A 64-year-old obese man comes to the office because of knee joint stiffness. It is most noticeable when he wakes up in the morning or after a period of inactivity. The symptoms have started several years ago and have worsened since then. The serum uric acid concentration is increased. He has never had kidney stones or an acute attack of gout. Indicate the least appropriate next step in this case:
- Astart treatment with allopurinol.
- Brecommend low purine diet.
- Cadminister nonsteroidal anti-inflammatory drugs.
- Dsuggest physical therapy.
- Eadvise weight loss.
Reveal the correct answerA 78-year-old woman comes to the office to continue the treatment of hypertension. The urine test shows increased number of leukocytes in urine. The woman does not have any symptoms of urinary tract infection. She feels well. Which of the following is the most appropriate next step?
- Aurine culture and then treatment with appropriate antibiotics.
- Bstart treatment with amoxicillin.
- Cstart treatment with amoxicillin with clavulanic acid.
- Dstart treatment with ciprofloxacin.
- Edo not perform urine culture or treatment with antibiotics.
Reveal the correct answerA 70-year-old man comes to the office because of dry mouth and increased thirst. His fasting plasma glucose is 213 mg/dl. Which of the following is the most appropriate next step?
- Adiagnose diabetes and start the pharmacological treatment of diabetes.
- Brepeat fasting plasma glucose.
- Cadvise oral glucose tolerance test.
- Ddiagnose diabetes but do not start pharmacological treatment.
- Etest HbA1C.
Reveal the correct answerA 75-year-old man with diabetes comes to the office for a check-up. He has had diabetes for 5 years. He takes the maximal dose of metformin. His HbA1C is 7.1%. Indicate the diet tip which is not proper for the man:
- Achoose high-fiber complex carbohydrates.
- Blimit soda and candy.
- Ceat regular small meals.
- Deat a lot of non-starchy vegetables.
- Eeat more trans fats e.g. margarine.
Reveal the correct answerA 75-year-old man comes to the emergency department because of bleeding from the nose. He takes drugs because of permanent atrial fibrillation, but he is not able to recall their names. His blood pressure is 130/80 mmHg. Which of the following tests is the most appropriate one to explain the cause of bleeding?
- Apartial thromboplastin time.
- BINR.
- Cplatelet count.
- Dbleeding time test.
- Ebone marrow test.
Reveal the correct answerA 72-year-old woman is brought to the emergency department because of dehydration caused by vomiting. She has tachycardia and her arterial blood pressure is 90/60 mmHg. Indicate the least appropriate next step in this case:
- A0.9% NaCl intravenous infusion.
- Bstart intravenous infusion of verapamil.
- Cintravenous KCl infusion in glucose solution.
- Dcheck serum creatinine concentration.
- Echeck blood glucose concentration.
Reveal the correct answerA 72-year old man has been brought to the emergency department because of acute tetany. Two weeks ago thyroidectomy was performed in this patients because of a retrosternal goiter. Which of the following is the most appropriate next step:
- Agive calcium gluconate infusion intravenously.
- Bgive 0.9% NaCl infusion intravenously.
- Cgive KCl infusion intravenously.
- Dgive 5% glucose infusion intravenously.
- Egive calcium blocker.
Reveal the correct answerIn the renal ultrasound examination two cortical cysts of the right kidney were found in a 53-year-old woman. Their diameters are 1 cm and 2 cm. The patient complains of hot flashes and irritability; her father died of lung cancer at the age of 83 and mother of a stroke at the age of 77. RR 135/80 mmHg, creatinine 0.8 mg/dl, FSH 53 mlU/L. Urinalysis normal. The physician should:
- Arecognize simple kidney cysts and recommend ultrasound checks in a year.
- Brecognize congenital polycystic kidney and recommend genetic testing.
- Crecognize acquired cystic kidney and perform the biopsy of the smaller cyst.
- Drecognize acquired cystic kidney and perform the biopsy of the bigger cyst.
- Esuspect ectopic secretion of FSH and perform the test for the inhibition with E3.
Reveal the correct answerA 66-year-old man with paroxysmal atrial fibrillation and his 30-year-old daughter in the 8th week of pregnancy have the same results: TSH = 0.1 mlU/L and FT4 and FT3 normal. Thiamazole treatment is justified:
- Ain both patients.
- Bonly in the case of the father.
- Conly in the case of the daughter.
- Din neither of them.
- Edepending on the level of antithyroid antibodies.
Reveal the correct answerA 52 year-old-man with his 42-year-old wife who is in 6th week of pregnancy have slightly elevated levels of TSH (5.6 mUl/l), with normal FT3 and FT4 concentrations. They do not have any clinical signs of hypothyroidism. Who should be promptly treated with thyroxine:
- Ahusband and wife.
- Bonly husband.
- Conly wife.
- Dneither husband nor wife.
- Ehusband or wife depending on the test result of TSH after TRH.
Reveal the correct answerThe blood glucose of a 57-year-old obese male is: fasting 121 mg/dL, after one hour oral glucose tolerance test 257 mg/dl and after two hours 195 mg/dl. The physician should:
- Arecognize diabetes and start insulin treatment.
- Brecognize diabetes and start treatment with metformin.
- Crecognize diabetes and recommend lifestyle modification.
- Dnot recognize diabetes, but consider lifestyle modification.
- Enot recognize diabetes or give any special recommendation.
Reveal the correct answerWhich of the following speak in favour of diagnosis of polymyalgia rheumatica in a male patients with muscle pains of the shoulder girdle, the pelvic girdle and the neck:
1) age > 50;
2) absence of morning stiffness;
3) ESR < 10 mm after one hour;
4) persistence of the symptoms despite the treatment with prednisone in a dose of 20 mg/day for two weeks.
The correct answer is:
- Aonly 1.
- B1,2.
- C2,3.
- D1,3,4.
- Eall the above.
Reveal the correct answerA 27-year-old man suffering from type 1 diabetes for 2 years was diagnosed with the sudden onset of nephrotic syndrome. HbA1c 6.3%, creatinine 1.5 mg/dL, no signs of diabetic retinopathy and hypertension. The doctor should:
- Arecognize diabetic nephropathy and intensify insulin treatment.
- Brecognize diabetic nephropathy and include ACE inhibitors in the treatment.
- Crecognize diabetic nephropathy and prepare the patient for dialysis.
- Drefer the patient to a nephrologist for a possible kidney biopsy.
- Eobserve the patient and refer him to a nephrologist if creatinine exceeds 1.7 mg/dL.
Reveal the correct answerA 30-year-old man with diabetes mellitus type 1 treated with insulin for about 6 months has hematuria and proteinuria 2 g/24 h, RR 155/95 mmHg and plasma creatinine steadily increasing to 5 mg/dl (442µmol/l) for the last two weeks. The most probable diagnosis is:
- Adiabetic nephropathy.
- Bhypertensive nephropathy.
- Crapidly-progressive glomerulonephritis.
- Dacute interstitial nephritis.
- Enephrotic syndrome.
Reveal the correct answerA 50-year-old woman has been complaining of progressing weakness, ankle edema and resistant arterial hypertension for some years now. Serum creatinine concentration is 15 mg/dl (1326 µmol/l), urea 230 mg/dl (38 mmol/l). What is the most probable diagnosis?
- Anephrotic syndrome.
- Bchronic kidney disease.
- Cchronic pyelonephritis.
- Dhypertensive nephropathy.
- EIgA nephropathy.
Reveal the correct answerA 50-year-old man with chronic kidney disease (eGFR 26 mL/min) was diagnosed with dyslipidemia: total cholesterol 280 mg/dL, triglycerides 380 mg/dL. Choose the appropriate treatment:
- Alifestyle modification + atorvastatin.
- Bgemfibrozil + rosuvastatin.
- Cgemfibrozil.
- Dlifestyle modification + gemfibrozil.
- Elifestyle modification.
Reveal the correct answerA 25-year-old man has noticed the recurrent episodes of macroscopic hematuria appearing 1-2 times a year during or immediately following upper respiratory infections for the last two years. What is the most probable diagnosis?
- Ahemolytic-uremic syndrome
- BHenoch-Schonlein purpura
- Cnephrolithiasis
- DIgA nephropathy
- Easymptomatic microscopic hematuria
Reveal the correct answerA 40-year-old woman suffered from dysuria which began during journey, progressing weakness, temperature 38.5°C and pain in the right lumbar region. What drug should be chosen?
- Aamoxicillin.
- Bfosfomycin.
- Cnitrofurantoin.
- Dquinolone.
- Eimipenem.
Reveal the correct answerA 50-year-old man has autosomal dominant polycystic kidney disease (ADPKD), a disease which his mother also had. Show the true statement concerning the disease:
- AUSG has 100% sensitivity for subjects > 30 years with a positive family history.
- Bin about 50% of patients liver cysts are present.
- Cpainful hematoma and the ruptures of the cysts may appear.
- Dall the above are true.
- Etrue are A and C.
Reveal the correct answerRheumatic fever is autoimmune disease caused by:
- AStreptococcus alfa-hemolytic A.
- BStreptococcus beta-hemolytic A.
- CStreptococcus beta-hemolytic B.
- DA, B and C are true.
- EA, B and C are not true.
Reveal the correct answerA 48-year-old male with a medical history of myocardial infarction treated with primary percutaneous coronary intervention (PCI) 3 years ago, hypertension and hypercholesterolemia both pharmacologically controlled arrived at ER presenting chest discomfort and mild dyspnoea of about 60 minutes' duration. The patient was alert and cooperative. The first myocardial necrosis markers (CK-MB, troponin T) were negative. ECG taken immediately revealed (paper speed: 25 mm/s):
Indicate the proper procedure in this case:
- Afirst immediate electrical cardioversion, then urgent coronary angiography and PCI (if necessary), and finally proper pharmacological treatment.
- Bfirst immediate amiodarone injection and if need arises electrical cardioversion (if amiodarone turns out to be ineffective), secondly urgent coronary angiography and PCI (if necessary). If acute coronary syndrome or other reversible causes can be excluded, the patient should have a cardioverter-defibrillator implanted before leaving hospital.
- Curgent electrical cardioversion should be performed, and after 2-3 hours of follow-up the patient can be discharged.
- Dpatient should be admitted to hospital and closely monitored. Electrical cardio-version should be performed only in the case of worsening - when the patient collapses or cardiogenic shock is developing.
- Eimmediate electrical cardioversion should be performed, and the patient should have a cardioverter-defibrillator implanted regardless of the results of other examinations and tests.
Reveal the correct answerA 40-year-old woman has edema, RR 170/100 mmHg, proteinuria >3.5 g/24h, hypoalbuminemia, hypercholesterolemia and microscopic hematuria. What is the diagnosis?
- Anephritic syndrome.
- Bnephrotic syndrome.
- Cacute interstitial nephritis.
- Drapidly progressive glomerulonephritis.
- Ehypertensive nephropathy.
Reveal the correct answerA 54-year-old man was admitted to hospital due to severe dyspnoea accompanied by chest pain which happened during physical exertion and lasted for approx. 1 hour. Physical examination revealed RR 180/95 mmHg, pulse 95, rales over more than half of the lungs. Which is the most possible diagnosis?
- Aacute heart failure due to acute coronary syndrome.
- Bchronic heart failure due to arrhythmia.
- Cisolated right heart failure.
- Dcardiogenic shock due to acute coronary syndrome.
- Ehigh cardiac output syndrome.
Reveal the correct answerThe urinalysis of a 30-year-old man is positive for erythrocytes and dismorphic RBCs. Please indicate the most probable diagnosis:
- Acystitis.
- Burolithiasis.
- Cprostatitis.
- Dchronic pyelonephritis.
- Eglomerulonephritis.
Reveal the correct answerA 68-year-old man was admitted to hospital with the symptoms of congestive heart failure. On examination: blood pressure - 160/86 mmHg, Hb 10.2 g/dL, creatinine level - 2.5 mg/dL, eGFR - 28 mL/min, Na - 132 mmol/L, K - 4.9 mmol/L. Choose the appropriate treatment:
- Afurosemide 40 mg i.v. (infusion pump), ramipril 2.5 mg, low sodium diet.
- Bhemodialysis.
- Cspironolactone 50 mg, furosemide 100 mg p.o.
- Dhydrochlorothiazide 50 mg, ramipril 10 mg.
- Ehydrochlorothiazide 25 mg, spironolactone 50 mg, ramipril 5 mg.
Reveal the correct answerA 48-year-old man, healthy so far, has abnormal liver tests: ALT 118 IU/L, AST 64 IU/L (performed on a regular check-up). He is abstinent, BMI is normal; he does not take any medicines or dietary supplements. Family history is negative for liver disease. During childhood he underwent three abdominal surgeries because of purulent appendicitis and adhesive bowel obstruction. Indicate an additional test which should be performed in this patient first:
- Aserum iron level.
- Bserum ceruloplasmin and copper levels.
- Cblood alpha-1 antitrypsin level.
- Dhepatic viruses markers - HBsAg and anti-HCV.
- Eno tests are needed, except for ALT and AST follow-up in 2-3 months.
Reveal the correct answerA 56-year-old man reports increasing severe lower abdominal and left iliac fossa pain lasting for the last three days. These are accompanied by dysuria, a variable mode of defecation and fever up to 39°C. He has not been treated because of chronic diseases. The most probable diagnosis is:
- Aleft renal colic.
- Bsigmoid diverticulitis.
- Cischemic colitis.
- Dcystitis.
- Einfectious colitis.
Reveal the correct answerAutoimmune pancreatitis should be suspected in a patient with:
1) inflammatory bowel disease;
2) primary biliary cirrhosis;
3) gastric ulcer;
4) Sjoegren's syndrome;
5) choledocholithiasis.
The correct answer is:
- A1,2
- B1,2,4
- C1,3,4
- D2,3,4
- Eall the above.
Reveal the correct answerA 24-year-old woman with no PMH had laparoscopic cholecystectomy because of numerous small gallstones in her gallbladder. Two weeks later at night she had pain in her middle upper abdomen. The next day laboratory exams showed: AST 300 IU/L, ALT 260 IU/L, serum bilirubin 2.4 mg/dL, serum and urine amylase negative. Ultrasound showed no changes in the liver, biliary ducts and pancreas. The patient's eyes are slightly yellow and urine is dark. The most probable diagnosis is:
- Aacute viral hepatitis.
- Bacute pancreatitis.
- Ccholedocholithiasis.
- Diatrogenic injury - the possibility of bile duct ligation.
- Eliver cirrhosis.
Reveal the correct answerThe diagnosis of malignant mesothelioma is based on:
- Acytological analysis of exudative pleural fluid.
- Bhistological analysis of tissues obtained by means of video thoracoscopy.
- Cchest CT scan.
- DPET-CT scan.
- Echest MRI scan.
Reveal the correct answerA patient hospitalized because of severe pneumonia and treated with a broad-spectrum antibiotic, complains of numerous loose stools, stomachache and fever. Laboratory tests revealed leukocytosis, electrolyte abnormalities and hypoalbuminemia. Colonoscopy revealed yellow plaques on the wall of the distal sigmoid colon and rectum. Faecal culture revealed Clostridium difficile, and additional tests were positive for toxins A and B. What is the diagnosis?
- Apseudomembranous colitis.
- Bcoeliac disease.
- Cfoodborne illness.
- Dulcerative colitis.
- Efood allergy.
Reveal the correct answerA 50-year-old woman who is overweight (BMI = 28 kg/m2) complains of severe right and middle abdominal pain that began a few hours after abundant and “fat” dinner. Additionally: nausea and food vomiting twice. She had similar symptoms 2 years ago, during a wedding reception. Ultrasound performed at that time revealed a few small gallstones in the gallbladder. Gastric endoscopy performed at the same time demonstrated only bile in the stomach. She has recently been taking ibuprofen because of a knee pain and 75 mg of aspirin daily (the latter was recommended by her cardiologist). Her temperature is 38.3 Celsius. Her blood pressure is normal. Her pulse is slightly increased. On examination the right upper abdomen is painful on palpation and the pain increases on shaking. No peritoneal symptoms. Normal intestinal motility. Indicate the most probable diagnosis:
- Abiliary gastritis.
- Bacute pancreatitis.
- Cacute gastric ulcer.
- Dcolon diverticulitis.
- Eacute cholecystitis.
Reveal the correct answerA 40-year-old man underwent gastric endoscopy because of gastroesophageal reflux symptoms lasting for a few days. The urease test is positive. PMH: peptic ulcer disease - negative, anemia - negative, family gastric cancer - negative. He does not take NSAIDs, does not smoke cigarettes. He had Helicobacter pylori (Hp) eradication done. One month after the eradication he had serological test performed (finger blood test, on his own initiative) and this was positive for Helicobacter pylori. In this clinical situation one should:
- Arepeat gastric endoscopy and Hp urease test.
- Bperform breathing test to confirm Hp infection.
- Crecommend Helicobacter pylori eradication with different drugs.
- Dorder the treatment with proton pump inhibitor (ex. omeprazole) for one month and repeat serological Hp test.
- Eexplain to the patient that Hp antibodies may appear positive on serological test for years and it is not equal to infection and does not always need treatment.
Reveal the correct answerA 50-year-old woman complains of skin itching in her trunk and extremities. It happens mainly after bathing in the evening. She has been using various ointments and “cooling” oils, and tried to take hydroxyzine at bedtime - to no avail. On exam: no signs except for excoriations of the arm and trunk skin. Lab tests: alkaline phosphatase and GGTP 1.5 times above upper limit, AST and ALT normal. Total cholesterol 260 mg%, bilirubin 1.0 mg%. Abdomen ultrasound shows no pathology. In this clinical situation you should first choose:
- Astool test for parasites and Giardia cysts.
- Bskin tests for food allergy.
- Cserum anti-mitochondrial antibodies test.
- Dattempt to change washing powder and the kind of underwear used by the patient.
- Erefer her to dermatologist.
Reveal the correct answerWhich of the following possess the prognostic value in malignant neoplasms?
- Astaging.
- Bgrading.
- Cage at diagnosis.
- DA and B are true.
- EA, B and C are true.
Reveal the correct answer- Arefers to metabolic disorders in terminally ill patients.
- Bincludes hypercalcemia and hyponatremia.
- Cincludes hyperuricemia and hyperkalemia, hyperphosphatemia and hypocalcemia.
- DA and B are true.
- Eis typical complication of gastrointestinal tract tumors.
Reveal the correct answerIn a 65-year-old man with hypochromic anemia and an increased serum CEA level you should suspect:
- Agastric cancer.
- Bpancreatic cancer.
- Ccolon cancer.
- DA and B are true.
- Eliver cancer.
Reveal the correct answerChemotherapy in patients with non-small cell lung cancer (NSCLC):
- Ais an adjuvant postoperative therapy in early stage cancer.
- Bis used in combination therapy together with radiotherapy in locally advanced cancer.
- Cis a palliative treatment in generalized cancer disease.
- DA and C are true.
- EA, B and C are true.
Reveal the correct answerCholedocholithiasis symptoms may mimic:
1) perforated duodenal ulcer;
2) myocardial infarction;
3) acute pancreatitis from other causes;
4) acute intermittent porphyria;
5) right renal colic.
The correct answer is:
- A2,4.
- B1,2,4.
- C1,3,4.
- D2,3,4.
- Eall the above.
Reveal the correct answerRevised Jones criteria are used in the diagnosis for the rheumatic fever in children. Which of the following is not a major criterion?
- Aarthritis.
- BSydenham's chorea.
- Cerythema marginarum.
- Dsubcutaneous nodules.
- Efever.
Reveal the correct answerPharmacological treatment of primary hypertension in children and adolescents should begin in the case, with the exception of:
- Apresence of organ damage.
- Bsymptomatic hypertension.
- Ccoexistence of other diseases that increase cardiovascular risk (diabetes, hyperlipidemia).
- Dafter 1-3 months of ineffective non-pharmacological treatment in children with hypertension I° without organ damage.
- Eafter 3-6 months of ineffective non-pharmacological treatment in children with hypertension I° without organ damage.
Reveal the correct answerThe most common cause of the arrhythmias in children is:
- Ahipokalemia.
- Bhipermagnesemia.
- Cinfections.
- Dasphyxia.
- Emalnutrition.
Reveal the correct answerFor febrile convulsions the most characteristic features are:
- Amore often in girls.
- Bin children over 5 years.
- Cin children under 5 years.
- Din children under 6 months.
- Emore often complex convulsions.
Reveal the correct answerA premature born infant with body weight 1200 g has:
- Alow birth weight.
- Bvery low birth weight.
- Cextremely low birth weight.
- Dnormal birth weight.
- Esmall birth weight.
Reveal the correct answerThe most often pathogenic agent in pyelonephritis in infants is:
- AEscherichia coli.
- BPseudomonas aeruginosa.
- CKlebsiella pneumoniae.
- DStreptococcus pneumoniae.
- ERotavirus.
Reveal the correct answerRubella infection in pregnant woman after 16 weeks of pregnancy may cause in newborn:
- Aeye malformations.
- Bmalformations of urinary tract.
- Ccataracta.
- Dhearing loss.
- Eteeth abnormalities.
Reveal the correct answerYou will advice parents who have a child with gastroesophageal reflux:
- AAR milk
- BHA milk
- Csoy milk
- Donly breastfeeding
- Eaminoacid mixtures
Reveal the correct answerIn atypical pneumonia in children you will prescribe:
- Aaminoglycozides.
- Bpenicyllins.
- Cmacrolides.
- Dantibiotics are not needed.
- Ecefalosporins.
Reveal the correct answerHypoglycemia cannot be caused by:
- Aphysical strain.
- Binsulin overdose.
- C.C. malnutrition.
- Dadditional meal.
- Estress.
Reveal the correct answerThe most common malignant solid tumor occuring in infants is:
- Aneuroblastoma.
- Bretinoblastoma.
- Costeosarcoma.
- Dhepatoblastoma.
- Enephroblastoma.
Reveal the correct answerThe following associations are characteristic of childchood malignancies, except:
- Aacute myeloid leukemias and bleeding gums.
- Bneuroblastoma and raised urinary catecholamines.
- Costeosarcoma and tumor in upper end of the femur.
- Dhepatoblastoma and raised AFP (alpha- fetoprotein) in serum.
- Ebrain tumors and early morning vomiting.
Reveal the correct answerIn a 2 year old child with viral infection of the nasopharynx platelet counts is 770 thousands/ul:
- Aplatelet count is within normal values and does not require investigation.
- Bthis is reactive throbocytosis and does not require investigation.
- Cit is an indication for urgent haematological investigation.
- Dantiplatelets drugs should be used.
- Eall answers are false.
Reveal the correct answerMost common tumors diagnosed in teenagers are:
- Aosteosarcoma
- Bneuroblastoma
- CHodgkin lymphoma
- Dsoft tissue sarcomas
- Ecorrect answer is A and C
Reveal the correct answerSyndromes associated with Wilms tumor are:
- AWAGR.
- BBeckwith-Wiedemann.
- CDenys-Drash.
- DPerlman.
- Eall answers are correct.
Reveal the correct answerNeutropenia is not characteristic of:
- AEvans syndrome.
- BDiamond-Shwachman syndrome.
- Cprimary immune neutropenia.
- DKawasaki disease.
- EKostmann disease.
Reveal the correct answerFactors predisposing to thrombosis are:
- Apolycythemia.
- Bsteroid therapy.
- Chipofibrynogenemia.
- Dcorrect answer is A,B.
- Ecorrect answer is A,B,C.
Reveal the correct answerAcute life-threatening conditions that occur in pediatric oncology are:
- Atumor lysis syndrome.
- Bleukostasis.
- Cstatus epilepticus.
- Dileus.
- Eall answers are correct.
Reveal the correct answerThe least probable finding in megaloblastic anemia of childchood is:
- Afolic acid and/or Vit. B12 defficiency.
- Bhepatosplenomegaly.
- Cthrombocytosis.
- Dpsychomotor developmental delay.
- Elack of appetite, diarrhoea.
Reveal the correct answerIsolated prolongation of INR in a child with bleeding diathesis in the skin, we suspect:
- Aisolated factor VII deficiency.
- Bfactor VIII deficiency.
- Cvitamin K deficiency.
- Dplasma factor V deficiency.
- Evon Willebrand factor deficiency.
Reveal the correct answerGottron's sign is found in:
- Alocalized morphea.
- Batopic dermatitis.
- Cdermatomyositis.
- Dgeneralized morphea.
- ESchoenlein-Henoch purpura.
Reveal the correct answerMedications used for treatment of constipation in children do not include:
- Alactulose.
- Bmacrogol.
- Cbisacodyl.
- Dmetoclopramide.
- Eparaffin.
Reveal the correct answerThe cause of hypoglycaemia in children could be, except for:
- Agrowth hormone deficiency.
- Bexcess insulin.
- Cexcess glucagon.
- Dhypothyroidism.
- Eadrenocortical insufficiency.
Reveal the correct answerThe characteristic symptoms of metabolic syndrome include, except for:
- Atriglyceride above normal values and HDL below normal values.
- Blactose intolerance.
- Cfasting glucose above normal.
- Dincrease in blood pressure above normal.
- Eincreased waist circumference or BMI above normal.
Reveal the correct answerThe most common cause of chest pain in children is:
- Amusculoskeletal cause.
- Bgastrointestinal cause.
- Ccardiac cause.
- Drespiratory cause.
- Ezoster.
Reveal the correct answerChoose the false statement concerning scarlet fever:
- Arash is caused by streptococcal pyrogenic exotoxin.
- Bit is related to the Group A beta-hemolytic streptococcal infection.
- Cthe most intense lesions are found in the area around the mounth and naso-labial folds (Filatov triangle).
- Dthe rash forms the classic red streaks known as Pastia lines.
- Eform the second week desquamation (flakes peeling) appears.
Reveal the correct answerChoose the false statement concerning rubella (German measles):
- Arubella virus (RNA) is a member of the genus of Rubivirus and belongs to the family of Togaviridae.
- Brubella incubation period lasts 7 to 10 days.
- Cthe day before the rash, sub-occipital and posterior cervical lymphadenopathy appears - the nodes are painful.
- Dcomplications of rubella include: arthritis, hemorrhagic diathesis, rarely encephalitis.
- Evaccination (active immunisation) is used in prophylaxis.
Reveal the correct answerChoose the false statement concerning juvenile idiopathic arthritis:
- Adiagnosis of JIA can be established if symptoms occure in child before the age of 16 years.
- BJIA is a heterogeneous disease, with three basic types of onset: polyarticular, oligoarticular and systemic.
- Cin the course of JIA "acute phase" reactants could be elevated or normal.
- Dthe diagnosis of JIA is a contraindication to swimming in a pool.
- Ethe JIA etiology is unknown and the treatment symptomatic.
Reveal the correct answerA 25-year-old woman in 34 weeks gestation comes to the doctor's because of sudden, not very abundant and painless bleeding from the uterus which occurred at night. What procedure should the doctor perform?
- Ainternal pelvic examination in order to determine the cervical dilation.
- Bspeculum examination in order to locate the bleeding area and stop the bleeding.
- Cabdominal ultrasonography in order to determine the location of the placenta.
- Dtransvaginal ultrasonography in order to measure the FHR (fetal heart rate).
- Einternal pelvic examination and then abdominal ultrasonography in order to assess the risk of abortion.
Reveal the correct answerWhich of the following is used to estimate gestational age?
- AFHR (fetal heart rate) measurement in transvaginal ultrasonography.
- Bcalculations based on the date of the last menstrual period.
- CCRL (crown-rump length) measurement after 12 weeks' gestation.
- Devaluation of the placenta maturity grade.
- EB and C are true.
Reveal the correct answerA 17-year-old woman says that 6 days ago she had a sexual initiation. Neither she nor her partner used contraception, so she asks if she got pregnant. So far, her menstruation has been regular. What information will you provide her with?
- Athe woman is not pregnant because it is impossible to get pregnant during the first in life sexual intercourse.
- Bdepending on the phase of the menstrual cycle in which the sexual intercourse took place you will be able to exclude pregnancy (but you will not be able to confirm it).
- Cyou will advise her to perform a standard urine pregnancy test and depending on its result you will evaluate the probability of pregnancy.
- Dyou will perform transvaginal ultrasound examination in order to be able to confirm the pregnancy.
- Enone of the above is correct.
Reveal the correct answerIn pregnant patients vaginal and rectal swabs for Streptococcus agalactiae (GBS) screening should be taken:
- Ain 8 weeks gestation.
- Bbetween 11 and 14 weeks gestation.
- Cin 20 weeks gestation.
- Dbetween 24 and 28 weeks gestation.
- Ebetween 35 and 37 weeks gestation.
Reveal the correct answerWhich of the following is a symptom suggestive of Mayer-Rokitansky-Kuster syndrome?
- Aprecocious puberty.
- Bhirsutism.
- Cprimary amenorrhea.
- Dabsence of secondary sexual characteristics.
- Edelayed puberty.
Reveal the correct answer- Amonochorionic monoamniotic pregnancy.
- Bmonochorionic diamniotic pregnancy.
- Cdichorionic monoamniotic pregnancy.
- Ddichorionic diamniotic pregnancy.
- EB or D are true.
Reveal the correct answerAccording to Modified White Classification of Diabetes the onset of the disease at the age of 20 or older and/or the duration of less than 10 years is class:
- AA.
- BB.
- CC.
- DD.
- ER.
Reveal the correct answerWhich of the following is the most common complication of sudden elevation of arterial blood pressure in a pregnant woman:
- Aplacental abruption .
- Bfetal cerebral edema.
- Cpulmonary edema.
- Dpostpartum uterine atony .
- EMendelson's syndrome.
Reveal the correct answerA 24-year-old woman complains on irregular vaginal bleeding 3 months after parturition. The examination shows the body of the uterus of normal size and painless, the vaginal part of the cervix is formed, the canal is closed. Which of the following examinations should be first performed?
- Aprogesterone concentration.
- Bβ-hCG concentration.
- CD&C (dilation and curettage).
- DFSH and LH concentrations.
- EDoppler spectrum of uterine arteries.
Reveal the correct answerWhich of the following is used in the prophylaxis of neural tube defects:
- Afolic acid.
- Bvitamin A.
- Cvitamin D.
- Dvitamin E.
- Evitamin K.
Reveal the correct answerGregg's triad represents the syndrome of congenital defects associated with viral intrauterine infection caused by:
- Acytomegaly.
- Brubella.
- Cchickenpox.
- Dmeasles.
- Emumps.
Reveal the correct answerHow much immunoglobulin-D will you give for an A Rh(-) woman who gave birth by caesarian section to an A Rh(+) child and hasn't got immunity antibodies?
- A50 µg.
- B75 µg.
- C100 µg.
- D150 µg.
- E300 µg.
Reveal the correct answerWhich of the following are the risk factors for endometrium cancer:
1) obesity;
2) PCOS;
3) diabetes;
4) hypertension;
5) nulliparity;
6) late menopause.
The correct answer is:
- A1,2,3,5.
- B1,3,4,5.
- C1,3,4,5,6.
- D2,4,5,6.
- Eall the above.
Reveal the correct answerDelayed puberty in girls is diagnosed when no somatic and hormonal changes occur after the age of:
- A10.
- B13.
- C15.
- D17.
- E18.
Reveal the correct answerThe mechanism of labor comprises four maneuvers of the fetus, which it performs in order to adapt to the space conditions during its way out through the birth canal. The third head maneuver is the following one:
- Ahead rotation from the transverse dimension into the straight conjugate.
- Bhead flexion.
- Chead rotation toward one of the woman's thigh.
- Dhead extension.
- Eactive descent through the birth canal.
Reveal the correct answerThe most frequent causes of the first trimester spontaneous miscarriage include:
- Acongenital uterus malformations.
- Bcorpus luteum insufficiency.
- Cgenetic causes.
- Dautoimmune causes.
- Einfections.
Reveal the correct answerWhich of the following is the most accurate method age of pregnancy assessment?
- ANaegele's rule.
- BCRL measurement during ultrasound performed between the week 7th and 11th.
- Cultrasound measurement of four parameters, independent of gestational age.
- Dpalpation of the uterus fundus height.
- Emeasurement of the beta-hCG serum level.
Reveal the correct answerThe most common neoplastic marker characteristic of ovarian cancer is CA 125. An increased CA 125 level occurs also in:
- Apancreatic cancer.
- Bendometriosis.
- Cadnexitis.
- Duterine leiomyomas.
- Eall the above.
Reveal the correct answerWhich of the following can inhibit uterus contractions?
- Aprogesterone.
- BACTH.
- Cprostaglandins.
- DA, B are true.
- EA, B and C are true.
Reveal the correct answerWhich of the following contraceptive methods has the lowest expectedPearl Index ?
- Acondom.
- Bcalendar method.
- Ccombined oral contraceptive pill.
- Dintrauterine device.
- Espermicides.
Reveal the correct answerWhich of the following concerning PCOS (polycystic ovary syndrome) is true?
1) it is a risk factor for endometrial cancer;
2) glucose disorders affect approx 40% of PCOS patients;
3) fertility of PCOS patients is similar to the fertility of healthy women;
4) elevated serum androgens and the clinical symptoms of androgen excess are characteristic features of PCOS;
5) increased FSH to LH ratio is characteristic of PCOS.
The correct answer is:
- A4,5.
- B3,4,5.
- C1,2,4
- D1,2,3
- E1,2,4,5
Reveal the correct answerWhich dose of folic acid is recommended in a woman who delivered a child with a neural tube defect in the past?
- A0.4 mg daily.
- B1.4 mg daily.
- C4 mg daily.
- D14 mg daily.
- E40 mg daily.
Reveal the correct answerAccording to WHO (World Health Organization) a premature birth is declared as such if it happens:
- Abefore 22 weeks pregnancy.
- Bbetween 22 and 34 weeks pregnancy.
- Cbetween 22 and 36 weeks pregnancy.
- Dbetween 22 and 37 weeks pregnancy.
- Ebefore 41 weeks pregnancy.
Reveal the correct answerThe fetus position means:
- Aorientation of fetus parts relative to the pelvis of the mother.
- Bratio of the long axis of the fetus and the long axis of the pelvis of the mother.
- Corientation between fetus parts.
- Dratio of the fetus head and trunk.
- Eorientation of the presenting fetus part relative to interspinous distance.
Reveal the correct answerEndometriosis should be taken into consideration in the following states:
1) pelvic pain syndrome;
2) dyspareunia;
3) ascites;
4) decreased fertility;
5) mixed urine incontinence.
The correct answer is:
- A1,2,3.
- B2,3,4.
- C3,4,5.
- D1,3,5.
- E1,2,4.
Reveal the correct answerThe differential diagnosis of ectopic pregnancy includes:
1) acute pancreatitis;
2) pneumonia;
3) salpingitis;
4) ovary tumor rupture;
5) adnexal torsion.
The correct answer is:
- Aall the above.
- B1,3,4.
- C3,4,5.
- D1,4,5.
- E1,2,3.
Reveal the correct answerCannabinoids act in the brain mainly through:
- Aenhancement of dopamine release.
- Breduction of dopamine release.
- Cenhancement of serotonine release.
- Dreduction of serotonine release.
- Eenhancement of noradrenaline release.
Reveal the correct answerSyndrome including various somatic and psychiatric symptoms which appear a couple of hours after cessation of alcohol drinking, is called:
- Adelirium.
- Bamnestic syndrome.
- Cabstinence syndrome.
- Ddelusional syndrome.
- EOtello's syndrome.
Reveal the correct answerThe diagnosis of schizophrenia is made mainly on the basis of presence og “4 A” symptoms, which include:
- Aambi (-valence, -sentence, -tendence) and automatism.
- Bautism and automatism.
- Cautomatism and association.
- Dambi (-valence, -sentence, -tendence) and autism.
- Eambi (-valence, -sentence, -tendence).
Reveal the correct answerFor the diagnosis of paranoia is essential the presence of:
- Adelusions and verbal hallucinations.
- Bverbal imperative hallucinations.
- Cthe feeling of being persecuted.
- Dsystematized delusions.
- Edelusional mood and anxiety.
Reveal the correct answerThe mood disorders characteristic for depression have two aspects. The first aspect is the feeling of sadness and gloom. Which is the second aspect?
- Ainability to concentrate
- Binability to enjoy life
- Clack of motivation
- Dloss of libido
- Eanxiety
Reveal the correct answerThe most frequent factor predicting the suicide is the presence of:
- Aalcohol abuse
- Bmental disorders
- Cabuse of stimulant substances
- Dsuicide in patients' family
- Eloneliness
Reveal the correct answerFor the diagnosis of bipolar affective disorder it is mandatory to diagnose in the course of the disorder:
- Aone depressive episode during the antipsychotic treatment.
- Bmultiple depressive episodes.
- Cmanic episode.
- Dmultiple manic episodes.
- Eall of above.
Reveal the correct answerThe antipsychotic treatment of schizophrenic pregnant women is:
- Athe treatment of choice in chronic schizophrenia.
- Bthe last option in the case of the failure of other therapeutic methods.
- Cthe treatment of choice in the presence of catatonic symptoms.
- Dharmless to the fetus.
- Eabsolutely contraindicated.
Reveal the correct answerAnxiolytic use of hydroxizine is limited because of its:
- Adependence potential.
- Black of sedation.
- Caffinity to the H1 receptor causing drowsiness.
- Danswers A and B are correct.
- Eanswers A,B and C are correct.
Reveal the correct answerWhich of the following is not the absolute contraindication for the electroconvulsive therapy?
- Asevere cardio-vascular disease.
- Bintense suicidal thoughts and tendencies.
- Cintracranial aneurism.
- Drecent brain infarct.
- Edecompensated diabetes.
Reveal the correct answerA 30-years old man who - because of love affair - has threatened to commit suicide and has begun the preparation for it has been brought by the police to the Emergency Room of a psychiatric hospital. The man has not been previously treated because of mental problems and does not give his consent for admission to the psychiatric hospital. What should be the correct decision of the physician from the Emergency Room (according to Polish Mental Health Act)?
- Ato admit the patient because he is “mentally ill”
- Bto refuse the admission because the patient is not “mentally ill”
- Cto refer the patient to the out-patient psychiatric care
- Dto admit the patient in order to clarify whether he is “mentally ill”
- Eto ask for the advice of another physician because the involuntary admission to the psychiatric hospital requires the decision of two psychiatrists
Reveal the correct answerBefore large surgery on gastrointestinal tract the prophylaxis of thromboembolism and the antimicrobial prophylaxis should be used, because these operations are associated with a high risk of bleeding, and the hospital flora is drug-resistant.
- Athe first and the second sentences are true and there is a logical connection between them
- Bthe first and the second sentences are true, but there is no logical connection between them
- Cthe first sentence is true, the second sentence is false
- Dthe first sentence is false, the second sentence is true
- Eboth sentences are false
Reveal the correct answerIn order to assess the capacity and patency of the deep and superficial veins of the lower limbs we can do:
1) Trendelenburg test;
2) Perthes test;
3) Adson test;
4) compression ultrasonography;
5) venography.
The correct answer is:
- A1,2.
- B1,2,4,5.
- C3,4,5.
- D1,4,5.
- Eall above.
Reveal the correct answerIn patient with acute biliary pancreatitis the recommended treatment is:
- Afirst, conservative treatment. After 7 days performance of endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and implantation of self-expanding prosthesis into the Wirsung 's duct.
- Bemergency laparotomy, cholecystectomy with biliary revision.
- Cpercutaneous biliary drainage.
- Demergency or early (within 24 hours) endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is the recommended treatment.
- Eacute pancreatitis is always treated conservatively.
Reveal the correct answerThe most common cause of the upper gastrointestinal tract hemorrhage is:
- Agastric ulcer.
- Besophageal varices.
- Cduodenal ulcer.
- Dgastric cancer.
- EMallory - Weiss syndrome.
Reveal the correct answerSymptoms of sigmoid cancer:
1) blood in the stool
2) alternating constipation and diarrhea
3) anemia
4) cachexia
5) narrow stools
The correct answer is:
- A1, 2, 4
- B1, 2, 3
- C1, 2, 5
- D2, 3, 5
- E2, 3, 4
Reveal the correct answerWhile examining electrocuted patient you should remember that:
- Atissue damage appear at the place where the current comes in.
- Bextension of skin burns may tell us about degree of inner tissue damage.
- Cthe patient may develop acute kidney failure.
- Dextra-low voltage does not cause cardiac arrhythmias.
- Edamage caused by thermal burns are greater than the damage caused by electric shock.
Reveal the correct answerFemoral neck fracture in the elderly may be life threatening due to the complications of immobility such as:
1) thrombosis;
2) pulmonary embolism;
3) urinary tract infection;
4) cardiac arrhythmias;
5) ascites.
The correct answer is:
- A1, 2, 3.
- B3, 4.
- C1, 2.
- D1,2,4.
- Eall the above.
Reveal the correct answerDuring the diagnosis of acute abdominal symptoms:
- Aabdominal X-ray examination is always performed as the first one.
- Babdominal X-ray is very useful in suspected gastrointestinal perforation and intestinal obstruction.
- Cabdominal ultrasound allows to determine the presence of fluid in the abdominal cavity above the amount of 500ml.
- Din the presence of intra-abdominal abscess in the first place abdominal CT scan should be performed, followed by abdominal ultrasound to visualize more details.
- Eto illustrate the complications of an aortic aneurysm the only useful examination is Doppler ultrasound.
Reveal the correct answer65-year old patients was admitted by a surgeon due to episodes of fresh blood in stool, weight loss and pencil-like stools. In DRE surgeon revealed infiltration in anal canal so he took biopsy and got endorectal ultrasound (ERUS) done. ERUS revealed infiltration through all layers of bowel wall but without infiltration of anal sphincters, in addition two metastatic lymph nodes were described in perirectal tissues. The histologic examination of biopsy specimen revealed adenocarcinoma. Choose the best treatment option for this patient:
- Aradical radiochemotherapy.
- Bneoadjuvant radiotherapy then surgery.
- Cneoadjuvant chemotherapy then surgery.
- Dsurgery without preoperative treatment.
- Ebrachytherapy then chemotherapy.
Reveal the correct answerAbsolute indications for amputation - select the false sentence:
- Anecrolysis in diabetic foot.
- Bmassive crushing limbs.
- Cextensive purulent wounds.
- Dgas gangrene when other treatments fail.
- Ecritical limb ischemia when other methods of treatment fail.
Reveal the correct answerWhat is the most common extratestinal manifestation of Crohn disease?
- Adermatitis.
- Beye disorders.
- Cliver and bile ducts disorders.
- Darthritis.
- Epancreas disorders.
Reveal the correct answerPharyngoesophageal diverticulum (Zenker's diverticulum) is:
1) the most frequent esophageal diverticulum;
2) caused mainly by the disorder of relaxation of upper esophageal sphincter;
3) may cause complete esophageal obstruction;
4) may cause Mendelson's syndrome;
5) may cause hoarseness when large.
The correct answer is:
- A1, 2, 4.
- B2, 3, 5.
- C1, 2, 3.
- D1,4,5.
- Eall the above.
Reveal the correct answerNutritional treatment should be started:
- Ain critically ill patients when planned starvation is going to last more than 5 days.
- Bwhen there is no effective oral nutrition for 7-10 days.
- Cin patients with cachexia when oral nutrition is not possible or it does not cover daily requirements.
- Dtrue answers: A and C.
- Etrue answers: A, B, C.
Reveal the correct answerPartial nail fold removal for the treatment of the first right toe paronychia should be performed:
- Ain block anesthesia (Oberst's method).
- Bin local anesthesia - conduction anesthesia.
- Cwith locally applied ethyl chloride.
- Dtrue answers: B and C.
- Eanesthesia is not required.
Reveal the correct answerCholecystolithiasis may cause obstruction of gastrointestinal tract because the large gallstone can get through the fistula into the small intestine and stop at the ileocecal valve (Bauhin's valve).
- Atheorem is true, rationale is false.
- Btheorem is false, rationale is true.
- Cboth theorem and rationale are false.
- Dboth theorem and rationale are true, but there is no cause-effect relationship.
- Eboth theorem and rationale is true, and there is a cause-effect relationship.
Reveal the correct answerIndicate the set of features characteristic of Crohn’s disease:
1) lesions can be observed in each part of the gastrointestinal tract;
2) lesions are limited to the mucosa and submucosa only;
3) perianal fistulas are frequently observed in the course of the disease;
4) surgical treatment of the disease is based on the principle of conserving surgery;
5) excessive resection is preferred in surgical treatment of the disease.
The correct answer is:
- A1, 2, 4.
- B1,3,4.
- C2, 3, 5.
- D2, 3, 4.
- E1,3,5
Reveal the correct answerCurrent recommendation for the surgical treatment of inguinal hernia include the implementation of alloplasty with the use of synthetic mesh, because this tension-free repair is characterized by a smaller number of infectious complications.
- Atheorem is true, rationale is false.
- Btheorem is false, rationale is true.
- Cboth theorem and rationale are false.
- Dboth theorem and rationale are true and there is a cause-effect relationship.
- Eboth theorem and rationale are true, but there is no cause-effect relationship.
Reveal the correct answerAcute appendicitis:
1) can occur at any age;
2) can be treated with laparoscopic surgery;
3) starts with heavy vomiting;
4) is caused by E. coli infection;
5) accompanies upper respiratory tract infections.
The correct answer is:
- A1, 2.
- B1, 3, 5.
- C3, 4, 5.
- D2, 4.
- E1, 5.
Reveal the correct answerPerforation of gastric or duodenal ulcer:
1) causes hematemesis;
2) gives peritonitis symptoms;
3) needs urgent surgery;
4) occurs most frequently in men;
5) is diagnosed with the gastric endoscopy.
The correct answer is:
- A1, 2, 4.
- B2, 3, 4.
- C3, 4, 5.
- D1, 2, 5.
- E1, 3, 5.
Reveal the correct answerSigmoid diverticulitis gives the following symptoms:
1) pain in left lower quadrant;
2) blood in the stool;
3) painful resistance above the left lower quadrant;
4) persistent diarrhea;
5) narrow stools.
The correct answer is:
- A1,2.
- B2,3.
- C3,4.
- D1,3.
- E1,5.
Reveal the correct answerFelon:
1) is an infection located on the palmar surface of fingers and metacarpus;
2) is an infection located on the plantar surface of a foot;
3) its treatment is based on antibiotics and immobilization;
4) its treatment is based on incision, drainage and immobilization;
5) it is caused by trauma.
The correct answer is:
- A1,3,5.
- B1,4,5.
- C2,3,5.
- D2,4.
- E2,4,5.
Reveal the correct answerHernias in surgical scar:
1) are the result of an abscess located in surgical incision;
2) should be treated with hernia belt;
3) can become a place of bowel incarceration;
4) should be treated with tension-free surgical repair;
5) can frequently cause gastrointestinal bleeding.
The correct answer is:
- A1,2,5.
- B1,3,4.
- C1,4,5.
- D1,3,5.
- E1,2,3.
Reveal the correct answerThe most frequent causes of acute pancreatitis:
1) alcoholic hepatic cirrhosis;
2) vitamin A deficiency;
3) alcohol ingestion;
4) excess carbohydrates in food;
5) choledocholithiasis.
The correct answer is:
- A1,2.
- B2,3.
- C1,3.
- D4,5.
- E3,5.
Reveal the correct answerIn pancreatic head cancer:
1) there is mechanical jaundice;
2) empyema of gallbladder develops;
3) coffee-grounds vomiting appears;
4) intrahepatic and extrahepatic ducts are being expanded;
5) portal hypertension occurs.
The correct answer is:
- A1,4.
- B1,5.
- C2,4.
- D4, 5.
- E2,3.
Reveal the correct answerWhich of the following is not a risk factor for thromboembolic disease?
- ABMI 30 kg/m2.
- Bmalignancy.
- Cpregnancy.
- Dmicrocytic anemia.
- Eairplane flight above 6 hours.
Reveal the correct answerA patient, who had removed a tick from his arm the previous day, has visited his/her GP. Which of the following do describe the correct doctor's approach?
- Aobservation for possible Lyme disease symptoms.
- Bsingle oral application of 100 mg doxycycline.
- Crecommendation to take amoxicillin 500 mg three times per day for 14-21 days.
- Drecommendation to take doxycycline 100 mg twice daily for 14-21 days.
- Erecommendation to take azithromycin 500 mg once daily for 14-21 days.
Reveal the correct answerIn the community acquired pneumonia of adults, the outpatient drug of first choice is:
- Aamoxicillin.
- Bamoxicillin with clavulanic acid.
- Cmacrolide.
- Dcephalosporin.
- Ebenzylpenicillin.
Reveal the correct answerPhysical exam of the patient reveals over the lung deadened tone on percussion, fremitus more pronounced, rales. These symptoms may suggest:
- Aobstructive atelectasis.
- Blung fibrosis.
- Clung infiltration.
- Dpneumothorax.
- Eairways obstruction.
Reveal the correct answerWhich of the following parameters is not included in SCORE scale?
- Aage.
- Bgender.
- Ctotal cholesterol level.
- Dglucose level.
- Esystolic blood pressure.
Reveal the correct answerWhich of the Lyme disease symptoms does not need laboratory confirmation of infection?
- Aerythema migrans.
- Blymphocytic leukemia.
- Cchronic atrophic dermatitis of extremities.
- Darthritis.
- Emyocarditis.
Reveal the correct answerOrthostatic hypotension can be diagnosed when during a 3-minutes tilting test:
- Aat least 20 mmHg drop of systolic blood pressure is noted
- Bat least 10 mmHg drop of diastolic blood pressure is noted
- Csystolic blood pressure drops below 90 mmHg.
- DA, B are true
- EA, B and C are true
Reveal the correct answerEosinophilia > 1500/µl on peripheral blood count can be caused by:
- Aallergy.
- Bparasitic diseases.
- CHodgkin's disease.
- DA, B are true.
- EA, B and C are true.
Reveal the correct answerWhich of the following is recommended for the rhythm control in atrial fibrillation with concomitant heart failure?
- Abeta blockers.
- Bdigoxin.
- Cverapamil.
- DA, B are true.
- EA, B and C are true.
Reveal the correct answerScreening for gestational diabetes should be performed at:
- A10th - 16th week of pregnancy.
- B20th - 24th week of pregnancy.
- C24th - 28th week of pregnancy.
- D28th - 32nd week of pregnancy.
- E16th - 20th week of pregnancy.
Reveal the correct answerIndicate which of the following statements is false:
- AEpstein Barr virus is an etiological factor of infectious mononucleosis.
- Brubella gives a lifelong immunity in most cases.
- Cpatient with measles can be infectious to the others from the moment of the rash occurrence till its disappearance.
- Dmumps is symptomless in 20-30% of cases.
- Efacial nerve paralysis can be a complication of shingles.
Reveal the correct answerWhich of the following interventions in COPD patients can reduce the risk for disease development and partially stop its progression?
- Asmoking cessation.
- Bregular physical activity.
- Cregular sanatorium treatment.
- Dannual flu vaccination.
- Eall the above.
Reveal the correct answerAbnormal health conditions are considered vaccination-associated reactions (except after BCG vaccine) when occur within:
- A4 weeks after the vaccination.
- B6 weeks after the vaccination.
- C8 weeks after the vaccination.
- D3 months after the vaccination.
- E6 months after the vaccination.
Reveal the correct answerSide effect typical of DTP vaccine (diphtheria, tetanus and pertussis) is:
- Athrombocytopenia.
- Borchitis.
- Cinflammation of salivary glands.
- Darthritis (usually of small joints of hands and feet).
- Ehypotonic-hyporesponsive episode.
Reveal the correct answerWhich of the following scales is used to assess the stage of puberty in children, youth and adults on the basis of morphological features, the genitals and breasts?
- ATanner.
- BApgar.
- CGlasgow.
- DSchmidt.
- ESCORE.
Reveal the correct answerGlycemic goal criteria in adults with type 1 diabetes and short-term type 2 diabetes (below 5 years of diabetes) comprise HbA1c level of:
- A<= 6.1%.
- B<= 6.5%.
- C<= 7.0%.
- D<= 5.5%.
- E<= 6.0%.
Reveal the correct answerRisk factor for chronic venous insufficiency is:
- Afemale gender.
- Bpregnancy.
- Cobesity.
- Dstanding or sitting position during working hours.
- Eall the above.
Reveal the correct answerWhich of the following is recommended in a patient on chronic vitamin K antagonist (VKA) therapy with INR > 4.5 but < 6.0, and no bleeding signs?
- AVKA withdrawal till INR drops to 2.0-3.0 (usually 1-2 days).
- BVKA withdrawal for 5-10 days and 2 mg of oral vitamin K.
- CVKA withdrawal for 5-10 days and 5-10 mg of oral vitamin K.
- DVKA withdrawal for 5-10 days and slow drip of 5-10 mg of vitamin K.
- Emaintain the existing dose of VKA and give orally 5 mg of vitamin K till INR reaches 2.0-3.0.
Reveal the correct answerDuration of amoxicillin treatment of uncomplicated acute otitis media in children under 2 years of age should be:
- A3 days.
- B5 days.
- C7 days.
- D10 days.
- E14 days.
Reveal the correct answerWhich of the following drug is recommended for the indefinite anti-platelet therapy in patients after acute myocardial infarction, in case of aspirin intolerance or contraindications to its use?
- Aclopidogrel.
- Bprasugrel.
- Crivaroxaban.
- Ddabigatran.
- Elow weight heparin.
Reveal the correct answerThe gold standard for the treatment of ventricular tachycardia is:
- Afast application of antiarrhytmic drugs.
- Bpercutaneous stimulation.
- Cthe treatment of the underlying cause because most of tachyarrhytmias can accompany various pathological conditions.
- Dcardioversion.
- Edefibrillation.
Reveal the correct answerIn paroxysmal atrial fibrillation rhythm control therapy should not be implemented because of the embolic complications risk in the following situation:
- Aif symptoms last more than 3 days.
- Bif symptoms last more than 2 days.
- Cif symptoms last more than 24 hours.
- Dattempt for rhythm control restoration is always necessary in paroxysmal atrial fibrillation.
- Ein patients age 60 and more there is low embolic complications risk.
Reveal the correct answerWhich of the following drugs are applied together with defibrillation in the treatment of ventricular fibrillation acc. to ALS?
- Aatropine, sodium bicarbonate.
- Badrenaline, amiodarone, magnesium sulfate.
- Catropine, sodium bicarbonate, magnesium sulfate.
- Datropine, amiodarone, hydrocortisone.
- Eadrenaline, calcium chloride, vasopressin.
Reveal the correct answerSymptoms indicating a stroke should be first differentiated from:
- Ahypokalemia.
- Bpulmonary embolism.
- Chypoglycemia.
- Dmyocardial infarction.
- Epneumonia.
Reveal the correct answerPlease indicate true statement about Barlow syndrome:
- Ait is a syndrome of the aortic valve prolapse.
- Bit is a syndrome of mitral valve prolapsed.
- Cuncomplicated Barlow syndrome does not need hospital admission.
- Don physical examination there is audible mid-systolic click with subsequent murmur best heard over the apex.
- Etrue statements are: B, C, D.
Reveal the correct answerPulmonary hemorrhage means:
- Aexpectoration of more than 100 ml of blood hourly or over 300-500 ml daily.
- Bexpectoration of approx. 50 ml of blood hourly or approx. 100-200 ml daily.
- Csingle expectoration of 500 ml of blood.
- Dhemoptysis at least 10 times daily.
- Enone of the answers is true.
Reveal the correct answerPlease indicate true statement about acute respiratory failure:
- Agas exchange disorder leads to hypoxemia, ventilation disorder leads to hypercapnia
- Bgas exchange disorder leads to hypercapnia, ventilation disorder leads to hypoxemia
- Cgas and ventilation disorder mean the same, and the hypercapnia develops secondary to hypoxemia
- Dhypoxemia is always associated with non-respiratory acidosis
- Ehypoxemia gives increased patient's drowsiness until coma
Reveal the correct answerPulse oximeter readings may be wrongly underestimated in the case of:
- Acyanide poisoning.
- Bhypovolemic shock.
- Ccarbon monoxide poisoning.
- Djaundice.
- Eall the above answers are true.
Reveal the correct answerIndication for electrical cardioversion is:
- Ahemodynamically unstable supraventricular tachycardia.
- Bevery ventricular tachycardia.
- Cthird degree atrioventricular block.
- Dpermanent atrial fibrillation.
- Eventricular tachycardia without a pulse.
Reveal the correct answerImmediate treatment of tension pneumothorax comprises cannula puncture in the following chest area:
- AIV intercostal space (above rib V) in midclavicular line.
- BIII intercostal space (below rib III) in midclavicular line.
- CII intercostal space (above rib II) in anterior axillary line.
- DIV intercostal space (below rib V) in midaxillary line.
- EII intercostal space (above rib III) in midclavicular line.
Reveal the correct answer40-years-old patient with cranio-cerebral damage presents flexion response to pain, does not open eyes and makes no sounds. How many points he/she gets on Glasgow scale:
- A8 points.
- B7 points.
- C6 points.
- D5 points.
- E4 points.
Reveal the correct answerOne of the indications for orotracheal intubation is to get on the Glasgow scale which of the following number of points:
- A12 points.
- B10 points.
- C9 points.
- D8 points.
- Enecessity for intubation is not connected with the number of points on Glasgow scale.
Reveal the correct answer30-years-old patient admitted to the ER after traffic accident presents rapid breathing, prolonged capillary return, pale skin, pulse 110/minute, arterial blood pressure 110/80 mmHg with decreased pulse amplitude. You should diagnose:
- Aclass I of hypovolemic shock.
- Bclass II of hypovolemic shock.
- Cclass III of hypovolemic shock.
- Dclass IV of hypovolemic shock.
- Enormal status - shock is not suspected.
Reveal the correct answerCardiopulmonary resuscitation should not be attempted if:
- Ajustified decision to discontinue resuscitation was made before cardiac arrest happened.
- Bbringing the patient back to life is not possible due to patient's condition and presence of comorbidities.
- Ccancer disease is diagnosed in a patient.
- Dtrue answers: A and B.
- Etrue answers: A, B, C.
Reveal the correct answerEtomidate is intravenous anesthetic indicated when necessary in the following patients:
- Awith hypotension
- Bpregnant
- Cwith increased intracranial pressure
- Dwith arterial hypertension
- Enone of the answers is correct
Reveal the correct answerComplications of CPR comprise:
- Arib fractures.
- Bsternum fractures.
- Chemorrhage into the pericardium.
- Dstomach rupture.
- Eall the answers are true.
Reveal the correct answerThe most frequent etiological pathogen of infectious endocarditis is:
- Astreptococci, staphylococci, enterococci.
- Bviruses.
- Crods, bacilli.
- Dmycobacteria.
- Enone of the above.
Reveal the correct answerGlucagon is a drug used, among others, in:
- Ahyperglycemia.
- Bhyperkalemia.
- Cbeta-blockers intoxication.
- Damanita phalloides poisoning.
- Ehyperkalcemia.
Reveal the correct answer68 year old female patient diagnosed with paranoid schizophrenia and mild dementia turned to endocrinologist asking for transvaginal examination, because she will soon gibe birth, threatening suicide if they refuse. According to Polish Medical Ethics Code endocrinologist should:
- Aperform the required examination.
- Bpropose a patient to increase the dose of antipsychotic medications.
- Crefer patient to a psychiatric outpatient clinic.
- Dimmediately consult a psychiatrist.
- Erefuse treatment if the patient does not have a endocrinological problem.
Reveal the correct answerA patient's husband came to the doctor. He brought his wife's results of the diagnostic tests and asked the doctor for prescription drugs and a certificate of temporary incapacity to work for his wife. What should the doctor do?
- Ahe is not allowed to issue the prescription without personal examination of the patient, but he is allowed to issue the certificate.
- Bhe is allowed to issue the prescription, but should refuse to issue the certificate without personal examination of the patient.
- Che is allowed to issue the prescription and certificate if he considers that the diagnostic test results were prepared by an authorized entity.
- Dhe is allowed to issue the prescription and certificate if the provision of the health care benefit is not financed from public resources.
- Ehe is not allowed to issue the prescription and certificate without personal examination of the patient.
Reveal the correct answerPolish Code of Medical Ethics regulating the behaviour of doctors in the modern world directly relates to:
- Ainternet.
- Bsocial portal.
- Ctherapeutic cloning.
- Danswers A,B,C are true.
- Eanswers A,B,C are false.
Reveal the correct answerThe doctor received by one of the social networking sites symptoms, test results and the photos of skin 34 year old woman indicating the systemic lupus erythematosus. In accordance with the Polish Code of Medical Ethics he/she should:
- Apropose a visit to his/her office for two months.
- Bcommunicate his/her opinion to this woman through the Internet and recommending the drugs an online pharmacy.
- Ccommunicate his/her opinion to this woman through the internet recommending a visit to the doctor.
- Dcommunicate all suggestions on the portal.
- Erefer the matter to the Patient Ombudsman.
Reveal the correct answerIn what circumstances, according to the Polish Code of Medical Ethics, the doctor should sustain the functioning of cells, tissues and organs after the declaration of brain death?
- Aif they are to be examined.
- Bif they are to be transplanted.
- Cif they are not to be transplanted.
- Dif required by the CPR.
- Eafter the CPR.
Reveal the correct answerThe Law on medical activity provides for the possibility of requiring a doctor to perform co-called telephone duty, or standby to provide health services:
1) only specialists can be committed for such duty;
2) order to perform such duty can be issued only in the event of natural disasters;
3) for each hour of such duty a doctor is entitled to remuneration in the amount of 50% of hourly basic salary;
4) duration of such duty shall not exceed three hours for 24 hours;
5) employees with higher education who perform medical profession, and are employed in the hospital can be committed for such duty.
The correct answer is:
- A3,4.
- B1,3.
- C2,3.
- D3,5.
- E4, 5.
Reveal the correct answerThe doctor fill out the death certificate of:
- Athe deceased; at the request of their close persons within the meaning of the Act on Patients' Rights and the Ombudsman for Patients' Rights.
- Bstillborn children, irrespective of the duration of gestation, in each case.
- Cstillborn children, irrespective of the duration of gestation, on a proposal from the persons entitled to give the burial.
- Dstillborn children if the gestation lasted at least 22 weeks.
- Ethe deceased; at the request of the registry office or cemetery administration.
Reveal the correct answerDuring an operation on a patient under general anesthesia a new circumstance occurs, namely a need to expand the operating field. Before the operation the patient, who is of legal age and capacitation, expressed neither his consent nor objection to that. Such an operation is permissible if:
1) doctor obtains consent of the legal representative of the patient;
2) patient's close person expresses their consent;
3) excluding this new circumstance would threaten patient's life, cause severe body injury or health dysfunction;
4) doctor, if possible, consults another doctor of the same as far as possible specialty;
5) only if there is a direct threat to the life of the patient.
The correct answer is:
- A1,2.
- B3,4.
- C2,4.
- D4,5.
- E1,5.
Reveal the correct answerDoes the Polish Code of Medical Ethics include an article concerning human cloning?
- Ayes, the Code prohibits the doctor from cloning humans.
- Bno, the Code does not regulate this issue.
- Cyes, the Code allows therapeutic cloning.
- Dyes, the Code allows cloning for reproductive purposes.
- Eyes, the Code recommends that the doctor should do it.
Reveal the correct answerIn accordance with the Law on an old age and a disability pension from the Social Insurance Fund (ZUS) a person, who has suffered the impairment of the body, is considered unable to live independently if they require:
- Aassistance in daily activities.
- Bcare in the acute phase of the disease.
- Cassistance in dealing with administrative matters.
- Dpermanent or long term care of another person in meeting basic needs.
- Elegal guardian appointed by the court.
Reveal the correct answerThe rulings on disability and the degree of disability are issued by:
- ASIF (ZUS) certifying doctors and SIF (ZUS) medical boards.
- BASIF (KRUS) certifying doctors and ASIF (KRUS) medical boards.
- Cdistrict and provincial Disability Adjudication Boards.
- DMinistry of Internal Affairs (MSW) medical boards.
- Emilitary medical boards.
Reveal the correct answerThe insured person is entitled to appeal to SIF (ZUS) medical board against the ruling of SIF (ZUS) certifying doctor within the following period of the receipt of the decision:
- A30 days.
- B14 days.
- C7 days.
- D5 days.
- E3 days.
Reveal the correct answerIn accordance with the Law on an old age and a disability pension from the Social Insurance Fund (ZUS), incapacity to work for the pension purposes is ruled for the period not longer than:
- A1 year.
- B2 years.
- C3 years.
- D4 years.
- E5 years.
Reveal the correct answerSocial pension is not granted if total incapacity to work resulted from the impairment of the body occurred:
- Aduring employment.
- Bduring scientific postgraduate studies.
- Cduring doctoral studies.
- Dduring high school or university period before the age of 25 years.
- Ebefore the age of 18 years.
Reveal the correct answerThe medical ruling on temporary incapacity to work is issued with two copies. The doctor issuing the ruling provides its first copy for:
- Alocal branch of SIF (ZUS).
- Bheadquarters of SIF (ZUS).
- Cinsured person.
- DNational Health Fund (NFZ).
- Eemployer.
Reveal the correct answerThe doctor issuing a ruling on temporary incapacity to work is required to store its second copy for:
- A7 years.
- B5 years.
- C3 years.
- D1 year.
- Ehalf a year.
Reveal the correct answerAccording to UN experts the population exceeds the threshold of old age at a time when:
- Apercentage of people aged 65 years is at 3%.
- Bpercentage of people aged 65 years is at 7%.
- Cpercentage of people aged 65 years is at 33%.
- Dthe number of people aged 60 years is more than 6 millions.
- Eaverage life expectancy exceeds 60 years.
Reveal the correct answerThe basic functions of public health measures to the general population include all the following except for:
- Amonitoring the health of the population and determining its health needs.
- Bidentifying and combating health risks in food, water as well as in learning, residence and work environment.
- Ceducating and training physicians and other staff.
- Densuring full accessibility to protective vaccination.
- Emonitoring the extend and quality of medical services.
Reveal the correct answerThe following definition: "Therapeutic and rehabilitative activities undertaken at the time when the disease is already fully developed aiming at reducing its impact and the risk of its recurrence" concerns:
- Aprimary prevention.
- Bsecondary prevention.
- Ctertiary prevention.
- Dhealth promotion.
- Enone of the above.
Reveal the correct answerWhich of the following are the examples of practical measures in health promotion implemented internationally and initiated by the World Health Organization?
- AProject Healthy Cities.
- BHealth Promoting Hospitals.
- CHealth Promoting Schools.
- DHealth Promotion at Workplace.
- Eall the above.
Reveal the correct answerWhat conditions should diagnostic screening test meet?
1) simplicity, ease of conduct and unambiguous interpretation;
2) acceptance by the subjects;
3) social significance of pathology for which the test is directed;
4) important economic and ethical aspect of the results of the diagnosis.
The correct answer is:
- Aall the above.
- B1,2,3.
- C1,2.
- Donly 1.
- Enone of the above.
Reveal the correct answerAccording to the definition health needs:
1) are associated with the incidence of diseases and pathologies within the population;
2) are objective states that are not human mental states;
3) are equivalent to the demand for health care;
4) require to take preventive and curative measures against possible loss of life or health.
The correct answer is:
- Aonly 1.
- B1,2,3.
- C1,2,4.
- D3,4.
- Eonly 3.
Reveal the correct answerWhich of the following concerning diagnostic test sensitivity is true?
1) it is another term for diagnostic test specificity;
2) it is characteristic feature of the diagnostic method (test);
3) it is the number of test positive results among clinically confirmed diagnoses.
The correct answer is:
- Aonly 1.
- B1,2.
- C1,3.
- D2,3.
- Eall the above.
Reveal the correct answerAccording to the World Health Organization statistics concerning the causes of death in the world Chronic Obstructive Pulmonary Disease is fourth in the ranking. The risk factors for this disease include:
1) environmental pollution;
2) smoking;
3) physical inactivity.
The correct answer is:
- Aonly 1.
- Bonly 2.
- Conly 3.
- D1,3.
- Eall the above.
Reveal the correct answerAcute diarrhea in children lasts for:
- A3 days.
- B5 days.
- C10 days.
- D14 days.
- Ethere is no definite time period.
Reveal the correct answerWhich of the following factor is considered as non important cause of the development of somatic diseases among people with schizophrenia?
- Atabacco smoking.
- Baggression.
- Cunderestimation of somatic symptoms.
- Davoidance of medical assistance.
- Edrug-caused sedation.
Reveal the correct answerAmong nutritional deficiencies which may contribute to the presence of depression the most important is the deficiency of vitamin B12 and:
- Avitamin C
- Bvitamin D and E
- Cvitamin A and D
- Dvitamin B1
- Efolic acid
Reveal the correct answerAccording to the Polish Mental Health Act (art. 23) the admission to the psychiatric hospital without patient's consent is allowed only when the person (indicate the exact description):
- Ahas mental disorders
- Bis mentally ill
- Cis an adult
- Ddoes not give consent for the treatment
- Eis aggressive toward others
Reveal the correct answerThere are following symptoms of acute abdomen:
- Astomachache.
- Bnausea and vomiting.
- Ccoprostasis and retention of gases.
- Dall among above.
- Eonly A and B answers.
Reveal the correct answerGastric cancer can by described by the following sentences:
1) one of the most frequently occurring cancers in men;
2) Lauren's classification is used for clinical classification;
3) most frequently located in the proximal part of the stomach;
4) gastric polyps of diameter more than 2 cm are correlated with increased gastric cancer risk;
5) there is an increased risk of gastric cancer in patients with pernicious anemia.
The correct answer is:
- A1,2,3.
- B2,3,5.
- C1,2,4,5.
- D1,2,3,5.
- Eall the above.
Reveal the correct answerMechanical ileus:
1) most frequently is caused by colon cancer;
2) starts with frequent urge to defecate;
3) gives slow heartbeat;
4) most frequently is caused by peritoneal adhesions;
5) most frequently refers to small intestine.
The correct answer is:
- A1,2.
- B2,3.
- C4,5.
- D2,5.
- EE 2,4.
Reveal the correct answerProven efficacy in CPR possesses:
- Aadrenaline.
- Bearly defibrillation used in the appropriate mechanisms.
- Catropine.
- Dearly orotracheal intubation.
- Evasopressin.
Reveal the correct answerExhaled air contains about 17% oxygen and 4% carbon dioxide, so mouth-to-mouth ventilation:
- Ais efficient and should always be applied.
- Bmay have deleterious effect on the cardiovascular system because of the excessive concentration of carbon monoxide in the mixture.
- Cis not recommended because of too low concentration of carbon dioxide concentration in the mixture.
- Dis not recommended because of too low oxygen concentration in the mixture.
- Enone of the answers is correct.
Reveal the correct answerDoctor who want to make use of the conscience clause are required to:
1) obtain the consent of their superiors;
2) inform the Ombudsman for Patients' Rights;
3) indicate the real possibility of obtaining the same service from another physician;
4) register and justify this fact in medical records;
5) apply for authorization to the competent court.
The correct answer is:
- A1,2.
- B1,3.
- C3,4.
- Donly 5.
- E4,5.
Reveal the correct answer