Differential diagnosis of syndrome of pulmonary consolidation

1. Sudden onset with dry cough, followed by expectoration, frequently with rusty
sputum, pleuritic chest pain, chills, fever up to 40 °C, clinical signs of pulmonary
consolidation (localized dullness on percussion, bronchial breathing and crepitation
on auscultation) are characteristic manifestations of:
A. lobar pneumonia
B. bronchopneumonia
C. interstitial pneumonia
D. pneumonia in immunocompromised host
E. eosinophilic pulmonary infiltrate
A

2. Homogeneous well delimited opacity of subcostal intensity with lobular or

segmental distribution found on chest X-ray is suggestive for:
A. lobar pneumonia
B. bronchopneumonia
C. interstitial pneumonia
D. pneumonia in immunocompromised host
E. eosinophilic pulmonary infiltrate
A

3. The most common causative agent of lobar pneumonia is:

A. Klebsiella pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Pneumocystis jiroveci
E. Streptococcus pyogenes
B

4. Pneumocystis jirovecii pneumonia is much more common in persons with:

A. HIV/ AIDS
B. diabetes mellitus
C. chronic kidney failure
D. heart failure
E. chronic obstructive pulmonary disease
A

5. Which of the following tumors develops intrabronchially, does not produce its own
image visible radioscopically, is highly vascularized, bleeds easily and can cause
hemoptysis?
A. hamartoma
B. bronchial adenoma
C. fibroma
D. myoma
E. lipoma
B

6.
 6. This radiological image is suggestive for:
A. bronchopneumonia
B. interstitial pneumonia
C. lobar pneumonia
D. atypical pneumonia
E. infiltrative pulmonary tuberculosis

7. Being in an air-conditioned space or in a swimming pool can lead to pneumonia

caused predominantly by:
A. anaerobs
B. gram negative bacili
C. Chlamydophila psittaci
D. viruses
E. Legionella spp.
E
 8. This radiological image is suggestive for:
A. lobar pneumonia
B. bronchopneumonia
C. pulmonary abscess
D. fibro-cavitary tuberculosis
E. pulmonary edema
B

9. Pulmonary infiltrate located in the apical and posterior parts of the lung is more
common in:
A. lobar pneumonia
B. bronchopneumonia
C. interstitial pneumonia
D. pulmonary tuberculosis
E. eosinophilic pulmonary infiltrate
D
 10. This radiological image is suggestive for:
A. lobar pneumonia
B. bronchopneumonia
C. interstitial atypical pneumonia
D. pulmonary abscess
E. fibro-cavitary tuberculosis
C

11. An opacity or opacities of various sizes, poorly defined, in one or both lung fields
found on chest X-ray are suggestive for:
A. lobar pneumonia
B. bronchopneumonia
C. pulmonary abscess
D. tuberculoma
E. pleural effusion
B

12. Polymicrobial association is common in:

A lobar pneumonia
B bronchopneumonia
C eosinophilic pulmonary infiltrate
D tuberculoma
E pulmonary atelectasis
B
 13. This image shows a chest X-ray of a patient with:
A lobar pneumonia
B bronchopneumonia
C multiple pulmonary abscesses
D interstitial pneumonia
E eosinophilic pulmonary infiltrate
C

14.

14. This radiological image is suggestive for:

A. bronchopneumonia
B. interstitial pneumonia
C. lobar pneumonia
D. atypical pneumonia
E. tuberculoma
E
 15. This radiological image is suggestive for:
A. pulmonary abscess
B. lobar pneumonia
C. miliary tuberculosis
D. bronchial adenoma
E. tuberculoma
C

16. . This radiological image is suggestive for:

A. pulmonary abscess
B. pulmonary infarction
C. miliary tuberculosis
D. bronchial adenoma
E. tuberculoma

B
 17. Pleuritic chest pain is highly suggestive for:
A. bronchopneumonia
B. lobar pneumonia
C. miliary tuberculosis
D. bronchial adenoma
E. tuberculoma
B

18. Crackles revealed on lung auscultation are suggestive for:

A. alveolitis
B. bronchial asthma
C. chronic obstructive pulmonary disease
D. bronchial adenoma
E. tuberculoma
A

19. A cavity with an air-fluid level found on chest X-ray is suggestive for:
A. lobar pneumonia
B. bronchial carcinoma
C. pulmonary abscess
D. pulmonary eosinophilia
E. sarcoidosis
C

20. Severe pneumonia in patients with profound immunosuppression, for example in

those with AIDS (acquired human immunodeficiency syndrome), is most often
caused by:
A. Haemophilus influenzae
B. Moraxella catarrhalis
C. Pneumocystis jirovecii
D. Chlamydophila psittaci
E. Staphylococcus aureus
C

21. In more than 90% bronchopulmonary cancer has a starting point in:
A. bronchial cells
B. cells of pulmonary parenchyma
C. cells of lymphatic vessels
D. cellsof blood vessels
E. cells of trachea
A
 Differential diagnosis of bronchoobstrucive syndrome

22. The following investigations may be useful in the differential diagnosis of chronic
obstructive pulmonary disease and bronchial asthma:

A. test of bronchodilatation
B. test of bronchial constriction
C. 6-minute walk test
D. Borg scale
E. smoking index

23. Harsh breathing with prolonged expiration, rhonchi and wheezes are signs of:

A. pulmonary consolidation
B. bronchial obstruction
C. bronchial inflammation
D. hydrothorax
E. alveolar inflammation
B

24. Based on which investigation can we assess the severity of bronchial asthma ?

A. full blood count

B. forced expiratory volume in the first second
C. chest X-ray
D. sputum analysis
E. electrocardiogram
B

25. Inspiratory dyspnea is common in:

A. bronchial asthma
B. chronic obstructive pulmonary disease
C. cystic fibrosis
D. alveolitis
E. bronchial carcinoma
D

26. What investigation allows the differentiation of bronchial asthma and chronic
obstructive pulmonary disease?

A. chest X-ray
B. spirometry
C. computed tomography
D. magnetic resonance imaging
E. chest ultrasonography

B
 27. Bronchial asthma is characterized by:

A. irreversible bronchial obstruction

B. reversible bronchial obstruction
C. irreversible restrictive disorder of pulmonary ventilation
D. reversible restrictive disorder of pulmonary ventilation
E. mixed disorder of pulmonary ventilation
B

28. Chronic obstructive pulmonary disease is characterized by:

A. irreversible bronchial obstruction

B. reversible bronchial obstruction
C. irreversible restrictive disorder of pulmonary ventilation
D. reversible restrictive disorder of pulmonary ventilation
E. mixed disorder of pulmonary ventilation
A

29. Sputum expectoration in large amounts is common in:

A. chronic obstructive pulmonary disease

B. bronchial asthma
C. bronchiectasis
D. pyopneumothorax
E. bronchial asthma
C

30. The viscous, gelatinous, whitish sputum is common in:

A. chronic obstructive pulmonary disease

B. bronchial asthma
C. bronchiectasis
D. pyopneumothorax
E. bronchial carcinoma
B

31. What disease is characterized by hemoptysis?

A. chronic obstructive pulmonary diseases

B. bronchial asthma
C. bronchial carcinoma
D. pyopneumothorax
E. idiopathic pulmonary fibrosis
C

32. The cause of precapillary pulmonary hypertension can be:

A. chronic cor pulmonale

B. essential arterial hypertension
C. secondary arterial hypertension
D. chronic obstructive pulmonary disease
E. pleural effusion
D
 33. At what age does chronic obstructive pulmonary disease develop more often?

A. less than 30 years old

B. 20 – 30 years old
C. 15 – 20 yeras old
D. more than 40 years old
E. 30 – 40 years old
D

34. Bronhodilatation test in spirometry is performed using:

A. beta2-adrenomimetics
B. beta2-adrenoblockers
C. methylxanthines
D. anticholinergics
E. acetylcysteine
A

35. The diagnosis of bronchoobstructive syndrome is made by:

A. bronchoscopy
B. bronchography
C. spirometry
D. chest X-ray
E. computed tomography
C

36. The diagnosis of the reversibility of bronchoobstructive syndrome is made by:

A. 6-minute walk test

B. spirometry and test with beta2-adrenomimetics
C. bronchoscopy
D. chest X-ray
E. computed tomography
B

37. Indicate the diagnostic criterion for status asthmaticus:

A. the extreme form of a bronchial asthma exacerbation accompanied by arterial

hypotension
B. bradycardia
C. a form of bronchial asthma exacerbation which develops in high fever
D. the extreme form of a bronchial asthma exacerbation which lasts more than 24 hours
E. the patient is dependent of corticosteroids
D
 38. The following deviation of the pulmonary ventilation tests is available for bronchial
asthma:

A. increased forced expiratory volume in the first second

B. decreased forced expiratory volume in the first second
C. increased vital lung capacity
D. decreased vital lung capacity
E. decreased total lung capacity
B

39. Status asthmaticus is caused by:

A. discontinuation of corticosteroid treatment

B. contact with allergens
C. acute right ventricle failure
D. acute respiratory viral infections
E. excessive use of beta2-adrenomimetics
A

40. The radiological image below is of a patient with:

A. syndrome of pulmonary consolidation

B. emphysematous type of chronic obstructive pulmonary disease
C. decompensated chronic cor pulmonale
D. cardiac asthma
E. pulmonary atelectasis
B
 41. The radiological image below is:

A. of a patient with lobar pneumonia

B. of a healthy person
C. decompensated chronic cor pulmonale
D. of a patient with cardiac asthma
E. of a patient with pulmonary atelectasis
D?

42. The patient is sitting with his hands fixed on the edge of the bed, with expiratory
dyspnea, spasmodic dry cough and noisy wheezing? What is the most probable
diagnosis?
A. exacerbation of bronchial asthma
B. pulmonary atelectasis
C. pleural effusion
D. right heart failure
E. cardiac asthma
A
43. Inspiratory crackles appear in the lesion of:
A. the trachea
B. large bronchi
C. small bronchi
D. alveoli
E. interstium

S
 44. Mark the factors that initiate the lesion in diffuse interstitial pneumonitis:
a) Abnormal regeneration

b) Repeated epithelial injury

c) Defects of endogenous defense mechanisms

d) Vascular remodeling

e) Normal regeneration

45. Select the factors that favor the perpetuation of the lesion in diffuse interstitial
pneumonitis:
a) Repeated epithelial injury

b) Abnormal regeneration

c) The continuous character of the fibrotic response

d) Alteration of the cytokine environment

e) All variants are correct

46. Select the major symptom in diffuse interstitial pneumonitis:

a) Fever

b) Hippocratic fingers

c) Cyanosis

d) Progressive exertional dyspnea

e) All listed above

47. What are the radiological manifestations of interstitial syndrome in diffuse

interstitial pneumonitis:
a) Nodules / micronodules

b) Fine reticular opacities

c) Reticulo-nodular opacities

d) Bilateral "woolly" infiltrative opacities

e) All listed above

E
 48. What are the types of HRTC lesions in diffuse interstitial pneumonia:
a) The linear pattern

b) The nodular pattern

c) The alveolar pattern

d) The cystic pattern

e) All variants are correct

49. What does the term of “linear pattern” on computed tomography mean:
a) Thickening of the interlobar septa

b) Multiple round opacities

c) Ground glass appearance

d) “Honeycomb” aspect

e) Traction bronchiectasis

50. What does the term of “nodular pattern” on computed tomography mean:
a) Thickening of the interlobar septa

b) Multiple round opacities, with diameter <1cm

c) Ground glass appearance

d) “Honeycomb” aspect

e) Traction bronchiectasis

51. What lymph nodes are most commonly affected in sarcoidosis:

a) Axillary

b) Cervical

c) Intrathoracic

d) Retroperitoneal

e) Inguinal

C
 52. Criteria for differentiating between sarcoid and tuberculosis granulomas (select
those that characterize only sarcoidosis):
a) Langhans giant cells

b) Epithelioid macrophages

c) Caseous necrosis

d) Lack of caseification

e) Lymphocytes

53. What is the frequency of the asymptomatic form of sarcoidosis:

a) 50%

b) 1%

c) 15-25%

d) 90%

e) 70%

54. The following statements are in favor of sarcoidosis:

a) Bilateral hilar lymphadenopathy

b) Erythema nodes

c) Hypercalcemia

d) Hypercalciuria

e) All those listed above

55. Select the basic preparation for the treatment of sarcoidosis:

a) Perindopril

b) Propranolol

c) Prednisolone

d) Procarbazin

e) Penicillamine

C
 56. The most common cause of death in idiopathic pulmonary fibrosis (IPF) is:
a) Heart failure

b) Infections

c) Lung cancer

d) Pulmonary artery thromboembolism

e) Respiratory failure

57. Acute interstitial pneumonitis has the following synonym:

a) Hermanski-Pudlak syndrome

b) Hamman-Rich syndrome

c) Churg-Strauss syndrome

d) Goodpasture syndrome

e) Raynaud's syndrome

58. What is the frequency of respiratory damage in rheumatoid arthritis:

a) 100%

b) 15-50%

c) 1%

d) 5%

e) 0%

59. For pulmonary involvement in granulomatosis with polyangiitis (Wegener) are

characteristic:
a) Impairment of the upper respiratory tract

b) Impairment of the lower respiratory tract

c) Nodular lung lesions with a tendency to excavate

d) Pulmonary infiltrates

e) All variants are correct

E
 60. Select the characteristics of lymphangioleiomyomatosis (LAM):
a) Proliferation of smooth muscle fibers

b) Radiological - cystic images

c) Recurrent pneumothorax

d) Chilothorax

e) All are correct

61. List the physiological ways of draining the pleural fluid:

a) Visceral pleura

b) Parietal pleura

c) Diaphragmatic pores

d) Alveoli

e) None is correct

62. Name the correct statements for pleural effusion:

a) It is a transudate

b) It is an exudate

c) It is an accumulation of blood

d) It is an accumulation of pus

e) All are correct

63. List the causes of chest pain in the pleural effusion:

a) Bronchial cause

b) Alveolar cause

c) Pleural cause

d) Musculoskeletal cause

e) All listed

C
 64. Select the correct statements for the chest pain in pleural effusion:
a) The pain is usually acute, intense

b) The location of the pain corresponds to the affected area

c) The pain is accentuated by deep breathing and coughing

d) The pain is calmed by the immobilization of the respective hemithorax

e) All statements are correct

65. List the characteristics of the cough in pleural effusion:

a) Dry cough

b) Cough with mucous sputum

c) Cough with mucopurulent sputum

d) Cough with bloody sputum

e) All listed

66. Name the causes of hemothorax:

a) Thoraco-pulmonary trauma

b) Aortic dissection with rupture in the pleura

c) Haemophilia

d) Severe thrombocytopenia

e) All are correct

67. List the pleural exudates in which glucopleuria is low:

a) Parapneumonic pleurisy

b) Neoplastic pleurisy

c) Tuberculous pleurisy

d) Rheumatoid arthritis pleurisy

e) All listed

E
Cardiomyopathy

68. It is currently accepted as diagnostic criterion for dilatative cardiomyopathy:

a) Left ventricle telediastolic diameter> 3.7cm / m2 body surface
b) Left ventricle ejection fraction 25%
c) Diastolic dysfunction of left ventricle
d) Hypertrophied interventricular septum
e) Normal size of left ventricle
B

69. Which of the following is not a known cause of dilatative cardiomyopathy:

a) Hemochromatosis
b) Chronic alcohol consumption
c) Myotonic dystrophy
d) Fabry disease
e) Dermatomyositis
D

70. Morphopathologically, dilatative cardiomyopathies are characterized by the

following, with one exception. What is this?
a) Expansion of the 4 heart cavities
b) Extensive areas of interstitial and perivascular fibrosis
c) Modified heart valves
d) Variations in size of myocytes
e) Intracavitary tubules frequently
C
71. The following paraclinical explorations are used in dilative cardiomyopathy to
establish the diagnosis, with one exception. What is this?
a) Cardiac catheterization
b) Radionuclear ventriculographyǎ
c) Spirometry
d) Choreography
e) Endomyocardial biopsy
C
72. Idiopathic dilatative cardiomyopathy, following incompletely cured viral
myocarditis, may occur through myocardial damage caused by the following
viruses, with one exception. What is this?
a) Cytomegaloviruses
b) ECHO-viruses
c) Viruses influence
d) Human immunodeficiency virus
e) Herpesviruses
E
 73. Chest x-ray in dilated cardiomyopathy reveals the following, with one exception.
What is this?
a) Cardiomegaly
b) Signs of redistribution of pulmonary circulation
c) Increased cardiothoracic index
d) Cord of normal size
e) Interstitial and alveolar edema
D

74. Name the most common cardiomyopathy

a) Arrhythmogenic
b) Dilatative
c) Hypertrophy
d) Restrictors
e) Alcoholic
B
75. Mention which component worsens predominantly in dilative cardiomyopathy:
a) Systole
b) Diastole
c) Blood pressure
d) Pulse
e) Peripheral resistance
A

76. State the characteristic ejection fraction values for patients with dilated
cardiomyopathy:
a) 25-39%
b) 50%
c) 60%
d) 70%
e) 100%
A

77. Mention the characteristic echocardiographic change for dilated cardiomyopathy:

a) Dilation of all cavities of the heart
b) Isolated dilation of the left ventricle
c) Increasing the ejection fraction
d) Isolated dilation of the right ventricle
e) Hypertrophy of the interventricular septum
A

78. Mention the worsening component in hypertrophic cardiomyopathy:

a) Systolic
b) Diastole
c) Blood pressure
d) Pulse
e) Peripheral resistance
B
 79. Mention the characteristic echocardiographic change for hypertrophic
cardiomyopathy:
a) Dilation of all cavities of the heart
b) Expansion of the left atrium
c) Increase of the ejection fraction
d) Isolated dilation of the right ventricle
e) Hypertrophy of the interventricular septum
E

80. Name the morphological substrate characteristic of restrictive cardiomyopathy:

a) Marked, diffuse thickening of the parietal endocardium of left ventricle, sometimes of right
ventricle
b) Hypertrophy of the left ventricle myocardium
c) Development of cardiomegaly
d) Thinning of right ventricle walls
e) Myocardial spongiosis
A

81. Name the morphological substrate characteristic of arrhythmogenic

cardiomyopathy of the right ventricle (RV):
a) The marked, diffuse thickening of the parietal endocardium of the left ventricle, sometimes of
the RV
b) Left ventricle hypertrophy of the VS myocardium
c) Development of cardiomegaly
d) Filtration (thinning) of RV walls
e) Myocardial spongiosis

82. State the cardiomyopathy in which the treatment is effective and the favorable

prognosis:
a) Hypertrophic cardiomyopathy
b) Alcoholic cardiomyopathy
c) Dilatative cardiomyopathy
d) Restrictive cardiomyopathy
e) Arrhythmogenic cardiomyopathy
B
Chest pain
83. The etiology of stable angina pectoris is determined in 95% of cases by:

a) Spasm of the coronary arteries

b) Congenital defects
c) Coronary atherosclerosis
d) Tachycardia
e) Coronaritis

84. The cause of life-threatening urgent cardiac chest pain is:

a) Stable angina pectoris

b) Dissecting aortic aneurysm
c) Pericarditis
d) Myocarditis
e) Aortic stenosis

B
85. The cause of non-urgent cardiac chest pain is:
a) Acute coronary syndrome
b) Aortic dissection
c) Pericarditis with tamponade
d) Pulmonary thrombolysis
e) Mitral valve prolapse
E

86. The cause of ischemic cardiac chest pain is:

a) Mitral valve prolapse

b) Dilated cardiomyopathy
c) Angina pectoris
d) Brugada syndrome
e) Drug abuse
C

87. Musculoskeletal cause of chest pain is:

a) Stable angina pectoris
b) Dissecting aortic aneurysm
c) Pericarditis
d) Myocarditis
e) Costochondritis
E
88. Angina attacks are precipitated by:
a) Effort
b) Rest
c) Bradycardia
d) Beta-blockers
e) Nitrates
A
 89. What is the best indicator of myocardial necrosis:
a) Increased creatinine phosphokinase
b) Increased myoglobin
c) Troponin elevation
d) LDH elevation
e) AST elevation
C

90. Which of the following happens in acute coronary syndrome without ST segment
elevation:
a) Angina pectoris
b) Permanent chest pain
c) Paraesthesia
d) Fever
e) Productive cough
A
91. Which of the following is the long-term effect of the post-infarction "remodeling"
phenomenon:
a) Pulmonay hypertension
b) Maintaining a constant volume of systolic ejection
c) Rhythm disorders
d) Left ventricular dilation
e) Atrial dilation
D
92. What symptoms associated with stable angina pectoris are suggestive of ischemic
heart failure:
a) Dyspnea
b) Palpitations
c) Syncope
d) Vertigo
e) Migraine
A
93. Which of the following represents the indication for ischemia tests (Troponines,
CFK-MB) in angina pectoris:
a) Myocardial infarction lasting more than 5 days
b) Heart rhythm disorders
c) Symptomatic obstructive cardiomyopathy
d) Severe heart failure
e) Symptomatic narrow aortic stenosis
A

94. What kind of repolarization abnormality is present on the EKG during the angina
crisis:
a) Elevation of ST
b) Reversed T waves
c) Ventricular extrasystoles
d) PQ segment extension
e) QS wave
B
 95. In case of septal myocardial infarction EKG changes occur in the following
derivations:
a) V1, V2, V3, V4
b) DII, DIII, aVF
c) V1,V2,V3
d) DI, aVL
e) V1,V2,V3, DII, DIII, aVF
C
96. The depression of the ST segment occurs in:
a) Acute coronary syndrome (mirror of an elevation)
b) Ventricular hypertrophy
c) Wolff-Parkinson-White ventricular pre-excitation
d) Branch block
e) All answers are correct
E

97. Which of the following is contraindicated in myocardial infarction of the right

ventricle:
a) Morphine
b) Anxiolytics
c) Aspirin
d) Nitrates
e) Heparin
D
98. Which statement about STEMI is NOT correct:
a) The coronary artery is completely occluded
b) It may cause transmural myocardial necrosis
c) The appearance of the Q wave on the EKG
d) During the previous angina episodes a collateral network is not developed
e) It may cause subendocardial necrosis
E

99. Treatment of acute coronary syndromes without permanent ST elevation does not
include:
a) Aspirin
b) Treatment of risk factors
c) Nitrates
d) Analgesics
e) Clopidogrel
D
 100. The pattern of hemopericardium with electromechanical dissociation
appears in:
a) Mitral insufficiency
b) Sepal rupture
c) Late pericarditis
d) Breaking of the free wall
e) Ventricular rhythm disorder
B

Cardiac arrhythmias

101. The second degree type 1 of atrioventricular block is characterized by:

a) Constant PR interval greater than 0.20 seconds
b) Progressive lengthening of PR interval, followed by blocking an atrial impulse
c) Sudden block, non-conduction of P wave without changes in PR interval
d) Total lack of transmission of atrial impulses to the ventricles
e) Junctional escape rhythm in conditions of severe sinus bradycardia
B
102. The second degree sino-atrial exit block:
a) It can be diagnosed by surface ECG
b) It shows intermittent absence of P waves
c) It is characterized by the absence of atrial activity
d) It is characterized by the appearance of an ectopic atrial pacemaker
e) There is a prolongation of conduction time from SA node to atrial tissue
B

103. In which of the following situations the electrical cardioversion is the treatment of
choice for atrial fibrillation:
a) Alcohol poisoning
b) Thyrotoxicosis
c) Pericarditis
d) Severe worsening of the patient's condition
e) Fever
D

104.The property of cardiac cells to depolarize spontaneously resulting in the formation of

an impulse is:
a) Inotropism
b) Contractility
c) Automaticity
d) Electricity
e) Conduction

C
105. The treatment of choice in haemodynamically unstable patients with WPW and atrial
fibrillation is:
a) Electrical cardioversion
b) Dopamine
c) Electrostimulation
d) Intravenous verapamil
e) Intravenous lidocaine

106. The second degree type 1 AV block is characterized by:

a) No P wave is followed by QRS complex
b) P waves are intermittently blocked while PR intervals are of constant duration
c) Extension of the PR interval, without blocked P waves
d) Blocking of a P wave, after the progressive extension of the PR interval
e) P waves totally dissociated from QRS complexes
D
107.Which of the following atrioventricular blocks (AVB) have a benign prognosis:
a) Infrastructure blocks
b) Truncular blocks
c) The right branch blocks
d) Node blocks
e) Left bandle brunch hemiblocks
D
108. The most common mechanism of cardiac arrest is:
a) Ventricular fibrillation
b) Persistent severe bradyarrhythmias
c) Asystole
d) Electromechanical dissociation
e) Sustained ventricular tachycardia
A

109. These statements about vasovagal syncope are false, with one exception:
a) Are the direct consequence of cardiac arrest
b) Insidious cause decreases effective blood flow
c) Many of which are reversible spontaneously
d) Is reversible only after therapeutic interventions
e) Is a common cause of sudden cardiac death

C
110. The following cardiac conditions are associated with cardiac arrest through decreased
cardiac output, except:
a) Acute massive pulmonary embolism
b) Severe anaphylaxis
c) Ruptured aortic aneurysm with internal bleeding
d) Unsupported ventricular tachycardia, without ventricular fibrillation transformation
e) Myocardial rupture after myocardial infarction
D
111. Treatment of cardiac arrest caused by bradyarrhythmia or asystole does not include:
a) External devices for electrotherapy
b) Orotracheal intubation
c) Defibrillation
d) Adrenaline
e) Atropine
C

Hypertension
112 The disease that requires differentiation in the presence of hypertensive syndrome
encountered more often:
a) Essential hypertension
b) Glomerulonephritis
c) Unilateral renal artery stenosis
d) Acromegaly
e) Primary hyperaldosteronism
B
113 Mention the endocrine cause that requires differentiation in the presence of
hypertensive syndrome less commonly encountered:
a) Obstructive sleep apnea syndrome
b) Pregnancy
c) Congenital adrenal hyperplasia
d) Nefroptosis
e) Aortic coarctation
C

114. The disease associated with secondary renovascular hypertension:

a) Chronic pyelonephritis
b) Diabetic nephropathy
c) Drug interstitial nephropathy
d) Thromboembolism of renal arteries
e) Glomerulonephritis

D
115. What we determine in the first degree of arterial hypertension:
a) Left ventricle hypertrophy
b) Generalized or local narrowing of the retinal arteries
c) Light protein and / or mild increase in plasma creatinine
d) Lack of objective signs of damage to target organs
e) Atherosclerotic plaques demonstrated by angiography or ultrasonography in
the iliac, femoral and aortic arteries
D

116 Mention the values of blood pressure in isolated systolic hypertension:

a) Systolic 130-139 mmHg, diastolic 85-89 mmHg
a) Systolic ≥180 mmHg, diastolic ≥110 mmHg.
b) Systolic ≥140 mmHg, diastolic <90 mmHg.
c) Systolic 160-179 mmHg, diastolic 100-109 mmHg.
d) Systolic 140-159 mmHg, diastolic 90-99 mmHg.
C

117.What does the marked turgescence of jugular veins mean in a patient with arterial
hypertension:

a. Aortic coarctation
b. Obesity
c. Severe biventricular decompensation
d. Cushing's syndrome
e. Superficial thrombophlebitis
C

118 What does the pulse asymmetry in the upper limbs mean in a hypertensive patient
in critical condition:

a) Hypertensive crisis
b) Aortic dissection
c) Obesity
d) Asthenic person
e) Cerebrovascular impairment
B

119 What does the occurrence of diastolic murmur over the aortic auscultation point
mean in a patient with arterial hypertension:
a) Stenosis of the aorta
b) Aortic dissection with proximal extension to the aortic valve
c) Decreased heart compliance
d) Increased telediastolic pressure in the left ventricle
e) The presence of sounds III and IV at auscultation of the heart
B
 120. Indicate the electrocardiographic feature of the Socolov-Lyon index:
a) Increased voltage of the R wave in all thoracic lids
b) S wave in thoracic lid V1 + R wave in thoracic lidds V5-6 will is higher than 35 mm (SV1
+ RV5-6 > 35 mm)
c) T wave is flattened or negative
d) The sub-level of ST segment
e) Deviation of the electrical axis of the heart to the left
B
121. Indicate which combination of antihypertensive drugs is not recommended for the
patients with metabolic syndrome:

a) Beta-blocker and thiazide diuretics

b) Calcium channel blocker and conversion enzyme inhibitors
c) Calcium channel blocker and angiotensin receptor antagonist
d) Calcium channel blocker and thiazide diuretic
e) Beta blocker and calcium channel blocker
A

122. Indicate which group of antihypertensive drugs in diabetics delays the onset of
nephropathy:
a) Beta-blockers
b) Thiazide diuretics
c) Potassium-sparing diuretics
d) Aldosterone receptor antagonists
e) Conversion enzyme inhibitors
E
123.Note the drug of choice used in aortic dissection:

a) Captopril
b) Enalapril
c) Lisinopril
d) Ramipril
e) Sodium nitroprusside
E
124. Thiazide diuretics cause frequent adverse reactions with an exception:

a) Hypokalaemia
b) Hyperuricemia
c) Hyperglycemia
d) Hypercholesterolemia
e) Hypocalcemia

E
125. Which of the following diuretics cause gynecomastia as a side effect:
a) Thiazide
b) Furosemide
c) Spironolactone
d) Triamterene
e) Amiloride
C
126. Which of the following risk factors does not indicate an unfavorable prognosis of
hypertension:
a) Female
b) Smoking
c) Diabetes mellitus
d) Excess alcohol intake
e) Early age
A

127. The final result of cellular membrane defect responsible for increased vascular
reactivity in hypertension is:

a) Increased intracellular sodium ion concentration

b) Increased intracellular potassium ion concentration
c) Increased intracellular chloride ion concentration
d) Increased intracellular calcium ion concentration
e) Increased intracellular magnesium ion concentration
D

128. Which statements are true regarding the treatment of hypertensive crisis in
pheochromocytoma?
a) The drug of choice is furosemide
b) The drug of choice is intravenous metoprolol
c) The drug of choice is nitroglycerin
d) The drug of choice is phentolamine
e) The drug of choice is intravenous enalapril

129. What adverse reaction is characteristic of ACE inhibitors:

a) Headache
b) Cough
c) Tachycardia
d) Heart failure
e) Hyperglycaemia
B
130. The features of malignant hypertension are the following, with an exception:

a) Papilloedema
b) Transient blindness
c) Dysuria
d) Transient paralysis
e) Heart failure

INTESTINAL DISFUNCTIONS
131. Mark the clinical manifestation of secretory diarrhea:
a) Faeces with mucus and pus
b) Large volume watery diarrhea
c) "False" diarrhea
d) Alternation of constipation and diarrhea
e) Rectorrhagia

---------------------------------------------------------------------
132. Indicate the synonym of celiac disease:
a) Gluten enteropathy
b) Tropical spruce
c) Secondary enteropathy
d) Wipple's disease
e) Eosinophilic enteritis
A
---------------------------------------------------------------------
133. Select the option that characterizes inflammation in case of Crohn's disease:
a) Diffuse inflammation of the colon
b) Diffuse inflammation of the ileum
c) Segmental inflammation of any segment of the gastrointestinal tract
d) Diffuse inflammation of any segment of the gastrointestinal tract
e) Diffuse inflammation of the esophagus and stomach
C
---------------------------------------------------------------------
134. Indicate the characteristic element for ulcerative colitis:
a) Fistula
b) Stenosis
c) Superficial ulcerations
d) Canker sores
e) Fissures
C
---------------------------------------------------------------------
135. Select the most common pathology of the large intestine from those mentioned:
a) Diverticulosis
b) Pseudomembranous colitis
c) Ulcerative colitis
d) Colon tumors
e) Irritable bowel syndrome
E
---------------------------------------------------------------------
136. Indicate the symptom that excludes irritable bowel syndrome:
a) Diarrhea
b) Pain and discomfort in the abdomen
c) Elimination of mucus on defecation
d) Lower digestive hemorrhage
e) Constipation
D

---------------------------------------------------------------------
137. Select the endoscopic sign of irritable bowel syndrome:
a) Pseudopolyposis
b) Intact mucosa
c) Singular ulcerations
d) Singular erosions
e) Intestinal diverticulum
B

---------------------------------------------------------------------
138. Select the type of diarrhea for which the positive hunger test is characteristic:
a) Osmotic
b) Secretory
c) Inflammatory
d) Exudative
e) Bloody
A
---------------------------------------------------------------------
139. Name what is characteristic of steatorrhea:
a) Fragments of undigested food in the stool
b) Large amounts of muscle fibers in the stool
c) Large amounts of fat in the stool
d) Acholic stool
e) Large amounts of starch in the stool
C
---------------------------------------------------------------------
140. Select the most common symptom in the onset of colorectal cancer:
a) Massive rectal bleeding
b) Occult rectal bleeding
c) Intestinal occlusion
d) Anal fissures
e) Proctalgia
B
---------------------------------------------------------------------
141. Select the most characteristic symptom in ulcerative colitis:
a) Massive rectal bleeding
b) Occult rectal bleeding
c) Bloody diarrhea
d) Abdominal pain
e) Proctalgia
C
---------------------------------------------------------------------
142. Indicate the diagnostic marker of gluten enteropathy:
a) Anti-mitochondrial antibodies
b) Anti-endomysial antibodies
c) Antinuclear antibodies
d) Antimicrosomal antibodies
e) Anti-DNA antibodies
B
---------------------------------------------------------------------

143. Name the most common clinical symptom in malabsorption syndrome:

a) Abdominal pain
b) Body mass deficiency
c) Aphthous stomatitis
d) Diarrhea
e) Constipation
B
---------------------------------------------------------------------
144. Note the most authentic test for the diagnosis of malabsorption syndrome
a) D-xylose test
b) Lactose tolerance test
c) Barium x-ray examination of the gastrointestinal tract
d) Determination of pancreatic elastase in faeces
e) Examination of gastric secretion
A
---------------------------------------------------------------------
145. Select the main sign of ulcerative colitis:
a) "Cobblestone" pattern
b) Granuloma on biopsy
c) Continuous inflammation of colon

d) Intestinal stenosis
e) Transmural inflammation
C
---------------------------------------------------------------------
146. Which pathology of those listed is more frequently and faster complicated by intestinal
occlusion?
a) Ulcerative colitis
b) Pseudomembranous colitis
c) Ischemic colitis
d) Crohn's disease
e) Lymphocytic colitis
D
---------------------------------------------------------------------
147. Mark the pathology for which the palpable intestinal abdominal mass is a clinical
sign:
a) Whipple's disease
b) Crohn's disease
c) Chronic colitis in dysentery
d) Celiac disease
e) Ulcerative colitis
B
---------------------------------------------------------------------
148. Specify the etiological agent of pseudomembranous colitis:
a) Clostridium difficult
b) Non-specific coccal flora
c) Hemolytic streptococcus
d) Escherichia coli
e) The cause of the disease is unknown
A
---------------------------------------------------------------------

149. Which pathology evolves with the triad of symptoms: persistent gastric
hypersecretion, recurrent ulcerations of the gastrointestinal tract and diarrhea?
a) Zollinger-Ellison syndrome
b) Gastric peptic ulcer
c) Ulcerative colitis
d) Chronic postbulbar ulcer
e) Chronic pancreatitis
A
---------------------------------------------------------------------
150. Mark the type of food that aggravates diarrhea in gluten enteropathy:
a) Meat
b) Raw vegetables and fruits
c) Croutons from bread
d) Rice
e) Corn
C
---------------------------------------------------------------------
151. Select a condition characterized by the presence of diarrhea and the absence of
malabsorption syndrome:
a) Irritable bowel syndrome
b) Achlorhydria
c) Chronic pancreatitis
d) Granulomatous colitis
e) Gluten enteropathy
A
---------------------------------------------------------------------
152. Name the most common location of tumors associated with Zollinger-Ellison
syndrome:
a) Stomach
b) Duodenal wall or multifocal
c) Lymph nodes
d) Spleen
e) Colon
B
---------------------------------------------------------------------
153. What is the most reliable test for diagnosing Zollinger-Ellison syndrome?
a) Basal gastric secretion
b) Maximal acid secretion
c) The level of gastrin in the blood
d) Upper digestive endoscopy
e) Biopsy of the gastric mucosa
C
---------------------------------------------------------------------
154. Identify decreased activity of which serum pancreatic enzyme indicates advanced
pancreatic exocrine failure:
a) Amylase
b) Lipase
c) Trypsinogen
d) Elastase
e) Chymotrypsin
C
---------------------------------------------------------------------

155. Identify the classic manifestation of pancreatic exocrine insufficiency:

a) Hemolytic anemia
b) Diarrhea with steatorrhea
c) Creatorrhea
d) Gastrointestinal bleeding
e) Abdominal pain
B
---------------------------------------------------------------------
156. Identify the research method used to objectify steatorrhea:
a) Determination of faecal nitrogen
b) Staining of faeces with Sudan III
c) Dosage of lactoferrin in faeces
d) Investigation of specific pancreatic elastase-1 in faeces
e) Determination of chymotrypsin activity in faeces
B
---------------------------------------------------------------------
157. Indicate the reference standard for quantifying the exocrine function of the pancreas:
a) Glucose tolerance test
b) Amylase to creatinine clearance ratio
c) Study of serum lipase activity
d) Direct tests requiring collection of duodenal juice in response to secretin-pancreosimin
stimulation
e) Determination of urine amylase
D
---------------------------------------------------------------------
158. Note the pathology that is often associated with exocrine pancreatic insufficiency:
a) Down syndrome
b) Marfan syndrome
c) Primary amyloidosis
d) Cystic fibrosis
e) Felty syndrome
D
---------------------------------------------------------------------
159. Note the pathology for which the creatorrhea is characteristic
a) Chronic pancreatitis
b) Crohn's disease
c) Ischemic colitis
d) Irritable bowel syndrome
e) Biliary dyskinesia
A
---------------------------------------------------------------------
160. A 56-year-old woman has had profuse watery diarrhea for the past 3 months.
Investigations performed from diarrheal stool highlight: Na 39 mmol/l, K 96 mmol/l, Cl 15
mmol/l, bicarbonate 40 mmol/l, osmolarity 270 mosmol/kg H2O (serum osmolarity 280
mosmol/kg H2O). The most likely diagnosis is:
a) Villous adenoma
b) Lactose intolerance
c) Laxative abuse
d) Pancreatic insufficiency
e) Nontropical sprue
A

---------------------------------------------------------------------
161. The following statements about eosinophilic enteritis are true, with one exception:
a) Eosinophilia occurs in the peripheral blood
b) The pathology may affect the stomach, small intestine and colon
c) Most patients have a history of food allergies or asthma
d) Corticosteroid therapy is often effective
e) The pathology is difficult to differentiate from regional enteritis
C
---------------------------------------------------------------------
162. Which of the following tests for malabsorption is usually normal in a patient with
intestinal dysmicrobism:
a) The amount of lipids in the stool in 24 hours
b) Phase II of the stage II Shilling test (administration of intrinsic factor and vitamin B 12)
c) D-xylose absorption test
d) Hydrogen breath test
e) Quantitative cultures of jejunal aspirate
C
---------------------------------------------------------------------
163. A 30-year-old patient complains about colic abdominal pain, flatulence and diarrhea,
exacerbated especially after ingestion of dairy products. There are no changes in the
clinical and paraclinical examination. In this case, the most sensitive and specific
investigation to clarify the diagnosis is:
a) Determination of expired hydrogen after ingestion of 50 g of lactose
b) Determination of blood glucose after ingestion of 100 g of lactose
c) Determination in expired air of labeled CO2 after ingestion of glycine-1- [14C] -glycolate
d) Determination of urinary excretion of xylose after ingestion of 25 g of D-xylose
e) Determination of serum vitamin A levels
A
---------------------------------------------------------------------
164. A 70-year-old Irish citizen has been seeking medical advice for diarrhea and weight
loss for 2 years. The blood count and serum ionogram are normal. Serum D-xylose is 0.76
mmol/l (15 mg/dl) 2 hours after oral loading, and the stool lipid content in 24 hours is 12 g
after a daily intake of 100 g. Microscopic image of the fragment of jejunal biopsy shows
villous atrophy, cryptic hyperplasia, inflammatory infiltrate in the lamina propria,
intraepithelial. Which of the following statements about this patient's condition is correct:
a) It is assumed that the disease is caused by a gram negative bacillus
b) Abdominal pain, arthralgia, subfebrile condition and lymphadenopathy may be frequently
associated
c) The treatment of choice is corticotherapy
d) The administration of a gluten-free diet is usually followed by the normalization of intestinal
absorption tests and the disappearance of histopathological changes
e) Repeat jejunal biopsy after gluten test is indicated
D
---------------------------------------------------------------------

165. Which of the following extraintestinal complications of inflammatory bowel disease is

least commonly associated with ulcerative colitis:
a) Pericholangitis
b) Pioderma gangrenosum
c) Arthritis
d) Uveitis
e) Oxalate kidney stones

E
---------------------------------------------------------------------
166. An 18-year-old patient complains of weight loss and diarrhea. Physical examination
shows edema in the dorsal surface of the legs and a decreased vesicular breath sound at the
base of the right lung. Thoracocentesis extracts milky fluid. Laboratory investigations
reveal lymphopenia, hypoproteinemia and hypogammaglobulinemia. In this case, all
findings are appropriate, except:
a) Abnormal peripheral lymphatic vessels
b) Dilated and telangiectatic lymphatic vessels in the lamina propria, on a biopsy fragment from
the small intestine
c) Steatorrhea
d) Relief of symptoms after a hypolipidemic regimen and supplementation with medium-chain
triglycerides
e) Elimination of 1 g of D-xylose in the urine in the first 5 hours after administration of 25 g of
D-xylose orally.
E
---------------------------------------------------------------------
167. All of the following conditions can cause secretory diarrhea, with the exception of:
a) Medullary thyroid carcinoma
b) Ileocecal resection
c) Zollinger-Ellison syndrome
d) Somatostatinoma
e) Carcinoid tumors
D
---------------------------------------------------------------------
168. The following manifestations are more commonly associated with Crohn's disease
than ulcerative colitis, with one exception:
a) Fistulas
b) Rectal hemorrhage
c) Segmental impairments
d) Palpable abdominal mass
e) Impairments of the mesenteric lymph nodes
B
---------------------------------------------------------------------
169. Select the hallmark of the diagnosis of celiac disease:
a) Abnormal small intestinal biopsy
b) Severe malabsorption syndrome
c) Reversibility of histological changes after a gluten-free diet
d) Presence of antimitochondrial antibodies
e) Presence of antigliadin antibodies
E

ABDOMINAL PAIN
170. Identify the most typical clinical sign of duodenal ulcer:
a) Abdominal pain
b) Nausea
c) Vomiting
d) Constipation
e) Diarrhea
A
---------------------------------------------------------------------
171. Identify the most typical description of duodenal ulcer pain syndrome:
a) Epigastric pain "on hunger", pain at night
b) Pseudoanginal pain
c) Postprandial epigastric pain
d) Upper abdominal pain with band-like radiation
e) Permanent pain in the epigastrium
A
---------------------------------------------------------------------
172. Mark which symptom is NOT typical for uncomplicated peptic ulcer:
a) Epigastric pain "on hunger"
b) Nocturnal pain
c) Therapeutic effect of antacids
d) Chronic antral gastritis associated with H. Pilory
e) Vomiting with food consumed the day before
E
---------------------------------------------------------------------
173. Select the sign that is NOT characteristic of the clinical picture of chronic duodenitis:
a) Epigastric pain that occurs 2-3 hours after a meal
b) Dyspepsia
c) Asthenovegetative disorders
d) Radiation of pain in the right / left hypochondrium
e) Seasonal exacerbation
C
---------------------------------------------------------------------
174. Mark the clinical syndrome characteristic of the early period of chronic pancreatitis:
a) endocrine
b) abdominal pain
c) of exocrine insufficiency of the pancreas
d) dyspeptic
e) allergic
B
---------------------------------------------------------------------
175. A 27-year-old woman, known to have mitral stenosis and atrial fibrillation, goes to the
doctor for severe abdominal pain that started suddenly 24 hours ago and had a peri-
umbilical location; at present it encompasses the whole abdomen. The patient takes digoxin
0.25 mg/day. The physical examination reveals an anxious patient, with a body
temperature of 38oC, a blood pressure of 100/60 mm Hg, a pulse of 120 per min and a
respiratory rate of 26 per min. The skin is cold and sweaty, the oral mucosa is dry.
Auscultation of the heart - diastolic murmur. Intestinal noises are normal. There is a slight
abdominal distension and general sensitivity to ordinary palpation, but not to
decompression. The occult blood test is positive, but there is no melena or blood in stools.
Laboratory investigations show: leukocytes 16 × 109/l, neutrophils 75%, eosinophils 10%,
lymphocytes 10%, monocytes 5%, hematocrit 42%, platelets 522 × 109/l. Abdominal x-ray
on an empty stomach reveals hydroaeric levels. The investigation of choice for establishing
the diagnosis is:
a) Exploratory laparotomy
b) Laparoscopy
c) Angiography
d) Abdominal computed tomography
e) Gastroduodenal barium transit with a follow-up of intestinal time
C
---------------------------------------------------------------------
176. Indicate the most characteristic clinical sign of gallstones:
a) Dyspepsia
b) Fever
c) Eructation
d) Steatorrhea
e) Biliary colic
E
---------------------------------------------------------------------
177. Identify the clinical variant of functional dyspepsia:
a) With the predominance of epigastric pain
b) With the predominance of nausea
c) With the predominance of constipation
d) With the predominance of bloating
e) With the predominance of diarrhea
A

HEPATOMEGALIA
178. Identify which type of serum immunoglobulin is elevated in alcoholic liver disease:
a) Ig A
b) Ig D
c) Ig E
d) Ig G
e) Ig M
A
---------------------------------------------------------------------
179. Identify the hallmark of liver damage:
a) Aphthous ulcers
b) Necrotizing gingivitis
c) Lip swelling
d) Acrocyanosis
e) Spider angiomas
E
---------------------------------------------------------------------
180. Indicate what may suggest diffuse hepatic hyperechoicity on ultrasound examination:
a) Hepatic hemangioma
b) Liver metastases
c) Hepatic steatosis
d) Liver cancer
e) Hepatic cysts
C
---------------------------------------------------------------------
181. Identify the marker of hepatic cytolysis syndrome:
a) Decreased serum albumin
b) Increase in ALT level
c) Decreased cholesterol
d) Hypergammaglobulinemia
e) Elevated alkaline phosphatase
B
---------------------------------------------------------------------
182.Specify for which disease the increased level of gammaglutamyltranspeptidase is
characteristic:
a) H. pylori positive duodenal ulcer
b) Chronic pancreatitis
c) Alcohol-related liver disease
d) Chronic cholecystitis
e) Autoimmune gastritis

C
---------------------------------------------------------------------
183. Indicate the clear sign of the presence of hepatitis B virus:
a) HBsAg-positive; HBV DNA detectable by PCR
b) Presence of jaundice for more than 2 weeks
c) Increased transaminases
d) Positive anti-HBc antibody
e) Positive anti-HBs antibody
A
---------------------------------------------------------------------
184. Indicate the serological marker of hepatitis B virus infection, undetectable in the
blood:
a) HBcorAg
b) HBsAg
c) Anti-HBcor
d) HBeAg
e) Anti-HBe
A
---------------------------------------------------------------------
185. Select the most informative diagnostic method for autoimmune hepatitis:
a) Liver biopsy
b) Retrograde cholangiopancreatography
c) Nuclear magnetic resonance
d) CT scan
e) Abdominal ultrasonography
A
---------------------------------------------------------------------
186. Mark the minimum duration of hepatitis required to determine chronic hepatitis:
a) 3 months
b) 5 months
c) 9 months
d) 6 months
e) 12 months
D
---------------------------------------------------------------------
187. Identify the true statement about hepatitis delta virus (HDV) infection:
a) Viremia is directly associated with the stage of liver disease
b) A co-infection with HCV is assumed
c) Hepatitis delta virus is a DNA virus
d) HDV superinfection in a person with chronic HBV infection has a good prognosis
e) Hepatitis delta virus is a defective virus
E
---------------------------------------------------------------------
188. Identify the condition for which an increased level of γ-globulins and serum IgG ≥ 1.5
times the upper limit of normal values has diagnostic value:
a) Wilson's disease
b) Alcoholic steatohepatitis
c) Acute viral hepatitis B
d) Drug hepatitis
e) Autoimmune hepatitis
E
---------------------------------------------------------------------
189. Identify the condition for which the increase in IgA levels has diagnostic value:
a) Alcoholic steatohepatitis
b) Wilson's disease
c) Nonalcoholic steatohepatitis
d) Autoimmune hepatitis
e) Primary biliary cirrhosis
A
---------------------------------------------------------------------
190. Select the form of hepatitis that is NOT included in the etiological classification of
chronic hepatitis, Los Angeles, 1994:
a) Viral hepatitis
b) Drug hepatitis
c) Alcoholic hepatitis
d) Cryptogenic hepatitis
e) Autoimmune hepatitis
C
---------------------------------------------------------------------
191. Identify histopathological changes that promote the spread of fibrosis in non-alcoholic
steatohepatitis:
a) Significant amounts of copper in hepatocytes
b) Presence of necrosis and inflammatory infiltrate
c) Injury to the interlobular and septal bile ducts
d) The presence of Mallory bodies
e) Hepatocellular ballooning
B
---------------------------------------------------------------------
192. Note the reference laboratory marker in alcoholic hepatitis:
a) Transaminases
b) Alkaline phosphatase
c) Aldolase
d) Carbohydrate deficient transferrin
e) Bilirubin
D
---------------------------------------------------------------------
193. Note the factor that is NOT associated with the progression of chronic hepatitis B to
cirrhosis/liver cancer:
a) The male gender of the patient
b) HBe-negative mutation
c) Alcohol abuse
d) Duration of the disease
e) Absence of fibrosis
E
---------------------------------------------------------------------
194. Select the pathology for which hepato- and splenomegaly are characteristic in
association with brown-green pigmentation on the cornea and neurological disorders:
a) Wilson's disease
b) Primary hemochromatosis
c) Chronic viral hepatitis with extrahepatic manifestations
d) Alcoholic hepatitis
e) Autoimmune hepatitis

A
---------------------------------------------------------------------
195. Mark the most important test for the diagnosis of primary hemochromatosis:
a) Increased hemoglobin and serum iron levels
b) Increased iron excretion in urine
c) Transferrin saturation greater than 70%
d) Transferrin saturation greater than 45%
e) Low serum ceruloplasmin
D
---------------------------------------------------------------------
196. Identify which type of serum immunoglobulin is elevated in autoimmune hepatitis:
a) Ig A
b) Ig D
c) Ig E
d) Ig G
e) Ig M
D
---------------------------------------------------------------------
197. Choose the characteristic morphological criterion for non-alcoholic steatohepatitis:
a) Hepatocyte nuclei in the shape of an "hourglass"
b) Lipid loading of hepatocytes in association with necrosis and lymphohistiocytic infiltrate
c) Remodeling of liver architecture and vascular bed
d) Hyaline and/or protein hepatic dystrophy in association with the presence of ground glass
hepatocytes
e) Presence of regeneration nodules
B
---------------------------------------------------------------------
198. Choose the test that is NOT characteristic of acute alcoholic hepatitis:

a) AST/ALT ratio > 2

b) Low Ig A level
c) Increased Gammaglutamyltranspeptidase (GGTP)
d) Increased carbohydrate deficient transferrin
e) Hypoalbuminemia
B
---------------------------------------------------------------------
199.Which pathology is frequently associated with liver cirrhosis induced by congenital α1-
antitrypsin deficiency?
a) Osteomalacia
b) Pathological fractures
c) Impairment of fertility
d) Recurrent chronic lung diseases with the development of respiratory failure
e) Progressive encephalopathy
D
---------------------------------------------------------------------
200. The differential diagnosis between active chronic hepatitis and persistent chronic
hepatitis is best supported by the presence of:
a) extrahepatic manifestations
b) hepatitis B surface antigen in the serum
c) hepatitis B core antibodies in the serum
d) a significant titer of anti-smooth muscle antibodies
e) specific histopathological changes
E
---------------------------------------------------------------------
201. Percutaneous liver biopsy for diagnostic purposes is indicated in the following cases
with one exception:
a) Hepatosplenomegaly of unexplained cause
b) Persistently altered liver tests
c) Suspicion of hepatic hemangioma
d) Suspicion of miliary tuberculosis
e) Intrahepatic cholestasis of uncertain cause
C
---------------------------------------------------------------------
202. Identify the condition for which the significantly lower level of ceruloplasmin has
diagnostic value:
a) Hereditary hemochromatosis
b) Alcoholic steatohepatitis
c) Wilson's disease
d) Autoimmune hepatitis
e) Primary biliary cirrhosis
C
---------------------------------------------------------------------
203. For women, what is the maximum daily amount of pure alcohol that is harmless for
the liver?
a) 50 gr pure alcohol/day
b) 20 g of pure alcohol/day
c) 40 gr pure alcohol/day
d) 60 gr pure alcohol/day
e) 100 gr pure alcohol/day
B

Portal hypertension
204. Identify the syndrome that reflects the progression of hepatitis to liver cirrhosis:
a) Asthenovegetative syndrome
b) Cytolysis syndrome
c) Immunoinflammatory syndrome
d) Cholestasis syndrome
e) Portal hypertension syndrome
E
---------------------------------------------------------------------
205. Name the characteristic histological sign for liver cirrhosis:
a) Portal inflammatory lymphoplasmacytic infiltrate
b) Cell necrosis
c) Dystrophy of hepatocytes
d) Hepatic steatosis
e) Regeneration nodules
E

---------------------------------------------------------------------
206. Select the syndrome that indicates decompensation of liver cirrhosis:
a) Dyspeptic
b) Immunoinflammatory
c) Asthenovegetative
d) Liver failure
e) Colestatic

D
---------------------------------------------------------------------
207. Indicate the most common cause of upper gastrointestinal haemorrhage in the liver
cirrhosis:
a) Rupture of esophageal varices
b) Mallory-Weiss syndrome
c) Stomach ulcer
d) Esophageal erosions
e) Hemorrhagic gastritis
A
---------------------------------------------------------------------
208. Indicate for which pathology the sinusoidal portal hypertension is characteristic:
a) Liver cirrhosis
b) Inferior vena cava thrombosis
c) Hepatic veno-occlusive disease
d) Constrictive pericarditis
e) Budd-Chiari syndrome
A
---------------------------------------------------------------------
209. Indicate the cause of hypoalbuminemia in liver cirrhosis:
a) Hypocatabolism
b) Insufficiency of liver synthetic function
c) Exudative gastroenteropathy
d) Malabsorption syndrome
e) Proteinuria
B
---------------------------------------------------------------------
210. Indicate which of the malignant liver tumors is the most common:
a) Cholangiocarcinoma
b) Hepatocellular carcinoma
c) Angiosarcoma
d) Hepatoblastoma
e) Carcinosarcoma
B
---------------------------------------------------------------------
211. Select the specific marker for hepatocellular cancer:
a) CEA
b) CA 19-9
c) alpha-fetoprotein
d) PSA
e) CA -125
C

---------------------------------------------------------------------
212. Identify the most common cause of liver cirrhosis:
a) Alcohol
b) Malnutrition, by-pass
c) Toxic industrial factors
d) Parasitosis
e) Prolonged venous stasis
A
---------------------------------------------------------------------

213. Indicate the specific sign of portal hypertension syndrome in liver cirrhosis:
a) Portal pressure gradient < 5 mmHg
b) Vascular angiomas
c) Esophageal varices
d) White nails
e) Epistaxis
C
---------------------------------------------------------------------
214. Mark the clinical symptom that occurs as a result of portal hypertension in liver
cirrhosis:
a) Spider angiomas
b) Digital hippocratism
c) Jaundice
d) Palmar erythema
e) Splenomegaly
E
---------------------------------------------------------------------
215. Mark the paraclinical element that contributes to the occurrence of hemorrhagic
syndrome in cirrhosis:
a) Leukopenia
b) Presence of vasoactive intestinal peptide (VIP)
c) Hypomagnesaemia
d) Decreased level of vasopressin
e) Secondary thrombocytopenia
E
---------------------------------------------------------------------
216. In which part of the esophagus are the esophageal porto-caval anastomoses most
commonly located?
a) In the proximal portion of the esophagus
b) In the middle third of the esophagus
c) In the distal part of the esophagus
d) Throughout the esophagus
e) In the upper and middle third of the esophagus
C

---------------------------------------------------------------------
217. Amino acid metabolism is also affected as a result of severe liver disease. In this
situation, which of the following substances is likely to have a below normal level of plasma
concentration:
a) Ammonia
b) Ammonium
c) Alanine
d) Urea
e) Glycine
D
---------------------------------------------------------------------
218. What is the cause of the appearance of spider angiomas in liver cirrhosis?
a) Hypoestrogenemia
b) Hyperglucagonemia
c) Hyperestrogenemia
d) Hyperaldosteronemia
e) Hyperinsulinemia
C
---------------------------------------------------------------------
219. Portal encephalopathy in a patient with liver cirrhosis may be precipitated by the
following factors, with one exception:
a) Digestive hemorrhage
b) Metabolic acidosis
c) Renal failure
d) Vomiting
e) Viral hepatitis
B
---------------------------------------------------------------------
220. A 52-year-old woman is hospitalized for severe alcoholic hepatitis. On the ninth day of
hospitalization, she presented with a fever of 38.3oC and diffuse abdominal pain. The
physical examination of the abdomen reveals the presence of the positive fluid wave test
and diffuse abdominal tenderness, without muscular defense. Hepatomegaly and
splenomegaly are unchanged from the time of hospitalization. Rectal and vaginal palpation
does not show sensitive areas. Occult blood test - positive. Hematocrit 27%, leukocytes
12×109/l, liver tests are unchanged from the values at the time of admission. Total bilirubin
214 mcmol/l, AST 150 U/l, alkaline phosphotase 180 U/l. Next, the most important
diagnostic test is:
a) Determination of serum amylase
b) Blood culture
c) Abdominal x-ray on an empty stomach in orthostatism and clinostatism
d) Abdominal ultrasound
e) Paracentesis
E
---------------------------------------------------------------------
221. Indicate the most informative examination to determine the level of obstruction of the
portal circulation:
a) Endoscopic retrograde pancreatography
b) Laparoscopy
c) Abdominal ultrasound
d) Angiography
e) Liver biopsy
D
---------------------------------------------------------------------
222. Which of the following statements about portal hypertensive gastropathy is false:
a) Occurs in patients with cirrhosis and portal hypertension
b) May manifest as severe digestive bleeding
c) Always requires biopsy for diagnosis
d) Injuries are caused by nitric oxide
e) Requires treatment with propranolol
C
JAUNDICE
223. Mark what condition may suggest the persistent jaundice in a patient with chronic
pancreatitis:
a) Neoplasm in the head of the pancreas
b) Hemolytic anemia
c) Hepatocellular insufficiency
d) Gilbert syndrome
e) Duodenal stenosis
A
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224. Identify which type of serum immunoglobulin is elevated in primary biliary cirrhosis:
a) Ig A
b) Ig D
c) Ig E
d) Ig G
e) Ig M
E
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225. Identify the condition for which the increase in IgM levels has diagnostic value:
a) Hereditary hemochromatosis
b) Alcoholic steatohepatitis
c) Hepatocellular carcinoma
d) Autoimmune hepatitis
e) Primary biliary cirrhosis
E
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226. What type of investigation is often used as an initial investigation for patients with
jaundice:
a) Abdominal ultrasound
b) Computed tomography
c) Endoscopic retrograde cholangiopancreatography
d) Abdominal x-ray examination
e) Magnetic resonance cholangiopancreatography
A
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227. Indicate the minimum level that bilirubin must exceed to determine skin jaundice:
a) > 10 mcmol/l
b) > 20 mcmol/l
c) > 40 mcmol/l
d) > 60 mcmol/l
e) > 80 mcmol/l
C

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228. Identify the marker of hepatic cholestatic syndrome:
a) Decreased serum albumin
b) Increased ALT
c) Decreased cholesterol
d) Hypergamaglobulinemia
e) Increase in alkaline phosphatase
E
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229. Identify the pathology for which antimitochondrial-M2 antibodies are characteristic:
a) Acute hepatitis A
b) Alcoholic cirrhosis
c) Primary biliary cirrhosis
d) Wilson's disease
e) Primary sclerosing cholangitis
C
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230. Mark the symptom that appears early in primary biliary cirrhosis:
a) Jaundice
b) Fever
c) Pruritus cutaneous
d) Pain in the right hypochondrium
e) Ascites
C
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231. A 56-year-old man goes to the doctor for jaundice. The patient does not take
medication and his only accusation is the slight fatigue, which appeared 2 months ago.
Physical examination only reveals the presence of jaundice. The patient has no significant
personal pathological history. Biochemical investigations: AST 35 U/l, ALT 35 U/l, total
bilirubin 119.7 mcmol/l (direct 85 mcmol/l), alkaline phosphatase 720 U/l. What is the
investigation of choice for the next stage of diagnosis of this patient:
a) Abdominal CT scan
b) Liver biopsy
c) Peripheral blood smear analysis
d) Endoscopic retrograde cholangiopancreatography
e) No further investigation is required for diagnosis, the patient has Rotor syndrome
A
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232. The following statements about primary biliary cirrhosis are true, with one exception:
a) More than 90% of patients test positive for antimitochondrial antibodies
b) Treatment with ursodeoxycholic acid is indicated
c) Most patients are women
d) D-penicillamine administration is an effective treatment
e) In patients with PBC, rheumatoid arthritis, CREST syndrome and scleroderma occur more
frequently.
D

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233. A patient, 19-year-old female, a student in London, presented in the last 6 months
seizures manifested by jaundice, fever, arthralgia, altered general condition and a marked
increase in transaminases; never took hepatotoxic drugs. Hypergammaglobulinemia was
detected, and serological tests for hepatitis A, B, C were negative, as were those for
systemic lupus erythematosus. Liver biopsy reveals bridging necrosis. Which of the
following tests is most useful for confirming the diagnosis?
a) Rheumatoid factor
b) Hemoglobin electrophoresis
c) Liver kidney microsomal autoantibodies (LKM-1)
d) Anti hepatitis D virus antibodies
e) Anti hepatitis E virus antibodies
C
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234. A 67-year-old woman, previously healthy, is undergoing emergency surgery due to a

ruptured aortic aneurysm. Blood is transfused to maintain blood pressure and hematocrit
intraoperatively. After the intervention the patient is hemodynamically stable. On the third
postoperative day the patient is jaundiced, afebrile, but the clinical examination of the
abdomen is normal. Total bilirubin 141 mcmol/l, and direct 107 mcmol/l, alkaline
phosphatase - 360 U/l, AST - 51 U/l. In this case, the most likely explanation for jaundice is:
a) Stone in the main bile duct
b) Toxic hepatitis caused by halothane
c) Post-transfusion hepatitis
d) Acute hepatic infarction
e) Benign intrahepatic cholestasis
E
---------------------------------------------------------------------
235. Which of the following conditions may be present in a patient with scleral jaundice
and bilirubin in the urine?
a) Autoimmune hemolytic anemia
b) Dubin-Johnson syndrome
c) Crigler-Najjar syndrome type II
d) Intermediate thalassemia
e) Gilbert syndrome
B
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236. Mark the gold standard in the diagnosis of Oddi sphincter dysfunction:
a) Endoscopic retrograde cholangiopancreatography
b) Esophagogastroduodenoscopy
c) Sphincter of Oddi manometry
d) Abdominal ultrasound
e) Multi-stage fractional duodenal sounding
C
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237. Indicate the most common investigation used to identify gallstones:
a) Abdominal x-ray
b) Endoscopic retrograde cholangiopancreatography
c) Oral cholecystography
d) Abdominal ultrasound
e) Abdominal CT scan
D
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238. Indicate autoantibodies that are found in 80% of cases of primary sclerosing
cholangitis:
a) Perinuclear antineutrophil cytoplasmic: p-ANCA
b) Anti-Soluble-Liver-Antigen: SLA
c) Antinuclear: ANA
d) Anti-Liver kidney microsomal: anti-LKM-1
e) Anti-mitochondrial: AMA
A
---------------------------------------------------------------------

239. Identify the pathology in which endoscopic retrograde cholangiopancreatography

reveals irregular, "beads-on-a-string" walls of the bile ducts:
a) Primary biliary cirrhosis
b) Viral liver cirrhosis
c) Primary sclerosing cholangitis
d) Hepatocellular carcinoma
e) Alcoholic liver disease
C
---------------------------------------------------------------------
240. Identify the most common causative agent of angiocholitis:
a) Staphylococci
b) Pneumococci
c) Escherichia coli
d) Streptococci
e) Fungi
C
---------------------------------------------------------------------
241. Mark which of the listed diseases is most commonly associated with primary
sclerosing cholangitis?
a) Rheumatoid arthritis
b) Postcholecystectomy syndrome
c) Alcoholism
d) Ulcerative colitis
e) Pulmonary tuberculosis
D
---------------------------------------------------------------------
242. Which of the following situations contributes to the formation of gallstones?
a) Chronic gastroduodenitis
b) Food allergy
c) Hemolytic jaundice
d) Excessive use of dairy products
e) Reflux disease
C

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243. Specify which statement is NOT typical for primary sclerosing cholangitis:
a) Presence of serum autoantibodies LKM-1, ANA, SMA
b) Thickening / narrowing of both intrahepatic and extrahepatic bile ducts
c) Presence of cholestatic syndrome
d) Association with ulcerative colitis
e) Absence of gallstones
A
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244. Specify which statement is NOT typical for primary sclerosing cholangitis:
a) Presence of cholestatic syndrome
b) Affects only intrahepatic bile ducts
c) Association with ulcerative colitis
d) Prevalent in males
e) Presence in serum of p-ANCA autoantibodies
B
---------------------------------------------------------------------

245. The yellow coloration of palms and plants without scleral icterus is characteristic for:
a) Jaundice
b) Carotinemia
c) Drug toxic hepatitis
d) Healthy people
e) Chronic hepatitis
B
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246. The clinical picture of choledocholithiasis includes the following signs, with one
exception:
a) Biliary pain
b) Jaundice
c) Fever
d) Heartburn
e) Hepatomegaly
D
247. What distinguishes true edema from false edema (mark the correct answer for true
edema):

a) Leave the pit

b) Do not leave the pit

c) They are unilateral

d) They are self-limiting

e) They are permanent

248. Which of the following are the stages of edema:

a) Subcutaneous, serous and visceral

b) Preedema, subcutaneous, serous and visceral

c) Initial, localized and generalized

d) Periorbital, facial and permalleolar

e) No variant is correct.

249. Cardiac edema is a manifestation of:

a) Left heart failure

b) Right heart failure

c) Global heart failure

d) Venous stasis in the great circulation

e) Decreased capillary permeability

250. Select the features of renal edema:

a) White, fluffy and soft

b) Painless

c) Leave the well

d) Symmetrical and bilateral

e) All variants are correct

E
251. What is the main differentiating indicator of nephrotic syndrome:

a) Lack of proteinuria

b) Proteinuria reduced below 3.5 g / 24 hours

c) Massive proteinuria over 3.5 g / 24 hours

d) Leukocyturia

e) Hematuria

252. Select the variant that contains all the components of nephrotic syndrome:

a) Hematuria, leukocyturia and cylindruria

b) Proteinuria 2-3 g / 24 hours and cylindruria

c) Proteinuria, edema and hypertension

d) Proteinuria> 3.5 g / 24 hours, lipiduria, hypoproteinemia, hyperlipidemia and edema

e) All variants are correct

253. Select the group of medications with antiproteinuric effect:

a) Calcium channel blockers

b) Alpha-blockers

c) Nitrates

d) Angiotensin conversion enzyme inhibitors

e) No group

254. What is the cause of edema in Ménétrier's disease

a) Hyperalbuminemia

b) Hypoalbuminemia

c) Decreased hydrostatic pressure

d) Increased hydrostatic pressure

e) No answer is correct

B
255. Which of the following drugs may have the side effect of edema:

a) Beta-blockers

b) Calcium channel blockers

c) Methyldopa

d) Minoxidil

e) All oft he above mentioned

Reumatology

256. Anti-CCP antibodies are positive in:

A. Osteoarthritis

B. Rheumatoid arthritis

C. Ankylosing spondylitis

D. Systemic lupus erythematosus

E. Rheumatic polymyalgia

257. Morning stiffness lasting more than 60 minutes is a clinical criterion for:

A. Systemic lupus erythematosus

B. Rheumatoid arthritis

C. Rheumatic fever

D. Osteoarthritis

E. Reiter`s syndrome

B
258. The temporomandibular joints are affected in:

A. Wegener vasculitis

B. Gout

C. Osteoarthritis

D. Ankylosing spondylitis

E. Rheumatoid arthritis

CE OR E

259. Interstitial pulmonary fibrosis in patients with rheumatoid arthritis occurs following
treatment with:

A. NSAIDs

B. Methotrexate

C Corticosteroids.

D. Gold salts

E. Antibiotics

260. The FABER maneuver (Patrick`s test) is used to identify the pathology of the
following joints:

A. Shoulders

B. Elbows

C. Hip

D. Knee

E. Tibiotarsal joints

C
261. HLA-B27 histocompatibility antigen is present in patients with:

A. Rheumatoid arthritis

B. SLE

C. Ankylosing spondylitis

D. Scleroderma

E. Osteoarthritis

262. Bilateral sacroiliitis of various degrees is a radiological criterion for:

A. Osteoarthritis

B. Rheumatoid arthritis

C. Reiter syndrome

D. Ankylosing spondylitis

E. Scleroderma

263. The most common cardiac valve defect that develops in ankylosing spondylitis is:

A. Aortic insufficiency

B. Aortic coarctation

C. Mitral stenosis

D. Aortic stenosis

E. Mitral insufficiency

264. Decreased chest expansion is a diagnostic criterion for:

A. Rheumatoid arthritis

B. Scleroderma

C.Gout

D. Ankylosing spondylitis

E. Osteoarthritic disease

D
265. Acute anterior uveitis occurs in over 40% of patients with:

A. Osteoarthritis

B. Ankylosing spondylitis

C. SLE

D. Scleroderma

E. Rheumatoid arthritis

266. Distal interphalangeal joints are affected in:

A. Rheumatoid arthritis

B. Psoriatic arthropathy

C. Rheumatic fever

D. Rheumatic polymyalgia

E. Wegener vasculitis

267. Onycholysis may be the only manifestation and is a characteristic symptom for:

A. Systemic lupus erythematosus

B. Osteoarthritis

C. Rheumatic polymyalgia

D. Psoriasis

E. Churg-Straus vasculitis

268. Psoriatic arthropathy has the following individual features:

A. Lumps

B. Distal interphalangeal involvement

C. Dactylitis

D. Entezopathy

E. Onycholysis

BCDE
269. This image shows:

A. Onychomycosis

B. Onycholysis in psoriatic arthritis

C. Nail eczema

D. Nail trauma

E. Paronychia

B
270. This image represents:

A. Onychomycosis

B. Onycholysis in psoriatic arthritis

C. Nail eczema

D. Nail trauma

E. Osteolysis in systemic scleroderma

E
271. The image shows the hands of a patient with

A. Osteoarthritis

B. Rheumatoid arthritis

C.Gout

D. Psoriatic arthropathy

E. Reiter`s syndrome

272. The image represents:

A. Rheumatoid arthritis

B. Psoriasis

C. Heberden`s nodes osteoarthritis

D. SLE

E. Gout

C
273. The image represents bilateral sacroiliitis characteristic for:

A. Ankylosing spondylitis

B. Osteoarthritis

C. Rheumatoid arthritis

D. Systemic lupus erythematosus

E. Still disease

A
274. For what disease is this image characteristic?

A. Rheumatoid arthritis

B. Spondylosis

C. Ankylosing spondylitis

D. Gout

E. Scleroderma

275. Achilles tendon bursitis is a symptom that appears in:

A. Gout

B. Rheumatoid arthritis

C. Rheumatic fever

D. Reiter`s syndrome

E. Scleroderma

D
276. Conjunctivitis is a classic manifestation and diagnostic criterion of:

A. Rheumatoid arthritis

B. Gout

C. SLE

D. Osteoarthritis

E. Reiter`s syndrome

277. In viral arthritis the following group of joints is involved:

A. Large joints

B. Medium joints

C. Spine

D. Small joints

E. Sternocostal joints

278. The long-lasting morning redness at the level of scapulohumeral belt and the
coxofemoral joint belt is specific for:

A. Rheumatoid arthritis

B. Ankylosing spondylitis

C. Osteoarthritis

D. Rheumatic polymyalgia

E. Rheumatic fever

279. Libman-Sacks endocarditis is a manifestation of heart involvement in:

A. Rheumatoid arthritis

B. SLE

C. Scleroderma.

D. Gout

E. Arthrosis

B
280. Autoantibodies that carry out cellular damage by type II cytotoxic reactions and type
III immune complexes reactions are present in the following disease:

A. Osteoarthritis

B. Gout

C. Rheumatic polymyalgia

D. Systemic lupus erythematosus

E. Still disease

281. Aseptic osteonecrosis of the hip joint is a secondary clinical manifestation of steroid
treatment in:

A. Rheumatoid arthritis

B. Systemic lupus erythematosus

C. Osteoarthritis

D. Gout

E. Reactive arthritis

282. Acroosteolysis of the distal phalanges is a symptom for:

A. Ankylosing spondylitis

B. Rheumatoid arthritis

C. Scleroderma

D. Systemic lupus erythematosus

E. Gout

C
283. Anticentromere antibodies are present in 60-70% of patients suffering from:

A. Systemic lupus erythematosus

B. Rheumatoid arthritis

C. Limited scleroderma (CREST syndrome)

D. Osteoarthritis

E. Reiter`s disease

284. The major criterion of systemic scleroderma is:

A. Arthritis

B. Morning stiffness lasting 30 minutes

C. Sacroiliitis

D. Proximal thickening of the skin

E. Esophagitis

285. The mechanical type of joint pain is present in:

A. Systemic lupus erythematosus

B. Scleroderma

C. Ankylosing spondylitis

D. Osteoarthritis

E. Gout

286. The Heberden`s nodules appear on the following joints:

A. Proximal interphalangeal joints

B. Distal interphalangeal joints

C. Elbows

D. Radiocarpal joints

E. Knee

B
287. The Bouchard`s nodules are located on:

A. Distal interphalangeal joints

B. Elbows

C. Proximal interphalangeal joints

D. Radiocarpal joints

E. Knee

288. Birefringent crystals of monosodium urate detected under microscopic examination of

synovial fluid confirm the diagnosis of:

A. Disease by deposition of hydroxyapatite crystals

B. Gout

C. Osteoarthritis

D. Chondrocalcinosis

E. Reactive arthritis

289. Calcium pyrophosphate dihydrate crystals detected by microscopic examination of

synovial fluid confirm the diagnosis of:

A. Gout

B. Disease caused by the deposition of hydroxyapatite crystals

C. Osteoarthritis

D. Rheumatoid arthritis

E. Chondrocalcinosis

E
290. The decrease of uric acid excretion occurs in:

A. Myeloproliferative disease

B. Lymphoma

C. Administration of diuretics, antiplateletes, cyclosporine

D. Psoriasis

E. SLE

291. Increased uric acid production occurs in:

A. Chronic kidney failure

B. Arterial hypertension

C. Saturnian nephropathy

D. Psoriasis

E. Hyperparathyroidism

292. Erythema of limb extension surfaces (Gottron`s papules) is a clinical symptom of:

A. Rheumatoid arthritis

B. Ankylosing spondylitis

C. Scleroderma

D. Dermatomyositis

E. Rheumatic fever

293. Heliotrope rash (periorbital erythema, edema and hyperpigmentation) is a symptom

of:

A. Rheumatoid arthritis

B. Systemic lupus erythematosus

C. Osteoarthritis

D. Dermatomyositis

E. Ankylosing spondylitis

D
294. The following condition is NOT a risk factor for osteoporosis:

A. Inactivity

B. Obesity

C. Early menopause

D. Reduced body mass

E. Family history of osteoporotic fracture

295. Which of the following is affected in the periarticular pain syndrome:

A. Synovial tissue

B. Periarticular structures

C. Cartilage

D. Bone

E. Synovial fluid

296. The Schober`s test determines:

A. Cervical mobility

B. Lumbar mobility

C. Thoracic mobility

D. Mobility of the humeral belt

E. Coxofemoral mobility

297. The distance between the fingers and the floor determines the level of lumbar mobility
in patients with:

A. Scleroderma

B. Systemic lupus erythematosus

C. Ankylosing spondylitis

D. Osteoarthritis

E. Gout

C
298. The presence of acute fever in intravenous drug users is mostly due to:

A. Inhalation pneumonia

B. HIV infection

C. Bacterial endocarditis

D. Cellulitis

E. Bursitis.

299. Differential diagnosis of rheumatoid arthritis with onset in the climacteric period is
necessary to be performed with:

A. Ankylosing spondylitis

B. SLE

C. Scleroderma

D. Rheumatic polymyalgia

E. Gout

300. Which of the following diseases does not belong to the group of seronegative
spondylitis:

A. Ankylosing spondylitis

B. Psoriatic arthritis

C. Scleroderma

D. Reiter`s syndrome

E. Reactive arthritis

C
301. Which of the following biological tests significantly increases in severe bacterial
infections:

A. Total bilirubin

B. Albumin

C. Procalcitonin

D. Urea

E. Creatinine

302. One of the following symptoms is not a criterion for Churg-Strauss vasculitis:

A. Bronchial asthma

B. Sacroiliitis

C. Blood eosinophilia > 10%

D. Migratory pulmonary infiltrates

E. Extravascular eosinophilia at histopathologic examination

303. A 50- year old patient complains of dysphagia for solid and partially liquid foods,
regurgitations and vomiting. Hands` serial radiographs reveals acro-osteolysis. What is the
diagnosis?

A. SLE

B. Rheumatoid arthritis

C. Scleroderma

D. Osteoarthritis

E. Gout

C
304. What phenomenon is shown in this image:

A. Vasculitis

B. Raynaud's syndrome

C. Frostbite

D. Osteolysis

E. Digital trauma

305. Periorbital erythema ("in glasses") is a symptom of:

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoarthritis
D. Dermatomyositis
E. Ankylosing spondylitis
D

306. Axial arthritis, bilateral sacroiliitis and marginal syndesmophytes on X-ray suggest
the diagnosis of:

A. Gout

B. Seronegative spondyloarthropathy

C. Ankylosing spondylitis

D. Rheumatoid arthritis

E. Scleroderma

C
307. The treatment of osteoarthritis has the following objectives:

A. Patient`s education

B. Reducing pain and maintaining joint mobility

C. Treatment of synovitis

D. Stopping the disease progression

E. All of the above mentioned

308. Pain with chewing and impaired mobility of the temporomandibular joints occur in:

A. Ankylosing spondylitis

B. Rheumatoid arthritis

C. Reiter`s syndrome

D. Gout

E. Reactive arthritis

309. The X-ray picture of erosive asymmetric arthritis of the distal interphalangeal joints,
sacroiliac joints and spine is observed in:

A. Rheumatoid arthritis

B. Systemic lupus erythematosus

C.Scleroderma

D. Psoriatic arthritis

E. Gout

310. SLEDAI-2K is an index used to determine the activity of:

A. Psoriatic arthritis

B. Scleroderma

C. Systemic lupus erythematosus

D. Osteoarthritis

E. Gout

C
311. The cervical spine is the only segment of the spine affected in:

A. Gout

B. Rheumatoid arthritis

C. Scleroderma

D. LES

E. Osteoarthritis

312. Anti-centromere antibodies are NOT present in:

A. Systemic lupus erythematosus

B. Rheumatoid arthritis

C. Limited scleroderma (CREST syndrome)

D. Osteoarthritis

E. Reiter`s disease

ABDE