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LEKEXAM / 2013 spring

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Question distribution — 2013 spring session

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

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Question 1

A 49-year-old obese man complains of headaches that began three days ago. He has never had such headaches before. Blood pressure measured is 180/100 mmHg. What should you recommend?

Aadvise the patient only to decrease his salt intake
Badvise the patient only to increase his physical activity
Cadvise the patient only to decrease his body mass
Dstart hypotensive treatment
Eorder 24-hour ambulatory blood pressure monitoring (ABPM)

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Question 2

A 72-year-old man complains of dizziness that began one week ago. Two weeks ago the urologist prescribed him doxazosin because of benign prostatic hyperplasia (BPH). Which of the following is the most likely cause of dizziness?

Aprostate cancer with brain metastases
Bhypoglycemia.
Corthostatic hypotension.
Dbradycardia.
Ehyperthyroidism.

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Question 3

A 31-year-old man was admitted because of leg swelling. Physical examination was otherwise normal. Urine tests demonstrated increased protein excretion (9 g/L) and no haematuria. What is the most probable diagnosis in this patient?

Aheart failure.
Bliver cirrhosis.
Cacute fluid overload (overhydration)
Dnephrotic syndrome.
Enephritic syndrome.

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Question 4

A 82-year-old woman is brought to the emergency department because of lethargy. Blood glucose is 950 mg/dL. Physical examination shows dehydration. She has never been diagnosed with diabetes before. In addition to administering intravenous fluids, which of the following is the most appropriate next step?

Astart oral treatment with metformin.
Bstart oral treatment with sulphonylureas.
Corder subcutaneous injection of intermediate-acting insulin.
Dorder intravenous injection of intermediate-acting insulin.
Eorder intravenous injection of short-acting insulin.

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Question 5

A 76-year-old man is brought to the emergency department because of sudden-onset dyspnea. He was discharged from the surgical unit 2 months ago after being treated for colon cancer. Physical examination discloses swelling in the right leg. Which of the following is the most appropriate initial diagnostic study?

AD-dimer concentration.
Blung scintigraphy.
Ccomputed tomographic pulmonary angiography.
Dechocardiography.
EINR evaluation

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Question 6

75-years old woman complains of weight loss, elevated body temperature, progressive weakness and pain in long bones. She has had several compression vertebrae fractures recently. Additional findings: high ESR, normocytic anemia, total protein level 8.5 g/dl. Diagnostic approach should comprise which of the following tests?

Aprotein electrophoresis.
Bskull X-ray.
Cserum calcium level.
Dtrue answers: A and B.
Etrue answers: A, B, C.

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Question 7

Which of the following is absent in cardiac tamponade?

Aparadoxical pulse.
Bcollapse of jugular veins on inspiration.
Clow pulse pressure.
Djugular veins distention.
Edistant, quiet heart sounds.

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Question 8

Hypoglycemic episodes are not observed in :

Ainsulin-secreting tumors
Binsulin overdose.
Cadrenal insufficiency.
Dhipopituitarism of the anterior lobe
Eduring glucocorticoid therapy.

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Question 9

55-year-old obese woman presented to the emergency room complaining of nausea, acute pain in the right subcostal area radiating to the right shoulder accompanied by discomfort in the epigastric region. Symptoms appeared after eating a large meal. The physical examinaton revealed tenderness in the right subcostal area and present Chelmonski's sign. What imaging examination should be performed in the first place?

Achest X-ray.
Babdominal X-ray.
Cabdominal ultrasound.
Dabdominal computed tomography.
Egastroscopy.

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Question 10

60-year-old patient without any previous symptoms of hyperglycemia, has been routinely screened for diabetes. First lab result of fasting glucose was 129 mg/dl (7,1 mmol/l). Patient's physician repeated the test at the next visit - the result was 108 mg/dl (6 mmol/l). What should follow?

Athe results point to diabetes mellitus
Bthe results point to impaired fasting glucose (IFG)
Coral glucose tolerance test should be performed to obtain proper diagnosis.
Dthe results are within reference limits - nothing needs to be done.
Ephysician should observe the patient and repeat the test after a week

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Question 11

70-year-old patient presented to the hospital emergency ward with severe, burning chest pain, which appeared for the first time in his life. What should be considered in differential diagnosis?

Agastroesophageal reflux.
Bmyocardial infarction.
Caortic dissection.
Dpulmonary embolism.
Eall the above.

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Question 12

35-year-old woman presents with following symptoms : erythema on the cheeks, nose and forehead after sunlight exposure, arthralgia, oral mucosae erosion, elevated ESR, pleural friction on auscultation, Raynayd phenomenon. Which of the following diseases should you suspect?

Adermatomyositis.
Bsystemic lupus erythematosus.
Csystemic sclerosis.
Drheumatoid arthritis.
Enone of the abovementioned diseases.

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Question 13

Please choose a false statement about dermatomyositis:

Ait manifests itself as inflammation of shoulder and hip girdles' muscles, and of neck and back muscles.
BGottron's papules and heliotrope eyelid rash are typical skin changes.
Canty-dsDNA antibodies are specific for the disease.
Dthe risk of malignancy is increased.
Eglucocorticoids are used as the first-line treatment.

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Question 14

Heart involvement may be expected in:

Arheumatoid arthritis.
Bsystemic lupus erythematosus.
Csystemic sclerosis.
Dtrue answers A and B.
Etrue answers A, B and C.

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Question 15

Please indicate the drug used as the first-line treatment in gout attack:

Aacetylsalicylic acid.
Bany NSAID.
Ccolchicine.
Dallopurinol.
Eintra-articular glucocorticoid injection.

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Question 16

Please indicate a false statement about psoriatic arthritis:

Apsoriatic arthritis may affect axial and vertebral joints.
Bskin lesions usually precede joint changes
Cpatients with psoriatic arthritis are HLA B27 antigen negative, and this differentiates this disease with ankylosing spondylitis.
DNSAIDs are the first line treatment.
Esynthetic disease-modifying medications or biologic drugs may be necessary in some patients.

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Question 17

22-year-old patient has been admitted to the hospital with rapid heartbeat, anxiety and shortness of breath which started about 1 hour earlier. It is known that the patient had been previously diagnosed with Wolff-Parkinson-White syndrome, and was offered an ablation procedure for which he didn't give his consent. The ECG disclosed tachycardia with wide QRS complexes and variable morphology. What should be done next as the first procedure?

Aurgent electrophysiological study and ablation
Burgent cardioversion.
Cintravenous administration of adenosine.
Dintravenous administration of amiodarone.
Ecarotid sinus massage.

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Question 18

After 4 weeks of hypertension therapy with ACE inhibitor in 57-year old man, we could not achieve normal pressure. Preferred treatment option is to:

Aadding second drug to the therapy.
Bchanging the drug.
Cincrease the dose of previously used drug.
Dhypertensiologist consult
Enone of the answers is correct.

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Question 19

75-year-old old patient has been admitted to hospital due to complete syncope. In ECG there was 3rd degree atrio-ventricular block with heart rate of 28 beats per minute. After exclusion of reversible causes of block, in that patient we should:

Aadminister betablocker.
Badminister adenosine
Cadminister amiodarone.
Dimplant cardioverter-defibrillator.
Eimplant pacemaker.

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Question 20

40-year-old woman with swelling of small joints of her hands for the last 2 months, elevated blood RF level and accelerated ESR (erythrocyte sedimentation rate) was diagnosed with rheumatoid arthritis. What treatment should be administered?

ATNF inhibitor, and NSAID to temporarily control symptoms.
Bsynthetic disease-modifying drug (methotrexate as the first-line treatment), and NSAID to temporarily control symptoms.
CNSAIDs alone for 3 months; synthetic disease-modifying drug when joint symptoms still present.
DNSAIDs alone for 4 weeks; if joint symptoms are still present, administer oral glucocorticoids for another month; if such combined treatment fails then use disease-modifying drug.
Eoral glucocorticoid alone for 3 months; if joint symptoms are still present switch to disease-modifying drug (e.g. methotrexate).

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Question 21

35-year-old woman presented with the rheumatoid factor (RF) blood test result. It showed increased IgM-RF titer. Based on this:

Ayou can diagnose rheumatoid arthritis (RA), because RF specificity for RA reaches 90%.
Byou cannot diagnose RA because increased blood RF titer is only one of the diagnostic criteria of this disease, though it's obligatory.
Cyou cannot diagnose RA because increased blood RF titer is only one of the diagnostic criteria of this disease and it's not obligatory.
Dyou cannot diagnose RA because increased blood RF titer may occur also in the course of other diseases.
Etrue answers C and D.

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Question 22

60-year-old male has productive cough every day (mainly in the morning, after getting out of bed; white sputum). He has been smoking one pack of cigarettes daily for 20 years now. He has shortness of breath while walking, mostly uphill. No other complaints. Physical exam: single dry rales, hushed respiratory murmur. Which of the following additional tests is necessary to diagnose COPD in this patient?

Achest X-ray.
Bhigh resolution computed tomography.
Cspirometry.
Darterial blood gas test or pulse oximetry.
Ethere is no need to perform any additional tests, because signs and symptoms are sufficient to diagnose COPD and start appropriate therapy.

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Question 23

Treatment of a patient with COPD (chronic pulmonary obstructive disease) depends on:

Aseverity of symptoms
Bthe number of exacerbations in last 12 months
CFEV1 value.
Dtrue answers: A and B.
Etrue answers: A, B and C.

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Question 24

50-year-old woman with no medical history of allergic drug reactions was diagnosed with community-acquired pneumonia. Based on her clinical status she can be treated outpatient. Which antibiotics should be applied?

Aazithromycin
Bamoxicillin.
Camoxicillin and clavulanate.
Dciprofloxacin.
Eclarithromycin

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Question 25

A 47-year-old man with a history of alcoholic acute pancreatitis (AP) 3 months before, reports recurrent pains in the upper abdomen. The abdominal ultrasound revealed the presence of a limited, regular, anechoic structure, 20 mm in diameter in the head of the pancreas. The most likely diagnosis is:

Anon-ecysted postinflammatory fluid reservoir after acute pancreatitis.
Bpseudocyst.
Cserous adenocarcinoma
Dcystadenoma
Epancreatic cancer.

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Question 26

In case of aggravated clinical symptoms (including tenderness) of a large pancreatic pseudocyst which occurred as a complication of acute pancreatitis (AP), cyst decompression is recommended. The method of choice is:

Aultrasound guided percutaneous puncture and decompression
Bcontinous percutaneous drainage.
Csingle endoscopic decompression (temporary drainage).
Dendoscopic cystogastro- or cystoduodenostomy.
Einternal surgical drainage.

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Question 27

The correct term for the movement of stomach contents into the mouth without additional effort and without vomiting reflexes is:

Aregurgitation.
Brumination.
Cdysphagia.
Dodynophagia.
Enone of the above

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Question 28

A 82-year-old man is brought to the emergency department. On physical examination, he has severe dehydration, hypotension and tachycardia. A serum potassium concentration of 6,1 mEq/L and serum creatinine concentration of 2,1 mg/dl is observed among initial laboratory studies. Which of the following is the most appropriate next step?

Aadminister 5% glucose solution intravenously
Badminister 0,9% NaCl solution intravenously (normal solution)
Cadminister furosemide intravenously
Dadminister natrium bicarbonate solution intravenously
Estart hemodialysis.

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Question 29

A 29-year-old man is brought to the emergency department because of lethargy. He has history of type 1 diabetes mellitus. Acidosis and hyperkalemia are observed among initial laboratory studies. Blood glucose is 470 mg/dL and serum creatinine concentration is 88 µmol/L (1,0 mg/dL). Which of the following is the most likely cause of acidosis?

Aimpaired renal function.
Baspirin intoxication.
Cinadequate insulin administration.
Dmetformin intoxication.
Eexcessive intake of potassium.

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Question 30

60 year old woman, with a history of hypertension for at least 15 years, nycturia and muscle cramps for at least a year and progressive weakness. Serum creatinine is 5 mg/dl, serum sodium is 130mmol/l. Abdominal ultrasound revealed small kidneys. What other abnormalities can be expected in this patient?

Ahypokalemia.
Bhigh hematocrit.
Cmetabolic alkalosis.
Dhyperphosphatemia.
Ehigh urine specific gravity.

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Question 31

20 year old pregnant woman in 9 hbd has dysuria, pollakisuria and nycturia. What is the proper treatment?

ACotrimoxazole for 5 days.
BCiprofloxacine for 5 days.
CCephalexin for 5 days.
DGentamycine for 5 days.
Eany of the above

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Question 32

55 year old man with increased thirst, ortostatic diziness and blood pressure 95/65 with heart rate 110/min has been admitted to the hospital.He connects the symptoms with him vomiting for two days because of „gastric flu”. Blood creatinine is 2 mg/dl (177 mmol/l), urea -100 mg/dl (16,6 mmol/l) hemoglobin - 16 g/dl. The most probable diagnosis is:

Aacute pyelonephritis.
Bprerenal acute kidney injury.
Chepatorenal syndrome.
Dacute glomerulonephritis.
Ehemolytic-uremic syndrome.

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Question 33

20 year old man complains of painless passing of red urine. Up until now, such episodes have occurred 3 times and the patient links them to throat infections. The physical examination was normal.Urinalysis revealed trace of protein and 15 erythrocytes per field of view. Serum creatinine is 0,8 mg/dl. The most probable diagnosis is:

Arapidly progressive glomerulonephritis.
Bacute glomerulonephritis.
CIgA nephropathy.
Dfocal segmental glomerulosclerosis.
Eminimal change disease.

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Question 34

80-year-old male patient is confused and restless. Stiff neck is present. What should be considered in differential diagnosis?

Asubarachnoid hemorrhage.
Bmeningitis.
Cincreased back muscles tension (e.g. due to parkinsonism).
Dtrue answers: A, B, C.
Etrue answers: A and B.

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Question 35

On the 4th day after the 7-day urinary tract infection (UTI) therapy with ciprofloxacin, with temporary relief of all the symptoms, a woman begins to complain of abdominal pain with concomitant fever and diarrhea. Which of the following may be the causative pathogen?

AEscherichia coli.
BClostridium difficile.
CGiardia lamblia.
DPneumocystis jiroveci.
ECandida albicans.

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Question 36

In the treatment of pseudomembranous colitis we use :
1) metronidazole orally or intravenously
2) macrolides orally or intravenously
3) 3rd generation cephalosporines orally
4) vancomycin orally
5) cholestyramin orally
Which of the following combinations is correct?

A1,2,3.
B2,4,5.
C1,4,5.
D2,3,5.
E1,3,4.

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Question 37

Definition of nephrotic syndrome includes:

1) swelling;

2) ketonuria;

3) hypoalbuminemia;

4) daily protein loss > 3.5 g / 1.73 m2;

5) hematuria.

Correct answer:

A1,2,3.
B2,4,5.
C1,4,5.
D2,3,5.
E1,3,4.

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Question 38

Which of the following is/are used in the management of hypercalcemia?

1) calcium gluconolactobionate iv;

2) 0.9% NaCl iv;

3) furosemide iv;

4) hydrochlorothiazidum po;

5) calcitonin iv.

Correct answer:

A1,2,3.
B2,4,5.
C1,4,5.
D2,3,5.
E1,3,4.

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Question 39

Mitral valve prolapse is most frequently observed in children, except children:

Awithout symptoms
Bobese ones.
Cwith connective tissue diseases.
Dwith chest deformations.
Ewith chromosomal aberrations.

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Question 40

In the fetus/newborn during hypoxia you expect one of the following, except:

Adecreased pH.
Bincreased PaCO2.
Cincreased lactate level.
Ddecreased plasma K+ level.
Eincreased free fatty acids level.

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Question 41

Which of the following is considered in the pathomechanism of breastfeeding jaundice in newborns?

Aincreased enterohepatic bilirubin circulation.
Bdelayed intestinal bacterial colonization.
Cdisorder of bile acids' metabolism.
Dincreased lipoprotein lipase activity.
Eall the above mentioned.

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Question 42

There is a 6-month infant with anxiety, irritation and loss of appetite for several days. It also had diarrhoea and vomited frequently with milk. Microbiological examination of the stool showed evidence of rotavirus. What will you apply in the treatment?

Aamoxicillin.
Bamoxicillin with clavulanic acid.
Cnifuroxazide.
Dclarithromycin
Eprobiotic.

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Question 43

A 12 year old boy was admitted with erythematous skin lesions one the eyelids, chin and cheeks, erythematous rash around hand joints, elbows and knees, shoulder girdle muscles weakness. The symptoms appeared a few weeks ago. On physical examination, eyelid and upper lip swelling, minor ulcerations on both auricles, painful tenderness and shoulder girdle muscles spasms were revealed. The probable diagnosis is :

Amyasthenia gravis.
Bsystemic sclerosis
CGuillain-Barre syndrome.
Dlupus erythematosus in the young
Edermatomyositis.

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Question 44

Which is the most common localization of non-Hodgkin's lymphoma in children?

Ahead.
Bneck.
Cthorax.
Dabdomen.
Elimbs.

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Question 45

The Apgar score of full-term newborn was 1 point in the first minute and 3 points in the 5th minute. The child needed resuscitation after birth. The child presented generalized seizures in the next 24 hours.. What is the method of choice in the treatment of such newborn?

Atotal body hypothermia.
Bbarbiturate continous intravenous infusion.
Copioide continous intravenous infusion.
Dintravenous glucocorticoids infusion
Eall above mentioned.

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Question 46

Clinical symptoms which are not typical for congenital hypothyroidism are:

Aumbilical hernia.
Bprolonged jaundice.
Cmuscular hypertonia.
Dmacroglossia.
Econstipation.

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Question 47

The first line therapy for an asthma attack in children is:

Ainhaled anticholinergic medicine.
Binhaled short-acting beta2 agonist.
Cintravenous antihistamines
Doral antihistamines
Eantuleukotrienes

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Question 48

Newborn presents with bilateral conjunctivitis on the 10th day after the delivery. The next day it presents with rhinitis, persistent cough and vomiting. Additional findings: blood count normal, slightly increased CRP and interstitial pulmonary changes. The most probable etiology of this condition is one of the following:

AStaphylococcus aureus.
BPseudomonas aeruginosa.
CPneumocystis jiroveci.
DChlamydia trachomatis.
EToxoplasma gondii.

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Question 49

In a 2-month-old infant greasy and difficult-to-remove scale lesions have been noticed in the scalp. No signs of itching, no pathological changes in other areas of the skin. Parents are healthy. The most probable diagnosis is:

Atinea capitis.
Bseborrheic dermatitis.
Catopic dermatitis.
Dscabies.
Epsoriasis.

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Question 50

Which of the following pathogens is the most frequent cause of respiratory tract infection in cystic fibrosis?

AStaphylococcus aureus.
BStreptococcus pneumoniae.
CPseudomonas aeruginosa.
DEscherichia coli
Eviruses.

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Question 51

Which of the following are not considered as frequent causes of chronic cough in juvenile patients?

Aasthma.
Bfood allergies
Ccystic fibrosis.
Dsmoking.
Epsychogenic cough

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Question 52

The least probable symptom of cystic fibrosis is:

Achronic sinusitis.
Brectal prolapse.
Cnasal polyps occurrence.
Dintussusception
Emalabsorption syndrome.

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Question 53

Which of the following is the indication for antibiotic therapy in children with acute diarrhoea?

Athe child refuses to take in any food or fluids
Bdiarrhoea in newborns.
Ca lot of mucus in stool
Dchronic and voluminous vomiting.
Esevere dehydration.

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Question 54

Which of the following symptoms are typical for moderate dehydration in children with acute diarrhoea?

1) lack of thirst;

2) anxiety;

3) excessive thirst;

4) sleepiness;

5) skin goes back slowly after pinching.

The correct answer is:

A1,4.
B2,3,5.
C1,4,5.
D3,4,5.
E3,4.

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Question 55

Which of the following is not a relative indication for tonsillotomy in 10-year old boy?

Aobstructive sleep apnea syndrome.
Bdysphagia.
Cconstant mouth breathing.
Dspeech disorders.
Eodynophagia.

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Question 56

Which of the following positions is suitable for gastric lavage in older children?

ATrendelenburg position on the right side.
Brecovery position on the left side.
CTrendelenburg position on the left side.
Drecovery position of the right side.
Esitting position.

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Question 57

Subcutaneous vaccination in infants < 12 months is performed in:

Aright arm.
Bforearm.
Cabdomen.
Dthigh.
Eleft arm.

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Question 58

Which veins will you choose first during venipuncture in neonates?

Awrist.
Belbow pit (cubital fossa)
Cdorsum of hand (back of the hand)
Dscalp
Edorsum of foot (back of the foot)

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Question 59

Which of the following is not an alarming symptom of primary immunological deficiency?

Atwo or more episodes of pneumonia a year.
B2 month long or longer antibiotic therapy only with slight improvement
Cno weight gains and growth inhibition.
Drecurrent iron deficiency anemia.
Esix or more infections a year.

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Question 60

The most common cause of bacterial pneumonia in children is:

AStreptococcus pneumoniae.
BMycoplasma pneumoniae.
CStaphylococcus aureus.
DKlebsiella pneumoniae.
EPseudomonas aeruginosa.

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Question 61

The diagnosis of cystic fibrosis is based on:

Anewborn screening test
Bgenetic testing
Csweat test.
Dclinical manifestations.
Eall of the above.

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Question 62

Which of the following is not characteristic for a life-threatening anaphylactic reaction in children?

Aabdominal pain.
Burticaria.
Cdyspnea.
Dhypertension.
Emucous membrane swelling.

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Question 63

Which of the following are contraindicated in an acute asthma (status asthmaticus) attack in children?

1) short acting beta2 agonists;

2) antitussives;

3) corticosteroids;

4) tranquilizers;

5) oxygen.

The correct answer is:

Aonly 2.
Bonly 4.
C1,2.
D3,4.
E2,4.

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Question 64

Cholestasis is characterized by:
1) increased synthesis and duodenal bile secretion;
2) decreased synthesis and duodenal bile secretion;
3) elevated ferritin and transferrin levels;
4) elevated bilirubin and bile acids levels;
5) malabsorption syndrome that leads to growth retardation.
Correct answer:

A1,3.
B2,3.
C2,3,4.
D1,4,5.
E2,4,5.

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Question 65

Hypertrophic pyloric stenosis is characterized by:
1) the presence of hypertrophy of pyloric circular smooth muscle layer;
2) frequent occurrence in girls;
3) projectile non-bilious vomiting;
4) dehydration and metabolic acidosis;
5) increased acetyl cholinesterase activity on histopathology.
Correct answer:

A1,2,3.
B1,3,4.
C1,3.
D2,4,5.
Eall the above.

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Question 66

Which of the following drugs should be used first in the prophylaxis of attacks of supraventricular tachycardia in a 10-year-old boy?

Apropranolol
Bpropafenone
Cdigoxin
Damiodarone
Eadenosine

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Question 67

The drug of first choice in hypertension pharmacological therapy in pregnant women is:

Amethyldopa
BACEIs
Cfurosemide.
Ddiuretics.
Eall of the above.

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Question 68

HELLP syndrome is characterized by:

Ahemolysis, elevated liver enzymes and jaundice.
Bhemolysis, elevated liver enzymes and decreased platelet count.
Celevated liver enzymes, pruritus, elevated bilirubin level and decreased platelet count.
Delevated liver enzymes, decreased platelet count, jaundice, oliguria and hypoglycemia.
Eappetite loss, hypoglycemia and decreased platelet count.

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Question 69

Which of the following is not an indication for cesarean delivery?

Apost cesarean section condition
Bfetal distress.
Ccephalopelvic disproportion.
Dplacenta abruption.
Eprolapse of the umbilical cord.

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Question 70

The interspinous distance (distantia spinarum) in a woman should be:

A20-21 cm.
B23-24 cm.
C25-26 cm.
D28-29 cm.
E30-31 cm.

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Question 71

Which of the following parameters equals 0 points in the Bishop scoring system?

Aposterior cervical position.
B50% of cervical effacement.
C4 cm of cervical dilation
Dfetal head at -1 station.
Esoft cervical consistency.

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Question 72

The suboccipitobregmatic circumference (circumferentia suboccipitobregmatica) of the mature fetal head is:

A10 cm.
B28 cm.
C30 cm.
D32 cm.
E34 cm.

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Question 73

Anti-D immunoglobulin should be administered within 72 hours after labor to prevent maternal sensitization when mother is found to be Rh D negative:

Awith negative indirect Coombs test, and the infant is found to be Rh D positive.
Bwith negative direct Coombs test, and the infant is found to be Rh D positive.
Cwith positive direct Coombs test, and the infant's father is found to be Rh D positive.
Dwith positive direct Coombs test, and the infant is found to be Rh D positive.
Ewith positive indirect Coombs test, and the infant is found to be Rh D positive.

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Question 74

Which of the following are indications for thromboembolism prophylaxis with low-molecular-weight heparins?
1) vaginal delivery;
2) cesarean delivery;
3) antiphospholipid syndrome with recurrent pregnancy loss or prior fetal death;
4) obesity;
5) lower levels of protein S, C and ATIII;
6) prior deep venous thrombosis;
7) history of pulmonary embolism.
The correct answer is:

A1,3,4,5.
B1,3,4,5,6,7.
C2,3,4,5,6,7.
Dall of the above.
Enone of the above.

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Question 75

Which of the following concerning gestational diabetes mellitus is false?

Afasting glucose in a pregnant woman below 110 mg/dl is normal.
Bfasting glucose of at least 126 mg/dl in two consecutive measurements is synonymous with the diagnosis of diabetes in pregnancy.
Cglycemia >200 mg% 120 minutes after OGTT with 75g of glucose (performed 7-14h after last meal and 72h after discontinuing glucocorticoids and beta-mimetics)
Dhuman insulin and short-acting insulin analogues are registered for the treatment of diabetes during pregnancy.
Eafter the delivery, an insulin dose should be reduced by 30-50% in a woman with PGDM, and in the case of GDM insulin discontinuation should be attempted.

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Question 76

Please indicate the risk factors for venous thromboembolism in pregnancy:

1) thrombophilia;

2) pre-eclampsia;

3) excess of protein C or S;

4) dehydration;

5) caesarian section, especially after going into labour.

Correct answer:

Aall of the above.
B1,2,4,5.
C2,3,4,5.
D1,2,3,5.
E2,4,5.

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Question 77

The most frequent cause of secondary amenorrhea is:

Athyroid diseases.
Bpituitary tumors.
Chypothalamic insufficiency or dysfunction.
Dpolycystic ovary syndrome.
ESheehan's syndrome.

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Question 78

Additional mammary glands (typical nipple and areola) appeared in a girl at her puberty. This phenomenon is the result of:

Aexcessive production of prolactin.
Bprepubertal increase in estrogen levels.
C45X genotype.
Ddeletion of one of the 21 chromosome.
Eit is not pathological symptom.

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Question 79

Premature ovarian failure:
1) is an example of hypogonadotropic hypogonadism;
2) is an example of hypergonadotropic hypogonadism;
3) is an example of eugonadotropic disorder;
4) manifests as primary amenorrhea;
5) manifests as secondary amenorrhea.
The correct answer is:

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

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Question 80

Placenta debris left in the uterus after the delivery:
1) may cause the infection;
2) may cause bleeding during the postpartum period;
3) may undergo neoplastic transformation;
4) are the indication for immediate uterine cavity inspection;
5) may cause excessive uterine contraction.
The correct answer is:

Aonly 1.
B1,2.
C1,2,3.
D1,2,3,4.
Eall the above.

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Question 81

The fundus of the uterus is located:

A2, 3 fingers below the navel - in the end of the 16th week of pregnancy.
B1, 2 fingers above the pubic symphysis - in the end of 20th week of pregnancy.
C1, 2 fingers above the pubic symphysis - in the end of 22nd week of pregnancy.
Dat navel - in the end of 24th week of pregnancy.
Eat navel - in the end of 32nd week of pregnancy.

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Question 82

The first fetal movements are felt in:

1) 18th week of pregnancy in multipara;

2) 15th week of pregnancy in primipara;

3) 10th week of pregnancy in primipara;

4) 25th week of pregnancy in multipara;

5) 20th week of pregnancy in primipara.

The correct answer is:

A1 and 2.
B1 and 3.
C4 and 5.
D3 and 4.
E1 and 5.

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Question 83

Which of the following defines the term pluripara?

Aprimipara who delivered as a result of plural pregnancy.
Bmultipara that gave birth to 2-5 children.
Cprimipara.
Dwoman that gave birth to quadruplets.
Emultipara that gave birth to at least 6 children.

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Question 84

The drug of choice in the prophylaxis of eclamptic seizures is:

Adiazepam.
Bphenytoin.
Clorazepam.
Dmagnesium sulphate.
Enone of the above.

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Question 85

Gregg's triad represents the syndrome caused by intrauterine infection with :

Achickenpox virus
Bmeasles.
Cmumps.
Dcytomegaly.
Erubella.

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Question 86

Which of the following represents the medication of choice in pregnant patients with tuberculosis?

Aisoniazid.
Bamikacin.
Cstreptomycin.
Dethionamide.
Enone of the above.

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Question 87

Which of the following is used to stimulate the development of fetal lungs?

Aprednisone.
Brifampicin.
Cfenoterol.
Dmagnesium sulphate.
Ebetamethasone.

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Question 88

The most common cause of pyelonephritis in pregnant patients is:

AGardnerella vaginalis.
BEscherichia coli.
CStreptococcus agalactiae.
DChlamydia trachomatis.
Enone of the above.

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Question 89

It is confirmed that uterine myomas (fibroids) have adverse effects on reproduction and may cause pregnancy complications. In which of the following situations should you expect problems with getting pregnant?

A3-cm submucosal myoma.
B4-cm intramural myoma.
C5-cm subserosal myoma.
Dtwo small myomas between the laminae of the broad ligament of the uterus.
Ethree small (less than 1 cm) intramural myomas that do not distort the uterus.

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Question 90

Which of the following concerning HRT is false?

Awomen taking estrogen replacement therapy require endometrial biopsy at least once a year
Bpersistent bleeding in a woman taking HRT, with 3-mm ultrasound endometrium thickness does not require further diagnostics
Chormonal replacement therapy decreases LDL and increases HDL cholesterol
DHRT decreases the risk of coronary heart disease in women up to 10 years after menopause
EHRT increases the mammographic breast density during first months of treatment

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Question 91

A 28-year-old pregnant woman (at the 12 week of her first pregnancy) presented to the outpatient obstetric-gynecological clinic with abnormal LSIL cytology. The incorrect procedure is:

Ato repeat Pap smear.
Bto test for HPV.
Ccolposcopy.
Ddiagnostic and therapeutic cervical conization.
Eanswers B and D are true.

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Question 92

Which of the following diagnosis is justified when anxiety and somatic symptoms occur during social interventions?

Aagoraphobia.
Bsocial phobia.
Cpanic attacks.
Dgeneral anxiety.
Eobsessive-compulsive disorder

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Question 93

In patients with several recurrent episodes of depression, for how long should the antidepressants be applied?

A6 months.
B1 year.
Cup to 2 years.
Dup to 3 years.
Eat least 5 years.

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Question 94

Choose the correct statement about BD-I and BD-II :

Ain BD-II there are alternating depression and sub-depression episodes
Bin BD-I there are no sub-depression episodes
Cin BD-I there is always a complete remission after a depression episode.
Din BD-I there are manic episodes and in BD-II s hypomanic episodes.
Ein BD-I depression symptoms are usually more severe

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Question 95

The situation when delusions are developed in an originally healthy person who is in a close relation with the sick person is called:

Aschizophrenia.
Binduced delusional disorders.
Cacute and transient psychotic disorders.
DOthello syndrome.
Eschizoaffective psychosis.

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Question 96

Logically consistent and systematic delusions with no other psychopathological symptoms justify the diagnosis of:

Aparanoid schizophrenia.
BMunchausen syndrome.
Cparanoic personality.
Dconfabulation.
Edelusional disorder.

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Question 97

The type of schizophrenia that meets general schizophrenia criteria and does not meet the criteria for each of its form is called:

Asimple-type schizophrenia.
Bundifferentiated schizophrenia.
Cschizophrenia-like disorder.
Dparanoid schizophrenia.
Eschizotypal disorder.

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Question 98

The estimated schizophrenia incidence in the population is:

A1%.
B2%.
C3%.
D4%.
E5%.

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Question 99

Occasional drinking (e.g. one to two drinks in a friendly company) that neither kills neurons nor adversely affects the organs is called:

Asocial drinking.
Bmoderate drinking.
Cheavy (pathological) drinking
Dharmful drinking.
Epsychiatry does not specify the name.

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Question 100

Acetylcholine esterase inhibitors are indicated in the treatment of:

Adementia syndromes.
Bdelirium.
Calcohol dependence.
Ddelusions.
Eall of the above.

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Question 101

Which of the following effects is not the result of using benzodiazepine derived drugs?

Aanxiolytic
Bantiemetic
Cmuscle relaxant
Dsedative
Eanticonvulsant

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Question 102

Extrapyramidal side effects and hyperprolactinaemia are the consequences of the influence of antipsychotic drugs on:

Aadrenergic transmission.
BGABAergic transmission.
Cserotoninergic transmission.
Dglutamatergic transmission.
Edopaminergic transmission.

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Question 103

Which of the statements concerning the administration of antidepressants when thoughts, tendencies to or attempted suicides are present is true?

Aeach suicide attempt should be followed with treatment with antidepressants.
Bpatients treated with antidepressants do not commit suicide.
Cantidepressants decrease the risk of committing suicide
Deffectiveness of antidepressants in reducing the suicide risk in not certain.
Eantidepressants are most commonly used in order to commit suicide in Poland.

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Question 104

In Poland organ harvesting after the death of a human may be performed:

Ain every case apart from neoplastic diseases
Bonly if the patient has given a written consent in life
Conly if the prior permission has been stated in the presence of two witnesses.
Din all cases if only the immediate family consent is stated.
Enone of the above.

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Question 105

Which of the following concerning acute appendicitis are true?
1) laparoscopic surgery is not recommended;
2) can occur at any age;
3) pain moving from epigastric to the right inguinal region is typical;
4) no gender preponderance;
5) often accompanies caecum carcinoma.
The correct answer is:

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

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Question 106

Periodic check-ups after the resection of the colon because of cancer should include:

1) abdominal ultrasound and chest X-ray;

2) colonoscopy;

3) CEA test;

4) barium enema;

5) alkaline phosphatase test.

The correct answer is:

A1,2,3.
B1,3,4.
C1,2,5.
D1,4,5.
E2,3,5.

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Question 107

Which of the following are the most frequent causes of acute pancreatitis:

1) alcoholic hepatic cirrhosis;

2) excessive fat-food intake;

3) alcohol;

4) low-protein diet;

5) cholelithiasis.

The correct answer is:

A1,2.
B2,3.
C1,3.
D4,5.
E3,5.

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Question 108

Which of the following concerning femoral neck fractures are true?
1) frequently occur in elderly people;
2) they are more frequent in women;
3) surgical treatment consists of hip debris being pinned together;
4) surgical treatment consists of hip replacement;
5) surgical treatment is indicated only in young patients.
The correct answer is:

A1,3,4.
B1,2,3.
C2,3,4.
D1,2,5.
E2,4,5.

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Question 109

Hoarseness occurred in a patient after the surgery of the huge goiter. Right vocal fold paralysis is seen during laryngoscopy. Damage to which of the following structures has caused those symptoms?

Avocal fold.
Bvocal cord.
Cinferior laryngeal nerve.
Dsuperior laryngeal nerve.
Erecurrent laryngeal nerve.

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Question 110

On UGI endoscopy performed for dyspepsia in a 78-year-old man, a 4-cm crater-like ulcer located in the cardiac region is diagnosed. Biopsy specimens showed gastric carcinoma of intestinal type. The patient is classified to group II according to the American Society of Anaesthesiology. Which of the following procedures is most recommended?

Acardiac (stomach) prosthetics.
Bneo-adjuvant radio-chemotherapy.
Ctotal gastrectomy and distal esophagectomy.
Dfeeding gastrostomy.
Eargon plasma coagulation of the lesion.

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Question 111

A 25-year-old man presented to the ER with a perianal pain. The pain is severe when he is seated and during defecation. Pain started 3 days ago and has been increasing. Physical exam: a painful tumor on the right buttock located 3 cm from the anus. The skin over the tumor is unchanged. Per rectum examination is unreliable because of severe pain and difficulty in carrying it out. What is the most appropriate procedure?

Aantibiotics.
Btransrectal ultrasonography.
Cincision and drainage.
Dultrasound-guided drainage.
Eper rectum examination under sedation.

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Question 112

A 56-year-old woman with craniocerebral trauma was admitted to the hospital. She opens her eyes to painful stimuli and there is extremity flexion (extremity with-drawal). She is confused and in a limited contact; it is difficult to gather the information. What is her Glasgow Coma Scale (GCS) score?

A5.
B7.
C9.
D11.
E13.

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Question 113

A female patient complains of the numbness of fingers and tingling around the lips three days after thyroidectomy for follicular carcinoma. She is upset and anxious. Recommend the correct therapeutic approach in this case:

Aadministering sedatives.
Badministering calcium preparations intravenously.
Cadministering drugs that improve peripheral blood circulation.
Dresurgery
Epsychological consultation.

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Question 114

To which of the following organs does distal esophagus carcinoma metastasize, in order of decreasing frequency?

Abones, kidneys, liver.
Bliver, lungs, bones.
Clungs, central nervous system (CNS), adrenals.
Dliver, CNS, kidneys.
Estomach, bones, adrenals.

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Question 115

Which of the following is false?
1) incarcerated hernia is a synonym of irreducible hernia;
2) incarcerated hernia is always an irreducible hernia;
3) femoral hernia is always an acquired hernia;
4) pseudohernia, unlike eventration, possesses hernia sac;
5) femoral hernia orifice traverses below the inguinal ligament.
The correct answer is:

A1,2.
B1,4.
C3,4.
D2,5.
E4,5.

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Question 116

Which of the following, increasing and synergistic factors are included in the “death spiral” in post-traumatic multiple organ dysfunction syndrome?

1) hypovolemia;

2) acidosis;

3) anuria;

4) coldness;

5) coagulopathy.

The correct answer is:

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

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Question 117

What diagnostic method is both quick and effective, and allows to assess the trauma degree in post-injury patient assessment?

AFAST ultrasound.
Babdomen CT scan.
CX-ray.
Ddiagnostic peritoneal lavage.
Earteriography.

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Question 118

Prolonged paralytic ileus after abdominal surgery may be caused by:

1) hypoalbuminemia;

2) acidosis;

3) hypokalemia;

4) increased intraabdominal hypertension syndrome;

5) intraperitoneal abscesses.

The correct answer is:

A1,3,4.
B3,4,5.
C2,3,4.
D1,4,5.
Eall the above.

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Question 119

Which of the following is not a prognostic factor in acute pancreatitis?

Aleft pleural effusion.
BCullen's and Grey Turner's signs.
Cserum lipase and amylase activities.
Dbody mass index (BMI).
Epercentage of necrotic tissue on CT scan.

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Question 120

Upper gastrointestinal (UGI) endoscopy performed in a 55-year-old patient for the search of the cause of anemia revealed a 6-cm tumor located in the body of stomach. It was covered with normally looking mucosa, except for 2-cm ulceration on the top of the tumor. Tissue samples have been collected (biopsy). Pathology exam revealed fusiform cells expressing CD117 antigen. On CT scan: there were no pathological changes except for the primary tumor. Indicate recommended procedure:

Atotal gastrectomy.
Btotal gastrectomy with D3 lymph nodes dissection.
Cgastric wedge resection.
Dgastric wedge resection with D2 lymph nodes dissection.
Esubtotal gastrectomy with D2 lymph nodes dissection.

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Question 121

Which organ is the most common localization of the metastatic development of other organs neoplasms?

Abrain.
Blungs
Cliver.
Dbones.
Eskin.

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Question 122

In a patient on the first day after right hemicolectomy, because of the severe abdominal pain, a plain abdomen X-ray in the vertical position was done, where free gas under the both phrenic archs was observed. Which action would be the most adequate?

Aurgent relaparotomy because of the suspicion of stress ulcer perforation.
BNMR scan to confirm the suspicion.
Cexplorative laparoscopy because of the suspicion of stress ulcer perforation.
DA and C are correct.
Enone of the above.

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Question 123

In a 35-year-old patient, after the orthopedic management of the broken ankle bone, muscle atrophia and painful oedema of the ankle joint were observed. After 3 weeks, bone atrophy appeared on the X-ray in the are around the fracture fissure. The symptoms relate to:

ASudeck's syndrome.
BVolkmann's contracture
Cpseudarticulation (rudimentary joint)
Dphysiological reparation of the injury.
Enone of the above.

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Question 124

The “T” Kehr drainage is used for:

Apleural cavity drainage
Bperitoneal drainage.
Cureteral drainage.
Dbile duct drainage.
Enone of the above.

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Question 125

A 57-year-old patient with histological diagnosis of an adenocarcinoma tumor located in the spleenic flexure. No other changes except for the primary tumor are seen on CT scans. He is classified ASA 2 by anesthesiologist. The “gold standard” surgical approach is:

Aright hemicolectomy.
Bextended left hemicolectomy.
Ccolectomy.
Dsegmental colon resection.
Etransverse colon with spleen flexure resection.

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Question 126

A 25-year-old patient presented with itching and periodic rectal spotting mainly after defecation. PMH: periodic abdominal pains. Physical exam: periumbilical tenderness; no other findings. On anoscopy: red edematous mucosa of the anal canal with two anal fissures: the first located posteriorly in the midline, the other on the right lateral wall. Which of the following diagnoses is the most probable?

Aulcerative colitis.
Bluetic rectitis and colitis.
Cperianal changes in Crohn's disease.
Danal canal mycosis.
Emechanical damage of the anal canal.

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Question 127

A 75-year-old patient called the ambulance because of severe left upper limb pain. The pain is located distally from the elbow. The patient cannot move his limb. On physical exam the limb is cold with cutaneous sensory disturbances. Which ad hoc disposal should be recommended?

Aangiography.
Bheparin 5000 units.
Cheparin intravenous infusion 18 units/h/kg of body weight.
Daspirin and clopidogrel.
Efasciotomy.

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Question 128

A 45-year-old man referred to the ER because of a furuncle in the right submandibular region. Past medical history (PMH): aortic valve replacement because of RA; no other medical problems. Physical exam: a red, tender tumor with the apical white discoloration located in the right submandibular region. Heart auscultation revealed pronounced prosthetic valve sound in the aortic area (second right intercostal space). No other changes on the physical exam. What is the recommended procedure?

Aincision and drainage.
Bremoval of necrotic plug and purulent content.
Cincision, drainage and anticoagulants.
Doral antibiotics and topical antiseptics.
Eremoval of necrotic and purulent content, and oral antibiotics.

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Question 129

In traumatic spleen rupture:
1) splenectomy is always necessary; â€â€4) peritoneal bleeding is always present;
2) partial splenectomy is possible; â€â€5) extraperitoneal hematoma often occurs.
3) laparoscopic approach is possible; â€â€
The correct answer is:

A1,3.
B3,4.
C2,3.
D1,4.
E2,5.

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Question 130

Which of the following should be used as first choice treatment (preferred method) In order to stop the UGI bleeding (hematemesis)?

Asurgery.
Bconservative treatment.
Cendoscopic treatment.
Dpatient observation.
Enone of the above.

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Question 131

Which of the following activities belong to the tertiary prophylaxis?

1) illness risk reduction;

2) illness occurrence prevention;

3) screening tests;

4) illness complications prevention;

5) prevention of deaths due to disease.

The correct answer is:

A1,2.
B2,4,5.
C4,5.
D1,3.
E3,4.

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Question 132

The following ones are live attenuated vaccines, except:

ATuberculosis.
BRotaviruses.
CVaricella.
DHepatitis B.
EPoliomyelitis (oral vaccine).

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Question 133

Please choose false statement about vaccination:

AMandatory vaccinations might be carried out by any physician with a right to practice a profession.
Bthe interval between live attenuated vaccines should not be less than 4 weeks.
Cthe interval between doses of the same vaccine should follow manufacturerâ€™s instructions.
Dthe interval between doses of live attenuated and inactivated vaccines is not strictly determined
Ethe interval between doses of inactivated vaccines is not strictly determined

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Question 134

Subcutaneous vaccination in infants < 12 months is performed in:

Aright arm.
Bleft arm.
Cforearm.
Dthigh.
Eabdomen.

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Question 135

Impaired glucose tolerance is diagnosed when:

Aglycemia 2 hours after oral intake of 75 g glucose is ≥ 140 mg/dl (7,8 mmol/l) and ≤ 200 mg/dl (11,1 mmol/l).
Bfasting glycemia ≥ 126 mg/dl (7,0 mmol/l).
Cfasting glycemia ≥ 140 mg/dl (7,8 mmol/l) and ≤ 200 mg/dl (11,1 mmol/l).
Dglycemia 2 hours after oral intake of 75 g glucose is ≥ 126 mg/dl (7,0 mmol/l) and ≤ 140 mg/dl (7,8 mmol/l).
Erandomly tested glycemia ≥ 140 mg/dl (7,8 mmol/l).

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Question 136

The indication for the treatment of Helicobacter pylori is not:

Afirst episode of stomach and duodenal ulcers
Bgastritis with metaplasia
Cprevious resection of gastric cancer
Dreflux disease
Etreatment is indicated in each case of diagnosed infection

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Question 137

Any form of chronic asthma requires continuous treatment with inhaled corticosteroids because the inflammation of the airways is the essence of the disease.

Aboth statements are true and there is causal relationship between them.
Bboth statements are true, but there are no causal relationship between them.
Cfirst statement is true, second is false.
Dfirst statement is false, second is true.
Eboth are false.

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Question 138

Eye examination for early detection of diabetic retinopathy in patients with type 2 diabetes should be done:

Aat the diagnosis or shortly after and then once a year.
Bat the diagnosis or shortly after and then every 5 years.
Cwithin 5 years from the diagnosis and then every 3-5 years.
Dafter 5 years from the diagnosis and the once a year.
Enone of the above is correct.

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Question 139

Diabetes mellitus in a child is contraindication for the vaccination against:

Aflu.
BPneumococci
CHepatitis A.
Ddiphtheria, tetanus and pertussis with reduced content of diphtheria and pertussis components.
Enone of the above.

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Question 140

Hepatitis B booster for healthy subjects with full previous vaccination series is recommended:

Ayes, every 10 years
Bwhen a surgery has been scheduled and last vaccination was more than 10 years ago.
Cyes, if the surgery has been scheduled and last does has been administered more than 5 years ago
Dwhen travelling to countries with high and intermediate hepatitis B endemicity if the primary vaccination was more than 5 years ago.
Eno booster is recommended.

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Question 141

Zoonotic parasitic diseases comprise the following ones, except:

ATrichinosis.
BToxoplasmosis.
CToxocarosis
DEnterobiasis.
ETaeniasis.

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Question 142

Changeable cardiovascular risk factors comprise:

Aimpaired glucose tolerance.
Bage.
Chypertension
Dtrue answers A and C.
Etrue answers A, B and C.

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Question 143

GP competence does not include:

Areporting of illness or suspected cases of infectious disease to the county sanitary-epidemiological station.
Breporting of suspected occupational disease.
Cascertaining death.
Ddecision on the need for teacher's leave of absence due to health reasons.
Edecision on the need to change the conditions of employment or reduction of work because of the harmful health effects of work.

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Question 144

Which subjects listed below are covered by the polish public healthcare system?

Ainsured ones.
Buninsured pregnant women.
Csubjects below 18 years old.
Dtrue answers A and C.
Etrue answers A, B and C.

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Question 145

Complication of hepatic cirrhosis might be:

1) encephalopathy;

2) ascites;

3) gastric varices;

4) hepatorenal syndrome;

5) hypogonadism.

Correct answer:

A1,2,3.
B2,3,5.
C2,4,5.
D1,2,4,5.
Eall mentioned above.

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Question 146

Please choose the true statement about tuberculosis (tbc) vaccination:

ATbc vaccination should be performed in newborns before their discharge from hospital.
BTbc vaccination in prematurely born newborns is performed after they reach 2000 g of weight.
Cin persons who did not receive the vaccine after birth, vaccination should be performed as soon as possible, not later than the age of 15.
Dthe assessment of post-vaccinal scar size and compulsory revaccination of children and young people has been abandoned.
Eall the above statements are true.

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Question 147

In ambulatory patients requiring antibiotics due to infectious exacerbation of COPD the first-line treatment (when no contraindications) is:

Aamoxicillin.
Bcefuroxime.
Cclarithromycin.
Dmoxifloxacin.
Edoxycycline.

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Question 148

Which of the following tests are ordered and financed by the GP:

Aresting ECG.
Blower extremity Doppler.
Cheart ultrasound (ECHO).
Dultrasound of the genitourinary system.
Eall the above.

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Question 149

Drug-induced hyperkalemia may be caused by one of the following, except:

Aamiloride.
Bangiotensin-converting enzymes inhibitors.
Cangiotensin receptor blockers.
Daldosterone receptor blockers.
Eglucocorticoids.

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Question 150

Which of the following groups of patients have increased risk of type 2 diabetes mellitus?

Awith history of gestational diabetes.
Boverweight and obese (BMI >= 25 kg/m2).
Cwith family history of diabetes (parents or siblings).
Dwith previously confirmed impaired glucose tolerance.
Eall the above.

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Question 151

According to ALS ERC 2010 algorithm 1mg of adrenaline should be delivered every:

A1-2 minutes.
B2-3 minutes.
C3-4 minutes.
D3-5 minutes.
E4-5 minutes.

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Question 152

Select the incorrect answer about dobutamine:

Abeta1 and beta2 agonist.
Bshould be given in an infusion pump.
Cshould be used in order to increase the stroke volume.
Dgets inactivated in an alkaline environment and should not be used in infusion solutions of alkaline.
Eshould be used to raise the blood pressure in patients in shock.

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Question 153

Indication for prolonged resuscitation efforts are following except for:

Asuspected pulmonary embolism.
Bintoxication with medicines causing depression of CNS.
Chypothermia.
Dsuspected myocardial infarction.
Eall of the above conditions are indications for extended CPR

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Question 154

Medication not used while performing cardiopulmonary resuscitation is:

Avasopressin.
Badrenaline.
Catropine.
Dlignocaine.
EA & D.

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Question 155

Alarming symptom for the new onset of atrial fibrillation could be:

Acardiogenic shock.
Bsingle faint.
Cpulmonary edema.
Dstinging chest pain.
Eall above correct.

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Question 156

The treatment of choice for a 65-year-old female after faint with Mobitz II AV block and HR 38/min would be:

Aatropine 3 mg iv.
Batropine 0,3 mg and if unsuccessful repeat up to total dose 3 mg.
Cif pharmacotherapy is unsuccessful apply transcutaneous stimulation.
Dcardioversion with energy of 70-100J.
EB & C correct.

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Question 157

Select the incorrect sentence for drugs used in cardiac arrest:

A300 mg of amiodarone is administered after the third defibrillation
B1 mg of Atropine is administered in asystole
C100 mg of Lidocaine instead of Amiodarone can be administered
D10 ml 10% calcium chloride is administered in the case of hyperkalemia
EB and D correct

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Question 158

The Cardiopulmonary Resuscitation in a hypothermic patient, the drugs should be administered when the core bidy temperature reaches:

A> 30Â°C.
B> 28Â°C.
C> 32Â°C.
Dfrom the very beginning of Cardiac Arrest.
Enone of the above.

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Question 159

In 1999 Center of Disease Control (CDC) published lists of pathogens which are theoretically dangerous when used by terrorists. There are three groups: A, B and C. Which of listed below belong to group B:

AVariola vera, Bacillus anthracis, Yersinia pestis
BVibrio cholerae, Coxiella burnetti, Shigella
CFrancisella tularensis, Arenaviridae
DTogaviridae, Flaviviridae, Salmonella
ENipahvirus, Hantavirus, Arboviridae, Flavivirus

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Question 160

Which of the following statements is correct?

Aearly defibrillation and BLS are the only interventions which are proven to have a positive influence on survival in cardiac arrest.
Bfirst defibrillation delivered within 5 minutes after cardiac arrest has a success rate of 90%.
Ctransthoracic electrical impedance has no influence on defibrillation effect
DBLS changes ventricular fibrillation into sinus rhythm.
EBLS shortens duration of ventricular fibrillation.

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Question 161

Which of the following statements is correct?

Athe purpose of triage is to provide medical attention to the most seriously-injured victim.
Bduring triage with START protocol victims who are expectant or dead are tagged white.
Ca priority of evacuation status of victims may be changed every now and again.
DJumpSTART is used in children aged 8 and more
Eall answers are correct.

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Question 162

A loss of 1/3 of blood may result in hypovolemic shock. Taking into consideration a theoretical loss of blood associated with fractures a probability of hypovolemic shock is the highest in case of:

Aforearm bones fracture.
Bone rib fracture.
Cone vertebrae fracture.
Dfemur fracture.
Earm and shoulder fracture.

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Question 163

START is one the most frequently used triage systems. Its uses colorful tags which indicate triage priority levels. Colors used in START are following:

Awhite, black, green, red
Bred, black, blue, green
Cblack, green, blue, yellow
Dblue, green, red, yellow
Eblack, red, yellow, green.

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Question 164

A 40 year old unconscious male (no eye opening, no verbal response) with laceration over the head and extension to pain stimuli would receive:

AGCS 3
BGCS 4
CGCS 5
DGCS 6
EGCS 8

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Question 165

The most commonly used medicine to treat the attack of narrow complex supraventricular tachycardia is:

Aadenosine.
Bamiodarone.
Catropine.
Dlidocaine.
Epropafenone.

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Question 166

In the ER, you are treating a 68-year-old man with exacerbation of chronic obstructive pulmonary disease. After initial treatment with bronchodilators by nebulization, the patient's arterial blood gas test revealed: pH 7.29 pCO2 65,3 mmHg pO2 84 mmHg HCO3 30,3 mmol / L; should be diagnosed as:

Acompensated respiratory acidosis.
Buncompensated metabolic acidosis.
Cpartially compensated respiratory acidosis.
Dcompensated metabolic acidosis.
Euncompensated respiratory acidosis.

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Question 167

According to the rule of nines, a burning of both lower limbs and the scrotum in adult patients affects:

A19% of the body surface.
B36% of the body surface.
C37% of the body surface.
D45% of the body surface.
Erule of nines is not related to burned body surfaces

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Question 168

Which signs and symptoms characterize II° burns best:

Aerythema, pain
Btissue necrosis, skin anesthesia.
Creddened skin and blisters.
DA and C are correct.
Eall listed above signs and symptoms are present in II° burns.

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Question 169

Emergency tourniquet can be used in:

Aall arterial bleedings
Btraumatic amputations.
Cevery case of a bite wound.
Dall venous bleedings
Ethe law prohibits usage of emergency tourniquets.

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Question 170

Which of the following is not an indication to amiodarone treatment?

Adefibrillation-resistant ventricular fibrillation.
Bhemodynamically stable ventricular tachycardia.
Cpulseless ventricular tachycardia.
Dpharmacoresistant tachyarrhythmias.
Ebradycardia.

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Question 171

The principles of medical ethics of the Code of Medical Ethics result from:

Adecisions of the National Convention of Doctors.
Bgeneral ethical standards.
CChristian ethics.
Dtradition.
EHippocratic Oath.

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Question 172

Doctors must not use:
1) methods recognized by science as harmful;
2) methods recognized by science as useless;
3) methods which have not been scientifically verified;
4) expensive methods;
5) drugs outside the Summary of Medicinal Product Characteristics.
The correct answer is:

Aall the above.
B1,2,3.
C1,2,3,5.
D4,5.
E1,5.

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Question 173

Doctors:

Acan advertise only in the health sections of newspapers.
Bcan advertise only on the Internet.
Cmust not advertise at all.
Dcan give their permission to use their surnames and profiles for advertising purposes.
Ecan advertise only on one billboard placed on the outside of the building.

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Question 174

In the case of unfavorable prognosis for the patient the doctor:
1) should inform the patient with tact and caution;
2) may not inform the patient if deeply convinced that the news will make the patient suffer badly;
3) may not inform the patient if deeply convinced that the consequences of the news will be detrimental to the patient’s health;
4) must provide information on the patient’s explicit request;
5) may inform the person in respect of whom he is convinced that this person acts in the interests of the patient.
The correct answer is:

Aall the above.
B1,5.
C2,3,4.
D1,2,3,4.
E1,3,5.

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Question 175

A female patient comes to the gynecologist’s in order to undergo cytology. She is accompanied by her husband who is apparently going to be present at the examination. How should the doctor react?
1) husband should be allowed to be present at the examination since he is someone close, so it may be inferred that the patient accepts his presence;
2) doctor may ask the husband to leave if the patient insists on it;
3) doctor should ask the wife’s permission for her husband to stay;
4) doctor may ask the husband to leave if she decides that her patient health safety requires this;
5) doctor has to ask the husband to leave because gynecological examination is an intimate one and nobody but the medical stuff can take part in it.
The correct answer is:

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

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Question 176

According to the Law on the profession of doctors and dentists, a doctor receives the protection provided for the public officer:

1) after obtaining the title of specialist;

2) if they provide health care services financed from public funds;

3) if they are employed under an employment relationship in a medicinal business entity;

4) if they are engaged in emergency services;

5) if they provide health care services in urgent cases.

The correct answer is:

Aonly 1.
B2,5.
C3,4.
D2,4.
E4,5.

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Question 177

There is a necessity to perform a bone marrow transplant in a 16-year-old child. The doctors have determined that, given the circumstances, a 14-year-old brother of the patient may be the only donor. Performing this transplant from the donor requires the approval of:

1) the donor's legal representative;

2) donors;

3) the local bioethics committee;

4) provincial consultant in the field of transplantology;

5) guardianship court.

The correct answer is:

A1,2,3.
B1,2,5.
C2,4,5.
D1,2.
Eonly 5.

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Question 178

A doctor who has her individual professional practice which includes mandatory vaccinations was offered an advantageous proposal of getting cheaper product directly from the vaccine manufacturer. What should the doctor do?

Adoctor is allowed to take advantage of the proposal if she sells the vaccines over to her patients without additional charges.
Bdoctor is allowed to take advantage of the proposal if she obtains the approval of the district state sanitary inspector.
Cdoctor is not allowed to purchase vaccines from the manufacturer since she is only allowed to buy them in the public pharmacy.
Ddoctor is not allowed to purchase vaccines from the manufacturer since she is only allowed to buy them in the pharmaceutical wholesaler.
Edoctor is not allowed to purchase vaccines from the manufacturer since in the case of compulsory vaccinations the vaccines are distributed exclusively by the Ministry of Health.

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Question 179

90-year-old patient has to undergo cardiac surgery. Afraid that her mental condition deteriorates and would like to give the possibility to decide on further treatment for her husband. According to ACT of 6 November 2008 on the rights of patients and the Patient Rights Spokesman it is possible if:

Aher husband is significantly younger.
Bhusband has at least 25 score in the MMSE.
Chusband enjoys full civil rights.
Dshe will be partially legally incapacitated and her husband appointed her guardian.
Eshe will be completely legally incapacitated and her husband appointed her legal representative.

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Question 180

In case of a conflict between physician knowledge and his conscience Polish Code of Medical Ethics:

Aorders the follow exclusively the voice of conscience.
Bthe Code leaves the doctor the freedom act according to conscience and knowledge.
Corders the proceedings in accordance exclusively with contemporary knowledge.
Dthe Code does not deal with matters of conscience.
Ecode not evaluate ethically, act in accordance or not with the medical knowledge.

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Question 181

If the incapacity for work arose before an insured person is twenty years of age, then the condition of having the required contributory and noncontributory period in order to receive a disability pension is fulfilled when this joint period is at least:

Aa year.
Btwo years.
Cthree years.
Dfour years.
Efive years.

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Question 182

The Law on social insurance dated 13October 1998 specifies four funds under the Social Insurance Fund. Which of the following funds is not mentioned in the Law?

Aold age.
Bdisability pension.
Cunemployment.
Dsickness.
Eresultant disability pension.

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Question 183

A medical ruling on temporary incapacity for work includes the statistical number of the disease according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems. That number is placed on:

Aoriginal of the ruling.
Bfirst copy of the ruling.
Coriginal and fist copy of the ruling.
Doriginal and second copy of the ruling.
Esecond copy of the ruling.

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Question 184

SIF(ZUS) certifying doctors and medical boards do not issue the ruling on:

Atemporary incapacity for work.
Btotal incapacity for work.
Cpercentage of damage to health.
Ddegree of disability.
Einability to live independently.

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Question 185

Sickness benefits are not payable for the first five days of temporary incapacity for work, an incapacity which resulted from:

Atuberculosis.
Balcohol abuse.
Coverdose of psychotropic drugs.
Dinfectious disease.
Eaccident on the way to or from work.

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Question 186

In accordance with the law on cash benefits from social insurance in the case of disease and maternity, sickness benefit due to temporary incapacity for work is granted for a period not longer than 270 days if that incapacity was caused by:

Amononucleosis.
Bstroke.
Cmyocardial infarction.
Dtuberculosis.
EAIDS.

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Question 187

The medical ruling on temporary incapacity for work due to disease or a stay in stationary health care facility includes the information concerning the circumstances which affect the right to the sickness benefit and its amount. This information is given in the form of a letter code. Incapacity for work due to alcohol abuse is marked as:

AA.
BB.
CC.
DD.
EE.

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Question 188

According the concept of ‘health fields’ by Marc Lalonde, the lifestyle field relates to the individual risk of illness caused by:
1) alcohol abuse;
2) abuse of drugs, especially psychotropics;
3) process of maturation and ageing;
4) tobacco smoking intensity;
5) unbalanced diet leading to obesity;
6) environmental pollution;
7) low physical exercise.
The correct answer is:

A1,2,3,4,5.
B1,2,4,5,7.
C2,3,4,5,6.
D3,4,5,6,7.
Eall the above.

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Question 189

The main aims of epidemiology as a scientific discipline include:

Aassessment of incidence and intensity of health problems in a population.
Bprognoses of tendencies in currently occurring health problems.
Cidentification of environmental and behavioral risk factors.
Dproviding data for the management of the health system.
Eall the above.

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Question 190

Negative phenomenon in the health status of Polish population observed in recent years is:

Aincrease in the mean lifespan.
Bdecreased neonatal mortality.
Cincrease in the number of people in elder age groups.
Dslight decrease in mortality because of circulatory disorders.
Enone of the above.

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Question 191

Prevalence rate depends on:

1) severity of the disease;

2) illness period;

3) number of new cases of the disease;

4) migration of the population.

The correct answer is:

A1 and 2.
B2 and 3.
C3 and 4.
D1 and 4.
Eall the above.

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Question 192

Which of the following definitions relates to the incidence rate?

Ait is the quotient of a number of ill people (dividend) and a number of people exposed to that illness (divisor) at a given period of time.
Bit is the quotient of a number of new occurrences of the disease (dividend) and a number of people exposed to that illness (divisor) at a given period of time.
Cit is the multiplication of a number of ill people and a number of people exposed to that illness at a given period of time.
Dit is the multiplication of a number of new occurrences of the disease and a number of people exposed to that illness at a given period of time.
Eit is the difference between a number of ill people and a number of deaths of the disease at a given period of time.

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Question 193

Which of the following aims of the National Health Program for years 2007-2015 belongs to the strategic aims?

Adecrease in smoking widespread.
Bdecrease in incidence and premature mortality due to malignant neoplasms.
Ccreation of conditions for healthy and active life of elderly.
Dincrease in physical exercise of population.
Enone of the above.

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Question 194

According to the Act on health care services financed from the public funds health programs especially concern:

Aimportant epidemiological phenomena.
Bother important health problems of the whole population or specific groups.
Cimplementation of new medical procedures.
Dimplementation of new prophylactic actions.
Eall the above.

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Question 195

Health care system is defined as an organized and coordinated set of efforts aiming at securing and improvement of health status of individuals and populations by:

Aprophylaxis.
Btreatment.
Crehabilitation.
Dhealth promotion.
Eall the above.

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Question 196

A 52-year-old woman comes to the office for her annual check-up. She is asymptomatic. He takes no medications. Physical examination is normal. Urinalysis shows bacteriuria. Which of the following is the most appropriate pharmacotherapy of bacteriuria in this patient?

Aco-trimoxazole.
Bnitrofurantoin.
Cciprofloxacin.
Damoxycylin.
Epharmacotherapy of bacteriuria is not required.

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Question 197

Birth of a child with a congenital or genetic disease is a psychological trauma, which is combined with unwarranted guilt in the family. Which of the following parental situation-based reaction is the least probable?

Ashock.
Bsadness/anger.
Cdisbelief/denial.
Drejection of the child.
Eadaptation/reorganization.

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Question 198

Stimulating fetal lung maturation with glucocorticoids is not justified in situations requiring immediate delivery, such as fetal hypoxia, intrauterine infection, and bleeding from the genital tract. However, an additional beneficial effect of glucocorticoids is the prevention of intraventricular hemorrhage (IVH).

Aboth sentences are true and connected
Bboth sentences are true but without connection
Cboth sentences are false
Dthe first sentence is true, the second is false
Ethe first sentence is false, the second is true

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Question 199

According to the Mental Health Protection Act (Article 23.1), a person may be admitted to the mental health facility without her consent when this person is:

A“dangerous”.
B“mentally ill”.
C“incapacitated”.
D“unconscious”.
E“mentally retarded”.

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Question 200

According to the Mental Health Protection Act (Article 18.1), direct coercion may be applied to people who: (this question has been annulled)

Aare “mentally ill”
Bare “dangerous to others”
C“with mental disorders”
Dare “mentally ill or mentally retarded”
Eare “mentally ill during in-patient treatment”

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