family medicine 3

Indicate the false statement: A. in adults the lymph modes are considered signifi- cantly enlarged if their diameter is e 2 cm. B. generalized lymphadenopathy may indicate sys- temic disease. C. hard lymph nodes suggest the presence of neo- plastic metastases, lymphoma or chronic leukemia. D. lymph nodes painful on palpation may suggest neoplastic process. E. lymph nodes unmovable against the skin and deep tissues suggest chronic inflammation or neoplastic process.

The most common cause of non-toxic goitre is: A. amiodarone treatment. B. excessive iodine supply. C. iodine deficiency. D. subacute thyroiditis. E. chronic thyroiditis.

An 18-year-old patient with a sore throat and body temperature 37.4 oC presents pus like exudate tonsils, enlarged cervical lymph nodes, spleen enlargement, and a maculopapular rash after amoxicillin administration. The most probable diagnosis is: A. streptococcal pharyngitis. B. infectious mononucleosis. C. diphtheria. D. scarlet fever. E. herpangina.

Menopause is when a woman has not had any vaginal bleeding after her last menstrual period for: A. 2 months. B. 3 months. C. 6 months. D. 8 months. E. 12 months.

Which group of bacteria is mainly responsible for the occurrence of a stye (hordeolum) and chalazion? A. Streptococcus. B. Staphylococcus. C. Acinetobacter. D. Haemophilus. E. Moraxella.

Indicate the correct definition of vaccination: A. is a type of passive immunization and consists in introducing live or dead microorganisms, their fragments or products of their metabolism into the body. B. is a type of active immunization and consists in introducing live or dead microorganisms, their fragments or products of their metabolism into the body. C. is a type of passive immunization and consists in introducing active antibodies into the body. D. is a type of active immunization and consists in introducing active antibodies into the body. E. all the above are incorrect.

„Illness is the most common in the autumn and win- ter, in children aged 1-3 years. It is caused by viruses, the characteristic symptom is 'barking' cough and stridor, the symptoms may be recurrent". This is a description of: A. pharyngitis. B. epiglottitis. C. croup. D. bronchitis. E. pneumonia.

Placing the code "B" in the electronic form of sick leave (ZLA) means incapacity for work: A. during pregnancy. B. due to alcohol abuse. C. due to tuberculosis. D. due to the same disease that caused incapacity for work before a period shorter than 60 days. E. due to an disease whose symptoms may not be recognized until more than 14 days.

Which one of the following positive tests confirms the ongoing Helicobacter pylori infection? A. serological. B. respiratory. C. for detecting H. pylori in the stool. D. A and B are correct. E. B and C are correct.

Paracetamol is the first-choice anti-fever medication. Its maximal daily dose in adults amounts to: A. 2 grams. B. 3 grams. C. 4 grams. D. 5 grams. E. 6 grams.

The class 3 obesity is a condition of a patient whose BMI is: A. 20-25.9. B. 26-29.9. C. 30-40. D. over 40. E. BMI is not an index of the obesity but only a ratio of the body weight (kg) to the height squared (m ).

Which of the following is a „disease without pulse" most frequently affecting young women under 20 years of age? A. Kawasaki disease. B. Schönlein-Henoch purpura. C. polyarteritis nodosa. D. dermatomyositis. E. Takayasu disease.

Which of the following is an etiological factor for in- fectious mononucleosis? A. HSV. B. Coxackie virus. C. EBV. D. group A Streptococci. E. adenoviruses.

In the advanced stage of hemochromatosis, a genet- ically determined disease, the following occurs: A. grey-brown coloration of the skin and mucous membranes. B. liver cirrhosis. C. diabetes mellitus. D. A and B are true. E. A, B, and C are true.

Indicate the false statement on the treatment of type 2 diabetes: A. metformin is the first choice medication. B. main side effects of sulphonylureas are hypo- glycemia and body weight gain. C. acarbose at a dose of 300 mg daily decreases fast- ing glycemia as efficiently as postprandial one. D. in the case of the secondary ineffectiveness of oral anti-diabetic medications, (HbA1c>7%) despite of intensification of pharmacological and be- havioral treatment, insulin should be included. E. initial insulin dose is usually 0.2 IU/kg b.w.

Anemia of chronic disease differs from iron deficiency anemia in: A. increased serum ferritin concentration. B. decreased total iron binding capacity (TIBC). C. decreased MCV values. D. A,B are true. E. A,B,C are true.

Which of the following has the greatest impact on the health of society? A. genetic factors. B. environmental factors. C. healthy behavior. D. healthcare. E. socioeconomic factors.

A mother comes to the doctor with her 2-year-old child, who defecated 6 times in the last 24 hours, does not vomit, has no fever, has no features of dehydratation. A proper approach in this case is: A. refer to the hospital. B. order metronidazole. C. order stool culture and then appropriate pharma- cotherapy according to the result of the culture. D. order co-trimoxazole. E. oral hydration at home.

Indicate the amount of glucose to be given and the scheme for blood sampling in a 60- year-old male while performing the oral glucose tolerance test: A. 50 g; at fasting, the first and the second hour of the test. B. 75 g; at fasting, the first and the second hour of the test. C. 50 g; at fasting and the second hour of the test. D. 75 g; at fasting and the second hour of the test. E. 100 g; at fasting, the first and the second hour of the test.

The alarming signs and symptoms in the course of gastroesophageal reflux disease, which are an indication for prompt endoscopic diagnostics, in- clude: 1) weight loss; 2) swallowing disturbances; 3) cough; 4) upper gastrointestinal bleeding; 5) hoarseness, aphonia; 6) chest pain of non-cardiac etiology. The correct answer is: A. 1,3,4. B. 2,4,6. C. 2,4,5. D. 1,3,6. E. 1,2,4.

Which of the following should not be administered in the case of streptococcal angina: A. phenoxymethylpenicillin. B. benzathine penicillin. C. 1 generation of cephalosporin. D. tetracycline. E. macrolide.

Pharmacological treatment should be initiated im- mediately after the diagnosis of: A. stage 1 arterial hypertension. B. stage 2 arterial hypertension. C. stage 3 arterial hypertension. D. isolated systolic hypertension. E. high normal blood pressure.

Purulent inflammation in the area of the nail fold is called: A. abscess. B. phlegmon. C. whitlow. D. paronychia. E. erysipelas.

Indicate the false statement concerning the diagnos- tics of Lyme disease: A. lack of data on a tick bite in the medical history is irrelevant for the diagnosis. B. positive serological tests without symptoms typical of Lyme disease are irrelevant for the diagnosis. C. specific IgM antibodies appear in blood after 3-4 weeks after the infection. D. specific IgG antibodies are detectable in blood 6-8 weeks after the infection. E. specific IgG antibodies are present in blood up to 12-24 weeks after the infection.

Any vaginal bleeding in a postmenopausal woman is an indication for: A. observation at the family doctor clinic. B. observation at the family doctor clinic and addi- tional examinations. C. detailed gynecological examination and observa- tion for 6 months. D. detailed gynecological examination and observa- tion for 9 months. E. detailed gynecological examination and additional specialist examinations.

A pale mucous vaginal discharge occurring in a neonate that subsides within several days is a symptom of: A. impact of mother's estrogens. B. impact of mother's oxytocin. C. fungal infection. D. trichomoniasis. E. bacterial infection.

The estimation of life signs, including breathing in a victim, in the case of circulatory arrest: A. should not take more than 5 seconds. B. should not take more than 10 seconds. C. should not take more than 15 seconds. D. should not take more than 20 seconds. E. should last as long as it takes until the rescuer is sure that the victim does not breathe spontaneously.

According to the Polish law patients with some infec- tious diseases are obligatorily hospitalized. Such obligation does not concern patients suspected of: A. diphtheria B. cholera. C. encephalitis. D. infectious mononucleosis. E. Guillain-Barré syndrome.

The frontal fontanelle in children properly closes: A. before the 12 month of age. B. before the 10 month of age. C. between the 12 and 16 month of age. (in the Polish version between 12-18months of age) D. over the 18 month of age. E. between the 10 and 13 month of age.

Indicate the true statements concerning the screen- ing examination for congenital dysplasia of the hip: 1) it includes physical examination - Ortolani and Bar- low maneuvers; 2) Ortolani and Barlow maneuvers are used in neonates and infants under 5 months of age; 3) radiographic assessment of the hips is also used as the screening procedure; 4) ultrasound imaging of the hips is also used as the screening examination; 5) ultrasound examination of the hips is performed between 4 and 6 week of life. The correct answer is: A. 1,2,3. B. 1,4,5. C. 1,2,3,5. D. 2,3,4,5. E. all the above.

A mother came to the GP office with her 7-day-old daughter worrying about a light mucous vaginal dis- charge in the child. What is the correct management? A. discharge is a consequence of mother's estrogen influence, usually self-subsiding, so only the proper care should be recommended. B. purulent vaginitis with vulvitis should be suspected and the child should be referred to the hospital. C. fungal vaginitis should be suspected and the child should be referred to a pediatric specialist for consultation. D. trichomoniasis should be suspected as a conse- quence of vaginal infection in the mother and the child should be referred to the hospital. E. viral vaginitis should be suspected as a conse- quence of vaginal infection in the mother and the child should be referred to the hospital.

Fatigue, nycturia, distension in the right subcostal region, ascites, jugular vein distention are the signs of: A. cardiac arrhythmia. B. chronic left-sided heart failure. C. chronic right-sided heart failure. D. chronic kidney disease. E. chronic pancreatitis.

The GP carried out the Fagerström test in a person smoking for the last 3 years. The result of 3 points means: A. lack of motivation to stop smoking. B. high level of motivation to stop smoking. C. weak nicotine addiction. D. strong nicotine addiction. E. need for psychological consultation in addition to pharmacological treatment.

Heralding symptoms of measles do not include: A. high fever. B. generalized lymphadenopathy. C. dry cough. D. marked rhinitis. E. conjunctivitis.

Which of the following is not a proved risk factor for cervical cancer? A. HPV infection. B. cigarette smoking. C. vaginal coinfection/infection. D. hyperglycemia. E. immunosuppression.

Pulmonary hemorrhage, which is an indication for hospitalization, can be diagnosed if a patient coughs up in short time more than: A. 10 mL of blood. B. 20 mL of blood. C. 50 mL of blood. D. 75 mL of blood. E. 100 mL of blood.

Subclinical hyperthyroidism is characterized by: A. increased TSH level, increased fT3 and fT4 levels. B. increased TSH level, fT3 and fT4 levels do not ex- ceed the upper limit of the range. C. decreased TSH level, increased fT3 and fT4 levels. D. decreased TSH level, fT3 and fT4 levels do not exceed the upper limit of the range. E. normal TSH level, increased fT3 and fT4 levels.

A pregnant woman should not be vaccinated against: A. hepatitis A. B. hepatitis B. C. smallpox D. pneumococcal infection. E. influenza.

Because of suspected hypothyroidism the physician ordered the measurement of TSHand fT4 levels. TSH was slightly elevated and fT4 was within limits. What diagnosis should be formulated considering these laboratory findings? A. euthyroidism. B. subclinical hypothyroidism. C. primary hypothyroidism. D. secondary hypothyroidism. E. tertiary hypothyroidism.

The BCG vaccination of neonates protects little chil- dren from developing: A. severe hematogeneous variants of tuberculosis. B. fibrous-cavernous pulmonary tuberculosis. C. fibrous-cavernous pulmonary tuberculosis and cir- rhotic pulmonary tuberculosis. D. exudative pleuritis. E. all the above.

Which of the following is not a functional gastroin- testinal disorder according to the Rome III classification? A. irritable bowel syndrome. B. functional abdominal bloating. C. functional constipation. D. functional diarrhea. E. paralytic ileus.

„Recurrent abdominal pain occurring for at least 3 days a month in the last 3 months, subsiding after defecation, and preceded by a change in defecation pattern" is a symptom description of: A. celiac disease. B. lactose intolerance. C. colonic diverticulosis. D. irritable bowel syndrome. E. hemorrhoids.

The minimal anti-smoking intervention consists in: A. 3 A's approach. B. 4 A's approach. C. 5 A's approach. D. Fagerström intervention. E. applying nicotine substitution therapy.

Which of the following should be regarded patholog- ical in a 9-month-old infant who was born at term with Apgar 10 points at 1 minute? A. presence of the positive Babinski sign. B. lack of Moro reflex. C. presence of cooing, lack of babbling. D. lack of the palmar grasp reflex, presence of the plantar reflex. E. lack of the posterior fontanelle.

A bi-phasic fever, conjunctivitis, photophobia, runny nose, maculopapular rash first occurring on the head and then spreading to the feet are characteristic of the infectious disease preventable with vaccination, called: A. chickenpox. B. rubella. C. measles. D. erythema infectiosum. E. scarlet fever.

A healthy, full-term infant: A. doubles their birth weight at 4 month, and triples it at 10 month. B. doubles their birth weight at 3 month, and triples it at 9 month. C. doubles their birth weight at 5 month, and triples it at 12 month. D. doubles their birth weight at 6 month, and triples it at 11 month. E. doubles their birth weight at 6 month, and triples it at 12 month.

In which of the following cases there is no need to notify the District Sanitary Inspection? A. suspicion of tetanus. B. diagnosis of infectious mononucleosis. C. suspicion of measles. D. confirmed diagnosis of influenza. E. suspicion of botulism.

Subclinical hypothyroidism is characterized by: A. increase in TSH concentrations with FT4 concentra- tions within the normal range. B. normal TSH concentrations and reduction of FT4 concentrations. C. decrease in TSH concentrations and decrease in FT4 concentrations. D. increase in TSH concentrations and decrease in FT4 concentrations. E. none of the above.

A patient with streptococcal angina symptoms, in ac- cordance with the Centor score modified by McIssac, will receive 1 additional point for affiliation to the following age group: A. 0-2 years. B. 3-14 years. C. 15-44 years. D. > 44 years. E. A, B are true.

Drug-induced hyperkalemia may be caused by one of the following, except: A. amiloride. B. angiotensin-converting enzymes inhibitors. C. angiotensin receptor blockers. D. aldosterone receptor blockers. E. glucocorticosteroids.

In 2005 a new vaccination was introduced into the mandatory vaccination schedule that significantly reduced the number of new cases of epiglottitis. That vaccination was directed against: A. pneumococci. B. measles, mumps and rubella. C. Haemophilus influenzae. D. chickenpox. E. meningococci.

In patients with type 2 diabetes mellitus the arterial blood pressure should be kept below: A. 140/90 mmHg. B. 140/85 mmHg. C. 135/85 mmHg. D. 130/80 mmHg. E. 120/70 mmHg.

A young obese patient comes by her family doctor. She has thinned hair and seborrheic lesions visible on her face. She complains of the dis- ordered menstruation. Indicate the probable diagnosis: A. Klinefelter syndrome. B. polycystic ovary syndrome. C. hyperthyroidism. D. hypoparathyroidism. E. tertiary hyperparathyroidism.

Acute coronary syndrome is suspected from changes in at least two contiguous leadson a resting electrocardiogram. For lead I, the contiguous lead is: A. lead II. B. lead III. C. lead aVL. D. A and B are correct. E. A, B and C are correct.

Surgical treatment of an aortic aneurysm is indicated when its diameter exceeds: A. 1 cm. B. 2 cm. C. 3 cm. D. 4 cm. E. 5 cm.

According to the current Polish vaccination schedule the booster vaccination against measles, mumps and rubella should be given in: A. 4 year of life. B. 5 year of life. C. 6 year of life. D. 8 year of life. E. 10 year of life.

Tertiary prophylaxis: A. prevents the occurrence of social and environmen- tal conditions that could lead to disease onset. B. reduces the risk of or avoids disease. C. detects the disease in its basic stage and treats it. D. reverses the course of the disease, stops or delays its development or sequelae. E. assesses the risks associated with iatrogenic com- plications.

The defined components of the metabolic syndrome do not include the criterion of: A. serum/plasma triglyceride concentration > 150 mg/dL. B. serum/plasma total cholesterol concentration > 250 mg/dL. C. serum/plasma fasting glucose concentration > 100 mg/dL or the treatment of hyperglycemia. D. WHR > 94 cm in males, > 80 cm in females. E. systolic and/or diastolic blood pressure > 130/85 mmHg or the current treatment of hypertension.

A family doctor visiting a 75-year-old patient at her home, who was diagnosed with ischemic heart disease and type 2 diabetes, found that the patient is disoriented about time, place and people, and she complains of dyspnea. The physical examination revealed fine crackles in the left subscapular area, the blood pressure was 90/60mmHg. Which of the following scales would be useful for making a decision on the indications for hospitalization of the patient? A. Wells score. B. CURB-65. C. CHA DS -VASc. D. Centor criteria. E. SCORE.

„Pulmonary interstitium, as well as alveoli are infil- trated by neutrophils, monocytes and lymphocytes. Proliferation occurs locally. Inflammatory lesions dis- appear and are replaced by collagen, intracellular matrix, fibrosis. The sign of this on CT is described as honeycombing'". This is a description of: A. primary pulmonary tuberculosis. B. idiopathic pulmonary fibrosis. C. caseous pneumonia. D. sarcoidosis. E. atypical pneumonia.