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Medical Licensing Exam( Mixed Questions 267-489)

Total questions: 212

Worksheet time: 2hrs 19mins

Name
Class
Date
1.

*267.Spontaneous bacterial peritonitis:

a)

appears at the patients with cirrhosis without decompensation

b)

for initiation of antibiotic therapy, it is mandatory to have a positive microbiological culture sample from ascites liquid

c)

infected ascites is produced on hematogenous pathway

d)

the main etiological agent is Staphylococcus aureus

e)

a high number of neutrophils in the ascites does not represent a proof for antibiotic therapy initiation

2.

*268.Post-systemic encephalopathy treatment:

a)

administration of enemas and purgatives it’s useful

b)

stopping the diuretic treatment is not necessary

c)

protein restriction over 48 hours

d)

antibiotic therapy with Rifaximin has not a demonstrated efficiency

e)

IV-line perfusion is not recommended because there is a risk of cerebral edema

3.

*269.Hepatorenal syndrome treatment:

a)

diuretic therapy is benefic

b)

volemic refilling should be made with saline solutions

c)

Noradrenaline administration leads to benefits in extended administration

d)

Terlipressin administration and human albumin improves the kidney’s function

e)

angiotensin-converting enzyme inhibitors (IECA) should be administered systematically

4.

*270.Primitive biliary cholangitis (named in the past primitive biliary cirrhosis) is a chronic liver disease characterized through:

a)

the destruction of the choledochus and secondary cholestasis

b)

chronic cholestasis associated with biliary lithiasis

c)

obstruction of the intra- and extrahepatic ducts

d)

progressive destruction of the interlobular bile ducts

e)

induced cholestasis by medication which can present a potential toxicity for the liver

5.

*271.Primary sclerosing cholangitis is a chronic cholestatic liver disease described through:

a)

reversible destruction of the biliary extrahepatic ducts

b)

Oddi sphincter disfunction with secondary cholestasis

c)

inflammatory destruction with fibrosis at the biliary intra- but also the extrahepatic ducts

d)

obstruction due to choledochal lithiasis with secondary chronic cholestasis and the development of a chronic liver disease

e)

destruction of the small intrahepatic bile ducts

6.

*272)Hereditary hemochromatosis is an inherited disease characterized by:

a)

Copper deposition in the liver

b)

excessive iron deposition only in the liver

c)

excessive iron deposition in various organs, without fibrosis in evolution

d)

Zinc deposition in various organs

e)

excessive iron deposition in various organs with fibrosis in evolution and organ failure

7.

*273)Alpha 1 antitrypsin deficiency

a)

is associated with liver disease and pulmonary emphysema

b)

hepatic cirrhosis occurs at an age around 30 years old

c)

it has an etiological treatment

d)

is a disease which appear at smokers

e)

clinically manifested disease occurs especially at heterozygotes

8.

*274)The most common etiological factor of liver cirrhosis worldwide is:

a)

alcohol consumption

b)

viral infection

c)

non-alcoholic fatty liver

d)

hemochromatosis

e)

Wilson disease

9.

*275)Micronodular cirrhosis is often caused by:

a)

alcohol

b)

liver virus B

c)

liver virus C

d)

non-alcoholic fatty liver

e)

autoimmune hepatitis

10.

*276)Relative contraindications of liver transplant includes:

a)

extended splanchnic vein thrombosis

b)

the age over 60 years old

c)

hepatocellular carcinoma with the presence of less than 3 small lesions (<3 cm )

d)

serum bilirubin over 10 mg/dl

e)

hepatocellular carcinoma with only one nodule with a dimension under 5 cm

11.

*277)After the liver transplant, acute graft rejection:

a)

appears at 2 or 3 days after the transplant

b)

it is always symptomatic

c)

can manifest through fever

d)

it is rarely reversible under immunosuppression therapy

e)

more precisely the histopathological expression is the thinning and the disappearance of the bile ducts

12.

*278)The surviving on long term after the liver transplant it’s compromised by the disease recurrence in following conditions:

a)

autoimmune cirrhosis

b)

hepatocellular carcinoma

c)

alcoholic cirrhosis

d)

non-alcoholic fatty liver

e)

hemochromatosis

13.

*279)Pick the right affirmation regarding portal hypertension:

a)

rectal varices are rarely seen

b)

the microvascularisation of the intestine atrophies leading to hypertensive colopathy

c)

the difference between rectal varices and hemorrhoids is given by the lower location of the rectal varices in the anal channel

d)

portal gastropathy is characterized by the presence of gastric varices with a bleeding potential

e)

the collaterals located at the gastroesophageal junction (varices) are superficial and have a

tendency to break

14.

*280)Posthepatic portal hypertension occurs in:

a)

liver cirrhosis

b)

splenic vein thrombosis

c)

schistosomiasis

d)

constrictive pericarditis

e)

regenerative nodular hyperplasia

15.

281)Choose the right answers regarding paracentesis in patients with liver cirrhosis:

a)

TIPS (transjugular intrahepatic portosystemic shunt) do not have indication in refractory ascites

b)

the main complications are hypovolemia and renal impairment dysfunction

c)

it is indicated at the patients that do not respond in a good way to diuretic therapy

d)

up to 20 L of ascites may be evacuated in 4 – 6 hours without the need of albumin perfusion

e)

paracentesis over 5 L may be associated with complications

16.

282)The shunts used in refractory ascites:

a)

TIPS (transjugular intrahepatic portosystemic shunt) in patients with porto-systemic encephalopathy

b)

TIPS in patients with an important renal dysfunction

c)

implementation of a peritoneo-vesical duct using a pump is indicated in advanced liver cirrhosis

d)

an abdominal drainage on long term allows the control of ascites at home

e)

using a TIPS will lead to a decreased frequency of evacuation paracentesis

17.

283)The treatment in spontaneous bacterial peritonitis:

a)

nonselective B-blockers should be stopped when PBS is being diagnosed

b)

secondary prophylaxis with norfloxacin increases survival rate

c)

broad-spectrum antibiotics are used

d)

antibiotic treatment is associated with albumin perfusion

e)

macrolides and aminoglycosides are the elective antibiotically treatment

18.

284)Porto-systemic encephalopathy:

a)

occurs in patients with liver cirrhosis

b)

occurs due to spontaneous or surgical porto-systemic shunts

c)

the main pathogenically mechanism seems to be determinate by a disturbance of the cerebral neurotransmitters balance

d)

accumulations of false neurotransmitters (octapamine) or activation of inhibitory neurotransmitters system of gamma-aminobutyric acid (GABA) appears to be a pathogenic mechanism

e)

it seems that there are not any precipitating factors

19.

285)Clinical signs of porto-systemic encephalopathy are:

a)

foetor hepaticus

b)

flapping tremor

c)

generalized tremor

d)

reversing the walking-sleep rhythm

e)

quality decrease of intellectual function

20.

286)The diagnosis of porto-systemic encephalopathy:

a)

it is clinical

b)

EEG presents a decrease frequency of alpha normal waves

c)

the ammonia from arterial blood can be useful for differential diagnosis of comas

d)

it is based exclusively on identification of porto-systemic shunts

e)

potentials evoked visually can detect subclinical encephalopathy

21.

287)Hepatorenal syndrome:

a)

usually occurs in patients with compensated liver cirrhosis

b)

renal histology is almost normal

c)

is precipitated by excessive diuretic treatment

d)

the mechanism is similar to the one which causes ascites, with a peripheric vasodilatation which leads to a decrease of effective volume of circulating blood

e)

the diuresis is maintained but with a high concentration of urinary sodium

22.

288)Precipitating factors for hepatorenal syndrome are:

a)

AINS use

b)

diarrhea

c)

paracentesis

d)

infectious (especially acute spontaneous peritonitis)

e)

hepatoprotective therapy

23.

289)Possible complications of hepatic cirrhosis are:

a)

hepatopulmonary syndrome characterized by appearance of lung consolidations zones

b)

porto-pulmonary hypertension

c)

primary hepatocellular carcinoma

d)

hepatic encephalopathy

e)

acute renal failure through tubular necrosis

24.

290)Clinical manifestation in primary biliary cholangitis:

a)

the patient can be asymptomatic

b)

pruritus is usually the first symptom

c)

fatigue can lead to disability

d)

it’s associated with autoimmune diseases

e)

keratoconjunctivitis sicca shows up rarely

25.

291)Paraclinical explorations of primary biliary cholangitis highlights:

a)

mitochondrial antibodies are present in most of the people

b)

alkaline phosphatase is increased in most of the people

c)

hepatic cytolysis syndrome represents the main biochemical manifestation

d)

serum cholesterol is raised

e)

abdominal ultrasound offers suggestive data for diagnosis

26.

292)Which of the next affirmations are truth according to primary biliary cholangitis (CBP)

a)

liver biopsy present specific histological features

b)

a group of patients with specific histological modifications of CBP bust serological the type of autoimmune hepatitis is called having autoimmune cholangitis and has a response to steroids and azathioprine therapy

c)

ursodeoxycholic acid (10-15 mg/kg) improves the level of bilirubin and liver transaminases

d)

the pruritus is easy to control with antihistamine therapy

e)

a malabsorption can set for fat-soluble vitamins (A, D and K) but their supplementary is not necessary

27.

293)Choose the right affirmation about primary sclerosing cholangitis (CSP)

a)

usually is detected through screening at patients with inflammatory bowel disease

b)

the main symptoms are: fluctuating pruritus and jaundice

c)

can occur cholangitis events

d)

specifical biliary modifications are associated with CSP and can be identified through MRCP

e)

the treatment involves corticosteroids with excellent results

28.

294)Hereditary hemochromatosis – clinical characteristics:

a)

clinical manifestations are more likely to appear at women

b)

most of the people that are affected are in the second decade of life

c)

classic triad is represented by: tanned pigmentation of the skin, hepatomegaly and diabetes mellitus

d)

hypogonadism is the most frequent endocrine disorder

e)

heart involvement is very rare and consists in myocadiac ischemic disturbance

29.

295)Morphopathology in hemochromatosis

a)

The total iron content in the body in a normal person is 20-40 g

b)

The iron content is increased especially in the liver

c)

The iron content in the pancreas is normal

d)

In the early stages, iron is deposited in the periportal hepatocytes

e)

Cirrhosis occurs early in hemochromatosis

30.

296)The paraclinical changes encountered in hereditary hemochromatosis consist of:

a)

Increase of serum iron over 30 mmol / L

b)

Transferrin saturation over 45%

c)

Serum ferritin below 100 mg / L

d)

Constant increase in liver transaminases

e)

Liver iron concentration above 180 mmol / g dry weight of the liver biopsy fragment

31.

297)In hemochromatosis, the elimination of excess iron from the body is achieved by:

a)

Blood emission phlebotomy

b)

Administration of infusions of saline and diuretics to force diuresis

c)

Administration of dietary fiber that prevents the absorption of iron

d)

Chelation therapy with desferioxamine infusion

e)

Administration of parenteral vitamin C.

32.

298)Wilson's disease

a)

It is a hereditary disease

b)

Affects copper metabolism

c)

It is characterized by the deposition of copper in the organs

d)

It has autosomal dominant transmission

e)

The liver is the only organ affected

33.

299)Which of the following statements about Wilson's disease are true?

a)

Young adults have more frequent neurological symptoms

b)

The Keyser-Fleischer ring is a specific sign

c)

Serum copper and ceruloplasmin are elevated

d)

Urinary copper is elevated

e)

Liver biopsy does not provide diagnostic input

34.

300)Treatment in Wilson's disease

a)

Penicillamine at a dose of 1-1.5 g daily is effective for chelating copper.

b)

The treatment is administered until the disappearance of neurological symptoms

c)

The dose of penicillamine is adjusted according to the level of urinary copper

d)

Trientine is used for asymptomatic cases

e)

Zinc acetate is ineffective

35.

301)In patients with alpha1 antitrypsin deficiency

a)

Serum alpha1 antitrypsin is low

b)

Alpha1 antitrypsin levels vary by phenotype

c)

Histological examination reveals blood cells negative for PAS staining in periportal hepatocytes

d)

Fibrosis and cirrhosis can occur in the course of the disease

e)

On histological examination, diastase-resistant globules appear in peri¬portal hepatocytes.

36.

302)In liver cirrhosis with ascites, treatment with diuretics is temporarily discontinued in the following situations:

a)

increase in serum creatinine;

b)

worsening of encephalopathy;

c)

portal vein thrombosis;

d)

the appearance of leg edema;

e)

hypovolemia

37.

303)Indicate the correct statements regarding paraclinical examinations in liver cirrhosis:

a)

serum albumin and bilirubin are the best indicators of liver function;

b)

a low sodium level indicates mild liver disease;

c)

creatinine value> 1.5 mg / dl is a marker with an unfavorable prognosis;

d)

the prognosis is unfavorable if the albumin level is <28 g / l;

e)

the increase in prothrombin time is proportional to the severity of the disease.

38.

304)In liver cirrhosis, ultrasonography is useful for evaluating:

a)

changes in the size and shape of the liver;

b)

fatty load of the liver;

c)

accumulation of copper in the liver;

d)

detection of hepatocellular carcinoma;

e)

portal vein system

39.

305)In liver cirrhosis, one-dimensional transient elastography (FibroScan):

a)

is achievable in only a small proportion of patients;

b)

not used in patients with ascites;

c)

is performed to avoid liver biopsy;

d)

correlates with the degree of portal hypertension;

e)

is easy to perform in obese patients.

40.

306)Treatment of liver cirrhosis includes:

a)

treatment of the root cause;

b)

water restriction in the case of serum sodium> 128 mmol / L;

c)

avoiding alcohol;

d)

reduction of salt intake;

e)

avoidance of aspirin and nonsteroidal anti- inflammatory drugs.

41.

307)The parameters used as predictors of mortality in patients with liver cirrhosis on the liver transplant waiting list are:

a)

serum creatinine;

b)

serum bilirubin;

c)

platelet count;

d)

alkaline phosphatase;

e)

glycemia.

42.

308)Acute hepatic failure on chronic liver disease is characterized by:

a)

high short-term mortality;

b)

appearance in old age;

c)

the presence of organ failure;

d)

lower prevalence of certain precipitating events (eg bacterial infections or excessive alcohol consumption);

e)

lower level of systemic inflammation.

43.

309)In advanced liver disease, intestinal barrier function is compromised by the following mechanisms:

a)

activation of stellate cells;

b)

alteration of intestinal motility;

c)

activation of myofibroblasts;

d)

suppression of the immune functions of the intestine;

e)

decreased intestinal permeability.

44.

310)Indicate the correct statements about the bowel-liver axis in liver cirrhosis:

a)

the intestinal-liver axis is a key pathophysiological mechanism in the progression of liver disease;

b)

intestinal barrier function is compromised in advanced liver disease;

c)

antibiotics block bacterial translocation;

d)

the intestinal-liver axis is not involved in the development of cirrhosis complications;

e)

nonselective beta-blockers promote bacterial translocation.

45.

311)Indications for liver transplantation include:

a)

primitive biliary cholangitis when serum bilirubin is constantly increased <20 μmol / L;

b)

acute liver failure of any cause;

c)

primitive sclerosing cholangitis;

d)

polycystic liver disease;

e)

Wilson’s disease.

46.

312)Liver transplantation has an absolute contraindication in the following situations:

a)

sepsis in a territory other than the hepatobiliary tree;

b)

identification of extrahepatic malignancies;

c)

the presence of hepatocellular carcinoma;

d)

detection of neuroendocrine liver metastases;

e)

lack of psychological commitment on the part of the patient.

47.

313)The immunosuppressive therapies used after liver transplantation are:

a)

Tacrolimus;

b)

Azathioprine;

c)

Methotrexate;

d)

Cyclosporine;

e)

Adalimumab.

48.

314)The main places of occurrence of porto-systemic collaterals are:

a)

right renal vein;

b)

gastroesophageal junction;

c)

the rectum;

d)

left renal vein;

e)

the diaphragm.

49.

315)The initial treatment for acute variceal bleeding includes:

a)

patient evaluation: pulse, blood pressure, state of consciousness;

b)

treating alcohol abstinence with Phenobarbital;

c)

restoring blood volume with plasma expanders or blood transfusions;

d)

correction of anemia up to a target hemoglobin value of 120 g / l in patients with cirrhosis;

e)

prophylactic administration of antibiotics.

50.

316)In gastrointestinal rupture of the esophageal varices, treatment with Terlipressin:

a)

reduces mortality;

b)

is administered in doses of 1 mg every 12 hours;

c)

may cause abdominal pain due to generalized vasoconstriction;

d)

should not be used in patients with ischemic heart disease;

e)

is reduced to 1 mg every 4 hours after 48 hours of administration.

51.

*317)Choose the false statement from the following:

a)

Naegele’s rule is used to estimate delivery date by taking last menstrual period (LMP), adding 7 days, subtracting 3 months, and adding 1 year.

b)

After 20 weeks, fundal height is used to estimate gestational age.

c)

In the second trimester, ultrasound (US) measurement of crown–rump length is the most accurate method of determining gestational age.

d)

Leopold maneuvers can be performed in the third trimester to determine fetal presentation.

e)

Initial visit in pregnancy includes detailed history, physical, and risk assessment.

52.

*318)Select the wrong information about HELLP syndrome:

a)

is a form of preeclampsia

b)

hemolysis occur

c)

liver enzymes are elevated

d)

high platelet counts is present

e)

in HELLP maternal mortality is approximately 1%

53.

*319)Lithium administration in pregnancy induces in most cases:

a)

cranial nerves damage

b)

renal defects

c)

neonatal withdrawal

d)

limb abnormalities

e)

Ebstein anomaly

54.

*320)Among most common causes of vaginal bleeding in early pregnancy there is not:

a)

ectopic pregnancy

b)

inevitable spontaneous abortion

c)

abruptio placentae

d)

physiologic bleeding related to implantation

e)

uterine–cervical pathology

55.

*321)Ultrasound measurement of cervical length in pregnancy:

a)

ultrasound measurement of cervical length is useful to diagnose labor

b)

a cervical length > 15 mm is associated with a very low risk of preterm birth

c)

a cervical length > 5 mm is associated with a very low risk of preterm birth

d)

a cervical length > 35 mm is associated with a very low risk of preterm birth

e)

ultrasound measurement of cervical length is not useful to estimate the risk of preterm birth

56.

322)Among normal changes in maternal physiology during pregnancy, the following are true:

a)

cardiac output increases 20%

b)

total body O2 consumption increases 20%

c)

nondiabetic hyperinsulinemia occur, with associated mild glucose intolerance

d)

hypocoagulability is present

e)

glomerular filtration rate increase 40%

57.

323)Iron deficiency may cause in pregnancy:

a)

maternal anemia

b)

preterm birth

c)

fetal limbs defects

d)

low birth weight

e)

high maternal blood pressure

58.

324)In the second trimester, gestational age assessment is performed by ultrasound measurements of:

a)

fetal abdominal circumference

b)

crown–rump length

c)

biparietal diameter

d)

fetal head circumference

e)

humerus length

59.

325)During the initial visit, common screening labs performed are:

a)

blood antibody and Rh typing

b)

quadruple screen

c)

Pap smear

d)

urinalysis

e)

hepatitis B surface antigen

60.

326)Prenatal Assessment for Congenital Diseases in High-Risk Pregnancies is performed as follows:

a)

group B streptococcus screening

b)

full-integrated test

c)

amniocentesis

d)

chorionic villi sampling

e)

1-hour glucose challenge to screen for gestational diabetes mellitus

61.

327)Maternal complications in Pregestational Diabetes Mellitus include:

a)

preeclampsia

b)

fetal cardiac defects (transposition of the great vessels, tetralogy of Fallot)

c)

maternal renal insufficiency

d)

maternal adrenal insufficiency

e)

diabetic ketoacidosis

62.

328)In preeclampsia severe features are:

a)

systolic blood pressure (SBP) >160 mmHg or diastolic blood pressure (DBP) >110 mmHg

b)

platelets < 200,000 /mmc

c)

increased creatinine

d)

low transaminases

e)

motor symptoms

63.

329)In regards to maternal nausea and vomiting, the following are true:

a)

are caused most likely by increases in human chorionic gonadotropin (hCG)

b)

may be related to imbalance of progesterone and estrogen

c)

most pregnant women experience these symptoms in the first trimester of pregnancy

d)

in most cases symptoms worsen during the second trimester

e)

are caused most likely by increases in placental lactogen hormone

64.

330)Maternal Deep Venous Thrombosis (DVT):

a)

the clinical diagnosis may be more difficult in pregnant patients, due to edema

b)

at diagnosis, IV heparin dosed to maintain partial thromboplastin time (PTT) at two times normal

c)

treatment in pregnancy is warfarin, orally

d)

treatment in pregnancy is heparin administered IM

e)

At discharge patients should be switched to subcutaneous LMWH.

65.

331)About Cytomegalovirus infection in pregnancy – the following are true:

a)

the diagnosis is achieved by IgG antibody screening

b)

Cytomegalovirus infection may cause intrauterine fetal growth restriction (IUGR)

c)

Cytomegalovirus infection causes fetal hydrops

d)

possible fetal/neonatal effects are: deafness, hepatosplenomegaly, hydrocephalus

e)

Ganciclovir may decrease the Cytomegalovirus infection effects in neonates

66.

332)About congenital infections we may state that:

a)

congenital rubella syndrome includes cardiovascular abnormalities, CNS abnormalities, deafness

b)

in HIV infection the risk of viral transmission in utero is 95%

c)

parvovirus 19 causes CNS malformations

d)

amniotic fluid PCR for Toxoplasma gondii may be helpful for diagnosing this infection

e)

Syphilis infection is responsible for osteodystrophy, hand/foot desquamation, neonatal anemia.

67.

333)For ectopic pregnancy, the following are true:

a)

most commonly ectopic pregnancy implants in the cervical cavity

b)

pelvic inflammatory disease is a major risk factor for ectopic tubal implantation

c)

the diagnosis is suggested by ultrasound features (absence of the gestational sac in utero) and positive serum β -hCG

d)

unruptured ectopic pregnancy of < 6 weeks’ gestation is treated with methotrexate

e)

serum β -hCG is not useful in ectopic pregnancy diagnosis.

68.

334)In spontaneous abortion (miscarriage):

a)

risk factors for spontaneous abortion are: increased maternal age, multiple prior births, uterine abnormalities

b)

spontaneous abortions are due mainly to abnormal placenta/abnormal umbilical cord

c)

first-trimester spontaneous abortions are usually the result of fetal chromosomal abnormalities

d)

spontaneous abortions occur in up to 50% of pregnancies.

e)

first-trimester spontaneous abortions are usually the result of cervical insufficiency

69.

335)In preterm labor the following are true:

a)

At < 34 weeks’ gestation expectant management is an option

b)

At < 34 weeks’ gestation tocolytic therapy with MgSO4 is an option

c)

At > 34 weeks’ gestation expectant management is an option

d)

At > 34 weeks’ gestation induction of labor with terbutaline is recommended

e)

At > 34 weeks’ gestation treatment with antibiotics is not recommended

70.

336)Most important risk factors for placenta praevia are:

a)

nulliparity

b)

prior cesarean section

c)

prior placenta praevia

d)

unicornuate uterus

e)

history of uterine surgery

71.

*337)Choose the correct chronologic order of events of normal female puberty.

a)

thelarche (appearance of breast tissue), gonadarche (activation of gonads by FSH and LH), pubarche (appearance of pubic hair), growth spurt, menarche (onset of menses), adrenarche (adrenal androgen production)

b)

menarche (onset of menses), thelarche (appearance of breast tissue), adrenarche (adrenal androgen production), gonadarche (activation of gonads by FSH and LH), growth spurt, pubarche (appearance of pubic hair)

c)

adrenarche (adrenal androgen production), gonadarche (activation of gonads by FSH and LH), thelarche (appearance of breast tissue), pubarche (appearance of pubic hair), growth spurt, menarche (onset of menses)

d)

gonadarche (activation of gonads by FSH and LH), growth spurt, thelarche (appearance of breast tissue), pubarche (appearance of pubic hair), menarche (onset of menses), adrenarche (adrenal androgen production)

e)

adrenarche (adrenal androgen production), menarche (onset of menses), growth spurt, pubarche (appearance of pubic hair), gonadarche (activation of gonads by FSH and LH), thelarche (appearance of breast tissue)

72.

*338)Risk factors for osteoporosis are:

a)

premenopause

b)

advanced age

c)

obesity

d)

black racial groups

e)

vitamin E deficiency.

73.

*339)The percentage of women having severe symptoms of premenstrual syndrome (PMS) that interfere with daily life is:

a)

50%

b)

5-10%

c)

75%

d)

40%

e)

1%

74.

*340)Primary Syphilis:

a)

has no symptoms

b)

granulomatous lesions on the skin are present

c)

solitary chancre forms near area of contact

d)

inguinal unilateral lymphadenopathy is present

e)

maculopapular rash on palms and soles occur.

75.

*341)Lymphogranuloma Venereum is a disease caused by:

a)

Genital Herpes

b)

Klebsiella granulomatis

c)

Treponema pallidum

d)

Human Papillomavirus

e)

Chlamydia trachomatis

76.

342)In Precocious Puberty the following statements are true:

a)

onset of pubertal changes occur in girls < 13 years

b)

onset of pubertal changes occur in boys < 9 years

c)

there are two types: isosexual (premature sexual development appropriate for gender) and heterosexual (virilization/masculinization of girls or feminization of boys)

d)

treatment consists in antagonists of GnRH (gonadotropin-releasing hormone)

e)

excessive growth disorders are known as complications.

77.

343)The Hormones Involved in the Menstrual Cycle have the following roles:

a)

luteinizing hormone (LH) induces ovulation

b)

thyroid-stimulating hormone (TSH) stimulates in a cyclic manner the ovarian follicles growth

c)

follicle-stimulating hormone (FSH) stimulates development of ovarian follicle and regulates ovarian granulosa cell activity

d)

luteinizing hormone (LH) stimulates endometrial gland development

e)

progesterone inhibits uterine contraction.

78.

344)In Endometriosis:

a)

endometrial tissue is present outside the uterus

b)

infertility is associated

c)

dyspareunia and dyschezia cannot occur

d)

progestins are not beneficial in controlling the symptoms

e)

hysterectomy may be required in severe cases.

79.

345)Secondary amenorrhea may occur in:

a)

gonadal dysgenesis

b)

pregnancy

c)

Asherman syndrome

d)

anatomical abnormalities

e)

Anorexia nervosa.

80.

346)The following statements are false in regards to Abnormal Uterine Bleeding:

a)

menses within < 24-day interval are considered abnormal

b)

menses at 26 – 30 days interval are considered abnormal

c)

a menstrual blood loss > 30 mL is considered abnormal

d)

complete blood count (CBC) and coagulation tests are not useful

e)

endometrial biopsy may be required to rule out cancer.

81.

347)The following statements are true in regards to Polycystic Ovary Syndrome (PCOS):

a)

some patients may have hyperinsulinemia and an increased risk of insulin resistance

b)

in PCOS ovarian cysts are large

c)

patients have a lower risk to develop endometrial cancer

d)

PCOS is a hypothalamic–pituitary disease characterized by anovulation or oligoovulation

e)

the ultrasound exam shows enlarged ovaries with multiple cysts.

82.

348)In Toxic Shock Syndrome the following statements are not true:

a)

is a severe systemic reaction to group B streptococcus (GBS)

b)

is associated with prolonged tampon use

c)

supportive care for hypertension is needed

d)

removing intravaginal objects is useful in treatment

e)

vancomycin is contraindicated.

83.

349)Pelvic inflammatory disease:

a)

is a progressive infection with N. gonorrhoeae or Chlamydia

b)

transvaginal ultrasonography (US) may detect tubo-ovarian abscess

c)

infection can extend into the abdomen and cause inflammation of the renal capsule

d)

low WBC (white blood cells) count is seen

e)

pelvic inflammatory disease produces no complications.

84.

350)Lichen planus is described as a vulvar irritation that can cause:

a)

pruritus

b)

bleeding

c)

dyspareunia

d)

painful defecation

e)

dysuria.

85.

351)CA-125 may be increased in:

a)

benign and malignant ovarian tumors

b)

endometrial cancer

c)

cervical cancer

d)

endometriosis

e)

leiomyomatosis

86.

352)In managing the palpable breast mass in women younger than 30 years old is mandatory:

a)

reassessment following every menses

b)

bilateral mammography

c)

bilateral breast ultrasound

d)

excisional biopsy in large or suspicious masses

e)

Computed tomography.

87.

353. Risk factors in breast cancer are:

a)

a) family history (first-degree relative)

b)

b) ovarian cancer

c)

c) thyroid cancer

d)

d) increased estrogen exposure

e)

e) late menarche

88.

354. In ductal carcinoma in situ (DCIS):

a)

a) there are malignant cells in ducts

b)

b) there are malignant cells in lobules

c)

c) stromal invasion is present

d)

d) the disease is multifocal

e)

e) the risk of subsequent invasive cancer is higher than in lobular carcinoma in situ (LCIS).

89.

355. Inflammatory carcinoma:

a)

a) is a subtype of ductal carcinoma

b)

b) is a subtype of lobular carcinoma

c)

c) is characterized by rapid progression and angioinvasive behavior

d)

d) has a good prognosis

e)

e) the clinical forms are faded: has no local symptoms.

90.

356. The following statements are true in cervical cancer:

a)

a) the most common histological form is squamous cell cancer

b)

b) the most common histological form is adenocarcinoma

c)

c) among most important risk factors there is persistent infection with Human Papillomavirus

(HPV) type 16 and 18

d)

d) smoking is recognized as protection factor against cervical cancer

e)

e) carcinoma with microscopic invasion may be treated with conization or total abdominal

hysterectomy.

91.

*357. Chose the wrong answer regarding cardiopulmonary resuscitation:

a)

a) chest compression rate is 100-120/min

b)

b) hyperkalemia is a reversible cause of cardiac arrest

c)

c) hypothermia is a reversible cause of cardiac arrest

d)

d) adrenaline (epinephrine) 1 mg should be administered if the patient presents pulseless electrical

activity

e)

e) adrenaline (epinephrine) 10 mg should be administered if the patient presents asystole

92.

*358. Third-degree atrioventricular block (complete heart block) consists in:

a)

a) the QRS complexes of the ventricular escape rhythm are always narrow

b)

b) the QRS complexes of the ventricular escape rhythm are always wide

c)

c) when it is caused by Lev’s disease it affects old patients

d)

d) pacemaker therapy is not required if the patient does not present syncope

e)

e) can be caused by ischemic heart conditions, such as Chagas disease

93.

*359. Choose the correct answer regarding atrial fibrillation:

a)

a) it is a common arrhythmia

b)

b) atrial waves have a rate of 200-250 bpm

c)

c) paroxysmal atrial fibrillation stops on its own within 3 months

d)

d) large P waves are present

e)

e) a low HAS-BLED score is associated with an increased hemorrhage risk

94.

*360. Valsartan is:

a)

a) a beta-blocker

b)

b) an angiotensin converting enzyme inhibitor

c)

c) a diuretic

d)

d) a neprilysin inhibitor

e)

e) an angiotensin II receptor blocker

95.

*361. Type 4b myocardial infarction is associated with:

a)

a) coronary artery bypass grafting

b)

b) severe anemia

c)

c) stent thrombosis

d)

d) arrhythmias

e)

e) coronary spasm

96.

362. Which of the following are part of “the four Hs” (reversible causes of cardiac arrest):

a)

a) hyperkalemia

b)

b) hypovolemia

c)

c) hyperuricemia

d)

d) hypothermia

e)

e) hypoxia

97.

363. Which of the following are extrinsic causes of sinus bradycardia:

a)

a) hypothyroidism

b)

b) intracranial hypertension

c)

c) sinus node infarction

d)

d) sick sinus syndrome

e)

e) digoxin

98.

364. Which of the following drugs are oral direct factor Xa inhibitors:

a)

a) dabigatran

b)

b) warfarin

c)

c) unfractionated heparin

d)

d) rivaroxaban

e)

e) apixaban

99.

365. Sustained ventricular tachycardia consists in:

a)

a) lasts more than 30 seconds

b)

b) AV (atrioventricular) dissociation

c)

c) wide QRS complexes

d)

d) narrow QRS complexes

e)

e) the heart rate is 400-600bpm

100.

366. Which of the following drugs can be used to treat heart failure:

a)

a) verapamil

b)

b) ivabradine

c)

c) ramipril

d)

d) bisoprolol

e)

e) valsartan

101.

367. Which of the following are antiplatelets used for the treatment of acute coronary syndromes:

a)

a) ticagrelor

b)

b) clopidogrel

c)

c) rivaroxaban

d)

d) heparin

e)

e) fondaparinux

102.

368. Which of the following are minor Duke criteria:

a)

a) fever (over 38°C)

b)

b) Osler nodes

c)

c) predisposing cardiac condition

d)

d) Roth spots

e)

e) oscillating intracardiac mass on valves or supporting structure

103.

369. Which of the following are part of hypertrophic cardiomyopathy treatment:

a)

a) verapamil

b)

b) beta-blockers

c)

c) vasodilators

d)

d) alcohol septal ablation

e)

e) surgical septal myectom

104.

*370. Select the true statement about fondaparinux:

a)

a) it is a direct inhibitor of Factor II

b)

b) does not interact with antithrombin

c)

c) it is administrated twice per day subcutaneous

d)

d) it is excreted by the kidneys and cannot be used in patients with severe renal failure

e)

e) it frequently produces thrombocytopenia

105.

*371. In which of the following situations, D-dimers do not rise

a)

a) infections

b)

b) inflammations

c)

c) surgical interventions

d)

d) hepatic diseases

e)

e) pregnancy

106.

*372. Select the true statement regarding the therapy in pulmonary embolism:

a)

a) unfractioned heparin lyses the thrombus

b)

b) oral antagonists of vitamin K have an immediate anticoagulant effect.

c)

c) administration of edoxaban and dabigatran is preceded by anticoagulation with low

molecular weight heparin for 5 days.

d)

d) apixaban and rivaroxaban require overlapping with parenteral anticoagulation for 5 days.

e)

e) fibrinolytics are administrated to all the patients with proximal pulmonary embolism.

107.

*373. Select the wrong statement about vitamin K antagonists:

a)

a) they are indirect anticoagulants that inhibit the synthesis of factors II, VII, IX, X.

b)

b) they inhibit the synthesis of protein C and S.

c)

c) prothrombin time is a more sensitive parameter than INR

d)

d) the half -life of warfarin is 36h

e)

e) after reaching the effective dose, monitoring of the effect is necessary at least once every 8-12

weeks

108.

*374. Select the wrong statement about warfarin:

a)

a) It is not administrated during the 6th -12th weeks of pregnancy

b)

b) it does not pass into breast milk

c)

c) the risk of fatal bleeding is 25%.

d)

d) in case of a major bleeding, you should administrate prothrombin complex concentrate

e)

e) in case of bleeding, you should administrate protamin sulfate

109.

375. Which of the following are risk factors for venous thromboembolism.

a)

a) advanced age

b)

b) major surgical intervention

c)

c) heparin-induced thrombocytopenia

d)

d) inflammatory bowel diseases

e)

e) smoking

110.

376. Which of the following statements about venous thromboembolism are true:

a)

a) it is the third leading cause of cardiovascular mortality

b)

b) 5% of the population will develop such a complication during their lifetime

c)

c) the etiology is unknown in 50% of cases

d)

d) birth and the postpartum period are strong risk factors.

e)

e) S protein deficiency is a strong risk factor.

111.

377. Which of the following clinical manifestations are found in pulmonary embolism

a)

a) pleuritic pain

b)

b) hemoptysis

c)

c) syncope

d)

d) gallop rhythm

e)

e) ”parvus et tardus” pulse

112.

378. Which of the following statements about venous thromboembolism are true:

a)

a) the increase of D-dimers is specific

b)

b) in a patient with Wells score indicating an unlikely pulmonary embolism, if D-dimers are

below the reference value, pulmonary embolism may be excluded.

c)

c) in a patient with Wells score indicating a probable pulmonary embolism, if D-dimers are below

the reference value, pulmonary embolism may be excluded.

d)

d) NT proBNP and troponin may increase in pulmonary embolism.

e)

e) atelectasis and ascension of the hemidiaphragm may be seen on chest X ray

113.

379. Select the correct answers about deep vein thrombosis (DVT).

a)

a) ultrasonographic evaluation has replaced the venography

b)

b) ultrasonographic evaluation checks whether the vein is compressible.

c)

c) ultrasonographic evaluation checks the presence of the thrombus.

d)

d) ultrasonography is very sensitive (>95%) for the diagnosis of distal DVT.

e)

e) ultrasonography is very sensitive for the diagnosis of proximal DVT

114.

380. The diagnostic algorithm in a stable patient (without shock or blood pressure <90 mmHg) with

pulmonary embolism includes the following evaluations in the emergency department.

a)

a) Wells score evaluation

b)

b) D-dimers dosage

c)

c) lung radiography

d)

d) echocardiography

e)

e) pulmonary ventilation -perfusion scintigraphy

115.

381. The diagnostic algorithm in pulmonary embolism in the patient presenting with shock/

hypotension includes:

a)

a) D-dimers dosage

b)

b) Wells score

c)

c) pulmonary angiography by CT

d)

d) echocardiography

e)

e) vascular ultrasonography

116.

382. Which of the following changes are found on the EKG in pulmonary embolism:

a)

a) sinus tachycardia

b)

b) negative T waves in DII, DIII, aVF.

c)

c) negative T waves in V1-V4

d)

d) S1Q3T3

e)

e) complete left branch block

117.

394. Select the correct statements about direct oral anticoagulants (DOACS)

a)

a) they are direct inhibitors of factors X or II.

b)

b) they require monitoring of the anticoagulant effect

c)

c) they can be given in severe kidney dysfunction

d)

d) they have a bleeding risk similar to heparin and warfarin

e)

e) they increase the risk of intracranial hemorrhage

118.

*395. Which of the following statements about masked hypertension is true?

a)

a) BP measured at the office is increased

b)

b) BP measured outside the office is normal

c)

c) BP measured outside the office is increased

d)

d) Cardiovascular risk is lowest

e)

e) Cardiovascular risk is highest

119.

*396. Which of the following conditions is a secondary endocrine cause of hypertension?

a)

a) Obesity

b)

b) Acromegaly

c)

c) Renal artery stenosis

d)

d) Aortic coarctation

e)

e) Obstructive sleep apnea syndrome

120.

397. Which of the following statements about threshold values for the diagnosis of grade 2

hypertension are true?

a)

a) Systolic BP at the office = 140-159 mm Hg

b)

b) Diastolic BP at the office = 90-99 mm Hg

c)

c) Outpatient systolic BP = 135-149 mm Hg

d)

d) Outpatient diastolic BP = 95-104 mm Hg

e)

e) Diastolic BP at home> 105 mm Hg

121.

*398. What impact does the reduction of salt intake <6 g / day have on the reduction of BP values?

a)

a) 5 mm Hg

b)

b) 10 mm Hg

c)

c) 3 mm Hg

d)

d) 1 mm Hg

e)

e) 15 mm Hg

122.

*399. Which of the following is a local factor that influences SVR (systemic vascular resistance) and

implicitly BP?

a)

a) Catecholamines

b)

b) SNS through alpha1 receptors

c)

c) Endothelin

d)

d) Aldosterone

e)

e) ADH

123.

400. Which of the following statements about orthostatic hypotension is true?

a)

a) It refers to a sustained decrease in BP, of more than 20 mmHg for systolic BP, 3 minutes

after switching to orthostatism

b)

b) It is more common at a young age

c)

c) It is more common in conditions associated with autonomic neuropathies

d)

d) It is usually asymptomatic

e)

e) May cause dizziness and falling

124.

401. Substances frequently involved in BP increase include:

a)

a) Alcohol

b)

b) NSAIDs

c)

c) Calcineurin inhibitors

d)

d) Diuretics

e)

e) Oral contraceptive pills

125.

402. Which of the following statements is true about the following causes of secondary

hypertension?

a)

a) Patients with renal artery stenosis may have a history of acute pulmonary edema with

normal cardiac function

b)

b) Paraclinical investigations in hypercortisolism include a suppressive test with high doses of

dexamethasone

c)

c) Pheochromocytoma is associated with neurofibromatosis-1

d)

d) Clinical examination in hypothyroidism may reveal pretibial myxedema

e)

e) Increased K+ levels and low aldosterone: renin ratio are found in primary hyperaldosteronism

126.

403. Injuries of target organs induced by high blood pressure include:

a)

a) Retinopathy

b)

b) Hypertrophy of the right ventricle

c)

c) Kidney disease

d)

d) Left ventricular hypertrophy

e)

e) Aortic coarctation

127.

404. The following statements are true about the classes of eye damage in hypertension, except:

a)

a) Mild: generalized and focal arteriolar narrowing

b)

b) Mild: arteriolar narrowing, microaneurysms, or a combination of them

c)

c) Moderate: hemorrhage, spots, hard exudates

d)

d) Moderate: signs of moderate retinopathy plus papillary edema

e)

e) Severe: signs of moderate retinopathy plus papillary edema

128.

405. Kidney disease in hypertension:

a)

a) It is both a cause and a consequence

b)

b) Early stages can be identified by increased microalbuminuria or urine albumin: creatinine

ratio

c)

c) Estimation of glomerular filtration rate can be obtained based on urinary creatinine and

demographic criteria

d)

d) Useful paraclinical investigations are renal ultrasound or immunological tests

e)

e) May be indicated by a difference in pulse or BP between the upper and lower limbs

129.

406. The initial therapy of hypertension includes the choice of one or two of:

a)

a) Angiotensin converting enzyme inhibitors / sartans

b)

b) Aldosterone antagonists

c)

c) Calcium channel blockers

d)

d) Loop diuretics

e)

e) Thiazide-like diuretics

130.

407. The following statements are true about antihypertensive therapy:

a)

a) Spironolactone is the best fourth-line drug

b)

b) Calcium channel blockers are recommended in elderly or black patients

c)

c) In elderly or black patients ACE inhibitors and ARBs are recommended as monotherapy

d)

d) ACEis and ARBs are recommended as monotherapy in young and white patients

e)

e) Calcium channel blockers are recommended in young and white patients

131.

408. Contraindications to antihypertensive drugs are:

a)

a) ACE inhibitors - bilateral renal artery stenosis

b)

b) ARBs - history of angioedema

c)

c) non-DHP CCBs - asthma

d)

d) Beta-blockers - high grade atrioventricular block

e)

e) Alpha-blockers - heart failure

132.

409. Hypertensive emergencies:

a)

a) They are defined by any increase in blood pressure over 180/120 mmHg

b)

b) They are represented by a significant increase in BP accompanied by signs or symptoms of

acute damage of the target organs

c)

c) Intravenous drug therapy is indicated

d)

d) They may present as acute pulmonary edema

e)

e) Pre-eclampsia can occur even at BP values above 140/90 mmHg

133.

410. The following statements are true about the management of hypertensive emergencies:

a)

a) Labetalol and intravenous magnesium are administered for pre-eclampsia

b)

b) Vasodilator medications such as nitroglycerin or nicardipine are initially given to patients with

acute aortic dissection

c)

c) In acute pulmonary edema, nitroglycerin and morphine are administered intravenously

d)

d) Vasodilators are contraindicated in acute coronary syndromes

e)

e) Patients with proximally-located acute aortic syndromes require early surgery

134.

411. The following statements are true regarding the clinical presentation of hypertensive

emergencies:

a)

a) Acute pulmonary edema - bilateral basal crackling rales and jugular vein turgor

b)

b) Pre-eclampsia - visual disturbances, edema, newly installed proteinuria

c)

c) Hypertensive encephalopathy - visual disturbances, headache, confusion

d)

d) Acute aortic dissection - chest pain, difference in BP between the upper limbs

e)

e) Malignant hypertension - can sometimes be associated with acute renal injury

135.

412. Isolated systolic hypertension:

a)

a) Occurs due to age-related arterial stiffness

b)

b) Increased pulse pressure is associated with increased vascular injury

c)

c) It has a different treatment than mixed hypertension

d)

d) It can be caused by aortic insufficiency

e)

e) It is more common in young people

136.

413. The most common causes of secondary hypertension are:

a)

a) Hyperthyroidism

b)

b) Obstructive sleep apnea syndrome

c)

c) Primary hyperaldosteronism

d)

d) Hypercortisolism

e)

e) Obesity

137.

414. The following statements are true about pheochromocytoma:

a)

a) The clinical presentation includes palpitations, sweating, hypertensive attacks

b)

b) The determination of plasma metanephrines is useful for diagnosis

c)

c) The treatment of choice is surgical resection after adequate beta-blockade

d)

d) Renal biopsy may provide additional information

e)

e) The clinical examination might reveal a vasculitic rash

138.

*415. The etiological classification of diabetes mellitus, based on the classification of the American

Association of Diabetes, includes the following types, EXCEPT:

a)

a) Type 1 diabetes

b)

b) Type 2 diabetes

c)

c) Diabetes insipidus

d)

d) Gestational diabetes

e)

e) Specific types of diabetes - diabetes secondary to genetic defects (eg MODY - Maturity Onset

Diabetes of Young)

139.

*416. 53 years old male, with obesity, without personal and family history of diabetes,

asymptomatic. Paraclinical: HbA1c = 5.3%, fasting plasma glucose = 89 mg/dl, 2 hours plasma

glucose during 75-g oral glucose tolerance test = 148 mg/dl. Choose the correct diagnosis for this

patient:

a)

a) Type 2 diabetes

b)

b) Impaired glucose tolerance

c)

c) Type 1 diabetes

d)

d) Normal glucose tolerance

e)

e) The diagnosis cannot be specified (the oral glucose tolerance test and HbA1c should be repeated

for clarification)

140.

*417. Choose the correct statements about type 2 diabetes:

a)

a) Insulin is always indicated in patients with type 2 diabetes

b)

b) In type 2 diabetes the insulin secretion deficit is absolute, being determined by the destruction of

pancreatic beta cells by autoimmune mechanism

c)

c) The onset of type 2 diabetes is sudden, with severe symptoms of hyperglycemia and always with

diabetic ketoacidosis

d)

d) Type 2 diabetes can be diagnosed directly in the stage of chronic complications (eg diabetic

retinopathy)

e)

e) Type 2 diabetes occurs predominantly in young people (age <30 years), normal weight or

malnourished

141.

*418. Which of the following statements regarding recommended glycemic targets in adult patients

with diabetes is FALSE:

a)

a) Glycemic targets should be individualized according to the clinical and biological characteristics

of the patients

b)

b) The HbA1c target is <6.5% in all patients with diabetes, regardless of the clinical and

biological characteristics

c)

c) Individualizations of glycemic targets is based on the duration of diabetes, life expectancy,

comorbidities, cardiovascular disease, history of severe hypoglycemia

d)

d) In a 35-year-old patient with type 2 diabetes for 1 year, without significant comorbidities, the

glycemic target should be stringent (eg HbA1c <6.5%, without hypoglycemia).

e)

e) In a 85-year-old patient with type 2 diabetes for 21 years, with gastric cancer, the glycemic target

should be less stringent to avoid severe hypoglycaemia

142.

*419. Which of the following is a chronic diabetic macrovascular complication:

a)

a) Atherosclerotic cardiovascular disease (myocardial

infarction, stroke, peripheral arterial disease)

b)

b) Diabetic nephropathy

c)

c) Diabetic retinopathy

d)

d) Hyperglycemic hyperosmolar state

e)

e) Diabetic neuropathy

143.

420. Diabetes can be diagnosed if:

a)

a) A single fasting plasma glucose value is ≥ 126 mg/dl, in the absence of symptoms of

hyperglycemia

b)

b) A single random plasma glucose value is ≥ 200 mg/dl, in the presence of symptoms of

hyperglycemia

c)

c) A single plasma glucose value at 2 hours during the 75-g oral glucose tolerance test is ≥ 200 mg/

dl, in the absence of symptoms of hyperglycemia

d)

d) Two HbA1c values are ≥ 6.5%

e)

e) Glycosuria is persistent in the presence of symptoms of hyperglycemia

144.

421. The evaluation of metabolic control in patients diagnosed with diabetes is performed by:

a)

a) Dosage of HbA1c

b)

b) Continuous glycemic monitoring by measuring interstitial glucose levels every few minutes

c)

c)Weekly glycosuria dosing

d)

d) Self-monitoring of capillary blood glucose

e)

e) Periodic dosing, at 6-month intervals of antibodies specific for glutamic acid decarboxylase

(GAD)

145.

422. Choose the correct statements about type 1 diabetes:

a)

a) Type 1 diabetes is not insulin dependent

b)

b) In type 1 diabetes mellitus the insulin secretion deficit is absolute, being determined by the

destruction of pancreatic beta cells by autoimmune mechanism

c)

c) The onset of type 1 diabetes is sudden with severe signs and symptoms of hyperglycemia

d)

d) Type 1 diabetes can be diagnosed directly in the stage of chronic complications (eg diabetic

retinopathy)

e)

e) Type 1 diabetes occurs predominantly in people> 50 years of age with obesity

146.

423. Choose the correct statements about insulin:

a)

a) In subjects without diabetes, insulin is secreted 24 hours a day (basal and prandial insulin

secretion)

b)

b) Insulin is a hyperglycemic hormone

c)

c) Insulin is a hypoglycemic hormone

d)

d) Insulin inhibits hepatic glucose production (glycogenolysis, gluconeogenesis)

e)

e) Endogenous insulin is secreted by alpha pancreatic cells into the portal circulation

147.

424. Specific types of diabetes (secondary to other causes) can be induced by:

a)

a) Genetic defects of beta cell function - MODY syndromes (Maturity Onset Diabetes of the

Young)

b)

b) Diseases of the exocrine pancreas: pancreatitis, pancreatectomy, neoplasm, cystic fibrosis,

hemochromatosis, etc.

c)

c) Endocrine diseases: acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma,

etc.

d)

d). Insulinoma

e)

e) Drugs (glucocorticoids, etc.)

148.

425. The management of diabetic ketoacidosis involves:

a)

a) Correction of fluids and electrolytes deficit with 0.9% sodium chloride solution and

potassium chloride solution (if potassium level is < 5.5 mmol/l)

b)

b) Administration of 10% glucose solutions is contraindicated in diabetic ketoacidosis

c)

c) Suppression of ketogenesis by administration of insulin and 10% glucose (dextrose)

solutions when blood glucose is <250 mg/dl

d)

d) Correction of acidosis using bicarbonate solution, regardless of the degree of acidosis (arterial

pH value)

e)

e) Treatment of precipitating factors

149.

426. Biological criteria for severe diabetic ketoacidosis include:

a)

a) Arterial/venous pH 7.35-7.45

b)

b) Serum ketone bodies >6 mmol/l

c)

c) Serum bicarbonate > 5 mmol/l

d)

d) Arterial/venous pH <7.00

e)

e) Anionic gap = (Na+K+) – (Cl- + HCO3-)> 16 mEq/l

150.

427. Choose the correct statements regarding insulin therapy:

a)

a) Insulin therapy involves the use of both long-acting insulin to reproduce basal insulin

secretion and short- acting insulin to cover carbohydrate intake.

b)

b) The basal insulin dose should be adjusted depending on the amount of carbohydrates consumed

c)

c) Insulin therapy is recommended for all patients with type 2 diabetes

d)

d) Insulin therapy is recommended for all patients with type 1 diabetes

e)

e) Insulin is administered subcutaneously using syringe, insulin pen, or insulin pump

151.

428. Select the classical symptoms of hyperglycemia:

a)

a) Polyuria

b)

b) Thirst and polydipsia

c)

c) Weight gain

d)

d) Headache

e)

e) Weight loss

152.

429. Indicate which of the statements regarding diabetic retinopathy are correct:

a)

a) Diabetic retinopathy can cause blindness

b)

b) Diabetic retinopathy is a chronic macrovascular complication

c)

c) The grading severity of diabetic retinopathy includes: non-proliferative, preproliferative,

proliferative retinopathy, advanced retinopathy and maculopathy

d)

d) Diabetic retinopathy may be detected at the time of diagnosis in patients with type 2

diabetes

e)

e) Pregnancy may induce a short-term progression of retinopathy lesions

153.

430. Which of the following patients can be diagnosed with type 2 diabetes

a)

a) 74 years old male, with obesity, presenting polyuria, polydipsia and 4 kg weight loss over

the last 18 months and fasting plasma glucose=172mg/dl

b)

b) 21 years old female, presenting polyuria, polydipsia and 12 kg weight loss over the last 6 weeks,

fasting plasma glucose =196 mg/dL, antibodies specific for glutamic acid decarboxylase (GAD) =

1430 IE/ml (normal value<10IE/ml)

c)

c) 59 years old female, with obesity, asymptomatic, fasting plasma glucose=156 mg/dL,

HbA1c=7.4%, eye fundus examination shows non-proliferative diabetic retinopathy

d)

d) 37 years old male, asymptomatic, fasting plasma glucose=118 mg/dL, HbA1c=6.2%

e)

e) 35 years old female, asymptomatic, fasting plasma glucose=99 mg/dL, 2 hours plasma glucose

during 75-g oral glucose tolerance test = 126 mg/dL, HbA1c=5.4%

154.

431. Choose the correct statements regarding Sodium-Glucose Cotransporter-2 (SGLT 2) inhibitors:

a)

a) SGLT 2 inhibitors increase urinary excretion of glucose and sodium

b)

b) SGLT 2 inhibitors determine hypertension

c)

c) SGLT 2 inhibitors determine weight loss

d)

d) SGLT 2 inhibitors have a high risk of hypoglycaemia

e)

e) Adverse effects of SGLT 2 inhibitors include: acute pancreatitis, pulmonary edema, genital

candidosis, ketoacidosis

155.

432. Choose the correct statements regarding Glucagon-Like Peptide-1 (GLP-1) receptor agonists:

a)

a) GLP-1 receptor agonists increase insulin secretion and decrease glucagon secretion

b)

b) GLP-1 receptor agonists increase appetite

c)

c) GLP-1 receptor agonists have a high risk of hypoglycemia

d)

d) GLP-1 receptor agonists determine weight loss

e)

e) All GLP-1 receptor agonists are administered orally

156.

433. The following statements regarding metformin, as an antidiabetic pharmacological agent, are

correct:

a)

a) Metformin has a high risk of hypoglycemia and weight gain

b)

b) Metformin decrease hepatic glucose production and increase insulin sensitivity

c)

c) Metformin stimulates insulin secretion

d)

d) Patients treated with metformin may experience gastrointestinal side effects (nausea,

diarrhea)

e)

e) Metformin is a first-line pharmacological agent and can be initiated independently of the

estimated glomerular filtration rate (eGFR)

157.

434. Hypoglycemia in patients with diabetes on insulin therapy may be caused by:

a)

a) Physical exercise without additional intake of carbohydrates or without decreasing insulin

dose

b)

b) Administration of higher doses of insulin than needed

c)

c) Interrupting of insulin flow administered by the insulin pump (because there is no basal insulin

storage)

d)

d) High alcohol (e.g., whisky) intake

e)

e) Low or no carbohydrate intake after short-acting insulin administration

158.

*435. Patients have the right to be informed of the following, except:

a)

a) the patient's medical condition

b)

b) prognosis of the disease

c)

c) therapeutic options

d)

d) medical errors in patient care

e)

e) the doctor's health condition

159.

*436. Prior to any procedure or therapy, the patient should be informed to the following, except:

a)

a) indications for treatment

b)

b) alternative treatments and their risks

c)

c) the potential risks of the proposed treatment

d)

d) the potential benefits of a proposed treatment

e)

e) the benefits of refusing treatment

160.

*437. The relative risk can be determined using what kind of study?

a)

a) case-control study

b)

b) cohort study

c)

c) case series

d)

d) cross-sectional survey

e)

e) randomized clinical trial

161.

*438. Sensitivity is:

a)

a) probability that a screening test will be positive in patients with a disease

b)

b) probability that a test will be negative in patients without a disease

c)

c) probability that a patient with a positive test has a disease

d)

d) probability that a patient with a negative test does not have a disease

e)

e) performance of diagnostic tests considering only number of true results

162.

*439. The study power is:

a)

a) performance of diagnostic tests considering only number of true results

b)

b) the association that exists between exposure and disease or treatment and response

c)

c) statistically detectable difference between groups

d)

d) ability of a study to detect an actual difference between two groups

e)

e) the probability of getting a disease in a group exposed to a specific risk factor compared to the

probability of getting that disease in an unexposed group (probability of disease in exposed

population)

163.

440. Which of the following represents same of the patient's rights:

a)

a) confidentiality

b)

b) physician’s medical skills

c)

c) informed consent

d)

d) full disclosure of information

e)

e) public reporting of certain diseases

164.

441. In order to be considered competent, a patient must:

a)

a) not be diagnosed as presently psychotic or intoxicated

b)

b) have an understanding of his/her medical condition

c)

c) be at least 18 years old

d)

d) have not been diagnosed with a mental illness in the past

e)

e) be able to make decisions that are in agreement with its present values

165.

442. Which of the following statements about the Do-Not- Resuscitate Order (DNR) are true:

a)

a) a type of advanced directive document that details care in cases of coma

b)

b) a type of advanced directive document that details care in cases of severe dementia

c)

c) a type of advanced directive document that details care in cases of chronic disease

d)

d) can refuse all palliative therapies

e)

e) can only restrict use of specific therapies (e.g., ventilation, cardiopulmonary resuscitation,

feeding tubes, antibiotics, etc.).

166.

443. Doctors may eliminate respiratory assistance in the following cases:

a)

a) when there is no will

b)

b) the patient is unable to express his decision

c)

c) the family believes that the elimination of care is consistent with what the patient would like

d)

d) the doctor believes that the elimination of care is consistent with what the patient would

like

e)

e) the patient is competent and refuses to stop life support measures

167.

444. Organs may be considered unsuitable for donation in case of:

a)

a) neoplasm with loco-regional dissemination

b)

b) sepsis

c)

c) organ-specific infection or disease

d)

d) hyperthermia

e)

e) age less than 14 years

168.

445. Which of the following about durable power of attorney are true:

a)

a) a legal documentation that designates a second party (e.g., family member) as a surrogate

decision maker for medical issues

b)

b) is valid in all US states

c)

c) is not valid in NY state

d)

d) a legal document that permit to a designated individual to be able to make decisions

consistent with the patient’s values

e)

e) a written document that details a patient’s wishes in specific medical situations (e.g.

resuscitation, ventilation, extraordinary maintenance of life)

169.

446. Confidentiality is not mandated when the patient:

a)

a) doesn’t allow the physician to share information with all the members of patient’s family

b)

b) has a disease that is not legally reportable (reported only to appropriate public officials)

c)

c) is considered to be suicidal or homicidal

d)

d) is an adolescent with a condition that is potentially harmful to self or others

e)

e) has suffered a gunshot or other type of penetrating wound from an assault

170.

447. Which of the following affirmations about RR value are false:

a)

a) > 1 suggests a negative relationship between exposure and disease

b)

b) > 1 suggests a positive relationship between exposure and disease

c)

c) <1 suggests a negative relationship between exposure and disease

d)

d) < 1 suggests a negative relationship between exposure and disease

e)

e) equal to 1 suggests no relationship between exposure and disease

171.

448. Which of the following affirmations are true:

a)

a) false-negative findings occur in patients with a disease and a negative test; approximated by (1 -

specificity).

b)

b) false-positive findings occur in patients without a disease and a positive test; approximated

by (1 - specificity).

c)

c) most acceptable confirmatory tests are typically >85% specific

d)

d) most acceptable screening tests are typically >80% sensitive

e)

e) most acceptable screening tests are typically >85% specific

172.

449. Positive predictive value (PPV) is not:

a)

a) probability that a patient with a positive test has a disease

b)

b) probability that a patient with a negative test does not have a disease

c)

c) performance of diagnostic tests considering only number of true results

d)

d) probability that a screening test will be positive in patients with a disease

e)

e) probability that a test will be negative in patients without a disease

173.

*450. Nephrotic syndrome is characterized by the following elements, except for one:

a)

a) massive proteinuria (> 3.5 g / day)

b)

b) hyperalbuminemia

c)

c) edema

d)

d) lipiduria

e)

e) hyperlipidemia

174.

*451. Rapidly progressive glomerulonephritis involves the following elements, except for one:

a)

a) segmental necrosis

b)

b) rapidly progressive renal failure

c)

c) the presence of crescents

d)

d) crescents may be missing

e)

e) progresses in a few weeks

175.

*452. Proteinuria occurs in part due to structural damage to the following elements that make up the

glomerular barrier, except:

a)

a) podocyte

b)

b) glomerular basement membrane

c)

c) fenestrated endothelium

d)

d) efferent arteriole

e)

e) alteration of electrical charge

176.

*453. Secondary glomerular impairment includes, with the exception of:

a)

a) Systemic lupus erythematosus

b)

b) Henoch-Schönlein syndrome

c)

c) Congenital nephrotic syndrome

d)

d) Immunotactoid glomerulopathy

e)

e) Fibrillar idiopathic glomerulopathy

177.

*454. The stages of diabetic nephropathy are the following, except for one:

a)

a) I - isolated thickening of the glomerular basement membrane with mesangial expansion

b)

b) II - slight mesangial expansion

c)

c) III - severe mesangial expansion

d)

d) IV – inter-capillary nodular glomerulosclerosis

e)

e) V - advanced diabetic glomerulosclerosis and> 50% global glomerulosclerosis

178.

455. Select neoplasms conditions that may glomerulonephritis:

a)

a) True Polycythemia

b)

b) Hodgkin’s lymphoma

c)

c) Malignant melanoma

d)

d) Leukemia

e)

e) Kaposi’s sarcoma

179.

456. The podocytic cytoskeleton can be modified by:

a)

a) abnormalities of cytoskeletal proteins such as α-actinin- 4, which cause hereditary focal and

segmental glomerulosclerosis

b)

b) capillary loop abnormalities

c)

c) lesions or abnormalities of slit diaphragm proteins

d)

d) mesangial proliferation

e)

e) direct injury of podocytes by viral infection, drugs, toxins or local activation of the renin-

angiotensin system

180.

457. In HIV-associated nephropathy (HIVAN), under light microscopy, the podocytes are:

a)

a) increased in volume

b)

b) hyperplastic

c)

c) coarsely vacuolated

d)

d) containing protein absorption droplets

e)

e) without any modifications

181.

458. The causes of secondary membranous glomerulonephritis are:

a)

a) in response to certain medications

b)

b) pregnancy

c)

c) infections

d)

d) autoimmune (SLE, thyroiditis)

e)

e) neoplasms

182.

459. Patients with reactive systemic amyloidosis (secondary AA) often present with:

a)

a) nephritic proteinuria (<3.5 g / day)

b)

b) nephrotic syndrome

c)

c) chronic kidney disease

d)

d) hypoglycemia

e)

e) normal spleen size

183.

460. AL amyloidosis (associated with light chains and immunoglobulin) may be associated with:

a)

a) multiple myeloma

b)

b) systemic lupus erythematosus

c)

c) chronic granulocytic leukemia

d)

d) macroglobulinemia Waldenström

e)

e) non-Hodgkin's lymphoma

184.

461. In diabetic nephropathy, in order to achieve renoprotection, the treatment must:

a)

a) maintains blood pressure <130/80 mmHg

b)

b) maintains blood pressure <140/80 mmHg

c)

c) decreases proteinuria <0.3g / day

d)

d) decreases proteinuria <0.5 g / day

e)

e) lowers cholesterol <4.5 mmol / L

185.

462. Major glomerular clinical syndromes are:

a)

a) Acute glomerulonephritis

b)

b) Asymptomatic hematuria, proteinuria or both

c)

c) Nephrotic syndrome

d)

d) Renal dysfunction syndrome

e)

e) Rapidly progressive glomerulonephritis

186.

463. Mixed nephrotic and nephritic syndrome involves:

a)

a) mesangial cells

b)

b) the endothelium

c)

c) glomerular basement membrane

d)

d) podocytes

e)

e) lysosomal damage

187.

464. The following statements are true about IgM nephropathy:

a)

a) the prognosis is always good

b)

b) is characterized by increased mesangial cellularity in most glomeruli

c)

c) affected people have transient or persistent episodes of hematuria and nephrotic syndrome.

d)

d) 10 to 30% of patients develop progressive BCR and GSFS

e)

e) all patients develop focal and segmental glomerulosclerosis

188.

465. The following statements about the Oxford Histological Classification of IgA nephropathy are

true:

a)

a) Class M1 means mesangial hypercellularity <0.5

b)

b) Class M0 means mesangial hypercellularity <0.5

c)

c) Class M1 means mesangial hypercellularity> 0.5

d)

d) Class M0 means mesangial hypercellularity> 0.5

e)

e) Class T2 involves tubular atrophy / fibrosis> 50%

189.

466. The following statements about the investigation of glomerular disease are true:

a)

a) C3 and C4 levels may be low

b)

b) antinuclear antibodies (ANA) are significantly present in systemic lupus erythematosus

c)

c) cryoglobulins are elevated in cryoglobulinemia

d)

d) urinary microscopy does not show erythrocytes and erythrocyte cylinders

e)

e) anti-glomerular basement membrane (anti-MBG) antibodies are absent in Goodpasture syndrome

190.

467. Nephrotic syndrome is characterized by:

a)

a) proteinuria> 3.5 g / day

b)

b) hypoalbuminemia

c)

c) edema

d)

d) dyslipidemia

e)

e) proteinuria <3.5 g / day

191.

468. The histological variants of focal and segmental glomerulosclerosis are:

a)

a) the primary variant

b)

b) acellular variant

c)

c) variant with lesion of the glomerular tip

d)

d) perihilar variant

e)

e) the collapsing variant

192.

469. About Fabry Disease we can say:

a)

a) is a lysosomal storage disease caused by a deficiency of the enzyme α-galactosidase.

b)

b) glycosphingolipids appear

c)

c) renal function is normal

d)

d) cardiovascular damage is missing

e)

e) includes cutaneous angiokeratomas

193.

*470. In the case of a diabetes patient requiring surgery, it is true that:

a)

a) Preoperative evaluation of metabolic control and associated complications is not necessary

b)

b) Gastroparesis is more common in diabetic patients and is caused by diabetic microangiopathy

c)

c) Gastroparesis is suggested by the presence of dysphagia

d)

d) Hyperglycemia negatively influences the function of the immune system, especially

phagocytic activity

e)

e) The infectious risk is significantly lower in diabetes patients

194.

*471. In pregnant patients requiring surgical intervention, it is recommended to be performed in:

a)

a) In the first trimester of pregnancy

b)

b) At any time during pregnancy

c)

c) Intervention during pregnancy is contraindicated

d)

d) In the second quarter

e)

e) In the third quarter

195.

*472. Nasogastric tubes are most commonly used in:

a)

a) Patients with peritonitis

b)

b) Patients with ileus or occlusion

c)

c) Patients with ascites

d)

d) Patients with peripheral gangrene

e)

e) Hemoptysis patients

196.

*473. Which of the following is a urethro-bladder probe:

a)

a) Blackmore tube

b)

b) Foley catheter

c)

c) Pigtail probe

d)

d) Hickman line

e)

e) Dormia probe

197.

*474. In the preoperative management of thrombocytopenia in BCR can be used:

a)

a) Dialysis

b)

b) Blood transfusions

c)

c) Administration of l-Desamino-8-D-arginine- vasopressin(DDAVP)

d)

d) Administration of vitamin K

e)

e) Administration of Adrenostazin

198.

475. Evaluation of the preoperative serum ionogram is recommended in the following situations:

a)

a) Patients with a chronic pathology (diabetes mellitus, arterial hypertension, cardiovascular,

renal, hepatic disease)

b)

b) Patients with long-term anticoagulant therapy

c)

c) Patients receiving long-term diuretic therapy

d)

d) Patients with persistent vomiting

e)

e) Young patients at high risk of fluid or electrolyte disorder

199.

476. The response to surgical stress from a cardiovascular point of view includes:

a)

a) Increased catecholamine levels as an effect of pain and anxiety associated with patient's

intervention or pathology

b)

b) Increased myocardial oxygen demand

c)

c) Suppression of the fibrinolytic system, with the patient's predisposition to thrombosis

d)

d) Suppression of the coagulation cascade, with the patient's predisposition to bleeding

e)

e) Decreases the risk of myocardial ischemia

200.

477. Evaluation of patients by cardiac ultrasound or stress test is indicated in the following

situations:

a)

a) All patients to undergo surgical intervention

b)

b) Low or undetermined cardiac function

c)

c) Patients at high cardiovascular risk

d)

d) Patients with arterial hypertension

e)

e) Low cardiovascular risk

201.

478. Performing preoperative chest radiography is indicated in the following situations:

a)

a) Patients to undergo intrathoracic surgery

b)

b) Patients with signs and symptoms of active lung disease

c)

c) Neoplastic patients

d)

d) Patients with cardiovascular disease

e)

e) Patients with dysphagia

202.

479. Regarding the ASA (American Society of Anesthesiologists) classification, the following

statements are true:

a)

a) Age is a factor to consider

b)

b) It includes 6 categories, the morbid patients are included in the first

c)

c) It was developed to predict operator risk

d)

d) Congestive heart failure is a factor to consider

e)

e) The rate of postoperative pulmonary complications increases in parallel with the ASA class

203.

480. In the perioperative management of patients with BCR or IRA, the following statements are

true:

a)

a) Maintenance of renal volemia and perfusion are the main targets

b)

b) Arterial hypotension may prevent renal malfunction

c)

c) Nonsteroidal anti-inflammatory drugs are generally contraindicated due to nephrotoxic

effects

d)

d) Drug dosage must be adjusted according to the degree of renal damage

e)

e) Opioids administered to patients with BCR have a high risk of respiratory depression

204.

481. Regarding gastrostomy: ???

a)

a) Represents the gastric cavity communcation with the upper rectum

b)

b) Can be used only for drainage of gastric contents

c)

c) Can only be used for food

d)

d) Is used for feeding or drainage

e)

e) Can be placed surgically or endoscopically

205.

482. In regards to thoracic drainage tubes, the following statements are true: ???

a)

a) They are connected to a special suction system that allows the dual air circuit

b)

b) They are used for air (pneumothorax), blood (hemothorax) or fluid (pleural effusion) drainage

from the airways

c)

c) Allows a continuous suction level (usually 20cm H2O)

d)

d) Allows air and fluid drainage from the pleural cavity

e)

e) An ‘underwater’ drainage is performed to prevent air from entering the pleural space

206.

483. The MELD score takes into account the following:

a)

a) The INR

b)

b) Bilirubin

c)

c) Transaminases

d)

d) Albumin

e)

e) Creatinine

207.

484. Ascites may complicate surgery through:

a)

a) Increased risk of wound dehiscence

b)

b) High risk of eventration after abdominal surgery

c)

c) Ascites in high volume can affect the cardiac contractile function

d)

d) Preoperative control of ascites with diuretics transjugular intrahepatic portosystemic shunt

(TIPS) is not recommended, as drainage will be performed intraoperatively

e)

e) Ascites drainage during surgical intervention is not recommended

208.

485. In regards to patients with liver pathology requiring surgical intervention, the following

statements are true:

a)

a) They have an increased risk of heavy bleeding due to decreased production of coagulation

factors

b)

b) They have an increased risk of thrombosis due to poor S protein production

c)

c) They have an increased risk of bleeding due to depletion of vitamin k deposits

d)

d) They have an increased risk of thrombosis due to platelet disorders, both in number and function

e)

e) They have an increased risk of wound dehiscence due to ascites

209.

486. In regards to the atelectasis that complicates a surgical intervention, the following are true:

a)

a) It is a rare complication with high mortality rate

b)

b) Represents an alveolar collapse

c)

c) Affects up to 90% of patients undergoing general anesthesia

d)

d) Patients with atelectasis require orotracheal intubation

e)

e) It is favored by general anesthesia, regardless of the agent used

210.

487. Postoperative atelectasis can occur through the following mechanisms:

a)

a) Patients under general anesthesia cannot cough or sigh, and the mucociliary clearance of

the tracheobronchial tree is impaired

b)

b) Patients cannot mobilize

c)

c) Postoperative, pain at the incision site, drowsiness due to analgesic drugs, cough

suppression, lack of mobility and nasopharyngeal instrumentation

d)

d) Because patients do not feed orally

e)

e) Due to operating stress

211.

488. Management of postoperative atelectasis:

a)

a) There is no consensus on treatment

b)

b) It is recommended to stop smoking 8 weeks before the intervention

c)

c) Initiation of inspiratory exercises 8 weeks before the intervention

d)

d) Proper management of postoperative pain

e)

e) Administration of preoperative mucosecretolytic drugs

212.

489. Surgical wound dehiscence may occur due to:

a)

a) Tissue ischemia resulting from the excessive tightening of the threads

b)

b) Deficient techniques

c)

c) Local infection

d)

d) Coagulation disorders

e)

e) Prolonged immobilization

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