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SED - 4 - VERSI ON I
February 2010
Nr 1. The presence of red cell casts in a patient with hematuria is characteristic of:
A. glomerular bleeding.
D
. cystitis.
B. calyceal bleeding.
E . all the answers are correct.
C. urethral bleeding.
Nr 2. Nephrotic syndrome is characterized by:
A. proteinuria < 3.5 g/dl.
D
. high albumin in blood.
B. dyslipidemia.
E . the correct answers are A and B.
C. low albumin in urine.
Nr 3. Urinary tract infection is regarded as complicated in:
A. pregnant women.
D
. all the above answers are correct.
B. men.
E . the correct answers are A and C.
C. individuals with diabetes mellitus.
Nr 4. The most common kidney stones consist of:
A. calcium oxalate with calcium phosphate. D. magnesium ammonium
B. calcium phosphate alone.
phosphate (struvite).
C. uric acid.
E . cystine.
Nr 5. Renal ultrasonography is not appropriate for:
A. renal size measurement.
B. characterizing renal masses as cystic or solid.
C. visualization a normal adult ureter.
D. diagnosis of polycystic kidney disease.
E. diagnosis of pelvicalyceal dilatation.
Nr 6. Renoprotection consists of:
A. the normalization of blood pressure.
B. lowering proteinuria < 0.3 g/24 h.
C. angiotensin converting enzyme inhibitor in proteinuria > 1g/24h.
D. all the above.
E. the correct answers are A and C.
Nr 7. The best method to access excretory renal function is:
A. sodium excretion in urine.
D
. urine osmolality.
B. glomerular filtration rate.
E . urine sediment examination.
C. specific gravity of urine.
Nr 8. In dehydrated patient with acute kidney injury you should consider as a
therapeutic option:
A. diuretic (e.g, frusemide).
B. non-steroidal nantiinflammatory drug (e.g. ibuprofen).
C. ACE inhibitor (e.g. enalapril).
D. intense hydration (e.g. 3-4 litres of physiological saline- 0.9% NaCl).
E. the correct answers are A and D.
SED - 5 - VERSI ON I
February 2010
Nr 9. In a patient with acute kidney injury due to obstruction of urinary tract the
treatment of choice is as follows:
A. the elimination of the obstruction by medical therapy, instrumentation or surgery.
B. diuretic administration.
C. pain-relieving drug administration.
D. dialysis therapy.
E. kidney transplantation.
Nr 10. In a patient with chronic kidney disease (CKD) serum creatinine on the last visit
was 4.5 mg/dL, and glomerular filtration rate (creatinine clearance) was 20 mL/min.
Due to generalized edema the patient requires diuretic administration. Which of the
following diuretics is the best option for this patient?
A. thiazide diuretic.
D. loop diuretic.
B. mannitol.
E . there is no effective diuretic at this stage
C. carbon anhydrase inhibitor.
of CKD.
Nr 11. A 32-year-old female suffering from hypertension for the last 5 years plans to
become pregnant. She is treated with enalapril and hydrochlorothiazide reaching target
values below 140/90 mm Hg. In hypotensive therapy, the medical advice is as follows:
A. continue previous therapy.
B. replace enalapril with calcium channel blocker when she becomes pregnant.
C. replace enalapril with calcium channel blocker or methyldopa before she becomes
pregnant, and, if possible, stop hydrochlorothiazide or replace it with another
diuretic (e.g. dihydralazine or methyldopa).
D. replace enelapril with losartan, continue diuretic.
E. add methyldopa, because in pregnancy the blood pressure will increase.
Nr 12. The most common cause of the end-stage renal failure requiring renal
replacement therapy (dialyses or kidney transplantation) is:
A. chronic glomerulonephritis.
D. hypertension.
B. urinary tract infection.
E. acute renal failure/acute kidney injury.
C. diabetic nephropathy.
Nr 13. A 57-year-old male with a history of well-controlled hypertension for many
years came to the doctor’s office due to elevated blood pressure values in the last
weeks (160/110, 150/100 mm Hg). He is treated with enalapril 20 b.i.d. and
amlodypine 10 q.d. In the laboratory test , serum creatinine is 0.89mg/dl, serum
sodium is 139 mEq/l, serum potassium is 5.45 mEq/l, fasting glucose is 89 mg%.
Which of the following options should be introduced for better control of his
hypertension?
A. increase the dose of enalapril to 30 mg b.i.d.
B. add angiotensin II receptor blocker e.g. losartan.
C. add beta-blocker (e.g. metoprolol).
D. add mineralocortocoid receptor antagonist (e.g. spironolactone).
E. add diuretic (e.g. hydrochlorothiazide).
SED - 6 - VERSI ON I
February 2010
Nr 14. A 30-year-old man, sexually active, complains of painful voiding localized in
the urethra, itch around urethra. He also discovered purulent urethral discharge.
The most probable diagnosis is the following:
A. cystitis.
D
. urethritis.
B. prostatitis.
E . urolithiasis.
C. benign prostatic hyperplasia.
Nr 15. After asthma had been diagnosed, a patient received inhaled budesonide 2 x
200 mcg and salbutamol as a rescue medication. After 4 weeks the patient made a
control visit. Now he reports significant improvement, but he wakes-up at night due to
cough at least once a week, he still reports worse exercise tolerance, the use of
salbutamol is 1-2 doses per day. The most appropriate therapeutic decision is:
A. continue the so-far treatment regime, because the improvement has been achieved.
B. recommend the use of salbutamol in regular doses, e.g. 2 doses every 6 hrs.
C. add theophylline.
D. add cromones.
E. add long-acting beta-mimetic or replace inhaled steroid with a composite
formulation, containing both drugs. The increase of the dose of inhaled steroid
should be considered.
Nr 16. The first choice treatment for the patient with acute asthma attack is:
A. rapidly acting inhaled bronchodilators.
D. theophilline and steroids
B. beta-mimetics given orally or intravenously.
intravenously.
C. inhaled steroids.
E . adrenalin subcutaneously.
Nr 17. The treatment of choice in the mild and symptomless COPD is:
A. monitoring of the rate of bronchial obstruction progression, no other
recommendations.
B. anti-nicotine therapy and respiratory rehabilitation.
C. high doses of inhaled steroids, long-acting beta-mimetics, short-acting beta-
mimetics on demand – the treatment should be initiated as early as possible in
order to inhibit the disease progression.
D. steroids – oral or depot.
E. oxygen therapy and respiratory rehabilitation.
Nr 18. Which of the following statements best describes the diagnostic value of
D-dimers in pulmonary embolism?
A. elevated concentration of D-dimers is specific to pulmonary embolism.
B. low concentrations allow to exclude pulmonary embolism with high probability.
C. D-dimers help to differentiate between thrombo-embolic processes and inflammatory or
neoplastic diseases.
D. high concentrations are detected especially in patients with pulmonary infarction.
E. high concentrations are detected especially in patients with infarction of the right
ventricle.
SED - 7 - VERSI ON I
February 2010
Nr 19. The pathogen most frequently causing community-acquired pneumonia is:
A. Legionella pneumophila.
D
. Streptococcus pneumoniae.
B. viruses.
E . Pneumocystis carini.
C. Klebsiella pneumoniae.
Nr 20. For which of the following rheumatic diseases the typical feature is a symmetric
synovitis involving wrists and small joints of the hands and feet:
A. Ankylosing spondylitis.
D. Reiter’s syndrome.
B. gout.
E . Lupus erythematosus systemicus.
C. Rheumatoid arthritis.
Nr 21. A 55-year-old obese male experienced at night a strong pain and swelling
involving the first metatarsophalangeal joint of the left foot with concomitant warmth
and redness of the skin in this area. The symptoms disappeared several days later.
Shortly thereafter however, (as a consequence of abundant dinner with alcohol) there
occurred an equally painful swelling and effusion in the right knee. In the synovial fluid
sample taken for a diagnostic purpose the most likely finding is:
A. Reiter’s cells.
B. rheumatoid factor (RF).
C. intracellular bacteria (e.g. gonococcal infection).
D. needle-shaped strongly negative birefringent crystals (in polarized light microscopy).
E. rhomboid-shaped or rectangular weakly positive birefringent crystals (in polarized
light microscopy).
Nr 22. A 32-year-old female shortly after delivery started to complain about weekness,
elevated temperature, migratory joint pain and swelling, hair loss and nontender oral
ulcers. After a sun exposure she developed erythematous skin lesions on cheeks and
dorsal part of the nose. The control chest radiograph revealed bilateral flattening of
costo-diaphragmal angles. In laboratory testing: HGB 10.5 g/dl, WBC 2.0 G/l, PLT 120
G/l. The most likely diagnosis in this case is:
A. lymphoma.
D
. lupus erythematosus systemicus.
B. mesothelioma.
E. Sjögren’s syndrome.
C. discoid lupus.
Nr 23. To the group of necrotizing vasculitides belong the following entities except for :
A. Wegener’s granulomatosis.
D
. Systemic sclerosis.
B. Polyarteritis nodosa .
E . giant cell arteritis.
C. Takayasu’s arteritis.
Nr 24. Which from the following situations does not require treatment consisting in
bisphosphonates administration as well as vitamin D and calcium supplementation?
A. senile osteoporosis .
D. periarticular osteoporosis.
B. postmenopausal osteoporosis .
E. secondary osteoporosis , e.g. related to
C. poststeroid osteoporosis.
endocrine conditions.
SED - 8 - VERSI ON I
February 2010
Nr 25. The hallmark of which from the following rheumatic diseases is the absence of
rheumatoid factor:
A. Rheumatoid arthritis.
D. Lupus erythematosus systemicus.
B. Ankylosing spondylitis.
E. rheumatoid factor may be present in all entities
C. Sjögren’s syndrome.
named above.
Nr 26. The aim of chemoprophylaxis against tuberculosis is:
A. preventing disease development in infected individuals.
B. active infection treatment.
C. preventing infection transmission.
D. protection against exposure to mycobacteria.
E. disease recurrence prevention.
Nr 27. The first line therapy in sarcoidosis is:
A. antibiotics.
D. long acting -mimetics.
B. inhaled glucocorticosteroids.
E. cytotoxic agents.
C. systemic glucocorticosteroids.
Nr 28. Non-complicated pneumonia caused by influenza virus requires:
A. hospital based treatment.
D. oral antibacterial therapy.
B. symptomatic treatment.
E. intravenous antibacterial therapy.
C. antiviral treatment.
Nr 29. Which of the following is not an unfavourable factor in hospital-acquired
pneumonia?
A. respiratory failure.
D
. bilateral pneumonia.
B. prolonged mechanic ventilation.
E . chronic respiratory disease.
C. age < 60 yrs.
Nr 30. QT interval in ECG reading is measured:
A. from the start of QRS complex to the start of T wave.
B. from the start of QRS complex to the end of T wave.
C. from the end of QRS complex to the start of T wave.
D. from the end of QRS complex to the end of T wave.
E. from the highest point of QRS complex to the start of T wave.
Nr 31. Which of the following is not a pulmonary hypertension symptom?
A. hoarseness.
D
. loss of appetite.
B. lower extremities edema.
E . increased sputum production.
C. stenocardia.
Nr 32. Which of the medications listed below reduce the risk of cardio-vascular
incidents and death in patients suffering from coronary disease?
A. nitrates.
D
. the correct answers are A and B.
B. statins.
E . none of the above.
C. calcium channel blockers.
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