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LEKEXAM / 2010 autumn

Question distribution — 2010 autumn 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

In a dehydrated patient with prerenal acute kidney injury the following medications should not be used except:

Aloop diuretic
Bnonsteroidal noninflammatory drug.
CACE inhibitor
Dangiotensin II receptor blocker.
Ebeta-blocker.

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Question 2

Which kind of treatment would you consider in patients with acute interstitial nephritis?

Aconservative treatment (periodic monitoring of kidney function).
Bwithdrawal of offending drug eg. nonsteroidal noninflammatory drug.
Cdialysis therapy.
Dcyclosporine A.
Eantibiotics.

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Question 3

In a 30-year-old Caucasian female a suspicion of IgA nephropathy was put forward on the basis of the persistent hematuria. It was confirmed on the kidney biopsy. She is clinically stable, with blood pressure of 120/80 mmHg, serum creatinine 0.8 mg/dL, and urinary protein excretion 0.46 g/day. Which kind of treatment would you consider in this patient?

A3 pulses of 1 g of methylprednisolone, followed by prednisone 1 mg/kg bw qd.
Bprednisone 1 mg/kg bw qd.
Ccyclophosphamide in pulses of 1 g every 4 weeks.
Dcyclosporine 100 mg bid.
Especific therapy at this stage is not recommended, possibly a low dose of ACE inhibitor may be considered.

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Question 4

In a 60-year-old Caucasian male during sonographic examination a small cyst (3 cm in diameter) was found in the left kidney and a small cyst (2 cm in diameter) was also found in the right kidney. The patient is clinically stable, with blood pressure of 130/80 mmHg, serum creatinine 1.09 mg/dL:

Aadult polycystic kidney disease.
Bsimple cysts.
Cacquired polycystic kidney.
Dmedullary cystic disease.
Emedullary sponge kidney.

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Question 5

In a 30-year-old Caucasian male during periodic screening erythrocyturia was found. On sonography there were no features of urolithiasis. There was no proteinuria on 24-hour urine collection. Serum creatinine was 1.05 mg/dl, and creatinine clearance was 112 ml/min. In kidney biopsy thin basement membrane nephropathy was diagnosed. The following treatment should be adopted:

Aconservative treatment (periodic monitoring of kidney function).
BACE inhibitor and angiotensin II receptor blocker.
Csteroids.
Dcyclosporine.
Eantibiotics.

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Question 6

Hemoptysis, stabbing unilateral pain in the chest during deep respiration, shortness of breath – the symptoms which appeared suddenly in a young woman with a past history of natural abortions, and whose mother is suffering from systemic lupus erythematosus (SLE) suggest:

Apneumothorax.
Bexudative pleuritis in the course of SLE.
Cpulmonary thrombosis.
Dlupus pneumonia.
Eendometriosis.

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Question 7

A 39-year-old female reports the feeling of progressing face skin tension, growing difficulty swallowing dry food and hard to heal skin ulcerations occurring on the tips of her fingers. In the history: for several years painful paleness and subsequent cyanosis of the fingers and ears in cold temperature. In physical examination: face skin smoothening, nostrils and labial red atrophy, skin thickening of hands, forearms and calfs. The most likely diagnosis is:

Asystemic lupus erythematosus.
Bsystemic sclerosis.
CSjögren’s syndrome.
Ddermatomyositis.
Egout.

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Question 8

Rheumatic fever results from autoimmunization which started with the infection caused by:

AStaphylococcus aureus.
BGram-negative bacilli like Yersinia sp., Shigella sp. or Salmonella sp.
CStreptococcus β-hemolyticus from group A.
DBorrelia burgdorferi.
ENeisseria gonorrhoeae.

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Question 9

Which from the following serological markers is the most specific one for rheumatoid arthritis (RA)?

Aantibodies against citrullinated antigens.
Brheumatoid factor.
Cantinuclear antibodies (ANA).
DASO (antistreptolysin).
EHLA B27 antigen.

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Question 10

The symmetrical (bilateral) sacroiliitis seen on CT scan or X-ray is generally typical of:

AReiter’s syndrome.
Bpsoriatic arthritis.
Crheumatoid arthritis (RA).
Djuvenile idiopathic arthritis (JIA).
Eankylosing spondylitis.

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Question 11

Which of the following diagnostic procedures is used for decreased tearing recognition in sicca syndrome (Sjögren’s syndrome)?

ASchober’s test.
BSchirmer’s test.
Ccrystallization test.
Dlacrimal glands scintigraphy.
Elacrimal glands biopsy.

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Question 12

A 52-year-old female suffering from rheumatoid arthritis reports increasing pain and swelling of the wrists, small joints of the hands and both knees. She also reports significant fatigue and weakness, as well as elevated temperature without concomitant infection signs. The patient is treated with leflunomid (20 mg/d), diclofenak (200 mg/d) and omeprasol (20 mg/d). In laboratory testing: CRP 35 mg/l, Hgb 10.2 g/dl, MCV 85 fl, Plt 550 G/l, iron in serum decreased, TIBC decreased, ferritin in serum increased. The exacerbation of the inflammatory process and anaemia were found. The anaemia should be treated as follows:

Airon with vit. C orally.
Berythrocyte concentrate transfusion.
Cwithdrawing of NSAID.
Dlaboratory testing of vit. B12 and folic acid orally.
Eintensive treatment of basic disorder while controlling the inflammatory process, which is a reason for the anaemia.

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Question 13

Which of the following beta-adrenergic receptor blocking agents (betablockers) possesses an additional vasodilating quality?

Ametoprolol.
Bbisoprolol.
Ccarvedilol.
Domeprazole.
Eacebutolol.

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Question 14

A peripheral pulse with abrupt upstroke followed by rapid collapse (also known as water-hammer pulse, collapsing pulse, pulsus celer et altus) is found in patients with:
1) aortic stenosis;
2) aortic regurgitation;
3) patent ductus arteriosus (Botall`s ductus);
4) mitral stenosis.
The correct answer is:

A1,2.
B2,3.
C1,2,3.
Dall the above.
Enone of the above.

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Question 15

Which of the following expressions related to left ventricular ejection fraction (LVEF) is false?

Ait represents the proportion of the left ventricular stroke volume to enddiastolic volume, expressed as a percentage.
BLVEF provides a measure of left ventricular systolic function.
Cnormal values range between 90 and 100%.
DLVEF shows no decrease in post menopausal women.
ELVEF can be assessed by echocardiography.

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Question 16

Typical pain caused by ischaemic heart disease:
1) demonstrates retrosternal localization in the chest;
2) is provoked by physical exertion or emotional stress;
3) exacerbates on inspiration;
4) is subsides after cessation of exertion or ingestion of nitroglycerin.
The correct answer is:

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

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Question 17

Causative factors that may be responsible for the development of pulmonary edema include:
1) rapid increase of systemic arterial blood pressure
2) acute coronary syndrome
3) meningitis
4) narcotics overdose
The correct answer is:

A1, 2
B1, 2, 3
C1, 2, 4
D3, 4
Eall the above

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Question 18

Three most prevalent cardiovascular diseases in the European population do not include:

1) arterial hypertension;

2) coronary artery disease;

3) aortic valve stenosis;

4) dilated cardiomyopathy;

5) myocarditis.

The correct answer is:

A1,2.
B2,3.
C3,4.
D3,5.
E4,5.

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Question 19

Which of the following expressions related to statins are false?
1) they are inhibitors of 3-hydroxy-3-methyl-glutaryl-Coenzyme A reductase;
2) they reduce serum LDL cholesterol level;
3) they reduce serum triglycerides level;
4) they decrease the risk of cardiovascular complications;
5) they should not be administered to patients with acute myocardial infarction;
6) they may cause endothelial injury.
The correct answer is:

A1,2.
B3,4.
C3,5.
D3,6.
E5,6.

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Question 20

The differential diagnosis of chest pain should include:
1) gastroesophageal reflux;
2) pneumonia;
3) pancreatitis;
4) herpes zoster;
5) acute pericarditis.
The correct answer is:

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

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Question 21

All the following are markers of high thromboembolic risk in patients with atrial fibrillation except:

Apast history of stroke.
Bsignificant mitral valve regurgitation.
Cprosthetic heart valves.
Dpast history of a transient ischemic attack.
Edyslipidemia.

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Question 22

The first day after implantation of cardiac pacemaker a patient complains of chest pain and increasing dyspnea. On physical examination hyperresonant percussion note and diminished breath sound are found. The most probable diagnosis is:

Apulmonary embolism.
Bmyocardial infarction.
Cpneumothorax.
Dpericarditis.
Epneumonia.

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Question 23

The electrocardiographic diagnosis of inferior myocardial infarction may be based on presence of ST elevation observed in the following leads:

AI, aVL.
BII, III, aVF.
CI, II, III.
DV1-V4.
EI, aVL, V5-V6.

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Question 24

A patient with chronic heart failure was brought by an ambulance to the Emergency room with pulmonary oedema. Which of the following factors could contribute to this clinical picture?

Acrisis of atrial fibrillation
Bacute coronary syndrome.
Cventricular tachycardia.
Ddecrease in the dose of diuretics.
Eall of the above.

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Question 25

A 45-year-old male with a past history of hypertension presents to the Emergency Department with acute chest pain radiating to the back. Physical examination reveals diastolic murmur and unequal arm pulse. Which of the following diagnoses is the most probable?

Amyocardial infarction.
Bpulmonary embolism.
Caortic aneurysm dissection.
Daortic stenosis.
Epericarditis.

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Question 26

Wide QRS complex above 0.12 s may be seen in the case of :
1) left bundle branch block;
2) right bundle branch block;
3) WPW syndrome;
4) left anterior hemiblock;
5) ventricular premature beats and rhythm.
The correct answer is:

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

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Question 27

An early diastolic murmur and widened pulse pressure is typical of:

Aventricular septal defect.
Batrial septal defect.
Caortic regurgitation.
Dmitral stenosis.
Ehypertrophic cardiomyopathy.

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Question 28

The symptoms of acromegaly do not include:

Aglucose intolerance
Bdry skin.
Cthyroid dysfunction.
Dgonadal dysfunction.
Eobstructive sleep apnea.

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Question 29

A 32-year-old riadiologist with recurring nephrolithiasis, hypertension and depression was diagnosed with hypercalcaemia, an increased concentration of PTH and decreased concentration of phosphorus. The most probable diagnosis is:

Asecondary hyperparathyroidism.
Bprimary hyperparathyroidism.
Cradiation damage to kidney and thyroid.
Dpostradiation hypoparathyroidism.
EMünchausen syndrome by proxy.

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Question 30

A 50-year-old obese man experiences the enlargement and painfulness of the right breast. In diagnostics it will be useless to carry out ultrasonography of:

Atestes
Bbreasts
Cliver
Dthyroid
Eall may be useful

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Question 31

A 30-year-old obese woman who has been treated with diet and physical activity because of diabetes for 3 years is in her twenty-fourth week of twin pregnancy. Oral glucose tolerance test:

Ashould be carried out after giving 50g, regardless of the meal.
Bshould be carried out after giving 75g, and after an 8-hour fast.
Cis not necessary for this patient.
Dis reasonable only if she has not been treated with insulin so far.
Eis useful to carry out only after the twenty-eighth week of pregnancy.

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Question 32

In acute renal failure, renal biopsy is carried out only if:

Athe patient does not need dialyses yet.
Bthe patient is not older than 70.
Cit will influence further treatment.
Dglomerulonephritis is suspected.
Eall the answers are correct.

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Question 33

Indicate which is not the cause of prerenal azotemia (prerenal acute kidney failure):

Ahemorrhage.
Bdehydration.
Csystemic vasodilatation.
Dantibiotics (e.g. beta-lactams).
Eimpairment of renal autoregulation (e.g. angiotensin converting enzyme inhibitors).

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Question 34

Rhabdomyolysis may be suggested by:

Ahypokalemia.
Bhypercalcemia.
Clow serum uric acid.
Delevated creatinine kinase.
Eall the answers are correct.

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Question 35

Plain film of the abdomen is a valuable initial screening technique in patients with suspected:

Aacute glomerulonephritis.
Bnephrolithiasis.
Cacute renal artery embolism.
Dautosomal polycystic kidney disease.
Eall the answers are correct.

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Question 36

Which of the following factors predispose to ischemic colitis?
1) hypercoagulable state;
2) mesenteric artery embolism;
3) colon lumen narrowing caused by carcinoma;
4) oral contraceptives;
5) diverticulitis.
The correct answer is:

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

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Question 37

A 24-year-old patient with ulcerative colitis diagnosed 3 years ago complains of persistent pruritus, chronic fatigue and weakness. The most probable diagnosis of his complaints is:

Acholecystitis.
Bchronic pancreatitis.
Cprimary sclerosing cholangitis (PSC).
Dcolorectal cancer.
Egastric stromal tumour.

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Question 38

Some tumour markers play a role in carcinoma diagnostics and monitoring the effectiveness of treatment. In the case of colorectal cancer the marker that should be evaluated is:

ACA 19.9.
BCEA.
CAFP.
DCA 125.
ECA 15.3.

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Question 39

Systolic hypertension in children could be diagnosed when three independent measurements of systolic pressure are:

Aabove 75 percentile according to height, age and gender.
Babove 90 percentile according to height, age and gender.
Cbetween 90 and 95 percentile according to height, age and gender.
Dabove 95 percentile according to height, age and gender.
Eabove 120 mmHg.

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Question 40

To diagnose rheumatic fever in children, we use, among others, major and minor symptoms included in the modified Jones criteria. Major symptoms include:

1) pancarditis (endocarditis, myocarditis, pericarditis);

2) chorea minor;

3) fever;

4) arthritis;

5) elevated inflammation indicators: ESR, CRP, leucocytosis.

Jones major criteria include:

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

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Question 41

Most heart murmurs in children in pre-school and school age are harmless; but in every case differential diagnosis with organic murmurs is essential. The following are characteristic of harmless murmurs, except:

Athey are silent; loudness max. 3/6 on the Levine scale.
Bthey are louder after physical effort.
Cthey could be heard in spite of proper heart anatomy.
Dthey become lauder during fever and emotional states.
Etheir loudness decreases during changing of body position from standing to lying.

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Question 42

The treatment of hypertension in children consists of pharmacotherapy and non-pharmacotherapy. Non-pharmacological treatment includes the following activities, except for:

Asalt intake reduction to 5-6 g/24h.
Bsaturated fats and carbohydrates intake reduction.
Cobesity reduction; weight loss.
Dreduction of physical activity.
Efamily and outside family stress reduction.

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Question 43

Paroxysmal supraventricular tachycardia is the most common arrhythmia in children. In long lasting cases, the paroxysmal supraventricular tachycardia could result in small stroke volume/reduced ejection symptoms and death. To stop the paroxysmal supraventricular tachycardia the following procedures could be used, except for:

Acooling of the face with ice or cold napkin.
Bunilateral carotid sinus massage.
Ccausing Valsalva’s reflex.
Dpharmacotherapy (adenosine, amiodarone, sotalol).
Evagus nerve stimulation by pressing on the eyeballs.

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Question 44

Chest pain in children is a common reason for sending to Cardiological Outpatient Departments and sometimes demands hospitalization. Cardiological causes of chest pain in children are the following, except for:

Aaortic dissecting aneurysm.
Bpericarditis.
Chypertension.
Darrhythmias.
Eanomalies of coronary arteries.

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Question 45

Which of the following is not one of the typical mononucleosis complications?

Aairway obstruction.
Bthrombocytopenia.
Csplenic rupture.
Dorchitis.
EAll of the above complications can occur in the course of mononucleosis.

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Question 46

Subacute sclerosing panencephalitis (SSPE) occurs 7-10 years after infection caused by the virus of:

Arubella.
Bvaricella.
Cmumps.
Dmeasles.
Eherpes simplex.

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Question 47

Choose the false information about roseola (exanthema subitum):

Athe etiologic factor is a virus belonging to the Herpes virus family.
Bis characterized by high fever.
Cvesicular rash appears in the course of the disease.
Dcomplications include fever seizures.
Ethe disease is typically observed in infants and toddlers.

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Question 48

A 10-year-boy in poor general condition was admitted to hospital and diagnosed was erysipelas. Choose the recommended treatment:

Aerythromycin ointment locally on the skin involved.
Bpenicillin intravenously.
Cgentamicin intramuscularly.
Dtrimethoprim-sulfamethoxazole orally.
Edoxycycline orally.

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Question 49

A patient, not vaccinated against hepatitis B, presents in a hospital for a planned surgery of hernia. The doctor informs him that the vaccination against hepatitis B is recommended but the patient refuses to be vaccinated. Choose the proper procedure in such a situation:

Adoctor should refuse to admit the patient for a surgery until he has been vaccinated against hepatitis B.
Bdoctor should refuse to admit the patient for a surgery and notify the relevant Local Sanitary Inspectorate about the patient’s decision.
Cdoctor should order a quantitative test for the specific anti-HBs antibodies in the patient’s serum and the further procedure depends on the result of this laboratory test.
Dpatient should be admitted for a planned surgery but a written statement signed by the patient should be taken confirming that he was informed about the recommended vaccination and refused to be vaccinated.
Epatient should be admitted for a surgery; the proposal of the hepatitis B vaccination was not needed since this vaccination is not mandatory before invasive medical procedures

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Question 50

Dull percussion sound is typical of the following, except for:

Aparenchymatous organs.
Bcellular infiltration of lungs.
Catelectasis.
Demphysema.
Epleural exudates.

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Question 51

Systemic vasculitis include:
1) polyarteritis nodosa;
2) Takayasu‘s arteritis;
3) Kawasaki disease;
4) rheumatic fever;
5) Henoch-Schonlein purpura.
The correct answer is:

Aall the above.
Bonly 1.
C1,2,3,5.
Donly 5.
Enone of the above.

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Question 52

Henoch-Schonlein purpura is characterized by the following symptoms:

Aconjunctivitis, arthritis, discoid lupus.
BRaynaud syndrome, arthritis, scarlet-like erythema.
Chemorrhagic purpura, arthritis, stomach pain.
Dpolymorphic skin rash, myocarditis, lymphadenopathy.
Ecoronary arteries aneurysms, muscle pain, fever.

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Question 53

Typical clinical symptoms of dermato-myositis are the following, except for:

Aheliotrope or “lilac” rash.
Bcalcinosis cutis.
CGottron’s sign.
Ddyscoid lupus.
Esymmetric proximal muscle weakness.

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Question 54

Hypoglycemia in children can be caused by the following, except for:

Agrowth hormone deficiency.
Belevated level of insulin.
Celevated level of glucagon.
Dhypothyroidism.
Eadrenal insufficiency.

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Question 55

The incubation period of varicella (chicken pox), the disease caused by varicella zoster virus is:

A1 – 3 days.
B5 -7 days.
C11 - 21 days.
D30 - 40 days.
E2 - 3 months.

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Question 56

The most common cause of anemia in children is deficiency of:

Airon.
BB6 vitamin.
Cfolic acid.
Dmagnesium.
EB12 vitamin.

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Question 57

Pink itching rash on the face which spreads to other parts of the body within 24 hours, swollen lymph nodes (sub occipital and posterior cervical lymphadenopathy), slight fever, primary symptoms similar to flu are clinical symptoms typical of:

Achicken pox (varicella).
Brubella (german measles).
Cmorbilli (measles).
Dmononucleosis.
Eroseolla infantum (exanthema subitum).

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Question 58

Which of the following antibodies are typical of the celiac disease?

1) anti-endomysium;

2) anti-nuclear;

3) anti-gliadin;

4) anti-transglutaminase;

5) anti-gastric parietal cell.

The correct answer is:

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

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Question 59

Which of the following diseases are the indications for screening of the celiac disease?
1) food allergy;
2) recurrent oral aphthae;
3) height and/or weight deficiency;
4) colitis ulcerosa;
5) insulin-dependent diabetes.
The correct answer is:

A1,2,3.
B1,3,5.
C2,3,5.
D1,2,4.
E3,4,5.

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Question 60

An eight-year-old girl with intensive red, inflamed and itchy rash with some bumps, excoriations and crusts. Skin symptoms are located mostly on elbows, wrists, popliteal area and behind ears. The most probable diagnosis is:

Aseborrheic eczema.
Bdyshidrotic eczema
Catopic dermatitis.
Dcontact eczema.
Escabies.

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Question 61

The physical examination of a 14-year-old boy shows an enlargement of the spleen (the spleen palpable near the umbiculus). Which degree of splenomegaly is it according to WHO?

A0.
BI.
CII.
DIII.
EIV.

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Question 62

The most common complication associated with angina in children is:

Aperitonsillar infiltration or abscess.
Bgingival abscess.
Cinflammation of cavernous sinus.
DLudwig’s angina.
Esubmandibular phlegmon.

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Question 63

A six-year-old boy reports fever, fatigue, sore throat and abdominal pain lasting for a few days. Medical examination revealed high fever, pharyngeal inflammation, enlarged cervical lymph nodes, painfulness in epigastric and umbilical region with splenomegaly and hepatomegaly. Blood cell count showed lymphocytic leucocytosis with atypical lymphocytes. The most probable diagnosis is:

Atyphoid fever.
Bscarlatina.
Cborreliosis.
Dinfectious mononucleosis.
Estreptococcal angina.

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Question 64

In which of the following pediatric gastrointestinal diseases can melaena be seen?
1) Mallory-Weiss syndrome;
2) anal fissure;
3) duodenal ulcer;
4) gastric ulcer;
5) functional constipation.
The correct answer is:

A2,4,5.
B1,3,5.
C2,3,5.
D1,2,4.
E1,3,4.

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Question 65

Babinski’s reflex can be physiological up to:

A6 months.
B12 months.
C16 months.
D24 months.
Enone of the above.

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Question 66

Which is the proper diet for a 5-year-old boy with functional constipation?

Alight.
Bnormal.
Chigh fiber.
Dlow fiber.
Ehypoalergic.

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Question 67

The clinical consequences of hyperprolactinemia does not include:

Aregular menses.
Bheadache.
Cpremature regression of corpus luteum.
Dlack of ovulation.
Ehirsutism.

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Question 68

The most common cause of primary amenorrhea is/are:

Ahypothalamic insufficiency.
Bpituitary tumors.
Cgonadal dysgenesis.
Dovarian hypoplasia.
Etesticular feminization syndrome (androgen insensitivity).

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Question 69

The rarest cause of secondary amenorrhea is/are:

Ahypothalamic insufficiency and dysfunction.
Bpolycystic ovary syndrome.
CCushing syndrome.
DSheehan syndrome.
Ethyroid dysfunction.

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Question 70

Policystic ovarian syndrome is diagnosed on the basis of:

Aclinical signs and symptoms of hyperandorgenization.
Bmenstrual disorders of rare menstruation or secondary amenorrhoea.
Cview of the ovaries obtained during US scan.
DLH to FSH ratio on 3rd day of the cycle.
Etwo or three symptoms mentioned in the answers A, B, C present on examination.

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Question 71

IgG anti-D immunoglobulin should be administered to all Rh-negative women, without the presence of antibodies:

A72 hours after the delivery of a Rh-positive baby
B72 hours after spontaneous or artificial abortion
Cafter invasive diagnostics and treatment on the fetus or placenta
Din about 28th week of pregnancy, unless the baby’s father is Rh-negative
Eall of the above

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Question 72

Oligohydramnios is connected with:

Afetal compression syndrome.
Bamniotic band syndrome.
Clung hypoplasia.
Dunderdevelopment of pulmonary alveoli.
Eall of the above.

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Question 73

The first Leopold’s manoeuvre is used for:

Apalpation of the uterine fundus and identification of which fetal part occupies the fundus.
Bdetermination of fetal parts on both sides of the abdomen.
Cdetermination of the presenting part.
Dlocalization of the placenta.
Enone of the above.

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Question 74

Symptoms of acute pyelonephritis include:
1) microscopic hematuria / hematuria;
2) normal renal flow;
3) reduced glomerular filtration;
4) massive proteinuria;
5) aching pain in the lumbar regions.
The correct answer is:

A1,2,3.
B1,2,5.
C1,3,4.
D2,4,5.
E3,4,5.

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Question 75

Intrauterine growth restriction caused by placental insufficiency occurs in:
1) isoimmunisation;
2) hypertension in pregnancy;
3) diabetes class R acc. to White;
4) diabetes class F acc. to White;
5) hypothyroidism.
The correct answer is:

A1,3,5.
B1,4,5.
C2,3,4.
D2,4,5.
E1,2,3.

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Question 76

In physiological pregnancy the hormone that does not exert diabetogenic effects is:

Aprolactin.
Bplacental lactogen.
Cprogesterone.
Destrogens.
EhCG.

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Question 77

The side effects of β-mimetics include:
1) hyperglycemia
2) tachycardia
3) hypoglycemia
4) pulmonary edema
5) hypercalcemia
The correct answer is:

A2, 3, 4
B1, 2, 4
C1, 3, 4
D2, 4, 5
E3, 4, 5

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Question 78

The urine pH in pregnancy:

Aincreases
Bdecreases
Cdoes not change
Ddepends on gestational age
Enone of the above

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Question 79

The causes of polyhydramnios is/are not:
1) abnormalities of the urogenital system, obstruction of the urinary tract;
2) duodenal atresia;
3) renal atresia;
4) anencephaly;
5) post-term pregnancy.
The correct answer is:

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

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Question 80

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 81

A 28-year-old patient presents at the out-patient clinic because she has just missed her period. She denies subjective pregnancy symptoms as nausea, fatique, frequent urination or breast tenderness. She thinks that she is pregnant and is worried because previous pregnancy was ectopic. Which of the following diagnostic methods is the most appropriate to confirm the pregnancy in this patient?

Abimanual examination and assessment of the uterine size.
Bultrasound examination with transabdominal probe.
Cdetection of the fetal heart activity with an ultrasound tone detector.
Dserum pregnancy test.
Ethere is no need to perform diagnostic test as the patient denies pregnancy symptoms and that rules out pregnancy.

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Question 82

Which of the following theories explains the dissemination of endometriosis and its occurrence in almost every organ of the woman’s body?

Aretrograde flow of the menstrual debris.
Bmetaplasia of müllerian remnants.
Cdissemination through blood vessels.
Ddissemination through lymphatic vessels.
Eall the above.

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Question 83

The profuse menstruation is called:

Apolymenorrhea.
Boligomenorrhea.
Cmenorrhagia.
Dmetrorrhagia.
Emenometrorrhagia.

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Question 84

The L/S ratio (lecithin/sphingomyelin) 2:1 is found approximately in:

A24th week of gestation.
B27th week of gestation.
C35th weeks of gestation.
D37th week of gestation.
E40th week of gestation.

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Question 85

In a healthy child the lowest serum immunoglobulin G concentration is observed:

Aat birth.
Bin 4th week of life.
Cbetween 2nd and 6thmonth of life.
Dbetween 6th and 12thmonth of life.
Ebetween 1st and 2ndyear of life.

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Question 86

Which is most common complication of gonorrhoea in a adolescent girl?

Acarditis.
Barthritis.
Cmeningitis.
Dcystitis.
Eophthalmitis.

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Question 87

A 40-year-old woman who has been receiving clindamycin for a Bacteroides infection develops diarrhea. Which of the following would be the most likely cause of diarrhea?

Amesenteric thrombosis.
BLesniowski-Crohn disease.
Cpseudomembraneous colitis.
Dulcerative colitis.
Elamblias.

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Question 88

Fallopian tube cancer in stage IIa:

Ais confined to the fallopian tube, infiltrates the mucous membrane and muscular layer.
Bis confined to the fallopian tube and infiltrates the serous membrane.
Cextends beyond the fallopian tube but is confined to the pelvis.
Dextends beyond the pelvis but is confined to the abdominal cavity.
Eextends beyond the abdominal cavity.

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Question 89

A 47-year-old patient during a routine US scan was diagnosed with endometrial polyp. On the grounds of this:

Ayou order the next US scan after half a year.
Byou perform D&C.
Cyou perform histeroscopic polyp removal.
Dyou take no action.
Ethe treatment depends on the risk factors for malignant disease present in the polyp.

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Question 90

Pregnancy loss is the most common obstetric complication affecting up to:

A2% of pregnant women.
B5% of pregnant women.
C25% of pregnant women.
D65% of pregnant women.
E75% of pregnant women.

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Question 91

The basic examination in the infertility work-up is:

Asemen analysis.
Bconfirmation of ovulation.
Cconfirmation of tubal patency (hysterosalpingography).
Dpostcoital test.
Eall the above.

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Question 92

Breast feeding contraindications include:

1) active tuberculosis;

2) acute circulatory and renal failure;

3) postpartum depression;

4) sulphonamide treatment of the mother;

5) breast cancer.

The correct answer is:

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

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Question 93

The lack of verbal responses, despite incentives and directions given to the patient, is called:

Amutism.
Binhibition.
Cautism.
Dnegativism.
Ehostility.

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Question 94

The typical picture of delirium does not include:

Avisual hallucinations.
Bdisorientation.
Caphasia.
Dworsening condition at night.
Eexcitement.

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Question 95

The temporo-frontal dementia is called:

AAlzheimer’s disease.
BPick’s disease.
CLevy bodies disease.
DParkinson’s disease.
EHuntington’s disease.

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Question 96

The risk of suicide in patients with schizophrenia is approximately:

A1%.
B2-3%.
C5%.
D10%.
E20%.

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Question 97

The basic dimensions of schizophrenia symptoms according to T. Crow are:

Aexcitation and inhibition.
Bdisorganization and paranoia.
Cdisorganization and negative.
Dpositive and negative.
Edeficit and non-deficit.

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Question 98

Which of the following is not one of the anxiety disorders according to the ICD-10?

Aacute reaction to stress.
Bpanic attacks.
Csocial phobia.
Dgeneralized anxiety disorder.
Edysthymia.

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Question 99

The Eating disorders (ICD-10) do not include:

Aanorexia nervosa.
Bbulimia nervosa.
Canorexia nervosa atypical.
Dovereating atypical.
Ebulimia nervosa atypical.

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Question 100

The prevalence of depression among patients with cerebral stroke is:

A60%
B30%
C20%
D10%
E5%

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Question 101

The standard (recommended by the manufacturer) maximal daily dose of olanzapine in the treatment of schizophrenic patients is:

A10 mg.
B15 mg.
C20 mg.
D25 mg.
E30 mg.

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Question 102

The following are risk factors for tardive dyskinesia during antipsychotic treatment, except:

Astrong affinity of the drug to dopaminergic receptors
Buse of phenotiazines derivates
Ctapered withdrawal of antipsychotic drugs
Duse of butyrophenones derivates
Eabrupt discontinuation of antipsychotic drugs

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Question 103

Which of the following Serotonine Selective Reuptake Inhibitors (the SSRIs) does not show distinct anxiolytic property (may even arose anxiety at the beginning of treatment)?

AFluvoxamine.
BFluoxetine.
CCitalopram.
DParoxsetine.
ESertraline.

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Question 104

Which of the following procognitive drugs does not enhance the cholinergic transmission?

ADonepezil.
BRivastigmine.
CPiracetam.
DGalantamine.
Eall of the above.

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Question 105

The organizational model of psychiatric care which provides care for patients residing In their homes, forms the basis for:

Apsychiatric out-patient care.
Bpsychiatric community care.
Cthe principles of organization of a hostel.
Dpsychiatric day-care.
Ethe principles of organization of a nursing home.

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Question 106

The belief in suffering from serious general disease accompanied by various complaints not justified by physical examination, is the basis for the diagnosis of:

Asomatization disorder.
Bsimulation (malingering) of general medical disorder.
CHypochondriasis.
Dobsesive-compulsive disorder.
Econfabulations.

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Question 107

The most common complications of the peptic ulcer includes:
1) upper GI bleeding;
2) perforation;
3) stenosis of the pylorus;
4) gastric cancer;
5) Mallory-Weiss syndrome.
The correct answer is:

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

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Question 108

The most dangerous complication associated with so called Barret’s oesophageus includes:

Areflux oesophagitis.
Bulceration of the oesophageus.
Cstricture of the oesophageus.
Dperforation of the oesophageus.
Ecarcinoma of the oesophageo-gastric junction.

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Question 109

Which of the following sentences best characterizes the incarcerated (irreducible) hernia?

Athe hernia which is not possible to reduce by manipulation.
Bthe hernia with associated relevant symptoms and signs of the mechanical obstruction.
Cthe hernia in which abdominal intestines have migrated into the hernia’s canal.
Dthe hernia in which spasm of the hernia’s ring resulted in its squeeze on the contents of the hernia’s sack.
Ethe hernia in which adhesions occurred between the hernia’s sack and its contents.

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Question 110

Which of the following techniques of operative treatment of inguinal hernias are non-tensioned ones (with the use of synthetic mesh)?
1) Lichtenstein method;
2) Halsted method;
3) Bassini method;
4) Rutkow method;
5) Schouldice method.
The correct answer is:

A1,2,3.
B1,4.
C2,3,4.
D2,3,5.
E4,5.

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Question 111

A 70-year-old lady has been complaining of constant pain in the left lower quadrant for 3 days. A history of chronic constipation. On the day of presentation the pain exacerbated suddenly. On examination tenderness along the whole hypogastrium, guarding, tachycardia, fever 38C. The most probable diagnosis is:

Aleft sided acute salpingitis.
Bperforation of the peptic ulcer.
Clarge bowel mechanical obstruction.
Durinary tract infection with left-sided pyelonephritis.
Eperforated sigmoid diverticulum.

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Question 112

A 62-year-old lady presents with diffuse pain of the whole abdomen of moderate intensity. A history of constipation, temporary presence of blood in the stools and weight loss of approx. 4 kg. Retention of stool and flatus for 3 days. No vomiting. On examination the patient in good shape, abdomen distended, tender at palpation, peritoneal signs negative, per rectum no stool in the rectal ampulla. The most probable diagnosis includes:

Aacute sigmoid diverticulitis.
Bstricture of the sigmoid due to diverticular disease.
Cexacerbation of the chronic constipation.
Dlarge bowel mechanical obstruction, probably caused by malignancy.
Elarge bowel mechanical obstruction, probably caused by a fecalith.

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Question 113

Which of the following factors are contraindications for breast conserving therapy in breast cancer?
1) size of the tumor less than 3 cm;
2) palpable single axillary lymph nodes on the affected side;
3) carcinoma localized in the medial quadrants;
4) multifocal cancer;
5) age under 40.
The correct answer is:

A1,2.
B1,3,4.
Conly 5.
D1,3.
Eonly 4.

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Question 114

The hereditary adenomatosus polypositas of the large bowel is characterized by:
1) occurrence of numerous hyperplasic polypi in the large bowel;
2) occurrence of fewer than 100 adenomatosus polypi in the large bowel;
3) occurrence of much more than 100 adenomatosus polypi in the large bowel;
4) risk of developing large bowel cancer in 3rd or 4th decade of life in nearly 100% patients;
5) presence of hyperpigmentation on the face, mouth and buccal mucosa.
The correct answer is:

A1,4,5.
B2,4,5.
C3,4,5.
D1,4.
E3,4.

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Question 115

A 40-year-old male hit repeatedly on the head with a blunt instrument is admitted to the Emergency Room beaten. He could not remember the circumstances of the incident. He complains of double vision. On physical examination: remarkable retraction of the eyeball on the right side, sensual deficiency under the orbit on the same side, and multiple bruises but without pathological mobility. The most probable injury includes?

Afourth ventricular haematoma.
Bsubdural haematoma of the occipital region.
Cfrontal lobes contusion.
DLeFort III type fracture.
Eorbital fracture.

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Question 116

A 58-year-old patient treated with liver cirrhosis in the Department of hepatology presents the symptoms of the upper GI tract bleeding. The blood pressure is 170/80, heart rate 118/min. The most probable diagnosis and therapy include:

Aesophageal varices – Panendoscopy.
Besophageal varices – Laparotomy.
Cbleeding duodenal ulcer – Panendoscopy.
Dbleeding duodenal ulcer – Laparotomy.
Enone of the answers is correct.

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Question 117

Over the years the problem of gastroduodenal ulcers become less critical. Which of the following is believed to be the main reason for this situation?

Aintroduction of truncal vagotomy.
Bintroduction of truncal vagotomy and antrectomy.
Cintroduction of selective vagotomy.
Dintroduction of highly selective vagotomy.
Eimprovement of pharmacotherapy.

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Question 118

A 48-year-old patient is admitted to the Emergency Room. His general condition is serious, he is suffering from circulatory insufficiency, with looming respiratory insufficiency. There was an incident of acute pancreatitis in his past. Currently he complains of very strong diffuse abdominal pain radiating to the back. On physical examination the abdomen is distended, peristalsis not auscultable, muscular defence reflex on examination. In lab tests the levels of amylase in serum and urine, as well as lipase in serum are manifoldly elevated. Which of the following is the most adequate procedure?

Aurgent laparotomy.
Bhospitalization in the Intensive Care unit.
Curgent endoscopic retrograde cholangiopancreatography.
Dintensive empiric antibiotic therapy.
Eall of the answers are correct.

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Question 119

Local femoral compression was administered to the patient. Then he had to flex and extend his limb in knee vigorously. After this procedure, the limb became pale and swollen, superficial veins became inflated with stagnating blood. How would you explain this situation?

Athe procedure is called Pratt’s test. It caused insufficient arterial blood flow, and the limb ischaemia as the consequence – it should be considered as physiologic phenomenon.
Bthe procedure is called Trendelenburg’s test. The symptoms denote positive result, and the insufficiency of perforator veins.
Cthe procedure is called Trendelenburg’s test. The symptoms denote negative result, and the sufficiency of perforator veins.
Dthe procedure is called Perthes’ test. The symptoms denote positive result, and the insufficiency of perforator veins and/or occlusion of deep veins.
Ethe procedure is called Perthes’ test. The symptoms denote negative result, and the sufficiency of perforator veins and correct blood flow in deep veins.

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Question 120

Pulse assessment can be performed in all these arteries, except:

Acubital artery.
Biliac artery.
Ctibial posterior artery.
Ddorsal artery of foot.
Ethe pulse can be assessed in all of the above.

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Question 121

During the catastrophe, according to START algorithm (Simple Triage and Rapid Treatment), an unconscious victim with the respiratory rate above 30/per minute should be marked as:

Agreen.
Byellow.
Cred.
Dblack.
Ethe victim cannot be qualified to any of the above-mentioned groups on the basis of the above description.

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Question 122

Acute toxic megacolon is a complication of:

Aintestinal tuberculosis.
Bulcerative colitis.
Crectal cancer.
Dproctostenosis.
Eabscess in the rectouterine pouch.

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Question 123

Open pneumothorax causes rapidly increasing cardiovascular insufficiency, due to significant dislocation of mediastinal organs away from the side of pneumothorax.

Aboth statements are true. There is a cause-and-effect relationship between them.
Bboth statement are true. The cause-and-effect relationship between them is not present.
Cthe first statement is true. The second statement is false.
Dthe first statement is false. The second statement is true.
Eboth statements are false.

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Question 124

A 56-year-old patient was admitted to hospital due to painless jaundice. Physical examination revealed enlarged, painless gallbladder. Laboratory tests revealed the elevation of a total bilirubin level (conjugated bilirubin/non-conjugated bilirubin levels ratio, 3:1) and the slight elevation of transaminases levels. The diagnosis is:

Acholecystolithiasis.
Bcholedocholithiasis.
Ctumor of the head of the pancreas.
Dviral hepatitis.
Eanswers A and D are correct.

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Question 125

Schwartz test is used for the assessment of:

Acompetence of saphenous vein valves.
Bcompetence of small saphenous vein valves.
Ccompetence of perforating veins.
Dcompetence of deep veins valves.
Epatency of deep veins.

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Question 126

Volkmann contracture is:
1) permanent hyperextension of the hand and fingers caused by ischemia/necrosis of the muscle fibres of the extensors of the wrist;
2) permanent flexion of the hand and fingers caused by cicatrisation of the muscle fibres of the extensors of the wrist;
3) permanent flexion of the hand and fingers caused by cicatrisation of the ischemic muscle fibres of the flexor group of muscles of the forearm;
4) complication of a fracture of the ulnar bone;
5) complication of a fracture of the humeral bone.
The correct answer is:

A1,4,5
B2,4.
C3,5.
D3,4.
E2,5.

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Question 127

A patient underwent surgical treatment of follicular thyroid carcinoma. Three days after thyroidectomy the patient suffered from numb sensations in the fingers and tingling sensations around the mouth. The patient was irritated and excited with a tendency to hyperventilation. Indicate the optimal treatment:

Acalcium gluconate.
Bsedative and anxiolytic drugs.
Cintensive oxygen therapy.
Dintravenous antibiotic therapy.
Epsychiatric consultation.

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Question 128

A twenty-year-old patient was admitted to the Emergency Department owing to a furuncle of right parietal region. The treatment should consist of:

Aincision and drainage.
Bremoval of the purulent plug and pus.
Cexcision of the furuncle and a local plastic operation.
Doral antibiotic therapy and local antiseptics.
Eremoval of the purulent plug and pus, antibiotic therapy.

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Question 129

One of the causes of the increase of pressure inside the bile ducts, leading to primary biliary cirrhosis, is primary sclerosing cholangitis (PSC). The true sentences about PSC are as follows:
1) in 60% to 70% of PSC cases ulcerative colitis or Crohn disease is diagnosed;
2) coexistence of PSC and inflammatory bowel diseases significantly increases the risk of cholangiocarcinoma;
3) Peyronie’s disease and pseudotumors of eyeballs may coexist with PSC;
4) main signs and symptoms include painless jaundice and skin itching (45-55% of patients);
5) endoscopic retrograde dilatation of the bile ducts and stent implantation are used to treat the patients with PSC.
The correct answer is:

A1,2,3,5.
B1,2,4.
C2,3,4,5.
Dall the above.
E1,4,5.

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Question 130

A 30-year-old patient, after a traffic accident, was admitted to the Emergency Department with blunt abdominal trauma. The patient’s blood pressure was 100/70 mmHg, heart rate was 90 beats per minute. Physical examination revealed: pain on pressure on the left side of the abdomen, a pain with fist percussion in the left lumbar region. FAST (Focused Assessment with Sonography in Trauma) exam revealed a presence of perisplenic fluid and presence of fluid in the rectovesical pouch. Urine was blood-stained. Computed tomography of the abdomen revealed Grade IV injury of the spleen (according to American Association for the Surgery of Trauma classification) and Grade II injury of the left kidney (acc. to AAST). One hour after the admission to the Emergency Department blood pressure decreased to <90 mmHg and heart rate increased to 100 bpm. The treatment should consist of:

Alaparotomy, splenectomy, a check-up of remaining abdominal organs, drainage.
Blaparotomy, splenectomy, left nephrectomy, a check-up of remaining abdominal organs, drainage.
Cconservative treatment.
Dlaparotomy, left nephrectomy, a check-up of remaining abdominal organs, drainage.
Elaparotomy, an attempt to preserve the spleen, a check-up of remaining abdominal organs, drainage.

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Question 131

A 33-year-old patient, after a traffic accident, was admitted to hospital with fracture of the shaft of the femur. No abnormalities were found on computed tomography of the head, chest X-ray, and abdominal sonography. Blood pressure was 120/80 mmHg; haemoglobin level was 12.5 g%. The treatment plan for the next day was to insert an intramedullary rod. Temporarily, a proximal tibial skeletal traction was applied. During the night, disturbances of consciousness and psychomotor agitation appeared. The most probable cause of such abnormalities is:

Apulmonary thromboembolism.
Bbrain concussion.
Cprogressive encephalomalacia.
Deffects of analgesics.
Ecerebral fat embolism.

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Question 132

In ambulatory conditions it is not wrong to start intravenous delivery of 20% glucose in an unconscious diabetic patient before having a sure reason of his/her unconsciousness, because the most probable reason of unconsciousness in such patients is a life threatening hypoglycemia.

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

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Question 133

Long-lasting β-mimetics inhalation is the basic treatment for all types of bronchial asthma, because apart from improving patients’ comfort of life they significantly decrease a sudden death risk in asthmatic patients.

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

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Question 134

The drugs useful for treating arterial hypertension in pregnant women are the following, except:

Aβ -blockers.
BACE-inhibitors.
Chydralazine.
Dprazosin.
Emethyldopa.

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Question 135

The most common reason for a prolonging fever with no accompanying symptoms in small children is:

Atuberculosis.
Bsalmonellosis.
Curinary tract infection.
DLyme disease.
Etoxoplasmosis.

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Question 136

Which of the following vaccinations is not obligatory during the first 12 months of life?

Aagainst tuberculosis.
Bagainst measles.
Cagainst tetanus.
Dagainst pertussis.
Eagainst diphtheria.

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Question 137

Strong pain, oedema and suppuration of the nail fold are the signs of:

Afuruncule
Berysipeloid
Cpanaritium
Dparonychia
Ephlegmon

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Question 138

Mark the most probable diagnosis in the case of a sudden appearance of the following symptoms: strong headache, loss of consciousness, nuchal rigidity:

Aischaemic stroke.
Bhaemorrhagic stroke.
Csubarachnoid haemorrhage.
Dencephalitis.
Elacunar stroke.

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Question 139

Which of the following activities belong to the tertiary prophylaxis?

1) illness risk reduction;

2) illness occurrence prevention;

3) screening tests;

4) illness complications prevention;

5) prevention of deaths due to disease.

The correct answer is:

A1,2.
B2,4,5.
C4,5.
D1,3.
E3,4.

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Question 140

A healthy 8-month-old infant was vaccinated against diphtheria, tetanus and pertussis. Next day his mother asks for one more vaccination – against flu. Should the doctor apply the vaccination?

Ano, the next vaccination may be given after 6 weeks’ time.
Bno, the next vaccination may be given after 4 weeks’ time.
Cyes, but the vaccination must be given in the same body area as the previous ones.
Dyes, but the vaccination must be given in a different body area than the previous ones.
Eno, because the child of this age should not be vaccinated against flu.

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Question 141

Mark the true sentence concerning ascariosis:

Ain order to find parasite’s eggs, stool smear must be done 3 times at intervals of 3-5 days.
Bascaris eggs are killed while food is being frozen.
Cpharmacological therapy is contraindicated in pregnant women.
Dasymptomatic forms of ascariosis should not be treated.
Eall the above are true.

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Question 142

Which of the following factors influence the premature obliteration of fontanelles in infants?

Amicrocephalia.
Bcraniostenosis.
Chypothyreosis.
Dcorrect A, B.
Ecorrect A, B, C.

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Question 143

The Tanner scale allows to assess:

Astage of sexual development.
Bfetus’ age after birth.
Cconsciousness status.
Dcardiac murmur volume.
Eclinical probability of phlebothrombosis.

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Question 144

Frequent episodes of bronchitis and fatty stools in a child with meconium ileus are characteristic of:

Abronchial asthma.
Bceliac disease.
Callergy to cow’s milk.
DHirschprung disease.
Ecystic fibrosis

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Question 145

Pains in a right lower quadrant of the abdomen may be caused by:

Asigmoid diverticulitis.
Bmesentery lymphonodulitis.
Ccaecal diverticulitis.
Dcorrect B, C.
Ecorrect A, B, C.

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Question 146

Alcohol dependence is diagnosed with:

ABeck questionnaire.
BTinetti test.
CFagerstrom test.
DAUDIT questionnaire.
ENorton scale.

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Question 147

Mark the most probable diagnosis in a 14-year-old boy with the following symptoms: strong throat pain, high fever, eyelids’ oedema; During physical examination: exudative pharyngitis, coating on the palatine tonsils, painless lymphadenopathy of cervical lymph nodes. After applying amoxicillin, a rash appeared.

AStreptoccocal paryngitis.
Binfectious mononucleosis.
Cscarlet fever.
Ddiphtheria.
Erubella.

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Question 148

According to the Polish vaccination calendar, the obligatory vaccinations are:

Aagainst measles, rubella, mumps (epidemic parotitis).
Bagainst rotavirus.
Cagainst meningoccoci.
Dcorrect A, B.
Ecorrect A, B, C.

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Question 149

A breast-feeded infant whose mother takes vitamin D below 2000 IU/day, should additionally receive vitamin D supplementation:

A400 IU/day.
B300 IU/day.
C200 IU/day.
D100 IU/day.
Evitamin D supplementation is unnecessary in this case.

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Question 150

The SCORE scale used in coronary heart disease prophylaxis determines:

A10-year risk of non-fatal myocardial infarction.
B10-year risk of a fatal cardiovascular incident.
Cabsolute death risk after myocardial infarction.
D20-year cause-independent death risk.
E10-year risk of non-fatal cardiovascular incident.

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Question 151

The effectiveness of some screening tests in revealing neoplasms at early stages is proved in:
1) cytological examination – cancer of the uterine cervix;
2) mammography – breast cancer;
3) per rectum examination – colon cancer;
4) per rectum examination – prostate cancer;
5) thorax radiogram – lung cancer.
The correct answer is:

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

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Question 152

An 18-year-old girl lost consciousness during intravenous injection of netromycin. Measured blood pressure: 70/40 mmHg, heart rate 52/min regular. The most probable reason for the observed disturbances is:

AHoigne’s syndrome.
Banaphylactic shock.
Cseptic shock.
Dtoxic reaction.
Esyncope.

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Question 153

An 18-year-old boy lost consciousness with seizures during intramuscular injection of penicillin. He has no history or any evidence of previous epilepsy. The most probable reason for the observed disturbances is:

AHoigne’s syndrome.
Banaphylactic shock.
Cseptic shock.
Dtoxic reaction.
Esyncope.

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Question 154

A 42-year-old man called for an ambulance because of a persistent stenocardial pain, which is not relieved by nitrates administration. There are no abnormalities in performed ECG. The patient should be:

Atreated by his family doctor.
Breferred to cardiologist.
Cadmitted into hospital.
Dleft untreated.
Egiven ambulatory treatment.

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Question 155

Recommended sedation drug in emergency and traumatology is:

Amidazolam because it acts fast and short.
Bdiazepam because it prevents from possible seizures.
Cpropofol because it prevents from vomiting.
Dketamine because it does not decrease respiration.
Emorphine because it acts as sedative and analgetic.

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Question 156

Airway management during resuscitation in hospital settings according to the relevant guidelines should be performed with:

AGuedel tube.
Blaryngeal mask.
Cjaw thrust (Esmarch manouver).
Dnaso-pharyngeal tube.
Ehead tilt, chin lift.

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Question 157

A patient presents to Emergency Room with multiorgan injury: chest injury – rib fracture, breathing sounds decreased unilaterally, breathing difficulties, symptoms of dyspnoea; head injury – conscious, GCS 13; broken arm – open fracture; abdominal tenderness. The first reaction is:

AUSG of the abdomen and abdominal punctuation – to find out if there is no bleeding.
BCT scan of the cranium – to exclude serious brain injury.
Cchest X-ray – for examination of possible pneumothorax.
Dchest drainage.
Eaffixing the open fracture to stop bleeding.

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Question 158

Which of the following settings of mechanical ventilation in an emergency situation in an adult patient with chest injury is not true?

Arespiration rate: 10-12/min.
Btidal volume: 6 ml/kg.
Cpeak inspiratory pressure: 45cm H2O.
Dplateau inspiratory pressure: 20 cm H2O.
Epositive end-expiratory pressure: upto 5 cm H2O.

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Question 159

How should you assess according to the Glasgow Coma Scale a patient who, after a traffic accident, articulates single words, opens his eyes only to a pain stimulus, reacts to pain by straightening the limbs, is assessed according to the Glasgow Coma Scale for:

A15.
B9.
C7.
D3.
E12.

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Question 160

What is the normal minimal value of urine output?

A10 ml/kg/h
B0.5 ml/kg/h
C1 ml/kg/h
D5 ml/kg/h
E50 ml/kg/h

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Question 161

What is the most frequent cause of cardiac arrest in children?

Acirculatory insufficiency.
Bcongenital heart defects.
Cseptic shock.
Drespiratory disorders.
Enone of the above.

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Question 162

The precordial thumb is performed in the case of:

Awitnessing cardiac arrest, especially in monitored patients
Bevery patient in cardiac arrest
Cunknown the exact time of cardiac arrest
Dcardiac arrest occurring in less than 5 minutes ago
Eall the answers are false

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Question 163

A victim of electrocution with high voltage can suffer from:

Aextensive burns.
Bbones fractures.
Cserious arrhythmias.
Dall the answers are true.
Eall the answers are false.

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Question 164

In the case of „near drowning” - after being got out from under the water a victim fast recovered consciousness. He has no complains, and no abnormalities in evaluation. What is the recommended approach?

Ahe can be released home after evaluation.
Bhe does not require medical evaluation.
Cafter evaluation he can be treated in out-hospital settings.
Dhe should be hospitalized because of possible acute respiratory failure.
Eall the answers are false.

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Question 165

The evaluation of circulation in a conscious patient found laying outdoor in winter morning should last:

A10 seconds.
Bhalf a minute.
Cone minute.
D10 minutes.
Eall the answers are false.

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Question 166

The only certain criterion of patient’s death in hypothermia is:

Alack of cornea reflex.
Bimpossibility of circulation recovery after warming up the patient.
Clack of brain-eye (doll eyes) reflex and deep reflexes.
Dlack of response to defibrillation.
Eall the answers are false.

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Question 167

During medical segregation the victim in whom you recognize II degree burn covering more than 30% of the body surface receives code (basing on Mettag color system):

Agreen
Byellow
Cred
Dblack
Eall the answers are false

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Question 168

During mass casualty incidents the coordinating person is:

Aphysician heading the ER.
Bcity physician on duty.
Cphysician of the ambulance who is the first at the site of the incident.
Dregional consultant in emergency medicine.
Eall the answers are true.

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Question 169

The factor influencing the decrease in intracranial pressure is:

Ahypotension.
Bhypoxia.
Chypocapnia.
Dintracranial bleeding.
Eall the answers are false.

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Question 170

An adult Jehovah’s Witness is admitted to hospital with acute symptoms indicating the need for urgent surgery. After a brief examination, the anesthesiologist on duty concludes that the patient needs blood transfusion. The patient does not give consent to it, and he confirms his refusal in writing. What should the surgeon do?

Ahe should refuse to perform surgery because of the level of risk.
Bhe should perform surgery, and, if necessary, give blood to the patient without informing him about this part of the treatment.
Che should respect the patient’s will and perform the surgery without blood transfusion.
Dhe should perform surgery; if necessary, he should give blood to the patient and inform him about this part of the treatment as soon as possible.
Ehe should apply to the guardianship court for the permission to act without the patient’s consent.

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Question 171

Patient’s contacts with clergymen:

Aare a condition for quick recovery.
Bcan only take place in the hospital chapel.
Cdepend on the decision of the family and doctor on duty.
Dare among the patient’s basic rights.
Eare possible only during visiting hours.

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Question 172

Did Hippocrates support euthanasia?

Ayes.
Bonly in special cases.
Che opposed euthanasia.
Dhe ignored euthanasia.
Ehe let patients decide.

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Question 173

Does the Polish Code of Medical Ethics contain a provision concerning maintaining life of the parts of the human body after patients death?

Ano.
Byes, this provision concern transplantation.
Cyes, this provision concerns road accidents.
Dyes, this provision concerns brain cells.
Eyes, this provision concerns terminal conditions.

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Question 174

Who, according to the Polish Code of Medical Ethics, has an exclusive right to supervise a medical experiment involving a human?

Apharmacist.
Bphysician.
Cphilosopher.
Dlawyer.
Esponsor.

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Question 175

Does the Polish Code of Medical Ethics allow a physician to participate in procedures causing heritable genetic changes in a human?

Aonly for therapeutic purposes.
Byes.
Conly in embryos.
Dno.
Eyes, only in the case of neoplasmatic disease.

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Question 176

Does the Polish Code of Medical Ethics allow to take bone marrow from a child?

Aonly up to the age of two.
Bno.
Conly from females.
Donly from males.
Eyes.

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Question 177

Does the Polish Code of Medical Ethics contain a provision concerning a risk associated with a therapeutic experiment?

Ano.
Bit refers to the legal provisions.
Cyes.
Dthe Code does not deal with medical experiments.
Ethere is only a provision concerning DNA.

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Question 178

Do the Declaration of Helsinki and the GCP principles apply to medical experiments carried out in Poland?

Aonly the Helsinki Declaration.
Bonly in special cases.
Conly the GCP principles.
Dyes.
Eno.

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Question 179

The so-called opt-out clause, which allows doctors to work for more than average 48 hours a week in a defined accounting period, can be introduced in the health care institution (ZOZ), provided that:
1) the consent is given by a relevant regional medical chamber council;
2) a physician gives his/her consent in writing;
3) accounting period does not exceed 4 months;
4) a health care institution (ZOZ) does not provide continuous services;
5) physicians are entitled to additional remuneration for their work in 200% of the hourly minimum wage rate.
The correct answer is:

A1,3.
B3,4.
C1,2.
D2,3.
E1,5.

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Question 180

In accordance with Law on cash benefits from social insurance in the case of illness and motherhood, a rehabilitation benefit can be granted for up to:

A3 months.
B6 months.
C8 months.
D9 months.
E12 months.

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Question 181

A medical statement on temporary incapacity to work can cover the period of up to 3 days preceding the day of physical examinations if their results indicate that the insured person involved was undoubtedly incapable to work during that period. Who is allowed to issue the statement covering longer than 3 day period before the examination?

Amedical unit manager.
Bhospital administrator.
Cpsychiatrist.
DSIF (ZUS) certifying doctor.
Eattending doctor upon receiving the SIF (ZUS) president’s approval.

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Question 182

Is a SIF (ZUS) insured person allowed to work for money while receiving rehabilitation benefit?

Ayes.
Bno.
Cyes. third time only.
Dyes, half time only.
Eyes, limited time only.

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Question 183

How long from the date of issuing a medical statement on temporally incapacity to work should it take the doctor to deliver its original to the local branch of SIF (ZUS)?

A3 days.
B5 days.
C7 days.
D10 days.
E14 days.

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Question 184

How long from the day of receiving a SIF (ZUS) certifying doctor’s statement on temporary incapacity to work an insured person is entitled to appeal to the SIF (ZUS) medical board?

A3 days.
B7 days.
C14 days.
D21 days.
E30 days.

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Question 185

In the proceedings to determine entitlement to benefits under the social insurance for farmers the medical specialist and ASIF (KRUS) medical boards do not issue the following rulings on:

Atemporary incapacity to work lasting longer than 180 days.
Bcomplete inability to farm labour.
Cdegree of disability.
Dpercentage of damage to health resulting from an accident at work in agriculture occupational disease.
Einability to live independently.

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Question 186

When an insured person lost their medical statement on temporary incapacity to work (ZUS ZLA), the doctor who had issued the statement acting upon insured person’s motion:

Aissues the second copy of the statement.
Bissues a photocopy of the second copy of the statement.
Cissues a photocopy of the original which was previously sent to the local branch of SIF (ZUS).
Dissues a new medical statement (ZUS ZLA) for the same period of time.
Eprovides excerpt from the second copy of the statement.

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Question 187

The most important reason for the decrease in general death rate in Poland in the last twenty years is the decrease in deaths:

Acaused by infectious diseases.
Bcaused by neoplastic diseases.
Ccaused by neoplastic and cardiovascular diseases.
Dcaused by cardiovascular diseases.
Eof newborns and infants.

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Question 188

The result of the latest epidemiologic studies in Poland show that the most common risk factors for cardiovascular diseases in our country are:

Ahypercholesterolemia, sedentary lifestyle and diabetes mellitus.
Boverweight and obesity, hypercholesterolemia and sedentary lifestyle.
Csmoking, family history and stress.
Dhypertension, genetic factors and environmental contamination.
Ehypertension, hyperglycemia and smoking.

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Question 189

The proper intensity of physical exertion for a fifty-year-old obese man without relevant contraindications against physical exercise is the exert:

Aof approximately the maximum intensity.
Bthat causes a fast heart rate to about 80-90 cons/min.
Cthat causes a fast heart rate to about 110-130 cons/min.
Dthat causes a fast heart rate above 160 cons/min.
Eof an intensity above 15 MET.

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Question 190

On the grounds of Fagerstrom test – nine points and the motivation test – two points the following can be inferred:

Athere is no physical addiction to nicotine, the patient has strong motivation to stop smoking.
Bthere are both a strong physical addiction to nicotine and strong motivation to stop smoking.
Cthere is neither a strong physical addiction to nicotine nor strong motivation to stop smoking.
Dthere is strong addiction to nicotine, but no motivation to stop smoking.
Enone of the above is correct.

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Question 191

What is the meaning of the notion that the relative risk of death associated with the administration of ABC drug in secondary prevention of coronary heart disease equals 0.78?

Athe risk of death to the patient taking the drug is 22% smaller than the risk of death in the general population.
Bthe estimation of the risk of death to the patient taking the drug is relative and most likely will be approximately 22%.
Cthe risk of death to the patient is approximately 22% smaller if he takes the drug than otherwise.
Dthe risk of death to the patient is approximately 78% smaller if he takes the drug than otherwise.
Enone of the above is correct.

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Question 192

The access of an insured person to health care covered by NFZ (National Health Found) depends on:

Athe amount of health insurance premium.
Bthe period of membership in the National Health Fund.
Cinsured person’s medical condition.
Dinsured person’s professional standing.
Enone of the above.

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Question 193

Outpatient specialist services financed from public funds shall be awarded on the basis of the referral from a doctor of health insurance. Such a referral is not required in the case of:
1) psychiatrist’s services;
2) diagnostic investigations including medical laboratory diagnostics;
3) patients suffering from tuberculosis;
4) HIV positive patients;
5) medicinal rehabilitation services;
6) dentist’s services.
The correct answer is:

A1,2.
B1,2,3.
C3,4,5.
D1,3,4,6.
E2,3,4,5.

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Question 194

In accordance with the Law on health care services financed from public funds, an insured person shall be provided and funded on the principles and scope defined in the Law following benefits:

Aprimary health care.
Boutpatient specialist services.
Cmedical rehabilitation.
Dtreatment in patient’s home.
Eall of the above.

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Question 195

Which of the following related to atrial fibrillation is false?
1) it is the most common supraventricular arrhythmia;
2) systemic arterial hypertension represents the frequent causative factor;
3) if there is no coexisting valvular heart disease, it is not associated with increased risk of cerebrovascular events;
4) treatment strategies include ventricular rate control or the restoration and maintenance of sinus rhythm.
The correct answer is:

Aonly 1.
Bonly 2.
Conly 3.
Donly 4.
E3,4.

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Question 196

A2,4,5.
B1,3,5.
C2,3,5.
D1,2,4.
E1,3,4.

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Question 197

Which of the pathological findings will be characteristic of malignant nature of breast tumour?

Afibroadenoma.
Bfibrosclerosis.
Ccystes.
Dtumor phyllodes.
Eall of the above are benign.

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Question 198

A patient has fallen down on the ground (from 4 meter height). The following signs and symptoms are present: dyspnoea, cyanosis, tachycardia, nausea, vomiting, decreased vesicular breath sound over the right lung. The physician should suspect:

Apneumothorax.
Bhaemothorax.
Cinjury of oesophagus.
Drupture of diaphragm and translocation of viscera into chest.
Epneumomediastinum.

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Question 199

In which medical disorder the oxygen index (PaO2/FiO2) falls below 200?

Aacute lung injury (ALI).
Bpneumonia.
Cacute respiratory distress syndrome – ARDS.
Dsubglottic laryngitis.
Enone of the above.

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Question 200

What is the most frequent form of cardiac arrest in children?

Aventricular tachycardia.
Bsupraventricular tachycardia.
Cbradycardia.
Dpulseless electrical activity-PEA and asystole.
Enone of the above.

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