, nor reveals motor responses shall be classified according to the Glasgow Coma Scale (GCS) at:

A3 points.
B5 points.
C6 points.
D7 points.
E15 points.

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Question 155

Rinsing the stomach is absolutely contraindicated in the case of:

Aanticonvulsant drugs poisoning.
Bcaustic substance poisoning, especially when a time interval since poisoning is longer than 30 min.
Cβ-adrenolitic drug poisoning.
Dantidepresant drugs poisoning.
Eparacetamol poisoning.

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Question 156

Pulse oximetry may be misleading in:

Aethyl alcohol poisoning.
Bcarbon monoxide poisoning.
Cthe sickle cell disease.
Dhyperthermia
Epolycythaemia.

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Question 157

During resuscitation chest compressions in adults should be performed with frequency:

A40 - 60/min
B60 - 80/min
C100 -120/min
D120 - 140/min.
Edepending on the age of a patient.

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Question 158

Calling for help is very important in basic life support (BLS). When is it recommended?

Aa call for help after you recognize cardiac arrest, before you start BLS in adults.
Bcalling for help after diagnosing cardiac arrest and performing BLS for 1 min. in children.
Ca call for help before you are sure that the patient has cardiac arrest.
Dcalling for help only after finding the lack of breathing and pulse.
Ewhen you recognize a person who is unresponsive and not breathing or breathing incorrectly

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Question 159

When cervical spine injury is suspected, non instrumental airway management should be achieved by:

Aonly a chin lift.
Bonly a head lift.
Cin the case of cervical spine injury only chest compressions are advised.
Da head tilt and chin lift may be performed avoiding aside movements of the head.
Eonly professionals can open the airway in this case.

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Question 160

During resuscitation of a pregnant woman the proper position is:

Alying flat on the back in supine position.
Blying on the right side.
Clying on the left side.
Dthe position does not have any influence on the efficiency of resuscitation.
Elying with elevated legs.

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Question 161

Which of the following actions helps deliver maximum current during defibrillation?

Aplacing alcohol pads between the paddles and skin.
Breducing the pressure used to push down on the defibrillator paddles.
Capplying conductive paste to the paddles.
Ddecreasing shock energy after the 2nd shock.
Eincreasing shock energy after the 1st shock.

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Question 162

Endotracheal intubation has just been attempted for a patient in respiratory arrest. During bag-mask ventilation you hear stomach gurgling over the epigastrium but no breath sounds, and oxygen saturation (per pulse oximetry) stays very low. Which of the following is the most likely explanation for these findings?

Aintubation of the esophagus.
Bintubation of the left main bronchus.
Cintubation of the right main bronchus.
Dbilateral tension pneumothorax.
Ebronchospasm.

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Question 163

Which of these statements about i.v. administration of medications during attempted resuscitation is true?

Agive epinephrine via the intracardiac route if i.v. access is not obtained within 3 minutes.
Bfollow i.v. medications through peripheral veins with a fluid bolus.
Cdo not follow i.v. medications through central veins with a fluid bolus.
Drun normal saline mixed with sodium bicarbonate (100 mEq/L) during continuing CPR.
Eepinephrine can be given only intravenously.

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Question 164

Which of the following drug-dose combinations is recommended as the initial medication to give a patient with asystole?

Aepinephrine 3 mg i.v.
Batropine 3 mg i.v.
Cepinephrine 1 mg i.v.
Datropine 0.5 mg i.v.
Eatropine 1 mg i.v.

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Question 165

A patient with a heart rate of 40 bpm is complaining of chest pain and is confused. After oxygen, what is the first drug you should administer to this patient while a transcutaneous pacer is unavailable?

Aatropine 0.5 mg.
Bepinephrine 1 mg i.v. push.
Cisoproterenol infusion 2 to 10 mg/min.
Dadenosine 6 mg rapid i.v. push.
Esublingual nitroglycerin tablet.

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Question 166

Which of the following agents are used frequently in the early management of acute cardiac ischemia?

Alidocaine bolus followed by a continuous infusion of lidocaine.
Bchewable aspirin, sublingual nitroglycerin, and i.v. morphine.
Cbolus of amiodarone followed by an oral ACE inhibitor.
Dcalcium channel blocker plus i.v. furosemide.
Efibrinolytic + heparin bolus i.v.

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Question 167

Which of the following rhythms is a proper indication for transcutaneous cardiac pacing?

Asinus bradycardia with no symptoms.
Bnormal sinus rhythm with hypotension and shock.
Ccomplete heart block with pulmonary edema.
Dasystole that follows 6 or more defibrillation shocks.
EPEA.

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Question 168

In paracetamol intoxication you should use:

Analoxon.
BN-acetylocysteine.
Cflumazenil.
Dcarbamazepine.
Enone of them.

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Question 169

Which sentence is true concerning acute coronary syndrom?

Ain ECG ACS is always present as ST-segment elevation.
Bthere is no risk of ventricular fibrillation.
Caspirine is first shot drug.
Dantiplatelet drugs are not used in pre-hospital stage.
Ethere is no point in use of nitroglicerine or some opioids.

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Question 170

The professional secrecy includes:

Aeverything that a physician finds during examination and that concerns treatment and prognosis.
Beverything that a physician finds when practicing profession and that concerns patient or his/her environment.
Ceverything that has been declared as confidential by the patient.
Deverything that, when revealed, may harm the patient.
Eeverything that a physician finds when practicing profession and that concerns patient’s disease and the physician’s activities.

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Question 171

A physician additionally employed in a military unit is preparing a dissertation on physiology of physical effort. Therefore he is going to conduct an experiment on recruits. In order to make it possible he has to:

Aobtain the consent of the soldiers.
Bobtain the consent of the soldiers and the commander of the unit.
Cobtain the consent of the ethical committee and the commander of the unit.
Dobtain the consent of the ethical committee and the soldiers.
Ethis kind of experiment is not allowed.

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Question 172

A dentist set up his private practice after moving into the town where he had not been known before. He had ordered leaflets with information about his office and sent them to all inhabitants’ post boxes. He promised that the patients visiting him with the leaflets would have 10% discount on dental procedures and all patients would have a free inspection of their oral cavity. Is his behavior proper?

Ahis behavior bears the hallmarks of advertising, and this is not allowed with respect to dental practice.
Bgiving information about prices was wrong; the other information was useful for patients.
Ca dentist is allowed to use this way of informing patients when starting his/her practice in a new place.
Dthis kind of wining over patients is allowed because private dental practice is being run under the principles of free market.
Ethe content of such leaflets must be agreed with the local Regional Chamber of Physicians and Dentists and only then it is possible to use it.

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Question 173

A patient had been admitted to a surgical ward where the doctoral staff consists of equally qualified specialists. The patient did not want to be operated by the surgeon appointed by the head of the ward. He wanted to be operated by the head who was not to operate on this day. The patient suggested treating him as a private patient and wanted to pay the head for the operation. Which conduct should be adopted?

Athe head should stand by his decision who was to operate on the patient.
Bhe is allowed to accept additional fee because he had not been expected to operate and the patient wanted just him.
Cknowing about equal qualifications of all concerned he would be acting unfriendly and groundlessly if he agreed to change the operator.
Dallowing for the patient’s particular trust and job organisation the head should accept the patient’s request and divide the fee between the members of the operating team.
Eallowing for the patient’s particular trust and job organisation the head should accept the patient’s request but no extra money should be involved.

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Question 174

A physician working for a sport club has been asked by a club body-builder to prescribe anabolics which the athlete has been buying so far from street dealers. What should the physician do?

Ahe should inform the athlete about threats for his health posed by taking anabolics and refuse the request.
Bhe should take the decision after consulting the athlete’s coach.
Che should inform the athlete about threats for his health posed by taking anabolics but if the athlete adheres to his request the physician should fulfill it.
Dhe should sent the athlete to the dealers.
Ehe should inform the Disciplinary Committee about the fact.

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Question 175

Does the Polish Medical Code of Ethics include an article concerning so called presumed consent in transplantology?

Ano, the article concerns relative consent.
Byes.
Cno.
Dyes, the article concerns family’s consent.
Eyes, it recommends informed consent.

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Question 176

Does the Polish Medical Code of Ethics include any articles concerning biomedical experiments?

Ano.
Byes, it refers to the decree of the Minister of Health.
Cyes.
Dyes, only concerning experiments on embryos.
Eno, this is not an ethical problem.

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Question 177

Who, according to the Polish Medical Code of Ethics, is allowed to supervise medical experiments on humans?

Aa pharmacologist.
Ba physician.
Ca pharmacist.
Da lawyer.
Ea medical administrator.

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Question 178

Does the Polish Medical Code of Ethics allow to renounce resuscitation in terminal states?

Ayes, only with the lawyer’s consent.
Byes.
Cno.
Dyes, only in neoplastic diseases.
Ethere is no such regulation in the Code.

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Question 179

In what kind of situations does the Polish Medical Code of Ethics allow medical experiments on humans incapable of giving informed consent?
1) if there is no possibility for experiments of comparable effectiveness on humans able to give informed consent;
2) only on recruits;
3) only in terminal states;
4) only on prisoners.
The correct answer is:

A1,3.
Bonly 2.
C3,4.
Donly 4.
Eonly 1.

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Question 180

The certifying doctors and medical boards of Agricultural Social Insurance Fund (KRUS) issue statements about the following:

Adegree of disability.
Binability to do military service.
Ccomplete inability to work on a farm.
Dchildren disability.
Einability to work.

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Question 181

Preliminary, routine, control examinations are carried out by:

ASIF (ZUS) certifying doctors.
BASIF (KRUS) expert doctors.
Cdoctors authorized to carry out prophylactic examinations.
DSIF (ZUS) medical boards.
Edistrict teams authorized to issue statements about the degree of disability.

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Question 182

In accordance with the Law on cash benefits from social insurance in case of sickness and maternity the doctor’s statement concerning temporary incapacity to work due to sickness or a hospital stay contains the information about the circumstances influencing the entitlement to the sickness allowance or its amount marked with letter codes. Incapacity for work caused by tuberculosis is marked with:

Acode A.
Bcode B.
Ccode C.
Dcode D.
Ecode E.

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Question 183

The decision stating an occupational disease after explanatory proceedings have been carried out is issued by:

Aa labour medicine doctor.
BThe Labour Medicine Institute.
CThe Central Institute of Labour Protection.
Da National Sanitary Inspection organ.
EThe Social Insurance Fund.

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Question 184

In accordance with the Law on old-age and disability pensions from the Social Insurance Fund, an insured person who has lost the capacity to do any work is:

Aa disabled person of the third category.
Bincapable to do farm work for a prolonged period of time.
Cpartially incapable to work.
Dcompletely incapable to work.
Eslightly disabled.

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Question 185

In accordance with the Law on the social insurance system, work incapacity pensions are paid out from the following:

ADisability Pensions Fund.
Bthe old-age Pensions Fund.
CNational Fund for Rehabilitation of the Disabled.
DSickness Allowances Fund.
Ethe state budget.

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Question 186

In accordance with the Law on cash benefits from social insurance in case of sickness and maternity the medical statement concerning temporary incapacity to work due to sickness contains the statistical number of the disease, established in accordance with the International Classification of Diseases and Health Problems, written in the following:

Athe original statement.
Bthe first copy of the statement.
Cthe second copy of the statement.
Danswers A,C are correct.
Eanswers A,B are correct.

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Question 187

Negative health measures are:
1) incidence;
2) the average life expectancy;
3) morbidity;
4) infant mortality;
5) fertility rate.
The correct answer is:

A1,3,4.
B1,2,3.
C1,3,5.
D2,4,5.
E1,2,5.

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Question 188

The first Public Health Act was implemented in:

AEngland.
BFrance.
CGermany.
Dthe USA.
EPoland.

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Question 189

According to Marc Lalonde’s Health Field Concept, which of the fields mentioned below is considered the most important health determinant:

Agenetic factors.
Bphysical environment.
Clifestyle.
Dsocial environment.
Emedical care.

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Question 190

The health care, its structure, organization, availability as well as the quality of medical services affect health within the following range:

Aup to 5%.
B10-15%.
C20-30%.
D55%.
E60%.

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Question 191

Health education as an important element of health promotion:
1) constitutes a significant element of the health policy of the State;
2) concerns exclusively the population of adolescents;
3) enables people to acquire competence for protection, maintenance and improvement of health;
4) exerts an effect on the change in attitudes and behaviours of society;
5) addresses mainly health care staff.
The correct answer is:

A1,3,4.
B1,2.
C3,5.
D1,5.
E1,3,5.

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Question 192

The programme document for health promotion is:

Athe Ottava Charter for Health Promotion.
Bthe National Health Programme.
Cthe Declaration of the World Health Organization.
Dthe Constitution of the Republic of Poland.
Ethe act in the Matter of Public Health Units.

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Question 193

Public authorities assignments in the field of provision of an equal access to health care services cover the following:

Acreating conditions for the functioning of the system of health care.
Banalysis and evaluation of health demands.
Chealth promotion.
Dprophylaxis.
Eall of the above.

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Question 194

The first-phase prophylaxis covers the following:

Aactions biased towards the strengthening of health.
Bactions biased towards an early detection of diseases and their causes.
Cactions with respect to the disease which has already developed.
Dexclusively therapeutic actions.
Eearly rehabilitation.

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Question 195

The immediate treatment of cardiac arrest includes the following except for:

Aintubation.
Bopen cardiac massage.
Ci.v. access.
Dadrenaline i.v.
Eultrasonography.

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Question 196

Drugs used for local anaesthesia include:
1) lidocaine;
2) bupivacaine;
3) midazolam;
4) ropivacaine;
5) propofol;
6) sufentanyl.
The correct answer is:

A1,2,3.
B2,5,6.
C5,6.
D1,2,4.
E2,4,6.

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Question 197

In the case of bleeding from the mouth of the patient an advised way of performing non-instrumental airway management and ventilation is:

Athe rescuer should use a single-use face mask (face shield) for mouth-to-mouth ventilation.
Ba professional rescuer must be prepared for mouth-to-mouth ventilation in every case.
Cno ventilation is advised because blood may be aspirated to patient’s lungs.
Dbleeding must be stopped by compression on the mouth and then mouth-to-mouth ventilation may be performed.
Ein this case it is advised to do rescue cricothyroidotomy.

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Question 198

Which of the following drug-dose combinations is recommended as the initial medication to give a patient with asystole?

Aepinephrine 3 mg i.v.
Batropine 3 mg i.v.
Cepinephrine 1 mg i.v.
Datropine 0.5 mg i.v.
Eatropine 1 mg i.v.

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Question 199

A victim of a car accident who was marked with red label in segregation can present one of the injuries:

Afemoral neck fracture.
Barterial bleeding.
Ccraniocerebral trauma with unconsciousness.
Ddysaesthesia in lower limbs.
Eis dead.

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