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LEKEXAM / 2009 autumn

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Question distribution — 2009 autumn session

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Internal medicinePediatricsSurgeryGynecology and obstetricsEmergency medicine, AnaesthesiologyFamily medicinePsychiatryMedical law and bioethicsPublic healthMedical certification

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Question 1

Which of the following drug(s) is/are recommended as prevention of the most frequently observed adverse events related to combined therapy with nonsteroidal antiinflammatory drugs and glucocorticoids:

AH2 receptor inhibitors.
Bproton pump inhibitors.
Cfolic acid.
Dvitamin D3.
EACE-inhibitors.

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Question 2

Which of the following is the contraindication to therapeutic or diagnostic arthrocentesis?

Aelevated systemic temperature.
Bpsoriatic skin lesions in joint area.
Cboil close to the joint.
Dsuspected reactive arthritis.
Egout.

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Question 3

Which test in physical examination gives positive results in acute intervertebral L5- S1 disc herniation?

ASchirmer’s test.
BPatrick’s test.
COtto test.
DSchober’s test.
ELasegue test.

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Question 4

Which of the following autoantibodies are most specific for lupus erythematosus systemicus?

Arheumatoid factor.
Banti- SS-A, anti-SS-B antibodies.
Canti-dsDNA (anti-double stranded DNA) antibodies.
Danti-histone antibodies.
Eanti-Scl-70 (anti-topoisomerase I) antibodies.

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Question 5

Which of the following statements is applicable to osteoarthritis?

Amorning stiffness is a specific symptom.
Binflammatory back pain occurs typically.
Cexercises completely relieve joint pain.
Dstiffness appears after prolonged rest.
Ejoint hypermobility is typical.

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Question 6

Which of the following are laboratory findings typical for lupus erythematosus systemicus?
1) anemia;
2) leukopenia;
3) thrombocytosis;
4) increased muscle enzymes activity;
5) high ferritin concentration.
The correct answer is:

A1,2.
B1,3.
C1,4,5.
Donly 5.
Eall above.

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Question 7

Which of the following factors increase the risk of oesophageal squamous cell carcinoma development?

1) cigarette smoking;

2) Barrett oesophagus;

3) chemical substance ingestion (lye or acid);

4) Helicobacter pylori infection;

5) Plummer-Vinson syndrome.

The correct answer is:

A1,2,4.
B3,4,5.
C2,4.
D1,3,5.
Eall above.

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Question 8

75-year old man, with long history of gastroeosophageal disease (GERD), for the last weeks complains of persistant pyrosis and dysphagia while swallowing solid food. The patient is on proton pump inhibitor (PPI) treatment at one daily dose before breakfast. In this case a general practicioner should recommend at first:

Aincreasing the dose of PPI (proton pump inhibitor) to twice a day in the morning and in the evening
Badding an H2-receptor blocker at bedtime.
Can urgent 24-hour pH-metry.
Dadding a prokinetic drug.
Ean urgent gastroscopy.

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Question 9

The risk of developing a colon cancer in a patient with FAP (familial asdenomatous polyposis) equals to:

A50%.
B30%.
C5%.
D100%.
Ethere is no such risk.

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Question 10

In differential diagnosis of inflammatory bowel diseases, despite clinical and endoscopic picture, some serological tests may be used. Which of the provided combination of serological test results suggests Leśniowski-Crohn’s disease (Crohn’s disease):

AASCA(+), pANCA(-).
BASCA(+), pANCA(+).
CASCA(-), pANCA(-).
DASCA(-), pANCA(+).
Enone of the above.

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Question 11

Improvement of exocrine pancreatic insufficiency is one of the aims of treatment of chronic pancreatitis. The indication to begin a substitution with pancreatic enzymes is:

Aprogressive weigh loss.
Bfatty diarrhea (steatorrhea).
Cpostprandial epigastric pain.
Dall are correct.
Ecorrect are A and B.

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Question 12

Serum ferritin reflects generally iron stores in the body. In which circumastances serum ferritin does not reflect iron stores:

Aduring inflammation/infection.
Bduring hemorrhage/bleeding.
Cduring oral iron administration.
Dserum ferritin always reflects iron stores in the organism.
Eduring folic acid administration.

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Question 13

Which hypotensive drugs should be avoided in a patient with bilateral renal artery stenosis or unilateral renal stenosis of the only functioning kidney?

AACE inhibitors.
Bbeta blokers.
Ccalcium channel blockers.
Dangiotensin receptor blockers.
Ecorrect are A and D.

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Question 14

Alport syndrom is a:

Ahereditary nephropathy caused by dysfunctional synthesis of collagen alpha type IV.
Bkind of primary amyloidosis.
Ctype of IgA nephropathy.
Dfamilial thin basement membrane disease.
Etype of adult polycystic kidney disease.

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Question 15

Asymptomatic bacteriuria (positive urine culture in an asymptomatic patient) in a female should be treated:

Aalways when present.
Bin all females in childbearing age.
Cduring pregnancy.
Dbefore bladder catheterisation.
Ecorrect are C and D.

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Question 16

Serum uric acid concentration is increased in the following conditions, except for:

Agout.
Bacute renal failure.
Ctumor lysis syndrome.
Dpregnancy.
Ediuretic treatment.

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Question 17

Oliguria is a typical symptom of:

Apolidypsia.
Bhypercalcemia.
Chyponatremia.
Ddiabetes insipidus.
Ediuretic treatment.

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Question 18

In ambulatory practice the most common way to evaluate excretory renal function is:

Acreatinine clearance.
BeGFR, calculated with the use of: serum creatinine, age and sex.
Cinuline clearance.
DeGFR calculated using serum creatinine and urea levels.
Ecystatine C clearance.

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Question 19

A construction worker was transported to rescue unit of a district hospital after his legs were crushed by reinforced concrete plate which slid off during construction of a bridge. Laboratory tests have shown elevated concentrations of creatine kinase, AST, lactate dehydrogenase, uric acid, potassium, phosphorus and low concentrations of serum calcium, normal blood cell count. The patient’s urinary bladder was catherized, and red-pink urine in a Foley’s bag was present. In this particular situation, the most probable diagnosis is:

Amyocardial infarct.
Bcarbon monoxide intoxication.
Chemolytic-uremic syndrome.
Dadvanced neoplastic disease.
Ecrush syndrome.

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Question 20

The main cause of anemia in chronic renal disease is:

Aexcessive destruction of red blood cells.
Bfolic acid deficit.
Cdeficit of vitamin B12.
Ddeficit of erythropoietin
Einhibition of erythropoiesis by uremic toxins.

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Question 21

Erythrocyturia may be a sign of:
1) nephrolithiasis;
2) urinary tract tuberculosis;
3) cancer of the kidney, urinary bladder or prostatic gland;
4) glomerulonephritis.
The correct answer is:

Aonly 3.
B3,4.
Call above.
D1,3,4.
E2,3,4.

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Question 22

Which of the below additional tests allow to exclude right ventricle dysfunction in a patient suspected of acute pulmonary embolism?

Aechocardiography.
Bspiral computed tomography.
Cestimation of serum B type natriuretic peptide (BNP) or NT-proBNP.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 23

To estimate the clinical probability of acute pulmonary embolism the following, among others, should be taken into consideration:

Apast deep venous thrombosis or pulmonary embolism.
Bcoexisting malignant neoplasm.
Ctachycardia.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 24

According to actual guidelines, which of the drugs listed below, apart from acetylsalicylic acid, should be taken continuously for the whole life by all patients after myocardial infarction, provided there are no contraindications:
1) clopidogrel;
2) statins;
3) beta-blocker;
4) angiotensin converting enzyme inhibitor;
5) nitrates.
The correct answer is:

A1,2.
B1,2,3.
C2,3,4.
D2,3,4,5.
Eall above.

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Question 25

According to Fontaine classification of chronic lower extremities ischemia, stage III is diagnosed when:

Aan ischemic ulceration of lower extremity is present.
Bthe patient suffers leg pain at rest.
Cthe pain appears after walking the distance of <200 m.
Dthe pain appears after walking the distance of >200 m.
Enone of the above is true.

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Question 26

Which of the following physical signs are typical for hypothyroidism?

Acold, rough, dry, non-elastic, pale skin of the yellowish tint.
Btachycardia.
Cpitting oedema.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 27

Which of the following drugs have been proven to decrease mortality in patients suffering from chronic heart insufficiency with decreased left ventricle ejection fraction?

Aangiotensin converting enzyme inhibitors.
Bβ-blockers.
Cdigoxin.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 28

In which of the following situations endoscopy of the upper digestive tract should be urgently advised in a patient complaining of dyspepsia, which has not been diagnosed so far?

Adysphagia.
Bunexplained loss of body weight.
Cpain or burning in the epigastrium.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 29

Physical exercise may cause:

Abronchospasm.
Burticaria.
Canaphylactic reaction.
Dcorrect are A and B.
Ecorrect are A,B,C.

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Question 30

Which of the conditions given below is not a contradiction to therapeutic bronchoscopy?

Aadvanced heart failure (IV stage according to NYHA classification).
Bsevere respiratory failure (PaO2 < 50 mmHg).
Cmyocardial infarct in the previous 2 weeks.
Dunstable angina.
Esevere heart rhythm disturbances, especially of ventricular origin.

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Question 31

Signet-ring sign in computer tomography is typical for:

Alung cancer.
Bpleural tuberculosis
Cbronchiectasis.
DCOPD.
EHodgkin’s lymphoma.

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Question 32

V4 (C4) lead in standard electrocardiography should be placed in the following location:

AIV intercostal space at the right sternum border.
BIV intercostal space at the left sternum border.
CV intercostal space in the left midaxillary line.
DV intercostal space in the left anterior axillary line.
EV intercostal space in the left midclavicular line.

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Question 33

QRS complex length in normal ECG is:

A< 0,06s.
B0,06-0,11s.
C0,11-0,12s.
D≥ 0,12s.
E≥0,12ms.

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Question 34

In cardiac tamponade pericardiocentesis is indicated when fluid level measured during echocardiography is:

A> 20 mm in the diastolic phase
B> 20 mm in the systolic phase.
C<20 mm in the diastolic phase.
D<20 mm in the systolic phase.
Eany amount of pericardiac effusion prompts pericardiocentesis.

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Question 35

In the case of obstructive pulmonary disorders, the physical examination is characterized by:

Adull percussion.
Btympanic percussion.
Cincreased vocal fremitus.
Dcrackles
Eincreased thoracic breathing movements.

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Question 36

(1) SCORE (Systemic Coronary Risk Evaluation) is very useful for stratification of cardio-vascular risk in patients with type 2 diabetes, (2) allows to estimate 10 years risk of fatal cardiovascular events.

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

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Question 37

Choose possible organ damages due to hypertension:
1) left ventricular hypertophy;
2) carotid wall thickening – IMT (intima-media thickness) > 0,9 mm;
3) microalbuminuria;
4) diabetes;
5) slightly decreased plasma creatinine.
Prawidłowa odpowiedź to:

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

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Question 38

Indicate modifiable cardiovascular risk factors:

Asmoking, obesity, sex, age.
Bphysical inactivity, increase body weight, smoking, low HDL.
Csmoking, family history, blood pressure level, high TGL.
Dfamily history, physical inactivity, sex, blood pressure level.
Eblood pressure level, CRP, sex, family history.

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Question 39

Primary contraindication to Treadmill Test is:

Ahypertrophic cardiomyopathy.
Bbradycardia < 60.
Cstable cardiac angina.
Dhemodynamically significant arrythmia.
Esecond-degree AV block.

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Question 40

In the case of which infectious disease it is not possible to apply prevention by vaccination?

Ameasles.
Bvaricella.
Crubella (German measles).
Dinfectious mononucleosis.
Erotavirus diarrhea.

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Question 41

Regarding von Willebrand disease, the following statements are true, except for:

Athe inheritance is usually autosomal dominant.
Bepistaxis appears.
Cprolonged and excessively heavy menstruation bleeding is typical.
Dpatients usually have bruises and petechias.
Ein treatment of the severe type of the disease anti-diuretic hormone and concentrate of VIII factor are used.

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Question 42

Before splenectomy in children with congenital spherocytosis or chronic thrombocytopenia it is essential to order prophylactic vaccinations against the following infectious diseases except for:

AStreptococcus pneumoniae.
BHaemophilus influenzae.
CMycobacterium tuberculosis.
DNeisseria meningitidis.
Ehepatitis virus B.

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Question 43

In a 9-month old infant with acute lymphoblastic leukaemia pneumonia was diagnosed. In oral cavity, foam sputum was observed and in the chest X-ray - bilateral diffused pulmonary hilar infiltrations were described (picture of so called “ground glass”). The most likely etiological factor is:

AStaphylococcus aureus.
BStreptococcus pneumoniae.
CPneumocystis jiroveci (previously: Pneumocystis carini).
DMycoplasma pneumoniae.
ERS virus (HRSV).

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Question 44

Bronchoscopy with the branchoalveolar lavage (BAL) is not useful in diagnosis of:

Aaspiratory syndroms.
Bpulmonary haemosiderosis.
Csuspected oportunistic infection.
Dneoplastic disease.
Esuspected foreign body.

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Question 45

The etiological factor for interstitial lung diseases could be:

1) cytomegalovirus (CMV);

2) Epstein-Barr virus (EBV);

3) Mycoplasma pneumoniae;

4) Chlamydia trachomatis;

5) Legionella.

The correct answer is:

A1,3.
B1,3,4.
C1,2,4.
D1,2,3,4.
Eall mentioned.

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Question 46

What are the atypical bacteria that could be the etiological factor for pneumonia?
1) Mycoplasma pneumoniae;
2) Legionella pneumophila;
3) Klebsiella pneumoniae;
4) Staphylococcus aureus;
5) Haemophilus influenzae.
The correct answer is:

A1,2.
B1,2,3.
C1,3.
D1,3,5.
Eall mentioned.

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Question 47

In order to classify patient with acute lymphoblastic leukaemia into the proper risk group it is essential to do the following diagnostic procedures except for:

Abone marrow biopsy.
Bcytogenetic tests of blasts in bone marrow.
Clymph node biopsy.
Dimmunophenotyping of blasts with flow cytometry to estimate the type of leukaemia.
Emolecular tests of bone marrow.

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Question 48

Bad prognosis factors (that influence therapy choice and prognosis) in children with acute lymphoblastic leukaemia are the following except for:

Aage between 1 to 6 years.
Bbcr/abl gene presence.
Cleukocytosis above 20 x 10³/ml.
Dmore than 5% of blasts in bone marrow in 33rd day of treatment.
Ebad reaction to steroid therapy (more than 1000 blasts in peripheral blood on 8th day of treatment).

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Question 49

The most frequent cause of the painless enlargement of testis in a very young boy is:

Ainflammation.
Bproliferation.
Cinjury.
Dhydrocele.
Enone of the above.

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Question 50

Pneumocystis carini pneumonia observed in children with inefficient immune system is diagnosed with the help of medical interview and:

Aphysical examinations.
Bchest X-ray.
Cbacteriological examination of the sputum.
DPCR.
Eelevated inflammatory markers.

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Question 51

Vesicoureteral reflux is mainly diagnosed on the basis of:

AUSG (ultrasonography) of urinary system.
Bplain X-ray film of the abdomen.
Curography.
Dcystography.
Erenal scyntygraphy.

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Question 52

Non-pharmacological treatment of children with borderline or mild hypertension without organ damage and cardiovascular risk factors include the following, except for:

Aincrease of regular physical activity (no isovolumetric exercise).
Breduction of sodium salts intake < 5g NaCl per day.
Creduction of dietary saturated fatty acids.
Dproper weight balance (weight reduction).
Ereduction of dietary proteins.

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Question 53

During periodic examination of a 5-year old boy, a continuous murmur in the right subclavian area, disappearing after changing body position from sitting into lying and after bowing the head forward, was auscultated. That kind of murmur is typical for:

Asystemic-pulmonary inflammation.
Bvenous hum.
Ccoronary arteries fistula.
Dpatent ductus arteriosus (PDA).
Eaortic stenosis.

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Question 54

Which of the following statements concerning febrile convulsions is false:

Acould appear several times during the same disease course with fever.
Busually appear as generalized convulsions, tonic-clonic.
Cusually accompany roseola (three day fever).
Dif focal and last > 15 min, are called complex convulsions.
Eare hereditary.

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Question 55

The pathogenetic mechanisms of circulatory insufficiency are:
1) decreased heart ejection fraction;
2) decreased cardiac output;
3) decreased renal blood flow;
4) decreased aldosteron release;
5) decreased angiotensin II release.
The correct answer is:

A1,2,3,4.
B1,2,3,5.
Call mentioned.
D1,2,3.
E1,2.

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Question 56

What are the indications for lumbar puncture in children with febrile convulsions?

Achildren < 18/12 months.
Bchildren treated with antibiotics before appearance of febrile convulsions.
Cchildren of any age if positive Brudzinski sign is observed.
Dall of the above.
Enone of the above, because febrile convulsions are not connected with neuroinfection.

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Question 57

Indicate the correct statement concerning acyclovir in zoster treatment:

Ais not recommended.
Brecommended only in case of pregnant women.
Crecommended only in case of newborns with zoster.
Dapplied only in patients with immunity disorders.
Eonly 50% of the recommended dose for herpes simplex virus infection treatment is applied.

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Question 58

Acute otitis media was diagnosed in a 6-years old boy. Bacteriological culture of the purulent fluid obtained during paracentesis was positive for Heamophilus influanzae. Choose the antibiotic that should be administrated:

Afenoksymetyl-penicyllin.
Broxytromycin.
Cdoxycycline.
Dcefuroxime.
Eerythromycin.

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Question 59

Which of the following statements concerning hepatitis virus B infection in children is false?

Aintrauterine infection is very rare.
Binfection is not observed in children properly vaccinated against hepatitis B.
Cthe course of acute hepatitis in children infected in infantile period is usually asymptomatic.
Dthe most frequent in children is chronic hepatitis.
Ecould result in chronic glomerulopathy.

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Question 60

In the course of Wilms' tumor (nephroblastoma) the following symptoms could be observed:

Aenlargement of the circumference of the abdomen.
Bstomach pain.
Chaematuria or erythrocyturia.
Dincreased blood pressure.
Eall of the above.

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Question 61

Which of the following are used in hypertriglyceridemia treatment:
1) diet with reduction of carbohydrates;
2) diet with reduction of calories;
3) fibrates;
4) statins;
5) thiazides.
The correct answer is:

Aall mentioned.
B1,2,4.
C1,2,3,4.
D2,4.
E3,5.

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Question 62

Determination of lipid metabolism parameters is justified in monitoring the course of treatment with the following drugs:

1) beta-blockers;

2) estrogens applied orally;

3) fibrates;

4) steroids;

5) statins.

The correct answer is:

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

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Question 63

Osteoporosis, psychosis, diabetogenic activity are the side effects of steroids treatment. Therefore the substitution treatment of the chronic adrenocortical insufficiency should last for maximum one and a half year.

Aboth statements are false.
Bboth statements are true and there is cause-effect relationship between them.
Cboth statements are true but there is no cause-effect relationship between them.
Dfirst statement is true and the second is false.
Efirst statement is false and the second is true.

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Question 64

Rheumatic fever develops from:

1) generalised connective tissue inflammation;

2) generalised mesenchymal system reaction;

3) generalised vessels inflammation;

4) immunological disorders;

5) autoimmunization of the organism (molecular mimicry phenomenon).

The correct answer is:

A1,3,4,5.
B2,3,4,5.
C3,4,5.
Donly 5.
Eall mentioned.

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Question 65

What are the clinical symptoms of the newborn with hypothyreosis?
1) big, bloated belly - “frog belly”, umbilical hernia;
2) sucking aversion, choking during feeding;
3) prolonged physiologic jaundice of newborns;
4) skin: pale, yellowish, than cold, pale and cyanotic, xeroderma, keratoderma, exfoliated epiderma;
5) generalized tonic-clonic seizure.
The correct answer is:

A1,3,5.
B1,2,3.
C4,5.
D2,4,5.
E1,2,3,4.

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Question 66

In the course of mucoviscidosis, chronic colonization with which pathogenic bacteria is frequently observed:

AStreptococcus pneumoniae.
BMycoplasma pneumoniae.
CBordetella pertusis.
DHeamophilus influanzae.
EPseudomonas aeruginosa.

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Question 67

The most frequent cause of the infant type of the haemolytic-uraemic syndrome is:

AStaphylococcus aureus.
BE. coli O157:H7.
CCandida albicans.
DStreptococcus pneumoniae.
EPseudomonas aeruginosa.

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Question 68

The best method to diagnose brain tumor is lumbar puncture along with magnetic resonance (MR), because in children with brain tumors vomiting, headaches and oedema of the optic disc appear.

Aboth statements are true but there is no cause-effect relationship between them.
Bboth statements are true and there is cause-effect relationship between them.
Cfirst statement is true and the second is false.
Dfirst statement is false and the second is true.
Eboth statements are false.

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Question 69

The following may be significant in etiopathogenesis of preeclampsia in second half of pregnancy in a woman:

Agenetic factor.
Bimmunologic factor.
Cimbalance between prostacyclin and thromboxane synthesis.
Dtrophoblast invasion disturbances.
Eall mentioned above.

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Question 70

In preconceptional period and first trimester of pregnancy the most important for normal fetal development is maternal dietary supplementation of:

Airon.
Biod.
Cfolic acid.
Dcalcium.
Etocopherol (vitamin E).

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Question 71

A young sexually inactive 19-years old woman is admitted for consultation with burning of the vulva, pollakisuria, dysuria, and a slight, non-offensive discharge for three months. She has had no vaginal bleeding. The most likely diagnosis would be:

Atrichomonal infection.
Bgonorrhoea.
Ccystitis.
Dforeign body.
Enon-specific vaginitis.

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Question 72

Screening for presence of irregular antibodies against red blood cells in serum of every pregnant woman near 28 week of pregnancy, independently of her blood group, is important for detection of one of the following:

Afeto-maternal hemorrhage
Bmaternal isoimmunization against fetal red blood cell antigens.
Cfetal blood group typing.
Dseverity of hemolytic disease.
Eno real value for this screening.

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Question 73

HELLP syndrome is the most dangerous complication of preeclampsia. Which of mentioned parameters is not connected to this disease?

Athrombocytopenia.
Bhypertension.
Cleukopenia.
Delevated liver enzymes.
Eintravascular hemolysis.

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Question 74

The diagnosis of postpartum hemorrhage is based on evaluation of:

Acontrol of uterine construction.
Bassessment of injury to birth canal.
Ccurettage of uterine cavity.
Dassessment of coagulation parameters.
Eall mentioned above.

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Question 75

The most frequent malignant neoplasm complicating pregnancy is:

Amelanoma.
Bbreast cancer.
Covarian cancer.
Dcervical cancer.
Euterine tube cancer.

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Question 76

The most typical ultrasound finding in complete hydatidiforme mole is:

Apicture of “snowstorm“.
Black of fetal or embryonic tissue.
Clack of amniotic sac and amniotic fluid.
Dpresence of theca lutein ovarian cysts.
Eall of the above.

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Question 77

Choriocarcinoma usually developes after:

Ahydatidiforme mole.
Bspontaneous abortion.
Cdelivery of single fetus.
Ddelivery of twins.
Eectopic pregnancy.

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Question 78

Which of the following events is not connected with physiological increase of serum prolactin level?
1) pregnancy;
2) breast feeding;
3) stress;
4) renal insufficiency;
5) hepatic cirrhosis.
The correct answer is:

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

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Question 79

The screening test for cervical cancer is:

1) cytological smear from ectocervix, external opening and endocervix

2) cervical biopsy

3) endocervical curettage

4) HPV-DNA testing

5) HPV-mRNA testing

The correct answer is:

Aonly 1
B1, 4
C1, 4, 5
D2, 3
E4, 5

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Question 80

The results of the following diagnostic tests:
• AFI (amniotic fluid index) - 4
• Vaginal pH – 7.0
• Amniotic cells in microscopic evaluation of vaginal specimen
• Positive result of “Fern Test”
• Presence of ILGFBP-1 (insulin-like growth factor binding protein-1) in the vaginal specimen
Suggest:

Aidiopathic oligohydramnios.
Boligohydramnios concomitant with fetal abnormalities.
Cpolihydramnios.
Dpremature drainage of amniotic fluid.
Ecervical insufficiency/weakness.

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Question 81

What are the most common symptoms of endometriosis?

1) dysmenorrhoea;

2) polymenorrhoea;

3) increased breast tenderness;

4) constant diffuse pelvic pain;

5) dyspareunia.

The correct answer is:

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

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Question 82

Which of the following descriptions referring to twin pregnancy is false?

Adichorionic, diamniotic pregnancy.
Bmonochorionic, monoamniotic pregnancy.
Cmonochorionic, diamniotic pregnancy.
Ddichorionic, monoamniotic pregnancy.
Econjoined twins.

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Question 83

Which of the following maternal disorders are thought to be the causes of spontaneous abortion?
1) diabetes mellitus;
2) antiphospholipid syndrome;
3) ulcerative colitis;
4) inherited thrombophilia;
5) rheumatoid arthritis.
The correct answer is:

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

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Question 84

Which of the following symptoms belong to classical triad of ectopic pregnancy symptoms?
1) abdominal pain;
2) vomiting;
3) abnormal uterine bleeding;
4) history of amenorrhoea;
5) pain in the mediastinum.
The correct answer is:

A3,4,5.
B2,3,4.
C1,2,3.
D2,4,5.
E1,3,4.

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Question 85

Which of the following factors are of poor prognostic value in women with recurrent miscarriage?
1) age over 30;
2) positive antibodies against β2 glycoprotein 1;
3) low level of progesterone in the middle luteal phase;
4) elevated mucine level;
5) no child.
The correct answer is:

A2,3,4.
B1,2,3.
C1,2,4.
D1,2,5.
E2,4,5.

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Question 86

Uterine septum was recognized in a 28-year-old woman after 3 spontaneous abortions. Which management should be offered before the next pregnancy?

AStrassmans’s operation.
Bcontinous use of estrogen-progestagen tablets.
Cconception without previous treatment.
Dhysteroscopic septum excision.
Etreatment with GnRH analogs.

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Question 87

A 39-year-old women was admitted to hospital due to abdominal pain, chills, fever and sanguinopurulent vaginal discharge. The last period was 3 months earlier. Which of the following disorders is the most probable?

Apurulent cholecytitis.
Bpyelonphritis.
Cseptic abortion.
Dappendicitis.
Eulcerative colitis.

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Question 88

The direct contraindications to tocolysis in preterm labor are:
1) placental abruption;
2) intrauterine fetal death;
3) intrauterine infection;
4) IUGR (Intrauterine growth restriction);
5) preeclympsia.
The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
D1,2,3,5.
Enone of mentioned.

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Question 89

Obstetric complications that can lead to oligohydramnios:
1) premature rupture of membranes;
2) intrauterine growth restriction (IUGR);
3) postterm pregnancy;
4) side effects of pharmaceutical agent (i.e. convertaze inhibitors, prostaglandin synthetase inhibitors).
The correct answer is:

Aonly 1.
B1,2.
C1,2,3.
Dall of mentioned.
Enone of mentioned.

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Question 90

The diagnostic criteria of pregnancy-induced hypertension include:

1) diastolic pressure ≥ 90mmHg;

2) systolic pressure ≥ 140mmHg;

3) increase in diastolic pressure by at least 15mmHg;

4) increase in systolic pressure by at least 30mmHg;

5) mean arterial pressure > 105mmHg.

The correct answer is:

A1,2.
B1,2,3.
C1,2,4,5.
D4,5.
Eall of the above.

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Question 91

The following clinical symptoms and lab results:

• Blood pressure of ≥ 160/100mmHg

• Proteinuria of ≥ 2g

• Oliguria (<= 400mL in 24 hours)

• Platetel count < 100 000mm3

• Headache, dizziness, blurred vision, consciousness disturbances

• Nausea, vomiting, RUQ (right upper quadrant) pain, epigastric pain.

Suggests:

Amild preeclampsia.
Bsevere preeclampsia.
Cecclampsia.
Dintrahepatic cholestasis of pregnancy.
Egestational diabetes.

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Question 92

The most common complication of ectopic pregnancy in the first trimester is:

Aacute tubal rupture.
Btubal abortion.
Clithopedion.
Dpersistent ectopic pregnancy.
Ecombined extra– and intrauterine pregnancy.

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Question 93

During phisiological pregnancy the highest value of amniotic fluid (AFI) is present in:

A25-26 weeks.
B33-34 weeks.
C38-40 weeks.
D41-42 weeks.
EI trimester.

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Question 94

The Montevideo unit is the most universally accepted and used value of quantifying:

Aintensity of uterine contractions.
Blevel of antitoxoplasmic antibodies.
Cenzymatic activity of alcalic phosphatase.
Dcardiocirculatory efficiency.
Ebiological activity of oxytocine.

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Question 95

The lithium blood level in the prophylaxis of bipolar disorders should be (in mmol/l):

A1,0-2,0.
B1,0-1,5.
C0,5-0,8.
D0,3-0,5.
Ethe blood level does not have any therapeutical meaning.

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Question 96

Hallucinations which occur during the period of falling in sleep are called:

Ahipnagogic symptoms.
Bhipnopompic symptoms.
Cparahallucinations.
Dpseudohallucinations.
Evisual hallucinations.

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Question 97

All of the following are characteristic for delirium, except:

Aqualitative disturbances of consciousness
Billusions and hallucinations
Cmood swings
Dterminal sleep
Eeuthymia

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Question 98

Projection tests are used to evaluate:

Aorganic brain damage.
Bpersonality.
Cmemory.
Dcognitive functions.
Eanswers C and D are correct.

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Question 99

The most common mental disorder caused by the direct effect of the HIV virus is:

Adysthymia.
BParkinson’s syndrome.
CWernicke-Korsakov’s syndrome.
Dcognitive function disturbances.
Eparanoia.

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Question 100

Which of the following are not characteristic for the uncomplicated alcohol abstinence syndrome?

Atremor of the hands.
Btremor of the tongue.
Csleepiness.
Dheadache.
Erestlessness.

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Question 101

The state in which under the effect of the psychoactive substance the actions potentially dangerous for person’s health or life are undertaken is called:

Adependance.
Brisky use.
Charmful use.
Dabstinence.
Esuch a definition does not exists.

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Question 102

Which of the following substances are not considered to be psychostimulants?

Aamphetamine.
Bnicotine.
Ccoffeine.
Dcocaine.
Eamphetamine derivates.

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Question 103

Which of the following statements regarding the term „schizophrenia” is true?

Athe name comes from the word “to split” (schizis).
Brefers to the disturbance of the scheme (for instance the scheme of the body).
Cwas proposed by Kreapelin.
Dwas proposed by Kępiński.
Eis caused by the destructions of neurons.

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Question 104

The synonym of the term „equivalent of the depression” is:

Adysthymia.
Bneurotic depression.
Cdrug-resistant depression.
Dmasked depression.
Eagitated depression.

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Question 105

Which of the statements regarding pedophilia is false:

Apedophilia means the sexual preference of an adult person for children.
Bfor persons with pedophilia, children age is important (children have to be before or during the puberty).
Cis more frequent in male subjects.
Dit can be diagnosed among females.
Ethe principal treatment is the use of drugs which lower the sexual drive.

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Question 106

Which of the following is not a contraindication to the use of derivatives of benzodiazepines as anxiolytic drugs?

Aepilepsy.
Bmyasthenia.
Calcohol intoxication.
Dpregnancy.
Ecirculatory insufficiency.

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Question 107

Systematized, internally coherent and logical delusions are:

Aparanoic delusions.
Bparanoid delusions.
Cincoherent delusions.
Dnihilistic delusions.
Edelusions of thought broadcasting.

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Question 108

Which group of symptoms is not an axial symptom of schizophrenia?

Athought broadcasting.
Bauditory hallucinations.
Ccatatonic behavior.
Dthought insertion.
Edelusions of control.

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Question 109

Wide excision of a breast cancer (breast-conserving therapy):

Ais performed in cases of small tumors.
Bmeans a local excision of a breast segment with the tumor.
Csimultaneous axillar lymphadenectomy is absolutely necessary.
Dpostoperative irradiation is always performed.
Eall are true.

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Question 110

The best prognosis after surgical treament of liver metastases is in the case of primary tumor:

Agastric cancer.
Bmelanoma.
Cbreast cancer.
Dcolorectal cancer.
Ecarcinoma of pancreas.

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Question 111

The patent had an open fracture of the femur, as a result of a traffic accident. The fracture was treated surgically. On the next day the patient complains of severe pain, not controlled by high doses of analgaetics. He is pale, sweating and delirious, although he has no high temperature. The wound is swollen and very sore. No crepitations are palpable. After removal of one stitch an ichorous, greyish fluid appeared. The most probable diagnosis is:

AMRSA infection.
Bgas gangraene.
Cearly strepotococcal phlegmon.
Dmassive E. coli infection.
Emeningococcal infection.

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Question 112

In the postoperative course after hemicolectomy, the patent presents symptoms of deep venous thrombosis of the leg. He has to be treated with low molecular heparin. The dose depends on:

APT and INR.
BAPTT.
Cpatient’s weight.
Dplatelet count.
Eextent of the thrombosis as assessed in Doppler-sonography.

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Question 113

After a routine examination of the removed gallbladder, the pathologist reported the presence of carcinomatous infiltration. The optimal proceeding is:

Aobservation and monitoring with ultrasound.
Breoperation: excision of liver tissue within the gallbladder bed and lymphadenectomy of the hepatoduodenal ligament.
Cirradiatin of the right epigastrium followed by “second look” laparotomy.
Donly chemotherapy.
Ethe patient does not require any therapy.

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Question 114

40-years-old male patent was two months ago discharged from the hospital after severe pancreatitis. Now he complains of epigastric discomfort and he noticed a swelling in this area. During physical examination a large, immobile tumor with no tenderness is palpable. Sonography reveals a large, thick-walled space containing fluid. The optimal method of treatment will be:

Apuncture and evacuation of fluid.
Bincision and drainage.
Canastomosis with intestine or stomach.
Dtotal removal of the tumor.
Eresection of the pancreas with the tumor.

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Question 115

A 75-years old male patent suddenly fainted. He is pale and sweating, complaining of epigastric pain as well as back pain radiating to the left inguinal region. He has tachycardia 130/min and low BP – 80/40 mm Hg. The first steps in the diagnostic process would be:

AECG and coronarography.
BCT or MRI of the lumbar spine.
Cgastroscopy.
Dultrasound or CT of the abdomen.
EIVP and examination of urine.

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Question 116

Which of the following statements are true:
1) perforated stomach ulcer is an indication for the emergency surgery;
2) the most frequent presentation of the perforated stomach ulcer is sudden onset of a severe, sharp epigastric pain;
3) upright abdominal X-ray is a basic diagnostic method of the perforated stomach ulcer;
4) typical presentation of the perforated stomach ulcer on the abdominal X-ray is presence of the free air in the peritoneal cavity (pneumoperitoneum).
The correct answer is:

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

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Question 117

The most frequent stomach malignancy is:

Aadenocarcinoma.
Blymphoma.
Cstromal tumor.
Dsquamous carcinoma.
Eall listed tumors are of similar frequency.

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Question 118

Endoscopic picture of the intensity of gastrointestinal hemoohage is classified by:

ARanson’s criteria.
BAPACHE II classification system.
CForrest’s classification.
DSengstaken.
EMallory.

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Question 119

False statement about diaphragmatic hernias is:

Aparaesophageal hiatal hernias are more frequent than sliding hiatal hernias.
Bfundoplication is the surgical treatment of the hiatal hernias.
Csliding hiatal hernia produce symptoms of gastroesophageal reflux disease.
Dcomplications of paraesophageal hernia include bleeding and incarceration.
Ethe congenital diaphragmatic hernias derive from Bochdalek and Morgagni foramen.

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Question 120

Carcinoma of the cecum is characterized by:
1) tumor in the right iliac fossa;
2) pain in the right lower abdomen;
3) anemia;
4) vomiting;
5) diarrhea.
The correct answer is:

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

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Question 121

The symptoms of perforated duodenal ulcer include: 1) melena; 2) vomiting with traces of blood; 3) periodic abdominal pain; 4) stoppage of flatus; 5) abdominal guarding. The correct answer is:

A1,2.
B3,4.
C4,5.
D2,5.
E1,5.

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Question 122

Panaritium:
1) is an infection of the palmar surface of fingers and hand;
2) is a fungal infection;
3) is a hematogenous bacterial infection;
4) treatment consists in incision, drainage and immobilization;
5) is an affection of the nail fold.
The correct answer is:

A2,4.
B3,4.
C4,5.
D1,4.
E2,5.

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Question 123

Typical signs of sigmoid colon carcinoma include:
1) thin, pencil-like stools;
2) elevated body temperature;
3) anemia;
4) body weight loss;
5) blood in the stool.
The correct answer is:

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

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Question 124

Three most common causes of upper GI bleeding include:
1) stomach cancer;
2) gastric mucosal inflammation (haemorrhagic);
3) ulcer disease;
4) Mallory-Weiss syndrome;
5) esophageal varices.
The correct answer is:

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

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Question 125

Large bowel obstruction most frequently is caused by:

Asigmoid colon carcinoma.
Bcarcinoma of the cecum.
Cpostoperative adhesions.
DCrohn’s disease.
Evolvulus of the sigmoid colon.

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Question 126

Three most common causes of mechanical bowel obstruction include:
1) postoperative adhesions;
2) colon cancer;
3) Meckel’s diverticulum;
4) intestinal intussuspection;
5) incarcerated hernia.
The correct answer is:

A1,2,5.
B2,3,5.
C1,3,4.
D1,2,4.
E1,3,5.

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Question 127

Symptoms of the cancer of the head of pancreas include:
1) jaundice
2) elevated temperature
3) abdominal pains varying in intensity
4) increased diameter of the biliary ducts and enlarged gallbladder on ultrasounds
5) anemia
The correct answer is:

A1, 2
B3, 4
C4, 5
D3, 5
E1, 4

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Question 128

The “preacher's hand” or “blessing hand” (“pope's blessing”, “hand of benedection”) syndrome is typical for:

Aulnar nerve neuropraxia.
Bmedial nerve neuropraxia.
Cradial nerve axonotmesis.
Dulnar nerve neurotmesis.
Eradial nerve axonotmesis.

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Question 129

35 years old patient suffers from palpable tumor localised in lower external right breast quadrant. The structure is painful, and the skin above is redden and warmened. The patient is feverish. In ultrasonographic examination there is regular hipoechogenic structure, 7cm in diameter. Which management would be the most appropriate?

Aincision and drainage of the breast abscess, additionaly antibiotics.
Bcomplete excision of the tumor, and the histopathological examination.
Crivanol compress and empiric antibiotic therapy.
Dfine needle biopsy with an antibiotic cover.
Enone of the answers are correct.

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Question 130

Necrosis of toes can be the consequence of:

ARaynaud disease.
BBuerger disease.
Cdiabetes.
Dcorrect answers are B and C.
Eall of the answers are correct.

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Question 131

Pregnant woman (8 month) suffers from strong pain in right subcostal area. 2 years earlier she had a classic cholecystectomy because of cholelithiasis. In physical examination she has tachycardia (up to 140/min), abdominal rigidity in projection of postlaparotomy scar, positive Blumberg sign, no auscultable peristalsis. The patient is feverish up to 38.0ºC, vomiting. Faetus pulse is 140/min. In laboratory tests: liver function tests normal, WBC 15 tys./mm³, CRP 120 mg/l. Which of the diagnosis is the most probable?

Adiverticulitis
Bcholangitis calculosa.
Cpostoperative adhesions.
Dappendicitis.
Epremature delivery.

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Question 132

The most frequent causes of acute pancreatitis include:
1) cholelithiasis;
2) high sodium diet;
3) alcohol;
4) low protein diet;
5) obesity.
The correct answer is:

A1,2.
B2,3.
C1,4.
D4,5.
E1,3.

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Question 133

Which statements about inguinal hernia are true?

1) inguinal hernia is equally frequent in males and females

2) each case of inguinal hernia has to be operated

3) tension-free (mesh) inguinal hernia operations gives fewest number of recurrences

4) incarceration is more frequent than in femoral hernias

5) majority of inguinal hernias are bilateral

The correct answer is:

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

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Question 134

Classic pleurocentesis for pleural fluid evacuation should be performed in:

AII intercostal space in midclavicular line.
BIV-V intercostal space in midaxillary line.
CIII intercostal space in midclavicular line.
DV-VI intercostal space in anterior axillary line.
EVII-VIII intercostal space in posterior axillary line.

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Question 135

The etiopathogenetic factor of the erysipelas is:

AVZV.
Bstreptococci.
Cstaphylococci.
Dmeningococci.
Eenterococci.

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Question 136

White pupil and lack of reflex from the eye fundus are symptoms of:

Aglaucoma.
Bcataract.
Ctrachoma.
Dchalazion.
Euveitis.

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Question 137

The brain imaging should be done in each epilepsy patient, because it is necessary to exclude secondary character of the disease.

Aboth statements are true and there is a causal relationship between them.
Bboth statements are true but there is no causal relationship between them.
Cthe first statement is true but the second is false.
Dthe first statement is false and the second is true.
Eboth statements are false.

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Question 138

Nitrates used to stop coronary pain are necessary element of recommendations given to patients with a stable coronary heart disease, because regular intake of these medicines decreases risk of heart infarction.

Aboth statements are true and there is a causal relationship between them.
Bboth statements are true but there is no causal relationship between them.
Cthe first statement is true but the second is false.
Dthe first statement is false and the second is true.
Eboth statements are false.

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Question 139

The commonly accepted procedure for the treatment of GERD assumes starting the therapy with proton pump inhibitors, because in the majority of patients the application of PPIs results in a rapid regression of clinical symptoms and the return of quality of life indicators to normal values.

Athe first statement is true, and the second false.
Bthe first statement is false, the second true.
Cboth statements are false.
Dboth statements are true; however, there is no cause-effect relationship.
Eboth statements are true and there is a cause-effect relationship.

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Question 140

The complications of flu affecting the nervous system may be as follows:
1) convulsive attacks;
2) secondary bacterial encephalitis;
3) Rey’s syndrome;
4) paresis and paralysis;
5) Guillain-Barre Syndrome.
The correct answer is:

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

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Question 141

Profound metabolic acidosis is a typical symptom of poisoning with the following:

Acarbon monoxide and carbon dioxide.
Bmethyl alcohol and ethylene glycol.
Cmorphine and heroine.
Dorganophosphorus pesticides and carbminians.
Eamphetamine and metamphetamine.

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Question 142

In a pregnant woman treatment should be applied in the following cases:

Ain each case of detection of bacteriuria in the amount larger or equal 105 CFU/ml in urine.
Bin each case of detection of bacteriuria in the amount larger or equal 103 CFU/ml in urine.
Cin each case of detection of bacteriuria in the amount larger or equal 104 CFU/ml in urine in women with the symptoms of acute pyelonephritis.
Danswers A and B true.
Eanswers A,B, and C true.

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Question 143

The following factors favor the appearance of acne rosacea:

Avasomotor disturbances.
Bseborrhea.
Calimentary tract diseases.
Dhormonal disorders in women.
Eall above are true.

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Question 144

Active immunity is achieved by the use of:

Avaccinations
Bimmunoglobulins
Cantitoxins
Danswers A and B are true
Eanswers A, B and C are true

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Question 145

To dermatological manifestations of borreliosis belong all of the presented below, except:

Achronic erythema migrans.
Bpemphigoid.
Clower limbs’ atrophic dermatitis (acrodermatitis chronica atrophicans).
Dpemphigus vulgaris.
Eanswers B and D are correct.

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Question 146

To estimate cardio-vascular risk the SCORE (Systematic Coronary Risk Evaluation) risk chart is recommended. The SCORE chart is a useful tool for estimating the 10-years risk of developing a fatal cardiovascular event according to:
1) gender;
2) age;
3) smoking;
4) systolic blood pressure;
5) diastolic blood pressure;
6) total cholesterol concentration;
7) LDL cholesterol concentration;
8) HDL cholesterol concentration;
9) diabetes mellitus.
The correct answer is:

A1,3,4,7,9.
B1,2,3,4,6.
C2,3,5,7,9.
D1,2,3,6,9.
Eall above.

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Question 147

Which of the following symptoms does not require an immediate diagnostics in order to exclude a neoplastic disease:

Ahoarsness lasting for a week.
Bcough lasting for over 2 months.
Cdysphagia lasting for 2 weeks.
Dbloody sputum for 2 days.
Eblood in stool for a year.

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Question 148

Family physician may take medical care of a healthy infant.

Athe above statement is not true.
Bthe above statement is true.
Cthe above statement is true but only if the obligatory vaccinations are performed in Outpatient Consultative Vaccination Clinic.
Dthe above statement is true but only if the infant is periodically consulted by a specialist in Paediatrics.
Ethe above statement is true but only if the infant is periodically consulted by a specialist in Paediatrics and if the obligatory vaccinations are performed in Outpatient Consultative Vaccination Clinic.

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Question 149

Patient bitten by a tick:

Ashould be observed within 30 days in order to reveal erythema migrans.
Bshould take a preventive dose of amoxicillin or doxycillin for 14-21 days.
Cshould take a dose of Immunoglobulin specific to borreliosis.
Danswers A and C are true.
Eanswers A,B and C are true.

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Question 150

According to GINA 2006, if in an adult with bronchial asthma, during the last 4 weeks: a) dyspnea and cough attacks have been observed 3-4 times in a week, limitating everyday-life activity of the patient b) dyspnea awaking the patient 2-3 times in a week has been observed, causing the necessity of immediate pharmacotherapy, the following type of bronchial asthma should be diagnosed:

Aasthma uncontrolled
Basthma partially controlled
Casthma controlled
Dchronic severe asthma
Esporadic asthma

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Question 151

In patient with diabetes mellitus type 2, hypertension and 24-hour albuminuria >150µg/min (estimated from the albumin concentration in a 24-hour urine collection sample), the recommended medicine is:

Aangiotensin-converting enzyme inhibitor.
Bbetablocker.
Ccalcium channel blocker.
Dloop diuretic.
Ealfa-blocker.

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Question 152

The most effective management reducing the risk of the chronic obstructive pulmonary disease and inhibiting the development of it is:

Asmoking cessation.
Bproper body mass maintenance.
Cpulmonal rehabililtation.
Dyearly influenza vaccination.
Eanswers B,C,D are true.

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Question 153

In patients with long-lasting diabetes mellitus type 2 ( > 5years), the criterium of good diabetes management is:

AHbA1 ≤ 7%.
Bfasting glucose and preprandial glucose concentration 70-110 mg/dl.
Cpostprandial glucose concentration (160 mg/dl in 2 hours after a meal).
Danswers B and C are true.
Eanswers A,B,C are true.

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Question 154

Following START evaluation system, an adult patient injured in a mass casaulty accident, presenting with symptoms: 15 breaths per minute, capillary refill time over 2 seconds, should be classified into group:

Agreen.
Byellow.
Cred.
Dcapillary refill time is not measured when breathing ratio is 15/min.
Ein mass casualties accident medical segregation is not performed.

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Question 155

During medical segregation with START system the following parameters are evaluated, except:

Abreathing ratio.
Bpulse presence on radial artery.
Cpulse presence on carotid artery.
Dcapillary refill time.
Econsciousness level.

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Question 156

Which of the following is false concerning medical segregation of adults according to START system?

Awhen the patient's breathing rate is 40/min he is marked with color red.
Bwhen the patient's breathing rate is 26/min and capillary refill time is over 2 seconds he is marked with color red.
Cwhen the patient is able to walk he is marked with color green.
Dwhen the patient is not breathing, the pulse is not checked on radial artery and the patient receives color black.
Ewhen the patient is not breathing, it is always necessary to check pulse on radial artery before marking with color black.

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Question 157

Which of the following is false concerning administration of amiodarone during CPR?

Ait is used in persistent ventricular fibrillation and ventricular tachycardia
Bis administered before third defibrillation
Cthe initial dose is 300 mg diluted in 5% glucose to the volume of 20ml
Dcan result in hypotension and bradycardia
Ewhen amiodarone is not present, lidocaine may be administered in a total dose of 300 mg over one hour period

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Question 158

In which type of fracture the suspected blood loss is the highest, so that hypovolemic shock may occur rapidly?

Afemoral.
Bshank.
Cforearm
Dfive vertebras.
Epelvis.

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Question 159

In AVPU evaluation scale the patient received U, which means:

Aresponds to vocal stimuli.
Bdoes not respond to vocal and painful stimuli.
Cdoes not respond to painful stimuli.
Dhas anizocoria.
Eprobably has a fracture.

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Question 160

Surface of II degree burn of both upper limbs and perineum measured in percentage of body surface in adult is:

A9%.
B35%.
C37%.
D50%.
E19%.

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Question 161

Which of the following symptoms may suggest crush of the chest?

Aribs fracture.
Bblurring of the aortic shadow.
Chaemorothorax.
Dpneumothorax.
Eall above.

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Question 162

Which of the following statements concerning acute myocardial infarct is false?

Apain is coronary and occurs when patient is resting.
Bpain is severe.
Cpain lasts longer than 20 minutes.
Dthere is a weak reaction to nitroglycerine administration.
Enormal ECG excludes diagnosis of acute myocardial infarct.

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Question 163

Diazepam does not produce:

Asedation
Banxiolysis
Chypnosis
Dantiemetic action
Eanticonvulsant action

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Question 164

Major route of elimination of inhaled anesthetics is:

Ametabolism by plasm esterases.
Bmetabolism by enzymes of the liver.
Cuptake of the agent by the reticuloendothelial system.
Dsimple excretion by the kidneys.
Eclearance by the lungs into the expired air.

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Question 165

Pulse oximetry is not useful in the following situations, except:

Acarbon monoxide poisoning.
Bstrong infrared radiation to measure oxyhaemoglobin.
Cmonitoring of the patient during passive oxygen therapy.
Dmeasuring of capillary flow in patients with anaemia (haemoglobin below 5g/dL).
Ehypothermia with peripheral vasoconstriction.

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Question 166

Which of the following is not a central opioid effect?

Aanalgesia.
Bdepression of respiration.
Creduction of the cough reflex.
Dreduction of the skeletal muscle tone.
Enausea and vomiting.

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Question 167

Every minute of delay of defibrillation during CPR reduces the probability of the patient survival up to hospital release by:

A1-2%.
B3-5%.
C5-7%.
D10-15%.
E15-20%.

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Question 168

In patient electrocuted or stroked by the lightening the following complications may occur:
1) avulsion fractures of the long bones;
2) breathing difficulties;
3) ear membrane breaking;
4) renal failure;
5) neurological injuries including spinal cord injury.
The correct answer is:

A1,2,3.
B1,2,4,5.
C2,3,5.
D2,4,5.
Eall above.

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Question 169

Hyperkaliemia is when the concentration of potassium in serum is above:

A> 4,5 mEq/l.
B> 5,0 mEq/l.
C> 5,5 mEq/l.
D> 6,0 mEq/l.
E> 6,5 mEq/l.

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Question 170

Propofol is:

Alipid emulsion.
Bphenol derivative.
Cbarbiturane.
Dbenzodiazepine.
Emuscle relaxant.

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Question 171

A woman with inevitable miscarriage came to a hospital with her permanent partner. This man asked her doctor for information about the state of the patient.

Aonly a husband has a right to this kind of information.
Bthe doctor knowing that it is a permanent partnership should give the information.
Cirrespective to the character of relationship between them information may be given only after having consent of the patient.
Dinformation may be given freely to a husband or close relatives and, after having consent of a patient, to other persons.
Ein this case the partner should be treated like a husband or close relative and information should be given.

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Question 172

Brain death has been diagnosed in an accident victim taken to a hospital. Doctors want to take his organs for transplantation. In order to make it possible:

Athe victim’s family must give consent.
Bliving will of the victim to give his organs for transplantation is needed.
Ca tutelary/guardianship court must approve it.
Dit must be checked whether the victim has not opposed to it before his death.
Ean approval of a local Ethics Committee is needed.

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Question 173

What kind of medical situation, according to the Code of Medical Ethics, is a condition essential to diagnose death before taking cells, tissues or organs for transplantation?

Acardiac arrest.
Bbreath arrest.
Ctissues necrosis.
Dbrain death.
Ezero blood pressure.

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Question 174

What kind of consent, according to Code of Medical Ethics, is needed for taking cells, tissues and organs from corpse for transplantation?

Ainformed.
Bpresumed.
Cwritten.
Dlegal approval.
Eapproval of the relatives.

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Question 175

There is a regulation in the Code of Medical Ethics on taking tissues for transplantation from minors. It concerns:

Anervous tissue.
Bmuscular tissue.
Cconnective tissue.
Dbone marrow.
Efatty tissue.

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Question 176

What kind of criteria, according to the Code of Medical Ethics, should be used by a physician determining the order of the patients receiving intervention when specific forms of diagnostics, treatment or prevention cannot be applied simultaneously to all persons in need?

Aadministrative.
Bmedical.
Cbiological.
Dlegal (Penal Code).
Eorganizational.

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Question 177

A rehabilitation of a patient addicted to narcotic agents, psychotropic substances or substitutes may be conducted by:
1) a health care institution;
2) a physician in his individual practice;
3) a specialist in psychiatry;
4) a specialist having university degree in non-medical field;
5) a specialist certified in therapy of addictions.
The correct answer is:

A1,2.
B3,5.
C3,4.
D2,5.
E1,5.

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Question 178

Direct coercion procedures in the form of immobilization or isolation of a patient, according to the principles of medical ethics and law, may be used for no more than:

A8 hours.
B4 hours and, if needed, after a personal examination immobilization may be prolonged for 6 hours periods.
C10 hours.
Dthere is no time limit for such procedures.
Ea maximum of 24 hours.

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Question 179

A physician is allowed to perform medical procedures without patient’s or his legal representative’s consent only if:
1) there is a need of immediate medical aid and the patient of age is unconscious;
2) there is a need of immediate medical aid and the legal representative of a minor patient is unavailable;
3) when a consent in the name of a patient in age is given by his close relatives;
4) when a patient does not give neither consent nor refusal;
5) there is a need of psychiatric examination of a patient whose behaviour may be dangerous for his or other people life and health.
The correct answer is:

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

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Question 180

Admission to a psychiatric hospital without patient’s consent is possible with a decision of:

Aany physician reading medical report of the patient.
Ban appointed physician after personal examination of the patient.
Can appointed physician after personal examination of the patient and, if only possible, having opinion of a second psychiatrist or psychologist.
Da physician based on the opinion of relatives or other persons presenting credible information on patient’s state.
Ea physician based on the opinion of police.

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Question 181

Authorization to issue medical certificates on temporary incapacity to work is granted by the National Health Insurance Company (ZUS) for:

A3 months.
B1 year.
C2 years.
D3 years.
Ean indefinite period.

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Question 182

In the case of a statement of fact that a medical certificate ZUS ZLA was issued by a doctor without directly checking the patient’s condition, the Social Insurance Institution (ZUS) can take a decision to withdraw the authorization for the doctor to issue medical certificates for:

Athe period of less than 3 months starting from the date of validation of the decision.
Bthe period of less than 6 months starting from the date of validation of the decision.
Cthe period of less than 12 months starting from the date of validation of the decision.
Dthe period of less than 3 years starting from the date of validation of the decision.
Ean indefinite period.

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Question 183

How many medical certificates ZUS ZLA should be given to an insured person who is working for 3 employers?

Aone.
Btwo.
Cthree.
Dfour.
Efive.

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Question 184

The Social Insurance Institution (ZUS) does not provide therapeutic rehabilitation as a form of pension prevention for insured persons who might lose the capacity to work due to diseases of:

Athe motor organs.
Bthe respiratory system.
Cthe digestive system.
Dthe cardiovascular system.
Epsychosomatic basis.

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Question 185

The correctness of issuing certificates on temporary incapacity to work due to illness and their correct proceeding is under control which is carried by:

AZUS (Social Insurance Institution) certifying doctors.
BAgricultural Social Insurance Fund (KRUS) certifying doctors.
Cmilitary medical boards.
DMinistry of Interior and Administration (MSWiA) medical board.
EDisability Adjudication Boards.

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Question 186

The medical certificate forms on temporary incapacity to work belong to ZUS (Social Insurance Institution). They are provided to:

Amedical specialists.
Battending doctors.
Cfamily doctors.
Dthe doctors who are authorized by ZUS (Social Insurance Institution) to issue medical certificates.
Eall doctors who have the right to practise.

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Question 187

Care allowance does not apply to:

Achildren under 16 if they are acknowledged as disabled.
Bpersons over 16 if they are disabled to a considerable degree; this applies also to moderate degree if the disability occured at the age which entitles to child benefit.
Cpersons entitled to a pension or an invalidity pension if the persons were acknowledged as completely incapable of working and independent existence.
Dpersons over 75, regardless of health condition and disability.
Epersons over 70, regardless of health condition and disability.

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Question 188

The public health care institution may be created by:

Achurch
Bunincorporated company
Ccentral organ of legal administration
Dreligious association
Ephysical person

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Question 189

The Lalonde’s health field concept does not include the following as factors exerting an effect on health:

Agenetic factors.
Bpsychological factors.
Cenvironmental factors.
Dhealth behaviours.
Ehealth care system.

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Question 190

Indicate the incorrect answer in the statement: ‘The negative measures of the state of health cover the following’:

Aincidence rate.
Binfant mortality rate.
Cexpected life span at birth.
Dprevalence rate.
Edeath rate (fatality rate).

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Question 191

The expected life span reflects the following:

Astate of health of the population.
Bquality of medical care.
Cliving conditions.
Denvironment status.
Eall the above.

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Question 192

Which of the below-mentioned services are not financed from the resources of the National Health Fund (NFZ)? ?
1) occupational medicine services;
2) making decisions concerning capability for driving vehicles;
3) decisions made on request of the insured, not connected with further rehabilitation, incapability for work;
4) costs of accommodation and meals in association with sanatorium treatment;
5) preventive vaccination recommended by the Ministry of Health;
6) plastic surgery procedures in cases which are not the consequence of disease, congenital defect, injury.
The correct answer is:

A1,2.
B2,3.
C3,4,5,6.
D2,3,4,5.
Eall above.

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Question 193

An epidemic is:

Athe occurrence of selected diseases over a region characteristic for these diseases, over specified time intervals.
Ba formal statement that in a specified area there are conditions and a considerable degree of probability of the occurrence of an epidemic.
Cincidence, deaths, carriers and population health threat in a specified area and over a specified time interval, with the consideration of individual and environmental traits.
Doccurrence of a certain disease in a given human population, in a specified area, during a given time interval, substantially exceeding that observed in previous years.
Ethe situation in an area where an ecological disaster occurred.

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Question 194

In order to evaluate the effectiveness of a vaccine the following should be performed:

Arandomised controlled trial with full randomization of the sample and control group.
Brepresentative study with precise assessment of the required sample size.
Cclinical-epidemiological study of those vaccinated.
Dscreening test of those vaccinated.
Elaboratory study of the quality of the vaccine applied, compared to the standard.

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Question 195

The screening test procedure requires the following:

Asimultaneous application of several diagnostic tests.
Bcovering by the study 90% of the group dedicated for the study.
Capplication of complete diagnostic procedure with respect to all the diseases covered by the study.
Dapplication of diagnostic tests with respect to people who had a positive test result.
Eapplication of complete diagnostic procedure with respect to people who had a positive test result.

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Question 196

Which of the vasoconstrictors in the dose of 3 mg/kg of the body weight will raise the renal perfusion?

Aepinephrine.
Bnorepinephrine.
Cdopamine.
Dcorrect answer is A and C.
Enone of the answers are correct.

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Question 197

Epinephrine during CPR for cardiac arrest with VF is administered:

Aright after achieving intravenous access.
Bbefore third defibrillation.
Cbefore second defibrillation.
Devery minute.
Eloading dose is 3 mg (initial dose).

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Question 198

The public access defibrillation program should be implemented in places where at least one case of cardiac arrest occurred during:

A1 year.
B2 years.
C3 years.
D4 years.
E5 years.

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Question 199

Correct sequence of CPR during diagnosed, persistent ventricular fibrillation:

Adefibrillation, drugs, CPR, rhythm evaluation.
Bdefibrillation, CPR, rhythm evaluation, drugs.
Cdefibrillation, rhythm evaluation, CPR, drugs.
Ddefibrillation, rhythm evaluation, drugs, CPR.
Edefibrillation, drugs, rhythm evaluation, CPR.

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Question 200

Which of the below-mentioned health services are financed from the State budget?

1) highly specialised health services;

2) plastic surgery and cosmetic procedures;

3) occupational medicine services;

4) preventive vaccinations recommended by the Ministry of Health;

5) treatment of an insured person abroad in the cases which are not treated in Poland;

6) costs of accommodation and meals in residential homes.

The correct answer is:

A1,2.
B2,3,4.
C1,4,5.
D3,4,5,6.
E1,2,3,4,5.

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