A. causes severe interstitial pneumonia in patients after bone marrow transplantation.

C. is susceptible to ribavirine.

D. is one of etiologic factors of chronic hepatitis.

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LEKEXAM / 2009 spring

Question distribution — 2009 spring session

Share of each category in the latest available session.

Internal medicinePediatricsGynecology and obstetricsSurgeryFamily medicineEmergency medicine, AnaesthesiologyPsychiatryMedical law and bioethicsMedical certificationPublic health

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Question 1

Each patient suffering from acute coronary syndrome must be treated with:

AAcetylsalicylic acid (ASA).
BASA or clopidogrel.
CASA and clopidogrel.
Ddepending on the type of myocardial infarction – ASA and clopidogrel or ASA only.
Edepending on the mode of treatment (invasive vs noninvasive) – ASA and clopidogrel or ASA only.

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Question 2

A patient in the class IV of Killip-Kimball classification has:

Apulmonary oedema.
Bcardiogenic shock.
Cblood retention (haemostasis) below the level of inferior angles of scapulae.
Dno signs of heart failure.
Echronic heart failure, previously at least in NYHA class III.

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Question 3

Schőnlein-Henoch purpura is a vasculitis that:

Ais characterized by nephritic syndrome with cANCA antibodies.
Bmay present as rapidly progressive glomerulonephritis.
Cis often accompanied by granulomas in the lungs.
Dis typically treated by a surgical excision of granulomas.
Eis typically treated by nephrectomy of the affected kidney.

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Question 4

Which of the following drugs can cause hyperkalemia?
1) angiotensin converting enzyme inhibitors.
2) loop diuretics.
3) aldosterone antagonists.
4) thiazides.
5) indapamide.
The correct answer is:

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

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Question 5

Which of the below is an absolute contraindication to thrombolytic therapy in acute myocardial infarction:

Aage above 75.
Bsuspected dissecting aortic aneurysm.
Ccerebral stroke 2 years ago.
Dhigh blood pressure >175/110 mmHg.
Einvasive cardiology unit available on duty, which can be reached within 90 minutes.

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Question 6

Which of the following treatments may be used to decrease the concentration of serum LDL-C:

Astatins.
Bbile acid sequestrants.
Cezetimibe.
DLDL apheresis.
Eall of the above.

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Question 7

Choose the symptoms mostly associated with renovascular hypertension:

Aobesity, somnolence and fatigue during the day, morning headaches, lack of pulse on femoral arteries.
Batrophic skin striae, hirsutism, petechie, thin extremities.
Cparoxysmal high blood pressure with pallor, heavy sweating, palpitations and anxiety.
Dsevere, treatment-resistant hypertension, malignant hypertension, and most of all vascular murmur in epigastrium.
Efamily history of renal diseases, recurrent infections of urinary tract, excessive use of analgesic drugs.

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Question 8

The most effective treatment of atrioventricular node reentry tachycardia (AVNRT) is:

Apsychological consultation, possibly followed by group psychotherapy.
Bsurgical treatment.
Cpercutaneous ablation.
Dtreatment with cephalosporins.
Etreatment with atropine.

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Question 9

A 28-year-old male, a football player, has arrived to hospital because of stabbing pain in the chest lasting for few days. The pain’s intensity was increasing with breathing. In physical examination the. percussion note was hyperresonant and the respiratory sounds were decreased on one side. Tuberculin test had 10 mm in diameter, ESR 15 mm/1 h, WBC 8 x 103/l, platelets 200 x 103/l, D-dimers 500 g/l, prothrombin index 90%.
What is the most probable diagnosis ?

Atuberculous pleurisy.
Btuberculous cavity.
Cchronic pulmonary artery embolism.
Dpneumothorax.
Epleuritis sicca.

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Question 10

A 46-year-old female patient was admitted to hospital due to non-productive cough, shortness of breath, elevated body temperature up to 38 Celsius degrees. The symptoms have lasted for few days before admission. Physical examination was normal. Positive skin prick tests for house dust and house dust mites. Spirometric values were: FVC 70% of predicted value, FEV1%VC 75%. Inhalation provocation test did not reveal bronchial hyperreactivity. On chest X-ray interstitial infiltrations were visible. Hemoglobin 11 g/dl, bilirubin 2 mg %, CRP 32 mg/l (upper normal limit 10 mg/l).
What is the most probable diagnosis ?

Aasthma exacerbation.
BCOPD exacerbation.
Ccommon cold.
Dpneumococcal pneumonia.
Emycoplasma pneumonia.

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Question 11

The risk factors for pancreatic carcinoma are:
1) smoking;
2) acute pancreatitis;
3) chronic pancreatitis;
4) genetic predisposition;
5) AIDS.
The correct answer is:

A2,3,4.
B1,3,4.
C1,2,3,4.
D1,2,4.
Eall of the above.

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Question 12

Dullness in percussion suggests decreased content of air in the lung due to:
1) pneumonia;
2) pleural effusion;
3) emphysema;
4) athelectasis;
5) pneumothorax;
6) lung overinflation.
The correct answer is:

A1,5,6.
B2,4.
C1,2,4.
D4,5,6.
Eall of the above.

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Question 13

Which of the antituberculous drugs listed below are used as the first-line therapy:

1) isoniazid;

2) ethionamid;

3) streptomycin;

4) fluorochinolons;

5) ethambutol.

The correct answer is:

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

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Question 14

It is recommended to check the effectiveness of antibiotic treatment of H. pylori infection by respiratory urea test:

A1 week after the end of treatment.
B2 weeks after the end of treatment.
C6 weeks after the end of treatment.
D6 months after the end of treatment.
E12 months after the end of treatment.

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Question 15

A 53-year-old male patient with a few-year history of gastroesophageal reflux disease complains of the exacerbation of esophageal burning (especially at night) with intermittent pain during swallowing (especially solid food). He has been treated from time to time with proton pump inhibitors in standard doses and with neutralizing agents. The family physician should:

Arecommend sleeping with elevated upper part of the body.
Bincrease the dose of proton pump inhibitors.
Cincrease the dose of proton pump inhibitors and add H2 blocking agent before night.
Drefer the patient urgently for gastrofiberoscopy.
Erefer the patient for an X-ray of the upper part of the digestive tract.

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Question 16

Thyroid gland cancer originating from C cells is the cancer:

Amedullary
Bpapillary
Cfollicullar
Danaplastic
Enone of the above

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Question 17

A 30-years old male patient suffering from ulcerative colitis has reported 2-3 loose blood-stained stools daily for the last week. He denies high fever. In laboratory results anemia was not found. Colonoscopy revealed inflammation limited to rectal mucosa. Which of the treatment modes should be considered in his case:
1) oral corticosteroids;
2) hospital treatment in a specialized unit;
3) sulphasalazine or 5-ASA per os, 3-4 g daily;
4) outpatient treatment;
5) 5-ASA in rectal suppositories.
The correct answer is:

A1,2,3.
B1,3,4.
C1,3,5
D3,4,5.
E2,3,5.

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Question 18

In acute disseminated intravascular coagulation (DIC) the following laboratory abnormalities can be found:

Athrombocytopenia.
Bprolonged coagulation times (prothrombin time, activated partial thromboplastin time – APTT, thrombin time).
Clowered concentration of plasma fibrinogen.
Dlowered concentrations of other coagulation factors in plasma.
Eall are the above.

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Question 19

All statements considering Hodgkin's lymphoma are true, except:

Atwo peaks of morbidity are noted: in the age of 25-30 and 50-55
Bthe risk of incidence in a sibling of the same gender is increased by more than 10 times
Clymph nodes located beneath the diaphragm (inguinal, retroperitoneal) are most frequently involved
Dloss of body weight of 10% during the last 6 months is a non-specific symptom
EIncreased activity of lactate dehydrogenase (LDH) and alkaline phosphatase are the markers of disease progression

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Question 20

In a patient suffering from multiple myeloma, all laboratory abnormalities listed below can be met, except:

Apolycythemia.
Berythrocytes in rouleaux formation (in about 50 % of patients).
Cleucopenia (in 20 % of patients).
Dincreased serum β2 microglobulin (prognostic factor).
Ehypercalcemia (in about 30 % of patients at the moment of diagnosis).

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Question 21

Which of the following are symptoms of megaloblastic anemia:
1) hands and feet paraesthesie;
2) slightly yellowish skin color;
3) leucopenia;
4) erythrocytes microcytosis;
5) reticulocytosis.
The correct answer is:

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

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Question 22

Erythrocyturia with the presence of erythrocytic (blood) casts is a common feature of:

Aminimal-change glomerulopathy.
Bfocal hyalinizing (segmental) glomerulonephritis.
Cmembranous nephropathy.
Damyloidosis.
Eacute glomerulonephritis.

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Question 23

Glomerulonephritis is one of the most common causes of chronic renal disease and is a common complication of diabetes.

Aboth parts of the statement are true.
Bonly the first part is true.
Conly the second part is true.
Ddiabetes may predispose to glomerulonephritis.
Enowadays glomerulonephritis is a rare disease.

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Question 24

Which of the serum antibodies are characteristic for Goodpasture syndrome:

Ac-ANCA.
Bp-ANCA.
Canti-GBM
DANA.
Enone of the above.

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Question 25

So called sterile leukocyturia is not caused by:

Amycobacterium tuberculosis infection.
Bchlamydia infection.
Cfungal infection.
Dinfection with anaerobic bacteria.
Einfection with Enterobacter spp.

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Question 26

The first-line therapy of osteoporosis, apart from vitamin D and calcium supplementation, should include:

Aestrogens in postmenopausal women.
Bsulphasalazin.
Cbisphosphonians.
Dcalcitonin.
Edexamethason.

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Question 27

Which of the DMARD drugs listed below should be chosen to modify the course of ankylosing spondylitis with peripheral joints involvement:

Asulphasalazine.
Bcolchicine.
Cdiclofenac.
DD-aminopenicillin.
Eprednisone.

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Question 28

Which of the below statements best characterizes osteoporosis:

Athe disease results from insufficient supply of calcium and/or vitamin D.
Bhappens in elderly women only.
Cis characterized by decreased bone mineral density.
Dis characterized by decreased quality of bone tissue and increased susceptibility to fractures.
EC and D are true.

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Question 29

A 42-year-old female patient has been suffering from increased skin tension on face and hands for a few months. She has noticed the thinning of the lips, and radial furrowing around her mouth have appeared recently. She complains of pain of hands and feet while in contact with cold water and during stress. In these instances the skin first becomes pale like a paper, than becomes bluish and finally redden. During meals she must consume large volumes of liquids because of her problems with swallowing solid-like pieces. This features are characteristic for:

Asystemic sclerosis.
Bdermatomyositis.
Crheumatoid arthritis.
Dsystemic lupus erythematodes.
Enone of the above.

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Question 30

The most frequent symptom of renal cancer is:

Apain in lumbar region.
Bhaematuria
Cfever.
Danemia.
Ehypertension.

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Question 31

Complementary postoperative chemotherapy is not a routine (standard) procedure in the case of:

Abreast cancer
Bcancer of the colon
Cpancreatic cancer
Dnon-small cell lung carcinoma
EC and D are true

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Question 32

The dysfunction of the cardiovascular system resulting from antineoplastic chemotherapy is not a common clinical problem, because drugs which are used in chemotherapy do not damage heart muscle cells. These statements are:

Aboth are true with casual nexus.
Bboth are true without casual nexus.
Cthe first one is false, the second one true.
Dthe first one is true, the second one false.
Eboth false.

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Question 33

Tobacco smoking is most strongly related to the etiopathogenesis of:

Arenal cancer.
Bovarian carcinoma.
Cbreast cancer.
Dmelanoma.
Egastric cancer.

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Question 34

A forest officer working in the area where rabies was detected was bitten by a wild fox. In order to prevent the disease he should be treated with:

Aactive and passive prevention (vaccine and specific gamma-globulin or anti-rabies serum)
Bactive prevention only because the risk of infection is low.
Cpassive prevention only because basic vaccination is included in the obligatory vaccination calendar.
Dnon-specific prevention only (surgical wound debridement) because wild foxes are not transmitting rabies.
Eprevention may be postponed providing the patient is observed in the outpatient unit.

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Question 35

Cytomegalovirus:

Acauses severe interstitial pneumonia in patients after bone marrow transplantation.
Brepresents RNA-viruses.
Cis susceptible to ribavirine.
Dis one of etiologic factors of chronic hepatitis.
Ehas oncogenic properties.

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Question 36

Which statement considering metformin activity is true?

AIt decreases glucose release to blood by inhibition of gluconeogenesis and glicogenolysis in the liver.
BIt increases the cell susceptibility to insulin, by acting on the post-receptor signaling pathways for insulin.
CIt induces insulin release.
DA and B are true.
EA and C are true.

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Question 37

Peripheral edema may occur in:

Ahyponatremia.
Bhyperkalemia.
Chyperthyreosis.
Dhypothyreosis.
EC and D are true.

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Question 38

The most frequent disease of the thyroid glandis:

Atoxic nodular goiter.
BGraves-Basedov disease.
Cnon-toxic goiter.
Dthyroiditis.
Ehypothyreosis.

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Question 39

The most frequent tumor of the pituitary gland is:

Ahormonally inactive tumor
Bsomatotropinoma
Cthyrotropinoma
Dprolactinoma
Eadrenocorticotropinoma

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Question 40

A 10-year-old boy comes to GP (family doctor) and complains of severe weakness and periodic headaches. Detailed interview reveals an additional health problem which is polyuria that causes also the necessity of nocturnal miction. So far, as his mother reports, he has never been seriously ill and currently he does not take any medications. Laboratory tests:
WBC 5.68 K/μl, RBC 4.89 M/μ, Hgb 13.4 g/dl, HCT 38.8%, MCV 79.3 fl, MCH 27.4 pg, MCHC 34.5 g/dl, glucose (s) 4.7 mmol/l (86 mg/dl), creatinine (s) 1.83 mg/dl, potassium (s) 6.2 mmol/l, sodium (s) 148 mmol/l, calcium (s) 2.3 mmol/l, phosphate (s) 2.2 mmol/l, total cholesterol (s) 174 mg/dl, triglycerides (s) 110 mg/dl, Urinalysis: specific weight (u) 1.007 g/ml, pH (u) 7.0, leukocytes (u) – absent, protein (u) – absent, glucose (u) – absent, ketone bodies (u) – absent, urobilinogen – within normal limits.
Point out the most probable diagnosis:

Akaliopenic nephropathy.
Bhypocorticism.
Chypoparathyroidism.
Dhypothyroidism.
Erenal insufficiency.

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Question 41

From the stated below, choose the ones characteristic of Turner syndrome (45, X0):

1) gonadal dysgenesis

2) hyperestrogenism

3) hypogonadotrophic hypogonadism

4) constitutional delay of sexual development

5) mental retardation

The correct answer is:

Aall of the above
Bonly 1
C1, 3
D4, 5
Enone of the above

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Question 42

The evaluation of electrolyte equilibrium parameters is justified in monitoring pharmacotherapy of the following drugs:
1) adiuretin;
2) furosemide;
3) spironolactone;
4) vitamin D3;
5) statins.
The correct answer is:

Aall of the above.
B1,2,3,4.
C1,3,5.
D3,4,5.
Enone of the above.

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Question 43

A physical examination of a child reveals lack of a femoral arterial pulse in both inferior limbs. Of which of the congenital heart diseases is this sign characteristic?

Aaortal stenosis.
Bhypertrophic cardiomyopathy.
Ccoarctation of the aorta.
Dtetralogy of Fallot.
Emitral stenosis.

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Question 44

The contraindication to lactulose administration is:

Ahepatic encephalopathy.
Bgalactosaemia.
Cfunctional constipation.
DIBS (irritable bowel syndrome).
Ephenylketonuria.

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Question 45

A 4-year-old child developed fever up to 39 Celsius degrees lasting 4 days with the symptoms of upper respiratory tract infection. Butterly-like, red, erythematous, maculopapular, lesions appeared on his face and limbs. Blood cell count revealed leukopenia with lymphocytosis. These clinical features most indicate:

Arubella
Bmeasles
Croseola
Dallergic hives
Eerythema infectiosum

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Question 46

Prophylaxis plays the most important role in the treatment of bronchial asthma in small children and in decreasing the number of exacerbations. Which of the following statements concerning prophylactic strategies is false?

Aallergen prophylaxis is suggested if there exists an obvious relation between allergen exposition and clinical symptoms.
Bonly constant allergen elimination gives the prophylactic effect.
Cit is necessary to perform the skin tests to confirm the role of allergens in clinical symptoms development.
Da well balanced diet and preventing obesity are the crucial elements in prophylaxis.
Ephysical activity is contraindicated; active training is not recommended.

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Question 47

Facial dysmorphia, cholestatic jaundice, pulmonary valve stenosis, vertebral column defects, posterior embryotoxon are the characteristic features of:

AAlagille syndrome.
BByler syndrome.
CZieve’s syndrome.
DCrigler-Najjar syndrome.
EBudd-Chiari syndrome.

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Question 48

Point out which of the following clinical situations are not contraindications to vaccination:
1) atopic dermatitis;
2) angina;
3) hypoalimentation (low body mass);
4) hypersensitivity to the vaccine components;
5) prolonged jaundice of the newborn.
The correct answer is:

A1, 2, 3.
B1, 3, 5.
C2, 3, 4.
D3, 4, 5.
E4, 5.

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Question 49

Which of the following is decisive in the diagnosis of Hirschprung’s disease in older children:

Aanamnesis and physical examination.
Babdominal ultrasound examination.
Cbarium enema.
Da suction biopsy and histological examination.
Eall of the above.

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Question 50

Which of the mentioned below imaging tests assures the correct diagnosis of the urinary tract infection?

Aabdominal ultrasound.
Bscintigraphy.
Cplain abdominal film (plain abdominal X-ray).
Dmiction cystourethrography.
Enone of them.

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Question 51

Which of the following does not appear in the model of recommended strategy (so called pyramid) in prevention of lifestyle diseases:

Aconsumption of vegetables and fruits.
Bplant fats consumption is preferred over other fats.
Cwhole-meal bread consumption.
Dsystematic physical activity.
Eavoidance of stressful situations.

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Question 52

During routine laboratory tests done before freezing umbilical blood in the Tissue Bank anti-HCV antibodies were found in a neonate. Choose the true statement concerning the child.

Abased on the presence of anti-HCV antibodies in the serum of a neonate only active infection in mother can be diagnosed.
Bin the child active HCV infection can be diagnosed.
Cin order to confirm the infection the test for anti-HCV antibodies should be repeated after 2 months.
Din order to confirm the infection, the presence of HCV RNA in a neonate’s serum should be assessed.
Ein order to confirm the infection, the presence of HCV RNA in mother’s serum should be assessed.

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Question 53

The Prophylactic Vaccination Programme obligatory in Poland expects measles, mumps and rubella vaccine to be administered:

1) in neonatal period

2) in 12 month old infants

3) in children at the age of 13 – 14 months

4) in children at the age of 7 years

5) in children at the age of 10 years

The correct answer is:

A1, 2
Bonly 2
C2, 4
D3, 4
E3, 5

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Question 54

Which of the following are not symptoms of hypoglycemia?

Ahunger, headache, weakness
Bdysphoria (behavioral disturbances), decreased concentration
Ctremor, tachycardia
Dparaesthesias, dysphasia
Exerodermia, polydipsia

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Question 55

Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart defects. Which of the following about PDA in older children is incorrect?

Athe ratio of PDA prevalence in girls to that in boys is 1 : 3.
Bin children with PDA pulsus celer is observed.
Ccontinuous machinery murmur over the pulmonary artery is present.
Dincreased pulmonary blood flow is observed.
Eenlargement of left atrium and left ventricle is present.

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Question 56

A mother of a 3-month-old infant has noticed in her child a gradually increasing retardation of psychomotor development, progressive muscle hypotonia, eczema type skin lesions, occasional vomiting and “mouse-like odor” of sweat and urine. The most probable diagnosis is:

Atyrosinaemia.
Bhyperglycineamia.
Cphenylketonuria.
Dhomocystinuria.
Eorganic acidosis.

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Question 57

The most common clinical symptoms in a child with leukaemia are: paleness, fever and haemorrhagic diathesis, and in the blood cell count: anaemia and thrombocytopenia. These are related to displacing proper haemopoietic cells by expanding malignant cells (blasts).

Aboth statements are true and remain in causal relation.
Bboth statements are true but without a causal relation.
Cboth statements are false.
Dthe first statement is true, the second one is false.
Ethe second statement is true, the first one is false.

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Question 58

In case of hypolactasia (lactose intolerance), after excessive ingestion of lactose e.g. drinking 250 ml of milk the symptoms of lactose intolerance can occur (abdominal pains, flatulence, rumbling, diarrhoea, vomiting). Point out which one of the tests mentioned below reflects the total intestinal lactose activity:

Ablood glucose curve after lactose ingestion.
Bevaluation of lactase activity in intestinal biopsy.
Chydrogen breath test after lactose ingestion.
Dradiological small bowel follow-through after lactose ingestion.
Ehistochemical evaluation of lactase in intestinal biopsy.

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Question 59

Coryza, impeded breathing in neonates and infants can be caused by:

Aretention of mucous secretion in nasal ducts.
Boedema of nasal ducts mucosa.
Cpartial choanal atresia.
Dpartial atresia of anterior nares (nostrils).
Econcomitant cleft palate.

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Question 60

The eye of a newborn:

Ais usually hypermetropic.
Bis usually myopic.
Cis emmetropic.
Dbecomes emmetropic in the first week of life.
Eremains open for most of a day.

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Question 61

Retinoblastoma:
1) is a tumor of the orbit;
2) most often develops in children above 2 years old;
3) is the most common intraocular neoplasm in children;
4) in imaging examinations is characterized by the presence of strongly calcified lesions;
5) similarly to cataract and Coat’s disease belongs to diseases characterized by leucoria.
The correct answer is:

A3, 4, 5.
B2, 3, 5.
C1, 2, 4.
D3, 5.
E3, 4.

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Question 62

Which grains are used in gluten-free diet?
1) rice;
2) wheat;
3) millet;
4) soya;
5) corn;
6) rye;
7) buckwheat;
8) oats.
The correct answer is:

A1, 3, 4, 5, 7.
B1, 4, 5, 7.
C4, 5, 7, 8.
D2, 3, 6.
E1, 3, 4, 5.

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Question 63

The characteristic audible sign of congenital atrial defect is:

Asplitting of S2 at the pulmonary artery.
Bsystolic ejection murmur at the pulmonary valve.
Clouder pulmonary component of the second sound.
Dcontinuous murmur, so called “machinary” murmur at the pulmonary valve.
Eholosystolic murmur radiating laterally.

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Question 64

The symptoms of gluten-sensitive enteropathy do not include:

Amacrocytic anaemia.
Bsideropenic anaemia.
Cdepression.
Dgastro-oesophageal reflux disease (GERD).
Eretardation of sexual maturation (pubescence retardation).

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Question 65

The symptoms of food allergy do not include:

Adiarrhoea.
Bconstipation.
Chyperirritability.
Dregurgitation
Enasal polyps.

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Question 66

(1)Trachooesophageal fistula can be a cause of recurrent respiratory infections, (2) the diagnosis of this fistula can be based on the result of HRCT (high resolution computer tomography).

A1 and 2 are true and they are in a cause and effect relationship.
B1 and 2 are true without a cause and effect relationship.
C1 – true, 2 – false.
D1 – false, 2 – true.
E1 and 2 false.

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Question 67

Drainage of the pleural cavity should be considered in:
1) aspiration pneumonia;
2) pleurisy;
3) pneumothorax;
4) pulmonary hemosiderosis;
5) pyothorax.
The correct answer is:

A2,3.
B1,2,3.
C2, 3, 5
D1,2,3,5.
Eall of the above.

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Question 68

The indication for prenatal biochemical screening in pregnancy (PAPP-A testing, “triple test”) is:

Athose tests should be advised to every pregnant woman.
Bthose test should be offered to pregnant women over 35.
Cmultiple pregnancy.
Dthe previous pregnancy terminated by delivery of a neonate with seizures.
Ethe previous pregnancy terminated by delivery of a neonate with Down’s Syndrome.

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Question 69

In the presence of the transverse lie of fetus it is not allowed to:

Aperform cesarean section after the initiation of delivery.
Bperform vaginal delivery.
Cmake a trial of external cephalic version.
Davoid amniocentesis for labor induction.
Eperform vaginal examination immediately after the rupture of membranes and drainage of amniotic fluid.

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Question 70

The risk factors for venous thromboembolism in pregnant women are:
1) pregnant woman younger than 35 ;
2) obesity;
3) alcohol intake during pregnancy;
4) lower limbs varices;
5) cigarette smoking during pregnancy.
The correct answer is:

A1,4,5.
B2,3,4.
C2,4,5.
D3,4,5
E1,3,5.

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Question 71

In a rape victim, a sample of vaginal secretions showing motile sperm indicates that the last intercourse had taken place within:

A6 hours.
B12 hours.
C24 hours.
D48 hours.
E72 hours.

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Question 72

The diagnostic criteria of preterm labor include:

1) gestational age: 23-37 weeks;

2) ≥ 4 contractions in 20 minutes;

3) contractions duration: 5-10 sec;

4) cervical dilation of 1cm;

5) cervical effacement ≥75%.

The correct answer is:

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

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Question 73

The risk factors for ectopic pregnancy include:
1) conservative therapy of ectopic pregnancy in the past;
2) oral contraceptives;
3) a history of recurrent PID;
4) salpingoplasty;
5) IUD with copper.
The correct answer is:

A1,4.
B3,4.
C1,3,4.
D1,2,3,4.
E1,2,3,5.

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Question 74

The definition of the engaged fetal head is:

Ain the third and fourth Leopold’s maneuvers the fingers can touch each other below the head of the fetus.
Bthe presenting point of a fetal head is 3 cm above interspinous distance.
Cthe presenting part of a fetal head is at the level of interspinous distance.
Dsacral promontory and linea terminalis are palpable during vaginal examination.
Ethe fetal head can be seen in rima pudendi.

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Question 75

The risk factors for cervical cancer include:
1) HPV 16/18 infection;
2) infertility;
3) multiple number of sexual partners;
4) cigarette smoking;
5) oral contraceptive usage.
The correct answer is:

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

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Question 76

To prevent Rh disease (serological conflict) in the next pregnancy, anti-Rh (D) immunoglobulin should be administered after delivery to:

ARh(D)–negative mother with anti-D antibodies with Rh(D)-negative newborn.
BRh(D)–negative mother without anti-D antibodies with Rh(D)-negative newborn.
CRh(D)–negative mother with a high titer of anti-D antibodies with Rh(D)-positive newborn.
DRh(D)–negative mother without anti-D antibodies with Rh-positive newborn.
ERh(D)-negative mother in any case.

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Question 77

The most common location for the primary tumor in the case of the metastatic ovarian cancer is:

Athe breast.
Bthe pancreas.
Cthe lung.
Dthe stomach.
Ethe large bowel.

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Question 78

The most common site of ectopic pregnancy is:

Athe uterine tube.
Bthe ovary.
Cthe abdominal cavity.
Dthe cervix
Ethe uterine horn.

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Question 79

The clinical symptoms of bacterial vaginosis include all of the following except:

Athick, white vaginal discharge.
Bitching.
Cburning.
Dfishy vaginal odor.
Ewhite-grey watery vaginal discharge.

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Question 80

According to Naegele’s rule the estimated delivery date (EDD) for a woman with LMP on 9th of October, 2008 is:

AJuly 2nd, 2009.
BJuly 16th, 2009.
CAugust 9th, 2009.
DAugust 16th, 2009.
EAugust 2nd, 2009.

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Question 81

Which of the following drugs are used for acceleration of fetal lung maturity: 1) prednisone; 2) methylprednisone; 3) betamethasone; 4) dexamethasone; 5) prednisolone. The correct answer is:

A1,3.
B1,4.
C2,5
D3,4.
E2,3.

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Question 82

A 30-year-old woman in the 37 week of pregnancy, was admitted to L&D. During the observation the following symptoms were observed: severe pain localized in the lower part of the abdomen, increased uterine tense and vaginal bleeding. The most likely diagnosis is:

Athe beginning of labor.
Ba spontaneous rupture of membranes.
Cbleeding from the marginal sinus.
Dplacental abruption.
Eplacenta previa.

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Question 83

The Actual Pearl Index is the lowest for:

Acombined oral contraception.
Bcopper IUDs.
Cminipill.
Dbarrier methods.
Enatural methods.

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Question 84

The following pathology is most common in man with decreased fertility:

Athe absence of one or both testicles.
Bhydrocele testis.
Cvaricocele.
Denlarged and painful epididymides.
Ean enlarged prostatic gland.

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Question 85

Serum testosterone is transported:

Afree (unbound).
Balbumin-bounded.
Cglobulin-bounded.
Dall of the above.
Enone of the above.

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Question 86

The normal sperm count (for 1mL) is:

A5 million.
B10 million.
C20 million.
D40 million.
E60 million.

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Question 87

Antithrombotic therapy for pregnant woman with artificial cardiac valve is based on:

Acontinuous administration of vitamin K antagonists throughout the whole pregnancy.
Bcontinuous administration of heparin throughout the whole pregnancy.
Cnot administrating of low molecular weight heparin.
Dkeeping the INR ratio >4.
Emixed therapy OAC / UHF / LMWH

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Question 88

The routine test for detection of sideropenic anemia is:

Ablood cell count.
Bthe serum iron level.
Cthe serum ferritin level.
Diron test.
Ebone marrow biopsy.

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Question 89

Choose the false statement about eclampsia:

Aan episode of clonic-tonic seizures, coma or both simultaneously in patient with preeclampsia.
Bmagnesium sulfate is the first-choice drug to stop seizures.
Cprophylaxis of recurrent seizures include valproic acid supplementation.
Dthe most effective management to prevent recurrent seizures is delivery.
Ethe recurrent seizures can be provoked by external stimulants such as light, noise or sharp objects.

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Question 90

Blood loss during normal delivery should range between:

A50-100 mL.
B100-150 mL.
C150-250 mL.
D250-350 mL.
E300-500 mL.

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Question 91

The tocolytic therapy of the preterm labor includes the following drugs:
1) beta-mimetics;
2) calcium-channel blockers;
3) beta-blockers;
4) prostaglandin inhibitors;
5) oxytocin antagonists.
The correct answer is:

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

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Question 92

After six hours from delivery, the newborn presents jaundice. The most probable diagnosis is:

Ahaemolytic disease of the newborn.
Bsepsis.
Cbiliary atresia.
Dneonatal hypothyroidism.
Eneonatal hepatitis.

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Question 93

Physiological events that increase a serum prolactin level include:
1) pregnancy;
2) breast feeding;
3) stress;
4) nipple stimulation;
5) sleep.
The correct answer is:

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

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Question 94

The lack of verbal reaction, regardless prompting and commands, is called:

Amuteness.
Bstupor.
Ccatatonia.
DGanser’s syndrome.
EParkinson’s syndrome.

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Question 95

Derailment is characteristic of:

Adepression.
Bschizophrenia.
Cautism.
Dobsessive-compulsive syndrome.
Eneurasthenia.

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Question 96

Wishful transformation of experiences and behavior caused by expectations and hope is called:

Ahyperthymia.
Banxiety.
Ccatathymia (wishful thinking).
Ddysthymia.
Eeuthymia.

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Question 97

The consequences of alcohol dependence include all the mentioned, except:

Aalcohol depression.
BParkinson’s syndrome.
CWernicke-Korsakoff syndrome.
Dpersistent alcohol halucinosis.
Ealcohol paranoia.

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Question 98

In which method of the therapy of opiates dependence the opioid receptors antagonism is the main mechanism of action:

Arehabilitation from the dependence.
Bpsychotherapy.
Csubstitution therapy.
Ddetoxication.
Eall of above mentioned.

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Question 99

The group of “4 A” symptoms of schizophrenia by E. Bleuler does not include:

AAutism.
BAffect disturbances.
CAmbivalence.
DAssociation disturbances.
EAmnesia.

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Question 100

The characteristic symptoms of depression do not include:

Alowering of mood.
Bpsychomotor slowing.
Cdisturbances of biological rhythms.
Dvisual hallucinations.
Eanxiety.

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Question 101

The intense anxiety in specific situations is characteristic of:

Ageneralized anxiety disorder.
Bobsessive-compulsive syndrome.
Cphobias.
Ddepression.
Eautism.

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Question 102

The complex or simple activities characterized by the urge or irresistible need to perform are called:

Acompulsions.
Bobsessions.
Cstereotypy.
Dmanierisms.
Ecatalepsia.

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Question 103

The features characteristic of the elderly are all mentioned below except:

Athe reduced need for care.
Bthe loss of interests.
Cthe aversion to intrapersonal contacts.
Dpsychomotor slowing.
Emore frequent disturbances of sleep.

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Question 104

The most characteristic feature of all anxiolytics is the efficacy against the following kind of symptoms:

Asomatic.
Banxiety.
Cinsomnia.
Ddepression.
Edisturbances of behavior.

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Question 105

The majority of antipsychotics acts in a mechanism of:

A5HT receptors agonism.
B5HT receptors antagonism.
CD receptors agonism.
DD receptors antagonism.
Eall mentioned mechanisms are typical of all antipsychotics.

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Question 106

The mean daily dose of olanzapine in the treatment of schizophrenia, is:

A1-2 mg.
B5-6 mg.
C10-20 mg.
D30-50 mg.
E50-100 mg.

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Question 107

The inability to stay still as the side-effect of the antipsychotics, is called:

Acatatonia.
Bakathisia.
Cakinesia.
Danhedonia.
Ealexia.

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Question 108

Which of the following lesions of the large intestine is characterized by the highest risk of malignant transformation?

Atubulovillous adenoma.
Bvillous adenoma.
Ctubular adenoma.
Dhyperplastic tumor.
Eall of the above have similar risk of malignant transformation.

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Question 109

A 65-year-old man who suffers from chronic constipation has had an aggravating pain in the left lower quadrant of the abdomen (iliac fossa) for the last 5 days. On admission he has diffuse pain of the abdomen and presents with peritoneal signs. All of the below examinations are favored except:

Acolonoscopy.
Bultrasound.
CCT scan.
DMRI.
Eplain abdominal x-ray.

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Question 110

A patient was hospitalized for 6 weeks because of acute pancreatitis. Three weeks after discharge from the hospital he started to feel epigastric pain accompanied by increasing fever. During examination a painful, fixed mass can be palpated in the epigastrium. The most likely diagnosis is:

Apancreatic pseudocyst.
Babscess.
Ccyst.
Dneoplastic tumor.
Erecurrent acute pancreatitis.

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Question 111

A 86-year-old woman with a history of a stroke which occurred a few months ago is bedridden. She has had an evacuation problems for some time but for three days she has been completely unable to defecate and pass the gasses. She also complains of severe abdominal pain. The abdomen is distended and bowel movements typical of mechanical bowel obstruction. What should be done first?

Aabdominal x-ray.
Badministration of spasmolytics.
Cdigital rectal examination.
Di.v. infusion of fluids.
Eenema.

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Question 112

According to the rule of 9's, the surface area affected by the burn of the front of the trunk and both upper extremities stands for:

A10%.
B18%.
C27%.
D36%.
E45%.

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Question 113

Which of the following statements concerning acute appendicitis is true?

Ait is the most common inflammatory disease of the abdomen; occurs mostly in the elderly.
Bmales are affected more frequently than females; urinary tract disorders most often mimic the symptoms of appendicitis.
Cstarts as a pain in the right iliac fossa; leucocyte count is one of the crucial factors of the diagnosis.
Dabdominal ultrasound determines the diagnosis; appendectomy is the only possible treatment of diagnosed appendicitis.
Ethe diagnosis of appendicitis is based on a thorough history and physical examination; urological and gynecological diseases are the most frequent ones in differential diagnosis.

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Question 114

Which of the listed symptoms is not characteristic of the mechanical bowel obstruction?

Aabdominal distention.
Bvomiting.
Cinability to pass gas or stool.
Dlack of bowel movements.
Eabdominal pain.

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Question 115

A patient with permanent atrial fibrillation had an onset of an acute pain in the right lower extremity. On examination the GP found the right limb cold and pale. The right limb has no palpable pulses. Patient is unable to move the foot. What is the most important emergency treatment before the patient gets to hospital?

Aplacement of the limb on a soft bedding.
Bheparin bolus.
Chigh doses of the vasodilatators.
Dadministration of analgetics.
Ecooling the affected limb.

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Question 116

Which of the following examinations is least useful in diagnosis of the mechanical bowel obstruction?

Aabdominal X-ray.
Bbarium enema.
Causcultation of the abdomen (type of bowel movements).
Dabdominal CT scan.
Eupper GI and bowel series.

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Question 117

A method of choice in the diagnosis of the icterus mechanicus (obstructive jaundice) is:

Aabdominal ultrasound.
Bendoscopic retrograde cholangiopancreatography – ERCP.
Cabdominal CT scan.
Dpercutaneous transhepatic cholangiography – PTHC.
Eabdominal X-ray.

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Question 118

Advanced carcinoma of the coecum presents with:
1) tumor in the right iliac fossa;
2) diarrhoea;
3) anaemia;
4) hypoalbuminemia;
5) right hypogastric pain.
The correct answer is:

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

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Question 119

The symptoms of the mechanical bowel obstruction are:
1) permanent abdominal pain;
2) recurrent abdominal pain;
3) inability to pass gas or stool;
4) hyperkalemia;
5) bradycardia.
The correct answer is:

A2,3.
B2,4.
C3,4.
D1,4.
E2,5.

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Question 120

The main symptoms of sigmoid cancer include:
1) narrowing of the stool (ribbon stools);
2) constipation and diarrhoea alternately;
3) elevated body temperature;
4) cachexia;
5) blood in the stool.
The correct answer is:

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

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Question 121

A 28-year-old woman comes to the physician with smooth, movable tumor in the upper external quadrant of the mamma. The most likely diagnosis is:

Afibrocystic breast disease.
Bpapilloma.
Cfibroadenoma.
Dphyllodes tumor.
Emammal carcinoma.

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Question 122

The presence of gallstones in the common bile duct can be suspected when:
1) the common bile duct is distended;
2) the gallbladder contains numerous small gallstones;
3) a patient has a history of obstructive jaundice;
4) the cystic duct is obstructed;
5) the cystic duct is enlarged.
The correct answer is:

Aall of the above.
B1,2,3,5.
C1,2,3,4.
D4,5
E3,4,5.

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Question 123

The most frequent clinical symptom after surgical treatment of esophageal carcinoma is:

Adysphagia
Bvomiting and eructation
Cretrosternal pain during swallowing
Dmusculo-articular pain
Eregurgitation

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Question 124

A 60-year-old obese woman comes to the emergency department because of acute pain in the right upper quadrant of the abdomen radiating to the right shoulder and scapula. The pain occurred 5 hours earlier after fatty meal. In the clinical examination there is a pain in the right upper abdomen just below the margin of the ribs, no peritoneal signs are present. Bowel movements are normal. She had similar symptoms in the past. Most likely diagnosis is:

Aperforated peptic ulcer.
Bsuperior mesenteric artery embolism.
Cleft-sided renal colic.
Dacute calculous cholecystitis.
Eacute appendicitis.

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Question 125

Which vein is suitable and appropriate for the performance of chronic TPN (total parenteral nutrition)?

Athe median cubital vein.
Bthe subclavian vein.
Cthe cephalic vein.
Dthe inferior vena cava.
Ethe saphenous vein.

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Question 126

Digital rectal examination evaluates:
1) the length of an anal canal;
2) the integrity and pressure of the sphincters;
3) the contents of the rectum;
4) the rectal wall;
5) the prostate gland.
The correct answer is:

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

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Question 127

„Acute abdomen” symptoms can be triggered by:

1) acute cholecystitis;

2) pancreatitis;

3) abdominal aortic aneurysm rupture;

4) acute mesenteric ischemia;

5) high levels of serum urea.

The correct answer is:

A1,2.
B1,2,3.
C3,4.
D1,2,3,4.
Eall of the above.

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Question 128

A 56-year-old woman is admitted to hospital with the hemoptysis and acute epigastric pain. She has a history of ischemic heart disease and substitution hormonotherapy. During physical examination she presents a central cyanosis. The most likely diagnosis is:

Aacute pancreatitis.
Bpulmonary embolism.
Cmyocardial infarction.
Dpneumonia.
Eperforated duodenal ulcer.

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Question 129

The criteria of the diagnosis of thrombangitis obliterans (Burger's disease) are:

Ait affects mainly males under 40.
Bpreceded by the migrating thrombophlebitis.
Cstrongly associated with the use of tobacco products.
Dabsent pulses on pedal and popliteal arteries.
Eall of the above.

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Question 130

A 42-year-old patient during his visit to the Emergency Department presents with severe pain in the left buttock and anus making him unable to sit; the symptoms are aggravated during defecation. The pain has lasted for 4 days and is accompanied by temperature of 38 degrees. During clinical examination there is a swelling and redness in the anal area extending to the left buttock. Rectal digital examination is painful and reveals hot protrusion in this area. The treatment would be:

Aanalgetics, antibiotics administration and referral to outpatient clinic in 3 days.
Banti-inflammatory ointments and analgetics.
Cantibiotic ointments, sitz baths and analgetics.
Durgent surgical treatment (excision and drainage).
Eobservation in the surgical ward, sitz baths, iv antibiotic and analgetics.

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Question 131

The risk factors for the esophageal carcinoma are:
1) GERD (gastrointestinal reflux disease);
2) esophageal mucosa atrophy due to iron deficiency;
3) alcohol overuse;
4) smoking;
5) ingestion of hot foods.
The correct answer is:

A1,2,3,5.
B1,2.
C1,4,5.
D1,2,5.
Eal of the above.

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Question 132

Coumarin-based anticoagulants administration has to be monitored by the blood testing of:

AAPTT.
BINR.
Cplatelet count.
Dserum fibrinogen.
Enone of the above.

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Question 133

Renal artery stenosis can lead to:

Ahypertension.
Bhematuria.
Cproteinuria.
Dcarcinoma of the kidney.
Eall of the above are true.

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Question 134

The advancement of the chronic venous insufficiency can be evaluated by means of:
1) clinical examination;
2) duplex ultrasonography imaging of the deep and superficial veins;
3) plethysmography;
4) phlebography of the leg veins;
5) arteriography of the leg arteries.
The correct answer is:

A1,2,4,5.
B1,2.
C4,5.
D1,2,5.
E1,2,3,4.

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Question 135

Which of the immunization listed below is not compulsory regarding the Polish Preventive Immunizations Program:

Avaccination against HBV.
Bvaccination against meningococcus.
Cvaccination against Heamophilus influenzae.
Dvaccination against poliomyelitis (virus type 1, 2, 3).
Evaccination against rotavirus diarrhea.

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Question 136

According to the current recommendation the daily dose of vitamin D3 in infants should be:

A400 IU.
B600 IU.
C800 IU.
D1200 IU.
E2000 IU.

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Question 137

In patient with asthma in case of exacerbation of symptoms (cough, shortness of breath) the medication of first choice to be used should belong to the group of:

Acromones.
Bshort- acting beta2-agonists.
Cmethylxanthines.
Danti-leucotriens.
Emacrolides.

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Question 138

Indicate the false sentence related to physiological (neonatal) jaundice:

Ain the children born on term the greatest severity occurs on 3rd-4th day afterbirth.
Bit resolves between 7th and 14th day after birth.
Cin preterm infants it occurs in the first 24 hours of life.
Dits occurrence is related to breastfeeding of the newborn.
Ethe condition does not require treatment.

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Question 139

The pharmacotherapy of a patient with suspected myocardial infarction in pre-hospital management consists of:

Aoral administration of acetylsalicylic acid.
Bpain reliving – intravenous administration of morphine.
Csublingual administration of nitroglycerine when systolic blood pressure is less then 90 mm Hg.
Dcorrect answers A and B.
Ecorrect answers A, B, C.

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Question 140

Life-threatening or alerting headaches do not include:

Aa sudden, first in the lifetime incident of heavy headache.
Ba post physical exertion headache.
Ca headache with associated neurological symptoms.
Da headache with Gunn’s sign seen on ophthalmoscopy.
Eall the above answers describe alerting headaches.

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Question 141

Ocular muscles weakness – eye lid drop, double vision resolving after night rest, are the most common initial symptoms of:

Acongenital myotonia.
Bintermittent oftalmoplegia.
Cmyasthenia.
Dmuscular distrophy.
EGuillain-Barre syndrome.

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Question 142

Each medical certificate should contain at least:

1) physician’s details;

2) certificate’s purpose;

3) assessment;

4) diagnosis;

5) the date and place of when and where the document has been issued.

The correct answer is:

Aall of the above.
B1,2,5.
C1,2,3,5.
D1,3,4,5.
E3,4.

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Question 143

When observing fear and crying during medical examination of a 7-month-old baby a physician should refer it to a psychologist because this kind of reaction should not occur at this age.

Aboth parts of the statement are true and there is a casual relationship between them.
Bboth parts of the statement are true but there is no casual relationship between them.
Cthe first part of the statement is true, but the second part is false.
Dthe first part of the statement is false, but the second part is true.
Eboth parts of the statement are false.

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Question 144

Healthy, one-year-old baby should already be vaccinated against:

1) hepatitis B;

2) tuberculosis;

3) diphtheria;

4) Haemophilus influenzae type B infection;

5) measles. The correct answer is:

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

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Question 145

In the treatment of arterial hypertension in a patient with diabetes the first line pharmacotherapy is:

Aβ-blocker
BACE-inhibitor.
CCCB.
Dα-blocker.
Emethyldopa.

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Question 146

Cancer screening is an examination of the people without the symptoms of the illness in order to early detect cancer, and indication of the effectiveness of the screening is the reduction of mortality related to the cancer. The efficacy of the screening has been documented for:
1) cytological diagnosis of the cervical cancer;
2) a chest X-ray in case of the lung cancer;
3) mammography in case of the breast cancer;
4) PSA measurement in case of the prostatic cancer;
5) colonoscopy in case of the colon cancer.
The correct answer is:

Aall of the above.
B1,2,3.
C2,4,5.
D3,5.
E1,3,5.

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Question 147

A physician has diagnosed anaphylactic shock in a 20-year-old female stung by a wasp. In such situation the physician must always administer:

A100 - 500 mg of hydrocortisone.
B0.3 – 1 mg of adrenaline.
C1 g of hydrocortisone.
D100 mg of phenasoline.
E1 g of calcium.

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Question 148

While treating arterial hypertension in a patient with:

1) diabetes – it is correct to choose ACE-inhibitor;

2) benign prostate hypertrophy – it is correct to choose α-blocker;

3) asthma – it is correct to choose β-blocker;

4) pregnancy - it is correct to choose ACE-inhibitor;

5) coronary heart disease - it is correct to choose β-blocker.

The correct answer is:

Aall of the above.
B1,2,5.
C1,5.
D2,5.
E3,4.

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Question 149

Before starting removing an earwax plug by ear irrigation a physician should take the history of ear diseases in this patient because acute otitis media (even if diagnosed a long time ago) is an absolute contraindication for ear irrigation.

Aboth parts of the statement are true and there is a casual relationship between them.
Bboth parts of the statement are true but there is no casual relationship between them.
Cthe first part of the statement is true, but the second part is false.
Dthe first part of the statement is false, but the second part is true.
Eboth parts of the statement are false.

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Question 150

These are the conditions of having a reliable examination of the uterine cervix swab:
1) not having vaginal irrigations during the last 24 hours before the examination;
2) not having sexual intercourses during the last 24 hours before the examination;
3) not having applied intravaginal medicines during the last week before the examination;
4) not having gynecological examination directly before the swab;
5) the swab done under the eye control (after introducing vaginal speculum).
The correct answer is:

Aall of the above.
B1,3.
C1,2.
D1,2,3,5.
E2,3,5.

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Question 151

Morphine should not be used in patients with biliary colic because it causes hepatopancreatic ampulla’s sphincter spasm.

Aboth parts of the statement are true and there is a casual relationship between them.
Bboth parts of the statement are true but there is no casual relationship between them.
Cthe first part of the statement is true, but the second part is false.
Dthe first part of the statement is false, but the second part is true.
Eboth parts of the statement are false.

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Question 152

The following medications should not be used in treating high blood pressure in a patient diagnosed with gout:

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

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Question 153

In venous ulcer treatment the most important is:

Asurgical debridement of the wound.
Bpressure therapy.
Cwound drying ointment application.
Dantibiotic therapy.
Elower leg varicose vein treatment.

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Question 154

In a ten-year-old boy, allergic to beta-lactam antibiotics, the examination shows high fever, tonsillar exudation, submandibular lymph nodes enlargement, lack of catarrhal symptoms. As the first choice of treatment the following medication should be administered:

Acefuroxime.
Bclarithromycin.
Cco-trimoxazole.
Ddoksycycline.
Eciprofloxacin.

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Question 155

Which of the statements referring to subdural hematoma are true?
1) it is the most common intracranial bleeding following a head trauma.
2) it occurs by tearing the bridging veins.
3) subdural hematoma can occur in patients without skull fractures.
4) subdural hematomas are accompanied by characteristic clinical picture: initial loss of consciousness, regaining of consciousness which lasts for minutes or hours, and finally again neurological disturbances due to raising intracranial pressure.
5) neurological examination and observation qualify for surgical treatment because the clinical symptoms of raising intracranial pressure are very characteristic.
The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
D1,3,4.
E2,4,5.

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Question 156

While sorting and prioritizing the victims of a mass casualty incident with the use of START system, a 9-year-old child respirating at 12 breaths/min, not responding to commands and without palpable pulse on radial artery should be triaged with:

Ayellow code.
Bgreen code.
Cred code.
Dblack code.
ESTART system should not be used in this case.

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Question 157

The haemorrhagic shock is a hypovolemic shock which is accompanied by the following clinical symptoms:

Apale skin, bradycardia, bradypnoea, hypotension.
Bpale skin, tachycardia, tachypnoea, hypotension, clammy skin.
Cpale skin, bradycardia, bradypnoea, hypertension.
Dpale skin, tachycardia, tachypnoea, hypertension, rising levels of catecholamines in blood plasma.
Epale skin, tachycardia, bradypnoea, hypotension, falling levels of catecholamines in blood plasma.

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Question 158

An airway blockage in an infant due to a foreign body aspiration is, according to the European Resuscitation Council guidelines, an indication for the following actions:

A5 back blows between the shoulder blades followed by 5 chest compressions using 2 fingers in the location typical for infants.
Bhold the baby's legs, raise it and give 5 back blows.
Ctry to get out the foreign body out of the upper respiratory tract with your fingers.
Duse only chest thrusts.
Eall the answers are wrong.

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Question 159

Which of the following are causes of consciousness disorders as a result of metabolic coma:

Aalcohol ingestion.
Bdrug overdose.
Chypoglycemia.
Dhyperglycemia.
Eall the answers are correct.

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Question 160

In a chest trauma, the following injuries are life-threatening:
1) heart contusion;
2) lung contusion;
3) cardiac tamponade;
4) tension pneumothorax;
5) esophageal rupture.
The correct answer is:

A1,2
B3,4.
C2,5.
D1,5.
Eall of the above.

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Question 161

The correct ratio of chest compression to ventilation in adults, according to the European Resuscitation Council guidelines, is:

A30:2.
B15:2.
C5:2.
D15:1.
Edepends on the cause of circulatory failure.

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Question 162

The syndrome of clinical symptoms characterizing the condition called syncope is:

Ashort-term loss of consciousness, hypotension, pale skin, loss of muscle tone.
Bshort-term loss of consciousness, hypertension, pale skin, loss of muscle tone.
Cshort-term loss of consciousness, hypotension, pale skin, muscle twitching.
Dno loss of consciousness, tachycardia, pale skin, loss of muscle tone.
Eshort-term loss of consciousness, hypertension, red color of the face skin, loss of muscle tone.

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Question 163

Which symptom is not characteristic of the anaphylactic shock:

Aitching.
Bfalling blood pressure.
Cwhizzing in larynx.
Deuphoria.
Enon palpable pulse.

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Question 164

In the basic life support (BLS) a very important step is non-instrumental airway management that should be achieved by:

Ahead-tilt maneuver.
Bhead-tilt/ chin-lift maneuver.
CJaw–thrust maneuver.
DSellick maneuver.
Enone of the above.

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Question 165

Instrumental airway management (intubation) during transport to hospital, is indicated in patients with the score in Glasgow Coma Scale of:

A15 points.
B1 point.
C3 – 7 points.
D8 – 15 points.
Ethe answers B and C are correct.

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Question 166

Which of the following treatments may not be used in patients with CNS injuries during the prehospital management?

Aoxygen.
B0.9% solution of NaCl.
Cglucose.
Ddopamine.
Edobutamine.

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Question 167

The symptom or sign which can indicate the immediate risk of cardiac arrest during hypovolemic shock is:

Atachycardia.
Bbradycardia.
Chypotension.
Dloss of consciousness.
Eanxiety.

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Question 168

Choose the true statement referring to electrical cardioversion:

ACardioversion is indicated in every tachycardia with wide QRS complex.
BThe discharge must be synchronized with T wave.
CThe energy of first discharge in tachycardia with wide QRS complex should be 120- 150 J in the case of biphasic cardioverter.
DThe energy of the first discharge in paroxysmal supraventricular tachycardia should be 150-200 J in the case of monophasic cardioverter.
ECardioversion should always be preceded by general analgesia.

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Question 169

Magnesium sulphate is indicated in advanced resuscitation of a 55-year-old man in the presence of:
1) ventricular fibrillation resistant to defibrillation when hypomagnesemia is suspected;
2) every ventricular tachycardia;
3) digoxin intoxication;
4) Torsade de pointes;
5) verapamil intoxication.
The correct answer is:

A1,3,4.
B1,2,3.
C3,4,5.
D2,3,4.
E1,3,5.

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Question 170

In a patient with blunt abdominal trauma and a spleen rupture suspected, the loss of about 40% of blood volume will result in:

Adrop in blood pressure.
Bincrease in capillary refill time.
Cincrease in heart rate.
Dconsciousness disturbances.
Eall of the above.

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Question 171

A 22-year-old patient with head injury opens the eyes to a verbal command, localizes painful stimuli and responds with incomprehensible speech. The Glasgow Coma Scale score of this patient is:

A6 points
B8 points.
C10 points.
D12 points.
E14 points.

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Question 172

The most probable mechanism of cardiac arrest in a patient injured by a lightning strike is:

Aventricular fibrillation.
Bventricular flutter.
Cventricular tachycardia without pulse.
Dmechanical injury of the heart.
Easystole.

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Question 173

According to the Code of Medical Ethics the decision to stop the resuscitation is taken by:

Amedical consultation.
Bhead of the hospital ward or their substitute
Chospital ethics committee.
Dmanager of a relevant medical facility.
Edoctor and is associated with the assessment of medicinal chances.

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Question 174

Is a physician, according to the Polish Medical Code of Ethics (MCE), allowed to break the patient confidentiality if the patient agrees?

Ano.
Bthere is no appropriate regulation in MCE (KEL).
Cyes.
Donly at the court.
Emedical privacy is unconditional.

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Question 175

What kind of risk, according to the Polish Medical Code of Ethics, is acceptable in therapeutic experiments?

Aminimal.
Bmaximal.
Cproportional.
Dmedium.
Eany.

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Question 176

Is it allowed, according to the Polish Medical Code of Ethics, to perform a medical experiment involving people without supervision of a physician:

Ayes.
Bonly when under the supervision of a pharmacologist.
Conly in extraordinary situations.
Dno.
Ethere is no appropriate regulation.

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Question 177

A major and non-incapacitated person’s objection to taking their cells, organs or tissues after their death (transplantation ex mortuo) may be declared earlier in the following forms:
1) a declaration of the objection made to the Central Register of Objections;
2) a written declaration with personal signature;
3) a declaration of the objection to the Central Register of Donors and Recipients;
4) presumed;
5) an oral declaration made in the presence of 2 witnesses who confirm it in writing.
The correct answer is:

A1,2,5.
B1,2,4.
C3,4,5.
D1,4,5.
E2,4,5.

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Question 178

A physician is not allowed to transfuse blood to an unconscious person who is a Jehovah witness when:
1) the patient has opposed to blood transfusion in pen when he/she was conscious;
2) the physician knows that the patient is a Jehovah witness;
3) a personally signed and clear written objection to blood transfusion has been found with the patient;
4) the patient orally objected to blood transfusion in the presence of witnesses when he/she was conscious;
5) the closest family opposes to blood transfusion.
The correct answer is:

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

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Question 179

A compulsory take of blood is allowed from:
1) a suspicious person;
2) a suspected person;
3) an accused person;
4) a person sentenced to imprisonment;
5) a mentally ill person or one with mental disorders.
The correct answer is:

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

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Question 180

A physician is allowed to change or extend the range of an operation when performing it if:
1) before the operation the patient gave consent to a possible change or extension of it;
2) according to the doctor the change or extension is good for the patient;
3) the patient has not been asked for his/her consent to a possible change or extension but not changing or extending it may expose the patient to a risk of death or serious body or health damage;
4) the patient opposed to change or extension but not changing or extending it may lead to patient’s death;
5) the procedure is being performed in a major patient who was unconscious even before the operation.
The correct answer is:

A1,3,5.
B2,3,5.
C1,2,5.
D3,4,5.
E1,2,3.

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Question 181

A consent to include a person having unlimited legal capacity who is not capable to consciously give his/her opinion on a medical experiment may be declared:
1) in case of research experiment by a guardianship court;
2) in case of therapeutic experiment by his/her spouse or another closest person;
3) in case of therapeutic experiment by a guardianship court;
4) in such a person any research experiment is not allowed;
5) in such amsituation a decision is made by an investigator taking into account the necessity of developing medical knowledge.
The correct answer is:

A1,5.
B2,5.
C3,4.
D2,4.
E1,2.

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Question 182

A medical court may punish a physician with the following penalties:
1) reprimand;
2) confiscation of the things used during the offence;
3) a fine to be paid to the appropriate regional chamber of physicians and dentists;
4) suspension from the right to practice the profession for the time of 6 months to 3 years;
5) limitation of freedom for the time of 1 month to 12 months.
The correct answer is:

A1,4.
B2,3.
C3,5.
D2,5.
E2,4.

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Question 183

Occupational diseases are the ones listed in the register of occupational diseases which have been caused by the action of health damaging factors occurring in the work environment, or by the manner of doing work. The Council of Ministers decree on occupational diseases does not list:

Apneumoconiosis.
Bbronchial asthma.
Callergic rhinitis.
Dmyocardial infarction.
Evibration white finger.

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Question 184

In the procedure of establishing the entitlement to benefits from having farmers social insurance, medical statements confirming the following are not issued:

Atemporary incapacity to work lasting more than 180 days.
Bpermanent or temporary complete incapacity to perform farm work.
Cdisability degree.
Done and only indemnity in case of permanent or long-lasting health damage or death as a result of a farm work accident or farm occupational disease.
Eadvisability of training for a new occupation because of permanent incapacity to perform farm work.

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Question 185

In accordance with the Combatants and some persons who are the victims of the war repressions and of the post-war period Act, their incapacity to work connected to them being in forced exile or deportation to the USSR is considered as the work incapacity resulting from injuries, contusions or diseases related to those circumstances. The statements about that work incapacity and its connection with being in forced exile or deportation to the USSR are issued by:

Athe voivodship and territorial medical boards subject to the Ministry of Internal Affairs and Administration.
Bthe local and regional military medical boards.
CSII (Social Insurance Institution) certifying doctors and medical boards.
DASIF expert doctors and medical boards.
Ethe district and voivodship teams who issue statements about the disability.

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Question 186

In accordance with the article 122, point 1 of the Law on Road Traffic Act the persons who want to obtain the qualifications to drive motor transportation vehicles and the persons who have obtained those qualifications have to undergo medical examinations which aim at stating the presence or absence of medical contraindications against them driving vehicles. Those examinations are carried out by:

ASII certifying doctors and medical boards.
BASIF expert doctors and medical boards.
Cteams who certify disability.
Dthe doctors authorized to issue statements about the presence or absence of medical contraindications against driving vehicles.
Efamily doctors.

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Question 187

Sickness allowance from the Sickness Fund has to be paid out during the period of temporary incapacity to work caused by sickness. An insured person who performs his/her job during the stated temporary incapacity to work or makes use of the sick leave in the way that is inconsistent with doctor's orders included in it:

Areceives 20 per cent of the basic allowance amount.
Breceives 40 per cent of the basic allowance amount.
Creceives 50 per cent of the basic allowance amount.
Dreceives 75 per cent of the basic allowance amount.
Eloses the entitlement to sickness allowance for the whole period of the sick leave.

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Question 188

If temporary incapacity to work:
- occurs during pregnancy,
- has occurred as a result of undergoing necessary medical examinations for prospective cell, tissue and organ donors, or collecting cells, tissues and organs,
- has occurred as a result of an accident on the way to/from work,
- has occurred as a result of an accident at work or occupational disease,
the monthly sickness allowance amounts to:

A40 per cent of the basic allowance amount.
B50 per cent of the basic allowance amount.
C70 per cent of the basic allowance amount.
D80 per cent of the basic allowance amount.
E100 per cent of the basic allowance amount.

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Question 189

ASIF expert doctors and medical boards do not issue statements about:

Acomplete incapacity to do farmwork.
Btemporary incapacity to work for more that 180 days.
Cinability to live unassisted.
Ddisability degree.
Eadvisability of training for a new occupation because of permanent complete incapacity to do farm work.

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Question 190

The actions within the second phase of prophylaxis cover the following:
1) active counselling;
2) dispanserization;
3) preventive vaccination;
4) health checks;
5) cancer prevention;
6) the epidemiological surveillance of food production.
The correct answer is:

A1,3.
B2,3,4.
C4,5,6.
D2,3,5,6.
E1,2,4,5.

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Question 191

The positive measures of the state of health are:
1) mortality;
2) female fertility;
3) death rates;
4) birth rates;
5) mortality rates;
6) expected life span.
The correct answer is:

A1,2.
B2,3,4.
C2,4,6.
D3,4,5.
E1,5,6.

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Question 192

Which of the following are responsible for the creation of the State health policy:
1) government ministries;
2) administration;
3) local self-governments;
4) National Health Service;
5) staff of the health care system;
6) society.
The correct answer is:

A1.
B1,2,5.
C1,3,4,5.
D3,4,5.6.
Eall of the above.

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Question 193

The health insurance is based on general principles expressing the basic assumptions of the system, i.e.:
1) social solidarity;
2) self-government;
3) the right to free choice of service providers;
4) the provision for free access to health services;
5) self-financing;
6) economic efficiency;
7) the state warrants.
The correct answer is:

A1,2,4.
B1,3,4,7.
C2,3,4,6.
D1,2,3,4.7.
Eall of the above.

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Question 194

The health service is the activity promoting the maintenance, saving, restoration and improvement of health associated with:
1) medical examination and advice;
2) treatment;
3) care of healthy child;
4) diagnostic test;
5) palliative care;
6) therapeutic rehabilitation;
7) making decisions and expressing opinions concerning health status.
The correct answer is:

A1,2,3.
B1,2,3,4.
C2,3,4,5,6.
D1,2,3,6,7.
Eall of the above.

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Question 195

Who is the author of the definition ‘Public health is one of the efforts organized by society to protect, promote, and restore the people’s health. It is the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. Public health is thus a social institution, a discipline, and a practice’.

AMilton Rosenau.
Bthe Milbank Memorial Found Commission.
CJ.P. Frank.
Dthe World Health Organization.
EC.E. Winslow.

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Question 196

According to the WHO definition of 1973 public health does not cover:

Aproblems concerning the health of the population.
Bthe health status of a cohort.
Cindividual treatment of patients.
Dgeneral health services.
Ehealth care administration.

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Question 197

Point out which of the below-mentioned laboratory results is not characteristic of AIDS?

Athe decreased number of CD4 lymphocytes.
Ban increased IgG fraction.
Cthe presence of RNA HIV revealed by PCR.
Dthe presence of antigen after 24 hours.
Ean increased IgE fraction.

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Question 198

The normal sperm count (for 1mL) is:

A5 million.
B10 million.
C20 million.
D40 million.
E60 million.

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Question 199

Which of the following actions are in the right order and are included in the basic life support algorithm?
1) precordial thump, airway access, circulation evaluation and external cardiac massage,, breath evaluation and ventilation;
2) airway access, breath evaluation and ventilation, circulation evaluation and external cardiac massage;
3) breath evaluation and ventilation, airway access, circulation evaluation and external cardiac massage;
4) circulation evaluation and external cardiac massage, airway access, breath evaluation and ventilation;
5) epinephrine administration, airway access, breath evaluation and ventilation, external cardiac massage.
The correct answer is:

A1,3.
B2,4.
C3,5.
D4,5.
E2.

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Question 200

Which of the following drugs cannot be administered intratracheally during cardio-pulmonary resuscitation:

Aadrenaline
Bamiodarone
Clidocaine
Datropine
EEndotracheal administration of drugs is not currently recommended.

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