QUESTIONS - INTERNAL MEDICINE 2

Department of Pneumology and Phthisiology

1. The most common symptoms of respiratory diseases are:

a) chest pain, loss of appetite, weight loss

b) dyspnea, cough, hemoptysis, chest pain

c) dyspnea, headache, sleep disorders

d) cough, loss of appetite, precordial pain

2. Shortness of breath (dyspnea) is:

a) subjective shortness of breath and/or the need for increased ventilation

b) difficult breath at cough

c) shortness of breath after 5 floor

d) tachypnea

3. Expectoration of yellow and green sputum is a sign:

a) of the presence of numerous leucocytes and eosinophils in sputum

b) chronic heart failure

c) asbestosis

d) interstitial lung disease

4. Hemoptysis is most common in:

a) flu

b) mitral stenosis

c) bronchiectasis, bronchogenic carcinoma, bronchogenic carcinoid

d) benign tumors of the respiratory tract

5. The aim of auscultation of lungs and pleura is:

a) assessment of the type and intensity of breath sounds

b) detection of the presence of auscultatory side phenomena

c) determine the quality and strength of the human voice

d) all above

6. Hyperventilation is:

a) tachypnea

b) exercise induced fatigue with an increased frequency of breath

c) ventilation more than is needed to maintain normal CO2

d) dyspnea with the sense of shortness of breath

7. Orthopnea is frequently:

a) associated with left heart failure and may also accompany the primary lung disease

b) shortness of breath in the upright position

c) shortness of breath lying down on one side

d) rapid breathing more than 20/min

8. Side or additionally auscultatory phenomena :

a) we can hear over the fluidothorax

b) are found above the pneumothorax

c) are audible only in dynamic maneuvers (e.g.cough), forced ventilation, hyperventilation

d) are not present over health lungs

9. The dry side additionally auscultatory phenomenons include:

a) rales

b) crepitations

c) celophane “crakles”

d) wheezing

10. Vesicular (alveolar) breath sounds of normal intensity are audible:

a) in severe asthma attack

b) over healthy lungs during inspiration and early expiration

c) with emphysema

d) with pneumothorax

11. Bronchial breath is audible:

a) over the pneumonic infiltration

b) with pneumothorax

c) with emphysema

d) with fluidothorax

12. Frequent causeses of dyspnea are :

a) lung diseases and psychosomatic disorders

b) cardiovascular and endocrine diseases

c) respiratory and hematological diseases

d) respiratory and cardiovascular disease

13. Chest x- ray of the patient for example with emphysema is characterized by:

a) dilated intercostial spaces

b) course with horizontal ribs

c) blunt, obtuse frenicocostal angels and depresion of the diaphragm

d) all of the above

14. The percussion of the lungs are used:

a) only comparative percussion

b) only topographic percussion

c) comparative and topographic percussion

d) neither option is not correct

15. Percussion over the healthy lungs is:

a) hypersonic

b) tympanic

c) dull

d) neither options not correct

16. Physical findings of pleural effusion are :

a) silent breathing, hypersonic percussion, weakened fremitus pectoralis

b) sharpened breathing with crackles and rales

c) decreased breathing , dull percussion, weakened fremitus pectoralis

d) scharpened vesicular breathing, hypersonic percussion, amplified fremitus pectoralis

17. Pleural friction rub:

a) acustic sounds like a barking dog

b) persists in breathholding

c) shows an inflammation of the pleura

d) occurs at venous stasis in the pulmonary circulation

18. A correct statement is :

a) right lung has three lobes

b) left lung has three lobes

c) at physiological breathing is expiration significantly longer than inspiration

d) none of the statements is correct

19. Patient with a large rigth side fluidothorax will probably lie in a position to:

a) on the left side

b) on the back

c) on the right side

d) on the abdomen

20. X-ray radiograph in the standing position fluidothorax is shown as:

a) inhomogeneous mottled shading

b) significant translucency

c) homogenous shading

d) increased bronchovascular drawing

21. Basic imaging in pulmonary medicine is :

a) radiographs of the chest in pesteroanterior and lateral position

b) chest MRI

c) chest CT

d) chest ultrasonography

22. Mark the correct statement of the bronchoalveolar lavage (BAL):

a) into the bronchial tree during the bronchoscopy is injected saline solution and then aspirated bronchoalveolar fluid for cytologic and imunologic examination

b) general anesthesia is required for examination

c) this investigation method is rare

d) BAL is used for clearing of the bronchial tree from bacteria

23. Typical spirometric finding of obstructive ventilatory defect is:

a) reduction of the peak flow rate (PEF), reduction of one-second forced expiratory volume (FEV1) and increased residual volume (RV)

b) reduction in vital capacity (VC) below 80% and decreasing of total lung capacity (TLC) below 90% of normal values

c) physiological spirometric finding

d) none of the statements is correct

24. In patients with arterial blood gas PaCO2=8,0 kPa, PaO2=6,0 kPa and SaO2 = 75%, we can say that it is :

a) hypoxemic respiratory insufficiency

b) hypercapnic respiratory insufficiency

c) physiological values

d) hyperventilation

25. Valid for cyanosis is :

a) yellowing of the skin and mucous membranes

b) blue coloration of the skin and mucous membranes caused by increased amount of reduced hemoglobulin in capillary blood

c) blue coloring of the skin and mucous membranes caused by decreased oxygen saturation of hemoglobin in capillary blood

d) gray coloration of the skin in patients with renal failure

26. Which risk factors are applied in the development of carcinoma of the lung ?

a) professional pollutants

b) tobacco smoking

c) scars after overcoming lung infections

d) interaction of multiple risk factors, especially tobacco smoking

27. Which of the symptoms will be manifested at first in case of lung carcinoma?

a) dry irritating cough

b) dyspnea

c) chest pain

d) hemoptysis

28. Which two tests are the most important before starting the therapy in lung cancer patients?

a) bronchoscopic examination with brushing of a lesion for cytologic and/or histologic examination and chest CT

b) ultrasonography and chest CT

c) PET and bronchoscopy

d) chest X-ray and chest CT

29. What examination we should be decided in case of localized peripheral lung cancer?

a) video-assisted thoracoscopy (VATS)

b) pleural puncture

c) bronchoscopy

d) chest CT

30. What is a paraneoplastic syndrome?

a) manifestation is caused by direct invasion of the tumor

b) manifestation is caused by direct invasion of the metastases

c) reaction to the presence of tumor

d) right is a and b too

31. Before drainage of suspected thoracic empyema is necessary:

a) chest X-ray

b) PET examination

c) chest X-ray, chest CT, chest sonography

d) physical examination of the chest – percussion, auscultation

32. What is therapeutic approach in case of confirmed thoracic empyema?

a) broad spectrum antibiotics and flushing the cavity through the drain

b) weapply broad spectrum antibiotics

c) only drainage without antibiotic coverage

d) choose surgery

33. Which pneumothorax is particularly dangerous ?

a) pallial

b) valve

c) open

d) iatrogenic

34. Is the aetiology of sarcoidosis is clarified ?

a) not clear

b) disease has cancer etiology

c) disease is caused by Mycobacterium tuberculosis

d) regards environmental disease

35. Which organs are affected in sarcoidosis?

a) only lungs and lymph nodes

b) lung, skin, eyes, bones, CNS, but also other organs

c) only lymph nodes

d) affects only the eyes

36. Obstructive diseases of the respiratory tract include?

a) silicosis

b) pneumonias

c) bronchial asthma

d) cryptogenic fibrosing alveolitis

37. Restrictive ventilation disorders arise in:

a) myasthenia gravis

b) pneumonias

c) kyphoscoliosis

d) all of the above

38. Hypoxemia is caused by:

a) decreased tension of oxygen in the inspired air

b) hypoventilation and shunt

c) ventilation-perfusion imbalance

d) all of the above

39. Risk factors for chronic obstructive pulmonary disease are:

a) tobacco smoking

b) some environmental and professional exposures

c) alpha 1 – trypsin deficiency

d) all of the above

40. Main clinical symptoms of COPD are :

a) dyspnea induced by exercise and expectoration

b) chest pain

c) interrupted sleep

d) sore throat

41. Most effective way to stop the progression of COPD is for cigarettes smokers is:

a) bronchodilator therapy

b) mucolytic therapy

c) influenza vaccination against flu or pneumococcal infection

d) quit smoking

42. The most effective therapy for asthma is application of:

a) combination of long-acting β2 – agonists and inhaled glucocorticoids

b) methylxynthines and mucolytics

c) antibiotics and anticholinergic agents

d) cromolyn, nedocromil and anticholinergics

43. Diagnose of the asthma involves

a) history of episodic wheezing, cough, dyspnea

b) wheezing

c) reversible airway obstruction which was documented by pulmonary function tests

d) all of the above

44. Clinical application of pulse oximetry has the following advantages:

a) reveals hyperoxia

b) does not requires arterial puncture and allows continuous monitor hemoglobin saturation oxygen

c) provides information on CO2 elimination

d) provides information about the acid-base balance

45. The most frequent stimuli inducing bronchoconstriction in asthmatic patients are:

a) inhaled allergens and inhaled irritants

b) respiratory infections

c) load

d) all of the above

46. Lung biopsy specimens can be received by:

a) flexible bronchoscopy

b) percutaneous needle aspiration and/or biopsy

c) video-thoracoscopy and open surgical procedure

d) all of the above

47. Lung function tests provide information about:

a) ventilation alveolar spaces

b) gas diffusion

c) blood oxygenation

d) all of the above

48. Conventional chest radiographs are necessery in 2 projections: posterior-anterior and lateral for the aim:

a) detection of disease severity

b) determination of disease progression

c) localization of pathologic finding

d) aetiologic determination of process

49. Flexible bronchoscopy helps:

a) visualization of the airways

b) obtaining samples for microbiological, cytological, histological examination

c) sunction of the secretions

d) all the above

50. Clubbing occurs at following respiratory diseases:

a) interstitial pulmonary diseases

b) lung cancer (or mesothelioma of pleura)

c) chronic pulmonary infection

d) in all above diseases

51. Chronic obstructive pulmonary disease (COPD) is a disorder of the respiratory system with impairment of expiratory flow and has symptoms:

a) chronic bronchitis

b) emphysema

c) chronic bronchitis and emphysema

d) any not listed above

52. Clinical symptoms and signs of respiratory insufficiency can be:

a) dyspnea after small exercise, speaking, dressing

b) headache, sleepiness (inverse sleep), agitation, disorder of consciousness, fatigue

c) disorders of consciousness, unconsciousness, tachycardia, heart arhytmia

d) all of the above

53. Exudative pleural effusion is usually caused by:

a) left heart failure

b) inflammation (tuberculosis or other bacterial infectins)

c) liver cirhosis

d) nephrotic syndrome

54. Tobacco smoking is the  most evident risk factor for:

a) 15 respiratory and cardiovascular disease

b) 30 respiratory and cardiovascular disease

c) 40 respiratory and other disease

d) 50 diseases of the human bod

55. Dysphagia is defined as:

a) painful swallowing

b) regurgitation of food from stomach to the mouth

d ) difficulty with swallowing

d) epigastric pain

56. The characteristic symptoms of acute abdomen are:

a) abdominal pain, fever, ptosis b) jaundice, chills and nausea c) haematochezia, restlessness and hypotension

d) abdominal pain, restlessness and défence musculaire

57. Differential diagnosis of vomiting involves:

a) cerebral tumor

b) pregnancy

c) tumor of pancreatic head

d) all of the above

58. How is the major duodenal papilla commonly referred to?

a) the papilla of Virchow

b) the papilla of Bauhin

c) the papilla of Vater

d) the Billroth papilla

59.Which esophageal disease has the highest prevalence in western countries?

a) gastroesophageal reflux disease

b) Carcinoma of esophagus

c) Barrett´s esophagus

d) the Zenker diverticulum of esophagus

60. Helicobacter pylori represents a risk factor for:

a) gastric carcinoma b) GIST

c) pancreatic carcinoma d) none of the above

61. The definition of diarrhea is as follows:

a) three or more liquid or loose bowel movements per day or the feces weight of more than 200g per day

b) abdominal pain preceding the defecation

c) loose stools

d) loose stools and weight loss

62. In antibiotic-associated diarrhea:

a) most cases are attributable to Clostridium difficile and sigmoidoscopy is necessary

b) most cases are attributable to Clostridium difficile and sigmoidoscopy is not necessary c) most cases are not attributable to Clostridium difficile and sigmoidoscopy is necessary

d )most cases are not attributable to Clostridium difficile and sigmoidoscopy is not necessary

63. What are the typical symptoms of the left-sided colorectal cancer?

a) weight loss, hematochezia, change in stool habits b) left lower quadrant pain, nausea and fever

c) weight loss, nausea and epigastric pain

d )haematochezia, spider nevi and anaemia

64. Which of the following conditions represents the most common cause of malabsorbtion in Western countries?

a) chronic pancreatic insufficiency in chronic alcoholic pancreatitis

b) Whipple disease

c) Celiac disease

d) Chronic pancreatic insufficiency in cystic fibrosis

65.At the emergency you see a 39-year-old male patient with a history of abdominal pain for several weeks. He has melena, blood pressure 80/40 mmHg, tachycardia and normal blood count. What should you do?

a) give norepinephrine, admit patient to the ward and arrange gastroscopy for the next day

b) give intravenous colloid solutions, secure blood transfusion of at least four units, admit patient at the intensive care unit and call the endoscopist to perform gastroscopy as soon as possible

c) give proton pump inhibitors and admit patient at surgery for observation d) give crystalloid solutions and call the endoscopists immediately

66. What are the two most frequent causes of acute pancreatitis:

a) binge drinking or eating

b) viral infection and choledocholithiasis

c) alcohol and choledocholithiasis d) post-ERCP complication and alcohol

67. For the diagnosis of acute pancreatitis following criteria are used:

a) abdominal pain and the elevation of serum amylase above three times of the upper limit b) any elevation of serum amylase

c) abdominal pain and vomiting

d) stopped passage of stools and gas, high erythrocytes sedimentation rate and elevated CRP

68. Typical biliary pain is characterized by:

a) pain in the left upper quadrant with radiation to the umbilical region

b) pain in the right upper quadrant with radiation to the right shoulder blade c) pain in the right upper quadrant with radiation to the umbilical region

d) pain in the umbilical region with radial propagation

69. In chronic pancreatitis:

a) patients never present with weight loss

b) patients do not carry an increased risk factor for pancreatic cancer c) calcifications and pseudocysts can be found at the imaging

d) all of the above

70. Which of the following statements regarding the mechanical ileus is correct?

a) at an advanced stage, mechanical ileus can lead to bowel paralysis with aperistalsis

b) the therapy of first choice is surgical intervention directed at the removal of the obstruction

c) in mechanical ileus, it is important to stop enteral nutrition, give i.v. fluids and correct the internal milieu

d) all of the above

71. The complications of liver cirrhosis are:

a) development of liver tumor

b) sever infections c) malnutrition

d) all of the above

72. What is the most likely diagnosis in a patient with jaundice, erythema palmare, spider nevi and esophageal varices:

a) chronic hepatitis

b) acute hepatitis

c) liver cirrhosis d) biliary colic

73. Steatorrhoe is:

a) increased amount of mucus in stools b) watery diarrhea

c) increase in fat content in stools d) presence of not digested food residues in stools

74. Melena:

a) refers to fresh blood in stools

b) refers so black stools that accompany upper gastro-intestinal tract bleeding

c) refers so black stools that accompany the gastro-intestinal bleeding of all localizations

d) does not represent a medical emergency

75. Abdominal X-ray in suspicion of ileus:

a) is performed in supine position with antero-posterior projection

b) is performed with oral contrast

c) is always upright if the patient can stand

d) is contra-indicated

76. Caput medusae is common in:

a) arterial hypertension

b) pulmonary hypertension

c) intracranial hypertension

d) portal hypertension

77. Defence musculaire is:

a) tonic-clonic contracture of muscles in seizure

b) abdominal guarding in peritonitis

c) a typical sign of tetanus

d) tensing of the muscles in meningitis

78. The upper border of the liver in midclavicular line may be assessed:

a) only by palpation

b) only by percussion

c) by percussion and palpation

d) by auscultation and palpation

79. Which statement about gall bladder is true:

a) gall bladder is never palpable

b) gall bladder is always palpable

c) a palpable gall bladder is an abnormal finding

d) a palpable gall bladder is a normal finding

80. Which of the signs is not positive in acute appendicitis:

a)Murphy sign

b)Blumberg sign c)Rovsing sign d)Plenies sign

81. Murphy´s sign is typically positive:

a) in appendicitis

b) in diverticulitis

c) in liver cirrhosis d) in cholecystitis

82. Normal percussion over the abdomen is:

a) resonant

b) dull

c) differential tympanic

d) amphoric

83. Palpation of the abdomen is:

a) surface and deep

b) direct and indirect

c) the least important method of physical examination of the abdomen d) always performed only by one hand

84. Spider naevi  (angiomas):

a) they occur in patients with hepatic cirrhosis

b) they can be seen mostly in the upper part of the chest and ont he face

c) they are telenagiectasia

d) all of the above is correct

85. During inspiration, the liver:

a) descends

b) elevates

c) disappears d) all of the above is correct

86. By Naegeli the second grade of liver stiffness is by:

a) carcinoma of liver

b) venostasis, chronic hepatitis and some types of liver cirrhosis

c) normal, healthy liver

d) liver cirrhosis

87.In acute peritonitis one can find out:

a) diffuse rigidity of the abdominal wall

b) painful palpation and percussion over the abdominal wall

c) tense abdominal wall

d) all of the above is correct

88. Cirrhosis of the liver can cause:

a) palmar erythema

b) plantar erythema

c) spider naevi

d) all of the above is correct

89 .Dull percussion sound over the abdomen can be present in:

a) greater amount of gas inside the bowels (meteorism)

b) free fluid in the abdominal cavity (in ascites)

c) presence of free gas in abdominal cavity (in pneumoperitoneum)

d) none of the above is correct

90. Assembly of dilated veins around the naval in liver cirrhosis is called:

a) Cullen sign b) striae

c) defence musculaire

d) caput medusae

91. Resistance of malign origin upon palpation is usually:

a) painless and of stone-hard consistency

b) extremely painful

c) always marked

d) soft and painless

92. A tense ascites may be confirmed by:

a) a succussion splash

b) a venous hum

c) a fluid thrill

d) a friction sound

93. In healthy individual the abdominal wall  is:

a) smooth,  elastic and nontender

b) tense, difficult to penetrate by palpation

c) diffusely painful

d) painless only by palpation in the supine position

94. Elevated niveau of abdomen above chest can be present in:

a) pregnancy

b) ascites

c) obesity

d) all of the above is correct

95.Jaundice, septic fever and right upper quadrant pain is a common characteristic of:

a) cirrhosis of the liver

b) acute pancreatitis

c) acute cholangitis

d) gallbladder tumor