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LEKEXAM / 2010 spring

Question distribution — 2010 spring session

Share of each category in the latest available session.

Internal medicinePediatricsSurgeryGynecology and obstetricsFamily medicineEmergency medicine, AnaesthesiologyPsychiatryMedical law and bioethicsPublic healthMedical certification

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Question 1

The presence of red cell casts in a patient with hematuria is characteristic of:

Aglomerular bleeding.
Bcalyceal bleeding.
Curethral bleeding.
Dcystitis.
Eall the answers are correct.

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Question 2

Nephrotic syndrome is characterized by:

Aproteinuria < 3.5 g/dl.
Bdyslipidemia.
Clow albumin in urine.
Dhigh albumin in blood.
Ethe correct answers are A and B.

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Question 3

Urinary tract infection is regarded as complicated in:

Apregnant women.
Bmen.
Cindividuals with diabetes mellitus.
Dall the above answers are correct.
Ethe correct answers are A and C.

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Question 4

The most common kidney stones consist of:

Acalcium oxalate with calcium phosphate.
Bcalcium phosphate alone.
Curic acid.
Dmagnesium ammonium phosphate (struvite).
Ecystine.

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Question 5

Renal ultrasonography is not appropriate for:

Arenal size measurement.
Bcharacterizing renal masses as cystic or solid.
Cvisualization a normal adult ureter.
Ddiagnosis of polycystic kidney disease.
Ediagnosis of pelvicalyceal dilatation.

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Question 6

Renoprotection consists of:

Athe normalization of blood pressure.
Blowering proteinuria < 0.3 g/24 h.
Cangiotensin converting enzyme inhibitor in proteinuria > 1g/24h.
Dall the above.
Ethe correct answers are A and C.

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Question 7

The best method to access excretory renal function is:

Asodium excretion in urine.
Bglomerular filtration rate.
Cspecific gravity of urine.
Durine osmolality.
Eurine sediment examination.

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Question 8

In dehydrated patient with acute kidney injury you should consider as a therapeutic option:

Adiuretic (e.g, frusemide).
Bnon-steroidal nantiinflammatory drug (e.g. ibuprofen).
CACE inhibitor (e.g. enalapril).
Dintense hydration (e.g. 3-4 litres of physiological saline- 0.9% NaCl).
Ethe correct answers are A and D.

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Question 9

In a patient with acute kidney injury due to obstruction of urinary tract the treatment of choice is as follows:

Athe elimination of the obstruction by medical therapy, instrumentation or surgery.
Bdiuretic administration.
Cpain-relieving drug administration.
Ddialysis therapy.
Ekidney transplantation.

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Question 10

In a patient with chronic kidney disease (CKD) serum creatinine on the last visit was 4.5 mg/dL, and glomerular filtration rate (creatinine clearance) was 20 mL/min. Due to generalized edema the patient requires diuretic administration. Which of the following diuretics is the best option for this patient?

Athiazide diuretic.
Bmannitol.
Ccarbon anhydrase inhibitor.
Dloop diuretic.
Ethere is no effective diuretic at this stage of CKD.

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Question 11

A 32-year-old female suffering from hypertension for the last 5 years plans to become pregnant. She is treated with enalapril and hydrochlorothiazide reaching target values below 140/90 mm Hg. In hypotensive therapy, the medical advice is as follows:

Acontinue previous therapy.
Breplace enalapril with calcium channel blocker when she becomes pregnant.
Creplace enalapril with calcium channel blocker or methyldopa before she becomes pregnant, and, if possible, stop hydrochlorothiazide or replace it with another diuretic (e.g. dihydralazine or methyldopa).
Dreplace enelapril with losartan, continue diuretic.
Eadd methyldopa, because in pregnancy the blood pressure will increase.

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Question 12

The most common cause of the end-stage renal failure requiring renal replacement therapy (dialyses or kidney transplantation) is:

Achronic glomerulonephritis.
Burinary tract infection.
Cdiabetic nephropathy.
Dhypertension.
Eacute renal failure/acute kidney injury.

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Question 13

A 57-year-old male with a history of well-controlled hypertension for many years came to the doctor’s office due to elevated blood pressure values in the last weeks (160/110, 150/100 mm Hg). He is treated with enalapril 20 b.i.d. and amlodypine 10 q.d. In the laboratory test , serum creatinine is 0.89mg/dl, serum sodium is 139 mEq/l, serum potassium is 5.45 mEq/l, fasting glucose is 89 mg%. Which of the following options should be introduced for better control of his hypertension?

Aincrease the dose of enalapril to 30 mg b.i.d.
Badd angiotensin II receptor blocker e.g. losartan.
Cadd beta-blocker (e.g. metoprolol).
Dadd mineralocortocoid receptor antagonist (e.g. spironolactone).
Eadd diuretic (e.g. hydrochlorothiazide).

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Question 14

A 30-year-old man, sexually active, complains of painful voiding localized in the urethra, itch around urethra. He also discovered purulent urethral discharge. The most probable diagnosis is the following:

Acystitis.
Bprostatitis.
Cbenign prostatic hyperplasia.
Durethritis.
Eurolithiasis.

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Question 15

After asthma had been diagnosed, a patient received inhaled budesonide 2 x 200 mcg and salbutamol as a rescue medication. After 4 weeks the patient made a control visit. Now he reports significant improvement, but he wakes-up at night due to cough at least once a week, he still reports worse exercise tolerance, the use of salbutamol is 1-2 doses per day. The most appropriate therapeutic decision is:

Acontinue the so-far treatment regime, because the improvement has been achieved.
Brecommend the use of salbutamol in regular doses, e.g. 2 doses every 6 hrs.
Cadd theophylline.
Dadd cromones.
Eadd long-acting beta-mimetic or replace inhaled steroid with a composite formulation, containing both drugs. The increase of the dose of inhaled steroid should be considered.

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Question 16

The first choice treatment for the patient with acute asthma attack is:

Arapidly acting inhaled bronchodilators.
Bbeta-mimetics given orally or intravenously.
Cinhaled steroids.
Dtheophilline and steroids intravenously.
Eadrenalin subcutaneously.

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Question 17

The treatment of choice in the mild and symptomless COPD is:

Amonitoring of the rate of bronchial obstruction progression, no other recommendations.
Banti-nicotine therapy and respiratory rehabilitation.
Chigh doses of inhaled steroids, long-acting beta-mimetics, short-acting betamimetics on demand – the treatment should be initiated as early as possible in order to inhibit the disease progression.
Dsteroids – oral or depot.
Eoxygen therapy and respiratory rehabilitation.

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Question 18

Which of the following statements best describes the diagnostic value of D-dimers in pulmonary embolism?

Aelevated concentration of D-dimers is specific to pulmonaryembolism.
Blow concentrations allow to exclude pulmonary embolism with high probability.
CD-dimers help to differentiate between thrombo-embolic processes and inflammatoryor neoplastic diseases.
Dhigh concentrations are detected especially in patients with pulmonary infarction.
Ehigh concentrations are detected especially in patients with infarction of the right ventricle.

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Question 19

The pathogen most frequently causing community-acquired pneumonia is:

ALegionella pneumophila.
Bviruses.
CKlebsiella pneumoniae.
DStreptococcus pneumoniae.
EPneumocystis carini.

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Question 20

For which of the following rheumatic diseases the typical feature is a symmetric synovitis involving wrists and small joints of the hands and feet:

AAnkylosing spondylitis.
Bgout.
CRheumatoid arthritis.
DReiter’s syndrome.
ELupus erythematosus systemicus.

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Question 21

A 55-year-old obese male experienced at night a strong pain and swelling involving the first metatarsophalangeal joint of the left foot with concomitant warmth and redness of the skin in this area. The symptoms disappeared several days later. Shortly thereafter however, (as a consequence of abundant dinner with alcohol) there occurred an equally painful swelling and effusion in the right knee. In the synovial fluid sample taken for a diagnostic purpose the most likely finding is:

AReiter’s cells.
Brheumatoid factor (RF).
Cintracellular bacteria (e.g. gonococcal infection).
Dneedle-shaped strongly negative birefringent crystals (in polarized light microscopy).
Erhomboid-shaped or rectangular weakly positive birefringent crystals (in polarized light microscopy).

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Question 22

A 32-year-old female shortly after delivery started to complain about weekness, elevated temperature, migratory joint pain and swelling, hair loss and nontender oral ulcers. After a sun exposure she developed erythematous skin lesions on cheeks and dorsal part of the nose. The control chest radiograph revealed bilateral flattening of costo-diaphragmal angles. In laboratory testing: HGB 10.5 g/dl, WBC 2.0 G/l, PLT 120 G/l. The most likely diagnosis in this case is:

Alymphoma.
Bmesothelioma.
Cdiscoid lupus.
Dlupus erythematosus systemicus.
ESjögren’s syndrome.

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Question 23

To the group of necrotizing vasculitides belong the following entities except for:

AWegener’s granulomatosis.
BPolyarteritis nodosa.
CTakayasu’s arteritis.
DSystemic sclerosis.
Egiant cell arteritis.

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Question 24

Which from the following situations does not require treatment consisting in bisphosphonates administration as well as vitamin D and calcium supplementation?

Asenile osteoporosis.
Bpostmenopausal osteoporosis.
Cpoststeroid osteoporosis.
Dperiarticular osteoporosis.
Esecondary osteoporosis, e.g. related to endocrine conditions.

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Question 25

The hallmark of which from the following rheumatic diseases is the absence of rheumatoid factor:

ARheumatoid arthritis.
BAnkylosing spondylitis.
CSjögren’s syndrome.
DLupus erythematosus systemicus.
Erheumatoid factor may be present in all entities named above.

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Question 26

The aim of chemoprophylaxis against tuberculosis is:

Apreventing disease development in infected individuals
Bactive infection treatment
Cpreventing infection transmission
Dprotection against exposure to mycobacteria
Edisease recurrence prevention

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Question 27

The first line therapy in sarcoidosis is:

Aantibiotics.
Binhaled glucocorticosteroids.
Csystemic glucocorticosteroids.
Dlong acting β-mimetics.
Ecytotoxic agents.

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Question 28

Non-complicated pneumonia caused by influenza virus requires:

Ahospital based treatment.
Bsymptomatic treatment.
Cantiviral treatment.
Doral antibacterial therapy.
Eintravenous antibacterial therapy.

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Question 29

Which of the following is not an unfavourable factor in hospital-acquired pneumonia?

Arespiratory failure.
Bprolonged mechanic ventilation
Cage < 60 yrs.
Dbilateral pneumonia.
Echronic respiratory disease.

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Question 30

QT interval in ECG reading is measured:

Afrom the start of QRS complex to the start of T wave.
Bfrom the start of QRS complex to the end of T wave.
Cfrom the end of QRS complex to the start of T wave.
Dfrom the end of QRS complex to the end of T wave.
Efrom the highest point of QRS complex to the start of T wave.

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Question 31

Which of the following is not a pulmonary hypertension symptom?

Ahoarseness
Blower extremities edema.
Cstenocardia
Dloss of appetite.
Eincreased sputum production.

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Question 32

Which of the medications listed below reduce the risk of cardio-vascular incidents and death in patients suffering from coronary disease?

Anitrates.
Bstatins.
Ccalcium channel blockers.
Dthe correct answers are A and B.
Enone of the above.

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Question 33

What ECG signs may be found in a patient with acute coronary syndrome?

Aelevated ST segments.
Bnew left bundle branch block.
Cinverted T-wave.
Dthe correct answers are A and B.
Ethe correct answers are A,B,C.

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Question 34

The most frequent cause of chylothorax is:

Aterminal renal failure.
Bacute renal failure.
Cneoplasm.
Dheart insufficiency.
Eliver cirrhosis.

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Question 35

The weakening of the 1stheart sound and systolic murmur over the apex which radiates to the left armpit are characteristic of:

Amitral valve insufficiency.
Baortic valve insufficiency.
Ctricuspid valve insufficiency.
Datrial septal defect.
Epatent arterial duct.

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Question 36

The group 0 freshly frozen plasma may be transfused to:

Aall patients, regardless AB0 group.
Bpatients with group A.
Cpatients with group B.
Dpatients with group 0.
Epatients with group AB.

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Question 37

Which of the following is not a characteristic feature of tetralogy of Fallot?

Aventricular septal defect.
Bpulmonary trunk stenosis.
Ca shift of aortic ostium to the right, over the interventricular foramen.
Dright ventricle hypertrophy.
Eatrial septal defect.

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Question 38

Which of the following is not a risk factor of venous thrombo-embolic disease?

Acongestive heart disease.
Bhormonal replacement therapy.
Cnephrotic syndrome.
Dchronic obstructive pulmonary disease.
Edeficiency of factor VIII.

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Question 39

A 32-year-old male visited the admission room with the fever reaching 40°C, bilateral ankle joints arthritis, painful reddish subcutaneous pretibial nodes. The symptoms had an acute onset and have lasted for the last week. During this time he has been treated with an antibiotic, without any improvement. His chest X-ray revealed bilateral enlargement of the hilar shadow. WBC 11.3 G/L, CRP 98 mg/L. The most probable diagnosis is:

Apneumonia.
Blymphoma.
Cdisseminated neoplastic disease.
Dsarcoidosis.
Etuberculosis.

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Question 40

Reiter’s syndrome triad includes:

Aserositis, haemolytic anaemia with reticulocytosis, keratitis.
Bchoroiditis, gout, sialoadenitis.
Carthritis, urethritis, conjunctivitis.
Dulcerative stomatitis, proteinuria > 0,5 g/24 hours, flexion contracture of the fingers.
Eobesity, hyperlipoproteinaemia, hypertension.

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Question 41

According to the current Prophylactic Vaccination Program obligatory immunization against tuberculosis is conducted:
1) in newborns;
2) in patients at the age of 6;
3) in patients at the age of 12 in the case of negative tuberculin test;
4) in patients at the age of 19 in the case of negative tuberculin test;
5) in the first year students of medical studies, in the case of negative tuberculin test.
The correct answer is:

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

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Question 42

According to the current Prophylactic Vaccination Program obligatory(financed by the government) immunization against hepatitis B is conducted in the following groups of people at risk of infection except for:

Apeople of medical profession at risk of infection.
Bpeople from the close society of patients with hepatitis B and carriers of hepatitis virus B (HBV).
Cpeople prepared for surgeries or procedures performed in extracorporeal circulation
DHIV positive patients.
EC and D are correct.

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Question 43

The parents of a 13-month-old child who is diagnosed with coeliac disease are asking what products could be used in their child diet. Which of the following products are allowed?
1) rice products;
2) wheat products;
3) potato flour products;
4) rye products;
5) corn products.
The correct answer is:

A1,2,4.
B1,3,4.
C1,3,4,5.
D1,3,5.
E3,4,5.

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Question 44

Which of the following antibiotics should be used in treatment of a 4-year-old child with pneumonia of Mycoplasma pneumoniae etiology?

Adoxycycline.
Bamoxicillin.
Campicillin.
Dcefuroxime.
Eclarithromycin.

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Question 45

The most common pathogenic factor of the haemorrhagic cystitis in children is:

APseudomonas sp.
BProteus sp.
CAdenovirus.
DCandida albicans.
EStaphylococcus saprophyticus.

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Question 46

The treatment of acute pyelonephritis in children does not include:

Aampicillin.
Bamoxicillin with clavulanic acid.
Camoxicillin.
Dnitrofurantoin.
Esecond-generation cephalosporin.

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Question 47

Morning vomiting, headache, nystagmus, ataxia suggest the diagnosis of:

Achronic peptic ulcer disease.
Bepilepsy.
Cvision defect.
Dbrain tumor of the posterior cranial cavity.
Eschizophrenia.

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Question 48

The control of urine culture in a child treated because of urinary system inflammation with persisting symptoms should be done:

A48 hours after starting the treatment.
B12 hours after starting the treatment.
C48 hours after the end of the treatment.
D12 hours after the end of the treatment.
E72 hours after starting the treatment.

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Question 49

The cause of bleeding from the lower part of the alimentary tract in infants could be all of the following except for:

Acongenital defect of the alimentary tract.
Bintussusception.
Cfood allergy.
Dpylorostenosis.
ESalmonella sp. infection.

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Question 50

Pneumonia of Chlamydia trachomatis etiology:

1) could be diagnosed in newborns in the first weeks of life;

2) is an atypical infection diagnosed most usually in school age children;

3) has non-productive, convulsive, whooping cough as a typical clinical symptom;

4) has conjunctivitis, rhinitis, cough and vomiting as typical clinical symptoms.

The correct answer is:

A1,2.
B2,3.
Cnone of the above.
D1,4.
E3,4.

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Question 51

What is the most probable etiology of pneumonia
- with primary multifocal then lobar inflammatory changes andabscesses in a chest X-ray
- with high leucocytosis
- in which leucopenia as a bad prognosis factor could appear
- in which clinical symptoms appear suddenly with high fever and cough?

APneumocystis carini.
BChlamydia pneumoniae.
CPseudomonas aeruginosa.
DStaphylococcus aureus.
EMycoplasma pneumoniae.

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Question 52

In the case of the following symptoms: meconium obstruction in neonatal period, malabsorption syndrom, fatty stools, prolapse of the anus, returning pneumonia, diagnostics of which disease should be conducted in the first place?

Acolitis ulcerosa.
Bcoeliac disease.
Cfood allergy.
Dmucoviscidosis.
Ehaemosiderosis.

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Question 53

Today early in the morning a 12-year-old boy with a two-day history of intense epigastric pain vomited blood few times and noticed two tarry stools. The most probable diagnosis is:

AMeckel’s diverticulum.
Boesophageal varices.
Cpeptic ulcer
DMallory-Weiss syndrome.
Earteriovenous malformation.

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Question 54

A 15-year-old boy with a few-months history of diarrhea associated with the passage of blood or mucus and painful cramps notified pain in left hypogastrium and his mother noticed loss of appetite. The patient has lost 8 kg in the last two months. Laboratorial examinations showed high C-reactive protein concentration. In endoscopic examination superficial ulcerations covered by fibrin in the rectum were noticed. In histopathological study - crypt abscesses. The most probable diagnosis is:

Asolitary rectal ulcer syndrome.
BCrohn’s disease.
Culcerative colitis.
Dischemic colitis.
Ecollagenous colitis.

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Question 55

A 5-year-old boy suffers from functional constipation. Which of the following drugs you won’t apply in the treatment?

Alactulose.
Bparaffin.
Cmacrogol.
Dphosphatic enema.
Eloperamide.

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Question 56

Which of the following diets should be applied to a 10-year-old boy with acute pancreatitis?

Aelimination diet.
Blight diet.
Chigh-fiber diet.
Dlow-fiber diet.
Efasting.

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Question 57

A 15-year-old boy has low back pain, nausea, loss of appetite and fever (> 39 °C). Laboratorial examinations showed high C-reactive protein concentration, leucocyturia and bacteriuria. The most probable diagnosis is:

Aurinary calculus.
Bidiopathic nephritic syndrome.
Cacute pyelonephritis.
Dglomerulonephritis.
Erenal amyloidosis.

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Question 58

A 3-week-old male neonate suffers from anxiety and has 2-day history of intensive vomiting after each breast-feeding. In medical examination the doctor felt a hard mass (olive shaped) in the epigastrium. The most probable diagnosis is:

Aesophageal atresia.
Bpylorostenosis.
Canal atresia.
Dfood allergy.
Eacute gastritis.

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Question 59

Physical examination of a 5-year-old boy revealed no pulse on femoral arteries. The above-mentioned symptom is characteristic of congenital heart defect such as:

APDA.
BSA.
CVSD.
DToF.
ECoA.

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Question 60

The propagation of echocardiographic examination caused that tendinous cords in the left ventricle of the heart are more commonly observed. Which of the sentences related to tendinous cords is false?

Atendinous cords may cause heart murmur.
Btendinous cords include conduction system cells.
Ctendinous cords may cause repolarization abnormalities in ECG.
Dtendinous cords may cause ventricular arrhythmia.
Echildren with tendinous cords in the left ventricle should limit physical efforts and should not exercise during physical education at school.

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Question 61

The drugs of the first choice in hypertension are among others angiotensin converting enzyme inhibitors (ACEI). The contraindication against ACEI is:

Ahypertension with significant hypertrophy of left ventricle.
Bhypertension in infancy.
Chypertension in a child with bilateral renal arteries stenosis.
Dhypertension with coexisting diabetes mellitus.
Ehypertension with coexisting dyslipidaemia.

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Question 62

Chest X-ray is still basic diagnostic examination in heart diseases. Which of the sentences related to interpretation of chest x-ray is incorrect?

Acardio-pulmonary index over 0.5 indicates heart enlargement.
Ba projection of the right lower heart outline indicates right atrium enlargement.
Cin left ventricle hypertrophy, the apex of the heart is moved upward.
Dthe abnormal left upper heart outline with proximal part of the descending aorta resembling a figure “3” indicates coarctation of the aorta.
Ediminish vessel markings are characteristic of heart defects with decreased pulmonary flow.

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Question 63

The most common congenital heart defect is ventricular septal defect (20-30 % of all congenital heart defects). Which one of the sentences related to ventricular septal defect is false?

Athe magnitude of cardiac shunt through septal defect depends on the dimension of defect and pulmonary resistance.
Bthe left-to-right shunt through septal defect leads to volume overload of the left ventricle and increased pulmonary flow.
Cincreased pulmonary flow causes progressing structural abnormalities in the pulmonary arterioles and increase in pulmonary resistance up to irreversible pulmonary hypertension.
Dpathognomonic for ventricular septal defect is a loud murmur involving systole and diastole of the heart, best heard to the left and in the lower part of the sternum.
Ein some cases spontaneous closure of ventricular septal defect is possible.

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Question 64

Vitamin D deficiency in children leads to short stature appearance, because the deficiency of active metabolites of vitamin D slows the growth of cartilages.

Athe first sentence is true, the second false.
Bthe first sentence is false, the second true.
Cboth sentences are false.
Dboth sentences are true, but there is no causal link between them.
Eboth sentences are true and there is a causal link between them.

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Question 65

A 10-year-old boy, previously healthy, has been feeling ill for several weeks. He presents weakness, lack of appetite and polyuria. He feels thirsty. Clinical examination: pulse 110/min (1.83 Hz), quick and deep breath. Urine findings: gravity 1.035g/ml, pH 5.5, leukocytes and proteins absent, glucose ++++, ketone bodies ++++. In this boy, we can expect the presence of the following medical problems:

Arespiratory alkalosis and osmotic diuresis.
Bmetabolic alkalosis and osmotic diuresis.
Cmetabolic acidosis and osmotic diuresis.
Drespiratory acidosis and diabetes insipidus.
Erespiratory alkalosis and diabetes insipidus.

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Question 66

Which from the following symptoms suggest hypothyroidism?

Ashort stature, vitiligo stains, constipation, breakable hair, Graefe's symptom, manic psychosis.
Bvitiligo stains, constipation, greasy hair, depression.
Cshort stature, supraventricular cardiac arrhythmias, vitiligo stains, constipation, greasy hair, Graefe's symptom, weakness.
Dshort stature, constipation, breakable hair, depression, weakness.
Evitiligo stains, constipation, breakable hair, depression, thrombocytopenia.

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Question 67

What is the most common etiological factor for heart muscle inflammation in children?

AEpstein-Barr virus.
BCytomegalovirus.
CCoxackie group B virus.
DMycoplasma pneumoniae.
EStreptoccocus aureus.

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Question 68

In congenital heart diseases dependent on ductus arteriosus flow, immediately after a newborn delivery the permanent infusion of E1 prostaglandin is essential, which enables the maintenance of ductus arteriosus patency.

Athe first statement is true and second is false.
Bthe first statement is false and second is true.
Cboth statements are true and there is cause-effect relationship between them.
Dboth statements are false.
Eboth statements are true but there is no cause-effect relationship between them.

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Question 69

Which of the following statements concerning placenta previa is correct?
1) the incidence is not related to the parity;
2) the first bleeding is usually painless and rarely fatal;
3) the vaginal examination should be performed immediately after the diagnosis;
4) the ultrasound examination is not more informative than clinical assessment;
5) the conservative management is not recommended in pregnancies less than 32 weeks of gestation.
The correct answer is:

A1,2.
B1,2,5.
C2,4,5.
Donly 2.
Eall of the above.

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Question 70

The drug of choice in therapy of urinary tract infections (UTI) in the third trimester of pregnancy is:

ACephalosporin.
BTetracycline.
CSulfonamide.
DNitrofurantoin.
EAminoglycosides.

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Question 71

Which of the following constitute risk factors for endometrial cancer:
1) obesity;
2) diabetes;
3) hypertension;
4) persistent HPV infection;
5) late menopause.
The correct answer is:

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

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Question 72

At hCG levels between 1000 and 2000 mIU/mL, or at 5.5 weeks’ gestation, a viable intrauterine pregnancy should be seen using:

Atransvaginal ultrasound.
Babdominal ultrasound.
Ctransvaginal ultrasound and abdominal ultrasound.
Dshould not be seen.
Etransvaginal ultrasound only at hCG levels above 9500 mIU/mL.

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Question 73

Ultrasound has become indispensable for the identification, assessment, and management of multiple gestations. The use of ultrasound in multiple gestations in the first trimester includes:

Athe determination of chorionicity and amnionicity.
Bthe determination of placental cord insertion.
Cthe assessment of cervical length.
Dfetal presentation.
Ethe screen for fetal growth restriction.

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Question 74

The obliteration of uterine cavity and hypomenorrhea or secondary amenorrhea, with the onset following the D&C in the puerperium period is the syndrome of:

AArnold-Chiari.
BBudd-Chiari.
CAsherman.
DMendelsohn.
ESheehan.

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Question 75

Which of the following infection is the risk factor for cervical cancer?

AHPV 16.
BHPV 6.
CHSV 2.
DHCV.
ECMV.

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Question 76

The most frequent malignant neoplasm in women in Poland is:

Acervical cancer.
Bbreast cancer.
Cuterine cancer.
Dovarian cancer.
Evulvar cancer.

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Question 77

The ovarian germ cell tumors include:

Afolliculoma.
Bthecoma.
Cadenocarcinoma.
Ddysgerminoma.
ESertoli cell tumor.

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Question 78

The rubella virus infection in pregnancy can result in:

1) congenital heart disease;

2) deafness;

3) congenital cataract;

4) limb deformations;

5) defects of the deciduous teeth.

The correct answer is:

A1,2.
B1,2,3.
C1,2,3,4.
Dall of the above.
E3,4.

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Question 79

Which is the most effective contraceptive method?

Aoral contraceptive.
Bintrauterine device (conventional).
Cintravaginal gel.
Dcondom.
Erhythm methods.

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Question 80

If basic diagnostic methods do not explain the reason for infertility, which of the following would you propose for the patient as the most valuable method?

Atest for sperm antibodies.
BMRI of pituitary gland.
Ckaryotype evaluation.
Dlaparoscopy.
Ehisteroscopy.

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Question 81

A 30-year-old patient, in which secondary amenorrhea with galactorrhea was found, what should be suspected:

Asecondary amenorrhea of hypothalamic origin
Bpituitary disease (adenoma)
Covarian tumor
Dbenign breast disease (mastodynia)
Egenetic disease connected with reproductive tract defect

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Question 82

In the mechanism of lactation what is responsible for milk ejection ?

Adecrease of estrogens and progesterone after delivery.
Boxytocin.
Chuman placental lactogen.
Dprolactin.
Ethyroxin.

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Question 83

Which of the following statements regarding gonococcal infections is correct?

Acan be prevented by the use of a dead pathogen.
Bcan be prevented by the use of a live attenuated pathogen.
Cconfers immunity to subsequent infections only if the primary infection involves extragenital sites.
Dconfers no immunity against repeated infection.
Ecan be prevented by specific serum immune globulin.

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Question 84

The pituitary gland releases the following hormones, except for:

Aoxytocin.
Bthyreotropin.
Ccortisone
Dprolactin.
Eluteinizing hormone.

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Question 85

What are the most common adverse effects of hormonal contraceptive pills?
1) bleeding and spotting during treatment;
2) nausea;
3) headaches;
4) increased libido;
5) diarrhoea.
The correct answer is:

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

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Question 86

A newborn may become infected with a cytomegalovirus by:
1) viremia during pregnancy;
2) exposure to infected cervical secretions;
3) exposure to infected breast milk;
4) transfusion of infected blood.
The correct answer is:

A1,2,3.
B1,3.
C2,4.
Donly 4.
Eall of the above.

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Question 87

The benign vulvar neoplasm does not include:

Aangiokeratoma.
Bplanoepithelial ca.
Cpyogenic granuloma.
Dlipomas.
Efibrous histiocytoma.

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Question 88

In diabetic women contraindications against pregnancy include:
1) severe nephropathy;
2) treatment-resistant hypertension;
3) treatment-resistant proliferative retinopathy;
4) ischaemic coronary disease;
5) persistent alimentary tract mycosis.
The correct answer is:

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

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Question 89

The rarest metastatic ovarian lesion is:

Agastric cancer.
Buterine tube cancer.
Cbreast cancer.
Dthe metastasis from the other ovary.
Ecolorectal cancer.

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Question 90

A patient presents to the clinic approximately 8 weeks after the last menstrual period (LMP). She has the positive result of pregnancy test but is not sure about the exact date of LMP as she has had irregular cycles (28-60 days). Which of the following methods is the most reliable in the assessment of gestational age?

Adigital examination and palpation of the uterus.
Bthe quantitative assessment of human chorionic gonadotrophin (hCG) serum level.
Cthe quantitative assessment of serum hCG together with progesterone level.
Dcrown-rump length (CRL) on ultrasound.
Ethe combination of digital examination with the assessment of progesterone level.

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Question 91

A healthy 20-year-old patient presents to the clinic for her first OB visit at 10 weeks’ gestation. The medical history of the patient is unremarkable. All of the following test should be ordered except for:

Ablood-group typing.
BHIV.
CToxoplasma gondi screening.
Dglucose challenge test (GCT).
Ecomplete blood count (CBC) and urine analysis.

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Question 92

Which of the following symptoms suggest the need for cervical cerclage?
1) irregular uterine contractions;
2) bleeding from the cervical canal;
3) the cervical dilation of 3 cm without uterine contractions;
4) the gestational age of 29 weeks;
5) intrauterine infection.
The correct answer is:

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

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Question 93

A 30-year-old patient, G2, 29 weeks of gestation, is diagnosed with gestational diabetes (GDM). She is concerned about the influence of the diabetes on her baby. Which of the following are the most common complications in the offspring of mothers with GDM?
1) macrosomia;
2) delivery trauma;
3) congenital malformations;
4) oligohydramnion;
5) the early “maturation” of the placenta.
The correct answer is:

A1,2.
B1,2,3.
C3,4,5.
Donly 1.
Eall of the above.

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Question 94

Hormonal contraceptive pills have been confirmed to protect from:

1) ovarian ca

2) liver ca

3) endometrial ca

4) renal ca

5) cervical ca

The correct answer is:

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

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Question 95

Which of the following does not belong to the disturbances of thought flow?

Amagical thinking.
Bdissociation.
Cacceleration of thoughts.
Dthought slowness.
Eincoherence.

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Question 96

The convincement about extraordinary possibilities, skills, knowledge is the base for the diagnosis of:

Asensitive delusions.
Bgrandiose delusions.
Cpersecutory delusions.
Dnihilistic delusions.
Enone of the above.

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Question 97

Pervasive thoughts, imaginations or repeated activities are called:

Adelusions.
Bfobias.
Cobsessions.
Dcenesthetic hallucinations.
Enone of above.

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Question 98

All of the following belong to the sexual disturbances, with the exception of:

Adiminished sexual drive.
Bincreased sexual drive.
Cprostitution.
Ddisturbances of the directions of sexual drive.
Einappropriate way of realisation of sexual drive.

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Question 99

Which of the following are not characteristic symptoms of delirium?

Anightmares.
Bexcitement.
Cillusions.
Dhallucinations.
Eincongruent delusions.

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Question 100

Nonspecific psychopathological states caused by external factors are called:

Apsychoorganic syndromes.
Becmnesias.
Cdisturbances of the body scheme.
DBonhoffer’s exogenic reactions.
Esituational reactions.

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Question 101

The classification of mental disorders by the American Psychiatric Association, which is alternative to the International Classification of the Diseases ICD-10, is abbreviated as follows:

AABC Psych.
BAmer Psych.
CAmClasPsych.
DDDT.
EDSM.

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Question 102

The obsessive-compulsive disorders are most commonly developed in individuals who have the following abnormal personality:

Apsychopathic.
Bcharacteropathic.
Cschizoid.
Danancastic.
Enarcistic.

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Question 103

The acute opiate intoxication can be fatal because of malfunction of:

Aheart.
Brespiratory center.
Cadrenal cortex.
Dkidneys.
Eliver.

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Question 104

The traditional name „cyclophrenia” is replaced by the contemporary name:

Amaniac syndrome.
Bperiodic schizophrenia.
Cseasonal depression.
Ddysthymia.
Ebipolar affective disorder.

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Question 105

Which of the following does not belong to the anxiolytics?

Achlordiazepoxide.
Bchlorprothixene.
Cclorazepate.
Dbromazepam.
Ealprazolam.

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Question 106

During the treatment with lithium the toxic reaction most frequently observed is:

Athyroid insufficiency.
Bthyroid hyperactivity.
Cadrenal insufficiency.
Dadrenal hyperactivity.
Eparathyroid insufficiency.

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Question 107

The basic mechanism of action of the majority of antipsychotics is:

Adopaminergic neurons agonism.
Bpartial dopaminergic neurons agonism.
Cdopaminergic neurons antagonism.
Dserotonergic neurons.
Eall of the above.

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Question 108

The expression „depot” refers to one of the following property of the antipsychotics:

Along-term activity.
Bthe efficacy against the positive symptoms.
Csedation.
Dthe option of administering the drug intravenously.
Ethe efficacy against the negative symptoms.

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Question 109

A patient operated for the large retrosternal nodular goitre developed right sided myosis, ptosis and enophtalmos after the procedure. Where in your opinion the injury could occur?

Aoculomotorius nucleus in the brain.
Btrunk of the vagus nerve.
Corbit.
Dcervicothoracic sympathetic nerves.
Eeye-ball.

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Question 110

Which of the following excludes the deceased as a cadaver organ donor?

Aobjection expressed by the deceased before his death.
Bobjection of the family.
Cpositive testing for HCV.
Dalcoholism.
EICU treatment for the 14 days before the death.

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Question 111

Twenty four hours after cerebral injury a patient develops increasing headache, nausea and apathy. Which of the following is the most likely diagnosis?

Aincreasing intracranial hypertension.
Bhypertensive crisis.
Cintracerebral bleeding.
Depidural hematoma.
Esubdural hematoma.

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Question 112

Gastroscopic exam performed for the symptoms of dyspepsia in a 60-year-old patient revealed crateriform ulceration 4 cm in diameter in the subcardiac part of the stomach on its lesser curvature. Histopathological diagnosis of the biopsy specimens revealed gastric cancer with an intestinal metaplasia. What type of the surgical procedure is indicated for this patient?

Atotal gastrectomy.
Btotal gastrectomy with lymphadenectomy.
Cproximal gastrectomy.
Ddistal gastrectomy.
Edistal gastrectomy with lypmphadenectomy.

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Question 113

A 56-year-old obese female patient was admitted to the hospital because of an epigastric abdominal pain lasting for the last 12 hours. On the ultrasound examination cholelithiasis was found and retroperitoneal space was not visualized. Lab testing revealed significantly increased WBC count, elevated CRP and amylase levels. What in your opinion is the most appropriate treatment?

Aurgent laparoscopic cholecystectomy
Bopen cholecystectomy with intraoperative cholangiography
CERCP
Dcareful monitoring of the patient in ICU
Efasting, iv fluids, antibiotics and observation

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Question 114

Acute appendicitis:
1) should not be approached laparoscopically;
2) is the most frequent at young age;
3) starts as a pain in the epigastrium which migrates into the right lower abdomen;
4) is not found in patients over 50;
5) frequently coexists with Crohn's diesase.
The correct answer is:

A1,2.
B3,4.
C4,5.
D2,3
E2,4.

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Question 115

Which statements about inguinal hernia are true?
1) it is several times more frequent in males than females;
2) only large hernias which had passed into the scrotum should be operated;
3) mesh (tension-free) hernia repair tend to give the best results;
4) it poses a risk of incarceration;
5) most frequently it is treated laparoscopically.
The correct answer is:

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

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Question 116

The most frequent symptoms of advanced cecum cancer are: 1) pain in the right lower abdomen; 2) tumor over right iliac ala; 3) anemia; 4) melena; 5) cachexia. The correct answer is:

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

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Question 117

The symptoms of perforated stomach or duodenal ulcer include:
1) retention of gases (inability to pass gas);
2) melena;
3) hematemesis;
4) severe, sudden abdominal pain;
5) abdominal guarding.
The correct answer is:

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

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Question 118

The main symptoms of the cancer of the head of the pancreas include:
1) coffee-grounds like vomiting;
2) painless obstructive jaundice;
3) enlarged gallbladder;
4) dilated biliary ducts;
5) splenomegaly.
The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
D2,4,5.
E1,3,5.

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Question 119

Segmental necrosis of the small intestine can be caused by:
1) incarcerated hernia;
2) diabetes;
3) strangulation of the bowel over peritoneal adhesions;
4) mesenteric embolism;
5) porphyria.
The correct answer is:

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

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Question 120

Panaritium:
1) is an inflammation of tissues of a finger;
2) frequently occurs without pain; pus evacuation and stabilization;
3) is a blood-related infection;
4) is treated by an incision,
5) is caused by a trauma.
The correct answer is:

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

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Question 121

The most frequent symptoms of the sigmoid cancer include:
1) narrow (pencil like) stools;
2) alternate diarrhea and constipation;
3) anemia;
4) cachexia;
5) bloody stools.
The correct answer is:

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

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Question 122

Despite the effectiveness of endoscopy in terminating of the bleeding from gastric varices, the use of balloon tamponade can still be useful in selected cases. When inserting a Sengstaken-Blakemore tube some rules have to be followed:

Athe tube is inserted orally with the assistance of the laryngoscope
Bboth balloons are inflated with air
Cboth balloons are filled with fluid
Dgastric balloon should be filled with fluid and esophageal inflated with air
Ea tension should be applied to the tube using 1 kg weight

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Question 123

Polyposis colon syndrom/s with genetic background is/are:

ATurcot’s syndrome.
BTurner’s syndrome.
CGardner’s syndrome.
Dthe correct answers are A and C.
Ethe correct answers are B and C.

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Question 124

A 29-year-old woman with abdominal pain on the left site radiating to the groin was admitted to ER, the pain started when she tried to pick up a heavy bag. RTG and US examinations showed no pathology apart from a big amount of gas in the bowels. WBC 9.6 G/L, there was no pain relief after metamizol and tramadol iv injection, there was no effect after spasmolytic drugs. The doctor on call decided to administer morphine sc, after which the pain grew stronger very quickly. What pathology do you suspect?

Aappendicitis.
Badnexitis.
Csubcapsular spleen haematoma.
Dradiolucent concrement in the ureter.
Eovarian cyst torsion.

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Question 125

The indications for the surgical treatment in Crohn’s disease are:
1) abscesses and fistulas;
2) obstruction (due to constrictions and adhesions);
3) intestinal perforation;
4) carcinogenesis.
The correct answer is:

Aall of the above.
B1,2,3.
C2,3,4.
D1,3,4.
E3,4.

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Question 126

The oesophagitis with intestinal metaplasia above cardia is called:

AMallory-Weiss syndrome.
Bcardiospasm.
Creflux disease.
DBarrett’s oesophagus.
Eachalasia.

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Question 127

A face and upper trunk skin rash lasting for about 30 minutes and caused by meal, extensive training, alcohol consumption together with diarrhea, asthmatic bronchus spasm and high blood pressure is characteristic of:

AZollinger-Ellison’s syndrome.
BMallory-Weiss syndrome.
CLynch syndrome.
DGardner’s syndrome.
Ecarcinoid syndrome.

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Question 128

The following symptoms:
- abdominal pain increasing during moving and coughing
- tachycardia
- fever
- palpable pain, guarding
- leucocytosis
are characteristic of:

Agastrointestinal bleeding.
Bperitonitis.
Cmechanical bowel obstruction.
Dabdominal angina.
Erenal colic.

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Question 129

The total parenteral nutrition at patient’s home should be administered after the following surgical procedure:

Asubtotal excision of small intestine owing to mesenteric embolism.
Btotal excision of large intestine owing to ulcerous colitis.
Ctotal gastrectomy owing to cancer.
Dexcision of the esophagus complicated by anastomotic fistula.
Eany of the aforementioned.

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Question 130

In the age of pharmacological treatment of HCl oversecretion, the indications for surgical treatment of gastric ulcer exist in the case of:

Aperforation.
Bnon effective treatment for more than 3 months.
Crecurrence of the ulcer despite correct treatment.
Dno possibility to rule out the diagnosis of cancer.
Eall the aforementioned.

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Question 131

In a young woman aged 20, a breast lump 1.5 cm in diameter, well limited, mobile, is most probably:

Aa cyst.
Bfibroadenoma.
Cphylloid tumor.
Don early stage of glandular cancer.
Efibrocystic dysplasia.

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Question 132

Primary hyperparathyreoidism, caused by an adenoma excreting parathormone may result in:

Arenal stones.
Babdominal pains.
Cformation of bone cysts and bone frangibility.
Dpsychical disorders.
Eall the aforementioned.

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Question 133

Therapeutic dose of small-molecule heparin depends on:

Apatient’s weight.
BAPTT.
Cprothrombin time.
DINR.
EPlatelet count.

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Question 134

The most adequate symptoms of the spinal cord lesion at the Th2 level could be:

Aurine and faeces retention.
Bupper limb paresis.
Clower limb paresis.
Dthe correct answers are A and C.
Eall of the above could be the consequence of the Th2 level spinal cord lesion.

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Question 135

Which of the blood group is a risk-factor for gastric cancer?

AA.
BB.
CAB.
D0.
Enone of the above blood group could be a risk factor for gastric cancer.

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Question 136

In therapy of mononucleosis one uses:

Apenicillins.
Bmacrolides.
Ctetracyclines.
Dparacetamol.
Efluorochinolones.

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Question 137

Eye pain in a patient with glaucoma attack is often accompanied with:
1) nausea;
2) vomiting;
3) abdominal pain;
4) sweating;
5) bradycardia.
The correct answer is:

A1,2,3.
B4,5.
C1,2,5.
D1,4.
Eall of the above.

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Question 138

Acute, non-complicated urinary tract infections in males occur sporadically; therefore, each case of urinary tract infection in males should be approached as a complicated infection, associated with the presence of anatomical or functional abnormalities, or a disease which increases the risk of the development of infection.

Athe first statement is true, the second false
Bthe first statement is false, the second true
Cboth statements are false
Dboth statements are true, but there is no cause-effect relationship between them
Eboth statements are true and there is a cause-effect relationship between them

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Question 139

It is traditionally considered that the pain caused by paranasal sinuses obstruction radiates to certain sites. The pain localized on the top of the head indicates the presence of an inflammatory process in the following:

Amaxillary sinuses.
Bethmoid sinuses.
Cfrontal sinuses.
Dsphenoidal sinuses.
Eit is not associated with inflammation of any sinus.

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Question 140

The causes of intestinal colic in infants include:

Agastrointestinal tract motoric immaturity.
Bgreedy fluid intake, swallowing a large amount of air.
Callergy to cow milk consumed by mother.
Dthe correct answers are A and C.
Ethe correct answers are A,B,C.

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Question 141

Which of the following vaccinations is not compulsory for all children according to the Polish vaccination calendar?

Atuberculosis vaccine.
Bhepatitis B vaccine.
Cpneumococcal vaccine.
Dpertussis vaccine.
Ediphtheria vaccine.

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Question 142

Which one of the following sentences concerning erysipelas is false?

Astreptococcus group A is a common etiologic factor.
Bfrequent erysipelas recurrence is observed in patients with lymphatic and venous circulation insufficiency.
Clocal treatment is the only method available.
Da high body temperature is characteristic of erysipelas.
Epainful, red, limited erythema is a typical skin sign.

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Question 143

The cause of reduction in absolute neutrophil count includes:

Aviral infection.
Baplastic anaemia.
Cautoimmunologic disease.
Ddrug influence.
Eall the above.

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Question 144

The most probable cause of sideropenic anemia and eosinophilia in a 16-year-old girl is:

Abronchial asthma.
Bfamilial intestinal polyposis.
Cincorrect diet.
Dabundant menses.
Eparasitic disease.

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Question 145

Point the false sentence concerning oral glucose tolerance test (OGTT):

Athe test should be carried out with 75g glucose dissolved in 300 ml water.
Bthe patient is obliged to drink the glucose solution in 5 minutes.
Cthe indication for OGTT is impaired fasting glucose (IFG).
Dsometimes to find out a reactive hypoglycaemia glucose should be determined at the 180 minute of OGTT.
Eto diagnose type 2 of diabetes mellitus it is necessary to find glucose plasma concentration ≥ 200 mg/dl (11.1 mmol/l) at the 120 minute of OGTT – examined twice.

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Question 146

The prophylactic daily dose of vitamin D3 for children and adolescents is:

A400 IU
B400-600 IU
C600-2000 IU
D600-1000 IU
E2000 IU

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Question 147

The risk SCORE chart enables to estimate CVD risk based on:
1) age;
2) smoking habits;
3) diastolic blood pressure (DBP);
4) LDL ratio;
5) glycaemia.
The correct answer is:

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

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Question 148

Which of the following sentences is false?

Athe optimal time for influenza vaccination is early autumn.
Bspecific antibodies appear after 20 days.
Cinfluenza immunity requires yearly vaccination.
Dall elderly people ≥ 65 years old should be vaccinated against influenza.
Einfluenza vaccine can be used during all the epidemiologic period.

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Question 149

A 79-year-old man reports excessive urination at night – at least 3 times per night. The symptom has been noted for several months. It can be caused by:

Aheart failure.
Bchronic kidney disease.
Cbenign prostate hypertrophy.
Ddiabetes.
Eall of the above.

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Question 150

Mark the true sentence concerning European population:

AIII degree obesity is diagnosed when BMI ≥ 40 kg/m2
Babdominal obesity in women is diagnosed when WHR > 1,0.
Cabdominal obesity in men is diagnosed when the waist circumference is ≥ 102 cm.
Dthe correct answers are A and C.
Ethe correct answers are A,B,C.

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Question 151

A first choice drug in acute bronchitis is ciprofloxacin because microorganisms responsible for 80% cases of bronchitis are sensitive to that antibiotic.

Aboth parts of the sentence are true and there is a cause-effect relation between them.
Bboth parts of the sentence are true, but there is no cause-effect relation between them.
Cthe first part of the sentence is true, the second is false.
Dthe first part of the sentence is false, the second is true.
Eboth parts of the sentence arefalse.

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Question 152

The supplementation of the vitamin D3 in breast-fed newborns whose mothers have not taken the vitamin D3 during the pregnancy should be initiated:

Aon the first days of life.
Bafter a week.
Cafter 2 weeks.
Dafter 3 weeks.
Eafter a month.

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Question 153

Tympanic membrane perforation and otitis media are absolute contraindications against swimming in natural and artificial reservoirs because water affecting semicircular canals region provokes strong vertigos and lack of orientation.

Aboth parts of the sentence are true and there is a cause-effect relation between them.
Bboth parts of the sentence are true, but there is no cause-effect relation between them.
Cthe first part of the sentence is true, the second is false.
Dthe first part of the sentence is false, the second is true.
Eboth parts of the sentence are false.

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Question 154

In the case of mushroom poisoning, gastric lavage should be carried out:

Aup to 4 hours after consumption.
Bup to 6 hours after consumption.
Cup to 12 hours after consumption.
Dup to 18 hours after consumption.
Eany time after consumption.

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Question 155

The following values in the arterial gas test measurement performed after 15 minutes of cardiopulmonary resuscitation: PaO2 100 mmHg, PaCO2 75 mmHg, pH 7.01, HCO3 19.3, BE -5.0, in patient weighing 60 kg (ERC guidelines 2005 adult):

Aprovide an indication for a 50 ml of 4.2% sodium bicarbonate solution infusion.
Bprovide an indication for a 25 ml of 8.4% sodium bicarbonate solution infusion.
Care an indication for the intervention other than a sodium bicarbonate infusion and for repeating gas test.
Dare an indication for a 25 ml of 8.4% sodium bicarbonate solution infusion + additional intervention + arterial gas test repetition.
Eprovide an indication for a 25 ml 4.2% sodium bicarbonate solution infusion + additional intervention + arterial gas test repetition.

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Question 156

TRALI specifies:

Apreparation consisting of coagulation factors dependent on vit. K and proteins C, S.
Bpost-transfusion acute lung injury.
Cblood transfusion after hypervolemic hemodilution.
Dpost transfusion thrombocytopenia.
Ehypothermia after massive blood transfusion.

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Question 157

After infusion of 10 units Packed RBCs during massive blood transfusion, the ratio of Packed RBCs to Fresh Frozen Plasma (FFP) should be:

Apacked RBCs :FFP = 2:1.
Bpacked RBCs :FFP = 1:1.
Cpacked RBCs :FFP = 1:2.
Dpacked RBCs :FFP = 1:3.
Epacked RBCs :FFP = 1:4.

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Question 158

Direct arterial access does not allow of:

Amean arterial pressure measurement.
Bwedge pressure measurement.
Carterial blood oxygenation measurement.
Dvascular bed filling evaluation.
Ecardiac output measurement.

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Question 159

Mechanical ventilation using lung protected strategy; for example in ARDS management, is based on the following parameter:

APeak Inspiratory Pressure ≤ 30 cm H2O.
BRespiratory Frequency < 20/min.
CPositive End Expiratory Pressure (PEEP) > 15cm H2O.
DPulmonary Wedge Pressure > 18 mmHg.
EPaCO2 < 60 mmHg.

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Question 160

Thermodilution is:

Athe method of heating the infusion fluids during operation.
Bthe infusion of heated fluids to the patient in hypothermia.
Cone of the methods of cardiac output measurement.
Dplanned cooling of the patient during some special operating procedures e.g. in cardiac surgery or neurosurgery.
Eplanned 24-hour cooling of the patient after cardiac arrest.

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Question 161

The target parameters for circulatory stabilization in severe sepsis management are:

ACVP > 4 mmHg, Scv O2 > 95%.
BCVP > 8 mmHg, Scv O2 > 70%
CCVP > 10 mmHg, Scv O2 > 90%.
DCVP > 16 mmHg, Scv O2 > 50%.
ECVP > 20 mmHg, Scv O2 > 30%.

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Question 162

The patient's blood pressure is 170/80 mmHg. The mean arterial pressure is:

A90 mmHg.
B100 mmHg.
C110 mmHg.
D120 mmHg.
E125 mmHg.

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Question 163

Select the false sentence:

Apneumonia is the most common form of hospital infections in the intensive care unit.
Bblood stream infection is the most common form of hospital infections the intensive care unit.
Cstaff hands are the main vectors of intrahospital infections.
Dthe control of organ hypoperfusion prevents digestive tract bacterial translocation.
EPseudomonas aeruginosa is a common cause of hospital infections.

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Question 164

The false is the statement:

Aepinephrine increases the level of lactates.
Bdopamine has stronger than norepinephrine inotropic effect.
CPDE inhibitors increase systemic vascular resistance.
Ddobutamine improves cardiac output.
Enorepinephrine is the catecholamine of choice in the treatment of septic shock.

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Question 165

Which of the following symptoms characterize increasing brain edema?

Acardiac arrhythmia
Boliguria.
Ccoma.
Ddilated pupils.
Ethe correct answers are A,C,D.

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Question 166

Which of the following scoring systems should be used for assessing the function of the central nervous system after brain injury?

ARamsey’s score.
BGlasgow coma scale.
CAPACHE score.
DSOFA score.
EMalampatie’s score.

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Question 167

Calcium chloride is used in:

Ahypocalcemia.
Bhypochloremia.
Chyperkaliemia.
Dthe correct answers are A and C.
Eall the answers are false.

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Question 168

In anaphylactic reaction:

Asymptoms are triggered by liberation of histamine.
Bwe use antihistaminic drugs as well as steroids.
Cnot all of the symptoms of anaphylactic reaction are present at the same time.
Din patients with dyspnoea and cyanosis adrenaline should be used.
Eall the answers are true.

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Question 169

Acute coronary syndrome – indicate the false answer:

Ain ECG an ST-segment elevation can be present.
Bthere is a risk of ventricular fibrillation.
Cacetylsalicylic acid is the first shot drug.
Dantiplatelet drugs are not used at pre-hospital stage.
Ewe use nitroglycerine or some opioids.

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Question 170

During resuscitation in children under 8:

Awe are allowed to use only automated external defibrillator.
Bthere is not any indication for defibrillation.
Cwe defibrillate using normal self-adhesive electrode pads.
Dwe cannot use defibrillator intended for adults.
Ethe energy of defibrillation should be at 40 J for every 10 kg of body weight.

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Question 171

Psychomotor agitation observed in the accident victim is mostly caused by:

Athe estimation of their serious state.
Bhypoxia and pain.
Chyperventilation and hypotonia.
Dthe accident in itself.
Eintracranial hematoma.

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Question 172

In the case of asphyxia:

Ayou should always start BLS with 3 artificial breaths.
Bonly intubation can rescue somebody’s life.
Cyou should always start BLS with 5 artificial breaths.
Ddefibrillation should be performed as fast as possible.
Ethe most important in the first aid is to call an ambulance.

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Question 173

Indicate the true answer:

Apulseless electrical activity is an indication for defibrillation.
Bthe Philadelphia collar must be used in all victims of any kind of accident.
Cthe task of a physician at the accident scene is to clear the accident site.
Din acute bronchospasm we should not use adrenalin.
Enone of the answers is true.

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Question 174

A 15-year-old Jehovah Witness is admitted to hospital. According to the physician on duty, he is in urgent need for blood transfusion due to blood loss. The patient’s parents are against this treatment, while the boy gives consent to it. What should the physician do?

Ain the case of the parent’s objection to blood transfusion in their child, the physician must not order this treatment; he should replace it with an intravenous therapy accepted by the adolescent patient’s parents.
Bas the boy is over the age of 14, his consent to blood transfusion is legally valid and effective; therefore the physician is entitled to order the treatment.
Cwhen consent decisions of an adolescent patient and his parents are in conflict, the decision should be made by a guardianship court.
Das the boy gives consent to blood transfusion, the physician should order this treatment, and keep it secret from his parents.
Ethe physician should have the boy’s parents sign a form certifying that they are aware of their responsibility for their child’s possible death; however, he must not violate their right to make decisions considering their adolescent child’s treatment.

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Question 175

After having a conversation with a terminally ill patient’s family, and presuming that the awareness of the actual diagnosis and prognosis would have a devastating effect on the patient, the physician decides not to inform her. However, the patient suspects the truth and confronts the physician, demanding full disclosure. What should the physician do?

Athe physician’s initial decision not to disclose the diagnosis and prognosis to the patient was wrong.
Bthe physician should convince the patient that he has already told her the entire truth about her illness.
Cthe physician should consult the patient’s family to find out what to do.
Dthe physician should ask another doctor for an opinion whether or not to tell the truth to the patient.
Ein this case, the physician should reveal the actual diagnosis and prognosis to the patient.

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Question 176

A physician diagnoses primary syphilis in his male patient. The patient doesn’t give consent to the treatment. After a few days, the patient’s wife visits the physician and asks him for the information on her husband’s illness because she is afraid of getting infected. What should the physician do?

Ahe should give the patient’s wife information on her husband’s illness.
Bhe should consult his patient to find out, how much to tell the wife.
Che should refuse to give any information to the patient’s wife, in accordance with the professional confidentiality rules.
Dhe should suggest that the wife should undergo serological tests.
Ehe should explain that only her husband can release the physician from the obligation to keep all the patient information confidential.

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Question 177

A surgeon carries out a retrospective comparative analysis of several operational methods to find out which of them yields better long-term therapeutic results. For this purpose he invites the patients, collects their clinical histories, and performs clinical examination and a set of diagnostic laboratory and instrumental tests. Does he have to apply for the acceptation of the Bioethical Committee?

Ano, because this type of research is qualified as a control study.
Byes, if any of the elements of examination is an increased-risk procedure.
Cno, if the patients give valid consent to the participation in the study.
Dyes, because all research projects in which medical examinations are performed for scientific reasons only must be approved by the bioethical commission.
Eno, if the medical examinations performed during the study are typical of the illness, which was the reason for the surgical procedure.

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Question 178

If a prosecutor confirms that a pregnancy is a result of a rape, Polish law allows termination of the pregnancy:

Aunless the fetus is mature enough to survive out of mother’s organism.
Bup to the 12th week of gestation.
Cup to the 22nd week of gestation.
Dwithin 2 weeks of the date of the prosecutor’s decision.
EIn this case Polish law does not allow the termination of pregnancy.

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Question 179

A patient or his legal representative is entitled to declare his objection to the doctor’s opinion or ruling if it affects his rights or obligations. This objection may be raised to:

Aan adequate provincial governor.
Ba medical committee acting on the Patient’s Rights Ombudsman.
Cthe Minister of Health.
Dthe manager of the health care institution.
Ea patient does not have this kind of right.

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Question 180

The act on medical and dental professions states that the doctor is obliged to:

Aprovide medical assistance only when on duty.
Bprovide medical assistance always when delay may cause a danger for life, serious body harm or serious danger for health.
Cprovide medical assistance to everyone even when there is no life or health in danger.
Dprovide medical assistance when the way of payment is set.
Ethere are no legal regulation concerning the provision of medical assistance.

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Question 181

The doctor is allowed by the Code of Medical Ethics and the law not to inform the patient about his health:

Aon request of the patient’s family.
Bif the patient wishes not to be informed.
Con superiors’ order.
Dwhen the diagnosis is inauspicious.
Ewhen the patient is a minor.

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Question 182

Does the Polish Code of Medical Ethics identify the human embryo with a human?

Ayes, except for Down syndrome.
Bno, it does not.
Cyes, it does.
Dit does not say.
Eit leaves the issue open.

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Question 183

In order to perform surgery on patients who came of age and are legally capacitated one has to obtain their consent:
1) in pen;
2) through form filling;
3) informed;
4) implied;
5) prior to the planned surgery.
The correct answer is:

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

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Question 184

In accordance with the Law on cash benefits from social insurance in the case of illness and motherhood, an insured person who is working for money during the time of stated temporary incapacity to work loses the right to sickness allowance for the period of:

Athe whole time of the stated temporary incapacity to work.
B2 first days of its length.
C3 first days of its length.
D5 first days of its length.
E7 days of its length.

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Question 185

A medical statement on temporary incapacity to work can cover the period preceding the day of physical examinations if their results indicate that the insured person involved was undoubtedly incapable to work during that period. This period, however cannot exceed:

A1 day preceding the examination.
B2 days preceding the examination.
C3 days preceding the examination.
D4 days preceding the examination.
E5 days preceding the examination.

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Question 186

A medical statement on temporary incapacity to work is issued with two additional copies. In accordance with the Law on cash benefits from social insurance in the case of illness and motherhood the first copy is passed by the doctor to:

Athe regional unit of SIF (ZUS).
Bthe central unit of SIF (ZUS).
Cthe insured person.
DNational Health Fund.
Ethe employer.

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Question 187

In accordance with the Law on cash benefits from social insurance in the case of illness and motherhood, a doctor issuing a medical statement on temporary incapacity to work is obliged to send the original statement to a local branch of SIF (ZUS) within:

A1 day of the date of the statement.
B3 days of the date of the statement.
C5 days of the date of the statement.
D7 days of the date of the statement.
E9 days of the date of the statement.

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Question 188

In accordance with the Law on cash benefits from social insurance in the case of illness and motherhood, a person issuing a medical statement on temporary incapacity to work is obliged to keep the second copy of the statement for the period of:

Ahalf a year.
B1 year.
C3 years.
D5 years.
E7 years.

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Question 189

The medical statement on temporary incapacity to work, which is a confidential document, contains the statistical number of the disease established in accordance with the International Statistical Classification of Diseases and Health Problems. This number is put on:

Athe original statement.
Bthe original statement and the first copy of the original statement.
Cthe original statement and the second copy of the original statement.
Dthe first copy of the original statement.
Ethe second copy of the original statement.

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Question 190

The attending doctor is not allowed to issue an application on behalf of an insured person for healing rehabilitation as part of SIF (ZUS) pension prevention owing to diseases of:

Athe cardiovascular system.
Bthe motor organs.
Cpsychosomatic basis.
Dgastroenterologic basis.
Ethe respiratory system.

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Question 191

The following factors have exerted an effect on the necessity to reform health care systems, both in Poland and in other countries:
1) population increase;
2) a rapidly advancing process of population ageing;
3) increase the proportion of population requiring intensive and long-term medical care;
4) the availability of modern diagnostic and treatment procedures in medicine;
5) the appearance of new health risks;
6) economic realities limiting the possibilities to increase outlays on health.
The correct answer is:

A1,2.
B2,3.
C1,2,4.
D2,3,4,5.
Eall of the above.

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Question 192

According to the World Heath Organization Report of 2002, the most important health risk factors associated with human behaviour and lifestyle cover:
1) lack of physical activity;
2) tobacco smoking;
3) low birth weight;
4) obesity;
5) high level of cholesterol;
6) elevated arterial pressure;
7) risky sexual behaviours.
The correct answer is:

A1,2.
B2,3,5.
C3,4,5,6.
D1,2,3,4,5.
Eall of the above.

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Question 193

The primary functions of the public healthcare system on behalf of the health protection of individuals concern, among other things, the following:
1) content-related supervision and financial support for charity institutions providing medical and social care for the poor;
2) covering with active advice the population groups at high risk of contracting selected diseases of social importance;
3) evaluation of the health situation in the home country in comparison with the situations in other countries;
4) analyses of hazards resulting from the process of globalisation;
5) providing medical assistance for the disabled and homeless;
6) monitoring of international legal regulations in health protection matters.
The correct answer is:

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

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Question 194

The ambulatory specialist services financed from public resources are provided on referral from a health insurance physician. Such a referral is required in the case of:

1) cardiologist;

2) opthalmologist and dermatologist;

3) rheumatologist;

4) laryngologist;

5) psychiatrist and oncologist;

6) gynaecologist and obstetrician.

The correct answer is:

A1,2.
B1,2,3,4.
C1,2,5,6.
D2,4,5,6.
E1,2,3,4,5.

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Question 195

According to the Act on the matter of health care services financed from public resources, the recipients have the following provided and financed:

Apsychological examination and therapy.
Bpalliative and hospice care.
Clogopaedic examination and therapy.
Dcare for women during breastfeeding.
Eall of the above.

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Question 196

Incidence is:

Athe number of new cases of a disease found within a population in a given area, noted over a certain period of time (month, year), expressed as a rate.
Bthe number of cases of a disease in relation to the number of population in a given area, found over a specified time interval, expressed as a rate.
Cthe number of deaths in relation to the total number of population in a given area, determined over a specified time interval, expressed as a rate.
Dthe number of deaths due to an individual disease in relation to the number of sick persons afflicted by this disease, mainly expressed as a percentage.
Ethe number of cases of contagious diseases in relation to the population in a given area.

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Question 197

Fatality is:

Athe number of new cases of a disease in relation to the number of population in a given area, recorded over a specified period of time (month, year), expressed as a ratio.
Bthe number of people afflicted by a disease in relation to the number of population in a given area, recorded over a stated period of time, expressed as a ratio.
Cthe number of deaths in relation to the total number of population in a given area, recorded over a specified period of time, expressed as a ratio.
Dthe number of deaths due to a specified disease in relation to the number of sick persons afflicted by this disease, expressed mainly in percentages.
Ean indicator of the quality of work of medical services.

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Question 198

While evaluating an increase in the frequency of occurrence of influenza in my area, I will use the following as the most rational: