family medicine 2

61. Groups that are at risk of vitamin D deficiency in- clude: A. preterm infants. B. obese children and adolescents (BMI > 90 per- centile for gender and age). C. obese adults (BMI > 30 kg/m ). D. people with dark skin and working at night. E. all the above.

The examination of an infant for hypoacusis com- bines all the following, except for: A. child's reaction to a loud sound. B. presence of cooing. C. results of hearing screening test. D. speech development. E. presence of hypoacusis risk factors.

Which of the following is recommended in a patient treated chronically with acenocoumarol if the control lab examination showed INR = 4.7? A. decrease next two doses of acenocoumarol. B. skip one dose of acenocoumarol and decrease sub- sequent doses of acenocoumarol. C. skip two doses of acenocoumarol. D. skip two doses of acenocoumarol and give vitamin K orally. E. continue the same acenocoumarol dosage.

Which of the following changes cannot be observed in the electrocardiogram of a patient suspected of the acute coronary syndrome, with the regular heart rate of 72/min, who had nor- mal previous ECG? A. ST depression. B. T-wave pseudonormalization. C. Q wave in the lead III. (Can be present in normal ECG) D. left bundle branch block (LBBB). E. ST segment elevation.

A retrosternal pain that radiates to the neck and the left shoulder should arise a suspicion of: 1) angina pectoris; 2) myocardial infarction; 3) pericarditis; 4) aortic dissection; 5) pneumothorax. The correct answer is: A. only 1. B. 1,2,3. C. 2,3,4. D. 2,5. E. all the above.

Human personality is a complex structure. The ICD-10 classification distinguishes specific personal- ity disorders which do not include: A. paranoid personality disorder. B. schizoid personality disorder. C. dissocial personality disorder. D. independent personality disorder. E. avoidant personality disorder.

Indicate the true sentence regarding the hepatitis B virus (HBV): A. HBV is the RNA virus. B. HBV infection is possible only through parenteral route. C. HBV incubation period lasts for 10-14 days. D. HBV doesn't trigger extrahepatic manifestations. E. determination of alanine transaminase (ALT) can't be used as a HBV infection diagnostic test. - it cannot be used as a DIAGNOSTIC.

Which of the following drugs can cause benign glan- dular breast tissue hypertrophy in men (gynecomastia)? A. spironolactone. B. cimetidine. C. diazepam. D. digitalis preparations. E. all the above.

Indicate the limit for normal arterial oxygen satura- tion as determined by the pulse oximeter in a person under 70: A. e 85%. B. e 89%. C. e 92%. D. e 95%. E. e 97%.

Which of the following risk factors is not mentioned in the SCORE and does not influence the estimation of a 10-year risk of fatal cardiovascular incident (death)? A. age. B. sex. C. smoking. D. systolic blood pressure. E. HbA1c level.

The body weight loss in the first days of life of a neonate amounts to about: A. 10%. B. 5%. C. 2%. D. 1%. E. neonate does not lose their weight after the birth.

A patient with hypothyroidism should be instructed to take levothyroxine: A. on empty stomach, 30-60 minutes before break- fast. B. on empty stomach, directly before breakfast. C. during breakfast. D. half an hour after breakfast. E. two hours after breakfast.

The most common symptom reported by patients with vulvar cancer is: A. pain. B. fever. C. malaise. D. pruritus. E. dysuria.

The first postnatal care home visit - during which medical history and physical examination of the child, assessment of physical development and head cir- cumference, also jaundice and basic neurological evaluation and the screening for congenital dysplasia of the hips - according to the law, is paid by: A. family doctor in 1 week of life. B. family doctor between 1 and 4 week of life. C. family doctor between 2 and 5 week of life. D. family doctor between 4 and 5 week of life. E. midwife.

Indicate the true statement concerning the clinical features of measles: A. rash is preceded by a high fever up to 40 °C. B. Koplik's spots are pathognomonic for the disease. C. rash is of maculopapular type. D. A,C are true. E. A,B,C are true.

Which of the following probiotics are used for the prevention of diarrhea related to antibiotic therapy? A. Lactobacillus rhamnosus GG. B. Saccharomyces boulardii. C. Bifidobacterium infantis. D. A,B are true. E. A,B,C are true.

Referred (secondary) otalgia may be caused by: 1) tooth disorders; 2) temporomandibular joint inflammation; 3) cervical spondylosis; 4) trigeminal neuralgia; 5) pharyngitis. The correct answer is: A. only 1. B. 1,2. C. 1,3. D. 2,3,4. E. all the above.

"A child is standing with their feet joined and upper limbs put forward, with extended elbows, carpal joints and fingers. The test is per- formed with the patient's eyes open and then repeated with their eyes closed". This descrip- tion characterizes: A. examination of the Rossolimo's reflex. B. examination of the Oppenheim's reflex. C. examination of the Babinski sign. D. examination of the cremasteric reflex. E. Romberg's test.

The disorders observed in the course of AIDS do not include: A. mycosis. B. periodontal lesions. C. hairy leukoplakia. D. Kaposi's sarcoma. E. Hodgkin lymphoma.

A 12-year-old girl came with her father to the GP of- fice. She complains of vomiting, intensifying abdom- inal pain which focuses in the hypogastric region. Her body temperature is 37.5 °C, she excreted a single soft stool earlier this day. On physical examination peritoneal signs can be noted. Which of the following is the most probable diagnosis? A. ulcerative colitis. B. urolithiasis. C. irritable colon syndrome. D. appendicitis. E. angina.

Treating a patient with vitamin K antagonists (VKA): acenocoumarol, warfarin, one should remember that food influences their action. Which of the following products decreases the action of VKA? A. spinach. B. broccoli. C. lettuce. D. A, B are true. E. A, B, C are true.

Indicate the condition for introducing a screening program: A. determination of the population to be tested. B. selection of the screening test used. C. determining the frequency of repeating the screening test. D. A and B are correct. E. A, B and C are correct.

Hyperuricemia leads to recurrent attacks of acute arthritis. This disease risk factors do not include: A. dyslipidemia. B. alcohol abuse. C. vegetarian diet. D. occupational exposure to lead. E. genetic predisposition.

The most frequent cause of non-complicated cystitis is the bacteria: A. of Acinetobacter group. B. of Propionibacterium group. C. Pseudomonas aeruginosa. D. Escherichia coli. E. Proteus mirabilis.

Main signs and symptoms of concussion do not in- clude: A. disturbances of consciousness. B. retrograde amnesia. C. vomiting. D. headaches. E. speech disturbances.

One of the family doctor's duties is to keep medical records. The individual documentation of the patient consists of the internal documentation, kept for the purposes of the entity providing care, and the exter- nal documentation. The internal individual documentation includes: 1) health and disease history; 2) patronage visit card; 3) referral for a diagnostic test; 4) referral to the hospital; 5) hospital treatment information card. The correct answer is: A. only 1. B. 1,2. C. 1,2,3. D. 1,3. E. all the above.

The spread of bacterial rhinosinusitis is an indication for antibiotic therapy. The medication of choice in an adult patient in such cases is: A. amoxicillin in a dose of 1.5 - 2.0 g daily, given every 12 hours for 10-14 days. B. amoxicillin and clavulanic acid in a dose of 1g (875 mg+125 mg) every 12 hours for 7days. C. amoxicillin in a dose of 3 g daily, given every 8 hours for 7-10 days. D. amoxicillin and clavulanic acid in a dose of 625 mg (500 mg+ 125 mg) every 12 hours for 7-10 days. E. azithromycin in a dose of 500 mg daily for 6 subse- quent days.

Prediabetic states include: A. impaired fasting glycaemia. B. impaired glucose tolerance. C. reactive hypoglycaemia. D. A,B are correct. E. A,B,C are correct.

A 5-year-old child presents with his mother to obtain a vaccination against flue. The medical documentation shows that the child under- went 10-day antibiotic therapy because of streptococcal pharyngitis which was withdrawn two weeks ago. Which of the following should be recommended?A. to vaccinate on the same visit. B. to vaccinate on a visit in 7 days. C. to vaccinate 4 weeks after the withdrawal of antibi- otic therapy. D. to postpone the vaccination for 2 months. E. to discourage the vaccination.

Complicated urinary tract infection (UTI) includes: A. each UTI in a male. B. UTI in women with anatomical urine flow distur- bances. C. UTI caused by new microorganisms originating from outside of the urinary tract. D. A,B are correct. E. A,B,C are correct.

A 58-year-old woman came by the family doctor office and complains of constant fatigue, weakness, sleepiness, feeling cold and constipation. The symp- toms last for about 3 months. She gained 6 kg in 2 months in spite of a stable diet. The physical exami- nation revealed dry, rough skin and swollen lower eyelids. The blood pressure was 110/60 mmHg, the heart rate was regular, 58/min, with quiet normal heart sounds. The respira- tory sounds were normal bilaterally. No other abnormali- ties were noted. The Most probable diagnosis is: A. depressive disorder. B. glomerulonephritis. C. hypothyroidism. D. irritable bowel syndrome. E. iron deficiency anemia.

A 31-year-old female working at a social care unit has reported to a family doctor complaining about the itchy abdomen skin, escalating during the night and a rash. In physical examination skin lesions in the form of papules and nodules, excoriations and single crusts were found. How should the doctor proceed? A. Recommend observation of the lesion progres- sion. B. refer the patient to the allergist. C. prescribe antihistamines. D. evaluate the presence of the burrow tracks and prescribe permethrin cream in the case of their visibility. E. none of the above.

Retrosternal pain with burning or crushing sensation, provoked by a large meal, may be the result of: A. angina. B. gastroesophageal reflux disease. C. irritation of the pleura. D. true are A,B. E. true are A,B,C.

A. in children born before 37 week of gestation or with the birth weight below 2500 g. D th The classic triad of signs present in shock consists of: A. hypotonia, bradycardia, oliguria. B. hypotension, bradycardia, oliguria. C. hypotonia, tachycardia, pale skin. D. hypotension, tachycardia, oliguria. E. hypotension, tachycardia, pale skin.

According to the current Polish vaccination schedule the vaccine against diphtheria, pertussis and tetanus with the acellular tetanus component (DTaP) should be used: A. in children born before 37 week of gestation or with the birth weight below 2500 g. th B. in children born before 35 week of gestation or with the birth weight below 2500 g. C. in children born before 35 week of gestation or with the birth weight below 2300 g. D. in children born before 34 week of gestation or with the birth weight below 2300 g. E. in children born before 33 week of gestation or with the birth weight below 2300 g.

"Nun's Knee", a condition characterized by edema and marked pain in the anterior part of the knee joint, is a consequence of: A. Baker's cyst. B. Achilles tendinitis. C. de Quervain's syndrome. D. fibromyalgia. E. prepatellar bursitis.

Which of the following is preferred for the treatment of gastroesophageal reflux disease in women during the first trimester of pregnancy? A. alginic acid. B. sucralfate. C. metoclopramide. D. A,B are correct. E. A,B,C are correct.

According to the Program of vaccinations for year 2016 a neonate should be vaccinated within 24 hours of birth against: 1) viral hepatitis B; 2) viral hepatitis A; 3) invasive infection with Neisseria meningitidis; 4) invasive infection with Streptococcus pneumoni- ae; 5) tuberculosis. The correct answer is: A. only 1. B. 2,3. C. 1,4. D. only 4. E. 1,5.

Which of the following features does not indicate the necessity for the surgical treatment of an umbilical hernia? A. hernia persists at the age of 4 years. B. complications occur. C. hernia is enlarging. D. hernia's diameter is 3.5 cm. E. hernia enlarges while the child is crying.

the first-choice drug in the treatment of giardiasis is: A. metronidazole. B. tynidazole. C. furazolidone. D. erythromycin. E. clarithromycin.

Fibromyalgia - a condition characterized by wide- spread pain in muscles and tendons - most frequent- ly affects: A. young males. B. elder patients of both genders. C. women at the age of 35-40. D. males at the age of 40-50. E. males at the age of 35-40.

Alanine (ALT) and aspartate (AST) aminotransferase levels 15-fold above the reference range suggest: A. chronic viral hepatitis. B. acute viral hepatitis. C. NAFLD. D. alcoholic hepatitis. E. cirrhosis.

Venous or arterial thrombosis, recurrent miscarriage, the presence of anti-cardiolipin antibodies allow to suspect: A. lupus erythematosus. B. systemic scleroderma. C. antiphospholipid syndrome.D. Sjögren's syndrome. E. Williams' syndrome.

The most common etiology of infectious conjunctivi- tis is: A. allergy (a sign of allergy to plant pollen). B. bacterial (Staphylococcus aureus, Streptococcus pneumoniae). C. atopy in patients with atopic dermatitis. D. viral (adenoviruses, herpesviruses). E. unknown factor.

Which of the following should be regarded as abnor- mal in a 7-month-old infant? A. making "cooing" sounds, no gurgling sounds. B. presence of the plantar grasp reflex. C. presence of the Galant reflex (a swing of the trunk towards the side on which the skin is tapped). D. presence of the Babinski reflex. E. no sitting up by itself.

The diagnosis of obesity class I should be made at BMI (kg/m ): A. 25.0 - 29.9. B. 30.0 - 34.9. C. 35.0 - 39.9. D. e 40. E. obesity class borders depend on sex.

Which of the following is the most probable diagnosis in the case of high fever, chills and malaise which accompany vivid red, well de- marked erythema on the leg with strained and shining skin? A. Lyme disease. B. furuncle. C. folliculitis. D. erysipeloid. E. erysipelas.

Blood pressure is regarded as normal if the average value of measurements performed for several days as home blood pressure monitoring (HBPM) is under: A. 140/90 mmHg. B. 140/85 mmHg. C. 135/85 mmHg. D. 130/80 mmHg. E. 120/80 mmHg.

In the case of short-term type 2 diabetes mellitus the recommended HbA1c levels should be kept below: A. 8% (64 mmol/mol). B. 7.5% (59 mmol/mol). C. 7% (53 mmol/mol). D. 6.5% (48 mmol/mol). E. 6.0% (42 mmol/mol).

Which of the following anti-diabetic drugs causes a hypoglycemic effect through the inhibition of hepatic glucose production: A. metformin. B. chlorpropamide. C. acarbose. D. pioglitasone. E. dapagliflozin (SGLT-2 inhibitor).

After the removal of a tick the patient should be in- structed to observe the place of the bite for possible appearance of erythema migrans for: A. 7 days. B. 14 days. C. 30 days. D. 60 days. E. 90 days.

The most common cause of chronic cough is: A. gastrointestinal reflux. B. bronchial asthma. C. chronic rhinitis with discharge running down the back of the throat. D. taking ACEI. E. psychogenic cough.

Superficial vesicular and purulent eruptions, with honey colored crusts over dried lesions, usually located in the lip area are character- istic of: A. erysipelas. B. fungal skin infection. C. orf. D. impetigo. E. psoriasis.

Prolonged QRS duration occurs in: A. pre-excitation syndrome. B. ventricular rhythms. C. left bundle branch block. D. A,B are true. E. A,B,C are true.

Which of the following is a reddish skin lesion that occurs in a neonate as a macule, usually located on the eyelids, forehead, occiput and nuchal region and disappears around the age of 1 year? A. mongolian spot. B. hemangioma. C. port-wine stain. D. milium. E. salmon patch.

Which of the following are the main symptoms of Hodgkin's lymphoma in children? A. abdominal pain, bleeding, vomiting, dysphagia. B. non-symmetrical lymphadenopathy, affecting mainly cervical and supraclavicular nodes (firm and painless, forming packets), fever. C. abdominal pain, bone pain, hepatosplenomegaly, normal lymph nodes. D. apathy, thrombocytopenic purpura, subfebrile state, predilection for infections. E. high fever, lesions on the mucosa of the pharynx, lymphadenopathy, hepatosplenomegaly.

A patient on a constant acenocoumarol therapy came to the family doctor with the result of INR=5.8 with- out any sign of bleeding. Which of the following should be recommended? A. reduce the weekly dose of acenocoumarol by 10%, without any break in the treatment. B. withdraw acenocoumarol for 1-2 days till obtaining INR values: 2.0 - 3.0. C. give immediately 1⁄2 tablet of vitamin K and de- crease the dose of acenocoumarol for that day. D. give immediately 1⁄2 tablet of vitamin K and with- draw acenocoumarol for 1-2 days. E. refer the patient to the hospital in order to admin- ister vitamin K intravenously.

To which type of prevention does vaccination be- long? A. early. B. primary. C. secondary. D. tertiary. E. quaternary.

Jaundice in breast-fed neonates is regarded as late if it appears in the end of: A. 2-3 day of life and subsides spontaneously during 2-3 week of life. B. 4-5 day of life and subsides spontaneously during 3-4 week of life. C. 6-7 day of life and subsides spontaneously during 2-3 week of life. D. 8-10 day of life and subsides spontaneously during 2-3 week of life. E. 1 week of life and lasts up to 4-12 weeks.

Indicate the true statement concerning the treat- ment of arterial hypertension: A. pharmacological therapy should be started with one antihypertensive drug at a meanor maximal dose. B. in patients with hypertension of the 2nd or 3rd degree the treatment should be started with 2 drugs in low doses. C. if the therapy with 2 drugs is inefficient the 3rd drug should be added at an at least mean dose. D. the most rational combination of three hypoten- sive drugs is the combination of ACEI with a potassium-sparing diuretic and a β-blocker. E. efficacy of the applied therapy should be assessed one week after its initiation.