A. is important to determine the prognosis for patients

B. helps to select the best method of treatment

C. is based on TNM classification for all malignant tumours

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LEKEXAM / 2016 autumn

Question distribution — 2016 autumn session

Share of each category in the latest available session.

Internal medicinePediatricsSurgeryGynecology and obstetricsFamily medicineEmergency medicine, AnaesthesiologyPsychiatryMedical law and bioethicsMedical certificationPublic health

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Question 1

The definition of 1 carbohydrate exchange (CE) includes an amount of the product comprising:

A5 g of carbohydrates
B10 g of carbohydrates
C15 g of carbohydrates
D20 g of carbohydrates
E25 g of carbohydrates

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Question 2

A pregnant woman (13 weeks of pregnancy) suffering from herpes zoster is concerned about the influence of this infection on her foetus. Choose the right answer concerning this situation:

Aherpes zoster in a pregnant woman doesn't create a risk for the foetus
Bzoster virus is potentially harmful for the foetus but only in the first 10 weeks of pregnancy.
Cto estimate a risk for the foetus the key question is whether the woman suffered from varicella in the past.
Dbecause of the safety of the foetus the treatment with acyclovir should be started immediately.
Especific immunoglobulin should be given immediately.

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Question 3

In the case of the mother being a carrier of the mutated gene, the risk that her son will be ill with haemophilia A is:

A0%
B25%
C50%
D75%
E100%

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Question 4

In chronic kidney disease there is a propensity for:

Ableeding disorders
Bthrombosis
Ccardiovascular diseases
Danswers a, b, c are true.
Eanswers a, c are true.

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Question 5

Excessive supply of active vitamin D in chronic renal disease may be dangerous because of:

Aabnormally low PTH.
Bfractures caused by adynamic bone disease
Cvascular calcifications.
DA, B, C are correct
EA and C are correct

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Question 6

The expansion of extracellular fluid volume is an inevitable consequence of diminished salt and water excretion in renal failure. Indicate the false consequence of overhydration:

Aweight gain
Boedema.
Craised jugular venous pressure.
Dhypernatermia.
Eanaemia.

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Question 7

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers:

Aare used in renoprotection
Bimpair renal autoregulation responses
Cmay cause prerenal acute kidney injury
DA, B and C are true.
EA and B are true.

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Question 8

Cancers of unknown origin:

1) represent 3-10% of all malignant tumours;

2) do not require detailed diagnostics, because the primary site may be identified in 5% of cases only;

3) are most frequently adenocarcinomas;

4) are more frequent in women

5) are indication for positron emission tomography.

The correct answer is:

A1, 2
B1, 3
C1, 3, 5
D2, 3, 4
E2, 4

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Question 9

Pancreatic cancer may be related to:

Aobesity
Bsmoking tobacco
Cdiabetes
Dcorrect answer: A and B
Ecorrect answer: A, B and C

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Question 10

The typical management of acute tumour lysis syndrome includes:

AHydration and forced diuresis
BAllopurinol administration
CGlucocorticoids administration
DA and B are true.
EA, B, C are true.

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Question 11

Choose the correct statements about the complications of chemotherapy in the course of cancer treatment:

ANeutropenia is the most common complication of myelosuppression type
BEarly vomiting and nausea can be prevented in over 50% of cases
CThe most common metabolic complications are hypercalcemia and hyponatremia
DA+C
EA+B+C

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Question 12

Cancer-related ileus:

Ais most frequent in patients with ovarian cancer and gastrointestinal tumours.
Bmay be caused by a mechanical obstruction or may be related to metabolic disorders.
Cis always an indication for using somatostatin analogues.
DA and B are true.
EA, B and C are true.

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Question 13

Cancer staging:

Ais important to determine the prognosis for patients
Bhelps to select the best method of treatment
Cis based on TNM classification for all malignant tumours
DA and B are true
EA, B and C are true

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Question 14

Which of the following is the most common cause of death due to neoplastic disease in women in Poland?

ALung cancer
BBreast cancer
CCervical cancer
DOvarian cancer
EColon cancer

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Question 15

Bronchoscopy in a patient with a suspicion of lung cancer:

1) is one of the basic diagnostic examinations;

2) should be applied to peripheral lesions only;

3) may include tissue sampling for histologic examination;

4) provides cellular material sampling for cytological examination;

5) may be performed only in patients with the normal values of respiratory function tests.

The correct answer is:

A1, 2
B1, 3, 4
C2, 4, 5
D1, 2, 5
Eall the above.

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Question 16

In a 49-year old patient after multiple organ trauma, acute renal failure occurred. Indicate which of the following parameters show the 2nd stage of acute renal failure:

1) urine sodium < 20 mmol/L;

2) double increase in serum creatinine compared to the initial value; 81 z 140

3) decrease in diuresis < 0.3 mL/kg/hour for more than 24 hours;

4) urea level increase of 50% as compared to the initial value;

5) decrease in diuresis <0.5 mL/kg/hour for at least 12 hours.

The correct answer is:

A1,3
B1,4.
C1,5.
D2,3
E2,5.

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Question 17

Which of the following accelerates the progression of chronic kidney disease?

Acigerette smoking
Bobesity
Cexcessive dietary protein.
DA, B, C are true.
EA, B are true.

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Question 18

Acute nephritic syndrome is not presented with:

AOedema
BHaematuria
CHeavy proteinuria
DRed blood cell casts
EHypertension

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Question 19

Metabolic acidosis in advanced chronic kidney disease is caused by:

Aadministration of calcium bicarbonate.
Binhibition of tubular HCO reabsorption.
Caccumulation of organic acids.
DA + B +C
EB + C

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Question 20

A 64-year-old woman with psoriasis complains of abdominal cramps, watery diarrhoea and weight loss in the last three months since the symptoms first occurred (about 6 kg). She has not been diagnosed with any chronic diseases before. On physical examination increased intestinal peristalsis was noted. In routine laboratory tests no abnormalities were found. Colonoscopy - macroscopically the colon and terminal ileum looked normal. In biopsies obtained from the right half of the colon mild infiltration of lymphocytes and plasmocytes in the lamina propria was found. The most probable diagnosis is:

AChronic pancreatitis
BCoeliac disease
CIrritable bowel syndrome (IBS)
DMicroscopic colitis
ECampylobacter jejuni infection

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Question 21

A 51-year-old man with bronchial asthma presents at GP because of recurrent episodes of food impaction, pyrosis, and chest pain increased after meals, and not associated with physical activity. The clinical picture suggests that the first strategy should be:

Apharmacological treatment with proton pump inhibitors (PPIs)
Bgastroscopy with urease test.
Cgastroscopy with urease test and oesophageal biopsies from the whole length of the oesophagus for histopathological evaluation.
DCT scans of the thorax.
Eradiography of the upper part of the gastrointestinal tract

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Question 22

The indications for the treatment of Helicobacter pylori infection according to Maastricht IV recommendations include:

1) MALT gastric lymphoma;

2) patient’s wish caused by the fear of gastric cancer;

3) first line relatives with gastric cancer;

4) unexplained sideropenic anaemia;

5) vitamin B12 deficiency.

The correct answer is:

A1, 3
B2, 3
C1, 3, 5
D1, 2, 3, 4
Eall the above.

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Question 23

A 52-year-old woman receiving orally iron formulations because of mild microcytic anaemia complains of abnormally heavy menorrhagia. The doctor ordered faecal guaiac occult blood test (FOBT) three times and the results were positive. Which strategy should be chosen first?

Acolonoscopy
BFOBT should be repeated after discontinuation of iron formulations.
Ccoeliac disease should be excluded.
Ddiet with elimination of high doses of vitamin C and repeat the test
Edecision needs to be based on gastrointestinal symptoms.

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Question 24

In the advanced stage of hemochromatosis, a genetically determined disease, the following occurs:

Agrey- brown coloration of the skin and mucous membranes
Bliver cirrhosis.
Cdiabetes mellitus.
DA and B are true.
EA, B, C are true.

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Question 25

Macroscopic haematuria occurs in a 65-year old smoking man with no accompanying pain, and the ultrasound shows a solid tumour with a diameter above 4 cm located in the pole of the left kidney. What should be done next?

1) follow-up of the tumour with ultrasound every 6 months;

2) urine analysis and urine cytology;

3) kidney function analysis, whole blood count, alkaline phosphatase, calcium level;

4) abdomen, pelvis and chest CT scan to establish the stage of the neoplastic disease;

5) partial or total (radical) nephrectomy depending on the stage of the disease.

The correct answer is:

A1
B1,2
C1,2,3
D2,3,4
E2,3,4,5

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Question 26

A 72-year-old woman in the 4th stage of chronic kidney disease and with severe back pain was admitted to the department of nephrology with the suspicion of monoclonal immunoglobulin deposition disease in the course of multiple myeloma. Indicate the examinations that allow to confirm the diagnosis:

1) presence of plasmocytes in the bone marrow > 10%;

2) nephrotic proteinuria;

3) presence of monoclonal immunoglobulins in the serum and in the urine;

4) haematuria;

5) deposits of light or heavy immunoglobulin chains in the kidney glomeruli.

The correct answer is:

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

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Question 27

In a 30-year old woman with spontaneous abortions, recurrent pain in her joints, feverishness, symptoms of nephrotic syndrome occurred. Urine sediment exam shows haematuria and leukocyturia. Indicate the correct diagnosis:

Aacute glomerulonephritis
Bsubmicroscopic nephritis
Clupus nephritis
Dacute interstitial nephritis
EIgA nephropathy

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Question 28

Indicate the true information on Alport’s syndrome of sex-linked inheritance:

1) it is caused by inherited defect in alpha 5 collagen IV chain synthesis and leads to end-stage renal disease;

2) women (heterozygotes) are healthy gene carriers or they have only mild symptoms;

3) haematuria and proteinuria occur in men at around 10 years of age;

4) therapy with cyclosporine inhibits the development of the disease;

5) angiotensin converting enzyme inhibitors are used to decrease proteinuria.

The correct answer is:

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

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Question 29

Asymptomatic urine system infection needs treatment only in specific clinical situations. Indicate those situations:

1) pregnancy;

2) kidney transplant recipients within the first 6-12 months after the transplantation;

3) patients with diabetes mellitus;

4) before planned transurethral prostate gland resection or other urologic procedures on the urinary tract;

5) patients with long-lasting presence of a urinary catheter.

The correct answer is:

A1, 3, 5
B1, 2, 4
C1, 3, 4
D2, 3, 5
E2, 4, 5

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Question 30

The rescue team’s doctor or paramedic on arrival to the patient with left-side hemiparesis of sudden origin and the blood pressure of 180/110 mmHg, after examining the patient and , if needed, securing of basic life functions, should immediately

Atake the medical history (from the patient or from the witnesses) about the hour and minute when the symptoms occurred, previous diseases and find out if and what drugs the patient takes and put it in the medical record.
Badminister acetylsalicylic acid at the dose of 300 mg orally, because ischemic stroke is the most frequent cause of sudden hemiparesis.
Cadminister acetylsalicylic acid at the dose of 300 mg orally and low-molecular weight heparin (e.g. enoxaparin sodium) at prophylactic dose 20-40 mg subcutaneously, but not at the therapeutic dose (e.g. 80 mg) in order not to exclude the possibility of thrombolytic therapy later on.
Dlow the blood pressure as quickly as possible to the level below 140/90 mmHg by administering calcium channel blocker (ex. nifedipine) 5 mg sublingually or with intravenous drugs (e.g. furosemide 20 mg i.v).
Eadminister low-molecular weight heparin (e.g. enoxaparin sodium) at prophylactic dose 20-40 mg subcutaneously, but not at therapeutic dose (e.g. 80 mg) in order not to exclude the possibility of thrombolytic therapy later on

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Question 31

Indicate the false information on diabetic kidney disease:

Ait is the most frequent cause of end-stage renal disease.
Bit is caused by hemodynamic and metabolic changes, which lead to hyalinization of the glomeruli and to fibrosis of the interstitial tissue.
Calbuminuria above 30 mg/day is the first clinical sign of diabetic kidney disease.
Ddysmorphic haematuria and blood casts indicate the severity of diabetic kidney disease which is equal to the IV stage of chronic kidney disease.
Eactivation of the renin-angiotensin-aldosterone system is among the factors that accelerate the progress of the disease.

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Question 32

Which of the following rheumatic diseases is accompanied by skin changes?

1. lupus erythematosus;

2. systemic sclerosis;

3. polymyalgia rheumatica ;

4. IgA-dependent vasculitis (Henoch–Schönlein purpura)

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

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Question 33

The first-choice drugs that inhibit the progress of rheumatic arthritis are:

Anon-steroidal anti-inflammatory drugs.
BGlucocorticosteroids.
CSynthetic drugs that modify the course of the disease (e.g. methotrexate).
DBiological drugs that modify the course of the disease (e.g. TNF inhibitors).
EA and B are true.

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Question 34

Spondyloarthritis may occur in the course of: 1) Crohn’s disease; 2) psoriasis; 3) gastrointestinal tract infection with coliform bacteria of Enterobacteriaceae group; 4) infection with Chlamydia trachomatis. The correct answer is:

Aonly 1
B1, 2
C3,4
D1, 3, 4
Eall the above

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Question 35

The choice of the drugs in COPD patients depends on:

Arisk of COPD exacerbation only.
Bseverity of symptoms only.
Crisk of COPD exacerbation and the severity of symptoms.
Drisk of COPD exacerbation and the diffusion capacity of the lung.
Eseverity of symptoms and the diffusion capacity of the lung

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Question 36

Oral anticoagulant drugs are all of the following, except for:

Aapixaban
Bwarfarin
Cdabigatran
Deptifibatide
Erivaroxaban

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Question 37

Indicate the true statement concerning clinical symptoms in patients with heart defects:

Ahigh arterial pressure amplitude is observed in mitral insufficiency.
Blate-diastolic heart murmur is present in mitral valve prolapse
Cin aortic stenosis the volume of the murmur does not correlate with the severity of valve stenosis.
Din mitral stenosis you don’t observed ascites, hepatomegaly and jugular vein distension.
Ein patent ductus arteriosus the murmur is of decrescendo character.

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Question 38

Indicate the false statement about resistant arterial hypertension:

Ablood pressure is above 140/90 mmHg despite appropriate lifestyle changes and combination therapy with calcium channel blocker, sartan and thiazide diuretic at optimal doses.
Bblood pressure is elevated during visits at the doctor’s but is normal during home/ambulatory measurements.
Cpatients with resistant hypertension face an increased cardiovascular risk.
Din patients with resistant hypertension you should consider therapy with aldosterone antagonist or alpha-blocker.
Ein the case of inefficiency of pharmacotherapy in a patient with resistant hypertension invasive procedures may be considered, such as renal denervation or a stimulation of cervical baroreceptors.

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Question 39

A 52-year-old male with arterial hypertension - correctly treated was admitted to the ER because of the severe headache radiating to the neck, which occurred during extensive physical work. On admittance: GSC (Glasgow Coma Scale) 15 points, blood pressure 140/85 mmHg, Kernig’s sign, nuchal rigidity 3 fingers. In this clinical situation from among additional tests you should order first:

Acervical spine X-ray
Belectroencephalography (EEG)
CCT scan with contrast
Dlumbar puncture and cerebrospinal fluid examination
ECT scan without contrast

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Question 40

Which of the following statements concerning trauma brain hematomas is false?

Aepidural hematoma is when blood accumulates between the skull bone and the lamina dura.
Bsubdural hematoma is when blood accumulates between the lamina dura and the arachnoid membrane.
Cdamaged bridge veins spanning the areas of the brain cortex with dural venous sinuses are the source of subdural hematoma.
Ddamaged meningeal arteries, especially medial meningeal artery are the most frequent source of epidural hematoma.
Ehemiparesis and papillary distension can be seen ipsilateral to the epidural hematoma.

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Question 41

What is the most probable disease presented with fever, cutaneous purpura, purulent rhinorrhea, nasal ulcers, sinus pain, polyarthralgia/arthritis, cough, hemoptysis, shortness of breath, microscopic hematuria and mild proteinuria?

Amembranous nephropathy
Bantiglomerular basement membrane disease
Cgranulomatosis with polyangiitis (Wager’s granulomatosis)
Dpoststreptococcal glomerulonephritis
EIgA nephropathy

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Question 42

A 38-year-old patient is admitted to the hospital because of headache, confusion, right hemiparesis and dysphasia lasting 24 hours. Additionally herpes is present, temperature 38.6 Celsius, nuchal rigidity 3 fingers. Cerebrospinal fluid examination shows: pleocytosis 250 leukocytes/mm - 90% of them are lymphocytes, protein level 70 mg/dL, glucose level 60 mg/dL (serum glucose level 85 mg/dL). Head MRI shows enhanced signal FLAIR in the medial left temporal lobe. Until you get microbiology and PCR tests, the first-choice drug against the most probable etiological factor in this situation is:

Aacyclovir
Bcephalosporin III generation e.g. ceftriaxone
Csteroids
D20% mannitol
Eamoxicillin and clavulanic acid

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Question 43

A 4-year old boy presents with a fever lasting 6 days. Which of the following conditions, if they were a part of this patient's presentation, would not cause suspicion of Kawasaki disease?

Abilateral conjunctival injection
Bcracked or fissured lips.
Cgeneralized polymorphous rash.
Dthrombocytopenia
Ecervical lymph node painful enlargement.

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Question 44

Which of the following symptoms are typical of systemic lupus erythematosus?

Aphotosensitivity, neurological disorders, acute pyelonephritis
Bphotosensitivity, neurological disorders, thrombocytosis.
Cphotosensitivity, headache, pancytopenia.
Dheadache, thrombocytopenia, the presence of HLA-B27.
Eheadache, acute pyelonephritis, leukocytosis

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Question 45

Which joints are most frequently involved in the oligoarthritis onset of juvenile idiopathic arthritis?

Asmall joints of the hands
Bhip joints
Cknees
Dankles
Espine

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Question 46

The foramen ovale is located:

Ain intraventricular septum.
Bin intraatrial septum.
Cbetween the right pulmonary artery and the aortic arch.
Dbetween the left pulmonary artery and the aortic arch
Ein the ductus arteriosus.

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Question 47

Polyuria with hypostenuria is typical of:

Aurinary tract infection
Bfebrile diseases
Curinary tract defects
Ddiabetes insipidus
Eintravenous administration of albumin

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Question 48

The appropriate treatment after the diagnosis of streptococcal angina is:

Apenicillin V (phenoxymethylpenicillin) for 5-7 days
Bpenicillin V (phenoxymethylpenicillin) for 10 days.
Cclarithromycin for 5-7 days
Dclarithromycin for 10 days
Eerythromycin for 5-7 days

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Question 49

The sudden onset of a disease in a child with a high fever, headaches, vomiting, rash on the skin, and “raspberry tongue” is the clinical description of:

Ameasles
Bchickenpox
Cscarlet fever
Dinfectious mononucleosis
Ediphtheria

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Question 50

In a 15-year-old girl with asymptomatic bacteriuria you should:

Aadminister nitrofurantoin at the therapeutic dose for 3 days
Badminister nitrofurantoin at the prophylactic dose for 7 days.
Cadminister amoxicillin at the prophylactic dose for 3 days.
Dnot administer any pharmacotherapy.
Eperform diagnostics at a specialist outpatient clinic.

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Question 51

A newborn with frothy secretion in the mouth and nasal cavity that does not subside after suction, with a loud murmur over the heart and with limb hypoplasia. The most likely diagnosis is:

ACMV infection
BTetralogy of Fallot
CDown syndrome
Desophageal atresia
EIntrauterine hypotrophy with infection

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Question 52

Jaundice connected with breast-feeding is probably the result of:

Aquick intestinal transit of meconium
Bhigh content of lactose in the first milk, which impairs bilirubin conjunction with glucuronic acid.
Cdelayed first feeding and not enough feeding.
Dinadequate newborn’s intestinal bacterial colonization.
Emother’s intake of drugs which cleave the ester bonds of bilirubin glucuronide

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Question 53

The most common causes of lower gastrointestinal tract bleeding in infants are:

1) Schoenlein-Henoch disease;
2) anal fistula;
3) food allergy;

4) inflammatory bowel diseases;

5) intussusception.

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

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Question 54

The most common cause of idiopathic nephrotic syndrome in children is:

AMinimal change glomerulopathy
BFSGS
CIgA nephropathy
DPoststreptococcal glomerulonephritis
EInterstitial nephritis

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Question 55

The most common causes of macrocytic anaemia in children include:

ADeficiency of vitamin B 12, deficiency of folic acid, hypothyroidism, liver diseases
BDeficiency of vitamin B12, iron deficiency, hypothyroidism, liver diseases
CDeficiency of vitamin B12, deficiency of folic acid, acute haemorrhage, liver diseases.
DAplasia of bone marrow, deficiency of folic acid, hypothyroidism, liver diseases
EDeficiency of vitamin B12, deficiency of folic acid, hypothyroidism, lead poisoning.

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Question 56

In the laboratory studies in children with type 1 diabetes in the course of ketoacidosis the following can be observed:

Ahyperglycemia, ketonemia, ketonuria, metabolic acidosis
Bhypoglycaemia, ketonemia, ketonuria and respiratory acidosis.
Chypoglycaemia, hypernatremia, ketonuria and metabolic acidosis.
Dhyperglycaemia, hypernatremia, ketonuria and respiratory acidosis.
Ehypoglycaemia, ketonemia, glycosuria and metabolic acidosis.

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Question 57

A girl with short stature, primary amenorrhea, aortic stenosis and facial dysmorphia. The most probable diagnosis is:

ANoonan syndrome
BPrader-Willi syndrome
CAngelman syndrome
DTurner syndrome
EKlinefelter syndrome

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Question 58

Which of the following is not a contraindication to the breastfeeding?

Aactive tuberculosis in the mother.
BHIV infection in the mother.
Cherpes simplex infection of the nipple or an areola of the mamma.
Dchronic hepatitis C in the mother.
Ecytostatic treatment of the mother.

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Question 59

A 12-year-old boy reported to the general practitioner after injuring his leg in the garden in order to ask about tetanus prophylaxis. The boy was vaccinated according to the standard vaccination schedule, the last dose was administered six years ago. The doctor assessed the risk of infection as low. In this situation:

APost-exposure prophylaxis against diphtheria and tetanus is not required.
BAdminister one dose of tetanus-diphtheria or tetanus vaccine.
CAdminister 2 doses of the vaccine mentioned above, the second dose after 4 weeks.
DAdminister 3 doses of the vaccine mentioned above in the schedule 0, 1, 6 months.
EAdminister one dose of the vaccine mentioned above and tetanus antitoxin.

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Question 60

A child at preschool age is presented in GP’s office. According to the parents the child has been suffering from fever for 10 days and 2 days ago they observed a facial rash intensely red and a symmetric, macular, lace-like rash on the trunk, buttocks and arms. The general condition of the child is good. Which diagnosis is the most probable?

Arubella.
Bmeasles.
Cscarlet fever.
Derythema infectiosum.
Eerythema multiforme.

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Question 61

A mother comes to the doctor with her 2-year-old child, who defecated 6 times in the last 24 hours, does not vomit, has no fever, hes no features of dehydration. TA proper approach in this case is:

ARefer to the hospital.
Border metronidazole.
Corder stool culture and then appropriate pharmacotherapy according to the result of the culture.
Dorder co-trimoxazole.
EOral hydration at home.

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Question 62

According to the current Polish National Program of Immunizations, which of the statements below is false in case of a child with the birth weight of 1700g?

ABCG vaccination should be postponed until the body weight has reached 2000 g.
Bvaccination against hepatitis B should be postponed until the body weight has reached 2000 g.
Cas a mandatory vaccination against diphtheria, tetanus and pertussis a vaccine with an acellular pertussis component should be used.
Das a mandatory vaccination the child should receive a conjugated pneumococcal vaccine
Evaccination against measles, mumps and rubella should be given according to the chronological age

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Question 63

Taking into consideration a theoretical risk of foetus malformations caused by the vaccine, an attenuated strain of rubella virus, what is the minimal interval between the vaccination with a combined measles-mumps-rubella vaccine and the planned pregnancy according to the Polish National Program of Immunizations?

A2 weeks
B4 weeks
C2 months
D3 months
E6 months

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Question 64

The common symptoms of type 1 diabetes do not include:

Apolydipsia
Bpolyphagia
Cpolyuria
Dfatigue
Eagitation

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Question 65

The target HbA1c value in preschool children with type 1 diabetes mellitus is:

A< 6,5%.
B< 7,0%
C< 7,5%.
D< 8,0%.
E< 8,5%.

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Question 66

In a 12-year-old patient with type 1 diabetes mellitus, treated with a personal insulin pump, hypoglycaemia occurs. It could be caused by:

1) overdose of long-acting insulin;

2) taking too high bolus dose at a meal;

3) eating less food than planned;

4) additional physical activity.

The correct answer is:

A1, 2
B2, 3, 4,
Call the above
D2,4
E1, 3, 4

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Question 67

Which stage of chronic kidney disease should be diagnosed in a 16-year-old patient with lupus nephropathy and eGFR = 45 ml/min/1.73 m ?

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Question 68

Numerous adenomatous polyps in the endoscopic examination of the large intestine and the coexistence of soft tissue fibromas in the area of the forearms and shins are characteristic of:

AGardner syndrome
BPeutz-Jeghers syndrome
CTurcot syndrome
Djuvenile polyposis syndrome
Efamilial polyposis

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Question 69

A mother comes with a 3-week-old newborn and she is concerned about regurgitations that occur after each feeding. A child, born at term is fed with modified milk, drinks greedily; it has gained 400 g of weight since the birth. A proper approach to this newborn is:

Aorder metoclopramide
Bsuggest thickening of the milk with ice gruel
Ccalming the mother, instructions on the appropriate positioning of the child during feeding.
Dorder urgent surgical consultation
EA and C are true

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Question 70

Which of the following foetal head diameters is the smallest and most conveniently goes through the spaces of the pelvic planes during physiological childbirth?

Asuboccipitobregmatic
Boccipitofrontal
Coccipitomental
Dsubmentobregmatic
Everticomental

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Question 71

Which of the following diseases in pregnant women constitute an absolute indication for Caesarean section?

AMyasthenia gravis
BScleroderma
CGestational diabetes mellitus type 2 (GDM2)
DHypertension
EMarfan syndrome

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Question 72

A 32-year-old woman in 14 week of pregnancy presented with severe nausea and emesis accompanied with weight loss, dyselectrolytemia and elevated transaminases. Which predisposing factors for severe morning sickness in pregnancy (hyperemesis gravidarum) one should consider in differential diagnosis?

1) hyperthyreosis;

2) H. pylori infection;

3) obesity;

4) previous psychiatric disorders;

5) age.

The correct answer is:

A1, 2
B2, 4
C1, 2, 4
Donly 2
Eall the above.

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Question 73

A disulfiram-like reaction can be expected in a patient who was drinking alcohol while undergoing the treatment for the symptoms of a genital infection with:

AHPV virus
BHSV virus
CChlamydia trachomatis
DTrichomonas vaginalis
ENeisseria gonorrhoeae

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Question 74

In a pregnant vegetarian you should expect the insufficiency of vitamin:

1. B2

2. B12

3. D

4. C

5. E

AOnly 1
BOnly 2
COnly 3
D1, 3, 4, 5
E1, 2, 4, 5

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Question 75

The composition of the amniotic fluid includes the following proteins produced by the foetus:

1) transferrin;

2) alpha- fetoprotein;

3) beta- microglobulin;

4) IgG immunoglobulins;

The correct answer is:

A1, 2, 4
B1, 2, 3
C2, 3, 4
DOnly 2
Eall the above.

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Question 76

What is the role of estrogens in the combined contraceptive pill?

Afallopian tube peristalsis reduction.
Bthickening of cervical mucus.
Cinhibition of selection and growth of the dominant follicle.
Dsuppression of the LH secretion
EA and C are correct.

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Question 77

Sheehan’s syndrome - postpartum pituitary gland necrosis - is characterized by

Ahypogonadotropic hypergonadism
Bhypogonadotropic hypogonadism.
Chypergonadotropic hypergonadism.
Dhypergonadotropic hypogonadism.
Eprimary amenorrhoea

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Question 78

Azoospermia is defined as:

Aabsence of semen
Babsence of sperm in semen
Cabsence of sperm mobility
Dsperm with abnormal morphology
Enumber of sperm in semen lower than 1 million/ml

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Question 79

Which of the following is not a risk factor for endometrial cancer?

AObesity
BSmoking tobacco
CDiabetes
DExogenous estradiol
ELate menopause

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Question 80

Which of the following is not typical of cervical cancer?

Aurinary urgency
Bbloody vaginal discharge with unpleasant smell
Cintermenstrual bleeding
Dabdominal pain.
Econtact bleeding.

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Question 81

When, during pregnancy, the concentration of the β-subunit of hCG in blood is the highest?

A5-6 week
B6-7 week
C9-12 week
D14- 16 week
E16-18 week

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Question 82

The most common complication in twin monoamniotic pregnancies is:

Apreterm birth
Bumbilical cord entanglement
Cintrauterine growth restriction.
Dpolyhydramnios.
Eumbilical cord prolapse.

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Question 83

A woman with severe preeclampsia suddenly develops respiratory depression after the administration of hydralazine and magnesium sulfate. Respiratory depression is due to:

Aimpending eclampsia
Bhydralazine toxicity
Cmagnesium sulfate toxicity
Dpulmonary embolism
Eheart attack

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Question 84

The combination of pharmacological therapy with a planned cesarean delivery has been shown to reduce the perinatal transmission of HIV to:

A25%
B17,5%
C5%
D1,5%
Eperinatal transmission of HIV does not depend on the mode of a delivery.

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Question 85

Vaginal hematoma was found during ultrasound examination in a 16-year-old girl, who does not menstruate. The most likely cause is:

Aimperforate hymen
Buterine septum
Cuterine aplasia
DMayer-Rokitansky-Küster-Hauser syndrome
Eovarian agenesis

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Question 86

A 34-year-old female patient 3 months after a physiological childbirth suddenly suffered a pain of the vulva. She complained that she could not sit, and while she tries to sit down she feels a resistance in the right side. In the light of reported symptoms one should:

Adiagnose complications of crotch sewing and refer the patient for crotch plastic surgery.
Bdiagnose viral vulvitis, most probably herpetic and order acyclovir therapy.
Cdiagnose vulva carcinoma and order biopsy.
Ddiagnose Skene’s gland abscess and order antibiotics.
Ediagnose Bartholin’s abscess, make incision and drainage.

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Question 87

Indicate the true statement concerning the uterine artery:

Aoriginates from the ovarian artery.
Bgives the branch running through the round ligament.
Coriginates from the internal iliac artery
Dcrosses the ureter from the rear.
Eprovides blood to the uterus only.

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Question 88

Which of the following manoeuvres is not recommended in the case of shoulder dystocia:

Asuprapubic pressure
BZavanelli’s manoeuvre.
CBracht’s manoeuvre.
DMcRoberts manoeuvre.
EWoods manoeuvre.

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Question 89

Indicate the correct sequence of fetal head movements in the birth canal during labor:

Aflexion, extension, rotation, rotation.
Bflexion, rotation, extension, rotation
Cflexion, rotation, rotation, extension
Drotation, flexion, extension, rotation
Eextension, rotation, flexion, rotation.

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Question 90

An absolute indication for primary cesarean section in breech presentation is not:

Afoetus weight above 3500 g.
Bprimipara.
Cumbilical cord prolapse.
Dplacenta previa.
Eplacental abruption.

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Question 91

The indications for elective cesarean section in twin pregnancy do not include:

AAny situation of incorrect position of one of the fetuses.
Bdeath of the fetus II.
CTTTs syndrome (twin-to-twin syndrome).
Dsignificant difference in foetuses weight > 20%.
Enon-cephalic presentation of the foetus I.

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Question 92

Which of the following is not among the abnormalities of the head position during labour:

Adeep transverse arrest.
Bbrow presentation.
Cocciput posterior position.
Dleft or right posterior position.
Eocciput anterior position.

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Question 93

The true conjugate is defined as:

Aline connecting the lower edge of the pubic symphysis with the iliococcygeus joint.
Bline connecting the promontory with the upper edge of the pubic symphysis
Cline connecting the promontory with the most inwardly facing part of the pubic symphysis.
Dline connecting a cavity between the spinous processes of L3 and L4 with the upper edge of the pubic symphysis
Eline connecting the promontory with the lower edge of the pubic symphysis.

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Question 94

Indicate the true statement concerning Duncan’s method of placental separation:

Ait is correlated with lower bleeding than in Schultze’s method.
Bit begins centrally.
Cit occurs in 80% of cases.
Dmore frequently occurs in twin pregnancy.
Eusually does not lead to a hematoma formation.

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Question 95

During which of the following sleep phase/stage loss of the tonus of striated muscles and dreams occur?

Awaking state
BREM.
CNREM, stage 1
DNREM, stage 2.
ENREM, stage 3

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Question 96

One can speak about dysthymia when its symptoms last at least:

A2 weeks
B1 month
C6 months
D1 year
E2 years

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Question 97

Catalepsy is a symptom belonging to the following disorder group:

Amood
Bimpulse control
Cphysical activity
Dawareness
Ewill and complex activity

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Question 98

Which of the following symptoms, apart from decreased mood, are among the basic symptoms of depressive syndrome?

1) attention disorder;

2) decreased energy or increased fatigue;

3) anhedonia or a loss of interest;

4) sleeping and eating disorders;

5) anxiety;

6) unwarranted guilt;

7) cancellation or suicidal thoughts.

The correct answer is:

A1,2.
B3,4
C5,7.
D2,3.
E4,6.

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Question 99

The most characteristic disorders of thought content in paranoid syndrome are:

Athought broadcasting.
Bpoisoning
Cjealousy
Dhypochondrical.
Eideas of reference

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Question 100

Which of the following drugs is one of the cholinesterase inhibitors?

Aquetiapine.
Bmemantine.
Cdoxepin.
Drivastigmine.
Ecarbamazepine

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Question 101

A drug for fast, short-lasting, ad-hoc controlling of anxiety disorders is:

AVenlafaxine
BSertraline
CAlprazolam
DQuetiapine
ELamotrigine

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Question 102

A 23-year-old male reports that he has been hearing the “voice in his head, which comments what the man is doing and tells him to commit suicide”. Which syndrome is this symptom the most characteristic of?

ADepressive
BParanoid
CParanoic
DAlcohol dependence
ECatatonic

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Question 103

The main symptom of alcohol hallucinations is:

Adelusional jealousy
Bvisual hallucinations
Cauditory hallucinations
Dauditory pseudohallucinations
Epersecutory delusions

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Question 104

Treatment of an episode of depression in the course of bipolar disorder should be initiated with the administration of:

Afluoxetine
Bhaloperidol
Cdoxepin
Dvalproic acid
Elamotrigine

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Question 105

The most frequent side effect of clozapine is:

Ametabolic syndrome
BParkinson-like syndrome.
Ccardiac arythmia.
Dleukopenia
Ehyperprolactinemia

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Question 106

Which of the following are typical of the Lewy body dementia?

1) faintings;
2) hypersensitivity to neuroleptics;
3) Parkinson-like syndrome symptoms;

4) delusions of poisoning;

5) visual hallucinations.

The correct answer is:

A1,2,5
B1,2,3,5
Call answers are correct
D1,2,3
E4.5

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Question 107

Indicate the true statement concerning neuroleptic malignant syndrome:

Acorrelates with the increased dopaminergic transmission.
Boccurs in 0.02-3% of patients treated with neuroleptics.
Cmore frequently occurs in women.
Dgives hypothermia.
Eis caused by renal insufficiency

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Question 108

Which of the following personalities is characterized by suggestiveness, shallow unstable emotionality, theatricality, exaggerated emotional expression, and focusing on physical attractiveness?

Aantisocial.
Bparanoid.
Cborderline
Dhistrionic
Eanankastic

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Question 109

A woman comes to the ER and complains of left side hypogastric pain which started the previous evening, temperature 39°C. A hardly movable tumour is palpable in the left lower quadrant of the abdomen. You should suspect first:

Airritable bowel syndrome
Bacute diverticulitis
CCrohn's disease
Dcolon cancer.
Eacute pancreatitis

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Question 110

The indication for splenectomy is not:

Asplenic abscess
Ba malignant tumor located near the spleen
Chereditary spherocytosis
Dcongenital haemolytic anemia
Eparasitic cyst of the spleen

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Question 111

What is removed during the Whipple procedure ?

Agallbladder, pancreatic head, duodenal bulb, pyloric part of the stomach
Bcommon hepatic duct, pancreatic head, duodenum, pyloric part of the stomach
Cgallbladder, pancreatic head, duodenum, the pyloric part and the body of the stomach
Dcommon bile duct, pancreatic head, duodenum, pyloric part of the stomach
Ecommon bile duct, pancreatic head, duodenal bulb, pyloric part of the stomach

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Question 112

The Roux-en-Y method after total gastrectomy consists of:

Aside-to-side method of the esophago-intestinal anastomosis and the end-to-end method of the enteroenterostomy formed by a stapler
Bmanual end-to-side method of the esophago-intestinal anastomosis and the side-to-end method of the enteroenterostomy
Cmanual end-to-end method of the esophago-intestinal anastomosis and the end-to-side method of the enteroenterostomy
Dmanual end-to-end method of the esophago-intestinal anastomosis and the end-to-end method of the enteroenterostomy
Eside-to-side method of the esophago-intestinal anastomosis and the side-to-side method of the enteroenterostomy formed by a stapler

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Question 113

Which of the following ways of treatment restores the anti-reflux barrier in gastroesophageal reflux disease?

Aprokinetic drugs
Bproton pump inhibitors.
Ccardiomyotomy
Dcardioplasty
Efundoplication

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Question 114

Regional anaesthesia does not include:

Aepidural anaesthesia.
Banalgosedation.
Cplexus anaesthesia.
Dspinal anaesthesia.
Einfiltrative anaesthesia.

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Question 115

In which of the following patients is an increased risk of perioperative complications observed?
1) obese;
2) below 30 years of age;

3) with coronary artery disease;
4) with diabetes mellitus;
5) classified to ASA PS category I according to the American Society of Anesthesiologists.
The correct answer is:

A1,2,3,4.
B3,4,5.
C1,3,5.
D1,3,4.
E2,3,4.

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Question 116

The most frequent complication after thyroid surgery is:

Abilateral recurrent laryngeal nerve paresis.
Bpost-surgical hypocalcaemia.
Cbleeding into the post-surgical wound.
Dkeloid.
Ethyroid storm.

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Question 117

Which of the following symptoms indicate the need for rectal cancer diagnosis ?

1) tarry stools

2) bleeding during defecation

3) change in bowel habits

4) anal itching

5) elevated leukocytosis

6) pencil-thin stools

A1, 5, 6
B2, 3, 4
C1, 2, 6
D1, 3, 4
E2, 3, 6

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Question 118

Which of the following are not classified as internal abdominal hernias:

Adiaphragmatic hernias.
Bhernias of the paraduodenal recess.
Cpericaecal hernias.
Dhernias of the omental bursa.
Elumbar hernias.

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Question 119

A 30-year-old woman, weighing 60 kg, was referred to the ER with III degree burnings of the left upper extremity, left lower extremity and of the groin. What volume of fluids should be administered within 24 hours?

Aapprox. 7 litres.
Bapprox. 2 litres
Capprox. 15 litres.
Dshe needs only oral fluids.
Edescribed degree and extent of burns do not need intensive fluid therapy.

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Question 120

Which of the following accesses to the digestive tract can be used in nutritional therapy?

Anaso-gastric tube, gastrostomy, jejunostomy.
Bnaso-gastric tube, gastrostomy, ileostomy.
Cesophagostomy, gastrostomy, jejunostomy.
Dgastrostomy, jejunostomy, ileostomy
Ejejunostomy, ileostomy, colostomy

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Question 121

Colles' fracture is a following fracture:

Afracture of femoral neck
Bfracture of the distal epiphysis of the ulnar bone
Cfracture of I metacarpal bone
Dfracture of the distal epiphysis of radial bone in the typical place
Esupracondylar humerus fracture

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Question 122

Ogilvie syndrome is:

Ainherited lack of colon autonomic innervations.
Bacute pseudo-obstructive large bowel dilatation.
Cmechanical large bowel obstruction.
Dhereditary non-polyposis colon cancer.
Eruptures of a ventral part of the oesophageal mucosa caused by vomiting.

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Question 123

Contraindications to laparoscopic surgery include:

1) surgery in anamnesis;

2) peptic ulcer of the stomach rupture;

3) cardio-respiratory failure;

4) surgery because of cancer disease;

5) clotting disorders;

6) lack of patient’s consent to this surgery.

The correct answer is:

A1,3,6.
B2,4,6.
C3,5,6
Donly 6.
E4,3,6.

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Question 124

A 65-year-old patient 10 years after aorto-aortic prosthesis because of ruptured aortic aneurysm. For the last 3 months periodical fever. Today admitted to the ER with the symptoms of heavy upper gastrointestinal bleeding. On CT features of inflammatory infiltration around the prosthesis with gas vesicles. You should first suspect in this patient:

Atrapped gas syndrome after aortic aneurysm surgery.
Bnecrotic haemorrhagic pancreatitis.
Cbleeding from an aorto-duodenal fistula.
Dforming of perianastomotic aneurysm.
Eoesophageal perforation.

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Question 125

The following symptoms, such as rapid and irregular breathing, extension of the limbs in reaction to external stimuli, bilateral Babinski sign, impaired pupil reaction to light, increased blood pressure, pulse acceleration and increased sweating indicate the contusion of:

Abrain stem.
Bcerebellar hemisphere.
Cfrontal lobes.
Doccipital lobe.
Etemporal lobe.

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Question 126

The symptoms of Whipple’s triad comprise:

1) consciousness disorders;

2) hypoglycaemia;

3) hyperglycaemia;

4) disappearance of symptoms after intravenous glucose administration;

5) gallstones.

The correct answer is:

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

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Question 127

Tertiary hyperparathyroidism develops as a consequence off:

Aincreased release of tropic hormone
Bchronic renal failure and dialysis therapy
Cautonomic, increased PTH release occurring after kidney transplantation
Dparathyroid carcinoma
Eparathyroid adenoma

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Question 128

The most frequent origin of metastasis in the liver is:

Aprostate cancer.
Bcolon cancer.
Ckidney cancer.
Dthyroid cancer.
Eparathyroid carcinoma.

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Question 129

Indicate the true statement concerning Charcot’s triad:

Arefers to cholecystitis.
Brefers to colon diverticulitis.
Cis characterized by epigastric pain, jaundice, recurrent fever and chills.
Dis characterized by left side hypogastric pain, diarrhoea, recurrent fever and chills.
Eis an indication for cholecystectomy.

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Question 130

Which of the following is used in colon cancer prophylaxis in the course of familiar adenomatous polyposis:

Alipoxygenase inhibitors
Bcyclooxygenase inhibitors
Chigh-protein diet
Dglucocorticosteroids
Elow-carbohydrate diet

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Question 131

Which of the following is not an indication for liver transplantation:

Apost-inflammatory liver cirrhosis
BBudd-Chiari syndrome.
CWilson's disease
Dprimary and secondary biliary liver cirrhosis.
Edisseminated hepatocellular carcinoma

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Question 132

Colon cancer most frequently is located within:

Acaecum
Bliver and spleen flexure.
Cdescending colon
Dsigmoid
Erectum

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Question 133

Lynch1 syndrome is characterized by occurrence of the following neoplasms:

Acolorectal cancer, endometrial cancer, ovarian cancer
Bcolorectal cancer, stomach cancer, small intestine cancer
Ccolorectal cancer, breast cancer, thyroid cancer
Dthyroid cancer, parathyroid cancer, retinoblastoma
Ecolorectal cancer

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Question 134

The essential element of hernia surgery is:

Askin plasty over the hernia sac
Bremoval of the intestines from the hernia sac
Cshortening and / or deep placement of the hernia sac
Dplasty of the fascial and muscular layer
Eclosure of the transverse fascia with sutures

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Question 135

The frontal fontanelle in children properly closes:

Abefore the 12 month of age.
Bbefore the 10 month of age
Cbetween the 12 and 16 month of age
Dover the 18 month of age.
Ebetween the 10 and 13 month of age.

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Question 136

Which of the following syndromes is the most frequent cause of genetically determined intellectual disability in human population?

APatau syndrome
BEdward's syndrome
CKlinefelter syndrome
DDown syndrome
ETurner syndrome.

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Question 137

Which of the following should be regarded pathological in a 9- month-old infant who was born at term with Apgar 10 points at 1st minute?

Apresence of the positive Babinski sign
Black of Moro reflex
Cpresence cooing, lack of babbling
Dlack of the palmar grasp reflex, presence of the plantar reflex
Elack of the posterior fontanelle

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Question 138

Enamel defects, esophagus and stomach mucosa erosions, muscle weakness due to dyselectrolitemia are the symptoms of:

AAnorexia nervosa
BBulimia
CVitamin C deficiency
DFluoride deficiency
EA and D are true

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Question 139

Which of the following risk factors is not mentioned in the SCORE and does not influence the estimation odf a 10- year risk of fatal cardiovascular incident (death)?

Aage
Bsex
Csmoking
Dsystolic blood pressure
EHbA1c level

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Question 140

Hypospadias is:

Aa condition in which the foreskin of the penis cannot be pulled back past the glans penis
Ba congenital defect consisting in cleft of the urethra on the dorsal side of the penis
Ca developmental defect consisting in the lack of development of the end segment of the urethra
DLack of one or both testes
ENone of the above

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Question 141

Gout is usually initiated by following factors except for:

Aalcohol.
Bingestion of high amounts of purines.
Csurgery.
Ddrugs.
Etrauma.

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Question 142

A skin disease of non-bacterial etiology is:

Aimpetigo contagiosa
Btinea versicolor
Cerythrasma
Derysipelas
Eecthyma

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Question 143

The most common cause of non-complicated cystitis is the bacteria:

Aof Acinetobacter group
Bof Propionibacterium group
CPseudomonas aeruginosa
DEscherichia coli
EProteus mirabilis

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Question 144

The administration of specific immunoglobulin is mandatory in the case of the pregnant, who had not been affected or vaccinated, and who had contact with a patient infected with:

1) type B hepatitis virus;

2) CMV virus;

3) fifth disease virus;

4) rubella virus;

5) chickenpox virus.

The correct answer is:

A1,3,5
B2,3,5.
C2,3,4.
D1,4,5
E4,5.

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Question 145

Subclinical hyperthyroidism is characterized by:

Aincrease in TSH concentration, increase in fT3 and fT4 levels
Bincrease in TSH concentration, fT3 and fT4 levels do not exceed the upper limit of normal.
Cdecrease in TSH concentration, increase in fT3 and fT4 levels.
Ddecrease in TSH concentration, fT3 and fT4 levels do not exceed the upper limit of normal
Enormal TSH levels, increased fT3 and fT4 levels

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Question 146

In the evaluation of child's school readiness the doctor must take into account the following components:

Aphysical maturity
Bintellectual maturity
Cemotional and social maturity.
DB, C are true.
EA, B, C are true.

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Question 147

The examination of an infant for hypoacusis combines all of the following, except for:

Achild's reaction to a loud sound
Bpresence of cooing
Cresults of hearing screening test
Dspeech development
Epresence of hypoacusis risk factors

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Question 148

The examination of life signs, including breathing in the victim, in case of circulatory arrest:

Ashould not take more than 5 seconds
Bshould not take more than 10 seconds
Cshould not take more than 15 seconds
Dshould not take more than 20 seconds
Eshould last as long as it takes until the rescuer is sure that the victim does not breathe spontaneously.

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Question 149

Which of the following anti- diabetic drugs causes a hypoglycemic through the inhibition of hepatic glucose production:

Ametformin
Bchlorpropamide
Cacarbose
Dpioglitazone
Edapagliflozin (SGLT-2 inhibitor)

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Question 150

To which type of prevention does vaccination belong?

Aearly
Bprimary
Csecondary
Dtertiary
Equaternary

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Question 151

Treating a patient with vitamin K antagonists (VKA): acenocoumarol, warfarin, one should remember that food influences their action. Which of the following products decreases the action of VKA?

ASpinach
BBroccoli
CLettuce
DA,B are true
EA, B, C are true

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Question 152

Which types of acute viral hepatitis are subject to mandatory reporting to the relevant county sanitary-epidemiological stations :
1) type A;
2) type B;

3) type C;
4) type D;
5) type E.

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

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Question 153

The differential diagnostics of a sudden and strong epigastric pain, accompanied by sweating, occurring for the first time in lifetime in a 50-year-old tobacco smoker should include:

1) myocardial infarction;

2) ulcer perforation;

3) biliary colic;

4) incarcerated inguinal hernia

5) bleeding in the digestive tract.

The correct answer is:

A1, 2, 3
B2, 3, 4, 5
C1, 2
Donly 1
Eonly 3

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Question 154

Which of the following are obligatory in the case of cardiopulmonary resuscitation performed by an unexperienced person?

1) chest compressions;

2) artificial ventilation;

3) pulse examination on the carotid artery;

4) pulse examination on the radial artery;

5) evaluation of consciousness and breathing.

The correct answer is:

A1,3.
B1,5.
Call the above.
D1,2,3
E1,2,3,5

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Question 155

Which of the following may be observed in the ECG of a patient with sudden cardiac arrest and normally working artificial ventricular pacemaker?

1) asystole without stimulation artifacts;

2) ventricular fibrillation without stimulation artifacts;

3) ventricular fibrillation and stimulation artifacts;

4) asystole and stimulation artifacts;

5) ventricular fibrillation and transient stimulation artifacts.

The correct answer is:

Aall the above.
B2,3,4,5
C2,3
D2,4
E1.2

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Question 156

The potentially reversible causes of cardiac arrest (so-called ‘four H’) do not include:

Ahypoxia
Bhypovolemia
Chypercalcemia
Dhyperkalemia
Ehypothermia

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Question 157

What is the correct frequency of chest compressions during cardiopulmonary resuscitation in an adult?

A60-70 / min
B80-90 / min
C100-120 / min
D130-140 / min
E140-150 / min

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Question 158

The man was admitted to the Emergency Unit due to syncope without loss of consciousness. The patient complains of pain in the chest and weakness. The patient is chronically treated with VKA due to atrial flutter. The examination reveals cold, pale and sweat skin, a heart rate 130 per minutes, blood pressure 80/50 mmHg. The electrocardiography shows atrial flutter. First of all you should apply:

A300 mg amiodarone within 10 minutes intravenously.
Belectrical cardioversion up to three times.
C2 g magnesium sulphate solution intravenously
D6 mg adenosine intravenously
E0.25 mg digoxin intravenously.

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Question 159

Which of signs listed below is not related to acute radiation syndrome?

Ainjury of the central nervous system
Binjury of bone marrow.
Cinjury of the myocardium.
Dinjury of the skin.
Einjury of the digestive tract

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Question 160

A 35-year-old man was admitted to the Emergency Unit because of black stools occurring for a few hours. He is also suffering from haemophilia A. The primary treatment should include:

Ablood group determination and a transfusion of two units of red blood cell concentrate.
Bprotonic pump inhibitor administration.
Cfactor VIII immediate administration.
Dimmediate gastroscopy.
Edetermination of factor VIII concentration.

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Question 161

The following lab results: glucose 651 mg/dl, Na 120 mmol/l, K 3.22 mmol/l, plasma osmolality 325 mOsm/l in a patient who is disoriented in time and place, dehydrated and who urinates about 5l/24h may indicate:

Ahypoglycemic coma.
Bdiabetic ketoacidosis
Cnonketotic hyperosmolar diabetic coma.
Ddecompensated diabetes insipidus.
Eadrenal crisis.

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Question 162

Indicate the true statements regarding hyperbaric oxygen therapy (HBOT):

1) in the case of CO intoxication recommended therapy involves putting the patient under the pressure of 4.0 atm during for minutes;

2) “golden hour” for HBOT in severe CO intoxication is 6h;

3) one of indications for HBOT is COHb concentration over 25%;

4) HBOT shifts the oxyhemoglobin dissociation curve to the left;

5) HBO is known to be safe both for pregnant women and the foetus.

The correct answer is:

A1, 2
B1, 3
C2, 3
D4,5
E1, 5

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Question 163

Indicate the true sentences regarding lithium intoxication:

1) charcoal binds to lithium and therefore activated charcoal is indicated in the case of lithium intoxication;

2) gastric lavage in the case of lithium intoxication is indicated if the patient presents within one hour of the ingestion;

3) the character of kidney failure in the case of lithium intoxication is only renal;

4) lithium is absorbed and eliminated fast from tissues;

5) forced diuresis with urine alkalization allows lithium elimination.

The correct answer is:

A1, 2
B1, 3
C2, 3
D4,5
E2,5

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Question 164

The consequences of ethylene glycol poisoning include:

1. metabolic acidosis

2. metabolic alkalosis

3. respiratory acidosis

4. respiratory alkalosis

5. acute renal failure

6. chronic renal failure

The correct answer is:

A1,6
B2,5
C1,5
D3,6
E4.5

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Question 165

Which of the following disturbances is an indication for dialysis therapy?

AAnuria 6 mg / dl
BAnuria >12 h, serum potassium level <6.5 mmol / l
CpH> 7.2, serum creatinine level > 6 mg / dl
DpH < 7.2, serum potassium level < 6.5 mmol / l
Eserum uric acid concentration 300 mg / dl, serum potassium level 6.5 mmol / l

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Question 166

A 7-year-old child was bitten by an adder and suffered from anaphylactic shock. The dose of adrenaline that should be given is:

A0.15 ml of 0.1% solution
B0.3 ml of 0.1% solution
C0.5 ml of 0.1% solution
D0.75 ml of 0.1% solution
E1 ml of 0.1% solution

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Question 167

Indicate the true sentences regarding PBLS:

1) during an infant CPR tidal volumes of approximately 500 mL should be delivered;

2) spend about 10 seconds to determine whether the infant is breathing before starting CPR;

3) you should spend about a minute to perform 5 effective rescue breaths before you start CPR on an infant;

4) while performing CPR on an infant you should compress the chest at a rate of at least 100/min;

5) while performing CPR on an infant you should continue compressions and breaths in the ratio of 15:2;

6) while performing CPR on an infant you should press the centre of the sternum.

The correct answer is

A1,5,6
B2,3,6
C1,3,6
D2,4,5
E2,5,6

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Question 168

After defibrillation during cardiopulmonary resuscitation the ECG should be evaluated:

Adirectly after defibrillation, but it should not take more than 5 seconds
Bdirectly after defibrillation, but it should not take more than 10 seconds.
Cafter 1 min of performing cardiopulmonary resuscitation.
Dafter 2 min of performing cardiopulmonary resuscitation or earlier if the signs of spontaneous circulation occurred
Eafter 5 min of performing cardiopulmonary resuscitation or earlier if the signs of spontaneous circulation occurred.

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Question 169

An antidote for benzodiazepine intoxication is

Aprotamine sulphate
Bglucagon
Cnaloxone
Dactivated carbon
Eflumazenil

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Question 170

Naloxone is used in the case of poisoning with:

Abenzodiazepines.
Bamanita phalloides (‘death cap’)
Catropine
Dopioids
Emethyl alcohol

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Question 171

Hypothermia is defined as a decrease in the core body temperature to:

A36°C or less.
B35°C or less.
C34°C or less
D33°C or less.
E30°C or less.

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Question 172

Which of the potentially reversible causes of cardiac arrest are the most probable in a victim hit by a car?

1) hypoxia;

2) hypothermia;

3) hypovolemia;

4) electrolyte and metabolic disturbances;

5) tension pneumothorax;

6) tamponade;

7) thromboembolism;

8) intoxication.

The correct answer is:

A1, 8
B2, 3
C2, 6
D3, 5
E4, 7

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Question 173

A doctor can issue the death certificate:

1) on the basis of their own tests and conclusions;

2) on the basis of the documentation of post-mortem examination made by another doctor;

3) on the basis of patient’s medical documentation made before their death.

4) only after autopsy;

5) on the basis of the information obtained from the deceased’s close persons.

The correct answer is:

A1,2
B2,3
Conly 4
D3,5
Eonly 5

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Question 174

A patient in need of dialysis has been taken to the hospital. He is not able to give effective consent for the surgery because of his health condition. In such a case the doctor is allowed to carry out the surgery:

1) after obtaining consent from their superior;

2) after obtaining consent from the patient’s spouse or his close person;

3) after releasing the ruling by the domestic Court of Protection stated incapacitation of the patient;

4) after obtaining judicial authorization;

5) in the situation in which a delay could cause death or grievous bodily harm, without anyone’s permission - but they should possibly consult another doctor if possible of the same specialty.

The correct answer is:

A1,4.
B4,5.
C1,3.
D2,4.
E1,5.

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Question 175

A contract of employment in the hospital has been offered to a doctor. The employment is based on the co-called equivalent work time. This means that:

1) standard daily working time can be increased up to 12 hours;

2) standard daily working time can be increased up to 18 hours;

3) standard weekly working time is increased to 48 hours;

4) basically the time calculation period is shortened to 1 month;

5) basically the time calculation period is prolonged to 6 months.

The correct answer is:

A1,3
B2,4
C3,5
D2,5.
E1,4.

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Question 176

A doctor is going to do some experiment on animals. Before launching it they should obtain the approval of:

Abioethical committee at the Medical University.
BDepartment of Science and Higher Education in the Ministry of Health.
CChief Veterinarian.
Dlocally appropriate district veterinarian.
Elocally appropriate local ethical committee.

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Question 177

The doctor may apply means of direct coercion, when:
1. The patient does not follow the orders of doctors and nursing staff.
2. The patient commits an assault against himself or others.
3. The patient violently destroys or damages objects in his surroundings.
4. There is a justified fear of leaving the hospital without staff's permission.

A1,2
B2,3
C1,2,3
D2,3,4
E4

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Question 178

Many doctors on their stamps use the title "doctor of medicine". According to the current law:

AThis title can be used by doctors, who have completed a postgraduate internship.
BThis title cannot be used at all, because it does not exist in a legal sense.
CThis title may be used by doctors, who graduated before 1996.
DThis title may be used by doctors, who graduated before 1989.
ECorrect A and C.

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Question 179

An employer turns to his doctor employee, who works on the contract of employment, to sign a contract including the so-called non-compete clause. What should the doctor do?

Athey should not sign such a clause without the prior consent of the trade union which represents them.
Bthey should not sign such a clause because it would be invalid whatsoever since it limits the freedom of the medical profession.
Cthey can sign such a clause but only if it takes effect after the termination of the contract of employment with this employer.
Dthey have to sign such a clause because otherwise the employer can terminate the contract of employment on disciplinary grounds.
Ethey can sign such a clause and it takes effect but they are not obliged to do so.

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Question 180

The World Medical Association’s Declaration of Helsinki, the founding document of modern medical ethics and medical law, states:

Aresearch on human beings is commonly allowed and unlimited.
Bresearch on humans can be carried out in violation of their assets if it is in a good interest of science.
Cin research on humans the conditions associated with a good interest of the tested should never be submitted to an interest of science or society
Dmedical research involving people can be carried out even if it is unlimited nontherapeutic experimentation
Ethe Declaration of Helsinki does not specify any principles associated with research on humans.

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Question 181

A homeless with clear symptoms of peritonitis was taken to a private hospital admission room. The hospital is able to help the patient but it does not have the contract signed with the National Health Fund (NFZ) for this type of medical services. How should the doctors proceed?

Athey should refuse help justifying the move in the medical documentation by a lack of funding for this type of medical procedures.
Bthey should refuse the medical service but it is their duty to indicate another medical facility where such a service is available.
Cthey can help but after assuring the financing from the National Health Service (NFZ) for this procedure.
Dif the patient’s life or health is in danger they should help the patient regardless of a lack of the contract with the National Health Service (NFZ).
Ethey can help but after obtaining a written agreement from the community administrator, mayor or city president that the community will cover the cost of the procedure.

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Question 182

Which of the following diseases is not an occupational disease?

Apneumoconiosis
Basthma
Cmyocardial infarction
Dallergic rhinitis
Ehand-arm vibration syndrome

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Question 183

SIF (ZUS) appointed doctors and medical commission of the Social Insurance Institution issue medical statements determining entitlements to benefits from the Social Insurance Fund. SIF (ZUS) appointed doctors and medical commission of the Social Insurance Institution do not issue medical statements regarding:

Ainability to work for disability pension purposes
Bthe need for medical rehabilitation as a part of disability pension prevention
Cpermanent or long-term damage to health caused by an accident at work or an occupational disease
Ddegree of disability
Ea relationship between inability to work and an accident at work or an occupational disease

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Question 184

Who can issue a medical statement for a period longer than 3 days preceding the day of examination?

AHospital director
BPsychiatrist
CHead of the out-patient clinic
DInternist
EGeneral practitioner

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Question 185

A person incapable of independent existence is:

AA person requiring help in everyday activities
BA person requiring assistance in dealing with official matters
CA person incapable of work during the acute phase of the disease
DA person requiring constant and long-term care to satisfy basic life needs
EA person awaiting the assignment of a legal representative

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Question 186

Social 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:

Apartially incapable of work
Bslight degree of disability.
Cconsiderable degree of disability
Dtotal incapacity for work.
Etotal incapacity for service.

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Question 187

The maximum period of granting a disability pension by the ZUS (SIF) appointed doctor is:

A1 year
B2 years
C3 years
D4 years
E5 years

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Question 188

Who receives the first copy of ZUS ZLA medical statement on temporary incapacity to work?

Aa local organizational unit of the Social Insurance Institution
Ba central organizational unit of the Social Insurance Institution
Cthe insured
Dthe copy is kept by the doctor
Ethe employer

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Question 189

Quantitatively, Polish society is characterized by the following features compared to other EU countries:

Aless amount of smoked cigarettes, a greater amount of consumed alcohol, lower percentage of obesity
Bhigher number of smoked cigarettes, a greater amount of consumed alcohol, higher percentage of obesity
Cless amount of smoked cigarettes, a greater amount of consumed alcohol, higher percentage of obesity
Dhigher number of smoked cigarettes, lower amount of consumed alcohol, higher percentage of obesity
Ehigher number of smoked cigarettes, a greater amount of consumed alcohol, lower percentage of obesity

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Question 190

The first clear legal basis for EU activities in public health is The Treaty of:

ALisbon
BAmsterdam
CNice
DMaastricht
ERome

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Question 191

Choose the false statement - Zika virus in pregnant women:

Acan cause hemorrhagic fever in women
Bcan cause microcephaly in children
Ccan cause joint pain and rash in women
Dmay cause fever and conjunctivitis in women
Eis asymptomatic in the majority of the cases

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Question 192

The abbreviation XDR TB means:

Adiagnostic method of M. tuberculosis XDR
Bexpanded multi-drug resistance of tubercle bacillus
Cmulti-drug resistant strain of tubercle bacillus
Dmethod of tubercle bacillus isolation
Egenetic mapping of tubercle bacillus

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Question 193

Nosocomial infection takes place in:

Astable
Bgarden
Czoo
Dhospital
Eairplane

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Question 194

The main cause of death of the elderly (65+) in Poland is associated with:

AInfectious diseases.
Bneoplasms (cancers).
Ccardiovascular diseases.
Dnervous system diseases
Ehearing organ diseases.

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Question 195

Which of the following are components of the Regional and National Maps of Health Needs specified in the Polish Ministry of Health Regulation of 26 of March 2015?

AWHO health need projections for the European Region; analysis of the state of resources and their utilization; health need projections.
Banalysis of the state of healthcare resources and their utilization; analysis of health risk factors; analysis of the main causes of death in the population.
Cdemographic and epidemiological analysis; analysis of the state of resources and their utilization; health need projections.
Dmonitoring of zoonotic diseases and zoonotic agents; keeping records of the new incidence of infectious diseases; analysis of the state of health of children and young people from different provinces.
Eanalysis of the state of health of the elderly; analysis of health needs of children and young people; analysis of the state of resources and their utilization.

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Question 196

Significant improvement in health and wellbeing of the population. Reducing inequalities in access to health care. Strengthening the position of public health. Provision of patient-orientated healthcare systems which are common, equal, stable and of high quality. Those constitute the strategic framework of EU regional policy for public health, a framework which was prepared by:

Athe Association of Schools of Public Health in the European Region (ASPHER) in the form of The Agency for Public Health Education Accreditation.
Bthe World Health Organization in the form of The Ottawa Charter for Health Promotion.
Cthe WHO Regional Committee for Europe in the form of the document entitled “Health 2020. The European policy framework supporting action across government and society to promote health and wellbeing”.
Dthe European Public Health Association (EUPHA).
Ethe Council of the European Union in the document of 1992 entitled “The Treaty on European Union” signed in Maastricht..

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Question 197

Which of the following are among factors increasing the risk of hyperemesis gravidarum?

1) cigarette smoking;

2) bulimia;

3) obesity;

4) pregnancy in a nullipara;

5) lipid metabolism disorders.

The correct answer is: