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LEKEXAM / 2012 spring

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Question distribution — 2012 spring session

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

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Question 1

A 56-year-old man has been admitted to hospital because of vomiting. The potassium level in blood serum is 2.4 mmol/l. The patient is not able to eat any foods. Indicate the best way to treat hypokalemia:

A40 mmol potassium chloride solution in a bolus
Bintravenous infusion of potassium chloride diluted in 0.9% saline solution with a speed of 10 mmol KCl per minute
Cintravenous infusion of potassium chloride diluted in 0.9% saline solution with short-acting insulin with a speed of 10 mmol KCl per minute
Dintravenous infusion of potassium chloride in 10% glucose solution with short-acting insulin with a speed of 10 mmol KCl per minute
Eintravenous infusion of potassium chloride in 10% glucose solution with short-acting insulin with a speed of 10 mmol KCl per hour

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Question 2

A 87-year-old woman has been admitted to hospital because of dehydration, low blood pressure and sinus tachycardia. Indicate the best way to treat tachycardia:

Averapamil intravenous injection.
Bverapamil administered orally.
Cbisoprolol administered orally.
Dmetoprolol administered orally.
E0.9% sodium chloride intravenous infusion.

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Question 3

A 74-year-old woman has been admitted to hospital because of dehydration. She takes ramipril 10 mg once a day. The serum creatinine concentration is 176 μmol/l. The normal values of serum creatinine concentration have been observed previously. Blood pressure is 90/60 mmHg. Which of the following treatment is correct?

Astop ramipril and give thiazide diuretics.
Bstop ramipril and give loop diuretics.
Cstop ramipril and give aldosteron antagonist.
Dstop ramipril and start intravenous 0.9% NaCl infusion.
Econtinue ramipril and start intravenous 0.9% NaCl infusion.

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Question 4

Which of the following antibiotics should be used as empiric first-line treatment in a 30-year-old woman with bacterial urinary tract infection?

Athird-generation cephalosporin.
Bsecond-generation cephalosporin.
Cfirst-generation cephalosporin.
Dantibiotics from fluoroquinolone group.
Eantibiotics from aminoglycoside group.

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Question 5

65-year-old man has been admitted to hospital because of nose bleeding. The patient takes acenocoumarol 3 mg once a day because of permanent atrial fibrillation. Indicate the best medical test to confirm the overdosing of acenocoumarol:

Ableeding time.
Bprothrombin time.
Cvitamin K concentration in blood plasma.
Dfactor VIII concentration in blood plasma.
Eactivated partial thromboplastin time.

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Question 6

Chronic Helicobacter pylori infection can lead to the development of:
1) gastric ulcer;
2) vitamin B12 deficiency;
3) bacterial overgrowth syndrome;
4) Barrett oesophagus;
5) gastric MALT lymphoma.
The correct answer is:

Aall the above.
B1,2,3,5.
C1,2,4.
D1,2,5.
E1,2,4,5.

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Question 7

The factors that trigger jaundice in the most common congenital hyperbilirubinemia, i.e. Gilbert's syndrome, include:
1) stress;
2) physical exercise;
3) starvation;
4) alcohol consumption;
5) febrile illness;
6) premenstrual period in women.
The correct answer is:

A1,2,3,5.
B2,3,5,6.
Call the above.
D1,2,4,5,6.
E1,2,3,4,5.

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Question 8

A 50-year-old male with chronic fatigue, itchy skin, weight loss, and a history of ulcerative colitis. Physical examination reveals the yellowing of the skin and mucous membranes, as well as numerous scratches on the skin; laboratory studies: increased ALP and GGT (2-10 fold), AST and ALT (2-4 fold). The most likely diagnosis is:

Aprimary sclerosing cholangitis.
Bautoimmune hepatitis.
Cprimary biliary cirrhosis.
Dintrahepatic cholestasis.
Echronic cholangitis.

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Question 9

Contraindications to the use of ursodeoxycholic acid (UDCA) in the treatment of cholecystolithiasis are:

1) pigment stones;

2) calcium stones;

3) deposits with a diameter exceeding 15 mm;

4) multiple stones;

5) pregnancy;

6) obesity. The correct answer is:

A1,2,3,5.
B4,5,6.
Call the above.
Dnone of the above.
Eonly 5.

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Question 10

The common causes of acute pancreatitis are:
1) stones in the gallbladder and biliary tract
2) alcohol
3) endoscopic retrograde cholangiopancreatography
4) some medications
5) abdominal trauma
6) bacterial infections
The correct answer is:

A1, 2, 3
B1, 2, 6
C2, 3, 6
D3, 5, 6
Eall the above

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Question 11

The complications of chronic pancreatitis include:
1) pancreatic cancer;
2) true pancreatic cyst;
3) pseudoaneurysm of the vessels in the vicinity of the pancreas;
4) narrowing or obstruction of the common bile duct or duodenum;
5) pancreatic ascites.
The correct answer is:

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

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Question 12

Risk factors for pancreatic cancer include:
1) smoking
2) chronic pancreatitis
3) acute pancreatitis
4) genetic predisposition
5) large intake of fat and meat
6) diabetes
The correct answer is:

Aall the above
B1, 3, 5
C1, 4, 5, 6
D1, 2, 3, 4, 5
E1, 2, 4, 5, 6

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Question 13

Hematuria is not a feature of:

Arenal carcinoma.
Binterstitial nephritis.
Chypocalciuria.
Drenal papillary necrosis.
Eglomerulonephritis.

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Question 14

Chronic hepatitis C infection:

Ahas renal manifestation in up to 30% of patients.
Bis a cause of mixed cryoglobulinemia.
Cmay cause nephritic syndrome.
Dall the above statements are true.
EB and C are true.

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Question 15

Pulmonary-renal syndrome is typical of:

AGoodpasture syndrome.
BANCA-associated small-vessel vasculitis.
Clupus erythematosus.
Dcryoglobulinemia.
Eall the above.

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Question 16

Which of the following concerning IgA nephropathy is false?

Aclassically is characterized by episodic hematuria.
Bis associated with the deposition of IgA in the Bowman’s capsule.
Cis one of the most common forms of glomerulonephritis worldwide.
Dshould be distinguished from Henoch-Schőnlein purpura.
Emay be familial.

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Question 17

Which of the following is not a risk factor for diabetic nephropathy?

Ahyperglycemia.
Bnormal blood pressure.
Cdyslipidemia.
Dsmoking.
Efamily history of diabetic nephropathy.

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Question 18

Which of the following concerning cholesterol emboli is false?

Ais caused by the release of plague cholesterol crystals into the circulation.
Bmost commonly follows endovascular procedure involving large arteries, such as aorta.
Cshould be treated with anticoagulants.
Dmay manifest itself through cerebral transient ischemic attacks.
Eoften livedo reticularis in the lower extremities is present.

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Question 19

Hypertensive nephropathy:

Ais arteriolosclerosis, chronic nephrosclerosis and interstitial fibrosis of the kidneys.
Bis 5 times more common in white race.
Cdevelops in most patients with hypertension.
Dshould be confirmed by renal biopsy.
Eis characterized by nephrotic syndrome.

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Question 20

Impaired renal blood flow may be caused by:

Anon-steroidal anti-inflammatory drugs.
BACE inhibitors.
Ccyclosporine.
Dangiotensin receptor blockers.
Eall answers are correct.

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Question 21

Acute kidney injury:

Ais associated with significantly increased mortality.
Bmay progress to end-stage renal disease in up to 10% of patients.
Ccomplete recovery is possible in some patients.
Dall the above are true.
EA and C are true.

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Question 22

A 52-year-old patient with a history of hypertension and hyperlipidemia was attended in the Emergency Room due to intense chest pain radiating to his back, accompanied by dyspnoea. On physical examination asymmetry in radial pulse and a diastolic murmur were found. Which is the most probable diagnosis?

Aacute mitral insufficiency.
Bmyocardial infarction.
Caortic dissecting aneurysm.
Dpulmonary embolism.
Epneumothorax.

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Question 23

A 75-year-old female patient with a two month history of stenokardia, palpitations and dizziness. Physical examination reveals a crescendo-decrescendo systolic murmur at the base of the heart radiating to the neck. Which is the most probable valvular heart disease?

Amitral stenosis.
Bmitral regurgitation.
Caortic stenosis.
Daortic regurgitation.
Etricuspid regurgitation.

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Question 24

Which of the following heart diseases can be treated with cardiac resynchronization therapy (CRT)?

Aacute coronary syndrome.
Bhypertension.
Cchronic heart failure.
Datrial fibrillation.
Eaortic stenosis.

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Question 25

Which of the following is the possible complication of coronary angiography?

Acardiac arrest.
Banaphylactic shock.
Ccontrast induced nephropathy.
Dhaemotoma at the puncture site.
Eall the above.

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Question 26

Which is the best laboratory marker reflecting heart failure advancement?

ACKMB.
Btroponin.
CproBNP.
DD-dimer.
Ehaemoglobin.

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Question 27

Which of the following is not associated with right-sided heart failure?

Aperipheral oedemas.
Bbasal crepitations in the lungs.
Cjugular vein distention.
Dpositive hepatojugular reflux.
Eascites.

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Question 28

Digoxin overdose may be associated with the following side effects:

Aparoxysmal atrial tachycardia with block.
Bincrease in ventricular arrhythmia.
Csinus bradycardia.
Dsecond degree atrio-ventricular block.
Eall of the above.

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Question 29

Atrial fibrillation may be complicated with:

Aaggravation of heart failure symptoms.
Bstroke.
Cdecrease in the quality of life.
Daggravation of stenocardia.
Eall of the above.

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Question 30

The photosensitivity is typical of:

Asystemic sclerosis.
Brheumatoid arthritis.
Csystemic lupus erythematosus.
Dpolymyositis.
Enone of the above.

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Question 31

Ketoprofen is a nonsteroidal anti-inflammatory drug given as a therapy for various types of arthritides. The maximal daily dose is:

A50 mg.
B100 mg.
C200 mg.
D1000 mg.
Eketoprofen is not a nonsteroidal anti-inflammatory drug.

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Question 32

A 55-year-old obese male woke up in the early morning with a strong pain and the swelling of the right toe. The skin in this region was red and warm. In laboratory testing: uric acid 10 mg/dl. The reasonable therapeutic option in the presented acute attack of the underlying disease is:

Acolchicine 1 mg each 6h during the first day.
Bacetylsalicylic acid 75 mg/d.
Cacetaminophen.
Dtramadol.
EA and/or B are true.

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Question 33

Which of the following is not a risk factor for osteoporosis?

Aincreased coffee intake.
Badvanced age.
Cobesity.
Dlong-term steroid therapy.
Evitamin D deficiency.

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Question 34

A rheumatoid factor may be present in the serum of patients with:

Arheumatoid arthritis.
Bviral hepatitis.
Cborreliosis.
Din the normal elderly.
Eall the above.

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Question 35

A 65-year-old obese female is complaining about stiffness occurring after prolonged rest (sitting or lying), pain in the joints of both hands and knees. In physical examination: Heberden’s nodules, genu varum. In X-ray imaging: osteophytes. In laboratory testing: ESR 12 mm/h. In the presented case the following should be diagnosed:

Aosteoarthritis.
Brheumatoid arthritis.
Cpolymyalgia rheumatica.
Dsystemic lupus erythematosus.
EPaget disease.

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Question 36

Which of the following body regions is/are typically involved in polymyositis?

Ahands.
Babdomen.
Cpectoral and /or pelvic girdle.
Dface.
Eall the above.

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Question 37

Dyspnoea, dry cough and decreased exercise tolerance occurring in the course of systemic sclerosis are related to:

Ainterstitial lung disease.
Bpulmonary hypertension.
Cemphysema.
Dbronchial asthma.
EA and B are true.

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Question 38

Which of the following autoantibodies are the most specific ones to systemic lupus erythematosus (SLE)?

Aanti-dsDNA.
Banti-Scl-70.
Canti-Jo1.
Danti-CCP.
Eanti-SS-A, anti-SS-B.

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Question 39

In rheumatoid arthritis, the first line modifier drug is / are:

Aglucocorticosteroids
Bnon-steroidal anti-inflammatory drugs
Cacetaminophen (paracetamol)
Dmethotrexate
Ebiological drugs with anti-TNFα anti-cytokine activity

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Question 40

Immunosuppressive treatment after renal transplantation significantly increases a risk of cancer development. In renal transplant recipients the most common neoplasms are:

Aliver tumors.
Bskin tumors.
Cbreast cancers.
Dcolon cancers.
Eleukemia.

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Question 41

The indications for blood pressure measurements in children aged <3 years are:
1) complications of perinatal period: prematurity, low weight at birth;
2) recurrent UTI/abnormalities of urinary tract;
3) malignancies;
4) post organ transplantation status;
5) diseases connected with hypertension.
The correct answer is:

A1,2.
B1,2,3.
C3,4.
Dall the above.
Eonly 5.

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Question 42

Which of the following tests GP should perform in a child with elevated arterial blood pressure?
1) diagnose arterial hypertension in the course of three visits;
2) confirm the diagnosis with ABPM (ambulatory blood pressure monitoring);
3) classify the hypertension;
4) make a preliminary assessment of organ damage and/or metabolic disorders;
5) refer to hospital.
The correct answer is:

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

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Question 43

In a child with paroxysmal arterial hypertension one should perform:
1) kidney ultrasound imaging;
2) abdomen CT or MRI;
3) measurement of noradrenaline and adrenaline metabolites;
4) adrenal scintigraphy with metaiodobenzylguanidine (MIBG);
5) echocardiography.
The correct answer is:

A1,2,3.
B2,3.
C3,4.
Donly 5.
Eall the above.

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Question 44

A tuberculosis risk after M. tuberculosis infection in children without immune deficiencies is the highest in the following age group:

A< 12 months.
B12-24 months.
C2-4 years.
D5-10 years.
E> 10 years.

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Question 45

The beginning of neonatal lung ventilation causes:

Adecreased PaCO2 and increased PaO2 and pH.
Bincreased PaCO2, PaO2 and pH.
Cincreased PaCO2 and decreased PaO2 and pH.
Ddecreased PaCO2, PaO2 and pH.
Edecreased PaCO2 and pH and increased PaO2.

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Question 46

Detailed physical examination should be carried out by a pediatrician (neonatologist) within the first:

A2 hours after birth.
B6 hours after birth.
C8 hours after birth.
D12 hours after birth.
E24 hours after birth.

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Question 47

In older children the most common causes of vomiting, which require surgical intervention are:

Aappendicitis, peritonitis, obstruction from adhesions
Bpyloric stenosis, peritonitis, necrotizing enterocolitis
Cintussusception, gastroesophageal reflux, obstruction
Dobstruction from adhesions, necrotizing enterocolitis, Hirschsprung disease
Eintestinal malrotation, Hirschsprung disease, peritonitis

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Question 48

Babinski’s reflex – when the sole of the foot is stroked the big toe moves toward the top of the foot and the other toes fan out – may physiologically occur in children:

Aup to 6 months old.
Bup to 12 months old.
Cup to 18 months old.
Dup to 24 months old.
Eit cannot occur.

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Question 49

Tetralogy of Fallot constitutes about 3-5% of congenital heart defects and is characterized by:

Aventricular septal defect (VSD), narrowing of the right ventricular outflow tract, trans- location of the aorta above the ventricular septal defect, right ventricular hypertrophy.
Batrial septal defect (ASD), narrowing of the left ventricular outflow tract, transloca- tion of the aorta above the ventricular septal defect, right ventricular hypertrophy.
Catrial septal defect (ASD), left ventricular hypertrophy.
Dventricular septal defect (VSD), translocation of the aorta above the ventricular septal defect, left ventricular hypertrophy.
Eventricular septal defect (VSD), narrowing of the left ventricular outflow tract, trans- location of the aorta above the ventricular septal defect, left ventricular hypertrophy.

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Question 50

Scarlet fever is an acute infectious disease caused by group A Streptococci. It can cause the following complications:

1) lymphadenitis;

2) otitis media;

3) nephritis;

4) arthritis;

5) myocarditis and endocarditis.

The correct answer is:

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

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Question 51

Assessment of neonatal maturity is possible through the use of a scale:

AChild.
BTanner.
CBallard.
DPirquet.
EGlasgow.

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Question 52

Which of the following manoeuvres is performed in a physical examination on infants to screen for the development of the hips?

ALasegue and Moro.
BBarlow and Ortolani.
CBarlow and Lasegue.
DOrtolani and Lasegue.
EMoro and Barlow.

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Question 53

Grott’s palpation method is performed to examine:

Apancreas.
Bstomach.
Cintestines.
Dliver.
Espleen.

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Question 54

Which of the following is an absolute contraindication to parenteral nutrition in children and adolescents?

Anecrotizing enterocolitis.
BHirschsprung’s disease
Cperinatal intestinal perforation.
Dshock.
Eimmunological enterocolitis.

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Question 55

A 13-year-old girl with abdominal pain with no specific location (mostly in the umbilical region), sudden beginning, crampy character and short-lasting (up to 10 minutes). The abdominal pain is increasing during a rest and decreasing during exercise. The most probable diagnosis is:

Apsychogenic abdominal pain.
Bsomatic abdominal pain.
Cfunctional abdominal pain.
Dorganic abdominal pain.
Eall the answers are false.

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Question 56

A 2-month-old female infant was admitted to hospital due to defecation disorders (alternating constipation and diarrhoea) and a loss of appetite. In medical examination abdominal distension and the empty rectal ampulla in a per rectum study were noticed. The contrast enema showed a stricture in the distal part of the colon with a widening above. In histopathological study - a lack of ganglion cells in the rectum. The diagnosis is:

Afunctional constipation.
BHirschsprung’s disease.
Cirritable bowel syndrome.
Dulcerative colitis.
Eintestinal colic.

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Question 57

Which of the following should be applied in the medical management of vesicoureteral reflux?

Apenicillin.
Bamoxicillin.
Camoxicillin with clavulanic acid.
Dnifedipine.
Efurazidin.

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Question 58

Which of the following should be applied in the first line treatment of febrile convulsions in a 7-year-old boy?

Avalproic acid.
Bclonazepam.
Ctopiramate.
Ddiazepam.
Evigabatrin.

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Question 59

In which of the following is a malformation of the brain which consists of a downward displacement of the cerebellar tonsils through the foramen magnum?

ADandy’ego-Walker.
BPrader and Wille.
CAngelman.
DPeutz-Jeghers.
EArnold-Chiari.

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Question 60

The characteristic symptoms of sepsis in newborns are:
1) fever;
2) hypothermia;
3) respiratory disorders;
4) jaundice;
5) hepatomegaly.
The correct answer is:

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

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Question 61

The diagnosis of juvenile idiopathic arthritis is excluded by:

Alack of rheumatoid factor (RF).
Black of anti-citrullinated protein antibodies (anti-CCP).
Cpresence of antinuclear antibodies (ANA).
Dinflammation of a single joint.
Enone of the above.

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Question 62

In the severe course of systemic juvenile idiopathic arthritis many symptoms which are present in proliferative diseases could be observed. What are the common symptoms that could be observed in either case?

Alymphadenopathy.
Bhepatosplenomegaly.
Cfever.
Darthritis.
Eall the above.

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Question 63

What are the side effects of chronic glucocorticosteroids therapy?
1) hypertension;
2) osteoporosis;
3) gastritis;
4) diabetes;
5) hyperkalemia.
The correct answer is:

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

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Question 64

Scarlet fever is an infectious disease caused by the group A Streptococci producing erythrogenic toxin. Which of the following symptoms are typical of this disease:
1) face appears flushed but with the presence of circumoral pallor;
2) presence of gray-white, sand grain-seized dots on buccal mucosa (Koplik spots);
3) rash that appears unsymmetrically every couple of hours, initially as small red papules and rapidly progresses to non-umbilicated oval vesicles;
4) areas of more intense erythema are noted in skin folds (Pastia lines);
5) red strawberry tongue;
6) palm and finger skin may peel off in thick patches 2 weeks after the relief of rashes.
The correct answer is:

A1,2,4,5,6.
B1,4,5,6.
C1,2,4,5.
D1,3,4,5,6.
Eall the above.

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Question 65

Accidental poisoning is one of the most common life-threatening conditions in the 1-5-year-old age group of patients. Which of the following is an incorrect method of initial therapy in the case of a patient who is conscious and without respiratory and heart rhythm abnormalities?

Ain the case of drug poisoning vomiting should be provoked
Bin the case of a lack of emesis after provocation one should perform a gastric lavage
Cgastric lavage should be the routine management of detergent poisoning
Din the case of corrosive substance ingestion one should not provoke emetic reaction. The proper management is to give 2-3 egg whites in 100 ml of water.
Ein the case of toxic plant ingestion one should provoke an emetic reaction

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Question 66

The Apgar Score assessment includes 5 clinical parameters excluding:

AGIT function (meconium presence).
Bcardiac function (heart rate).
Crespiration.
Dcolor of the body.
Emuscle tone.

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Question 67

Which of the following cardiac anomalies is/are the most characteristic of Turner syndrome:

Apulmonary stenosis, VSD.
Bbicuspid aortic valve and coarctation of the aorta.
Chypoplastic left heart syndrome (HLHS).
Dtetralogy of Fallot.
EAVSD.

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Question 68

The triad of symptoms of ectopic pregnancy localized in the salpinx includes:
1) temperature above 38.3°C;
2) period of amenorrhoea;
3) abdominal pain;
4) watery vaginal discharges;
5) vaginal bleeding.
The correct answer is:

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

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Question 69

Which of the following is the most likely disease in patient with temperature above 38°C, pain with movement of the cervix, tenderness of the uterus and/or ovaries on palpation, and with muco-purulent vaginal discharge?

Apelvic inflammatory disease.
Bectopic pregnancy.
Cdiverticulosis.
Dpelvic endometriosis.
Erupture of ovarian tumor.

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Question 70

The most common unrelated to pregnancy cause of acute abdomen during pregnancy is:

Aintestinal obstruction.
Bacute cholecystitis.
Cacute appendicitis.
Dduodenal ulcer.
Erupture of liver.

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Question 71

Generally, anemia in pregnant women can best be defined as:

Alack of iron stores.
Bgenetic defect.
Cfolic acid deficiency.
Dhemoglobin below 11 g/dL.
Elow blood volume.

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Question 72

Which of the following is released from the Graafian follicle during ovulation?

Aprimary oocyte.
Bprimary oocyte and first polar body.
Csecondary oocyte.
Dsecondary oocyte and first polar body.
Esecondary oocyte and second polar body.

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Question 73

During which of the following conditions would serum prolactin reach the highest level?

Asleep.
Bovulation.
Cparturition.
Dmenopause.
Eorgasm.

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Question 74

Tyrosine is an essential amino acid for the biosynthesis of:

Adopamine.
BGnRH.
Cdynorphin.
Dvasopressin.
Eprostaglandins.

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Question 75

A 76-year-old obese patient reported to a doctor because of slight vaginal bleeding for two weeks. The last menstruation occurred 22 years ago. She never was pregnant, did not take oral contraceptives nor hormonal replacement therapy. She suffers from diabetes mellitus for 20 years and takes oral hypoglycemic drugs. The best way to find the cause of the bleeding is:

Atransvaginal ultrasound examination.
Bto calm the patient and to plan a control visit in 2 weeks.
Ccytological examination.
Dcolposcopy and cervical biopsy.
Edilation and curettage with histopathological examination of the removed tissue.

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Question 76

The diagonal conjugate can be measured clinically to help predict ability to deliver a baby vaginally. In the normal pelvis it should be at least:

A6 cm.
B8.5 cm.
C10 cm.
D12 cm.
E14 cm.

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Question 77

The diagnostic criteria of antiphospholipide syndrome include the following except:

Aproteinuria.
Bthrombosis.
Crecurrent pregnancy loss.
Dpresence of anticardiolipin antibodies.
Epresence of lupus anticoagulant.

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Question 78

Hyperemesis gravidarum is frequently accompanied by:

Adiabetes.
BCushing syndrome.
Chypoparathyroidism.
Dhypothyroidism.
Ehyperthyroidism.

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Question 79

Which of the following is not associated with an increased risk of ectopic pregnancy?

Aprevious pelvic inflammatory disease.
Bprevious Fallopian tube surgery.
Cin vitro fertilization.
Doral contraception.
Esalpingitis.

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Question 80

Blood pressure ≥140/90 mmHg after 20. weeks of gestation and proteinuria ≥ 300 mg/24 hours represent the diagnostic criteria of:

Agestational hypertension.
Bpreeclampsia.
Ceclampsia.
Dchronic hypertension.
Enone of the above.

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Question 81

Which agent is used to stimulate the development of the fetal lungs in the case of threatened preterm labor?

Abetamethasone.
Bfenoterole.
Cmagnesium sulphate.
Dprednisone.
Enifedipine.

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Question 82

The most frequent mechanism of placental delivery is:

ADuncan mechanism.
BSchultze mechanism.
CBracht mechanism.
DDeLee mechanism.
Enone of the above.

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Question 83

The intercristal distance in a woman should be:

A20-21 cm.
B23-24 cm.
C25-26 cm.
D28-29 cm.
E30-31 cm.

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Question 84

Differential diagnosis of hyperemesis in pregnancy should take into consideration:

1) enteritis and gastritis;

2) cholecystitis;

3) acute pancreatitis;

4) primary hyperparathyroidism;

5) primary hypoparathyroidism.

The correct answer is:

A1,3,5.
B1,3,4
C2,3,4.
D2,3,5.
EAll of the above.

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Question 85

The following conditions are the risk factors for ectopic pregnancy:
1) infection with Chlamydia trachomatis;
2) fallopian tube surgery in anamnesis;
3) pelvic inflammatory disease in anamnesis;
4) presence of IUD in the uterus;
5) candidiasis of the vagina and the uterine cervix.
The correct answer is:

Aall the above.
B1,3,5.
C2,3,4.
D2,3,4,5.
E1,2,3,4.

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Question 86

Vitamin A deficiency in pregnancy may cause in the fetus:
1) growth disorders;
2) congenital xerophthalmia;
3) central nervous system malformation;
4) excessive adipose tissue;
5) prematurity.
The correct answer is:

Aall the above.
B1,3,5.
C2,3,4.
D1,2,3,5.
E1,3,4.

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Question 87

The following symptoms are necessary to diagnose pregnancy:
1) abdominal girth increase;
2) hearing of fetal cardiac activity;
3) fetal visualization during an ultrasound examination;
4) increased level of human chorionic gonadotropin;
5) increased level of human placental lactogen.
The correct answer is:

Aall the above.
B1,2,3,4.
C2,3,4.
D2,3,4,5.
E2,3.

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Question 88

Delayed puberty in girls or arrest of sexual development in women may be caused by:

Aendometriosis.
Banorexia nervosa.
Cnocturia.
Dovarian tumour producing estrogens.
Epolycystic ovary syndrome.

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Question 89

A 17-year-old girl reported to a medical office because of a pain in her lower abdomen. Despite normal tertiary sexual characteristics she never menstruated. Which of following should be considered as a possible diagnosis?

Aunicornuate uterus.
Buterus didelphys.
Cseptate uterus.
Drudimentary horn of the uterus.
Econgenital absence of the cervix.

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Question 90

Which of the following diseases are caused by viruses:
1) syphilis;
2) molluscum contagiosum;
3) Herpes genitalis;
4) gonorrhea;
5) trichomoniasis;
6) chancroid.
The correct answer is:

A1,2.
B2,3.
C3,4.
D5,6.
E3,6.

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Question 91

Which of the following tumours is observed in Lynch II syndrome?

Acervical cancer.
Bvulvar cancer.
Cendometrial cancer.
Dvaginal cancer.
Enone of the above.

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Question 92

Which of the following tumours should be treated with chemotherapy as a treatment of choice?
1) cervical cancer;
2) choriocarcinoma;
3) ovarian cancer;
4) fallopian tube cancer;
5) vulvar cancer.
The correct answer is:

Aonly 2.
B2,3.
C3,4.
Donly 4.
E4,5.

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Question 93

CIN-2 found in a patient at 24 weeks of gestation makes it necessary to perform:

Aamputation of the cervix.
Bconization of the cervix.
Conly repeated colposcopic examinations of the cervix until the delivery.
Dtreatment with glucocorticosteroids and cesarean section at 28 weeks of gestation.
Ekriotherapy of the cervix.

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Question 94

A cognitive impairment clearly associated with stroke is essential for the diagnosis of:

AAlzheimer’s disease.
BParkinson’s disease.
Cmulti-infarct dementia.
DHuntington’s disease.
EPick’s disease.

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Question 95

Which of the following is not part of chronic alcohol-induced psychotic states?

Achronic reaction to stress.
Balcoholic paranoia.
Cchronic alcoholic hallucinosis.
Dalcoholic depression.
EKorsakow’s psychosis.

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Question 96

Which of the following is not a typical symptom of benzodiazepines overdose?

Asomnolence.
Baphasia.
Capraxia.
Dmemory impairment.
Edepression of the respiratory center.

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Question 97

Schizoaffective disorder is diagnosed when in the clinical picture there are features of schizophrenia and:

Adepression
Bmania
Chypomania
Dbipolar affective disorder
Esubdepression

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Question 98

The term “paranoia” is currently replaced by the term:

Aschizophrenia.
Bdelusional disorders.
Cacute and transient psychotic disorders.
DOtello syndrome.
Eschizoaffective disorder.

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Question 99

According to the ICD-10 the diagnosis of mania requires the duration of symptoms for at least:

A3 days.
B4 days.
Cone week.
D10 days.
Eone month.

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Question 100

Which of the following statements best describes the role of antidepressants in suicide risk?

Aantidepressants decrease the risk of suicide.
Bantidepressants increase the risk of suicide.
Cthe role of antidepressants in suicide risk is not clear.
Dtricyclic antidepressants increase the risk of suicide.
Ethe SSRIs decrease the risk of suicide.

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Question 101

Panic attacks are frequent in patients with the following medical conditions, except:

Aacute pain syndromes.
Bmitral valve prolapse syndrome.
Canorexia nervosa.
Dadrenal function disturbances.
Ethyroid function disturbances.

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Question 102

The diagnosis of ADHD requires the presence of concentration disturbances, hyperactivity, and:

Aimpulsive behaviour.
Bmemory disturbances.
Clow intellectual performance.
Dlow body height.
Eeating disorder.

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Question 103

Side effects of antipsychotic drugs: extrapyramidal, hyperprolactinaemia, and sexual dysfunction are associated with the affinity of those drugs for:

Aadrenergic system.
BGABA-ergic system.
Cserotoninergic system.
Dglutamatergic system.
Edopaminergic system.

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Question 104

Which of the following is not a risk factor for extrapyramidal side-effects of antipsychotic drugs?

Ayoung age.
Bunstable blood pressure.
Cfrequent changes of the doses of antipsychotics.
Dmale sex.
Euse of psychoactive substances.

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Question 105

Which of the following antidepressants acts mainly through the noradrenergic transmission?

Afluvoxamine.
Bvenlafaxine.
Ccitalopram.
Dreboxetine.
Esertraline.

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Question 106

What is the correct serum lithium level in the prophylactic treatment of bipolar disorder?

A0.5 – 0.8 mmol/l.
B0.8 – 1 mmol/l.
C1 mmol/l.
D1.2 mmol/l.
Elithium level is not important for therapeutic effects.

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Question 107

Which of the following drugs is primarily used in the pharmacological treatment of nicotine dependence?

Abuspirone.
Bbupropion.
Cbuprenorphine.
Dbutyrophenon antipsychotics.
Ebudesonide.

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Question 108

Which of the following medications are administered in the case of bleeding caused by oral anticoagulants overdose?

Afresh frozen plasma preparations.
Bplatelets preparations.
Chuman recombinant factor VII.
DA and C.
EA, B and C.

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Question 109

The plain abdominal film should be ordered to confirm:

Agastrointestinal obstruction.
Bgastrointestinal perforation.
Ccholecystolithiasis.
DA and B.
EA, B and C.

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Question 110

Acute cholangitis occurs as a result of bile infection induced by impaired bile duct patency which in turn is caused by:

Acholedocholithiasis.
Bbile duct neoplasms.
Ciatrogenic biliary damage.
Dparasites.
Eall the above.

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Question 111

Which of the following are true?
1) alcohol ingestion is one of the most frequent causes of acute pancreatitis;
2) chronic pancreatitis is related to the increased risk of pancreatic cancer;
3) about 50% of cases of acute pancreatitis is severe;
4) Whipple surgery procedure is the basic surgical treatment of acute necrotizing pancreatitis.
The correct answer is:

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

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Question 112

Is cholecystectomy indicated in the treatment of asymptomatic patients with a sonographic picture of normal thickness of the gallbladder wall and multiple gallbladder stones?

1) yes, on the patient’s explicit request;

2) never;

3) yes, in patients awaiting cardiac surgery;

4) yes, in patients requiring immunosuppressive treatment.

The correct answer is:

Aonly 2.
B1,3.
C1,3,4.
D3,4.
Eonly 1.

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Question 113

In which of the following situations percutaneus endoscopic gastrostomy (PEG) would be inappropriate?

Ain the case of obstructing esophageal tumor.
Bin the case of obstructing gastric cardia tumor.
Cin the case of obstructing gastric pylorus tumor.
DA and B.
EA, B and C.

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Question 114

70-year-old female comes to the ER because of abdominal pain and distension lasting 3 days, and constipation (last stool 4 days ago). In anamnesis there are no abdominal surgeries. For the last 2 months she has lost approx. 5 kg. What is the proper management?
1) laparotomy as soon as possible due to mechanical obstruction;
2) radiological diagnostics (plain abdominal film) for mechanical small bowel obstruction caused by adhesions, as the most probable cause of the complaints;
3) radiological diagnostics (plain abdominal film) for mechanical large bowel obstruction caused by cancer, as the most probable cause of the complaints;
4) after confirming mechanical obstruction on the plain abdominal film – urgent laparotomy;
5) after confirming mechanical large bowel obstruction on the plain abdominal film – contrast enema in order to determine the level of obstruction and whether it is partial or complete. Decision concerning a mode of the operation depends on the result of the contrast enema.
The correct answer is:

Aonly 1.
B3,5.
C2,4.
D2,5.
Enone of the above.

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Question 115

Which of the following properly characterize the most probable causes of the condition following head trauma:
1) if a patient was temporarily unconscious, suffered head trauma and at the same time urinated, then the most probable cause of his/her condition would be brain stroke;
2) if a patient was temporarily unconscious, suffered head trauma and at the same time passed tarry stool, then the most probable cause of his/her condition is gastrointestinal bleeding;
3) if a patient suffered head trauma, was unconscious for a moment and does not remember circumstances of the event, then it is a typical picture of brain concussion;
4) if a patient was temporarily unconscious, suffered head trauma and presents with anisocoria, it is most probably the result of epileptic seizure;
5) if a patient suffered head trauma, is unconscious, presents with anisocoria and bradycardia, then it is most probably caused by intracranial hematoma.
The correct answer is:

A1,2,3.
B1,4,5.
C2,4,5.
D2,3,4.
E2,3,5.

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Question 116

Which of the following sentences concerning gastric cancer is true?
1) early cancer, when the infiltration does not exceed the mucosa, with tumor diameter up to 2 cm can be treated with endoscopy (mucosectomy);
2) advanced cancer is treated surgically with total gastrectomy, regardless of the location of the tumor;
3) early cancer typically is treated surgically with partial gastrectomy and regional lymph nodes resection;
4) adjuvant chemotherapy is as important part of the treatment as surgery;
5) preoperative radiotherapy is a standard procedure before surgical treatment of advanced gastric cancer.
The correct answer is:

A1,2,4.
B1,2,5.
C1,3.
D3,5.
E1,4.

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Question 117

The best way to differentially diagnose GI bleeding from esophageal varices and GI bleeding from gastric or duodenal ulcer is:

Anature of vomit: the presence of bright red blood or clots (varices) or vomit that looks like coffee grounds (ulcer).
Bcharacteristics of stool: bloody stool (varices) or tarry stools (ulcer).
Cpatient’s general condition: severe with hemodynamic instability (varices) or good, with no hemodynamic changes (ulcers).
Danamnesis and physical examination: liver cirrhosis in anamnesis and clinical symptoms of cirrhosis on physical examination (varices).
Eintensity of bleeding: massive bleeding (varices) or small bleeding (ulcer).

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Question 118

Which of the following concerning abdominal hernia incarceration are true?:
1) inguinal hernia is most often incarcerated;
2) in some cases only the intestine wall is incarcerated;
3) incarcerated hernia always leads to mechanical bowel obstruction;
4) incarceration occurs mostly at night during sleep.
The correct answer is:

Aall the above.
B1,2,4.
C2,4.
D1,2.
E1,2,3.

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Question 119

A pathologic fracture is when a bone fails in an area weakened by pre-existing disease. The causes do not include:

Ainjury to an old fracture site.
Bprimary bone tumors or metastatic lesions.
Cbone infection.
Dmetabolic and systemic diseases.
Einborn diseases.

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Question 120

A patient comes to the surgery ER because of severe pain in the anal region lasting for the last 24 hours. On physical exam, to the left of the anus there is a fluctuant mass covered with red and palpable tender skin. In anamnesis: there are no concomitant diseases. Which of the following abscesses according to Corman’s classification is the most probable in this patient?

Aintersphincteric abscess.
Bischioanal abscess.
Csupralevator abscess.
Dabscess in rectal marginal clot.
Eabscesses mentioned in A, B and C are equally frequent.

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Question 121

Which of the following are the correct approaches to an asymptomatic, incidentally found adrenal tumor of 5 cm in diameter:
1) only laparoscopic surgery;
2) surgery should be dependent on hormonal evaluation;
3) laparoscopic or traditional surgery;
4) approach should not be dependent on tumor size changes in subsequent imaging studies;
5) start pharmacological treatment before the surgery.
The correct answer is:

A1,2.
B3,4.
C1,5.
D2,4.
E3,5.

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Question 122

The intestine wall undergoes necrosis as a result of:
1) hernia incarceration;
2) portal hypertension;
3) bowel strangulation around peritoneal adhesions;
4) mesentery artery embolism;
5) diverticula of small intestine.
The correct answer is:

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

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Question 123

Which of the following concerning acute appendicitis are true?
1) should be operated only laparoscopically;
2) does not occur over the age of 50;
3) ultrasound imaging is helpful in diagnosis;
4) is a result of Clostridium difficile infection;
5) begins with an epigastric pain migrating to the right iliac fossa.
The correct answer is:

A3,5.
B2,4.
C3,4.
D1,5.
E2,5.

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Question 124

Which of the following are the symptoms of mechanical bowel obstruction:
1) elevated white blood count
2) wave-like abdominal pain
3) retention of gases and constipation
4) hyperkalemia
5) bradycardia
The correct answer is:

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

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Question 125

Mechanical jaundice and the enlarged gallbladder are typical symptoms of:
1) cancer of the pancreatic corpus;
2) pancreas head cancer;
3) hepatocellular carcinoma;
4) cholecystolithiasis;
5) carcinoma of the ampulla of Vater.
The correct answer is:

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

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Question 126

In the treatment of perianal fistulas in Lesniowski-Crohn’s disease all of the following are used except:

Afistulotomy and drainage.
Bsteroids.
Cinfliximab and adalimumab.
DEUA (examination under anaesthesia) and placing of non-cutting loose setons.
Efistulectomy.

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Question 127

The intestinal obstruction most commonly results from:

Agallstone disease.
Binguinal hernia incarceration.
Cbig polyp of small intestine.
Dcolon cancer.
Esmall intestine torsion.

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Question 128

Which of the following methods is not used in the surgical treatment of the hemorrhoidal disease?

ADGHAL.
BStretta.
CMilligan-Morgan.
DLongo.
EFerguson.

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Question 129

The knowledge of the Calot’s triangle topography is necessary in the surgical treatment of:

Aadrenal tumor.
Bpancreatic tumor.
Cgastric ulcer.
DHashimoto disease.
Egallstone disease.

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Question 130

TEM (Transanal Endoscopic Microsurgery) is the surgical technique useful in:

Aminiinvasive treatment of advanced anal tumors.
Btreatment of the low grade (poorly differentiated) sigmoid cancer.
Cminiinvasive treatment of rectal tumors.
Dlaparoscopic treatment of rectal cancer.
EC and D are correct.

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Question 131

Which of the following concerning post-thrombotic syndrome are true?
1) develops as a result of superficial vein thrombosis;
2) develops as a result of deep vein thrombosis;
3) causes trophic skin changes near the medial ankle;
4) causes trophic skin changes near the lateral ankle;
5) venous hypertension is the cause of trophic skin changes;
6) perforating vein ligations do not prevent recurrent ulcerations.
The correct answer is:

A1,3,5.
B1,4,6.
C2,3,5.
D2,4,5.
E2,4,6.

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Question 132

Which of the following concerning erysipelas are true?
1) it is an acute skin inflammation caused by Streptococci;
2) it is an acute skin inflammation caused by Staphylococci;
3) it is characterized by high fever (up to 40 °C);
4) it is characterized by fever that does not exceed 38 °C;
5) systemic symptoms are characteristic;
6) only local symptoms are characteristic.
The correct answer is:

A1,3,5.
B1,3,6.
C1,4,6.
D2,3,5.
E2,4,6.

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Question 133

The most common complication of the treatment of the humerus shaft fractures is:

Aulnar nerve palsy.
Bmedian nerve palsy.
Cradial nerve palsy.
Dbrachial artery damage.
Epost-traumatic algodystrophy.

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Question 134

Which of the following are the complications of fractured bone union?
1) mal-union of fractured bone;
2) osteitis;
3) contractures in neighbouring joints;
4) delayed union of the fractured bone;
5) pseudoarthrosis.
The correct answer is:

A1,2,5.
B1,4,5.
C2,3,5.
D2,4,5.
E3,4,5.

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Question 135

Problems with coordination, euphoria, anxiety, xerostomia, tachycardia and the feeling of the slow passage of time – are the signs of the use of:

Aamphetamine.
BCannabis indica (marihuana).
Copioids.
Dcocaine.
Esedatives.

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Question 136

Oncological screening is performed for early detection of neoplasms. Only few screening methods are effective enough. Indicate the effective ones:

Acervix cancer cytodiagnostics, mammography, colon cancer investigation (occult blood test and colonoscopy).
Bprostate-specific antigen – PSA (prostate cancer), lung X-ray (lung cancer).
Cgastroscopy (stomach cancer), sputum cytology (lung cancer).
Dper rectum examination (rectal cancer).
Eall the above.

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Question 137

Low height, infertility, skew palpebral fissures, short and fin-shaped neck, usually normal IQ, often heart defect – are the signs of:

ADown syndrome (trisomy of chromosome 21).
BKlinefelter syndrome (karyotype 47XXY).
CTurner syndrome (monosomy of chromosome X).
DEdward syndrome (trisomy of chromosome 18).
Enone of the above.

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Question 138

Which of the following considering innocent murmurs is false?

Ausually occur during systole.
Bare soft, less than 3/6 in intensity (according Levine’s scale).
Cincrease intensity during cry or anxiety.
Dare often position-dependent.
Eoccur only in young children (before school age).

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Question 139

The painful shoulder may be caused by:

1) cervical intervertebral discopathy;

2) shoulder injury;

3) syringomyelia or tumor of the cervical spinal cord;

4) cervical rib;

5) coronary heart disease.

The correct answer is:

A1,2.
Ball the above.
C2,3,4.
D1,5.
E1,2,4,5.

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Question 140

Oseltamivir is effective in treating:

Acomplications of influenza.
Bprotracted influenza.
Cinfluenza if administered during the first two days of the disease.
Dparainfluenza syndromes.
Eif administered after lowering patient’s body temperature.

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Question 141

Limiting exposure to noise is important for the health of workers because noise is the most common cause of received ear function damage related to acquired hearing loss.

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

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Question 142

In streptococcal pharyngitis or tonsilitis, macrolides should be applied only to patients with immediate-type hypersensitivity to beta-lactams; however, the use of macrolides in these disorders should be accompanied by the determination of drug- resistance to erythromycin.

Athe first statement is true but the second is false.
Bthe first statement is false and the second is true.
Cboth statements are false.
Dboth statements are true but there is no causal relationship between them.
Eboth statements are true and there is a causal relationship between them.

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Question 143

Indicate the true statement:

Aroutine performing of microbiological tests is recommended to diagnose acute inflammation of the nasal cavities and paranasal sinuses.
Bperforming X-ray examinations is required to diagnose acute inflammation of the nasal cavities and paranasal sinuses.
Cdiagnosis of acute inflammation of the nasal cavities and paranasal sinuses cannot be made on the basis of medical history and physical examination.
Dduration of the symptoms of acute inflammation of the nasal cavities and paranasal sinuses over 10 days and deterioration of the clinical status after 5 days are the most important criteria differentiating viral and bacterial infections.
Ein patients with a moderate course of acute inflammation of the nasal cavities and paranasal sinuses lasting less than 7-10 days, a course of antibiotics is recommended.

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Question 144

In order to reduce the spread of infection a patient with streptococcal pharyngitis or tonsillitis should not be in contact with others at nursery school, school or work for the period of:

A24 hours from the application of an effective antibiotic.
B48 hours from the application of an effective antibiotic.
C72 hours from the application of an effective antibiotic.
D96 hours from the application of an effective antibiotic.
E120 hours from the application of an effective antibiotic.

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Question 145

Which of the following is the recommended frequency for performing glycemia self-control in patients with type 2 diabetes taking oral anti-diabetic drugs or GLP-1 analogues:

Aonce a month an abbreviated glycemic profile.
Bonce a week an abbreviated glycemic profile.
C1 measurement of glycemia daily, in addition once a week an abbreviated glycemic profile.
Dmultiple measurements daily according to established principles.
Emultiple measurements daily according to established principles, and additional measurements in the case of malaise.

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Question 146

In patients aged over 45 without clinical symptoms of hyperglycemia and without risk factors, an examination for diabetes should be performed once per:

Ayear.
B2 years.
C3 years.
D4 years.
E5 years.

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Question 147

In the treatment of acute bronchitis caused by Bordatella pertussis, antibiotics should not be used because the application of an antibiotic in whooping cough does not affect the course of the disease, but only reduces the spread of infection.

Athe first statement is true but the second is false.
Bthe first statement is false and the second is true.
Cboth statements are false.
Dboth statements are true but there is no causal relationship between them.
Eboth statements are true and there is a causal relationship between them.

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Question 148

A contraindication to the administration of oral contraceptives in diabetic women is:

Aunstable diabetes.
Btobacco smoking.
CBMI < 30.
DA and B.
EA,B,C.

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Question 149

When a women treated for hypothyroidism becomes pregnant it is necessary to:

Alower the dose of levothyroxine.
Bincrease the dose of levothyroxine.
Cstart potassium iodide administration.
DA and C.
EB and C.

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Question 150

The increased concentration of D-dimers is observed in:

Apulmonary embolism.
Bpregnancy.
Cdeep vein thrombosis.
DA and C.
EA,B,C.

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Question 151

Decreased appetite, pale skin, tearfulness, anal itching at night, teeth grinding observed in a 3-year-old preschooler suggest:

Alambliosis.
Batopic dermatitis.
Cpinworm infection.
Dhemorrhoids.
Efood allergy.

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Question 152

The preventive examination of children at the age of six does not include:

Aheight.
Bweight.
Cblood pressure.
DHirschberg test (a screening test for strabismus).
Esexual development according to Tanner scale.

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Question 153

A medical ruling about pupil’s ability to attend physical education classes that assigns him to group B states that the pupil:

Amay attend physical education class without limitations.
Bmay attend physical education class with limitations and/or requires teacher’s special attention.
Cshould attend corrective gymnastics classes only.
Dmay do only selected individual exercises without group exercises.
Eis unable to attend physical education classes.

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Question 154

In a 5-week-old boy fed since his birth with modified milk, spitting up has been observed for 2 weeks. Lately projectile vomiting with coagulated milk but without traces of bile has occurred during feeding or just after. In spite of good appetite the child losses his weight, and anxiety as well as distended epigastrum are observed. The most probable diagnosis is:

Acow’s milk protein allergy.
Bmilk intolerance.
Cpyloric stenosis.
Dcystic fibrosis.
Egastroesophageal reflux.

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Question 155

Abdominal aortic aneurysm is usually misdiagnosed as:

Amyocardial infarction.
Bnephrolithiasis.
Cpancreatitis.
Ddiverculitis.
Epain in the dorsal muscles.

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Question 156

Which of the following is the most common cause of upper gastrointestinal bleeding?

AMallory-Weiss syndrome.
Baorto-intestinal fistula.
Cpeptic ulcer.
Darteriovenous malformation.
Eesophageal varices.

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Question 157

Which of the following methods of oxygen supplementation allows the most exact dosage?

Anasal tube.
Bstandard oxygen mask.
Cmask equipped with an oxygen reservoir and a one-way expiratory valve.
DVenturi mask.
Eself-inflating bag with a valve and a respiratory mask.

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Question 158

What is the basic element of clinical assessment and treatment in the case of chemical eye burns?

Aslit-lamp examination to assess the degree of the lesion.
Brepeated eye irrigation with normal saline solution or water upon ER admission.
Cvisual acuity test.
Dtherapy with antibiotics to limit the risk of secondary infection.
Epharmacological cycloplegia to increase the aqueous humour flow to the anterior chamber to lower the pain.

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Question 159

Which of the following is the primary management in the case of a patient presenting active aggression?

Amonitoring with pulsoxymeter.
Bimmobilisation to protect the patient and people around him.
Csecuring the venous access.
Durine examination for the presence of psychoactive substances.
Eblood glucose examination.

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Question 160

Which of the following cycloplegic agents is the shortest acting one?

Aatropine.
Bhomatropine.
Cpilocarpine.
Dcyclopentolate.
Etropicamide.

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Question 161

A 60-year-old male suffering from crushing chest pain for 2 hours reaches the Emergency Room (ER) and suddenly collapses. ECG as follows. The diagnosis and the first line treatment would be:

.

Aventricular tachycardia & cardioversion.
Bventricular fibrillation & defibrillation.
Catrial flutter & amiodarone.
Datrial fibrillation & cardioversion.
Enormal sinus rhythm & no treatment required.

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Question 162

The major clinical signs of tension pneumothorax include:
1) respiratory distress;
2) tracheal deviation;
3) neck vein distension;
4) decreased breath sounds and hyperresonance ipsilateral to the injury.
The correct answer is:

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

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Question 163

The initial treatment of tension pneumothorax includes:

Aneedle thoracostomy, usually a 14-gauge IV catheter at the midclavicular line in the second intercostal space.
Bchest drain at the anterior axillary line in the third intercostal space.
Cendotracheal intubation and mechanical ventilation.
Demergency thoracotomy.
Eoxygen therapy.

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Question 164

Which part of the heart is most commonly injured in blunt myocardial contusion?

Aleft ventricle.
Bleft atrium.
Caorta.
Dpulmonary artery.
Eright ventricle.

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Question 165

The most common cause of SCA (sudden cardiac arrest) in adults is:

Aasystole.
Bventricular fibrillation.
CPEA (Pulseless Electrical Activity).
Dtachycardia.
Ecardiac tamponade.

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Question 166

MONA treatment is essential in:

ADVT (deep venous thrombosis).
Bmyocardial infarction.
Cpneumonia.
Dhypovolemic shock.
Ehypoglycemia.

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Question 167

Magnesium sulphate is the drug of choice in:

Aasystole.
Bventricular fibrillation.
Cbradycardia.
DTorsades de pointes.
Eatrial fibrillation.

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Question 168

A 75-year-old male presents to the Emergency Room (ER) with the laceration over his left eye after sustaining a head injury without any loss of consciousness. His past medical history states that he suffers from atrial fibrillation and takes anti- coagulants. His GCS is 15 with irregular HR of 75-80 beats/min and normal BP. The best care in ER would be:

Aconsult a neurosurgeon at first.
B24 hours ER observation and discharge.
Cperform the CT scan during observation in ER.
Dtreat the wound and send the patient home.
Eadmission to a cardiology ward.

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Question 169

A 27-year-old female presents to the Emergency Room (ER) with a RLQ (right lower quadrant) abdominal pain. On exam – acute tenderness at RLQ, HR – 140/min, BP – 110/70. The right initial diagnosis:

Aappendicitis or extrauterine pregnancy.
Bbiliary or renal colic.
Cpancreatitis or gastroenterocolitis.
Drenal colic only.
Eextrauterine pregnancy or renal colic.

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Question 170

The most common side effect of placing a central venous catheter in the jugular vein is:

Apneumothorax
Bcarotid artery puncture
Chematoma of the neck
Dsevere pain
Edysphagia

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Question 171

The 2010 ERC Adult CPR guidelines regarding manual chest compressions state as follows:

A80-100 chest compressions/min with the depth of 4-5 cm.
B80-100 chest compressions /min with the depth of 1/3 of the chest.
C80-100 chest compressions/min with the depth of at least 5 cm.
Dat least 100 chest compressions/min with the depth of at least 5 cm.
Eat least 100 chest compressions /min with the depth of 1/3 of the chest.

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Question 172

The surface area of a burn injury can be estimated with the use of:

Arule of 18.
BWallace’s rule of 9.
Chand rule.
Dcreatinine excretion.
Eserum albumin concentration.

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Question 173

While transporting on a backboard a pregnant woman after trauma, the following should be observed?

A15 degree tilt to the left.
B15 degree tilt to the right.
C45 degree tilt to the left.
D45 degree tilt to the right.
Eexact horizontal position.

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Question 174

The treatment of choice of atrial fibrillation lasting more than 48 hours is:

Acardioversion in the Emergency Room upon presence
Bamiodarone 300 mg bolus i.v.
Cbretylium 5 mg i.v.
Ddelayed cardioversion with anticoagulants prescribed to attain therapeutic INR range
Ecardioversion after a bolus of amiodarone (300 mg i.v.)

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Question 175

According to the Polish Code of Medical Ethics are donors of cells, tissues or organs for transplantation allowed to get paid for their cells, tissues or organs?

Ayes
Byes, but only for organs
Cthere is no relevant provision in the Code
Dno
Epossible payment depends on the donor’s decision

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Question 176

According to the Polish Code of Medical Ethics is medical secrecy absolute, or does the Code provide for exceptions to this principle?

Ait is absolute secrecy.
BCode provides derogations from medical secrecy.
Cthere is no relevant provision in the Code.
DCode refers to the relevant legislation.
Erelevant provision applies only to surgeons.

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Question 177

What form of consent for getting cells, tissues or organs from corpses does the Polish Code of Medical Ethics allow?

Aconsent of the family of the deceased.
Blawyer’s permission.
Cdoctor's permission.
Ddoctor's permission.
Eimplied consent.

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Question 178

Proceedings at a medical court were instituted against a physician. The defendant doctor may be assisted by counsel. This may be:
1) another physician;
2) any designated agent;
3) professional liability screener of the regional chamber of physicians and dentists, a chamber before which the proceedings are taking place;
4) solicitor;
5) judge ruling on criminal matters.
The correct answer is:

Aonly 2.
B1,3.
C4,5.
D1,4.
E3,5.

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Question 179

The formal bodies of a regional chamber of physicians and dentists are, among others:
1) regional medical assembly;
2) regional doctors’ ombudsman;
3) regional patients’ ombudsman;
4) regional medical council;
5) regional agent for the postgraduate education of physicians and dentists.
The correct answer is:

A2,4.
B1,4.
C1,5.
D2,3.
E2,5.

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Question 180

A doctor has a duty:

Ato keep medical secrecy until patient's death.
Bto keep medical secrecy also after patient's death.
Cto disclose medical information concerning patients playing important social roles.
Dto disclose medical information concerning patients who are public officials.
Eto disclose medical information concerning patients who are minors.

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Question 181

In the event of the death of a patient from injury or poisoning the medical records must be kept:

Afor 10 years from the last entry.
Bfor 30 years from the end of the year in which the death occurred.
Cfor a period specified by the judicial authorities (in each case individually).
Das decided by the manager of a health care institution.
Ethere is no such legal regulation.

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Question 182

A person can be involuntarily hospitalized in a psychiatric ward only when:

Asuch a need is being reported by the patient's family members.
Bsuch a need is seen by his family physician.
Chis behavior indicates that due to his illness he directly threatens his own life or health and the lives of other people.
Dpolice recommend it.
Elaw does not regulate compulsory psychiatric hospitalization.

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Question 183

Which of the following bodies sets and takes care of universally binding all doctors principles of medical ethics (including professional liability)?

AGovernment.
BParliament.
CMinister of Health.
DPhysician Self-Government.
Epatients association.

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Question 184

In particularly justified cases, a doctor may refuse to treat or to continue treating the patient. However, he cannot do this:

Aif the patient is in hospital.
Bin urgent cases where there is a threat to the patient's life.
Cif the service has already been paid.
Dwhen he received the order from his superior.
Ewhen the patient has not chance to receive another doctor’s assistance immediately.

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Question 185

In old age and disability insurance for farmers one of the condition for granting a pension is the decision of:

Adegree of disability.
Bpartial incapacity for work.
C50% of damage to health resulted from an accident on the farm.
Dtotal incapacity to work on a farm.
Einability to live independently.

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Question 186

How many medical statements ZUS, ZLA should be issued to an insured person who is employed by four employers?

Aone.
Btwo.
Cthree.
Dfour.
Efive.

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Question 187

Social Insurance Fund (ZUS) authorizes doctors to issue medical rulings on temporary incapacity to work for the period of:

A3 months.
B1 year.
C2 years.
D3 years.
Eindefinitely.

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Question 188

Agricultural Social Insurance (KRUS) expert doctors and its medical boards do not give a ruling on:

Atotal incapacity for work on a farm.
Btemporary incapacity for work, an incapacity lasting longer than 180 days.
Cinability to live independently.
Ddegree of disability.
Edesirability of professional retraining resulting from total incapacity for work on a farm.

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Question 189

Social pension is not granted to an adult who is totally incapable to work due to violation of the efficiency of the body, which arose:

Abefore the age of 18.
Bduring school or college before the age of 25.
Cduring doctoral studies.
Dduring studies for fellowship in science.
Ein the course of employment.

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Question 190

Which of the following serves as a basis to issue a medical statement on temporary incapacity to work due to illness (ZUS ZLA)?

Awritten request from a medical specialist.
Bcertificate of the residence of the insured person in hospital.
Cdirect medical examination of the insured person.
Dcertificate of medical assistance from emergency ambulance service.
Ecertificate of medical assistance from the emergency department.

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Question 191

Who is authorized to issue medical statements on temporary incapacity to work for the earlier period than 3 days prior to the medical examination day of the insured person?

ASIF (ZUS) certifying doctor.
BASIF (KRUS) certifying doctor.
Cattending doctor after obtaining approval from the President of SIF(ZUS).
Dpsychiatrist.
Ehospital administrator.

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Question 192

Which of the following factors are most useful for characterizing the health status of the population?
1) average life span;
2) newborn mortality rate;
3) number of hospital beds per 10000 inhabitants;
4) number of nurses per 10000 inhabitants;
5) cardiovascular disease standardized mortality ratio.
The correct answer is:

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

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Question 193

Which of the following statements concerning average life expectancy in Poland is true?

Alongest life expectancy is among inhabitants of Lodz and Silesia cities.
Blife expectancy in rural areas is about 3-5 years longer than in big cities.
Caverage life expectancy in Poland has nothing in common with the education.
Dwomen in Poland live on average 3-5 years longer than men.
Eall the above are false.

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Question 194

Which of the following information illustrating a number of adult Poles with chronic diseases or risk factors in the first decade of 21st century is false?

Asmoking - about 9 mln inhabitants.
Bdiabetes - about 1.5-2.0 mln inhabitants.
Chypercholesterolemia - about 17 mln inhabitants.
Dhypertension - about 2 mln inhabitants.
Eall the above are true.

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Question 195

Which of the following reasons are responsible for premature mortality in Poland?
1) coronary heart disease;
2) congenital cardiac defects;
3) cancers;
4) traffic accidents and injuries;
5) infectious diseases.
The correct answer is:

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

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Question 196

Which of the following documents indicates the particular role of primary healthcare in the operation of the entire healthcare system?

ADeclaration of WHO International Conference in Alma-Ata in 1978.
BOttawa Charter for Health Promotion of 1986.
CAmsterdam Treaty of 1997.
DWorld Health Declaration of 1998.
Enone of the above.

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Question 197

Which of the following disease risk factors are related to lifestyle?
1) low physical activity;
2) nutritional habits;
3) polluted water;
4) alcohol abuse;
5) nicotine addiction;
6) occupational risk factors;
7) use of psychoactive agents.
The correct answer is:

A1,3.
B2,4,6.
C1,2,3,4.
D1,2,4,5,7.
E2,3,4,5,6.

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Question 198

According to the Law on the health care financed from public resources which of the following services are available without referral?

Aspecialist consultations.
Bprimary health care (family doctor consultation).
Cmedical rehabilitation.
Ddiagnostic examinations.
EA and D.

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Question 199

The current National Health Programme (NHP):

Aspecifies the aims of national health policy.
Bcovers years 2007-2015.
Cdistinguishes strategic and operational aims.
Daims to improve public health.
Eall of the above.

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Question 200

The physiological process of teething is regulated by genetic, hormonal and environmental factors. Locally, the redness and oedema of the gums is seen. Which of the following are the most common systemic symptoms accompanying teething?
1) excessive drooling and biting hard objects;
2) decreased appetite, gastrointestinal disorders;
3) subfebrile body temperature;
4) sleeping disorders;
5) fever >39 °C.
The correct answer is:

A1,2,3.
B1,2,3,4.
C1,4,5.
Dall the above.
E2,5.

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