My written state exam with all the questions

I took my written state exam on June 9th  2009.

Gettin’ ready!

Concentrate!

The Norwegians (and some Swedes) got together after the written state exam to grab a bite at Liszt Ferenc tér.

Egészségedre!

Note: This is an exact copy of my exam. After the exam we were allowed to take the booklet with all the questions home.
The order of the answer alternatives has been shuffled on some of the questions compared to older exams. Just a heads up

Here are the questions (total of 180 points)

1. Which of the following methods is appropriate for evaluating the severity of late occurring toxemia of pregnancy?

A) the measurement of blood pressure
B) the measurement of urinary protein concentration
C) assessing the severity of edema as well as the patient’s subjective symptoms
D) all of the above
E) only answers (B) and (C) are true

2. Valid statements regarding cohort studies include:

A) these are descriptive studies
B) these are analytic studies
C) these are usually longitudinal studies

3. The blood-brain barrier is composed of:

A) capillary endothelium
B) basal membrane
C) podocytes of the astrocytes
D) all of the above

4. Associate the following statement(s) with their corresponding term(s)!

4.1 Paget’s disease

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis angina – pectoris

4.2 Hyperostosis

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

4.3 Osteoporosis

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

4.4 Fibrotic dysplasia

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

4.5 Ollier’s syndrome

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

4.6 Relapsing polychondritis

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

4.7 Tietze’s syndrome

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis – angina pectoris

5. Case Study:
A 40-year-old worker had a massive upper gastrointestinal hemorrhage accompanied by splenomegaly. He never consumed alcohol. Which of the following could have caused this gastrointestinal bleeding?

A) esophageal varices
B) gastric carcinoma
C) a peptic ulcer
D) gastritis
E) esophagitis

6. Lumbar and low extremity pain, peripheral low extremity paresis and urination disorders occur in:

A) lumbar spondylosis
B) lumbar disc hernia
C) a tumor of the cauda equina
D) all of the above

7. Salivary stones (sialoliths):

A) develop most freqently in the parotid gland
B) can develop in association with urinary calculi
C) are easily palpable
D) are readily detected on roentgenograms
E) can be detected by palpation, using a lacrimal probe

8. The term “incidence” is defined as:

A) the contingence of the occurrence of diseases
B) the total number of cases over a specified time-period
C) the number of chronic cases over a specified time-period
D) the number of new cases occurring over a specified time-period

9. Currently, the most effective contraceptive method is the:

A) oral (hormonal) contraceptive
B) intrauterine device
C) condom
D) cervical diaphragm
E) calendar rhythm method (periodic abstinence)

10. Which of the following ECG changes are typical of Printzmetal’s angina during a fit?

A) diffuse ST elevation
B) ST elevation in a localized area
C) diffuse ST depression
D) ST depression in a localized area
E) none of the above

11. Case Study:
A 45-year-old male patient complains of lumbar pain radiating to his leg. Ipsilateral Achilles areflexia and hypesthesia in the small toe were found.
At which spinal root level does the patient have a disc hernia compression?

A) L4 root
B) L2 root
C) S1 root
D) L3 root
E) L5 root

12. Leukemia may develop insidiously with prolonged exposure to:

A) benzene
B) carbon tetrachloride
C) methylbromide
D) trichlorethylene

13. The proportion of suicides which have already been preceded by earlier suicie attempts is:

A) 10%
B) 50%
C) 60%
D) 100%
E) 20%

14. The most pronounced gastrointestinal fluid absorption occurs in the:

A) duodenum
B) jejunum
C) ileum
D) colon
E) none of the above

15. The most frequently occurring chromosomal abnormality that can be reliably detected by amniocentesis is:

A) trisomy 21
B) translocation 21/22
C) trisomy 18
D) trisomy 13
E) translocation 13-15/21

16. Case Study:
You are summoned to an emergency at a nearby café. Arriving on the scene, you find a middle-aged, obese man sagging in his chair. Bystanders inform you that the patient had ordered a coffee and two croissants. After he had been served, he began to make forceful and wild gestures, swept everything off from his table, howled incoherently, then collapsed back into his chair.
On physical examination he is still uttering incoherent sentences. The patient resists physical examination and beats about with his arms. Ifis skin and mucous membranes are of normal colour, but the patient is streaming -with perspiration. Me chest and abdomen are normal on physical examination. A Babinski-tendency is observed on the left side and patellar clonus can be elicited on the right. Breath: no characteristic odour is scented.
Pulse: 88/min with sporadic extrasystoles. Blood pressure: 190/ 100 mmHg.
The most likely diagnosis is:

A) acute psychosis
B) a cerebral embolism
C) hypoglycemia
D) a transient cerebral ischemic attack
E) alcoholic psychosis

17. A ball on the foot develops in patients with:
1) a bronchogenic carcinoma
2) a lung abscess
3) bronchiectasia
4) chronic obstructive pulmonary disease

A) 1, 2, and 3 are true
B) 1 and 3 aretrue
C) 2 and 4 aretrue
D) only 4 is true
E) all of the above

18. Negative symptoms of schizophrenia include all of the following, EXCEPT:

A) anhedonia
B) flat affect
C) auditory hallucinations
D) poverty of thought content
E) lack of motivation and initiative

19. Possible causes of a fever of unknown origin include all of the following, EXCEPT:

A) pyelonephritis
B) thyroiditis
C) subacute bacterial endocarditis
D) hypothyroidism
E) Salmonella enteritis

20. All of the following statements regarding polyhydramnios are valid, EXCEPT:

A) therapeutic amniocentesis is indicated solely for the alleviation of maternal distress
B) in polyhydramnios, the incidence of major congenital abnormalitiesis 20%
C) the rapid removal of amniotic fluid is contraindicated
D) occasionally, it can be treated safely and effectively with diuretics as well as restricting the intake of water and dietary salt
E) polyhydramnios is associated with an increased incidence of premature separation of the placenta, uterine dysfunction and post-partum bleeding

21. The typical memory loss occurring in Korsakoffs syndrome is due to a lesion of which of the following structures?

A) habenula
B) frontal associative cortex
B) parietal associative cortex
C) mammilary body, limbic cortex

22. Epidemiology can be regarded as the study of:

A) the incidence and causes of human death
B) the etiology of human diseases
C) the functional parameters of the health care delivery system
D) the distribution of human diseases and the incidence of their determining factors

23. The most prevalent cause of mortality due to a duodenal ulcer can be:

A) an esophageal rupture associated with the regurgitation of the acidic gastric contents
B) hemorrhage
C) an untreatable disease
D) pyloric obstruction and inanition
E) peritonitis resulting from acute perforation

24. Case Study:
The family history of a 2-year-old child reveals, like both his parents,
Allergic rhinitis caused by ragweed. The child also has had pseudocroup (thymic
asthma) twice. Is an allergological examination indicated in this case?

A) no, because there is no relationship between ragweed allergy and pseudocroup, plus sensitivity for other allergens cannot be usually demonstrated
B) yes, because there is a positive family history for allergy
C) yes, because desensitization with the demonstrated allergen can be used to prevent the development of a pseudocroup
D) yes, because pseudocroup is a forerunner of bronchial asthma

25. The diganosis of endometriosis refers to:

A) the precancerous stage of endometrial carcinoma
B) fibrosis resulting from chronic endometritis
C) endometrial lesions caused by IUDs
D) the presence of extrauterine endometrium implants
E) viral endometritis

26. All of the following are characteristic features of full-blown traumatic (hypovolemic) shock, EXCEPT:

A) an increased blood viscosity
B) peripheral vasoconstriction
C) bradycardia
D) stupor
E) oliguria

27. Case Study:
The history of a 48-year-old female patient contains 2 vaginal deliveries and an uncomplicated arteflcial abortion. Her last menstruation has occurred 3 years ago. She has observed slight, speckling vaginal bleeding occurring after intercourse and defecation. Her body weight
is stable; constipation is a frequent symptom.
Physical examination: Breasts show no particular finding. The abdomen is soft and palpable. External genitals are normal. Hemorrhoids are visible in the anal orifice. Capacious vagina; scar of a previous episiotomy. The surface of the portio vaginalis of the cervix is irregular; with an exophytic, coated neoplasm that bleeds easily on touch. The anteflexed uterus is of regular size; its vicinity and the cul-de-sac are normal.
Colposcopy: swollen, irregular portio vaginalis wth an exophytic, coated neoplasm that bleeds easily. Malodorous vaginal discharge, slight bleeding after the examination.
Rectal examination: No abnormality is palpable, the parametrium is normal on both sides. Several inflamed, moderately hemorrhoids are visible in the anal orifice.
Colposcopy: the ventral labium of the portio vaginalis is covered by rough epithelium with numerous atypical capillaries that bleed easily.
Tumor cytology: P5.
What is the likely diagnosis?

A) inoperable carcinoma of the uterine corpus
B) primary affection on the surface of the portio vaginalis
C) malignant neoplasm of the portio vaginalis of the cervix
D) cervicitis
E) grade I stress incontinence + vaginitis with acute cervicitis

28. All of the following are risk factors for hypertension, EXCEPT:

A) a high bodyweight
B) a hereditary disposition
C) an excessive intake of sodium
D) the regular use of alcohol
E) smoking

29. The most appropriate method for maintaining patent airways in a patient with multiple trauma resulting from a car accident due to drunken driving is:

A) tracheostomy
B) intubation with a cuffed endotracheal tube
C) thrusting the jaw and lifting the chin
D) oropharyngeal intubation
E) endotracheal intubation

30. Case Study:
An 80-year-old alcoholic male patient complains of a headache probably due to skull injury. He has had left-sided hemiparesis for a month. The right carotidangiography showed detachment of the cerebral vessels from the internal surface of the skull. The most probable diagnosis is:

A) right-sided glioblastoma of the frontal lobe
B) occlusion of the right middle cerebral artery
C) cerebral contusion
D) right-sided subdural hematoma
E) right-sided epidural hematoma

31. All of the following can occur as a complication of chronic obstructive pulmonary disease EXCEPT:

A) respiratory insufficiency
B) left ventricular insufficiency
C) polycythemia
D) cor pulmonare
E) bronchogenic carcinoma

32. In which of the following do pulmonary abscesses develop?

1) pneumococcus type-III pneumonia
2) mitral stenosis
3) pulmonary infarction
4) scleroderma
5) regional enteritis

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

33. Case Study
A 6-month-old infant is referred to the hospital by the physician. The infant has been ill for 5 weeks. The disease started with the symptoms of bronchitis and cough, for which penicillin therapy had been initiated.After a transient improvement, the cough became more severe, and subfebrility, then febrility developed. Following this, tetracycline (Tetraolean) and penicillin had been administered in injection form. These did not relieve the cough. The physical symptoms were characteristic for bronchitis. Current symptoms: are loss of appetite, stagnation of somatic growth, the stool is bulky, loose and fetid. Family history: the parents mention that they lost their first child: she had an operation on the 2nd day of her life and 3 days later she died. They remarked that: “There was something wrong with her intestine”.

33.1 The most likely diagnosis is:

A) interstitial plasmocytic pneumonia
B) gastroesophageal reflux
C) apiration pneumonia
D) ascariasis
E) cystic fibrosis

33.2 Which of the following diagnostic tests is the most important?

A) testing of the gastrointestinal passage
B) bronchography
C) rectal digital examination
D) chest x-ray
E) native abdominal x-ray

33.3    Which of the following, additional tests would you order to confirm your diagnosis?

A) laryngoscopy
B) the demonstration of worm eggs in the stool
C) determination of the chloride concentration in the sweat
D) liver biopsy
E) barium enema

33.4 Which of the following additional tests is also useful?

A) determination of the enzyme activities in the duodenal fluid
B) a lung biopsy
C) an explorative laparotomy
D) an oral glucose tolerance test
E) abdominal ultrasound

33.5 Based on the anamnestic data, which of the following drugs would you order?

A) penicillin
B) a strict diet; mucolytics; enzyme substitution
C) broad spectrum antibiotic
D) metronidazole (Klion)
E) trimethoprim-sulfamethoxazole (Sumetrolim)

34. Cerebral metastatic carcinomas usually originate from the:

A) bones
B) lungs
C) prostate gland
D) esophagus
E) salivatory glands

35. The most important etiological factor of epididymitis is:

A) gonorrhea
B) syphilis
C) listeriosis
D) blastomycosis
E) brucellosis

36. The most common hepatic lesion in cystic fibrosis is:

A) postnecrotic cirrhosis
B) fat atrophy
C) multinodular biliary cirrhosis
D) Laennec’s cirrhosis
E) none of the above

37. Alcohol and drug abuse:

A) are equally prevalent in both sexes
B) are more prevalent among males
C) have an age-dependent prevalence
D) are more prevalent among females

38. The most accepted hypothesis explaining the biological basis for schizophrenia is:

A) the dopamine hypothesis
B) the transmethylation hypothesis
C) the double bind hypothesis
D) the serotonin hypothesis
E) the endogenous opiate hypothesis

39. Cataplexy occurs in:

A) grand mal epilepsy
B) Kleine-Levin’s syndrome
C) psychomotor epilepsy
D) narcolepsy
E) “status epilepticus”

40. Case Study:
A 29-year-old multiparous woman (4 pregnancies, 4 deliveries) undergoes laparoscopic fulguration of the oviducts. Thirty-six hours after the operation, the patient begins to complain about abdominal pain and nausea. Her body temperature is 38.3 °C and slight abdominal distention is palpated. The most likely diagnosis is:

A) pelvic inflammation
B) tubal abortion
C) a perforating injury to the gut resulting from a stab wound
D) hemorrhage from the uterine tube
E) thermal injury to the gut

41. In a chronic subdural hematoma:

A) the EEG can be normal
B) the EEG exhibits a slow-wave focus
C) the EEG has decreased amplitude
D) all of the above
E) none of the above

42. The time to seek needed medical help is determined by:

A) the personality of the given individual
B) the intensity of the signs and symptoms
C) the pain-sensitivity of the individual
D) all of the above
E) none of the above

43. Which of the following statements characterize the function of the hypothalamo-pituitary-ovarian system correctly in true precocious puberty?

A) menstruation is irregular with prolonged episodes
B) menstruation is usually absent, the appearance of sexual changes depends on hormonal effects
C) menstruation is regular but ovulation is absent
D) regular ovulatory cycles similar to those in reproductive age

44. Case Study:
A 65-year-old male patient passes tarry and loose stools (melena) three days after aortobifemoral bypass surgery. The most likely cause of this condition is:

A) an aortoduodenal fistula
B) DIC (disseminated intravascular coagulation) related to a transfusion
C) a bleeding stress ulcer
D) ulcerative colitis
E) ischemic colitis

45. Case Study:
A 6-hour-old newborn exhibits tachypnea and dyspnea and vomits repeatedly. The body temperature of the newborn is normal. The physical examination reveals a tympanic resonance over the left side of the chest-, no respiratory sounds are audible over this side. The surface of the abdomen is concave. What is the most likely cause of this condition?

A) neonatal sepsis
B) left-sided pneumonia
C) IRDS
D) a diaphragmatic hernia on the left side
E) pneumothorax
F) congenital valvular disease

46. The anion gap can be increased in:

A) pyloric stenosis
B) bromide intoxication
C) liver cirrhosis
D) ammonium chloride intoxication
E) multiple myeloma

47. Case Study:
A 25-year-old unconscious female patient was admitted to the hospital. No friends or witnesses could give any further information on what had happened Centrifugation of the urine obtained by catheter revealed fat drops in the sample. Which of the following diagnoses is possible?

A) eclampsia
B) bone fracture
C) CO intoxication
D) all of the above
E) none of the above

48. All of the following polysystemic autoimmune diseases contribute to the development of Mixed Connective Tissue Disease (MCTD), EXCEPT:

A) systemic lupus erythematosus (SLE)
B) polymyositis/dermatomyositis
C) rheumatoid arthritis
D) progressive systemic sclerosis (scleroderma)
E) Sjörgen’s syndrome

49. During which childhood age is the onset of acute lymphoblastic leukemia most frequent?

A) 6 months
B) 3-5 years
C) adolescence
D) the neonatal period
E) 10-12 years

50. In infectious mononucleosis, preventive measures include that:

A) reporting is not required
B) laboratory testing is mandatory
C) the patient should be isolated
D) continuous disinfection is necessary

51. All of the following statements are valid regarding tenosynovitis, EXCEPT:

A) starting from the wound of the thumb, the infection spreads to the radial bursa and the interstitial spaces of the thenar
B) the infection of the other four fingers spreads to the ulnar bursa
C) postoperative physiotherapy must be started early to preserve tendon functions
D) poor natural resistance of the region is characteristic
E) early surgical drainage is essential

52. Which type of abortion is characterized by cramping lower abdominal pain, vaginal bleeding, an open cervix but no passage of the products of conception?

A) imminent abortion
B) post-abortion residue
C) incipient abortion
D) missed abortion
E) incomplete abortion

53. To properly develop a good behavior in a child, it is advisable to:

A) punish the child
B) reward the child
C) both of the above
D) none of the above

54. Asbestos causes cancer in which of the following organs?

A) the pleura
B) the kidneys
C) the brain
D) the adrenals

55. Therapy of hypotonic contraction failure includes the administration of:

A) gestogens
B) spasmolytics and ergotamine
C) oxytocin infusion
D) corticosteroids

56. Case Study:
A round-shaped shadow of 3 cm in diameterwas found on an X-ray screening of a 65-year-old, complaint-flee, smoking male patient. 15 years ago the patient had undergone a successful operation for colon carcinoma. Select the most probable diagnosis:

A) pulmonary abscess
B) carcinoma metastasis
C) bronchial carcinoma
D) tuberculosis
E) aspiration pneumonia

57. Clavicular fractures of children under 10 years of age should be treated as follows:

A) open reduction is appropriate
B) the medial third of the clavicle should be removed
C) no therapy is necessary in most cases
D) reduction and the application of a “figure-of-eight” splint dressing
E) open fixation by a medullary rod is necessary

58. Which of the following is used as health indicators of a population?

A) demographic parameters
B) somatometric parameters
C) epidemiologic parameters
D) all of the above
E) none of the above

59. The most appropriate therapy for clean, fresh lacerations of peripheral nerves is:

A) the administration of antibiotics only
B) delayed suture
C) immobilization of the limb only
D) debridement of the wound only
E) immediate approximation of separated nerve endings

60. In Crohn’s disease, the most frequent indication for surgery is:

A) an intra-abdominal mass (intestinal conglomerate)
B) stagnant bowel syndrome
C) intestinal obstruction
D) an external fistula
E) an intra-abdominal fistula

61. Embolization of the cerebral vessels occurs:

A) as a sequel of mitral valve prolapse
B) as a sequel of atrial fibrillation
C) if a lateral thrombus develops
D) as a sequel of subacute bacterial endocarditis
E) after cardiac surgery
F) all of the above

62.    A    45-year-old    female    patient has undergone a cholecystectomy. Three days following the procedure, she developed a deep-vein thrombosis. The treament of choice is:

A) anticoagulation therapy
B) ligation of the great saphenous vein
C) active exercises
D) elevation of the lower extremities
E) thrombolytic therapy with streptokinase or urokinase

63. Case Study:
You are examining an 18-month-old boy. The parents have noted the occurrence of large hematomas on the skin following mild traumas during the last6 months. The results of the laboratory tests are not yet ready, when theparents inform you that the child’s finger started to bleed again, two hoursafter the puncture. What is the most likely diagnosis?

A) thrombocytopenia
B) thrombocytopathy
C) vasculopathy
D) von Willebrand’s disease
E) hemophilia

64. Cheilosis develops as a result of:

A) a vitamin D deficiency
B) a vitamin A deficiency
C) a vitamin B deficiency
D) a riboflavin deficiency

65. The most common histological type of thyroid carcinoma is:

A) papillary carcinoma
B) undifferentiated small-cell carcinoma
C) undifferentiated large-cell carcinoma
D) follicular carcinoma
E) medullary carcinoma

66. Case Study:
Shortly after a penetrating foot injury a pediatric patient developed trismus, risus sardonicus, opisthotonus, abdominal rigidity. The most probable diagnosis is:

A) drug allergy
B) meningitis
C) tetanus
D) hysteria
E) gas gangrene

67. Should a mother with active tuberculosis nurse her baby?

A) yes
B) no
C) only if she has been receiving antituberculotic chemotherapy during her pregnancy

68. Case Study:
A 41-year-old multiparous (7 pregnancies ,7 deliveries) woman is undergoing a vaginal hysterectomy and reconstructive surgery for uterovaginal prolapse. She has been taking oral contraceptives for the last 10 years. Which of the following potential complications is the most likely associated with contraceptive use?

A) pulmonary embolism
B) pneumonia
C) retinal detachment
D) periorbital cellulitis
E) ileus

69. In puerperal mastitis, the pathogen most often cultured from the excretions of the mammary glands is:

A) Staphylococcus aureus
B) Streptococcus fecalis
C) Staphylococcus epidermidis
D) Bacteriodes species
E) Escherichia coli

70. Combined tumors of the salivary gland:

A) usually have a submaxillary localization
B) are usually malignant
C) usually develop in the parotid gland
D) usually cause facial nerve paralysis
E) typically cause sialolithiasis

71. Typical electric signs of a paradox sleeping behavior are:

A) high amplitude, low frequency
B) low amplitude, high frequency
C) low amplitude, low frequency
D) high amplitude, high frequency

72. Eczema, blond hair, blue eyes and mental retardation are typical of:

A) phenylketonuria
B) Down’s syndrome
C) toxoplasmosis
D) cretinism
E) tuberous sclerosis

73. Supraclavicular lymph nodes are often involved in:

A) following injury to the anterior two-thirds of the tongue
B) the metastatic spread of primary malignancies
C) gastric and lung cancer
D) carcinoma of the lip
E) a neuroblastoma

74. According to data obtained in many hospital patients, hyperuricemia is primarily caused by:

A) poorly treated hypertension
B) chronic diuretic therapy
C) obesity and an increased consumption of purines
D) diabetes mellitus in adults
E) chronic renal insufficiency

75. A 4-month-old baby boy, born at term with 3400 g birth weight, currently weighs 6000 g. What is your opinion?

A) the infant is overweight
B) the body weight of the infant is normal
C) the infant’s nourishment is deficient

76. Which of the following statements concerning congenital megacolon is correct?

A) constipation is always present; diarrhea never occurs
B) the cause of this condition is the lack of parasympathetic ganglia in the distended portion of the colon or rectum
C) on rectal digital examination, the rectal ampulla is found empty
D) both the narrow and the distended portion have to be removed during the neonatal period
E) it may cause paralytic ileus

77. Select the most important effect of a normal dose of nitroglycerin in angina pectoris (apart from coronary dilation!):

A) relaxation of bronchial smooth muscles
B) dilation of the peripheral vessels
C) constriction of the peripheral arterioles
D) constriction of the peripheral venules
E) none of the above

78. Hypothermia occurs in:

1) myxedema
2) high-dose sedatives
3) alcohol intoxication
4) hyperthyroidism

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

79. Select the correct localization of a concretion in case of hydrops vesica felleae:

A) Vater’s papilla
B) the common bile duct
C) Wirsungian’s duct
D) the hepatic duct
E) the cystic duct

80. In dysmenorrhea:

A) nausea and vomiting, etc. are the primary symptoms, not abdominal cramps
B) abdominal cramping is the leading symptom, seldom associated with nausea and vomiting, etc.
C) symptoms are present from the time of the menarche
D) the symptoms develop after the first delivery
E) initially, menstruation is normal becomes associated with cramps subsequently

81. Exploration of the kidney through the transabdominal route is indicated in:

A) pyelonephritis
B) cystic disease
C) hydronephrosis
D) neoplastic disease
E) tuberculosis

82. The portal of entry for the tetanus pathogen is:

A) the oral mucosa
B) the gastrointestinal tract
C) the conjunctiva
D) the excoriated skin

83. Contraindications to lithium administration include:

A) an administration in combination with imipramine (Tofranil)
B) any occurrence of the symptoms of schizophrenia
C) the presence of depression
D) an administration in combination with chlorpromazine (Thorazine)
E) the presence of a renal disease

84. The most frequent cause of arterial occlusion is:

A) embolism
B) arteriosclerosis
C) varicose veins
D) all of the above

85. Cerebral posterior arteries:

A) originate from the basilar artery
B) can join with the superior cerebellar artery
C) supply the occipital lobe
D) all of the above
E) none of the above

86. Case Study:
A routine test has revealed proteinuria in a 35-year-old male patient. Electrophoresis of the urine proteins showed low molecular proteins at high concentration and only sustained albuminuria. RIA (radioimmunoassay) identifiedthe predominance of beta 2microglobulins.
Which of the following caused the proteinuria?

A) cadmium intoxication
B) mercury intoxication
C) penicillin intoxication
D) glomerulonephritis
E) none of the above

87. Oocytes in the ovaries of a neonate are in the following developmental stage:

A) in the prophase of the first meiotic division
B) at the appearance of oogonia (primordial germ cells)
C) in the stage of maturation
D) in the anaphase of the second meiotic division
E) none of the above

88. Which of the following is the characteristic feature of the Mallory-Weiss syndrome?

A) portwine stains (naevus flammeus) of the stomach
B) rupture of the esophageal mucosa and the gastric mucosa in the region of the cardia
C) bleeding from a gastric polyp
D) mucosal rupture in the esophagus
E) rupture of the gastric mucosa

89. Case Study:
A 4-week-old infant is brought to the physician by the mother. The mother reports that the physiologic jaundice has never ceased completely. The stool is greyish-white and the baby’s urine stains the diaper brown. The severity of the baby’s jaundice soon increases.

89.1 What is the most likely diagnosis?

A) sepsis
B) hepatitis
C) biliary tract atresia

89.2 The most informative laboratory test is:

A) a hemoculture
B) the RBC sedimentation rate; blood cell counts and the differential count
C) a hepatic functional test
D) a renal functional test
E) a native abdominal x-ray

89.3 What is your diagnosis if the non-conjugated bilirubin fraction is exclusively elevated?

A) sepsis
B) biliary tract atresia
C) hemolytic anemia
D) viral infection

89.4 What is your diagnosis if both the conjugated and non-conjugated bilirubin fractions are elevated?

A) Crigler-Najjar syndrome
B) hemolysis
C) biliary tract atresia

89.5 Which of the following tests are needed for the differential diagnosis of biliary tract atresia and hepatitis?

1) liver biopsy
2) intraoperative cholangiography
3) further observation for 4 weeks
4) administration of prednisone

A) (1) and (2) are correct
B) (2) and (3) are correct
C) (1) and (4) are correct
D) (2) and (4) are correct
E) (3) and (4) are correct

90. A disorientation to time is characteristic of:

A) hypomania
B) depressive psychosis
C) Korsakoff’s syndrome
D) an acute schizophrenic episode
E) agoraphobia

91. Case Study:
A middle-aged waiter was admitted to the psychiatric ward in a drunken state. While in the ward his behavior became bizarre and he gradually became became disoriented to place and time. He sometimes acted as if he was taking orders or serving dishes. On examination he usually misinterpretated the antecendents and circumstances of his admission. He was unable to recall his answers to simple questions after a few minutes. He denies any hallucinations or delusions. The patient has had no prior psychiatric disorders. His relatives haven’t found anything extraordinary about his behavior. The most likely diagnosis is:

A) alcohol withdrawal syndrome (delirium tremens)
B) alcohol amnestic syndrome (Korsakoff’s syndrome)
C) alcoholic hallucinations
D) acute paranoid schizophrenia
E) manic phase (of bipolar disorder)

92. In which of the following conditions can the administration of progestogenic agents be considered reasonable for the therapy of imminent abortion?

A) in all patients with lower abdominal pain
B) if lower abdominal cramps are present
C) if the history contains spontaneous abortion
D) if the serum progesterone level is low
E) if bleeding is present

93. The single most important sign of appendicitis is:

A) leukocytosis
B) tenderness in the right lower abdominal quadrant
C) an elevated body temperature
D) hyperesthesia in the right lower abdominal quadrant
E) vomiting

94. Paronychia of the finger is best treated by which of the following types of incisons?

A) a “J-shaped” incision at a 3 mm distance from the distal unguicular margin
B) a wide “fishmouth
C) at a considerable distance from the distal unguicular margin
D) any incision that ensures adequate drainage from the phalanx
E) halfway between the unguicular margin and the pulp of the finger

95. Meconium ileus is a possible early symptom of:

A) pyloric stenosis
B) cystic fibrosis
C) intestinal perforation
D) Hirschprung’s disease

96. The term “hypertonic contraction failure” means:

A) that the intensity of contractions gradually decreases during the progress of labor
B) that contractions occur infrequently, their amplitude is low but the basal tone of the uterine musculature is normal
C) that contractions occur infrequently, their amplitude is low just as the basal tone of the uterine musculature
D) that contractions are ineffective from the start of labor

97. All of the following statements about retropharyngeal abscesses are correct, EXCEPT:

A) laryngoscopy is indispensable for the diagnosis
B) they inhibit swallowing
C) they occur as a complication of a purulent pharyngitis
D) a painful swelling of the lymph nodes is detected on both sides of the mandible
E) it is advisable to wait for the spontaneous opening of these abscesses instead of performing an operation
F) the position of the head is similar to that observed in meningism
G) they might cause laryngeal edema

98. Case Study:
The parents of a child who is suffering from a metabolic disease, characterized by an autosomal recessive inheritance pattern, ask for your advice. They intend to have a second baby. Which of the following considerations is INCORRECT?

A) the phenotype of 75% of the potential offspring will be normal
B) the genotype of 25% of the potential offspring will be normal
C) the genotype of 50% of the potential offspring will be normal
D) 50% of the offspring will be heterozygous

99. Case Study:
In a patient with primary biliary cirrhosis, polyclonal gammopathy was established by protein-electrpphoresis. The immunoglobulin found is predominantly:

A) IgG
B) IgM
C) IgD
D) IgA
E) IgE

100. A 40-year-old male patient develops a sudden vertigo, vomiting, and imbalance. Which disease is the least probable?

A) multiple sclerosis
B) acoustic neuroma
C) acute labyrinthitis
D) Meniére’s syndrome
E) vascular disease of the brain stem

101. Lyme disease is caused by:

A) Streptobacillus moniformis
B) Borrelia recurrentis
C) Borrelia burgdorferi
D) Bartonelle baciliformis
E) none of the above

102. The leading cause of death during the first three decades of life is:

A) heart disease
B) trauma
C) drug addiction
D) inadvertent poisoning

103. Case Study:
A 3-month-old infant is brought to you with a 5-week history of diarrhea. No microorganism has been demonstrated by fecal bacteriology. Furthermore, the administration of several antibacterial drugs failed to normalize the condition. The infant has been on an average diet containing mixed food since the age of 6 weeks. The possible causes of this condition include all of the following, EXCEPT:

A) a lactase deficiency following a bacterial diarrhea
B) a diarrhea caused by a viral infection
C) a change of the GI flora caused by the administration of antibiotics
D) the so-called infantile, intractable diarrhea of unknown origin
E) cow’s milk protein intolerance

104. In which of the following diseases does kallikrein secretion decrease?

A) essential hypertension
B) pheochromocytoma
C) primary aldosteronism
D) all of the above
E) none of the above

105. Pyloric stenosis is associated with which of the following metabolic acid-base disorders?

A) hypochloremic alkalosis
B) hyperchloremic alkalosis
C) hypochloremic acidosis
D) hyperchloremic acidosis

106. The following substrate is mainly metabolized by the human brain:

A) glutamate
B) albumin
C) glucose
D) none of the above

107. The most common defect in the adrenogenital syndrome (congenital adrenal hyperplasia) is:

A) none, as it is an idiopathic disorder
B) an 11-hydroxylase deficiency
C) a 17-hydroxylase deficiency
D) a 21-hydroxylase deficiency
E) 3-beta-ol-dehydrogenase deficiency

108. Case Study:
A 32-year-old male patient complains of various fits of hypertension and headaches. The repeatedly determined urine and plasma vanillylmandelic acid, catecholamine, and metanephrine values were normal. Select a possible explanation:

A) a non-functioning adrenal tumor
B) cerebral astrocytoma
C) aortic coarctation
D) aberrant adrenal tissue
E) an inadequate sampling of the urine

109. Considering the low success rate of therapy in affected cancer patients already detected by screening, primary prevention is particularly important in:

A) cervical cancer
B) bronchial cancer
C) skin cancer
D) rectal cancer
E) breast cancer

110. Which of the following mitral prolapse-induced arrhythmias (usually occuring at night during increased vagal tone) is the most dangerous?

A) atrial tachycardia
B) torsade de points
C) non-sustained ventricular tachycardia
D) ventricular extra-systole
E) sustained ventricular tachycardia

111. In which of the following is the angiotensinogen (renin substrate) level abnormally high?

A) colitis
B) during estrogen therapy
C) leukemia
D) essential hypertension
E) Hodgkin’s disease

112. Possible causes of hypertension in childhood include all of the following EXCEPT:

A) encephalitis
B) hypothyroidism
C) acute glomerulonephritis
D) pheochromocytoma
E) coarctation of the aorta

113. Prior to the surgical extraction of the placenta:

A) any shock must be completely corrected
B) blood for any required transfusion should be made available
C) any performed blood transfusions must have been completed before the extraction
D) all of the above
E) none of the above

114. Possible causes of a tall stature in childhood include all of the following EXCEPT:

A) a chromophobic adenoma of the pituitary
B) Hand-Schüller-Christian disease
C) an eosinophilic adenoma of the pituitary
D) Marfan syndrome

115. Which of the following procedures is appropriate for the definitve diagnosis of congenital megacolon?

A) a stool culture and parasitology
B) pancreatic enzyme activity measurements in stool specimens
C) a rectal biopsy
D) a radiographic examination
E) a sweat test

116. Case Study:
Which of the following is the most important therapeutic interventions in familial spherocytosis of a 6-year-old child, who frequently becomes anemic?

A) a splenectomy
B) iron replacement therapy
C) a transfusion of packed red blood cells
D) the prolonged administration of steroids
E) immunosuppressive therapy

117. The HIV virus is synergistic with all of the following viruses, EXCEPT:

A) Herpesviruses
B) papilloma viruses
C) Epstein-Barr virus
D) cytomegalovirus

118. All of the following statements concerning the incidence of the sudden infant death syndrome (SIDS) are correct, EXCEPT:

A) the incidence of the sudden infant death syndrome is the highest at the age of 5-6 months
B) the incidence is higher among girls
C) the incidence is higher among the subsequent siblings of SIDS victims
D) it is more frequent in families with poor social conditions

119. Case Study:
A 35-year-old male patient complains of a resistant limb edema which has persisted for many years. He spent most of his life in tropical countries. His urine is milk-like. Which of the following explains the pathological changes of his urine?

A) gonorrhea
B) a urinary tract infection
C) an increased consumption of milk
D) lipiduria
E) chyluria

120. Select the differential criteria of renal and non-renal progressive hypertension:
1) proteinuria
2) red blood cells casts
3) a high serum creatinine level
4) none of the above

A) 1,2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

121. Case Study:
A 3-year-old child, attending nursery school, becomes repeatedly ill with mild respiratory tract infections which heal spontaneously. What is the most likely cause of these symptoms?

A) an environmental cause, because of the polyetiologic nature of respiratory tract infections
B) a cellular immune defect
C) a vitamin C deficiency
D) an immunoglobulin deficiency
E) rickets
F) malnutrition

122. A 24-year-old primigravida presents in the 28th week of her pregnancy with spider nevi, palmar erythema and diffuse pruritus.
Liver function test results: alkaline phosphatase: 190 IU/L (normal value: 29-91 IU/L); SGOT: 38 IU/L (normal value: 6-18 IU/L); total bilirubin: 1.8 mg% (normal value: 0.3-1.0 mg%); direct bilirubin: 1.0 mg% (normal value 0.1-0.3 mg%).

122.1 The most likely diagnosis is:

A) liver cirrhosis
B) cholecystitis
C) infectious hepatitis
D) cholestasis
E) acute pancreatitis

122.2 After delivery, the doctor should recommend to the patient:

A) none of the above
B) to avoid exertion
C) to abstain from food with a high fat content and not to take oral contraceptives
D) not to have any more babies
E) to undergo a cholecystectomy

123. Acute mastitis is common in:

A) lactation
B) neonates
C) adolescents
D) menopause
E) pregnancy

124. The most common symptom of increase intracranial pressure in children is:

A) stupor
B) ataxia
C) diplopia
D) vomiting
E) a loss of visual acuity

125. Case Study:
A 20-year-old football player presents with a “locked up” knee after a torsion injury to his lower extremity. The most likely diagnosis is:

A) fracture of the distal portion of the femur
B) meniscus injury
C) avulsion of the tibial tuberosity
D) disruption of the tibial collateral ligament
E) disruption of the anterior cruciate ligament

126. What is the influence of pregnancy on epilepsy?

A) seizure threshold is lower
B) seizure threshold is higher
C) there is no relation between pregnancy and seizure threshold

127. The tumor which most frequently causes supersellar calcification is:

A) craniopharyngioma
B) chromophobic adenoma
C) clivus chordoma
D) aneurysm
E) optic nerve glioma

128. Case Study:
A 47-year-old diabetic patient developed oliguria after intravenous urography. The urine osmolarity was 480 mOsm. The most probable diagnosis is:

A) acute renal insufficiency
B) obstructive uropathy
C) prerenal azotemia
D) diabetic nephropathy
E) papillary necrosis

129. Which of the following is a cross-reaction (heterophilic agglutination)?

A) Sabin-Feldmann’s reaction
B) Weil-Felix reaction
C) Widal’s test
D) Stein-Leventhal reaction

130. In total uterine prolapse:

A) despite the descensus of the uterus, the portio vaginalis of the cervicx does not sink beneath the level of the hymenal ring
B) the position of the uterine corpus is normal but the cervix is significantly elongated
C) the uterus is found before the introitus, in the prolapsed vaginal sac
D) the uterus descends beneath the level of the hymenal ring and the portio vaginalis of the cervix appears in the vaginal introitus

131. Which of the following facilitates the anticoagulant effect of coumarin?

A) high-dose salicylate
B) phenylbutazone
C) multivitamins containing vitamin K
D) quinine and quinidin

132. Associate the following statement(s) with their corresponding term(s)!

132.1 Scwartzman’s reaction

A) rash, pruritus, arthritis, neurological disorders
B) hemorrhagic necrosis caused by endotoxins
C) deficiency of the inhibitor of the first complement component

132.2 Serum disease

A) rash, pruritus, arthritis, neurological disorders
B) hemorrhagic necrosis caused by endotoxins
C) deficiency of the inhibitor of the first complement component

132.3 Inherited angio-edema

A) rash, pruritus, arthritis, neurological disorders
B) hemorrhagic necrosis caused by endotoxins
C) deficiency of the inhibitor of the first complement component

133. A “projection” mechanism is most characteristic for which of the following personality disorders?

A) a hypomanic personality
B) a paranoid personality
C) an anancastic personality
D) a schizoid personality
E) an antisocial personality

134. The most frequent cause of an epileptic seizure in a middle-aged patient with an otherwise fair condition is:

A) arteriosclerosis
B) previous cerebral trauma
C) a brain tumor
D) Parkinson’s disease
E) an idiopathic seizure

135. The main cause of neonatal mortality is:

A) septicemia
B) pulmonary hyaline membrane disease with resorptional atelectasis
C) bronchopneumonia
D) bleeding
E) cerebral malformation

136. The defecation stimulus is triggered by:

A) distension of the sigmoid colon
B) contraction of the rectum
C) contraction of the external anal sphincter
D) contraction of the internal anal sphincter
E) distension of the rectum

137. The most common tumor of the 3rd ventricle is:

A) astrocytoma
B) medulloblastoma
C) pinealoma
D) colloid cyst
E) ependymoma

138. Placental contractions:

A) brief uterine contractions occurring at irregular intervals during the last week of pregnancy
B) induce the separation and delivery of placenta
C) are uterine contractions resulting in the effacement of the cervix
D) are contractions occurring during the first days of the puerperium
E) propel the fetus along the osseous and soft tissue passage after the complete effacement of the cervix

139. The therapy of interstinal carcinoid tumours is comprised of:

A) irradiation
B) chemotherapy
C) administration of serotonin antagonists
D) surgery followed by irradiation
E) intestinal resection

140. Nasal discharge of cerebrospinal fluid occurs in:

A) cranial fractures
B) brain tumors
C) congenital defects
D) pseudotumor
E) all of the above

141. Case Study:
A 64-year-old male patient has mental disorders, abnormal gait and incontinence. The CT study revealed expanded ventricles and compression of the subarachnoid space. The most probable diagnosis is:

A) Quentin’s disease
B) Alzheimer’s disease
C) Pick’s disease
D) a normal pressure hydrocephalus
E) Jakob-Creutzfeldt disease

142. Chronic obstructive pulmonary disease (COPD) can be either emphysematous or bronchitic, depending on the character of the pathological alterations in the lung. Though they rarely occur as autonomous forms, the two diseases can be differentiated on the basis of their clinical manifestation. Select the most common feature characteristic of emphysematous and bronchitis COPD:

A) dyspnea
B) hypercapnia
C) a chronic cough
D) bronchodilators can improve the airflow
E) polycythemia

143. A brain abcess:

A) is a sequel of bronchiectasis
B) is a sequel of frontal sinusitis
C) is similar to other intracranial space occupying processes as it causes neurologic symtoms
D) is fatal if left untreated
E) all of the above

144. The most prevalent gynecological malignancy of women between 36 and 65 years of age is:

A) endometrial carcinoma
B) ovarian carcinoma
C) breast carcinoma
D) vulvar carcinoma
E) cervical carcinoma

145. Which of the following is affected in Dupuytren’s contracture?

A) the tendons
B) the meniscus
C) the joint
D) the muscles
E) the palmar fascia

146. All of the following are manifestations of the superior vena cava syndrome, EXCEPT:

A) dyspnea
B) enlarged veins which are visible on the anterior chest wall
C) edema of the head and neck
D) increased venous pressure
E) cyanosis

147. In which of the following diseases does pulmonary hemorrhage occur?

A) systemic lupus erythematosus (SLE)
B) Henoch-Schönlein purpura
C) hypersensitive vasculitis
D) Legionnaires’ disease
E) all of the above
F) none of the above

148. Case Study:
A 56-year-old male presents with symptoms with irritability and disinterest in his daily activities. At time, he is confused and forgetful. His gait is unsteady. The deep tendon reflexes are diminished. He frequently experiences tingling in his legs. The most likely diagnosis is:

A) presenile dementia
B) a vitamin B12 deficiency
C) a cerebellar tumor
D) hypothyroidisim
E) multiple sclerosis

149. Mechanical ileus due to obstruction by a biliary stone develops most frequently in the:

A) anorectal junction
B) sigmoid colon
C) ileum
D) duodenum
E) jejunum

150. In which of the following diseases, (which are accompanied with orthostatic hypertension), does hyperglycemia, glucosuria, hypermetabolism, and type-II multiple endocrine neoplasm occur?

A) essential hypertension
B) cerebellar hemangioblastoma
C) pheochromocytoma
D) malignant hypertension
E) Cushing’s disease

151. The term “criminal abortion” means:

A) fetal death is not followed by abortion
B) an intact pregnancy is terminated by an illegal, prohibited procedure
C) one or more subsequent pregnancies terminating spontaneously
D) an intact pregnancy is terminated by a legal procedure

152. Which part of the colon is the largest feces reservoir?

A) the cecum
B) the descending colon
C) the transverse colon
D) the sigmoid colon
E) the rectum

153. Rachitis tarda is characteristic in:

A) the neonatal age
B) advanced age
C) the adult age
D) puberty

154. The increased degradation of structural proteins results from a deficiency of:

A) sodium
B) magnesium
C) calcium
D) potassium

155. Case Study:
A 23-year-old woman complains of becoming occasionally anxious. These occurences are associated with tachycardia and excessive sweating. The condition usually develops in the morning. Which of the following tests has to be performed urgently?

A) determination of the serum sodium level
B) determination of the serum ammonia level
C) determination of the blood glucose level
D) toxicological screening
E) thyroid function tests

156. Case Study:
An 11-month-old infant is referred to you. The infant cannot sit up or stand up, but crawls and plays with objects, understands plenty of words and commands. The somatic growth is apparently normal. After careful examination, the infant’s psychic development is found to be normal and an organic neurological disorder is excluded. Which could be your advise to the parents?

A) to observe the child and repeat the examination at a later date
B) to elevate the dose of the regular vitamin D
C) although the infant’s hip joints have been found to be normal in a physical examination, an x-ray of the hip joint is ordered
D) curative gynmastics should be recommended

157. The optimal monthy gain of body weight during pregnancy is:

A) 0.5-0.6 kg
B) 2.0-2.5 kg
C) 1.5-2.0 kg
D) 2.5-3.0 kg
E) 1.0-1.5 kg

158. Select the correct name for a gastroduodenal ulcer developing together with a gastrin-secreting pancreatic tumor:

A) Mallory-Weiss’ syndrome
B) Sheehan’s syndrome
C) Zollinger-Ellison’s syndrome
D) Stein-Leventhal’s syndrome
E) Waterhouse-Fridrichsen’s syndrome

159. Which of the following diagnostic methods is used for establishing the diagnosis of a glanders infection:

A) Strauss’ reaction
B) hemagglutination inhibition test
C) Nidal’s reaction
D) hemadsorption inhibition test

160. Moeller-Barlow disease is caused by a deficiency of:

A) vitamin A
B) vitamin D
C) vitamin K
D) vitamin C

161. Case Study:
A patient with chronic renal insufficiency due to severe chronic hypertension is examined for chest pain. For the last 2 year the patient has been undergoing hemodialysis twice a week. Hypotensive episodes occurred several times during dialysis. The chest pain is localized above the trapezius muscle; in an orthostatic position it decreases, and during deep inspiration it increases. Select the most probably cause of this chest pain:

A) pulmonary embolism
B) pericarditis
C) costochondritis
D) coronary disease
E) diffuse esophageal spasm

162. Case Study:
A neonate, born five minutes ago exhibits the following symptoms: a pulse rate of 130/min, the extremities are cyanotic, muscle tone is normal, the newborn cries loudly and makes grimaces. Hos much is the Apgar score?

A) 10
B) 3
C) 5
D) 9

163. Which of the following renal calculi are the most common?

A) magnesium ammonium phosphate
B) calcium-phosphate
C) calcium oxalate
D) mixed calcium-oxalate and calcium-phosphate
E) urate

Hope that was helpful!