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LEKEXAM / 2011 autumn

Question distribution — 2011 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

Diagnosis of diabetic kidney disease is based on:

Aincreased urine albumin excretion.
Bincreased leukocyte count in the urine.
Cincreased erythrocyte count in the urine.
Dpresence of red blood cell casts.
Epresence of white blood cell casts.

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Question 2

Indicate the method which is not appropriate in preventing contrast-induced acute kidney injury:

Awithholding metformin.
Badministration of furosemide.
Cavoiding dehydration.
Dminimizing the volume of radiographic contrast media.
Ewithholding, if clinically appropriate, aminoglycoside antibiotics.

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Question 3

The effective method to prevent the recurrence of renal stones is:

Aincrease fluid intake.
Bfurosemide.
Cincrease protein intake.
Dincrease intake of sodium chloride.
Eall the above methods are effective to prevent the recurrence of renal stones.

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Question 4

Progress of diabetic kidney disease may be prevented by:

Atreatment of hypertension.
Bbetter glucose control.
Csmoking cessation.
Dreduced protein intake.
Eall of the above methods can prevent the progress of diabetic kidney disease.

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Question 5

Symptomatic bacteriuria should be treated with the antibiotic in:

Apregnant woman.
Btype 2 diabetes patient.
Ctype 1 diabetes patient.
Dpatient with indwelling urinary catheter.
Eall the above are indications to start treatment with an antibiotic.

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Question 6

The risk of renal stone may be increased by:

Aurinary tract infection.
Bprimary hyperparathyroidism.
Culcerative colitis.
Dleukaemia.
Eall of the above are correct.

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Question 7

A patient who underwent colon tumor removal, in the first three days after the surgery should have his fluids intravenously supplemented with:

Aonly saline solution (0.9% NaCl).
Bonly glucose solution (5% glucose).
Cboth 5% glucose and 0.9% saline solution.
Dsaline solution (0.9%) in patients with diabetes and glucose solution (5%) in patients without diabetes.
Eonly Ringer's solution.

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Question 8

In a patient without any symptoms the serum potassium concentration of 3.4 mmol/L was observed. The patient should be advised first to:

Aincrease potassium intake.
Bstop taking spironolactone.
Ctake furosemide orally.
Dtake thiazide diuretics orally.
Estop taking angiotensin converting enzyme inhibitors.

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Question 9

The first thing to increase blood pressure in dehydrated patient with hypotension is to administer:

Amidodrine orally.
Bhydrocortisone intravenously.
Cfludrocortisone orally.
Dcaffeine orally.
Esaline 0.9% solution intravenously.

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Question 10

Metformin is contraindicated in patients with:

Aend-stage renal disease.
Bsevere liver damage.
Cacute kidney injury.
Dacute myocardial infarction.
Eall the above are correct.

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Question 11

Iron deficiency is accompanied by:

Adecreased transferrin saturation.
Bdecreased total iron-binding capacity.
Cdecreased unsaturated iron-binding capacity.
Dincreased serum ferritin levels.
EA, B & C are correct.

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Question 12

In a patient with nephrotic syndrome treated with cyclosporine for a long-time, several disturbances in serum lipids are found. Total cholesterol is 278 mg/dL, serum triglycerides are 308 mg/dL, serum creatinine is 1.45 mg/dL. In order to improve lipid profile the drug of choice should be:

Astatin e.g. atorvastatin at a mean dose (20 mg/d).
Bfibrate e.g. fenofibrate.
Cfibrate together with statin at high doses.
Dfibrate together with statin at mean doses.
Efibrates and statins are contraindicated in kidney diseases.

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Question 13

In chronic kidney disease erythropoiesis stimulating agents are used to treat anaemia. What is the target haemoglobin level?

A9 g/dL.
B9-10 g/dL.
C11-12 g/dL.
D14-15 g/dL.
E>15 g/dL.

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Question 14

What is the cause of thrombotic complications in patients with nephrotic syndrome:

Atreatment with ACE inhibitors (e.g. enalapril).
Bhyperlipidemia.
Cincreased coagulation and impaired fibrinolysis due to loss of coagulation inhibitors and activators of fibrinolysis with the urine.
Dlow protein diet.
Eheparin.

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Question 15

Which of the following statements concerning systemic lupus erythematosus (SLE) is false?

Arenal involvement is clinically evident in up to 85% of patients.
Bglomerular injury is triggered by the formation of immune complexes within the glomerular capillary wall.
Cin patients with antiphospholipid syndrome thrombotic microangiopathy may be the dominant feature.
Drenal biopsy has not proven to be useful for treatment design.
Eanti-double-stranded DNA (dsDNA) antibodies are highly specific to SLE.

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Question 16

A typical feature of nephrotic syndrome is:

Aalbumin urine excretion > 2 g per 1 g creatinine.
Balbumin urine excretion >2 g per 1 g creatinine + red cell casts.
Cprotein urine excretion >3.5 g per 1 g creatinine + red cell casts.
Dprotein urine excretion > 3.5 g per 1 g creatinine.
Eprotein urine excretion > 2g per 1 g creatinine + hyperlipidemia.

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Question 17

Central diabetes insipidus may result from:

Ahead trauma.
Bsuprasellar tumor.
Cintrasellar tumor.
Ddamage to the posterior lobe of the pituitary gland.
Eall of the above.

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Question 18

Albuminuria serves as:

Akey adjunctive tool for monitoring nephron injury.
Btool for evaluation of the response to therapy in many forms of chronic kidney disease.
Cparticularly useful diagnostic tool in diabetes, hypertension and glomerulonephritis.
Dthe best tool when albumin-to-creatinine ratio is calculated in a spot first morning urine sample.
Eall of the above answers are correct.

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Question 19

It has been advised to assess the effectiveness of antibiotic treatment of Helicobacter pylori measured by the urea breath test some time after termination of the treatment. It should be evaluated after:

A2 weeks.
B6 weeks.
C3 months.
D9 months.
E12 months.

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Question 20

In which of the following clinical conditions can elevated serum amylase be found?
1) pancreatic diseases;
2) biliary tract diseases;
3) spleen rapture;
4) ruptured ectopic pregnancy;
5) inflammation of the salivary glands.
The correct answer is:

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

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Question 21

In a woman with ulcerative colitis a flare of the disease occurred during pregnancy. Which of the following methods of treatment are safe in pregnancy?

1) sulfasalazine

2) ciprofloxacin

3) mesalazine

4) biological treatment

5) glucocorticosteroids

The correct answer is:

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

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Question 22

The risk for cancer transformation in colon polyps depends on their histologic structure and size. Which polyps show the highest risk for cancer transformation?

Avillous adenomas.
Btubular adenomas.
Ctubulovillous adenomas.
Dmetaplastic polyps.
EPeutz-Jeghers polyps.

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Question 23

A 42-year-old male reports tender swelling of the third finger of the right hand, as well as two fingers of the left foot (the second and the fourth), pain and the limitation of motion range of the right knee. He is also complaining about the fatigue, lost of weight and elevated temperature without infection. In physical examination: dactylitis (“sausage digits”) of the mentioned fingers with pitting nail changes, swollen knee joint with effusion – the removed synovial fluid was of inflammatory type. In laboratory testing: rheumatoid factor negative, CRP 48 mg/L. The most likely diagnosis is:

Asystemic lupus erythematosus (SLE).
Bsystemic sclerosis (SSc).
Cpsoriatic arthritis (PsA).
Drheumatoid arthritis (RA).
Egout.

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Question 24

Which from the following autoantibodies are the most typical of Sjögren’s syndrome (sicca syndrome)?

Arheumatoid factor.
Banti-dsDNA antibodies.
CANCA antibodies.
Dantibodies anti-SS-A, anti-SS-B.
Enone of the above.

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Question 25

Which of the following drug(s) can be given to a pregnant female with systemic lupus erythematosus and secondary antiphospholipid syndrome diagnosis?
1) glucocorticosteroids;
2) vitamin K antagonists (acenocoumarol, warfarin);
3) acetylsalicylic acid in a dose of 75 mg/d;
4) cyclophosphamide;
5) low molecular weight heparin (LMWH).
The correct answer is:

A1,2,3.
B1,3,5.
Conly 2.
D3,4.
Eonly 5.

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Question 26

The following changes are all visible on plain radiographs except for:

Atophi (gout nodules).
BSchmorl’s nodules.
CHeberden’s nodules.
Dsyndesmophytes.
Eosteophytes.

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Question 27

The following features are all typical of polymyalgia rheumatica clinical picture except for:

Aonset in old age.
Bpain of the muscles in the shoulder and/or pelvic girdles.
Chigh ESR.
Dpositive and rapid response to glucocorticoid therapy.
Ehigh activity of muscles enzymes.

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Question 28

Which of the following features is/are applicable to the clinical picture of antiphospholipid syndrome? .
1) hypercholesterolaemia; .
2) arterial thrombosis; .
3) venous thrombosis; .
4) enthesitis; .
5) pregnancy loss. .
The correct answer is:

A1,3.
B2,3,5.
Conly 4.
D4,5.
Enone of the above.

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Question 29

A 48-year-old male was referred to rheumatologist owing to fever, chronic otitis media refractory to antibiotics, chronic sinusitis with purulent and bloody nasal discharge, and perforation of the nasal septum. The chest X-ray showed bilateral disseminated parenchymal infiltrates in the form of oval nodules. In the urinalysis microhematuria. One can expect in the serum of this patient the following autoantibodies:

Aanti-dsDNA.
Bc-ANCA.
Canti-CCP.
Danti-Scl-70.
Eanti-Jo-1.

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Question 30

For which of the following connective tissue diseases the typical clinical features include: sclerodactyly, pulmonary interstitial fibrosis, pulmonary hypertension and Raynaud’s phenomenon related to irreversible vascular changes (a.o. megacapillars - capillary dilatation) visible in nailfold capilaroscopy:

Asystemic lupus erythematosus.
Brheumatoid arthritis.
CSjögren’s syndrome.
Dsystemic sclerosis.
Epolymyositis.

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Question 31

The diagnosis of restrictive ventilatory pattern is doubtless when:

AFEV1/FVC > 85%.
BFVC < 80% of the predicted value.
Cdecreased TLC (< 5 percentile, standard deviation score < -1.645).
Ddecreased DLCO (< 5 percentile, standard deviation score < -1.645).
EFEV1 < 80% of the predicted value.

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Question 32

Positive spirometric reversibility test shows:

Areversibility of bronchial obstruction.
Breversibility of gas transfer disturbances.
Creversibility of restriction.
Dimproving in exercise capacity.
Eimproving airflow in the small airways.

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Question 33

Which of the following clinical features are the most typical of community acquired pneumonia caused by Mycoplasma pneumoniae?

Ahigh body temperature, severe clinical state, respiratory insufficiency.
Bhigh body temperature, myalgia and ostealgia, mild symptoms of upper respiratory tract infection, elevated WBC with a left shift in the WBC differential count.
Cpreceding mild symptoms of upper respiratory tract infection, subfebrile body temperature, good clinical condition, dry and protracting cough.
Dsevere condition, massive purulent expectoration, high body temperature.
Esevere condition, early signs of respiratory insufficiency, a disproportion between minimal radiological changes and severe clinical symptoms.

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Question 34

Chronic obstructive pulmonary disease (COPD) may be diagnosed when:

Achest CT scans reveal the areas of emphysema and thickened bronchial walls.
BFEV1/FVC is decreased below 70% in a spirometry performed after bronchodilator.
Cthe patient is a smoker or former smoker and complains of chronic cough, shortness of breath, and a limited exercise tolerance.
DFEV1 is below 80% of the predicted value and reversibility test is negative.
EFEV1 is below 70% of the predicted value and reversibility test is negative.

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Question 35

If a patient with chronic heart failure suffers from dyspnea during normal physical activity but shows no symptoms at rest, then his/her clinical condition is indicative of the following functional class:

AI according to NYHA (New York Heart Association)
BII according to NYHA (New York Heart Association)
CIII according to NYHA (New York Heart Association)
DIV according to NYHA (New York Heart Association)
EII according to CCS (Canadian Cardiovascular Society)

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Question 36

High normal blood pressure defined by clinical measurements:
1) ranges between systolic values of 140-159 mmHg and diastolic values of 90-99 mmHg;
2) ranges between systolic values of 140-149 mmHg and diastolic values of 90-94 mmHg;
3) ranges between systolic values of 130-139 mmHg and diastolic values of 85-89 mmHg;
4) ranges between systolic values of 120-129 mmHg and diastolic values of 80-84 mmHg;
5) includes general target values associated with the management of arterial hypertension.
The correct answer is:

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

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Question 37

Which of the following statements concerning the right bundle branch block (RBBB) are true?

1) QRS is widened >120 ms;

2) rsR’ morphology of QRS is observed in V1-V2 leads;

3) rsR’ morphology of QRS is observed in V5-V6 leads;

4) it is an indication for thrombolytic therapy in patients with acute myocardial infarction;

5) it is an absolute indication for pacemaker implantation.

The correct answer is:

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

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Question 38

Increased levels of cardiac troponins may be observed in the following situations:
1) acute myocardial infarction;
2) heart failure;
3) rhabdomiolysis
4) renal insufficiency;
5) pulmonary embolism.
The correct answer is:

Aonly 1.
B1,2.
C1,2,3.
D1,2,5.
Eall of the above.

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Question 39

Administration of which of the following drugs does not need monitoring of their anticoagulant effect?

Aacenocoumarol.
Bwarfarin.
Cunfractionated heparin.
Dlow molecular weight heparin.
Eadministration of each of the above mentioned drugs needs monitoring.

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Question 40

In children and adolescents arterial hypertension is diagnosed considering percentiles of blood pressure values and:
1) age;
2) sex;
3) body mass percentile;
4) height percentile.
The correct answer is

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

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Question 41

The congenital anemias caused by the bone marrow failure include:

Aaplastic anaemia – Fanconi type.
Bcongenital dyskeratosis.
CShwachman-Diamond syndrome.
DBlackfan-Diamond syndrome.
Eall of the above.

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Question 42

The main symptoms of nephritic syndrome in children are:

Aproteinuria, erythrocyturia, cylindruria, hypertension.
Bisolated proteinuria.
Corthostatic proteinuria, cylindruria, haematuria.
Dproteinuria, erythrocyturia.
Eisolated erythrocyturia.

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Question 43

Which of the following are diagnostic criteria of Alport syndrome?
1) family history of nephrocalcinosis;
2) family history of unexplained haematuria;
3) recurrent urinary tract infections;
4) retinal pigmented lesions;
5) recurrent urolithiasis.
The correct answer is:

A1,4.
B2,3.
C1,5.
D2,4.
E3,5.

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Question 44

The diagnostic gold standard in food allergy is:

Asingle-blind food challenge, without placebo.
Bsingle-blind placebo-controlled food challenge.
Cdouble-blind food challenge, without placebo.
Ddouble-blind placebo-controlled food challenge.
Eall the answers are false.

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Question 45

The proper interval between the administration of live vaccines is at least:

A1 week.
B2 weeks.
C3 weeks.
D4 weeks.
E6 weeks.

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Question 46

A 12-year-old boy presents a few weeks’ history of a skin rash which occurred in symmetric fashion over the metacarpophalangeal and interphalangeal joints, a “lilac” rash on the upper eyelids and symmetric proximal muscle weakness. The clinical examination shows also oedema of the eyelids and of the upper lip, minor ulcerations within the auricles as well as pain on palpation and contracture of the shoulder muscles. The most probable diagnosis is:

AGuillain-Barré syndrome.
Blocalized scleroderma.
Cmyasthenia gravis.
Djuvenile systemic lupus erythematosus.
Edermatomyositis.

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Question 47

A 12-year-old boy has presented dysphagia, odynophagia, vomiting, regurgitation of undigested food and heartburn over the past several years. All symptoms have aggravated over the last week. In medical examination - weight deficiency. Radiological examination showed an acute tapering at the lower esophageal sphincter and narrowing at the gastroesophageal junction (“bird’s beak”). The esophagus above the narrowing was dilated. The most probable diagnosis is:

Aesophageal agenesis.
Besophageal atresia.
Cesophageal achalasia.
Dgastroesophageal reflux disease.
Epyloric stenosis.

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Question 48

Which of the following diseases are an indication for a screening test for celiac disease in children and adolescents?
1) Down syndrome;
2) diabetes mellitus type 1;
3) Gilbert’s syndrome;
4) autoimmune hepatitis;
5) diabetes mellitus type 2.
The correct answer is:

A2,3,4.
B1,4,5.
C1,2,4.
D2,3,5.
Eall of the above.

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Question 49

Which of the following is the first-line treatment of the pertussis (whooping cough) in a 9-year-old girl?

Afirst-generation cephalosporin.
Bmacrolide.
Csecond-generation cephalosporin.
Dtetracycline.
Ethird-generation cephalosporin.

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Question 50

Carbohydrate exchange is the amount of product (in grams) which contains:

A0.1 g of carbohydrate.
B1 g of carbohydrate.
C10 g of carbohydrate.
D100 g of carbohydrate.
E1000 g of carbohydrate.

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Question 51

Conjunctivitis, serositis, lymphadenopathy, swollen palms and feet with exfoliating, myocarditis and inflammation of the coronary vessels are the symptoms of:

AHenoch-Schonlein purpura.
Brheumatic fever.
CKawasaki disease.
DTakayasu disease.
Edilated cardiomyopathy.

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Question 52

Choose the false statement concerning Lyme disease (borreliosis):

Ain the first phase of the disease erythema migrans appears on the skin.
Bin the course of the disease cardiac arrhythmias could be observed.
Cvirus of the tick-borne encephalitis is the etiological factor of the disease.
Din the third phase of the disease atrophic inflammation of the skin occurs.
Ethe disease could result in plegia of the cranial nerves.

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Question 53

Mental retardation, flattened occiput, single transverse palmar crease, epicanthal folds, and atrioventricular septal defect (AVSD) are the symptoms of:

AKlinefelter syndrome.
BTurner syndrome.
CDown syndrome.
DHenoch-Schonlein purpura.
ETRPS syndrome.

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Question 54

The etiological factor of infectious mononucleosis is:

AEpstein-Barr virus (EBV).
BMorbillivirus.
CMycoplasma pneumoniae.
DParvovirus.
EECHO virus.

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Question 55

Choose the true statement concerning neonatal lupus erythematosus (NLE):

Ait is a disorder caused by the transplacental passage of maternal anti-Sm antibodies to the fetus.
Bcardiac manifestation of NLE is direct life-threat to the newborn; the most common symptoms of cardiac manifestation are complete heart block and other arrhythmias.
Chematologic abnormalities in NLE – leucopoenia, anaemia, thrombocytopenia - always require treatment with glucocorticosteroids.
Dchildren with NLE in the future course of life always develop systemic lupus erythematosus.
Ehematologic and skin abnormalities of NLE disappear at the age of 3-4 years.

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Question 56

The most common type of syncope in children during puberty is:

Avasovagal syncope.
Bcardiac syncope.
Csyncope connected with epilepsy.
Dsyncope in the course of carotid sinus syndrome.
Esyncope connected with hypoglycemia.

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Question 57

Typical symptoms of the tetralogy of Fallot and other congenital heart defects with similar hemodynamic disturbances are “tet spells”. Treatment procedures in „tet spell” include the following, except for:

Aknee chest position of the child.
Bpassive oxygenation.
Cintramuscular epinephrine in the dose of 0.01 mg/kg body weight.
Dintramuscular dolantine in the dose of 1 mg/kg body weight.
Ecompensation of acidosis with intravenous sodium bicarbonate in the dose of 1 mEq/kg body weight.

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Question 58

The most common congenital heart defect in children is ventricular septal defect (VSD). Which of the following statements referring to this heart defect is false?

Athe hemodynamic disturbances are the consequence of left-to-right shunt and changes in the pulmonary vessels.
Bthe shunt size depends upon the size of the defect and the value of vascular pulmonary resistance.
Cleft-to-right shunt causes left ventricular volume overload and as a consequence dilatation and hypertrophy of the left ventricle.
Dtypical of ventricular septal defect is ejection systolic murmur, the loudest along the left sternum margin and over the lower sternum.
Espontaneous septal defect closure is possible.

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Question 59

Cyanosis is always an alarming symptom. It is caused by increased level of reduced hemoglobin in capillary vessels. What is the lowest level of reduced hemoglobin in the arterial blood at which cyanosis could be observed?

A9 g/dL.
B7 g/dL.
C5 g/dL.
D3 g/dL.
E1 g/dL.

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Question 60

Non-pharmacological treatment of children with hypertension include the following, except for:

Aincrease in regular physical activity.
Breduction of protein intake.
Cweight reduction in the case of overweight.
Davoiding stressful situations at home and away from it.
Ereduction of sodium salt (NaCl) intake to 5-6 g per day.

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Question 61

Sinus arrhythmia is a common physiological phenomenon in children and sometimes it is the reason for referring a child to the Pediatric Cardiological Outpatient Department. Which of the following statements concerning sinus arrythmia is false?

Asinus arrhythmia is diagnosed when differences between the following R-R segment intervals in electrocardiography are longer than 0.08 sec.
Bsinus arrhythmia is not the symptom of sick sinus syndrome.
Csinus arrhythmia in children is physiological if the heart rhythm is within normal limits for age.
Dsinus arrhythmia is dependent on respiratory phase – increase in the heart rate during expiration and decrease during inspiration is observed.
Ethe cause of sinus arrhythmia includes the decrease in intra-chest pressure during inspiration, which results in the increase in blood volume flowing into the right atrium.

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Question 62

Which of the following is the drug of choice in a child under 1 year old in the case of ineffective physical methods to stop paroxysmal supraventricular tachycardia?

Averapamil.
Badenosine.
Cdobutamine.
Datropine.
Eadrenaline (epinephrine).

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Question 63

Most of the heart murmurs in children are harmless. Which of the following statements concerning heart harmless murmurs is false?

Aharmless murmurs are usually barely audible of loudness up to 3/6 on Levine’s scale.
Bcould be auscultated in the healthy heart without an anatomical defect.
Cintensity and radiation of the harmless heart murmurs decrease in fever and after a physical effort.
Dharmless heart murmurs become louder while changing from standing to lying.
Eone of the causes of harmless heart murmurs is the presence of the tendinous chord in the left ventricle.

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Question 64

The parents bring their 3.5-year-old daughter to the emergency room because of the increasing fatigue, weakness, fever and oliguria lasting for about one day. From the past medical history taken by the MD it is known that the girl has been ambulatory treated because of diarrhea for the last 3 days. On physical examination the physician finds body temperature of 37.2°C, heart rate of 120 per minute, shortness of breath with the breathing rate of 26/minute, the blood pressure of 85/50 mmHg. Laboratory tests reveal: severe haemolytic anaemia (Hb=6.8 g/dL) with the presence of schistocytes on the blood smear, thrombocytopenia of 80,000/µL, leukocytosis of 8,500/µL, the serum urea level of 89 mg/dL and creatinine level 1.4 mg/dL. The observed abnormalities are most probably related to the pathogenic effect of:

Abeta-hemolytic Streptococcus group A causing acute glomerulonephritis in the patient.
Bgram-negative Salmonella enterica rod.
CEscherichia coli having the ability to synthesize verotoxin.
Dviruses from the group of rotaviruses or adenoviruses.
Enone of the above mentioned germs, because they do not have the infectious root; however, they are related to the activation of mechanisms of autoimmunity leading to the lysis of erythrocytes and thrombocytes.

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Question 65

MODY – the type of diabetes mellitus:

1) is inherited in autosomal dominant manner;

2) can be traced in several generations of the patient's family;

3) insulin resistance is a pathogenic substrate;

4) diagnosis can be made from childhood to young adulthood;

5) is not connected with the increased risk of the complications such as microangiopathy.

The correct answer is:

Aall of them.
B1,2,4.
C2,3,5.
D1,3.
E4,5.

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Question 66

A 15-month-old girl has been restless and weepy for the last 3 weeks, and lost weight. The parents noticed the enlarged abdominal circumference and its asymmetry. GP immediately referred the child to the hospital, assessing its general condition as medium-heavy. The girl was pale with increased body temperature and a palpable hard tumor in the abdomen. In the light of the clinical presentation the most likely diagnosis is:

AWilms’ tumor, because it is the most frequent tumor in the abdominal cavity during childhood.
Bneuroblastoma, because catecholamines secreted by this tumor cause rapid cachexia, they cause the clinical presentation of severe systemic disease, and the tumor itself often arises from the adrenal gland.
Cgerminoma, because of the asymmetrical localization of the tumor in the abdominal cavity.
DT-cell lymphoblastic lymphoma, because the abdominal cavity is the most frequent localization of this type of lymphoma, and rapid progression characteristic of this disease explains multiple general symptoms.
Eteratoma, because it is a benign tumor and its growth is very slow.

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Question 67

According to the obligatory Vaccination Program in Poland, in order to maintain the concentration of anti-HBs antibodies above the protective level (10 j.m./L), additional doses of hepatitis B vaccine are administered to the following persons:

1) chronically ill with immune deficiencies;

2) from the household of hepatitis B patients and the carriers of hepatitis B virus;

3) residing in care facilities, educational institutions and closed establishments;

4) undergoing hemodialysis;

5) undergoing surgery after 5 years of the previous dose of hepatitis B vaccine.

The correct answer is:

A1,2.
B1,2,3.
Call of the above.
D1,3,4.
E1,4.

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Question 68

What procedure should be implemented in the case of a diamniotic dichorionic (DA/DC) twin pregnancy complicated by intrauterine demise of one fetus?

ADIC prevention with the use of heparin.
Bemergent cesarean section.
Cantibiotic therapy.
Dobservation.
Eintravenous tocolytics.

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Question 69

A 24-year-old month postpartum breastfeeding woman decided to use contraception. Which of the following is the best choice?

Aprogestogen-only pills.
Bcervical cap.
Ccombined oral contraceptives.
Destrogen-only pills.
Epatient does not need contraception owing to lactation effect.

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Question 70

What procedure should be implemented in the case of breast swelling and tenderness in a woman that does not wish to breastfeed?

Aoral analgesic.
Bwarm compress to the breast.
Cbroad spectrum antibiotic.
Doral bromocriptine.
Emedroxyprogesterone injection.

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Question 71

A 26-year-old woman has vaginal bleeding 3 months after delivery. Gynecological examination revealed a normal size uterus with a closed cervix. What action should be taken in the first place?

Aultrasound examination.
BDoppler examination.
Cevaluation of β-hCG serum level.
Ddilation and curettage.
Eantibiotic therapy (ampicillin iv).

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Question 72

Normal fetal heart rate is between:

A110-150 beats/min.
B160-180 beats/min.
C100-120 beats/min.
D80-100 beats/min.
Enone of the above.

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Question 73

The following complications can occur in a pregnant diabetic woman:

Aabortion, urinary tract infections.
Bpreterm delivery, polyhydramnios.
Chypertension and preeclampsia.
DA, B and C are true.
Enone of the above is true.

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Question 74

Fetal complications of gestational diabetes include:

Amacrosomia.
Bprematurity, respiratory distress.
Chypoglycemia, polycythemia, hypokalemia.
Dall the above are true.
Enone of the above is true.

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Question 75

The management of atonic uterine bleeding include the administration of:

Aoxytocin.
Bmethylergometrine.
CPGF2α prostaglandin.
Dall of the above.
Enone of the above.

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Question 76

Factors that predispose to breech presentation include:

Apreterm delivery, low birthweight.
Babnormalities of pregnancy implantation in the cases of uterine congenital malformations.
Cfetal anomalies, polyhydramnios or oligohydramnios, multiple gestation.
Dall of the above.
Enone of the above.

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Question 77

The treatment of pre-invasive cervical cancer consists in:

Aexcision of the affected part of the cervix.
Bstrict cytologic and colposcopic examination once a month.
Csimple hysterectomy.
Dradical hysterectomy.
Ebrachytherapy.

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Question 78

The second Leopold’s maneuver is used for:

Apalpation of the uterine fundus and identification which fetal part occupies the fundus.
Bidentifying fetal parts on both sides of the abdomen.
Cidentifying the presenting part.
Dall of the above.
Enone of the above.

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Question 79

Vaginal bleeding during early pregnancy can be a sign of:
1) spontaneous abortion;
2) ectopic pregnancy; termination of pregnancy (TOP);
3) gestational trophoblastic disease;
4) complication after the first trimester;
5) ovarian cancer.
The correct answer is:

A1,3,4.
B3,4,5.
C1,2,3.
D1,2,3,4.
Eall of the above.

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Question 80

Fetal tachycardia is caused by:

1) fetal compensation mechanism;

2) maternal infection;

3) mother’s alcoholism;

4) maternal smoking;

5) mental excitation of the mother.

The correct answer is:

A1,2,3,4.
B2,3,4.
Call of the above.
D2,3,4,5.
E1,2,4,5.

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Question 81

Mayer-Rokitansky-Küstner-Hauser Syndrome (MRKH) is characterized by:

Acongenital absence of the uterus.
Bcongenital absence of the vagina.
Ccongenital absence of the ovaries.
Dcongenital absence of the vagina, partial uterus and Fallopian tube in the presence of the ovaries.
Ekaryotype 46XY and androgen insensitivity.

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Question 82

It is not true that in polycystic ovary syndrome one observes:

Aincreased serum total testosterone
Bincreased serum free testosterone
Chypoestrogenism
Dincreased prolactin level
Enormal levels of insulin

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Question 83

Which of the following symptoms least suggest external and extragenital endometriosis in a 34-year-old woman?

Adysmenorrhea.
Bpainful intercourses.
Cprimary infertility.
Dlower abdominal pain not related to menstrual cycle.
Eprolonged and profound menses, with clots.

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Question 84

Which of the following conditions can lead to either primary or secondary lack of menstruation?

Aanorexia nervosa.
Bovarian dysgenesis.
CAsherman syndrome.
DKallmann syndrome.
ESheehan syndrome.

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Question 85

An 18-year-old woman (BMI=21kg/m2) professionally practicing long-distance running came to the outpatient clinic due to the absence of menses. The history revealed that she never had menses and her breast growth was delayed. In gynecological examination the breasts on Tanner scale were in phase V and the pubic hair in phase IV. Speculum examination showed normal cervix and in bimanual examination the uterus was anteverted and of proper size and both ovaries were normal. The runner did not take any medications and suffered from any chronic diseases; generally she was in a good clinical condition. The most probable diagnosis is:

Aanorexia nervosa.
Bhypogonadotropic hypogonadism.
Ctransverse vaginal septum.
Dandrogen insensitivity syndrome.
Eovarian dysgenesis.

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Question 86

The upper limit of serum Ca-125 level is:

A20 U/mL.
B25 U/mL.
C30 U/mL.
D35 U/mL.
E40 U/mL.

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Question 87

Several findings of elevated blood pressure in a pregnant woman is an indication for hypotension therapy. The first-line medication is:

Aangiotensin-converting enzyme (ACE) inhibitors.
Bdiuretics.
Cα-adrenergic receptor antagonists.
Dmagnesium sulfate.
Emethyldopa.

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Question 88

The most frequent ovarian cancer is:

Amucinous.
Bserous.
Cendometroid.
Dclear cell.
Esquamous cell.

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Question 89

The most frequent cause of an irregular menstrual cycle is:

Aduplex uterus.
Banovulatory cycles.
Chyperprolactinemia.
Dendometriosis.
Ecombined oral contraceptives.

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Question 90

Typical signs and symptoms of vaginal fungal infections include:

1) vaginal pH > 4.5;

2) white, white, cottage cheese-like vaginal discharge;

3) clue cells;

4) hyphae in microscopic examination;

5) itching and burning sensation.

The correct answer is:

A1,3,5.
B2,4,5.
Call of the above.
D1,2,3.
E2,3,4.

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Question 91

Biological effect of estrogens include:

Astimulation of the development of secondary and tertiary sexual characteristics.
Bstimulation of glucagon synthesis.
Cincrease in body temperature.
Ddiuretic effect through aldosterone inhibition.
Edecrease in hypoglycemic effect of the saliva.

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Question 92

The presence of amyloid plaques and neurofibrillary tangles is characteristic of neuropathological examination of the brain in:

APick’s disease.
BAlzheimer’s disease.
CParkinson’s disease.
DHuntington’s disease.
EWilson’s disease.

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Question 93

The “classic triad” (three symptoms) of alcohol delirium includes:

Avisual hallucinations, disorientation, tremor.
Bdisorientation, autonomic hyperactivity, delusions.
Ctremor, tachycardia, agitation.
Dvisual hallucinations, visual illusions, tremor.
Evisual hallucinations, autonomic hyperactivity, lack of criticism.

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Question 94

Which of the following is not a symptom of benzodiazepine overdose?

Asomnolence
Bataxia
Caphasia
Dmemory impairment
Edepression of the respiratory center

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Question 95

Lethal dose of nicotine for human is 50-75 mg. How much nicotine is absorbed into the body after smoking a cigarette?

A0.25 mg.
B0.5 mg.
C1-2 mg.
D5 mg.
Eover 5 mg.

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Question 96

Repeated complains about somatic symptoms and constant requests for further laboratory tests despite their negative results are characteristic features of:

Amelancholic depression.
Bparanoia.
Cobsessive-compulsive disorder.
Dborderline personality disorder. B
Esomatoform disorder.

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Question 97

Mental disorders may be caused by the anticholinergic activity of various medications, except for:

Atricyclic antidepressants.
Bbenzodiazepines.
Cantihistaminic drugs.
Dalkaloids of Datura stramonium (jimson weed).
Espasmolytic drugs.

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Question 98

A complete lack of verbal communication is called:

Aalogia.
Bmutism.
Cstupor.
Dpsychomotor slowness.
Edissociation.

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Question 99

The group of schizophrenia symptoms called “4A” does not include:

Aacathisia.
B“ambi” symptoms.
Cautism.
Dflat affect.
Eassociation disturbances.

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Question 100

Which of the following is necessary for diagnosing bipolar disorder?

Adepression.
Bdysthymia.
Cmania or hypomania.
Dalternating symptoms of anxiety and sadness.
Edelusions of richness.

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Question 101

The risk of suicide is lower if the family is:

Amultigenerational (many generations live in the same household).
Bdisplays full and supportive atmosphere.
Cshows a high rate of expression of emotions.
Dis without familiar history of mental diseases.
Efamiliar atmosphere does not influence the risk of suicide.

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Question 102

Transient (lasting 2-3 days) severe mental disorders as a reaction to exceptional stress of the person who did not previously display any mental disorders, is called:

Afirst episode of schizophrenia.
Bposttraumatic stress disorder.
Cadjustment disorder.
DGanser syndrome.
Eacute stress reaction.

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Question 103

The diagnosis of neuroleptic malignant syndrome does not include:

Adisturbances of consciousness.
Bincrease in muscular tension.
Cdecrease in muscular tension.
Dincrease in body temperature.
Eincrease in creatine phosphatase activity.

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Question 104

Which of the following antidepressants does not belong to the group of SSRI (selective serotonin reuptake inhibitors)?

Afluoxetine.
Bescitalopram.
Cparoxetine.
Dvenlafaxine.
Esertraline.

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Question 105

Method of choice for the treatment of upper gastrointestinal tract bleeding is:

Alaparoscopic surgery.
Bblood or blood substitute transfusion.
Cclassical surgery.
Dendoscopy.
Enone of the above.

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Question 106

Choose the true sentence:

Asurgery is the proper therapy for rectal cancer.
Bcaecum is the most frequent localization of colorectal cancer.
Centeritis is not related to the increased risk of colorectal cancer occurrence.
Dsquamous cell carcinoma is the most common histopathological type of colorectal cancer.
Eneo-adjuvant radiotherapy is the proper therapeutic management for rectal cancer T3N0 localized 5cm from the edge of the anus.

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Question 107

Kwashiorkor is the deficiency of:

Acarbohydrates.
Bwater.
Ccarbohydrates and water.
Dprotein.
Eprotein and carbohydrates.

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Question 108

Prophylaxis of thromboembolic complications includes:

Aearly mobilisation.
BLow Molecular Weight Heparin administration.
Cacetylsalicylic acid administration.
Dcompression stockings.
Eall of the answers are correct.

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Question 109

Which of the conditions mentioned below may be a cause of hyperkalemia?

Aposttraumatic injury of the muscles.
Bchronic diarrhoea.
Chyperthyroidism.
Dcorrect answers are A and C.
Enone of the answers is correct.

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Question 110

Referred by GP, a 32-year-old male came to the outpatient surgery clinic. He presented suppurative wound caused by a rod sticking out from the ground, with fetid substance. The patient is feverish up to 38.0°C, apathetic, erythema is seen around the wound, the skin is tensioned, glittering, on compression palpable tissue crepitus. In the lab tests performed by GP, apart from elevated inflammatory parameters, the creatinin level is also higher than the reference. Which of the proceeding would be the most likely in this case?

Awound culture examination, empiric antibiotic therapy, nephrology consultation, continuous treatment in the outpatient clinic.
Bsurgery department admission, wound culture examination, intravenous antibiotic therapy, extensive necrotic tissue excision, possible limb amputation.
Csurgery department admission, wound culture examination, empiric antibiotic therapy, incision and phlegmon drainage.
Dincision of phlegmon in the outpatient surgical clinic, wound culture examination, empiric antibiotic therapy.
Enone of the answers is correct.

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Question 111

Choose the right set of features characteristic of Leśniowski-Crohn disease:
1) pathologic changes may occur in each part of the digestive tract;
2) pathologic changes are limited to the mucosa and the submucosa;
3) changes are often accompanied by perirectal fistulas;
4) in this disease limited resections are the most appropriate;
5) in this disease extensive resections are the most appropriate.
The correct answer is:

A1,2,4.
B2,3,4.
C2,3,5.
D1,3,4.
E1,2,3,4.

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Question 112

The proper placement of a tube in tube thoracostomy is of primary importance in chest trauma patients’ care. The standard position is in the midaxillary line in the fifth or sixth intercostal space. Which of the following statements are true:
1) this location is usually safely above the diaphragm;
2) this is the area with the thinnest chest wall musculature;
3) this positioning depends on gravitation and assures possibility of removing both: air and blood.
The correct answer is:

Aonly 1.
Bonly 2.
C1,2.
D1,3.
E1,2,3.

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Question 113

The patient treated with oral anticoagulants because of atrial fibrillation comes to hospital with an upper abdominal pain and yellowish discoloration of the sclera. Sonography reveals small gallstones in the gall bladder. The proper management is:
1) endoscopic papillotomy and evacuation of the gallstone from the bile ducts as soon as possible;
2) therapy with spasmolytic drugs and fluids till the gallstone is eliminated from the bile ducts;
3) determination of INR level and – if it is not above 5 – endoscopic papillotomy with the evacuation of the gallstone from the bile ducts;
4) urgent transfusion of 3-4 units of fresh frozen plasma, endoscopic papillotomy with the evacuation of the gallstones from the bile ducts;
5) endoscopic papillotomy and the evacuation of the gallstones from the bile ducts if INR level is below or equals 1.5.
The correct answer is:

Aonly 1.
Bonly 2.
C2,3.
D4,5.
Eonly 5.

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Question 114

Indicate sentences which properly characterize brain concussion:
1) this is a transient loss of consciousness as a result of head trauma, lasting a few seconds or hours;
2) lumbar puncture, which decreases troublesome headaches, is the method of treatment;
3) ischemic stroke can be the complication of concussion;
4) retrograde and anterograde amnesia are characteristic features of brain concussion;
5) headache and vertigo, nausea and vomits frequently last a few days after the trauma.
The correct answer is:

A2,3.
B1,4,5.
C2,4,5.
D2,3,4.
E1,2,3.

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Question 115

The typical symptoms of upper gastrointestinal bleeding do not include:

Asudden fainting or syncope.
Bhemodynamic shock (blood pressure drop, paleness, sweating).
Cvomiting blood clots.
Dtarry stool.
Epresence of fresh blood in the stool.

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Question 116

Choose the true sentences concerning the treatment of upper gastrointestinal tract bleeding:
1) in about 80% the bleeding stops spontaneously or with the conservative treatment;
2) the best method of treatment is to achieve hemostasis with endoscopy;
3) the most effective method of hemostasis is the surgery;
4) the safest method of treatment is endovascular procedure (embolisation of the bleeding vessel);
5) in some cases an effective method of therapy is to control bleeding with the balloon (Sengstaken-Blakemore tube).
The correct answer is:

A1,2,4.
B1,2,5.
C1,4,5.
D3,5.
Enone of the above.

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Question 117

Which of the following sentences concerning the treatment of incarcerated hernia are true?
1) incarcerated hernia can be reduced within the first few hours;
2) hernia may be always undertaken, irrespective of an elapsed time from incarceration;
3) incarcerated hernia should always be treated surgically;
4) reduction of hernia may be associated with the risk of damage to the contents of the hernia sac.
The correct answer is:

A1,4.
B2,4.
C3,4.
Donly 3.
Eonly 4.

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Question 118

Which of the following statements concerning mechanical ileus (colorectal) are true:
1) it is most frequently caused by colon cancer;
2) surgery should include the excision of part of the intestine with the tumor;
3) formation of artificial anus is always necessary;
4) it is caused by sigmoid diverticulosis;
5) artificial anus is not always necessary.
The correct answer is:

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

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Question 119

Which of the following statements concerning hernias in postoperative scar are true:
1) they may become incarcerated;
2) they are frequently caused by wound suppuration;
3) truss is the proper method of treatment;
4) the results of the surgery with or without polypropylene mesh are similar;
5) they are the result of anaemia.
The correct answer is:

A1,2.
B1,3.
C4,5.
D1,5.
E2,4.

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Question 120

Colorectal cancer develops on the basis of:
1) colorectal polyp;
2) hypochromic anemia;
3) familial adenomatous polyposis;
4) ulcerative colitis;
5) colon diverticulosis.
The correct answer is:

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

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Question 121

Which of the following statements concerning hernias of inguinal region are true:
1) their formation is connected with the disorders of collagen metabolism;
2) their formation is connected with the defect of abdomen musculature;
3) laparoscopic surgery is the best method to treat them;
4) femoral hernias are more frequent in men;
5) surgery with the use of plastic mesh gives the lowest rate of recurrence.
The correct answer is:

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

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Question 122

The symptoms of sigmoid cancer are:
1) narrow stools and constipation;
2) anaemia;
3) increased body temperature;
4) cachexia;
5) presence of blood in the stool.
The correct answer is:

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

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Question 123

Which of the following statements is true with regard to the risk of colorectal adenocarcinoma occurrence in patients with Lesniowski-Crohn disease and ulcerative colitis?

Athe risk is similar to the risk in healthy population.
Bthe risk is respectively: 5% (Lesniowski-Crohn disease) and 10% (ulcerative colitis) after 10 years of the illness.
Cthe risk increases with the duration of the illness.
Dthe risk is not related to the duration of the illness and is 30% in the population of patients with Lesniowski-Crohn disease and ulcerative colitis.
Ethe highest risk is related to the presence of proctitis.

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Question 124

A 25-year-old patient came to the ER because of the wound in his right foot. Three hours before, while cleaning up his garage, the plantar surface of his foot had been pierced with a nail. This is a puncture wound but according to the patient the nail stuck in the foot at the depth of about 2 cm. The patient received tetanus vaccine during his military service at the age of 19. Which of the following methods of management is the most correct?

Arinsing the wound, dressing, antibiotic.
Bsurgical debridement, anatoxin.
Csurgical debridement, anatoxin, antibiotic.
Ddebridement, human anti-tetanus immunoglobulin, antibiotic.
Eantiseptic wet dressing, antibiotic, secondary wound suture after debridement.

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Question 125

Which of the following can be used in the treatment of the pancreatic pseudocysts:

AUS-guided percutaneous drainage.
Bsurgical anastomosis.
Cendoscopic drainage.
Dthe answers A and B are true.
Eall the answers are true.

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Question 126

The antibiotic prophylaxis in the treatment of patients with colorectal cancer:

Acan be used only in patients with disseminated disease.
Bshould be introduced one day before the surgery.
Ccan be used only in patients with obstruction.
Dshould be introduced before the operation on the same day.
Ethe answers A and C are true.

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Question 127

The treatment of the first stage of acute pancreatitis includes:

1) treatment of shock, and water and electrolytes disturbances;

2) prevention of secondary infection;

3) surgery – laparotomy;

4) parenteral or enteral feeding;

5) constant suction through the gastric tube.

The correct answer is:

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

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Question 128

Superficial thrombophlebitis:

1) brings a risk of pulmonary embolism;

2) always requires administration of low molecular weight heparins;

3) requires treatment with heparin pump;

4) requires the administration of anti-inflammatory drugs;

5) may be treated with surgical removal of the clot.

The correct answer is:

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

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Question 129

The following are contraindications to laparoscopic cholecystectomy:
1) acute cholecystitis;
2) adhesion in the abdominal cavity;
3) heart failure;
4) 1 and 2 trimester of pregnancy;
5) mechanical jaundice in anamnesis.
The correct answer is:

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

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Question 130

A 85-year-old female patient fell over in her house and suffered a fracture of the femoral neck. The most probable cause of the fracture is:

Alocal osteoporosis.
Bpostmenopausal osteoporosis.
Csenile osteoporosis.
Dbone metastases.
Emultiple myeloma.

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Question 131

The following are the causes of pathological fractures:
1) long lasting bone strain;
2) abuse of anabolic steroids;
3) bone metastases;
4) congenital bone fragility;
5) osteoporosis.
The correct answer is:

A1,3,4.
B1,3,5.
C2,3,4.
D2,3,5.
E3,4,5.

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Question 132

Which of the following suggests bacterial etiology of pharyngitis:

Atemperature above 38.5°C.
Bpresence of cough.
Cpainful enlargement of front cervical lymph nodes.
DA and C are true.
EA, B and C are true.

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Question 133

Indicate the false sentence concerning skin lesions:

Aerythema migrans occurs in Lyme disease (borreliosis).
Bmacular rash with the preceding appearance of petechiae in the natural skin folds (Pastia’s sign) occurs in rubella.
Cpapulo-macular rash with the preceding 3 days of fever occurs in rapid erythema.
Dpolymorphic, multiform lesions present also in the hairy skin are characteristic of chickenpox.
Efusing big macular skin lesions, originating in the head, descending down the trunk to lower extremities and then disappearing in the same order, occur in the measles.

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Question 134

A 32-year-old man presents with chronic cough, excessive production of spu- tum, wheezing. His past medical history is positive for cigarette smoking (10 pack- years) and similar ailments occur in his father; chest X-ray is characteristic of emphysema. The most probable diagnosis in this case is:

Abronchial asthma.
Bcystic fibrosis.
Clung cancer.
Dchronic bronchitis.
Ealpha 1-antitrypsin deficiency.

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Question 135

During the treatment of osteoporosis with bisphosphonates, the patient should receive appropriate calcium and vitamin D supplementation, because oral bisphosphonates are poorly absorbed and should be taken on an empty stomach with water.

Aboth statements are true and remain in the causal relationship.
Bboth statements are true, but without the causal relationship.
Cthe first statement is true, the second is false.
Dthe first statement is false, the second is true.
Eboth statements are false.

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Question 136

A 50-year-old woman with arterial hypertension receives perindopril 5mg, bisoprolol 5 mg and amlodipine 5mg every day. Her blood pressure during this treatment is 160/95 mmHg. GP should proceed to:

Adiagnose resistant hypertension and refer the patient to the specialist.
Bdouble the dose of each drug.
Cadd diuretic (or replace with diuretic one of the drugs received so far).
Dadd sartans (or replace with sartan one of the drugs received so far).
Eadd α-adrenolytic (or replace with α-adrenolytic one of the drugs received so far).

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Question 137

The most frequent cause of the acute coronary syndrome is:

Avascular spasm.
Bclot formed on the damaged atherosclerotic plaque.
Cembolism.
Dinflammation of the coronary vessels.
Evascular malformation.

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Question 138

Patients with acute coronary syndrome, after the discharge form hospital, are recommended to:

Areceive ASA (75-100 mg/d) lifelong.
Breceive clopidogrel for 12 months.
Creceive clopidogrel lifelong when allergic to or intolerant of ASA.
DA and B are true.
EA, B and C are true.

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Question 139

Diagnosis of acute pharyngitis and tonsillitis caused by group A beta- hemolytic streptococcus (PBHA) includes:

Aclinical and epidemiological evaluations (e.g. Centor score).
Bthroat swab or fast PBHA antigen testing.
Cmeasurement of the level of interleukin-6.
DA and B are true.
EA, B and C are true.

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Question 140

Which of the following is found on physical examination of a patient with pneumothorax?

Adiminished or absent breath sounds.
Bdullness on percussion.
Cincreased vocal fremitus.
DA and B are true.
EA, B and C are true.

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Question 141

Patient with suspected gastroesophageal reflux disease needs endoscopy if:

Asymptoms of difficulty on swallowing (dysphagia) are present.
Bpainful swallowing (odynophagia) is present.
Cis more than 40-year-old.
DA and B are true.
EA, B and C are true.

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Question 142

10-year cardiovascular risk of death according to the SCORE board might be higher than indicated by the board in the following people:

Aobese.
Bwith strong positive family history of early cardiovascular disease.
Cwith low HDL-cholesterol concentration.
DA and B are true.
EA, B and C are true.

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Question 143

Pharmacological treatment of moderate COPD consists in:

Aregular use of short-acting anticholinergics 4-6 times per day.
Bregular use of inhaled long-acting bronchodilators.
Cregular use of selective phosphodiesterase 4 inhibitors.
Dregular use of low and/or medium dose of inhaled corticosteroids.
Ead hoc use of selective short-acting β2-agonists.

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Question 144

One of the therapeutic components of COPD treatment, which reduces the risk of development of the disease and stops its progression is:

Aprevention and cessation of smoking.
Bregular physical activity regardless of the stage of the disease.
Cannual flu vaccine.
Dsystematic pharmacotherapy.
Epulmonary rehabilitation.

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Question 145

A injured person, with a low risk of tetanus, who had the last dose of tetanus booster 3 years before, the preventive approach against the development of tetanus is (apart from the proper wound dressing):

Aadministration of tetanus-pertussis (or tetanus) vaccine followed with the vaccination scheme 0-1-6 months.
Badministration of tetanus-pertussis or tetanus booster once.
Cadministration of single tetanus antitoxin and tetanus vaccine according to the scheme 0-1-6 months.
Dadministration of tetanus antitoxin and vaccine in a single booster.
Epatient does not need specific prophylaxis.

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Question 146

The obligatory scheme of varicella vaccination in children is:

Afrom 9 to 13 months of age - single dose
Bfrom 9 to 13 months of age - single dose; 13-years old and older – 2 doses given at 4-6 weeks interval
Ceach child older than 9 months, regardless of age, 2 doses administered at minimum 4 weeks interval
Deach child older than 9 months, regardless of age, 3 doses given according to the scheme 0-4-24 weeks
Enone of the answers is correct

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Question 147

Contraindication to the performance of the oral glucose tolerance test is:

Apreviously diagnosed diabetes.
Bmalabsorption syndromes.
Cpartial gastrectomy.
Dacute myocardial infarction.
Eall of the above.

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Question 148

When giving a student with controlled diabetes the certification for physical education and sport activities, a physician should qualify the person to the group:

AAs.
BA.
CB.
DC.
ECl.

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Question 149

Fagerström questionnaire is used for assessing:

Astrength of nicotine dependence.
Blevel of motivation to quit smoking.
Ctype of obesity.
Dstrength of benzodiazepine dependence.
Edistance of intermittent claudication.

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Question 150

Choose the true statement regarding a randomized controlled clinical trial (RCT):

Ait is a prospective study comparing the effect of intervention versus control group.
Bpatient’s assignment to the control or intervention group is random.
Capplication of the double-blind method prevents the errors of wishful interpretation made by the patient or by physician.
DA and C are correct.
EA, B, C are correct.

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Question 151

Screening test for the presence of strabismus is:

AHirschberg’s test.
Bwhite pupil test.
Ctesting with fork charts.
Dtesting with Ishihara charts.
Eear-eyelid reflex.

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Question 152

Which of the following pharmaceutics is a specific antidote for the poison with cholinolytic-blocking agents?

Aflumazenil.
Bphysostigmine.
Catropine.
Dbenzodiazepine.
Eantihistaminic drugs.

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Question 153

What is the cause of primary spontaneous pneumothorax?

Aruptured bulla or cyst usually located in the apex of the lung.
BStaphylococcal pneumonia.
Ccystic fibrosis.
Dlung metastases.
Etuberculosis.

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Question 154

Which of the following pharmaceutics are used for the treatment of neuroleptic malignant syndrome and malignant hyperthermia ?

Acalcium gluconate.
Bfurosemide.
Cdantrolen.
Ddiphenhydramine.
Ecalcium antagonists.

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Question 155

What is the most frequent cause of pulmonary edema in the patients admitted to the ERs?

Acardiogenic (ACS, myocardial infarction, cardiac arythmias).
Bcardiogenic (congenital and acquired heart defects).
Cpneumonias.
Dintoxications.
Epulmonary embolism.

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Question 156

Immediate mortality at the scene of road accidents victims in Poland is about 50%. What is the leading, most frequent cause of immediate death?

ACNS trauma and blood loss caused by rupture of large thoracic and/or abdominal systemic blood vessels.
Bsuffocation caused by pneumothorax.
Cbleeding caused by liver and/or spleen parenchyma injury.
Dbleeding caused by fracture of the pelvis and long bones.
Erupture of the diaphragm with acute respiratory insufficiency.

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Question 157

Which of the following is not an indication for intubation?

Aunconscious patient with uncontrolled airway patency.
Bpatient with <9 on GCS scale or P(pain) on AVPU scale.
Cnot decompressed tension pneumothorax.
Dairway burns.
Emultiple injury with shock and disturbances of consciousness.

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Question 158

How long after acute myocardial infarction do most deaths happen (about half of all the deaths)?

Ain the first 4 hours of the beginning of infarction.
Bin the first 24 hours after infarction.
Cin the first week after infarction.
Din the first month after infarction.
Ein the first year after infarction.

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Question 159

Which of the following statements concerning defibrillation is not true?

Ait is performed with alternating current with a voltage of 300-500V.
Bit is performed with direct current with a voltage of 3000-5000V.
Cthe most common energy used in adult patients is 200-360J.
Denergy of 4J/kg of body weight is used in children.
Eit should not be used in asystole.

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Question 160

5-8 thousand people per year died in the last decade in road traffic accidents in Poland. The mortality rate for traffic accidents in Poland is 2-3 times higher than in the most economically developed countries of the EU. The ratio of killed/wounded for these countries was 1:39 in the last decade. What was the ratio of killed/wounded in the same period for Poland?

A1:5.
B1:12.
C1:25.
D1:35.
E1:45.

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Question 161

At a construction site one of the workers burned his eye with building lime. What should be done in this situation?

Atake the victim to ophthalmologist as soon as possible.
Bbegin rinsing the eye with neutral fluid as soon as possible.
Capply drops containing antibiotics to the burned eye.
Dapply neutralizing fluid.
Eput dressing on the burned eye and take the victim to the ER.

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Question 162

What are the symptoms of eye burn with ultraviolet radiation?
1) increased lacrimation and photophobia;
2) eye pain occurring a few hours after the irradiation;
3) clouding of cornea;
4) impaired color vision.
The correct answer is:

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

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Question 163

While playing tennis, the man was hit with a ball in the right eye socket. The symptoms are swelling and a small wound of the eyelid upper eye overview and eyeball spots upwards. The patient complains of double vision. Signs of symptoms on:

Afracture of the upper wall of the eye socket
Borbital expansion fracture
Crupture of the upper wall of the eye socket
Dfracture of the top of the eye socket
Enone of above

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Question 164

The leading causes of death by lightning strike are:

Aspine trauma and injury of spinal cord.
Bextensive burns.
Cmulti-organ injury.
Dmyocardial infarction.
Ecirculatory arrest due to respiratory muscles paralysis.

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Question 165

A young man suffered heavy burn of the right hand and of his head while firing off fireworks. What % of his body surface do the burns cover?

A5%.
B9%.
C10%.
D15%.
E18%.

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Question 166

A 1.5-year-old child has been admitted to the ER with the symptoms of food poisoning. The child previously played in the garden. Which of the plants listed below could not have caused the poisoning?

Anettle.
BEnglish ivy.
CConvallaria majalis (lily-of-the-valley).
Dcommon yew.
Enone of the listed plants is poisonous.

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Question 167

Most pulmonary emboli originate from venous thrombi in the:

Acalf.
Bupper extremity.
Clower extremity and pelvis.
Dheart.
Eall the above are equally possible.

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Question 168

Which of the following is the most effective in the treatment of angina pectoris associated with hypertrophic cardiomyopathy?

Anitroglycerine.
Bdigitalis.
Cbeta blocker.
Dmorphine.
Eepinephrine.

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Question 169

Which of the following kinds of tissue have the least electrical resistance?

Askin.
Bnerve, blood vessel.
Cfat.
Dbone.
Etendon.

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Question 170

The law states that the patient or his legal representative has a right to object to the opinion or decision of a doctor, if it affects the rights and obligations of the patient. The objection may be lodged with:

Avoivode, who is the founding body of the health care facility.
Bmedical committee operating at the Patients' Rights Ombudsman.
CMinister of Health.
Ddirector of the healthcare facility.
Epatient has no such right.

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Question 171

In Poland (as in many other countries in Europe) physician’s membership in a particular medical self-government structure (a regional chamber of physicians and dentists):

Adepends entirely on the willingness of a doctor.
Bis mandatory only for physicians working in health care facilities of the Ministry of Defence.
Cis mandatory only for physicians working in health care facilities of the Ministry of Internal Affairs and Administration.
Dis obligatory by law.
Ethe law does not regulate this issue.

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Question 172

Mental Health Protection Act allows for the use of direct coercion against a patient in the form of:

Aadministration of painful injections.
Bphysical restraint, immobilization, isolation, and drug administration.
Conly drug administration.
Disolation in specially prepared rooms.
Eact does not define the powers of health workers in this matter and leaves it to doctor's individual decision.

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Question 173

The doctor has an obligation to provide medical assistance:

Aonly when being on duty.
Bin any case when delay may cause a danger of loss of life, serious health disorder or in other urgent cases.
Cwhen principles of payment are stated.
Dthe rules of ethics does not govern situations in which a physician has a duty to provide assistance.
Ein any situation concerning a minor.

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Question 174

World Medical Association considers its Declaration of Geneva as the foundation of modern bioethics and medical law. It states:

Amedical art is the noblest of all human activities.
Bphysician should avoid lecherous society.
CI shall never give a lethal drug to anyone even if I am asked to.
DI shall be saving the patient's life in any situation.
EI shall never agree to the situation in which religious, ethnic, racial, party or class views might affect me in performing my duty to the patient.

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Question 175

Patient’s corpse must undergo autopsy when:
1) that person died within 12 hours from his admission to the hospital;
2) requested by a legal representative of the deceased;
3) the death cause cannot be defined unequivocally;
4) asked by the Patients' Rights Ombudsman;
5) it is suspected that the death occurred as a result of the crime.
The correct answer is:

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

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Question 176

Autopsy generally cannot be performed within:

A6 hours from a declaration of death.
B12 hours from a declaration of death.
C24 hours from a declaration of death.
D12 hours from issuing a death certificate.
E24 hours from the approval of a person close to the deceased.

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Question 177

A physician may be professionally responsible to the medical court for a professional offense which is:
1) only an intentional crime against life and health;
2) a violation of medical ethics;
3) only non-compliance with current medical knowledge, as a result of which there has been a serious injury or serious health disorder in his patient;
4) an offense specified in the Patient’s Rights Ombudsman’s notice;
5) a violation of the provisions relating to the medical profession.
The correct answer is:

Aonly 1.
B2,4.
Conly 3.
Donly 4.
E2,5.

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Question 178

A policeman visits a physician and, in connection with pending criminal proceedings, he wants to hear the doctor and demands confidential medical information. The doctor can fulfil his demand, provided that: :
1) the policeman shows the police badge or ID card; :
2) the public prosecutor decides to release the doctor from medical confidentiality; :
3) the court orders to release the doctor from medical confidentiality; :
4) the patient to which the information relates agrees; :
5) doctor’s superior agrees. :
The correct answer is:

A1,5.
B2,4.
C2,3.
D3,4.
E2,5.

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Question 179

Access to medical records can be charged if:
1) medical records are shared at the premises of a health care facility;
2) extracts or copies are prepared by a health care facility;
3) an original copy is given for return;
4) an electronic extract or a copy is prepared;
5) it concerns records older than 10 years.
The correct answer is:

A2,5.
B3,4.
C1,3.
D2,4.
E3,5.

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Question 180

In accordance with the Law on an old age and a disability pension paid from the Social Insurance Fund (ZUS), incapacity to work for the pension purposes is ruled for the period not longer than:

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

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Question 181

The Regulation of the Minister of Labor and Social Policy of 2002 on the criteria for assessing disability in people under the age of 16 years does not include the following as a condition necessitating constant care or assistance:

Apsychosis and psychotic syndromes.
Bautism.
Cepilepsy with frequent seizures.
Dfrequent respiratory infections.
Emalignant tumors and hematologic proliferative diseases up to 5 years after treatment.

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Question 182

Social pension is not granted if total incapacity to work resulted from the impairment of the body occurred:

Abefore the age of 18 years.
Bduring high school or university period before the age of 25 years.
Cduring employment.
Dduring doctoral studies.
Eduring postgraduate studies.

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Question 183

After how many days of the end of the previous period of sickness benefit may be granted a new period of sickness benefit if temporary incapacity to work caused by the same disease is stated again?

A20 days.
B30 days.
C40 days.
D50 days.
E60 days.

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Question 184

In accordance with the Law on an old age and a disability pension paid from the Social Insurance Fund (ZUS) a person, who has suffered the impairment of the body, is considered unable to live independently if s/he requires:

Aassistance in daily activities.
Bcare in the acute phase of the disease.
Cassistance in dealing with administrative matters.
Dpermanent and long-term care of another person in meeting basic needs.
Elegal guardian appointed by the court.

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Question 185

The insured person is entitled to appeal to SIF (ZUS) medical board against the ruling of SIF (ZUS) certifying doctor within the following period of the receipt of the decision:

A3 days.
B5 days.
C7 days.
D14 days.
E30 days.

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Question 186

SIF (ZUS) certifying doctor does not issue rulings on:

Apartial incapacity to work.
Btotal incapacity to work.
Ctotal incapacity to work on the farm.
Dpercentage of damage to health.
Einability to live independently.

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Question 187

Who of the following is the author of the definition: “Public health is the science and the art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts…”?

AJulio P. Frank
BCharles-Edward A. Winslow
CDonald Acheson
DWHO
ECommission of the Milbank Foundation

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Question 188

Epidemiological transition that is changing the structure of disease in the world is the result of:

Achanges in socio-economic situation of countries.
Bchanges in the surrounding environment.
Cmodifying effect of these changes on human health determinants.
Dimpact of these determinants on the profile of existing diseases, causes of death, incapacity to work and disability.
Eall of the above.

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Question 189

Health promotion is a process that allows each person to increase the impact on their health, its improvement and maintenance through:

Amaking choices and decisions conducive to health.
Bshaping needs and competence to solve health problems.
Cstrengthening the capacity of health.
DA and B are true.
EA,B and C are true.

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Question 190

According to most actual (2009) epidemiological data in Poland the proportion of deaths due to cardio-vascular diseases (CVD) and cancers to total mortality is about:

A35% CVD and 25% cancers.
B45% CVD and 35% cancers.
C55% CVD and 20% cancers.
D55% CVD and 28% cancers.
Eall the above answers are false.

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Question 191

Health promoting behaviours include:
1) regular consumption of foods rich in homocysteine;
2) regular physical activity;
3) avoiding excessive exposure to sunlight;
4) regular consumption of “red” meat;
5) regular consumption of sea fish.
The correct answer is:

A1,2,5.
B1,2,4.
C2,3,5.
D1,2,3,5.
Eall the answers are true.

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Question 192

Potential beneficial effects of regular physical exercise in patients participating in cardiac rehabilitation program include:
1) reduction of body fat percentage
2) slower heart rate at rest
3) increase in LDL concentration and reduction of triglycerides
4) reduction of the risk of recurrent heart attack by at least 70%
5) better frame of mind
The correct answer is:

A1, 2, 3, 5
B1, 2, 5
C1, 2, 4, 5
D1, 3, 4
Eall the answers are true

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Question 193

Strategic goals of the National Health Programme for 2007-2015 include:

1) reduction of premature mortality due to cardiovascular diseases;

2) reduction of premature mortality due to cancers;

3) reduction of regional and social inequalities in population health status;

4) increase in accessibility of highly specialized services related to imaging diagnostics;

5) increase of at least 20% in national health care expenditures.

The correct answer is:

A1,2.
B1,2,3.
C1,2,3,4.
D1,2,5.
Eall the answers are true.

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Question 194

In treatment of tonsillitis the first-line drugs are:
1) phenoxymethyl penicillin V;
2) first generation cephalosporin (e.g. cefadroxil);
3) second generation cephalosporin (e.g. cefaclor);
4) macrolides.
The correct answer is:

A1,2.
B1,4.
C2,3.
D1,2,3.
Eonly 4.

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Question 195

The contraindications to breast feeding do not include:

Aalcohol and drug abuse.
Bmaternal HSV and HPV infection if specific IgG antibodies are present in neonatal blood.
Cmaternal HIV infection and maternal active tuberculosis.
Dbreast cancer treatment.
Ebreast abscess.

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Question 196

Breast cancer prevention in healthy women without risk factors, according to the recommendations of Polish Union of Oncology, include:

1) self-inspection of the breasts after menses (once a month);

2) ultrasound examination of the breasts every year in women over 30;

3) mammography every 12-24 months in women over 50.

The correct answer is:

A1,2.
B1,3.
C1,2,3.
D2,3.
Eonly 3.

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Question 197

The most effective drug for so called “treatment-resistant schizophrenia” is:

Aclozapine.
Bhaloperidol.
Czuclopenthixol acetate.
Dolanzapine.
Eall of the above mentioned.

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Question 198

In the carbon monoxide poisoning, the half-life of carboxyhemoglobin in the organism of a patient breathing the atmospheric air is about:

A80 minutes.
B250 minutes.
C520 minutes.
D800 minutes.
E24 hours.

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Question 199

Which kind of burns are pathognomonic of lightning strikes?

Apunctate
Blinear
Cthermal
Darborescent
Ein the shape of lightning

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Question 200

Which of the following risk factors contribute to falling ill to diseases of the circulatory system?
1) diabetes;
2) smoking;
3) low physical activity;
4) obesity;
5) hypertension;
6) high blood cholesterol.
The correct answer is:

Aonly 1.
B1,4.
C4,5,6.
D1,2,3,4,5.
Eall of the above.

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