2024 Conditional Internal Medicine

1. Indicate which of the following advices should not be given to a patient taking levothyroxine (LT4) for the treatment of hypothyroidism:
A. LT4 should be drunk abundantly with boiled water
B. LT4 can be used in the evening, at least 3 hours after the last mosl
C. LT4 used in the morning should be taken 45-60 minutes before the morning meal
D. when using LT4 and PPIs, there should be a minimum interval of 3-4 hours between these drugs, taking LT4 first
E. if you suffer from adrenal insufficiency, you should ensure proper alignment of the corticotropic axis before increasing the dose of LT4

2. Indicate the false statement about atrial fibrillation (AF):

A. AF is the most common supraventricular tachyarrhythmia
B. AF lasting 48 hours is termed "persistent"
C. the most common non-cardiac cause of AF is hyperthyroidism
D. the basic diagnostic criteria for AF on the ECG are: irregularly irregular QRS complex and no P waves
E. chronic poerly controlled AF may lead to the development of tachycardia-induced cardiomyopathy and heart failure

3. Which of the following statement regarding myelodysplastic syndromes is correct:

A. Myelodysplastic syndromes may progress into acute myeloid leukemia
B. Thrombocythemia is a common sympan
C. Myelodysplastic syndromes usually affect young patients
D. Myelodysplastic syndromes can develop as a result of vitamin deficiency
E. Myelodysplastic syndromes result from intervertebral bernia and spinal cord compression

4. Which of the following symptoms is not related to B defficiency:

A. Neuropathy
B. Chronic gastritis
C. Stomatitis
D. Hair loss and brittle nails
E. Yellowish skintone

5. Symptoms of nephrotic syndrome include:

A proteinuria>3.5 g/d, edema, hypoalbuminemia
B. proteinuria >3.5 g/d, hypoalbuminemia, arterial pertension
C. proteinuria <3.5 g/d, hemataria, arteral hypertension
D. proteinuria >3.5 gid, hematuria, hypoalbuminemia
E proteinuria >3.5 g/d, edema, arterial hypertension

6. Which of the following statements is correct in case of constrictive pericarditis?

A. In cardiac CT a calcified pericardium is most commonly observed
B. The dominant pathology in case of restrictive pericarditis is a zystolic dysfunction of the left ventricle
C. Recurrent acute pericarditis always leads to constrictive pericarditis
D. All the answers above are corect
E. None of the answers above is correct

7. Indicate the possible reason for the presence of a persistently low urine specific gravity during property conducted dehydration tests:
A central diabetes insipidus
B. nephrogenic diabetes insipidus
psychogenic polydipsia
D A and B are correct
E A and Care correct

8. Which of the following diseases should be diagnosed with cardiac magnetic resonance if suspected?
A. dilated cardiomyopathy
B. amyloidosis of the heart
C. sarcoidosis of the heart
D. A,B correct
E. A,B,C correct

9. Indicate the contraindication for the choice of mechanical valve prosthesis in the surgical treatment of severe aortic stenosis:
A. age <40 years
B. hyperparathyroidism
persistent atrial fibrillation
pregnancy planning
E. type 2 diabetes treated with insallin

10. Which of the following is not a diagnostic criterion for diagnosing polycythemia vera
A. JAK 2 marion
B. High erythropoietin level
C. Hypercellular blood marrow
D. Increased growth of endogmous erythroid colonies
E. High hematocrit and hemoglobin count

11. What is not typical for de Quervain's thyroiditis?

A. transient decrease in TSH concentration
B. good response to antibiotic weatment
C. presence of multinucleated giant cells in the cymingical inage
D. high C-eractive protein concentration
E. increased neck pain
12. Which of the following features differentiates parsysmail noctural hemoglobinaria from annan bemolytic anemia:
A. Rapid haemolysis
B Increased tendency to clot formation and thrombotic events
C. Presence of spherocytosis
D. Normal serum bilirubin concentration
E. Neurological symptoms

13. Which one of the following is not a risk factor for venous thromboembolism
A. Chronic heart failure
B. Chronic obstructive pulmonary disease
C. COPD
C. Hormonal replacement therapy
Factor VIII deficiency
Nephrotic syndrome

14. The secondary prevention of sudden cardiac death in patients who survived cardiac arrest in the mechanism ventricular fibrillation unrelated to
acute coronary syndrome requires
A cardioverter-defibrillator implantation
B. cardiac pacemaker implantation
C. proper anti-arrhythmic drug treatment only, including amiodarone
D. cardiac ablation
E. first cardiac pacemaker implantation and in the next stage, cardiac ablation

15. The most common locations of a gastrinoma tumour include stomach, 1)stomach 2) duodenum 3) gallbladder 4) pancreas; 5) appendix. The
correct answer:
A. 1,3
B. 1,4
C. 2,5
D. 2,4
E 4,5

16. A typical disorder in the ionogram of patient with primary aldosteronism:

A hypokalaemia
B. hyperkalaemia
C. hypochloraemia
D. hyperchloraemia
E. hyponatraemia

17. The natural decline in glomerular filtration that occurs for the age of 45
A. 1ml/min/1.73m2 for each year of life
B. 2ml/min/1.73m2 for each year of life
C. 3ml/min/1.73m2 for each year of life
D. 4ml/min/1.73m2 for each year of life
E. 5ml/min/1.73m2 for each year of life

18. Treatment of hepatorenal syndrome can be realised by:

A. furosemide and spironolactone
B. albumin and terlipressin
C. furosemide and albumin
D. propranolol and furosemide
E. furosemide and neomycin

19. An indication for diabetes screening in every year of life is not:

A. overweight and obesity
B. A second degree relative with diabetes
C. history of gestational diabetes
D. little physical activity
E. PCOS in women

20. Diagnostics for H.pylori infection is not necessary in

A. duodenal ulcer
B. folate deficiency anaemia
C. pernicious anaemia
D. chronic atrophic gastritis
E. stomach cancer treated with endoscopic mucosectomy

21. Which of the following arrhythmias should be treated with defibrillation: 1) atrial fibrillation 2) ventricular fibrillation 3) ventricular tachycardia
with pulse in a haemodynamically stable patient 4) asystole 5) pace-less ventricular tachycardia
A. 2,5
B. 1,2,3,5
C. 1,2,3,4,5
D. 2,4
E. 2,3,4

22. In a patient with acute heart failure, severe shortness of breath and significantly overhydrated, administer the following medications to reduce
shortness of breath and dehydrate the patient:
A. Furosemide i.v. -> if there is no desired effect, I will add hydrochlorothiazide -> if there is no desired effect, I will add dobutamine/dopamine
B. Torasemide i.v. -> if there is no desired effect, I will add hydrochlorothiazide or spironol -> if there is no desired effect, I will add
dobutamine/dopamine
C. High dose furosemide i.v. only
D. Only dopaminę i.v. and spironol p.o.
E. A and B are correct

23. Which one of the following laboratory abnormalities does not indicate haemolysis:
A. Elevated LDH
B. Elevated serum haptoglobin concentration
C. Elevated direct and indirect bilirubin levels
D. Elevated stool sterkobilinogen
E. Urobilinogenuria

24. 24. Which of the following conditions predisposes towards recurrent acute pancreatitis?
A. HFE gene mutation (C282Y)
B. regular consumption of drinks rich in fructose
C. hyperaldosteronism
D. hypertriglyceridemia
E. ectopic pancreatic tissue in the stomach

25. Charcot's trind is a set of signs typical of:

A cholangitis
B. chronic pancreatitis
C. hepatic steatosis
D. colon cancer
E. bleeding from a duodenal ulcer

26. In the treatment of acute hyperkalemia in a patient with eGFR <25ml/min/1.73m² and concomitant decompensated non-respiratory acidosis:
A. 10% glucose and insulin solution, nebulized salbutamol, spironolactone
B. 10ml 10% calcium chloride solution; salbutamol; thiazide diuretic
C. 10% glucose and insulin solution; 8.4% NaHCO, solution; furosemide
D 10% glucose and insulin solution; heparin, furosemide (E. 8.4% NaHCO, solution; salbutamol; eplerenone

27. Which of the following medications should be used in an ambulatory patient with a chronic heart failure with reduced ejection fraction (LVEF
38%) and permanent atrial fibrillation according to the European Society of Cardiology?
A. Verapamil
B. Diltiazem
C. Ivabradine
D. Flozin
E. Aspirin

28. Which one of the following is related to unfavourable prognosis in acute lymphoblastic leukaemia:
A. The presence of Philadelphia chromosome
B. Achieving remission after the first cycle of chemotherapy
C. The presence of common antigen (CD10)
D. Paediatric patient
E. Low initial leukocyte count

29. On the fifth day after anterior wall ST-segment elevation myocardial infarction patient presents rapidly increasing dyspnoea. On the physical
examination the following were found: pulse rate 130/mis, RR 120/70mmHg, crackles over entire lung fields, loud holosystolic murmur best audible
over the apex of the heart (which was not heard the previous day). In a ECG: sinus tachycardia and features of the evolution of myocardial infarction
were found. Choose a response containing the most likely cause of the deterioration of the patient and the urgent diagnostic tests that you should
perform in the first place:
A. free wall of the left ventricle rupture; urgent coronary angiography
B. free wall of the left ventricle rupture; urgent echocardiography
C. interventricular septum rupture; urgent coronary angiography
D. papillary muscle rupture; urgent coronary angiography
E. papillary muscle rupture; urgent echocardiography

117. The characteristics of urticaria wheat and urticaria do not include

A. Resolution without scarring
B. The lesion is itchy, well confined to the environment, fading under pressure
C. Resolution with scarring
D. The lesions usually disappear spontaneously or under the influence of antihistamines
E. None of the above

118. Specific immunotherapy is effective in treating

A. food hypersensitivities
B. Allergic rhinitis
C. Allergic asthma
D. A + C
E. B + C

119. Hypersensitivity to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (e.g. in aspirin induced asthma) is a hypersensitivity of
A. allergic IgE-mediated atopic
B. non-allergic
C. independent allergic IgE-controlled disease initiated by mechanisms related to the presence of antibodies other than lg
D. independent allergic IgE-independence initiated by cellular mechanisms
E. non-topic allergic IgE-dependent

120. Treatment of lower airway obstruction in allergy involves (lower respiratory tract):
A. intravenous administration of corticosteroids
B. inhaled corticosteroids
C. administration of B2-mimetics by inhalation
D. intravenous administration of epinephrine
E. endotracheal intubation and replacement ventilation in each case before swelling builds up