A female patient with acute deep vein thrombosis of the lower extremity receives low molecular weight (LMW) heparin and simultaneously she is put on warfarin in order to continue anticoagulation. When is it possible to discontinue heparin?
- Awhen INR >= 2.0 for at least 2 consecutive days.
- Bwhen INR > 3.0 for at least 2 consecutive days.
- Cwhen INR >= 2.0 for at least 5 consecutive days.
- Dwhen INR > 3.0 for at least 5 consecutive days.
- Eimmediately after putting her on warfarin.
Reveal the correct answerA patient with heavy diarrhoea developes hypovolemic shock. In this case the treatment of the shock should be started with:
- Aintramuscular adrenaline injection.
- Bintravenous noradrenaline injection.
- Ccontinuous noradrenaline infusion.
- Dcontinuous dopamine infusion.
- Etransfusion of fluids.
Reveal the correct answerA tuberculin skin test (TST) in an adult without immune disorders who was BCG vaccinated only once at birth is considered positive if the diameter of the indurated area is at least:
- A5 mm.
- B10 mm.
- C15 mm.
- D20 mm.
- E25 mm.
Reveal the correct answerMetformin is considered the first choice drug in the treatment of type 2 diabetes, except for patients with:
1) advanced vascular atherosclerosis
2) renal insufficiency (GFR <30 ml/min)
3) liver damage
4) heart failure
5) respiratory failure
The correct answer is:
- A1, 2, 5
- Bonly 2
- C2, 5
- D2, 4
- Eall the above
Reveal the correct answerA 70-year-old man comes to the doctor's because of syncope. He has had diarrhea for two days. Which of the following is the most likely cause of syncope?
- Ahyperkalemia.
- Bhypermagnesemia.
- Chypotension.
- Dbradycardia.
- Eacidosis.
Reveal the correct answerA 65-year-old woman with CKD keeps complaining of constipation. She was treated for artralgia with ketoprofen and for hypertension with enalapril and spironolactone. She has serum level of K 6.0 mEq/l. The possible cause of hyperkalemia is:
- Aconstipation.
- Benalapril.
- Cspironolactone.
- Dketoprofen.
- Eall the above.
Reveal the correct answerParoxysmal atrial fibrillation is diagnosed if:
- Ait does not resolve spontaneously and lasts over 7 days.
- Bpersists over 1 year and the decision to restore sinus rhythm was made.
- Cpersists over 1 year and the restoration of sinus rhythm was abandoned.
- Dlasts up to 7 days.
- Eatrial fibrillation in the course of hyperthyroidism reverses once euthyreosis is obtained.
Reveal the correct answerA 20-year-old man with generalized edema was admitted to the local Department of Nephrology. On admission his arterial pressure was 100/70 mmHg; there was selective proteinuria of 7 g/day, no change in urinary sediment, albumin level 22 g/l, eGFR of 110 ml/min. Indicate the most probable cause of the nephritic syndrome:
- Aacute glomerulonephritis.
- Bsubmicroscopic glomerulonephritis.
- Crapidly progressive glomerulonephritis.
- Dmembrane-proliferative glomerulonephritis.
- Echronic interstitial nephritis.
Reveal the correct answerA 35-year-old male patient came to the ED complaining of acute pain in the left lumbar region radiating to the groin and associated with hematuria and vomiting. Indicate the most probable diagnosis:
- Aacute glomerulonephritis.
- BIgA-nephropathy with recurrent hematuria.
- Cnephrolithiasis.
- Dacute pyelonephritis.
- Ebladder inflammation.
Reveal the correct answerLeft ventricular hypertrophy is a frequent complication in patients with chronic kidney disease (CKD) Stage 5 and it is caused by:
- Avolume overload.
- Bstimulation of sympathetic nervous system.
- Carterial hypertension.
- Danemia.
- Eall the above.
Reveal the correct answerA 78-year-old woman comes to the doctor's because of the weakness that began 3 months ago. She lost 8 kg during the last 6 months. Blood plasma glucose is 430 mg/dl. Which of the following is the most appropriate next step?
- Astart insulin treatment.
- Bstart therapy with metformin.
- Cstart therapy with sulfonylurea.
- Drecommend low-carbohydrate diet.
- Erecommend low-protein diet.
Reveal the correct answerWhich of the following does have the biggest influence on the natural course of COPD (chronic obstructive pulmonary disease)?
- Aregular intake of inhaled steroid.
- Bregular intake of inhaled long-acting beta2-mimetic.
- Cregular intake of tiotropium.
- Dsmoking cessation.
- EA + B or A + C.
Reveal the correct answerIn a 64-year-old obese male fasting glycemia was found to be 115 mg/dl. What should the next step be?
- Arepeat fasting glycemia measurement and order low-calorie diet
- Boral glucose loading test + low calorie diet, rich in fibers, with the restriction of saturated fats and simple carbohydrates
- Cgliclazide 30 mg/day
- Dno further control is needed
- Ediagnose patient with diabetes
Reveal the correct answerA 30-year-old previously healthy man comes to the doctor's because of vomiting and diarrhea during the last 24 hours. Which of the following is the most appropriate first step?
- Astart antiemetic drug
- Bstart intravenous 0.9% saline infusion
- Cstart intravenous 5% glucose infusion
- Dstart antidiarrheal drug
- Eadvise the patient to increase the intake of fluids
Reveal the correct answerUrinalysis in a pregnant woman (1st trimester) with no complaints about the urinary tract shows E. coli > 105 CFU/ml of urine. What should be done in this case?
- Aimmediately administer nitrofurantoin.
- Badministration of an antibiotic chosen according to the antibiogram and one that is not contraindicated during pregnancy.
- Cantibacterial treatment is not indicated because asymptomatic bacteriuria does not pose a risk to a mother and child.
- Dimmediately administer co-trimoxazole.
- Eimmediately administer ciprofloxacin.
Reveal the correct answerA 32-year-old woman comes to the doctor's because her right leg is swollen. She gave birth to her son three weeks ago. What is the most probable diagnosis which has to be excluded/confirmed first?
- Aliver cirrhosis.
- Bnephrotic syndrome.
- Cdeep venous thrombosis.
- Dallergy.
- Eerysipelas.
Reveal the correct answerA patient with a diagnosed Prinzmetal's angina reported to his general practitioner. What group of medicines should not be used in the management of this patient?
- Along-acting nitrates.
- Bbeta-blockers.
- Ccalcium channel blockers.
- DA, B and C are correct.
- EB and C are correct.
Reveal the correct answerA 45-year-old patient with medical history of arterial hypertension presented to the emergency department after a sudden collapse but without complete loss of consciousness. The collapse occurred for the first time in her life around noon on the day of the presentation. First blood pressure measured after the incident at the patient's home was 135/75 mmHg. The patient takes her BP lowering medicine always in the evening. The ECG revealed (paper speed is 25 mm/s)
Which is the correct treatment in this case?
- Ai.v. atropine up to a maximum dose of 3 mg → search for reversible causes → if necessary consider insertion of a transvenous temporary pacemaker → consider permanent pacemaker implantation if the cause is irreversible and symptoms are recurring.
- Binsert a transvenous temporary pacemaker and refer to permanent pacemaker implantation as soon as possible (to prevent sudden cardiac death).
- Chospital observation for 24 hours → if electrocardiographic abnormalities persist, start orciprenaline iv infusion for the next 24 hours → if abnormalities still persist, implant a permanent pacemaker.
- Dhospital observation for 24 hours, then if symptoms do not recur, discharge home as the fainting was apparently caused by hypotension.
- Ei.v. atropine up to a maximum dose of 3 mg → orciprenaline iv infusion. → implant an automatic cardioverter-defibrillator.
Reveal the correct answerWide QRS complexes (>= 0,12 s) are a result of the improper depolarization of the ventricles and are present in following conditions:
1) right bundle brunch block;
2) left bundle brunch block;
3) premature depolarization of the ventricles through accessory pathway in preexcitation syndrome;
4) ventricular extra-systoles and rhythms;
5) diffused ventricular conduction disturbances;
6) sick sinus syndrome.
The correct answer is:
- A1,2,3.
- B1,2,3,4.
- C1,2,3,4,5.
- D1,2,3,4,6.
- Eall the above.
Reveal the correct answerA 64-year-old male is treated for rheumatoid arthritis and for ischemic heart disease with myocardial infarction in the past. He complains of increasing muscular pains; significantly elevated CK concentration was found. Which of the medication he uses regularly is the most probable cause of his complaints?
- Ametoprolol.
- Bspironolactone.
- Catorvastatin.
- Dmethylprednisolone.
- Eclopidogrel.
Reveal the correct answerA 79-year-old man was brought to the emergency department because of anuria. Clinical examination did not determine the potential underlying causes of anuria. Which of the following is the most appropriate next step to explain the cause of anuria?
- Aabdominal ultrasound.
- Brenal scintigraphy.
- Cendoscopy of the urinary bladder.
- Durography.
- Ecomputer tomography of the abdomen.
Reveal the correct answerAn unconscious male patient deep breaths with respiratory rate 28 per min. Metabolic acidosis was found: bicarbonate concentration 11 mmol/l, pH 7,16. What kind of intoxication is the probable cause of his serious condition?
1) methyl alcohol;
2) ethyl alcohol;
3) benzodiazepines;
4) opiates with respiratory insufficiency;
5) ethylene glycol.
The correct answer is:
- Aonly 5.
- B1,5.
- C1,2,4.
- Dall the above.
- Eonly 1.
Reveal the correct answerA 34-year-old male presented with the history of fatigue, a lack of appetite, weight loss and dizziness up on standing. Neither polyuria nor polydipsia occurred. He was diagnosed earlier with Hashimoto disease and was adequately treated with levothyroxine. On physical examination hyperpigmentation of the skin and low blood pressure with orthostasis were revaled. Basic laboratory results revealed low Na concentration in serum - 127 mmol/l. What is the probable diagnosis?
- Atoo low dose of thyroid hormone.
- Bdilutional hyponatremia resulting from water retention.
- Cprimary adrenal insufficiency.
- Dspurious hyponatremia in patient with severe hyperglycemia.
- EA and C are correct.
Reveal the correct answerA 48-year-old male patient with diagnosed previously severe arterial hypertension resistant to treatment. He presents with acute, very severe pain in his anterior chest with the tendency to move towards upper abdominal region. On physical examination: “new” diastolic murmur over the aortic valve. What is the initial diagnosis?
- Aacute myocardial infarction with the ischemia of the papillary muscle.
- Bacute pulmonary embolism.
- Cascending aortic dissection.
- Drupture of the free cardiac wall as a complication of myocardial infarction.
- EA and B are correct.
Reveal the correct answerA 85-year-old woman comes to the doctor's because of high blood pressure. The most frequent value at home was 160/100 mmHg during the last two weeks. She takes ramipril 1 x 10 mg. Which of the following is the most appropriate next step?
- Aincrease dose of ramipril.
- Badd diuretic.
- Cadd methyldopa.
- Dadd alpha-blocker.
- Eadd beta-blocker.
Reveal the correct answerChoose the true statement on D-dimers (DD):
- Aincreased concentration of DD always confirms the presence of thromboembolic disease.
- Bnormal concentration of DD makes thromboembolic disease very unlikely.
- Cevery patient with elevated DD concentrations should be treated with anticoagulants.
- Dpregnant women with high concentrations of DD should be treated with acenocoumarol.
- Eall the statements are false.
Reveal the correct answerA 95-year-old woman with dementia and impaired proprioception was referred to the hospital because of weight loss and megaloblastic anemia. This syndrome best matches:
- Acolon cancer.
- Bgeneralized atherosclerosis.
- CAlzheimer's disease.
- Dvitamin B12 deficiency.
- Evitamin D deficiency.
Reveal the correct answerLaboratory tests showed that an 80-year-old man treated with non-steroidal anti-inflammatory drugs because of lumbar spine pain has high levels of creatinine, deep normocytic anemia, hypercalcaemia and hyperproteinemia. The most likely diagnosis is:
- Agastrointestinal bleeding following NSAIDs.
- Bacute renal failure after NSAIDs.
- Cstomach cancer.
- Dplasma cell myeloma.
- Eparathyroid cancer.
Reveal the correct answerA 62-year-old car painter came to the hospital because of fever, hemoptysis and the dark colour of urine. The chest X-ray showed disseminated infiltration, and laboratory tests - CRP 50 mg%, ALT 65 U/L, proteins and red blood cells in urine. RR 130/80 mm Hg. High titer of cANCA in this case points to:
- Aextensive bacterial pneumonia.
- BSIRS.
- Csepsis.
- Dmicroscopic vasculitis.
- Eheavy paint poisoning.
Reveal the correct answerAn ultrasound of the carotid arteries in a 68-year-old woman accidentally discovered a 15 mm hypoechoic lesion in the right lobe of the thyroid gland, a lesion imperceptible in palpation. The doctor should:
- Aperform biopsy under ultrasound control.
- Brefer the patient for thyroidectomy.
- Cmake scintigraphy with technetium.
- Ddetermine control ultrasound examination in 6 months.
- Ethere is no need for further testing or observation of such a lesion.
Reveal the correct answerA 66-year-old woman treated chronically with 80 mg simvastatin before sleep, after 4 days of treatment with claritromycine passes brick-coloured urine and complains of the pains of the thigh muscles and shoulder girdle. Indicate true statement:
- Athe most probable diagnosis is myositis caused by simvastatin.
- Bclaritromycine increases the metabolism of simvastatin.
- Cmyoglobinuria does not result in brick-coloured urine.
- Dlowered blood CKMB and LDH confirm rhabdomyolysis.
- EA and C are correct.
Reveal the correct answerA 70-year-old man has eGFR 70 ml/min/1,73 m2without hypertension, proteinuria and hematuria. Which is the right diagnosis?
- Aphysiological decline in GFR with age.
- B1st stage of chronic kidney disease (CKD).
- C2nd stage of CKD.
- D3rd stage of CKD.
- E4th stage of CKD.
Reveal the correct answerA 23-year-old woman with feeling of fainting and recurring attacks of dyspnea, not related to physical activity, has been taking oral contraceptives for 2 years. Cardiac ultrasonography revealed increased pulmonary artery pressure. Choose the most probable cause of her symptomatology:
- Arecurring bacterial pneumonia.
- Bbronchial asthma.
- Cprimary pulmonary fibrosis.
- Drecurrent pulmonary embolism.
- Enone of the above.
Reveal the correct answerA 72-year-old man with benign prostatic hyperplasia (BPH) suffered from sudden oliguria with bilateral loin pain radiating to the lower abdomen and testes. Which is the true statement?
- Athe most probable diagnosis is nephrolithiasis.
- Bthe most probable diagnosis is acute pyelonephritis.
- Cthe most probable diagnosis is urinary tract obstruction by BPH.
- Dthese are typical symptoms of renal cell carcinoma.
- EB and C are correct.
Reveal the correct answerA 56-year-old obese woman with diabetes and hypertension was admitted to the hospital with acute retrosternal pain, normal troponins and left ventricular hypertrophy. In the urine culture E. coli >10^5. What should you administer against urinary tract infection?
- Ano antibacterial treatment.
- Btrimethoprim-sulfamethaxazole.
- Camoxicillin.
- Dnitrofurantoin compound.
- Eciprofloxacin.
Reveal the correct answerA 19-year-old student with pharyngeal infection lasting for two days is treated with paracetamol. He suffers from painless hematuria. He has experienced gross hematuria three times during sore throat for the last 2 years. Urine examination revealed dysmorphic erythrocyturia and hoarse granular casts. The most probable diagnosis is:
- Arenal cell carcinoma.
- Burinary tract obstruction.
- Crenal colic.
- DIgA nephropathy.
- Eacute poststreptococcal glomerulonephritis.
Reveal the correct answerA 50-year-old woman, a heavy smoker, with type 2 diabetes asks her physician whether it is possible to minimize the risk of diabetic nephropathy. Which of the following should constitute the answer?
- Athere is no possibility of intervention as the renal complications of diabetes are genetically determined.
- Bproper control of glycemia and HbA1c.
- Ccontrol of hypertension.
- Dstop smoking.
- EB, C and D are correct.
Reveal the correct answerHow to treat a 30-year-old man with recurrent nephrolithiasis caused by hyperoxaluria?
- Aanimal meat diet.
- Bhigh fat diet.
- Ccalcium and vitamin C supplementation.
- Dlow sodium and normal calcium diet.
- Eall the above.
Reveal the correct answerWhich of the following statements concerning vasovagal syncope is false?
- Ait is the most common type of syncope in children.
- Busually appears during physical effort.
- Cin the majority of children directly before vasovagal syncope prodromal symptoms could be observed: dizziness (vertigo), blurred vision, visual dusturbances, fatigue.
- Dcould be provoked by emotions or pain.
- Evasovagal syncope prevention is to avoid stressful situations, increase intake of fluids and table salt.
Reveal the correct answerWhich of the following is not the indication for colectomy in acute ulcerative colitis in children and adolescents?
- Apseudopolyps.
- Btoxic megacolon.
- Cbowel perforation.
- Dmassive haemorrhage.
- Erapid course of ulcerative colitis.
Reveal the correct answerVentricular tachycardia with the palpable pulse in a child with the presence of cardiac insufficiency symptoms is the indication for:
- Adefibrillation.
- Brapid parenteral infusion of adenosine.
- Ccardioversion.
- Ddigoxin infusion.
- Estimulation of the vagus nerve.
Reveal the correct answerWhich of the following concerning procalcitonin (PCT) is true?
1) PCT under physiological conditions is released in very small quantities in the C cells of the thyroid;
2) in the course of an inflammatory response the increase of serum PCT is observed; the liver is then a major source of PCT;
3) factor causing an increase in blood levels of PCT is mainly bacterial endotoxins;
4) PCT highest concentrations are observed in systemic viral infections;
5) PCT concentration increases 2-6 hours after the activation of the stimulus (early marker).
The correct answer is:
- A1,4,5.
- B1,2,3,4.
- C1,2,3,5.
- Dall of the above.
- Enone of the above.
Reveal the correct answerWhich of the following concerning C-reactive protein (CRP) is true?
1) it is produced in the liver
2) CRP binds to the bacteria, and then activates complement via an alternative route, taking part in the process of opsonisation
3) it plays an important role in the innate immune system capabilities directed against microorganisms, particularly bacteria
4) this parameter is non-specific
5) it is an acute phase protein
The correct answer is:
- A1, 4, 5
- B1, 2, 4, 5
- C1, 3, 4, 5
- Dall of the above
- Enone of the above
Reveal the correct answerA fully developed clinical picture of rickets consists of the following set of symptoms:
1) craniotabes;
2) widening of the metaphyses of the forearms and lower legs
3) kyphosis within lumbar spine;
4) decreased muscle tone;
5) delayed dentition.
The correct answer is:
- A1,2,3.
- B1,2,3,5.
- C4,5.
- Donly 4.
- Eall of the above.
Reveal the correct answerWhich of the following are true?
1) measles rash has descending character;
2) thrombocytopenia may be the complication of rubella;
3) both chickenpox and zoster are caused by Vericella-Zoster virus;
4) herpangina is caused by Herpes viruses;
5) orchitis in the course of mumps concerns children after puberty.
The correct answer is:
- A1,2,4.
- B1,4,5.
- C3,4.
- D1,2,3,5.
- Eall of the above.
Reveal the correct answerBetween which months of life does anterior fontanelle close?
- Ain the 2-3 month of life
- Bin the 4-6 month of life
- Cin the 13-18 month of life
- Din the 20-24 month of life
- Ein the 34-36 month of life
Reveal the correct answerIn the case of pancreatitis in a child the diagnostic value has:
- Aamylase in blood.
- Bamylase in faeces.
- Camylase in urine.
- Dall of the above.
- Enone of the above.
Reveal the correct answerAccording to the current Polish National Immunization Programme the immunization against Invasive Pneumococcal Disease is not mandatory for:
- A2-year-old child infected with HIV.
- B3-year-old child after bone marrow transplantation.
- C7-year-old child after splenectomy.
- D4-month-old infant born in the 37th week of gestation with the birth weight 2420 g.
- E4-year-old child suffering from the recurrent nephrotic syndrome.
Reveal the correct answerA General Practitioner has to decide about the vaccination of a 13-month-old child against measles, mumps and rubella. According to the parents rubella was diagnosed in this child by a doctor in the Emergency Room 2 months ago. Choose the GP's right decision:
- Athe child can be vaccinated against measles, mumps and rubella at this visit in the GP's office.
- Bthe child can be vaccinated against measles, mumps and rubella in 4 weeks at the earliest.
- Cthe presence of the specific antibodies against rubella should be examinated in the child's serum and the vaccination should be given only in the absence of specific antibodies.
- Donly monovalent vaccines against measles and mumps may be used in this child.
- Ethe child can be vaccinated against measles, mumps and rubella in 3 years of the diagnosis of rubella at the earliest.
Reveal the correct answerChoose the true answer concerning the use of oral polio vaccine (OPV) in Poland in the year 2013:
- Ais used only as the booster dose in 6 year olds
- Bis used only for the 3rd and 4th dose of the mandatory vaccination in two year olds and six year olds
- Cis no more used
- Dis used for all 4 doses of the mandatory vaccination
- Eis used only in persons traveling to polio endemic countries
Reveal the correct answerPregnancy in a teenager is a significant contraindication to the vaccination against:
- Ahepatitis B.
- Binfluenza.
- Cdiphteria, tetanus, pertussis (dTpa).
- Dtetanus.
- Emeasles, mumps, rubella.
Reveal the correct answerDisturbing symptoms suggestive of primary immunodeficiency do not include:
- Aat least eight infections a year.
- Bchronic oral or skin candidiasis in children above three years of age.
- Clack of weight gain and the inhibition of proper development.
- Dantibiotic therapy lasting at least 2 months with slight clinical improvement.
- Enecessity for intravenous antibiotic applications during infections.
Reveal the correct answerWhich of the following does not occur in the classic DiGeorge syndrome?
- Ahypocalcemic tetany.
- Bhyperthyroidism.
- Cmalformed auricle.
- Dheart or major vessels defects.
- Eincreased susceptibility to infections.
Reveal the correct answerIn which of the following infections the examination of the CSF reveals: pleocytosis 500 cells per 1 µl, low percentage of polymorphonuclear cells, a slightly decreased glucose level, an increased protein level and the variable concentration of chlorides?
- Apurulent.
- Bpurulent treated with antibiotics.
- Cviral.
- Dtuberculous.
- Efungal.
Reveal the correct answerIn necrotizing staphylococcus enterocolitis you should apply:
- Aamoxicillin.
- Bamoxicillin and clavulanic acid.
- Campicillin.
- Damikacin.
- Evancomycin.
Reveal the correct answerWhich of the following does not occur in hemolytic uraemic syndrome?
- Amicroangiopathic hemolytic anemia.
- Bleucopenia.
- Cthrombocytopenia.
- Dfever.
- Eacute renal injury with oliguria.
Reveal the correct answerWhich of the statements on the rotavirus digestive tract infection in children is false?
- Awater-mucous diarrhea without blood is the main presentation of the disease.
- Bit is frequently accompanied by fever.
- Cantibiotics are indicated in severe clinical cases.
- Dprobiotics play important role in the treatment.
- Esecondary lactose intolerance may develop.
Reveal the correct answerWhich of the following does not occur in Gregg's syndrome (congenital rubella)?
- Acentral deafness.
- Bpatent ductus arteriosus.
- Ccataract.
- Dgoitre
- Eimpaired psychomotor development.
Reveal the correct answerIndicate false statement on Duchenne muscular dystrophy:
- Afirst symptoms occur between the 3rd - 4th year of life.
- Bit is characterized by symmetrical muscle atrophy that starts in the pelvic girdle and progresses centrally.
- Cpseudohypertrophy of the affected muscles occurs.
- Ddeep reflexes persist.
- Eawkward waddle and difficulties in getting up from a lying position and climbing the stairs are typical symptoms.
Reveal the correct answerIn the treatment of Wilson's disease you should administer:
- Agold salts.
- Bdesmopressin.
- Cpenicillamine.
- Dglucagon.
- Ecopper salts.
Reveal the correct answerWhich of the following does not occur in the maple syrup urine disease?
- Aketones in the urine.
- Bhyperglycemia.
- Cincreased blood valine concentration.
- Dcaramel smell of the urine.
- Eincreased blood leucine and isoleucine levels.
Reveal the correct answerIn newborns with birth weight below 2500g phototherapy should be started when the bilirubin level is above:
- A5 mg%.
- B7.5 mg%.
- C10 mg%.
- D12.5 mg%.
- E15 mg%.
Reveal the correct answerWhich of the following is not absolute indication for prophylactic iron application?
- Aprematurely born children.
- Binfants of multiple pregnancies.
- Cposthemorrhagic anemia.
- Dheavy menstrual bleeding.
- Einfants of women with anemia during pregnancy.
Reveal the correct answerClassical developmental anomalies in Fanconi anemia (a type of aplastic anemia) do not include:
- Alow height.
- Bmacrocephaly.
- Cthumb hypoplasia.
- Dbrode nasal bridge and micrognathia.
- Ediscoloration of the skin.
Reveal the correct answerThe most frequent haemorrhagic diathesis in children is:
- Ahemophilia.
- Bidiopathic thrombocytopenic purpura.
- Cvon Willebrand disease.
- DHenoch Schönlein purpura.
- EFanconi syndrome.
Reveal the correct answerCentral motor neuron damage leads to:
1) spastic paralysis
2) flaccid paralysis
3) hyporeflexia
4) hyperreflexia
5) muscle dystrophy
6) pathological reflexes
The correct answer is:
- A1, 4, 5
- B2, 3, 6
- C1, 3, 6
- D2, 4, 5
- E1, 4, 6
Reveal the correct answerHyperemesis gravidarum often coexists with:
- Ahypothyroidism.
- Bhyperthyroidism.
- Cdiabetes.
- DCushing's syndrome.
- Ehypoparathyroidism.
Reveal the correct answerWhich of the following is not associated with increased risk of ectopic pregnancy?
- Aprevious pelvic inflammatory disease.
- Bprevious Fallopian tube surgery.
- Cin vitro fertilization.
- Doral contraception.
- Eadnexitis.
Reveal the correct answerThe most common metastatic site of choriocarcinoma is:
- Avagina
- Blung
- Cliver
- Dkidney
- Ebone
Reveal the correct answerThe duration of the fourth stage of labor is:
- A30 minutes.
- B1 hour.
- C2 hours.
- D3 hours.
- E6 hours.
Reveal the correct answerDizygotic twins are:
- Amonochorionic monoamniotic pregnancy.
- Bdichorionic monoamniotic pregnancy.
- Cmonochorionic diamniotic pregnancy.
- Ddichorionic diamniotic pregnancy.
- Eall of the above may be true.
Reveal the correct answerWhich of the following should be advised in prophylaxis of neural tube defects?
- Afolic acid.
- Bvitamin A.
- Cvitamin D.
- Dvitamin K.
- Enone of the above.
Reveal the correct answerAn elevated serum prolactin level may result in:
- Aprolonged, heavy menstrual bleeding.
- Bdecreased libido.
- Csmell sensing disorders.
- Dexcessive sweating.
- Ediarrhea.
Reveal the correct answerBlood pressure ≥140/90 mmHg after the 20th week of gestation and proteinuria ≥ 300 mg/24 hours represent the diagnostic criteria of:
- Agestational hypertension.
- Beclampsia.
- Cpreeclampsia.
- Dchronic hypertension.
- Enone of the above.
Reveal the correct answerA female patient complains of secondary amenorrhea, low libido and the discharge of white fluid from the nipples. The following can be the reason for these symptoms, except for:
- Ahypothyroidism
- BAddison's disease
- Cintake of antidepressants
- Dintake of bromocriptine
- Ebreastfeeding
Reveal the correct answerA 27-year-old patient with BMI 34 kg/m2, whose mother has diabetes type 2, reported to her first visit in pregnancy to have her glucose level measured. The patient had her last meal 3 hours before. The glucose level was 180 mg/ml (10.0 mmol/l). What should be done next?
- Adiagnose the patient with gestational diabetes.
- Bconduct 75g oral glucose tolerance test.
- Crepeat glucose blood test between the 24th and 28th week of pregnancy.
- Dperform fasting glucose blood test the next day and if the result is ≥126 mg/dl (7,0 mmol/l), apply the treatment.
- Estart treatment with insulin and repeat glucose blood test in a week time.
Reveal the correct answerWhich of the following concerning spontaneous abortion is false?
1) spontaneous abortion is an expulsion of the embryo from the uterus before 20th week of pregnancy;
2) about 30% of pregnancies end in spontaneous abortion;
3) 3 or more consecutive spontaneous abortions are classified as recurrent abortions;
4) most frequently spontaneous abortions occur before implantation;
5) basic symptoms of spontaneous abortion are suprapubic ache and bleeding.
The correct answer is:
- A1,2.
- B1,2,3.
- C2,4.
- D2,3.
- E4,5.
Reveal the correct answerWhich of the following methods can be useful in order to differentiate between the normal and pathologically changed epithelium of the cervix?
- ASchiller's test.
- Biodine test.
- Cacetic acid test.
- DA and B are true.
- EA, B and C are true.
Reveal the correct answerA 40-year-old, 10 weeks pregnant was admitted to the Gynecological Department with heavy pain in the right upper quadrant, fever 38.3 Celsius, nausea and vomiting. Physical exam: the maximum pain at McBurney's. Additional tests: slight leukocytosis, no changes in the urine analysis. Imaging studies: changes in adnexa excluded, intrauterine pregnancy confirmed. Taking into account this clinical picture, the most appropriate clinical procedure will be:
- Aconservative treatment with antibiotics and relaxants until the symptoms disappear.
- Bconservative treatment and surgery in the 2nd trimester.
- Curgent surgery.
- Dplanned treatment after delivery.
- Eurgent surgery and prostaglandin administration in order to end pregnancy.
Reveal the correct answerA female patient aged 56, nullipara with BMI 24 kg/m2, complains of suprapubic ache and difficulty in defecation. Ultrasound examination reveals a large quantity of free fluid in the abdominal cavity and the presence of a complex cystic and solid mass with thick septa about 10 cm big located on the left side. The most probable diagnosis is:
- Amalignant epithelial ovarian tumor.
- Bmalignant germ-cell ovarian tumor.
- Cbenign ovarian tumor.
- Dtheca lutein cyst.
- EKrukenberg tumor.
Reveal the correct answerThe following are the reason for postmenopausal bleeding, except for:
- Aovarian tumor.
- Bendometrial cancer.
- Ccervical cancer.
- Dsubserous myoma.
- Eendocervical polyp.
Reveal the correct answerThe quadrilateral of Michaelis shows the structure of pelvic bones and its possible defects. Indicate anatomical points delineating its shape on the pregnant woman's back:
- Aspinous process of 5th sacral vertebra, the top of the intergluteal cleft, and posterior superior iliac spines
- Bhole below the spinous process of 3rd - 4th lumbar vertebra, the top of the coccyx, and posterior superior iliac spines
- Cspinous process of 1st lumbar vertebra, the top of the coccyx, and posterior superior iliac spines
- Dhole below the spinous process of 3rd - 4th lumbar vertebra, the top of the intergluteal cleft, and posterior inferior iliac spines
- Ehole below the spinous process of 3rd - 4th lumbar process, the top of the intergluteal cleft and posterior superior iliac spines
Reveal the correct answerPreferred anesthesia in laparoscopic surgery is:
- Alocal.
- Bconduction anesthesia.
- Cgeneral.
- Dsubarachnoid.
- Eepidural.
Reveal the correct answerBoth hands are put parallel on the sides of the abdomen at umbilicus level. This grip explains on which side the back and small parts of a fetus are located. This statement refers to:
- Afirst Leopold maneuver.
- Bsecond Leopold maneuver.
- Cthird Leopold maneuver.
- Dfourth Leopold maneuver.
- Efifth Leopold maneuver.
Reveal the correct answerIndicate the main localization of endometrial cancer metastases:
- Avia lymphatic vessels to the iliac and periaortic lymph nodes.
- Bvia lymphatic vessels to the inguinal lymph nodes.
- Cvia blood vessels to the lungs.
- Dvia blood vessels to the breast.
- Evia intraperitoneal dissemination to the intestines and stomach.
Reveal the correct answerOral glucose tolerance test is a screening test of gestational diabetes that should be performed:
- Ain every pregnant woman between the 24th-28th week of pregnancy.
- Bonly in pregnant women with incorrect oral glucose test done in the 1st trimester.
- Conly in pregnant women with diabetes risk factors.
- Donly in pregnant women with BMI > 25 before pregnancy.
- Ethere is no indication for oral glucose tolerance test during pregnancy.
Reveal the correct answerBoth hands are put parallel on the sides of the abdomen at umbilicus level. This grip explains on which side the back and small parts of a fetus are located. This statement refers to:
- Afirst Leopold maneuver.
- Bsecond Leopold maneuver.
- Cthird Leopold maneuver.
- Dfourth Leopold maneuver.
- Efifth Leopold maneuver.
Reveal the correct answerThe sure symptoms of pregnancy include:
1) amenorrhea
2) presence of fetus heart sounds
3) detecting movements of a fetus
4) enlargement and softening of the uterus
5) breast enlargement
The correct answer is:
- Aonly 1
- B1, 2
- C2, 3
- D2, 3, 4
- E3, 4, 5
Reveal the correct answerWhich of the following concerning pregnancy is false?
- Ait is the most frequent reason for secondary amenorrhea.
- BHegar's sign is demonstrated as the softening of uterine consistency.
- Cmultiparas begin to feel the movements of the fetus between 18th and 20th week of pregnancy whereas nulliparas between 16th and 18th week of pregnancy.
- Dhormonal pregnancy tests are based on the detection of beta hCG in blood or urine.
- Efeeling fetus movements in the physical examination is a certain pregnancy sign.
Reveal the correct answerRisk factors for premature childbirth do not include:
- Aage under 18.
- Bnephritis.
- Canemia.
- Dlow educational level.
- Emenstrual cycles shorter than 25 days.
Reveal the correct answerThe diagnostic criteria of antiphospholipid syndrome do not include:
- Aproteinuria.
- Bthrombosis.
- Crecurrent pregnancy loss.
- Dpresence of anticardiolipin antibodies.
- Epresence of lupus anticoagulant.
Reveal the correct answerDistorted or wrongly interpreted perceptions are called:
- Ahallucinations.
- Billusions.
- Cdysmnesias.
- Ddelusions.
- Econfabulations.
Reveal the correct answerConfabulations are classified as:
- Apseudo memories.
- Bdelusions.
- Challucinations.
- Dillusions.
- Enone of the above.
Reveal the correct answerThe Mini Mental State Examination is the test used for:
- Aevaluation of working memory.
- Bevaluation of the presence of mental disorders.
- Cscreening for the evaluation of cognitive functions.
- Dscreening for the evaluation of mental retardation.
- Escreening for the evaluation of organic brain damage.
Reveal the correct answerAfter intake, the ethyl alcohol reaches the peak of plasma concentration after:
- A15 minutes.
- B30 - 60 minutes.
- C1.5 to 2 hours.
- D2 hours.
- E3 hours.
Reveal the correct answerThe diagnosis of schizophrenia according to the ICD-10 requires the duration of main symptoms for at least:
- Ahalf a year.
- B2 months.
- C3 months.
- D1 month.
- E14 days.
Reveal the correct answerThe first choice drug to treat schizoaffective disorder (of the depressive type) is:
- Aantipsychotic
- Bantidepressant
- Cmood stabilizer
- Dantipsychotic and mood stabilizer
- Eantipsychotic and antidepressant
Reveal the correct answerThe light therapy (phototherapy) is the most effective one in the treatment of depression:
- Aatypical.
- Bduring bipolar type II disorder.
- Cseasonal.
- Dmasked.
- Ewith psychotic features.
Reveal the correct answerThe diagnosis of bipolar type I disorder requires, in the course of the disease, the presence of a depressive episode and:
- Amanic episode.
- Bhypomanic episode.
- Cswitch of the phase under the treatment.
- Dpresence of therapy resistance.
- Eall the above.
Reveal the correct answerWhich of the following is the drug of choice in the prophylactic treatment of bipolar I disorder of the typical course?
- Avalproid derivate.
- Bcarbamazepine.
- Clamotrigine.
- Dlithium.
- Enone of the above.
Reveal the correct answerFor the diagnosis of phobia (a kind of anxiety disorders) the presence of the following is mandatory:
- Aanxiety symptoms in a particular situation.
- Banxiety which anticipates the particular situation.
- Cavoidance of the particular (anxiogenic) situation.
- Donly the conditions A and B need to be fulfilled.
- Eall conditions A, B, and C need to be fulfilled.
Reveal the correct answerThe minimal duration of the symptoms which is required for the diagnosis of somatoform disorders is:
- A2 years.
- B1 year.
- Chalf a year.
- D3 months.
- E6 weeks.
Reveal the correct answerThe presence of abormal events during sleep is crucial for the diagnosis of:
- Adissomnias.
- Binsomnias.
- Cparasomnias.
- DREM phase of sleep.
- Enon-REM phase of sleep.
Reveal the correct answerFor the diagnosis of anorexia nervosa in adult person the maximal value of the Body Mass Index (BMI) is:
- A15.
- B17,5.
- C20.
- D22,5.
- E25.
Reveal the correct answerHumans are the only reservoir of this organism. The infection is transmitted by droplets, through direct contact and through the placenta. Infectivity for people in the household contact exceeds 90%. The asymptomatic course rarely occurs. The incubation period lasts 10-21 days. This characteristic refers to:
- Arubella.
- Bvaricella.
- Cinfectious mononucleosis.
- Dmumps.
- Emeasles.
Reveal the correct answerGallbladder polyps are indication for surgical treatment (cholecystectomy) when the their diameter exceeds:
- A3 mm.
- B5 mm.
- C1 cm.
- D2 cm.
- E3 cm.
Reveal the correct answerWhich of the following can be used in the treatment of patients with esophagus cancer?
- Achemotherapy.
- Blaser ablation.
- Cphotodynamic therapy.
- DA,B are correct.
- EA,B,C are correct.
Reveal the correct answerIn patients with Barrett's esophagus:
- Athere are symptoms of gastroesophageal reflux disease.
- Blower resting pressure of the lower esophageal sphincter is found.
- Cantisecretory treatment eliminates regurgitation into the esophagus.
- DA,B are correct.
- EA,B,C are correct.
Reveal the correct answerIn patients with esophageal diverticulum:
- Athe main diagnostic test is contrast radiographic examination and treatment includes only myotomy.
- Bendoscopy determines the treatment and the treatment consists only in endoscopic excision of the diverticulum.
- Cdisorders of the upper esophageal sphincter relaxation are among the causes of the diverticulum and the treatment involves the excision of the diverticulum and myotomy.
- Dthe most important diagnostic procedure is MRI and the treatment includes only excision of the diverticulum.
- Eall the above are false.
Reveal the correct answerA female patient with right subcostal pain was diagnosed with choledocholithiasis and the extrahepatic bile ducts distention up to 12 mm. What is the most proper approach?
- Aopen cholecystectomy, choledochotomy and the removal of stones.
- Bpreoperative retrograde cholangiopancreatography and laparoscopic cholecystectomy.
- Claparoscopic cholecystectomy.
- Dopen cholecystectomy with cholangiography.
- Emagnetic resonance cholangiography.
Reveal the correct answerAn ICU patient with acute pancreatitis complained of tingling around the mouth, paresthesia in the fingers of both hands and cramps in both legs. These symptoms began on the second day after the admission. ECG shows sinus bradycardia with prolonged QT interval. Which of the following therapeutic procedures is the most correct one?
- Aintravenous calcium supplementation
- Bmodification of antibiotics
- Cdialysis
- Dantiarrhythmic drugs
- Eoxygen therapy
Reveal the correct answerA 42-year-old man was admitted to the ER because of pain in the anal area. He feels strong pain while sitting and defecating. This has lasted for the last few days and is gradually getting worse. The physical exam shows: a painful lump on the left buttock 3 cm from the anal canal. The skin is slightly reddened. Per rectum exam gives strong pain and is not successful. What is the most probable diagnosis?
- Aperianal abscess.
- Bhemorrhoidal thrombosis.
- Canal fissure.
- Dpost-injection gluteal abscess.
- Erectal cancer.
Reveal the correct answerIt is the most frequent benign hepatic neoplasm, usually asymptomatic. The risk of bleeding into the tumor or its rupture occurs when its diameter is over 10 cm. Surgical treatment is indicated when it is symptomatic or when diameter is more than 10 cm. The above characteristics refers to:
- Anodular liver hyperplasia.
- Bhepatic haemangioma.
- Cliver adenoma.
- Dliver cyst.
- Enone of the above.
Reveal the correct answerDuring the follow up of the patient with the history of adrenal pheochromocytoma you find hyperparathyroidism and elevated calcitonin level. Which will be the most proper first-line curative approach in this patient?
- Achemo-radiotherapy.
- Bcomplete thyroid resection.
- Cablative radioiodine treatment.
- Dcomplete thyroid resection and lymphadenectomy.
- Edialysis.
Reveal the correct answerIn an ICU patient after an abdominal surgery and no prior PMH you monitor various parameters of the cardiovascular system. Which of the following parameters make you decrease fluid administration?
- Amean arterial pressure approx. 72 mmHg.
- Bdiuresis approx. 40 ml/h.
- Ccentral venous pressure approx. 22 mmHg.
- Dpulmonary capillary wedge pressure approx. 15 mmHg.
- Epulse approx. 96/minute.
Reveal the correct answerA 63-year-old man was diagnosed with a rectal tumor located 8 cm from the edge of the anus. Histopathological examination shows adenocarcinoma infiltration. The abdominal and pelvic CT scan shows no distant metastases. Transrectal ultrasound shows the tumor that goes beyond the rectum wall and invades the fatty tissue of the mesorectum. What is the correct approach in this case?
- Arectum prosthesis.
- Bsurgery with possible adjuvant chemotherapy.
- Cneo-adjuvant radiotherapy and surgery.
- Dneo-adjuvant chemotherapy and surgery.
- Esurgery.
Reveal the correct answerTenderness on palpation in the right lower quadrant of the abdomen, temperature above 37.5 Celsius, Blumberg's sign, tenderness on per rectum exam, increased muscle tension are the signs of:
- Aacute cholecystitis.
- Bacute pancreatitis.
- Cadnexitis.
- Dduodenal ulcer perforation.
- Eacute appendicitis.
Reveal the correct answerPotential pathogens in diffuse peritonitis caused by the perforation of the lower gastrointestinal tract are as follows:
- AG(-) bacilli, Enterococcus sp., anaerobes.
- BG(+) bacilli, Clostridium welchi, Helicobacter pylori.
- CG(-) bacilli, Morganella morgani, Staphylococcus aureus.
- DAnaerobes, Streptococcus aeruginosa, Campylobacter.
- EG(+) bacilli, G(-) bacilli, anaerobes.
Reveal the correct answerA 45-year-old man was admitted to the ER because of diffuse abdominal pain which has been getting worse for the last few hours. Patient says that the pain radiates to the right groin and that it becomes the most severe in this area. It is accompanied by retching, gases and fecal retention and urinary problems (small amounts of urine). PMH: patient underwent surgery for a perforated duodenal ulcer years ago. Which of the following initial diagnoses should be taken into account first?
- Agastric ulcer, duodenal ulcer, diverticulitis, urolithiasis, incarcerated inguinal hernia.
- Bperforated gastric or duodenal ulcer, perforated diverticulum, testitis, bowel obstruction.
- Csplenic rupture, appendicitis, renal colic, biliary colic.
- Dcholecystitis, adnexitis, bowel obstruction, appendicitis.
- Eincarcerated hernia, appendicitis, ureterolithiasis, Meckel's diverticulitis.
Reveal the correct answerYou decide to start the pharmacological therapy in a patient with endoscopically confirmed duodenal ulcer disease. Helicobacter pylori infection is excluded. Which of the following group of drugs has the smallest therapeutic use?
- Aproton pump inhibitors.
- BH2-receptor blockers.
- Ccalcium- and magnesium-based antacids.
- Dantibiotics.
- Eprostaglandin derivatives.
Reveal the correct answerWhich of the following concerning thrombosis is true?
1. thrombosis rarely occurs in patients who underwent surgery
2. degree of risk depends on individual features, clinical condition, the type of interventions: either diagnostic, surgical or preventive
3. a minority of patients is exposed to no more than 1 risk factor
4. prophylaxis is effective and justified clinically and economically
5. it is recommended not to use ASA as the only antithrombotic prophylaxis in any group of patients;
6. prophylaxis is not effective clinically and increases the costs of treatment
- A1, 2, 3
- B2, 4, 5
- C4, 5, 6
- D1, 3, 6
- E2, 4, 6
Reveal the correct answerLarge projectile vomiting, ulcer disease in anamnesis, progressive loss of weight, gradual dehydration, "splashing" symptom occur in:
- Agastric ulcer perforation.
- Bduodenal ulcer disease.
- Cpyloric stenosis.
- Dacute pancreatitis - severe form.
- Eearly gastric cancer.
Reveal the correct answerIn the diagnosis of the achalasia the basic diagnostic tests are:
- Abarium swallow X-ray of the upper gastrointestinal tract, esophageal manometry and endoscopic ultrasound (EUS).
- Bbarium swallow X-ray of the upper gastrointestinal tract, endoscopy and esophageal manometry.
- Cbarium swallow X-ray of the upper gastrointestinal tract, abdominal computed tomography and endoscopy.
- Dabdominal CT scan, EUS and esophageal manometry.
- Enone of the above.
Reveal the correct answerMurphy's sign is typical of:
- Aacute pancreatitis.
- Bgallbladder cancer.
- Cacute cholecystitis.
- Dacute appendicitis.
- Eleft adnexitis.
Reveal the correct answerWhich of the following concerning the anal fissure is true?
1) transverse surgical sewing of the fissure is the recognized method of treatment
2) before choosing the method of treatment you should take tissue biopsy because it is a pre-cancerous condition
3) main symptoms of the anal fissure are: itching and burning sensation in the anal canal
4) anal fissure is most frequently localized within the anterior commissure
5) acute anal fissure always becomes the chronic anal fissure
The correct answer is:
- A3, 5
- B2, 3
- C1, 3, 5
- D2, 5
- Enone of the above
Reveal the correct answerAbdominal pain in a 33-year-old man which has been reccurent for 3 months, occurring only during the day, increasing after meals and decreasing after defecation, without additional symptoms and signs suggest the diagnosis of:
- Agastroduodenal ulcer.
- BCrohn disease.
- Cirritable bowel syndrome.
- Dliver failure.
- Eexocrine pancreas failure.
Reveal the correct answerCaries in young children is fostered by:
1) sweet liquids;
2) lack of oral hygiene;
3) sleeping with a baby food bottle;
4) low level of fluoride in drinking water;
5) delaying start of solid food eating.
The correct answer is:
- A1,2.
- B1,3,4.
- C2,3,5.
- D1,2,3,4.
- Eall the above.
Reveal the correct answerAn examination for diabetes, irrespective of age, should be performed once a year in:
1) overweight patients;
2) obese patients;
3) sedentary patients;
4) women with polycystic ovary syndrome;
5) women with gestational diabetes history;
6) patients with arterial hypertension.
The correct answer is:
- A1,2,3,4,5
- B2,3,4,5,6
- C2,3,5,6
- D2,4,5,6
- Eall the above.
Reveal the correct answerIndicate the true statement:
- Aphenoxymethylpenicillin is the drug of choice for streptococcal angina.
- Btreatment of acute sinusitis should be started with doxycycline.
- Cacute bronchitis should be treated with cephalosporins.
- DA, B are true.
- EA, B, C are true.
Reveal the correct answerThe severe forms of extrapulmonary tuberculosis in children are:
- Atuberculous meningitis and genito-urinal tuberculosis.
- Btuberculosis of the vertebral column and peripheral lymphatic nodes.
- Ctuberculous meningitis and miliary lung tuberculosis.
- Dtuberculous meningitis and tuberculosis of peripheral lymphatic nodes.
- Egenito-urinal tuberculosis and tuberculosis of peripheral lymphatic nodes.
Reveal the correct answerThe Centor and McIsaac score is used to:
- Aassess the probability of acute Streptococcus pyogenes pharyngitis and tonsillitis in adults and children.
- Bassess the degree of cognitive impairment in people over 80.
- Cassess the severity of bronchial asthma exacerbation in adults and children.
- Destimate the risk of type 2 diabetes in adults with more than one risk factor for diabetes.
- Eassess the risk of death in the course of community-acquired pneumonia in adults.
Reveal the correct answerPlease indicate the recommended dosage of amoxicillin in the treatment of acute otitis media in children below 40 kg of weight:
- A25-50 mg/kg/day in two doses per day.
- B50-70 mg/kg/day in two doses per day.
- C75-90 mg/kg/day in two doses per day.
- D500 mg/day one dose per day.
- E1000 mg/day one dose per day.
Reveal the correct answerEosinophilia may be due to:
- Aallergy.
- Bparasitic diseases.
- CHodgkin's disease.
- Dpolicythemia vera.
- Eall the above.
Reveal the correct answerIf a student is qualified for the group A in school physical education and sport, it means that the student:
- Ais capable of physical education classes, without limitation.
- Bis capable of physical education classes with limitations and requires trainer's special attention.
- Crequires additional corrective physical activities.
- Dis incapable of physical education, but participates in rehabilitation.
- Eis incapable of physical activities.
Reveal the correct answerThe diagnosis of arterial hypertension in the elderly (more than 65 years of age) is based on standardized cabinet blood pressure measurements. The diagnosis is made when the blood pressure is equal or more than:
- A130/84 mmHg.
- B140/90 mmHg.
- C150/90 mmHg.
- D150/94 mmHg.
- E160/100 mmHg.
Reveal the correct answerCentral obesity in Europeans is diagnosed when the waist circumference (measured in the narrowest place between the navel and the ribs) in men and women is, respectively:
- A>= 84 cm and >= 70 cm
- B>= 90 cm and >= 75 cm
- C≥ 94 cm and ≥ 80 cm.
- D>= 101 cm and >= 85 cm
- E>= 111 cm and >= 95 cm
Reveal the correct answerAccording to the recommended 2013 immunization schedule, tuberculosis vaccination is performed (if there are no contraindications):
- Ain newborns within 24 hours after birth before its discharge from hospital.
- Bin 7-week-old children together with the first dose of DTP vaccine.
- Cin children older than 13 months simultaneously with a combined MMR (measles, mumps, rubella) vaccine.
- Din 6 year olds before they start school.
- Ein newborns within 24 hours after birth and in 6 year olds before they start school.
Reveal the correct answerMetformin is used in the treatment of:
- Atype 2 diabetes.
- Bpolycystic ovary syndrome.
- Cmetabolic syndrome.
- DA, B are true.
- EA, B, C are true.
Reveal the correct answerThe medications that improve the prognosis in patients with stable angina with no history of myocardial infarction are:
1) antiplatelet drugs
2) beta blockers
3) calcium channel blockers
4) nitrates
5) molsidomine
The correct answer is:
- Aonly 1
- B1, 2
- C1, 2, 3
- D1, 2, 3, 4
- Eall the above
Reveal the correct answerThe so-called "alarming symptoms" that point to the organic cause of the upper gastrointestinal tract ailments include:
- Adysphagia.
- Bodynophagia.
- Cpersistent vomiting.
- Danemia of unknown etiology.
- Eall the above.
Reveal the correct answerWhich of the following is the basic immunization regimen for hepatitis B vaccination in adults:
- A4-dose schedule: 0, 7, 21, 365 days.
- B3-dose schedule: 0, 1, 6 months.
- C4-dose schedule: 0, 1, 6, 12 months.
- D4-dose schedule: 0, 1, 6 months and a booster dose in 5 years.
- E3-dose schedule: 0, 6, 12 months.
Reveal the correct answerA shortened glycemic profile measured once a week should be recommended to treated patients:
1) stable doses of insulin;
2) oral drugs;
3) GLP-1 analogs;
4) diet only.
The correct answer is:
- Aonly 1.
- B1,2.
- C1,3.
- D1,2,3.
- Eall the above.
Reveal the correct answerWhich of the following is recommended for the spirometric post bronchodilator test (post BD) in the diagnosis of COPD?
- A400 µg of inhaled short-acting β-agonist (salbutamol).
- B150 µg of inhaled long-acting β-agonist (salmeterol).
- C0.5 mg of intravenous short-acting β-agonist (salbutamol).
- D350 mg of oral theophylline.
- E250 µg of inhaled beclomethasone.
Reveal the correct answerWhich of the following is not a risk factor for osteoporosis?
- Aold age.
- Bfemale gender.
- Cblack race.
- Dlow weight.
- Epostmenopausal period.
Reveal the correct answerThe patient's degree of dependence on nicotine may be assessed by:
- AWeber test.
- BBaltimore test.
- CFagerström test.
- DBeck test.
- ECooper murmur.
Reveal the correct answerA 6-year-old child has choked on a LEGO block. Emergency services were notified and the ambulance will arrive in 10 minutes. The parents did 5 back blows and 5 abdominal thrusts. Unfortunately, the child became unconscious, the block cannot be seen inside the throat and the chest does not respond to rescue breathing. In this case the parents should:
- Atry to pull out the block with the finger "blindly"
- Buse CPR algorithm: 30 chest compressions: 2 breaths
- Cuse CPR algorithm: 15 chest compressions: 2 breaths
- Duse asynchronous CPR
- Enone of the above
Reveal the correct answerIn the evening, a family brought a man aged 35 to the hospital emergency department concerned about his high fever, up to 40°C and impaired consciousness. During the examination a physician on duty noticed the following: increased muscle tone, lockjaw, myoclonus, sinus tachycardia and mild hypertension. Laboratory tests showed only leukocytosis and the increased activity of creatine kinase in the serum. Family history: the patient had been treated for schizophrenia for 15 years, recently taking clozapine formulation at the dose of 500 mg daily. The patient's conditions most probably results from:
- Aneuroleptic malignant syndrome.
- Bmalignant hyperthermia.
- Cserotonin syndrome.
- Dlethal catatonia.
- Ethyroid crisis.
Reveal the correct answerThe recommended ratio of compressions to ventilation during cardio-pulmonary resuscitation on newborns in the ERC 2010 recommendations is as follows:
- A30:2
- B15:1
- C3:1
- D15:2
- E5:1
Reveal the correct answerAccording to the ERC 2010 recommendations in the case of non-shockable rhythms (PEA and asystole), atropine should be administered:
- Aimmediately after iv injection.
- Bafter the third unsuccessful administration of adrenaline 1 mg iv.
- Crepeat the administration of 3 mg of atropine with every second loop of CPR.
- DA and C.
- EERC 2010 guidelines do not recommend the use of atropine in the treatment of asystole and PEA.
Reveal the correct answerWhich of the following should be used as an antidote in phosphoroorganic insecticide poisoning?
- Aflumazenil.
- Bnaloxone.
- Cdeferoxamine.
- DN-acetylcysteine.
- Epralidoxime.
Reveal the correct answerO in MNOPRRST algorithm stands for:
- AmonitOring.
- BOxygenation.
- CsedatiOn.
- DtranspOrtation.
- Enone of the above.
Reveal the correct answerIrradiation of the entire body may lead to development of the Acute Radiation Syndrome (ARS). Which of the following sentences is true regarding the signs and symptoms of ARS?
- Aexposure of the whole body to 3Gy of irradiation is always lethal.
- Bin bone marrow syndrome an improvement in patients' condition is observed within a day after the exposure to radiation.
- Cin bone marrow syndrome the number of erythrocytes decreases immediately after the irradiation.
- Din bone marrow syndrome death occurs due to general infection.
- Eall the above.
Reveal the correct answerA 25-year-old man presents to the emergency department complaining of muscle fatigue, vomiting and confusion after running a 10-km race. He suffers from disorientation. He has been treated for hyperthyroidism for about 5 years. The core temperature is 40°C; his skin is hot and dry. His blood results are essentially normal except for minimally elevated hepatic transaminases. Given this patients' signs and symptoms as well as lab results, what is the most likely diagnosis?
- Aheat stress.
- Bheat cramps.
- Cheat stroke.
- Dheat exhaustion.
- Eheat oedema.
Reveal the correct answerBefore giving fibrinolytic therapy all its contraindications and risks should be carefully thought out by a healthcare professional. All the listed below conditions are regarded as absolute contraindications except for:
- Apregnancy and the period of 1-week post-partum.
- Bischaemic stroke in the preceding 6 months.
- Cgastro-intestinal bleeding within the last month.
- Dknown bleeding disorder.
- Eaortic dissection.
Reveal the correct answerNiroglycerin relaxes vascular smooth muscles. At low doses, its effects are seen in:
- Alarge arteries.
- Bsmall arteries.
- Cveins.
- Dcoronary arteries.
- Ebrain arteries.
Reveal the correct answerThe most common cause of death of patients after cardiac arrest is:
- Adamage of internal organs.
- Binfectious complications.
- Cischemic heart damage.
- Dischemic brain injury.
- Eimproper post-resuscitation care.
Reveal the correct answerThe patient reports cut injury of the head (about 5 cm long). The most important initial affixing of the wound is:
- Ashaving hair surrounding the wound, removal of foreign bodies, disinfection using hydrogen peroxide.
- Bwashing the wound with running water, removal foreign bodies, hair trimming.
- Cremoval of foreign bodies from the wound, disinfecting the wound edges with alcohol, cover the wound with sterile dressings until the final treatment.
- Dhead wounds do not require thorough cleaning, the scalp is richly supplied with blood, there is a small risk of infection.
- Eif the wound does not require sewing it is best to start dressing from granuflex - it absorbs impurities.
Reveal the correct answerThe narrowest fragment of the upper respiratory tract in a 2-year-old child is:
- Aoropharynx (oral part of the pharynx).
- Blarynx vestibule.
- Cintermediate laryngeal cavity.
- Dglottis.
- Esubglottis.
Reveal the correct answerAn alcohol poisoned patient opens his eyes in response to painful stimulus, withdraws his limb to a painful stimulus, makes no sounds. The score on the Glasgow Coma Scale (GCS) is:
- A11
- B5
- C7
- D6
- E9
Reveal the correct answerA 30-year-old pedestrian was hit by a car. After preliminary examination the Emergency Team stated: AVPU=P, breathing 10/min, pulse 110/min on the carotid and radial arteries. Quick trauma exam reveals: a right femur fracture and the tender abdomen on the spleen projection. The paramedic considers placing an oropharyngeal airway. He should be prepared for the complications of oropharyngeal airway placing, which include:
1) provocation of vomiting
2) causing tachycardia
3) increased intracranial pressure
4) anisocoria
5) tension pneumothorax
The correct answer is:
- A1, 2
- B1, 3
- C3, 4
- D2, 5
- E1, 5
Reveal the correct answerThe second dose of epinephrine in cardiac arrest in the mechanism of PEA in a 60-year-old patient is:
- A1 mg.
- B2 mg.
- C2 - 4 mg.
- D1 mg/kg body weight.
- Enone of the above.
Reveal the correct answerEarly in the morning a specialized emergency medical unit brought into the hospital emergency department about 12-year-old boy, found in an abandoned building. During the examination it was found that the patient is in severe hypothermia. The core body temperature was 27.5°C. Intensive active heating of the patient began. During the intubation abnormal heart rhythm progressing to ventricular fibrillation (VF) appeared. Cardiopulmonary resuscitation (CPR) began and defibrillation was performed three times but it failed to restore sinus rhythm. The most proper next action is:
- Acontinuation of CPR and patient intensive heating to the core body temperature of 30°C and after reaching it, the execution of defibrillation attempts
- Bcontinuation of CPR and defibrillation redo
- Cinterruption of CPR, patient intensive heating to the core body temperature of 33°C and again CPR and defibrillation
- Dcontinuation of CPR, the administration of lidocaine iv infusion
- Econtinuation of CPR, redoing defibrillation, the administration of lidocaine iv infusion
Reveal the correct answerIn accordance with the commonly abiding law, the doctor is obliged to obtain written consent from the patient in the case of surgery or when applying treatment or diagnostics (here called intervention) that poses a considerable risk to the patient. The doctor:
- Amay take the consent before the intervention.
- Bmust take the consent before the intervention.
- Clegislation does not specify when the consent is to be obtained.
- Dmust take the consent after the intervention.
- Emay take the consent before or after the intervention.
Reveal the correct answerIn connection with preparing a patient for major orthopedic surgery the doctor called the nurse on the phone and delegated her to give the patient 40 mg of enoxaparin subcutaneously. The nurse refused claiming that because of the preventive nature of the order she should receive it in writing. In this case:
- Anurse was right because a verbal order can be issued only in emergency medical conditions.
- Bnurse was right because the legislation does not provide for issuing orders to nurses at all.
- Cnurse was wrong because the law allows for the verbal issuance of preventive orders.
- Dassessment of the admissibility of issuing verbal orders depends on the contents of therapeutic entity regulations that should govern these matters.
- Eassessment of the admissibility of issuing verbal orders depends on the fact whether or not the doctor is a holder of medical specialization (specialists can issue verbal orders).
Reveal the correct answerA patient reports to a private healthcare institution to have her breasts enlarged. Unfortunately, she does not speak Polish and none of the doctors can communicate with her. Does treatment in esthetic medicine require informed consent, that is the possibility of direct patient-doctor communication?
- Ano, in the case of esthetic medicine the doctor does not need to obtain informed consent from the patient
- Bno, the doctor can think that a patient who shows up for cosmetic surgery understands the matter of medical intervention well enough.
- Cno, it is enough to inform the patient that the medical intervention will be carried out by the medical specialist.
- Dyes, the patient should always be informed about the course of any medical intervention and have the possibility for constant communication with their doctor.
- Eyes, because esthetic medicine requires special patient-doctor relations.
Reveal the correct answerA doctor is going to carry out a medical experiment testing usefulness of the new method of intubation on an unconscious patient. Such an experiment:
- Acan be carried out after obtaining the permission from the proper Court of Protection.
- Bis acceptable but must be preceded by consultation with at least two doctors, possibly of the same specialty.
- Ccan be carried out if the close person, within the meaning of the Patient's Rights and Patient's Rights Ombudsman Act, expresses their consent.
- Dis generally inadmissible unless obtained results are cognitively significant.
- Eis unacceptable.
Reveal the correct answerAn insurer turns to a doctor asking for an access to the medical records of his patient. The insurer is going to sell the patient life insurance. What should the doctor do?
- Ahe cannot share the records whatsoever because it would be the disclosure of medical confidentiality.
- Bhe may share the records on condition that the insurer indicates a legal interest.
- Che may share the records because it is in the interest of the patient.
- Dhe may share the records after obtaining the patient's consent.
- Ehe may share the records after obtaining the Insured Rights Ombudsman's consent.
Reveal the correct answerAutopsy may be performed within 12 hours of the confirmation of death when:
- Aprosecutor investigating the case of manslaughter demands it.
- Bthere is a need to take of the body cells, tissues or organs.
- Cdeath occurred for reasons that are not possible to determine clearly.
- Ddetermination of the cause of death is necessary to exclude liability of the therapeutic entity for a medical event.
- Eclose person, within the meaning of the Patient's Rights and Patient's Rights Ombudsman Act, requests it.
Reveal the correct answerThe Polish Code of Medical Ethics provides that “in terminal stages, the doctor is not required to take up and pursue resuscitation or persistent medical treatment nor emergency measures”. Persistent medical treatment is:
- Aset of medical activities, with no chance of treatment effect, which lose their justification because of ensuing infringement on the patient’s goods.
- Bset of medical activities economically unjustified.
- Ccarrying on medical intervention at the request of the family.
- Dforcing the doctor to take medical action against his will and medical experience.
- Eunnecessary pain or suffering directed against man with no chance of treatment effect.
Reveal the correct answerDoctors providing health services under contract can withdraw from treatment of their patients if there is no emergency and if:
- Athey warn their patients or their legal representatives or their actual guardians about the intention of withdrawing from treatment.
- Bthey indicate real possibility of receiving these services from another doctor or therapeutic entity.
- Cpatients do not object.
- DA and B are correct.
- EA, B and C are correct.
Reveal the correct answerPatient's rights to the use of fair, based on medical criteria, procedures for establishing the order of access to health services do not include:
- Aurgent cases in patients treated chronically.
- Bmedically stable patients.
- Chealth or life emergencies.
- Dmedical interventions in aesthetic medicine and dentistry.
- Epatients treated palliatively.
Reveal the correct answerA patient on admission to the hospital received the declaration to sign: "I agree to stay in the hospital and the proposed treatment". On this basis can a medical intervention be considered legal?
- AYes, because the patient expressed their consent.
- BNo, because the law requires consent only for stay in the hospital.
- CNo, the phrase "proposed treatment" does not make medical activities requiring informed consent legal.
- DYes, it is a sufficient declaration for the whole treatment process, except for research.
- EPolish law does not provide for expressing consent for treatment in the hospital.
Reveal the correct answerOccupational disease is a disease registered on the list of occupational diseases and which was caused by factors detrimental to health in the workplace or the way of working, the so called "occupational exposure". Which of the following is not included in the Council of Ministers Regulation on occupational diseases?
- Apneumoconiosis.
- Bbronchial asthma.
- Callergic rhinitis.
- Dmyocardial infarction.
- Evibration syndrome.
Reveal the correct answerWhich of the following rulings is not issued by SIF (ZUS) certifying doctors for establishing the rights to benefits from the Social Insurance Fund?
- Aon incapacity for work for disability pension purposes.
- Bon the need for medical rehabilitation in the prevention of disability pension.
- Con permanent or long-term damage to health caused by industrial accident or occupational disease.
- Don the degree of disability.
- Eon the connection between the incapacity for work and the industrial accident or occupational disease.
Reveal the correct answerWhich of the following rulings is not issued by ASIF (KRUS) certifying doctors and ASIF medical boards for establishing the farmers' rights to benefits from the Social Insurance Fund?
- Aon total incapacity for work on the farm.
- Bon temporary incapacity for work lasting longer than 180 days.
- Con inability to live independently.
- Don the degree of disability.
- Eon proportional damage to health due to accident at work in agriculture or agricultural occupational disease.
Reveal the correct answerSocial pension is due to a person of age who suffered damage to health in the periods specified in the Act on social pension and who holds a ruling on:
- Apartial incapacity for work.
- Bslight degree of disability.
- Cconsiderable degree of disability.
- Dtotal incapacity for work.
- Etotal incapacity for service.
Reveal the correct answerIn accordance with the Law on cash benefits from social insurance in the case of disease and maternity, medical rulings on temporary incapacity for work can be issued for the period not longer than three days prior to the day of the examination of the insured if the results indicate that the insured was undoubtedly unable to work in that period. Who can issue the medical ruling for the period longer than three days prior to the day of the examination?
- Aoutpatient unit manager.
- Bhospital administrator.
- Cpsychiatrist.
- DSIZ (ZUS) certifying doctor.
- Eattending doctor after obtaining the consent of the president of the Social Insurance Fund.
Reveal the correct answerIn accordance with the Law on old age and disability pension from social insurance, a training pension is due to a person with a relevant period of insurance and who was stated to be:
- Apartially incapable for work.
- Btotally incapable for work.
- Ctemporary incapable for work.
- Dappropriate for professional retraining owing to inability to work in current occupation.
- Etotally incapable for service and capable for work.
Reveal the correct answerIn accordance with the Law on old age and disability pension from social insurance, the insured person who does not agree with the ruling of a SIF(ZUS) certifying doctor is entitled to:
- Aappeal to the Court of Labor and Social Insurance.
- Bappeal to the manager of the local branch of SIF(ZUS).
- Cappeal to the president of SIF(ZUS).
- Dlodge the objection with the SIF(ZUS) medical board within 14 days of the date of receiving the ruling.
- Elodge the objection with the SIF(ZUS) medical board within 30 days of the date of receiving the ruling.
Reveal the correct answerWhich of the following indicators of society health belong to the positive ones?
- Alife expectancy at birth.
- Bprevalence rate.
- Cincidence rate.
- Dneonatal mortality rate.
- Enone of the above.
Reveal the correct answerAn important condition for effective prevention of cardiovascular disease is to detect risk factors that should comply with certain conditions, such as:
- Athey should be connected with the disease occurrence.
- Bthere is the possibility to reduce the exposure to these factors.
- Creducing of the exposure reduces morbidity.
- Dthere is the possibility to eliminate these factors.
- Eall the above.
Reveal the correct answerThe most important goals of health promotion contained in the National Health Programme for 2007-2015 are associated with the following actions:
- Arestrictions on the use of psychoactive substances.
- Breducing the prevalence of smoking and alcohol consumption.
- Cimprovement of the diet of the population and reduction of the prevalence of obesity.
- Dreducing the exposure to harmful factors of the physical environment and the improvement of sanitary conditions in Poland.
- Eall the above.
Reveal the correct answerWhich of the following is the most useful screening test from a scientific, ethical and financial point of view?
- Adetection of the congenital dislocation of the hip and phenylketonuria in infants.
- Blung cancer detection.
- Cbreast and cervical cancers detection in women.
- Dhypertension and diabetes detection.
- Eall the above.
Reveal the correct answerThe following statement: "this planned and complex action including transfer of knowledge, experience and practical skills in order to strengthen health" refers to:
- Ahealth education.
- Bhealth insurance system.
- Cdemographic transformation.
- Depidemiological transformation.
- Enone of the above.
Reveal the correct answerThe most important global changes that create health challenges and threats, and require international cooperation are as follows:
- Ademographical transformation (fast population aging).
- Bglobal environmental threats caused by increasing urbanization and industrialization.
- Crapid technological progress in many areas.
- Dglobal infectious disease threats due to mobility of people, animals and microorganisms.
- Eall the above.
Reveal the correct answerThe demographic structure of the population is affected by:
- Avital statistics.
- Bmigration.
- Csocioeconomic conditions.
- Dall the above.
- Enone of the above.
Reveal the correct answerThe level of demographic aging advancement is assessed on the basis of:
- Apercentage of elderly people (65+).
- Bmaximum life expectancy of the population only.
- Cfeminization index.
- Dincidence rate of chronic diseases.
- Epercentage of people of working age.
Reveal the correct answerA female patient with cholelithiasis develops a heavy colic pain. Which of the following may be used to manage the pain?
- Amorphine.
- Bpentazocine.
- Cpethidine.
- DB or C.
- Eopioid analgesics are not used.
Reveal the correct answerA female patient aged 56, nullipara with BMI 24 kg/m2, complains of suprapubic ache and difficulty in defecation. Ultrasound examination reveals a large quantity of free fluid in the abdominal cavity and the presence of a complex cystic and solid mass with thick septa about 10 cm big located on the left side. The most probable diagnosis is:
- Amalignant epithelial ovarian tumor.
- Bmalignant germ-cell ovarian tumor.
- Cbenign ovarian tumor.
- Dtheca lutein cyst.
- EKrukenberg tumor.
Reveal the correct answerIn an internal medicine ward a patient suffering from asthma has become aggressive towards the personnel (punched the nurse) and was threatening the doctor with the knife because "he was strangling her at nightâ". What should the internal medicine physician do in order to execute the coercive measure against this patient (according to the Polish Mental Health Act)?
- Athere is no need to use the coercive measure. The patient has to be discharged from the ward immediately.
- Bto diagnose the mental illness in this patient which justifies the use of coercive measures.
- Cto drop the use of coercive measures, because the patient is not in a psychiatric ward.
- Dto diagnose the mental disorder in this patient which justifies the use of coercive measures.
- Eto seek psychiatric consultation because only a psychiatrist can order the use of coercive measures.
Reveal the correct answerCancer of the gallbladder coexists with gallbladder stones in:
- A30% of patients.
- B50% of patients.
- C60% of patients.
- D80% of patients.
- E95% of patients.
Reveal the correct answerWhich of the following concerning secondary hyperparathyroidism is false?
1) it is always the indication for surgery;
2) calciphylaxis is the indication for surgical treatment;
3) surgery involves the removal of a single parathyroid adenoma that is the most frequent cause of the disease;
4) surgery involves the subtotal resection of the parathyroid gland or total resection of the parathyroid gland with the autotransplantation of one of them;
5) core treatment involves the correction of calcium and phosphate levels into the normal reference range and of iPTH level to be 2-9 times the upper limit value.
The correct answer is:
- A1,2,4.
- B1,4,5.
- C1,3.
- D2,3.
- Eall the above.
Reveal the correct answerA patient with upper gastrointestinal (UGI) bleeding was admitted to the surgical ER. Endoscopy shows active bleeding from the duodenal bulb ulceration. Hemostasis was obtained with local endoscopic saline and adrenaline administration. The pulse and blood pressure were stabilized after the correction of volemic disorders. Twenty hours later the pressure dropped to approx. 100/60 mmHg and the pulse increased to 120/minute. Which is the most proper approach?
- Aincrease the dose of proton pump inhibitors.
- Bsurgery.
- Ctransfusion of 2 units of packed red blood cells.
- Dadministration of pressor amines.
- Egastroscopy.
Reveal the correct answerWhich of the following should be performed in gastric cancer?
- Aresection (modo Rydygier) and the restoration of the proper passage.
- Bpartial gastrectomy with lymphadenectomy.
- Cgastrectomy with lymphadenectomy.
- Dtumor excision.
- Egastric resection (modo Billroth II).
Reveal the correct answerWhich of the following factors have impact on the occurrence of recurrent duodenal ulcer bleeding?
- Ableeding activity in Forrest classification, the size of the bleeding source, localization, a type of treatment.
- Bcardiovascular sufficiency, bleeding activity in Forrest classification, a type of treatment, impaired motility.
- Cefficiency of the respiratory system and kidneys, bleeding activity in Forrest classification, type of treatment.
- Dbleeding activity in Forrest classification, esophageal erosions, a type of treatment.
- Eesophageal varices, esophageal erosions, an ulcer clip in anamnesis, impaired motility.
Reveal the correct answerCaroli disease is characterized by the congenital cystic expansion of intrahepatic bile ducts. Which of the following concerning this disease is false?
- Aoccurs predominantly in men.
- Bin some cases is limited to one hepatic lobe only.
- Ccholelithiasis develops in extended bile ducts.
- Dbiliary tract cancer never develops in the course of the disease.
- Erecurrent inflammations of the biliary ducts may start during childhood.
Reveal the correct answerAn emergency medical team brought into the hospital emergency department an 8-year-old girl. The child is unconscious, rated by GCS at five points, dysfunctional breathing, intubated. On clinical examination anizokoria: pupils L> R, spasms, positive extensor plantar response. Interviewed parents said that there had been gradually increasing episodes of headache for about six months and for the two last days the child was apathetic, had nausea and vomiting. Today, she experiences a very bad headache and a sudden loss of consciousness. What is the correct order of diagnostic evaluation?
- Alumbar puncture, computed tomography, magnetic resonance imaging.
- Bcomputed tomography, magnetic resonance imaging, and possibly a lumbar puncture.
- Ccomputed tomography, magnetic resonance imaging, cerebral angiography.
- Dlumbar puncture, magnetic resonance imaging.
- EB or C.
Reveal the correct answerA 60-year-old patient was brought to the ER because of impaired consciousness, headache, vomiting. You suspect meningitis and brain infection. You take blood samples for laboratory analysis and then:
- Aperform a lumbar puncture because it is a test allowing to recognize meningitis and brain infection. You should give antibiotics within 30 min.
- Bperform fundus examination to rule out increased intracranial pressure.
- Cdo not perform a lumbar puncture, the diagnosis is based on the most common signs and symptoms as well as laboratory tests. You should give antibiotics within 30 min.
- Dperform a lumbar puncture, then computer tomography of the head.
- Eyou perform a CT scan of the head, then a lumbar puncture.
Reveal the correct answerTherapeutic hypothermia is recommended in patients just after cardiac arrest in:
1) only in cardiac arrest in the PEA mechanism;
2) only in cardiac arrest with ventricular fibrillation;
3) it is recommended regardless of the rhythm in which SCA occurred;
4) it is recommended to maintain the target temperature within 32-36 ° C for at least 24h;
5) pre-hospital but not in-hospital cardiac arrest due to the lower risk of central nervous system hypoxia;
6) Pre-hospital cold fluid supply is not recommended for the initial induction of hypothermia.
The correct answer is:
- A3,4,6
- B1,3,5
- C2,3,5
- D1,3,6
- E3,4,5
Reveal the correct answerWhich of the following symptoms is not characteristic of shock?
- Alowering blood pressure
- Bincreased heart rate
- Coliguria, anuria.
- Dfeeling cold, thirsty.
- Eshortened capillary refill
Reveal the correct answer