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Second Faculty of Medicine


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Which test do we use for monitoring of efficacy during warfarin treatment?
INR
What basic therapeutic measures do we institute in patient with recently proven DVT in calf venous bed?
FRAXIPARINE 0.01 ML/KG S.C
What is the basic need for liquids in an uncomplicated recumbent patient in ml/kg/day?
30-40 ML/KG/24H
Which disease do we find Osler´s nodes in?
Infective endocardtitis
The pulmonary hypertension is characterized by elevated pulmonary artery pressure upper than:
20-30 mmHg (more than 20)
What antidote do we use in a serious heparin overdosing?
PROTAMINE SULFATE 1MG/100IU 
What is the most common etiology of pneumonia in immunocompromised patients?
Encapsulated bacteria- Haemophilus I., s. Pneumoniae, N.meningitidis? CMV
What is plasmapheresis?
BLOOD PLASMA REMOVED FROM THE BODY, TREATED AND RETURNED TO BLOODSTREAM
What is the causal treatment of fulminant liver failure in cases when the complex non-specific treatment fails?
LIVER TRANSPLANT
What occupational diseases are most frequent in the healthcare workers (list at least 2)?
Scabies, hepatitis C, allergies
Define the indication of corticosteroids in the treatment of extrapulmonary tuberculosis
CNS, adrenal, pleural, Septic shock
What is the definition 2nd type of nephrotic syndrome?
FOCAL SEGMENTAL GLOMERULOSCLEROSIS AND MEMBRANOUS GN, NON-SELECTIVE PROTEINURIA > 5G/24H WITH ERYTHROCYTURIA (20), MILD HT
List at least two of the most common complications of Felty´s syndrome?
BACTERIAL INFECTION, ANEMIA, SPLENOMEGALY
In a patient with Addison's crisis one can expect hypertension, hypotension or a patient is normotensive?
HYPOTENSION
How many patients (in percentage) have a secondary cause of hypertension?
5-10% 
What is the consequence of (what follows after) a myocardial free wall rupture?
CARDIAC TAMPONADE
At what size of a lymph node do we consider lymphadenectomy?
> 2.5 CM (DEPENDING ON LOCATION)
List at least 2 groups of antibiotics used for the empirical treatment of nosocomial pneumonia?
Antipseudomonas penicillin, carbapenems 
Which imaging method helps us to distinguish left ventricular dysfunction present in dilated cardiomyopathy and coronary heart disease?
CORONAROGRAPHY
Which imaging method could be used for evaluation of the size of lymph nodes.
CT 
Which examination is necessary to perform in differential diagnosis of aplastic anemia?
BONE MARROW ASPIRATION 
Which laboratory parameter indicates a serious bleeding into gastrointestinal tract at the earliest?
LEUKOCYTOSIS WITH LEFT SHIFT
Which types of pacing we can use in cardiology?
Atrial, ventricular and , dual chamber
What has to be corrected first in patient with hyperosmolar hyerglycemic state?
DEHYDRATION 
What does the term " impaired fasting glucose" mean?
INCREASED LEVELS OF FASTING BLOOD GLUCOSE IN VENOUS BLOOD (5.6-6.9 MMOL/L)
What diagnostic method do we use in oder to prove achalasia?
X-RAY WITH SWALLOWING TEST, ESOPHAGEAL MANOMETRY
List at least five trace elements.
IRON, IODINE, ZINC, COPPER, COBALT, SELENIUM, CHROMIUM, MOLYBDENUM, MANGANESE, RUBIDIUM, STRONTIUM, LEAD, ARSENIC, VANADIUM, CADMIUM
Define chronic kidney disease
defined as the presence of kidney damage (microalbuminuria > 30mg/day) or decreased kidney function (eGFR <1ml/s or <60ml/min) for at least 3 months.?
What is the correct first aid after ingestion of acids or alkalis?
DRINK MILK/WATER, NO VOMIT, NO CHARCOAL
What is the definition of "community acquired" pneumonia?
Acquired outside of healthcare establishment, can present in the 2 first days of hospitalization 
At what concentration of hemoglobin do we administer blood transfusion?
70g/L and lower 
What is the normal value of QTc interval at ecg ?
men: QTc = 390–450 ms. women: QTc = 390–460 ms
What is the first aid for a patient who is unconscious due to hypoglycemia?
GLUCOSE (40% 20ML I.V.)
List at least three basic symptoms of hypoglycemia
TREMORS, PALPITATIONS, PERSPIRATIONS, TACHYCARDIA, HUNGER, LOSS OF CONSCIOUSNESS
List micronutrients administered for their antioxidative properties.
VIT. C, VIT. E, VIT A, ZINC, COPPER, SELENIUM (not sure about coenzyme Q)
What pathogens cause so-called "atypical" pneumonia?
M. Pneumoniae, C. Pneumoniae, Legionella pneumophilla, coxiella
Which hepatotropic viruses spread mainly by the orofaecal route?
HEPATITIS A + E
What is the most common cause of secondary pneumothorax?
Rupture of emphysematous Bullae in COPD
What antidotes are used after ingestion of ethylene glycol and methanol?
ETHANOL, FOMEPIZOLE
What is the most common cause of aortic dissection?
ARTERIAL HTN
What is definition of obesity (using BMI value)?
30-35
Which group of medications is currently considered as a basic pharmacological intervention in hypercholesterolemia?
STATINS
Which examination can prove vibrations-induced or overload-induced peripheral neuropathy?
EMG
What hemodynamic parameter precludes the possibility of unilateral lung transplant?
Pulmonary HT
In which parts of GI tract could we find gastrinoma? List at least two organs.
STOMACH (ANTRUM PYLORI), DUODENUM, PANCREAS
What are the most frequent complications after bone marrow transplantation?
PANCYTOPENIA, INFECTION, GvHD
List at least two the most common causes of atrial fibrillation.
HT, DM, CAD, VALVULAR DISEASE, HF, THYROTOXICOSIS
What kind of patients use the ortopnoeic position?
Most commonly due to left heart failure ( also Bronchial asthma. Mitral stenosis. Ascites. Anxiety and hyperventilation. Pericardial disease)
What does the term "postprimary TBC" mean?
reactivation of disease (when health status declines) or reinfection
Which pharmacological group do we use in treatment of chronic portal hypertension?
BETA BLOCKERS
List the components of Wirchov-Rokitanski triad?
ENDOTHELIAL DAMAGE, HYPERCOAGULABLE STATE, BLOOD STASIS 
What examination after ingestion of corrosives is considered the gold standard to diagnose the damage and to decide further steps ?
ENDOSCOPY
Which antituberculotic drugs are used in the continual treatment and for how long?
4months isoniazid + rifampin
What tumours may be caused by asbestos (at least 2 types)
LUNG CARCINOMA, LARYNX CARCINOMA, MESOTHELIOMA
What is the clinicaly definition of rapidly progressive glomerulonephritis?
> 70% IMPAIREMENT OF GLOMERULI PROGRESSING TO ESRD
What is multiresistant tuberculosis?
Resistant to at least 2 AntiTB drugs, usually Rifampin Isoniazid
What is the recommended concurrent pharmacotherapy in patients undergoing long-term corticosteroid treatment?
Ca, VIT. D, BIPHOSPHONATES, PPI, BLOOD GLUCOSE MONITORING
What examination is crucial for the diagnosis of silicosis/ asbestosis?
CHEST X-RAY
List three symptoms associated with aortic stenosis?
EXERTIONAL DYSPNEA, SYNCOPE and ANGINA PECTORIS 
What amount of muscular mass could be catabolised in severe acute critical state per day?
500gt
After petroleum distillates ingestion (gasoline, naphta) following procedures are contraindicated in the pre-hospital and hospital care (2 examples)
VOMITING, MILK
What is the name of disease characterised by increased resistance in upper respiratory tract and periods of apnea during sleep?
Obstructive sleep apnea 
What is the upper limit of normal size of lymph node?
0.5-1 CM INGUINAL, 1.5 CM AXILLA, GROIN, 1 CM NECK
Which two pathological phenomena characterize the morphology of the left heart chamber in mitral insuficiency.
HYPERTROPHY + DILATION 
Define the possible sources of nosocomial infection. List at least two possible causes.
Mechanical ventilation, humidifiers, AC, Staff members. Ventilator pneumonia (MRSA,Strep. Pneumo, Pseudomonas). Aspiration pneumonia (enterobacteriae, anaerobes)
Which inborn valvular disease is prone to development of infectious endocarditis?
Bicuspid aortic valve
List the most common cause of development of mitral stenosis.
RHEUMATIC FEVER
Which indication for lung transplant is associated with the best postoperative prognosis of the patients?
CF
What signs and symptoms could inform us about possible hypocalcemia?
TETANY, DECREASED BP, ARRHYTMIA, NAUSE, VOMITING, ANOREXIA, ECG W/ LONG QT
List at least two skin signs of dermatomyositis.
‘SHAWL AND FACE’ RASH, MECHANICAL HANDS
What kind of obstructive ventilation disorder is typical of astma bronchiale?
Reversible
What is typical concentration of natrium in patient with isotonic dehydration ?
Normal serum sodium (135-145 mmol/L)
List five most common causes of pericardial effusion:
INFECTION, AMI, IATROGENIC, CANCER, UREMIA
What is a first typical symptom of rheumatoid arthritis manifestation?
STIFF JOINTS IN THE MORNING 
What examinations are used to diagnose vibrations-induced Raynaud syndrome (at least 2)?
Finger plethysmography, Cold test
What is the definition of non-selective glomerular proteinuria?
EXCESSIVE SECRETION OF PROTEINS IN URINE. LOSES CAPACITY TO DISTINGUISH AND FILTER PROTEINS BY SIZE. IgGs IN URINE
List at least 2 groups of antibiotics used for the empirical treatment of community acquired pneumonia?
Amoxicillin, macrolides
Most important information in material safety data sheet of a chemical product is its formula. Where can it be found (at least 1 possibility)?
MSDS, ONLINE
What is time is required to perform cultivation of M. tuberculosis?
10-14d liquid cultures. 4-6ww solid culture mediums 
List two main causes of hepatic cirrhosis.
ALCOHOL, VIRAL
Can we use aspirin treatment in patients with deep venous thrombosis?
Treatment for deep vein thrombosis is 1. Low molecular weight heparin (enoxaparin) 2. Factor Xa inhibitor (fondaparinux) 3. Unfractionated heparin (bolus plus infusion, in patients with renal failure)
Which coronary artery supplies the inferior waal of left ventricle?
Left anterior descending artery (LAD)
How long after a cardiac arrest does the patient develop a mydriasis?
60-90s (60) 
How we classify polyuria ?
OSMOLALITY OF URINE
What type of skin tests (and where applied) are used to diagnose contact allergic dermatitis?
Apicutaneous test, Patch test. Applied on the upper back
List 5 basic groups of antihypertensive therapy
ACEi, ARBs, Thiazide diuretics, CCBs, BB 
List signs of digitalis overdose.
N/V. Diarrhea. Abdominal pain. Anorexia. Xanthopsia. Photophobia. Blurry vision with a yellow tint and halos. Palpitations (due to arrhythmias)
Is the primary focus of non-hodgkin lymphoma located always in a lymph-node?
NO
Which disease is caused by Tropheryma Whipplei?
WHIPPLE’S DISEASE
When is the chemoprophylactic treatment of TBC indicated?
Kids in contact with TBC, immunosuppressed in contact with TBC, tuberculin rxn. >10 mm
Define changes in blood gases caused by alveolar hypoventilation
Hypercapnia. Hypoxia. Resp acidosis 
In how many adult patients (in percentage) persist patent foramen ovale?
0.25
Are we able to recognise ischemic changes at the ecg in a patient with cardiac pacing?
No
Which laboratory parameter indicates the seriousness of hepatic encephalopathy?
AMMONIA
Which laboratory parameter is the most useful in patient with hypercalcemia and why?
PTH TO DISTINGUISH PRIMARY HYPERPARATHYROIDISM, SERUM Ca + P (Ca > 2.75 mmol/l and P< 0.65 mmol/l)
Specify the auscultation findings in pneumothorax.
Reduced or Absent breathing sounds, inaudible sounds. Hyperresonant percussion. Low Fremitus on that side 
What examinations is it necessary to perform before the treatment with anti-TNF alfa agents?
IGRAs + chest XRAY
What is the most common pathophysiology and underlying cause of acute myocardial infarction?
ATHEROSCLEROSIS, THROMBOSIS
What is the consequence of inadequate ADH secretion?
Etiology: pituitary high ADH release due infection or drugs // ectopic production (SCLC) // nephrogenic due to vasopressin 2R mutation
Which severe side-effect can occur during opiates therapy?
DEPRESSION OF RESPIRATORY CENTRE 
What are predisposing factors for vascular nephropathy?
GENETICS, ATHEROSCLEROSIS, CHOLESTEROL, ENDOTHELIUM DYSFUNCTION, HT, DM, AGE
The latency from ingestion to first symptoms of poisoning with Amanita phalloides is typically
7-13H. PPT says 8-12HRS 
What are typical symptoms of hypothyroidism?
WEIGHT GAIN, BRADYCARDIA, HOARSENESS, COLD INTOLERANCE, CONSTIPATION, MYXEDEMA, OBSTIPATION, DECREASED BP
What kind of drugs used in treatment of DM can cause hypoglycemia?
INSULIN AND SECRETAGOGUES (SULFONYLUREAS, GLINIDES)
How can we differentiate polyuria caused by diabetes insipidus from polyuria in diabetes mellitus or due to hyperparathyroidism?
URINE OSMOLARITY OR VASOPRESSIN TEST
What is the definition of selective glomerular proteinuria?
SECRETION OF PROTEINS MEDIUM SIZE (69-88kDa) – ALBUMIN, TRANSFERRIN
At what time do we observe filling of dorsal veins during the performance of modified Ratschow´s test?
10s
What is the normal value of QRS at the ecg?
<0.1 s
What value of ankle-brachial index (ABI) do we consider as diagnostic for periphery artery disease?
LESS OR EQUAL TO 0.9 
What shape have the opacities on the chest radiograph in silicotic patients?
EGGSHELL IN UPPER LOBES
At what site do we perform confirmatory determination of blood groups of a patient and PRBC?
BEDSIDE TABLE
Which valve could we expect to be affected in most cases by infective endocarditis in i.v. drug users?
TRICUSPID
In lying patient (for example ventilated) where is the aspiration pneumonia localised?
Posterior segments of lower lobes
Which antituberculotic drugs are used in the initial treatment and how long does the initial phase last?
2 months of RIPE
Describe the absolute indication for surgery in patient with infectious endocarditis.
Heart failure
What changes do we find on ECG record in patient with acute cor pulmonale?
SINUS TACHYCARDIA, ”S1Q3T3” pattern ( large S wave in lead I, a large Q wave in lead III and an inverted T wave in lead III), NEGATIVE T IN V1-V3, Right axis deviation and incomplete or complete RBBB
Which antigen is always present in the blood of patients with chronic hepatitis B?
ABsAg
What is the characteristic feature of diffuse idiopathic skeletal hyperostosis?
CALCIFICATION AND SKELETAL HYPEROSTOSIS OF AXIAL SKELETON AND PERIPHERIES AND WITH LARYNX PROBLEMS
What is the treatment of silicosis and asbestosis ?
NO CURE
Is lymphadenopathy present in a patient with Whipple´s disease?
YES 
Which disease is associated with Pel-Ebstein fever with?
Hodgkin lymphoma
What is a fatal complication in patients with systemic sclerosis?
PULMONARY FIBROSIS, PULMONARY HT, REPIRATORY INSUFFICIENCY
What acute disease could imitate "a new case" of Crohn´s disease?
APPENDICITIS
The first used test (except of resting ecg) in differential diagnosis of chest pain in non-emergent patient should be:
EXERCISE STRESS TEST
Which valvular heart defect should be considered in a young person who experienced syncope during exertion?
AORTIC STENOSIS 
We are able to classify acute kidney injury. What parameter are used ?
KDIGO (combination of RIFLE and AKIN criteria) plotting S-Crea and diuresis?
What dose of furosemide do you choose for treatment of acute heart failure in diuretic naive patient?
20-40mg 
What does the term "latent TBC" (LTB) mean?
It is a state of Constant immune response stimulation due to M.Tub Antigens, with no signs of active TB (lifelong asymptomatic carriage). 
What is the most common cause underlying development of microcytic anaemia?
Chronic blood loss (gyn, GIT, uro)
What antidote can treat intoxication with methemoglobinemia (at least 1)?
METHYLENE BLUE
What criterion is used forclassification of metabolic acidoses ?
ANION GAP
What parameter and signs do we look for during ultrasound examination in patient with suspected cholestasis?
BILE DUCT DILATION, CHOLELITHIASIS, LIVER SIZE, ECHOGENICITY
What is the basic need for full-value proteins for a healthy person?
0.8 G/KG
What are two main causes leading to acute pancreatitis?
OBSTRUCTION, ALCOHOL
How long after a cardiac arrest is the patient unconscious?
10-20s (10)
What is the usual daily dose of penicilin in treatment of infective endocarditis?
G 12-18 mie U/24 h IV
What is Walderstrom´s disease?
non-Hodgkin lymphoma associated with abnormal production of monoclonal IgM antibodies, mostly occurs in old age. Lymphoplasmocytic lymphoma with macroglobulinemia
Describe the typical finding at ecg in a patient with exsudative pericarditis.
Low voltage complexes and electrical alternans
What is P wave at ecg - what does it mean?
Atrial depolarization
The systolic murmur heard at the second right intercostal space is typical for which valvular heart defect ?
AORTIC STENOSIS 
What is the basic treatment of aortic stenosis? (2)
AORTIC VALVE REPAIR/REPLACEMENT (statins ? B blockers? )
What are the three typical directions of stenocardia (angina pectoris) radiation ?
SHOULDER, NECK, EPIGASTRIUM (JAW, LEFT ARM)
Which therapy is recommended in a pattient with massive, life-threatening pulmonary embolism?
Bolus 5000-10000 I.E. Heparin IV. Thrombolytic therapy tPA 
What situation should we assume in patients with pathological Q wave and persistant ST elevation in leads monitoring anterior myocardial wal?
Anterior wall aneurysm formation following acute STEMI 
Could we evaluate glomerular filtration rate without performing any clearance methods (clearance of creatinin, inulin, DTPA )?
IDK
List at least 2 groups of antibiotics used for the treatment of atypical pneumonia?
Macrolides, tetracyclines, fluoroq
What is the definition of oliguria?
DECREASED DIURESIS PER 24 H (< 500MG/D)
Can brain arteries atherosclerosis lead to the cerebral atrophy?
YES
So called Corrigan pulse ("water-hammer" pulse) is characteristic for...?
AORTIC REGURGITATION
What medication contains dual antiplatelet therapy?
Aspirin and ADP receptor inhibitors ( ex. Clopidogrel )
What is the most frequent and wide-spread type of anemia?
Iron deficiency anemia (sideropenic)
What are the tests for "latent TBC" (LTB)?
Tuberculin skin test / interferon Gamma release assay
What diseases cause left ventricle hypertrophy?
HT, AORTIC STENOSIS, AORTIC REGURGITATION, COARCTATION OF AORTA, Hypertrophic CMP, MITRAL REGURGITATION
List 3 causes of cardiac syncope.
Arrhythmogenic: sick sinus syndrome, ventricular tachycardia, AV block, supraventricular arrhythmias, Torsades de pointes. Cardiovascular: massive MI, aortic stenosis, PE, severe asymmetric septal hypertrophy 
List the two most frequent locations of the extra-thoracic tuberculosis, occured in the Czech Republic
LN, joints, skeleton
What does antidote mean in toxicology?
COUNTERACTS THE EFFECT OF POISONING (negates the effect of poison)
Poisoning with Amanita phalloides can be treated with following drugs - "antidotes"
SILIBININE, VITAMIN K (this is wrong...). SILIBININE/ N ACETYLCYSTEINE 
How long lasts the permanent ventricular tachycardia? More than...
More than... 30s
What is characteristic for the W-P-W syndrome at ecg?
ECG delta wave ( + short PR interval + wide QRS complex)
Which conditions support the development of macrocytic anemie - what could cause lack of folic acid and vitamin B12?
B12: inadequate dietary intake (vegetarians, alcoholics), achlorhydria (PPI use, gastritis), pernicious anemia, terminal ileitis (crohn’s disease, resection), medications like metformin. B9: malnutrition, malabsorption (celiac, IBD, surgery), drugs (methotrexate), increased consumption (hemolysis, pregnancy)
Which diabetic treatment could we use in patient with the heart failure?
SGLT-2 inhibitors gliflozines?
What is the mechanism of warfarin effect?
Inhibition of vit K epoxide reductase -> decreased hepatic synthesis of active form of VitK -> decreased y-carboxylation of glutamate residues on coagulation factors II, VII, IX and X, protein C and protein S -> decreased activation of coagulation factors in the liver
Which is the therapy of choice in a patient with acute myocardial infarction and elevated ST?
1ST PTCA (percutaneous transluminal coronary angioplasty) + 2ND THROMBOLYSIS 
What does the term preglomerular ("overflow") proteinuria" mean?
HIGH PLASMA CONCENTRATION OF LOW MOLECULAR WEIGHT PROTEINS PASS INTO FILTRATE
List at least 2 of some antituberculotic drugs used for the treatment of MDR tuberculosis?
Amikacin, Linezolid, Ethionamid
Which arrhytmia is the most frequent in old people?
Atrial fibrillation
What is the crucial difference between ERCP and MRCP?
ERCP – ENDOSCOPIC CANNULATION OF VATER’S PAPPILA (INVASIVE VS NON- INVASIVE)
What are the upper limits of normal blood pressure?
129/84
What is the combination of clinical presentation consisting of rheumatoid artritis, splenomegaly and leukopenia called?
FELTY’S SYNDROME
How long (how many months) should the patient have a productive cought to consider such disorder to be chronic?
3m each year in 2 consecutive years 
What is a typical clinical symptom of acute left-sided heart failure?
DYSPNEA (Shortness of breath)
What pathogens cause aspiration pneumonia?
Mixed anaerobic, klebsiella, Fusobacterium, Bacteroides, peptostrep
What disease are betablockers contraindicated in?
ASTHMA,, AV BLOCK, BRADYCARDIA, ACUTE HF (non compsensated)
In which medium are vitamins D and K soluble?
FAT
What examinations should be performed at least annualy in patients with diabetes? List at least three.
FUNDOSCOPY, MICROALBUMINURIA, EXTREMITIES EXAMINATION, LIPIDS, LIVER TESTS
Which congenital heart disease is the most commonly diagnosed in adulthood?
ASD
What is the first therapeutic approach in a patient with ventricular fibrillation?
CPR + DEFIBRILLATION
How is possible to recognize the atrio-ventricular pacing at the ecg?
Pacing spikes will precede each p wave or QRS complex, or both. 
What is the definition of sepsis?
OVERALL EXTREME RESPONSE TO INFECTION – CHANGES OF TEMPERATURE, INCREASED HR AND RR, ALTERATION OF LEUKOCYTES
Occupational diseases in the Czech Republic can be acknowledged solely by
Specialised departments of occupational diseases in university and regional hospitals 
List drugs used for eradication of Helicobacter pylori.
METRONIDAZOLE, CLARITHROMYCIN, OMEPRAZOL, AMOXICILLIN
Which disorder is characterized by paroxysmal hypertension?
PHEOCHROMOCYTOMA
What are clinical signs of hyperaldosteronism?
HT, MUSCULAR FATIGUE, PARALYSIS, METABOLIC ALKALOSIS, INCREASED Na, DECREASED K, POLYURIA, PALPITATIONS
STEMI of the lateral wall - describe the ecg finding.
Pardee waves in leads I, aVL, V5, V6
List at least two of the most common complications of pneumonia?
Pleural effusion, empyema, abscess, fistula, sepsis, pleuritis
What countries do we find the highest rate of tuberculosis?
Developing countries mostly (Acc to WHO: India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh, South Africa )
What is a typical finding in blood count in a patient who suffers from aplastic anemia?
PANCYTOPENIA, anemia, RETICULOPENIA (0.1%), THROMBOCYTOPENIA 
What is the definition of microalbuminuria?
30-300 MG/24H IN 3 DIFFERENT MEASUREMENTS OVER 6M
What is the effect of the prolonged shock to diuresis?
KIDNEY FAILURE
Which viral hepatitides never become chronic?
HEPATITIS A + E
How do we call syndrome of preexcitation?
It includes Wolff-Parkinson-White...
What is the first symptom of valvular regurgitant defects?
HEART MURMUR 
What is the detection rate of disease causing pathogens in sputum?
0.5
What is the time-course and associated characteristics of a colic?
WAVY COURSE, SPONTANEOUS, SPASMODIC
What are the acute forms of ischemic heart disease?
SUDDEN DEATH, AMI, ANGINA PECTORIS (unstable) 
Decision concerning antidote treatment in paracetamol ingestion is based on (at least 1 option)
SILIBININE, VITAMIN K (this is wrong...). SILIBININE/ N ACETYLCYSTEINE 
What diagnostic method do we use in oder to evaluate compliance of a patient treated for celiac disease?
GLIADIN Abs
In patient suffering from obstruction of calf arterial bed where is claudicatory pain localized?
PLANTAR AREA OF THE FOOT
What are typical symptoms of thyreotoxicosis?
LOSS OF WEGHT, TACHYARRHYTHMIA, INCREASED HR, PALPITATIONS, DIARRHEA, TIREDNESS
What is the most notable symptom of haemolytic anemia?
Icterus
List at least five adverse effects of corticosteroid treatment.
CUSHING’S, OSTEOPOROSIS, HYPERGLYCEMIA, INFECTION, HT, OBESITY, HYPERLIPIDEMIA, HYPOKALEMIA
ECG record: The hulking ST elevation which blends with the T-wave is called:
PARDEE’S SIGN 
What diet should be instituted in a patient with acute exacerbation of idiopathic proctocolitis?
LOW RESIDUE DIET WITH GRADUAL TRANSITION TO RATIONAL DIET
What is the examination used for detection of urate crystals?
POLARIZING MICROSCOPE FROM JOINT ASPIRATION
Which class of immunoglobulins is important for diagnosis of acute M. pneumonii and Ch. pneumonii infections?
IgM, IgA
What is the basic energetic need of a healthy young person not extremely burdened physically?
2100 KCAL for men and 1700-1900 KCAL for women 
List at least two groups of drugs using in the treatment of patients with COPD.
Bronchodilators salbutamol salmeterol / ipratropium. Inhaled CS budesonid. Beta agonists (SABAs/LABAs). Antimuscarinics (SAMAs/LAMAs)
What kind of obstructive ventilation disorder is typical for COPD?
Irreversible
What are pharmacological options for the treatment of pseudomembranous enterocolitis? Be specific.
STOP PREVIOUS ATBs, REPLACE FLUIDS + ELECTROLYTES, METRONIDAZOLE, VANCOMYCIN, STOOL TRANSPLANT
What does the abbrevation " MDR" mean in relation to TBC?
Multi drug resistant TB
List basic groups of anticoagulation drugs according to their effect mechanism (4)
1.     Antiplatelets  2.     Coagulation factor inhibitors: Vit-K antagonists (Coumarins); DOACs (direct oral anticoagulants) 3.     Anti-factor Xa: Heparins
What is the leading sign in an adult patient with elevated growth hormone production?
IDK
What is the most common pathogen causing nosocomial pneumonia?
Pseudomonas
What is the name for class of drugs used for treatment of unproductive (irritating) cough?
Antitussics
What waist circumeference (in cm) is diagnostic for metabolic syndrome according to IDF guidelines?
WOMEN > 94 CM AND MEN > 80 CM
What is the term for lean dyspnoic patients with emphysema and no cyanosis?
Pink puffers 
Antidote indication in benzodiazepines or morphine derivates poisoning is based on
7-13H. PPT says 8-12HRS 
We are able to classify chronic kidney disease (CKD) according to calculated GFR and albuminuria. How the CKD stages are marked ?
IDK
What changes (in laboratory parameters) could we expect in a serious bleeding into gastrointestinal tract? List at least three.
(Dec) IRON, (Dec) SAT. TRANSFERIN, LEUKOCYTOSIS, ANEMIA, coagulation (?)
What is the most common cause of acute arterial occlusion in extremities?
EMBOLISM (AF, AORTIC ATHEROSCLEROSIS, THROMBI AFTER MI)
What is "antiphospholipid syndrome"?
AUTOIMMUNE DISEASE WITH INCREASED BLOOD CLOTTING CAUSED BY THE PRESENCE OF ANTIPHOSPHOLIPID Ab
What is the common effect of organic solvents?
NEUROTOXICITY
How do we call the combination of RBBB+LAH at the ecg and how we recognize it?
Bifascicular block. Left axis deviation. qR pattern in lead aVL
Which substance is used in the basic treatment of polymyositis and dermatomyositis and what is the dosing of this drug?
PREDNISONE 40-80 MG (0.5-1MG/KG)
What is the usual range (min-max dose) of the dose in chronic prednisone therapy?
5-60MG
What purpose does the indirect calorimetry serve?
Indirect calorimetry (IC) is considered as the gold standard to determine energy expenditure, by measuring pulmonary gas exchanges.
What diagnostic method do we use in oder to prove chronic pancreatitis?
AMYLASE, CHYMOTRYPSIN IN STOOLS, ELASTASE IN STOOLS + US, CT, MRCP. I would say: Contrast enhanced CT, MRCP, Endoscopic - US, Fecal elastase -1 
Describe the Ebstein´s anomaly.
malformed tricuspid valve leaflets that are displaced into the right ventricle with subsequent tricuspid valve regurgitation and right heart enlargement (known as RV “atrialization”)
What is the change of ventilation pattern in a patient with acute exacerbation of COPD?
Shallow, faster, NO involvement of accessory muscles 
What is the definition of nosocomial pneumonia?
Pneumonia acquired in a healthcare establishment, 2 days after hospitalization or within 14 days after discharge
What class of drugs is overused in the highest level in patients with COPD?
CS
Which examination is indicated to confirm the diagnose of vaso-vagal syncope?
Tilt table test
What is volume (in litres) of the total body water in a patient whose body weight is 75kg.
75 x 0.6 = 45L IN MALE (60%), 41L IN FEMALES (55%)
List at least three causes for metabolic acidosis with anion gap.
KETOACIDOSIS, LACTIC ACIDOSIS, KIDNEY FAILURE, TOXIC INGESTION, UREMIC ACIDOSIS, ALCOHOLIC KETOACIDOSIS
What is the most frequent complication of chronic lymphocytic leukemia?
INFECTION
What typical damage (besides CNS effect) causes methylalcohol?
GASTROTOXIC, CYANOSIS, HYPOTENSION
What kind of complaints does the patient with claudicatory pain describe?
CRAMPING PAIN (AFTER WALKING AND RELIEVED BY REST) 
Which treatment is used in a patient treated by warfarin who must undergo acute surgery?
Vitamin K
Which groups of population are currently vaccinated against TBC in CR?
Kids > 2.5 kg from day4 to 6weeks if : 1. Hose member has or had active TBC 2. Member in country with active TBC 3. Social groups, homeless
List at least 5 causes of pulmonary hypertension.
Valvular heart diseases. Left-to-right shunt. COPD. Emphysema. OSA. Chronic plumonary thromboembolisms. Interstitial lung diseases. High altitude
What oxygen concentrations could be administered during acute astma bronchiale treatment?
High flow nasal cannula with 2-4l of O2. The goal of oxygen saturation is 92-95%
What is characteristic laboratory finding in incipient diabetic nephropathy?
MICROALBUMINURIA (70-200 microg/min)
Is hemolytic anemia possible to be observed in a patient after a cardiac surgery (using extracorporal circulation)?
YES, MECHANICAL TRAUMA 
What laboratory parameter is most important for classification of chronic kidney diseases ?
GFR
Which antiarrytmic drugs do we use for pharmacological version of atrial fibrilation?
AMIODARONE, BETA BLOCKER(SOTOLOL) 
In which disorder hypertension limited to the upper half of the body is usually observed?
COARCTATION OF AORTA
What are the most common signs of primary hyperparathyroidism?
NEPHROLITHIASIS, POLYURIA, INCREASED Ca, OSTEODYSTROPHY, BONE PAIN, NEPHROCALCINOSIS, PANCREATITIS, STOMACH ULCERS, WEAKNESS, FATIGUE
Finding of Gramm positive diplococci in sputum is suspective of what pathogen?
S.pneumoniae
Which extra-articular symptoms in a young man might signalize a presence of Bechterew's disease?
UVEITIS, DACTYLITIS
Which severe disorder can be caused by extremely high level of serum triglycerides?
ACUTE PANCREATITIS
What laboratory abnormalities are typical of secondary hyperparathyreoidism ?
normo or hypocalcemia, hyperphosphatemia and elevated level of parathormon in plasma
What extent of pneumothorax (given by distance between the thoracic wall and lung) could be considered as a small rim PNO?
3cm
What way of drug administration is preffered in the astma bronchiale treatment?
Long term - inhaled BA, muscarinic antagonist, Leukotriene R antagonists, inhaled CS 
What is predisposig factor for development of thrombangiitis obliterans?
SMOKING
List three unequivocal indications for eradication of Helicobacter pylori.
PEPTIC ULCER, MALT LYMPHOMA, GASTRITIS, GASTRIC CARCINOMA
What does sentinel lymph node mean?
FIRST LYMPH NODE DRAINING A TUMOR, PRIMARY SITE OF METASTASIS 
Which hormonal deficit is the most important in pituitary insufficiency and why?
ACTH – RISK OF ADDISON CRISIS (hypotension,DECREASED GLUCOSE, INCREASED K)
Which joint is most commonly affected by hydroxyapatite artritis?
SHOULDER JOINT
What are the clinical symptoms of methemogloginemia (2 signs at least)?
CYANOSIS, DYSPNEA, TACHYCARDIA
What is the consequence of the Bence-Jones protein production?
RENAL FAILURE 
What is the treatment of thoracic empyema? List at least two methods.
Empiric ATB (ceph+metronidazole) and later adjust accordingly + chest tube drainage 
Do calcium channel blockers belong among the preferred drugs for treatment of heart failure?
NO 
Is disseminated intaravascular coagulation a dynamic disorder?
YES
List 2 most frequent indications for heart transplant.
Cardiomyopathy and CHD
What detection method is used to find out microhematuria? What is reference value ?
AUTOMATED MICROSCOPY OF NATIVE URINE WITHOUT CENTRIFUGATION. Reference value: 3-4 RBCs
What is the basic and first therapeutic approach in a patient with asystolia (cardiac arrest)?
CPR
Which imaging method informs about morphology of kidney, ureters and urinary bladder ?
US, CT, EXCRETORY UROGRAPHY, MRI, CYSTOSCOPY
Describe first aid in a patient with vaso-vagal syncope.
Lie on the floor and raise legs 
Where is polymyalgia rheumatica pain typically localized?
SHOULDERS, HIPS
Which imaging method should be performed in patients with stroke before initiation of low-molecular weight heparin treatment?
CT
List class of drugs used for treatment of immune-mediated adverse reaction to blood transfusion?
ANTIHISTAMINICS, CS, ANTIPYRETICS, ANTITHROMBIN, HEPARIN, COAGULATION  FACTORS. (I would say IV fluids + diuretics?)
Intoxication with morphine and its derivatives can be treated with
VOMITING, MILK
When performing drainage of pleural cavity by active suction, what is the range of negative pressures used?
-10 to -30 cmH2O
What basic therapeutic measures do we institute in patient with recently proven thromboflebitis?
EFFECTIVE COMPRESSION, VENOACTIVE DRUGS, NSAIDs 
What three features characterize diabetic dyslipidemia?
LDL > 2.5, TAGs >1.7, ALL CHOLESTEROL > 4.5 AND DECREASED HDL
What are three characteristic features of the gastrointestinal lesions occured in patients with Crohn disease?
SKIP LESIONS, GRANULOMAS, TRANSMURAL INFLAMMATION
Which preparation is the most effective to normalize protrombin test in a patient who is overdosed by warfarin?
FRESH FROZEN PLASMA 
Which imaging method is the best for infective endocarditis diagnosis?
Transthoracic echocardiography
List the classification of anemias according to their development mechanism
1.     Blood loss 2.     Decreased synthesis of RBCs 3.     Increased destruction of RBCs 4.     Combined causes 
List at least three inborn hypercoagulable states?
LEIDEN V MUTATION, DEFICIENCY OF PROTEIN C, PROTEIN S, ANTITHROMBIN III, prothrombin G20210A 
What is astma cardiale?
A manifestation of CHF that mimics asthma, with shortness of breath, wheezing and coughing
What diagnostic method do we use in oder to prove unequivocally celiac disease?
ENDOSCOPY, HISTOLOGY, BIOPSY, IMMUNOLOGIC (ANTI-TISSUE TRANSGLUTAMINASE, ANTI-GLIADIN, ANTI-ENDOMYSIUM)
What are the disadvantages of using PCR to diagnose M. tuberculosis when compared with classic cultivation tes?
Risk of false positives, Expensive, cannot be used in resource limited settings
What EFNa is in patient with renal failure of prerenal etiology?
LOW FeNa < 1%
Which adverse effect is the most commonly observed when we treat a patient by furosemide?
Hypokalemia, hypotension, ototoxicity 
List the two most common causes of development of aortic stenosis nowadays.
AGE CALCIFICATION, BICUSPIDE VALVE
How many liters ECT has a person weighing 70 kg ?
ECF is 1/3 of TBW. So 14L for males and 11.7L for females
What means tetany?
INCREASED MUSCULAR SPASMS (DECREASED Ca AND Mg)
Which disease could cause restrictive cardiomyopathy?
Amyloidosis
What antidote is used to treat internal contamination by iodine radionuclide?
Potassium Iodine 
What extra benefit gives the examination by scintigraphy in comparison to other imaging method ?
CAN VIEW FUNCTIONAL RENAL CHANGES
List the new classification of heart failure (2016).
HFrEF: symptomatic HF with LVEF ≤40%. HFmrEF: symptomatic HF with LVEF 41-49%. HFpEF: symptomatic HF with LVEF ≥50%. HFimpEF: symptomatic HF with a baseline LVEF ≤40%, a ≥10-point increase from baseline LVEF, and a second measurement of LVEF >40%
What is the main risk factor for development of chronic bronchitis?
SMOKING
What is the definition of polyuria?
INCREASED DIURESIS PER 24H (>2,5L/D)
What is mycosis fungoides?
A cutaneous CD4+ T-cell lymphoma
What is the most serious complication of pernicious anemia?
Gastric cancer 
What is the most common pathogen causing pneumonia?
Strep pneumoniae
What value of fasting glycemia is diagnostic of diabetes? (measured in venous plasma)
7MMOL/L
What is the definition of nephrotic syndrome?
PROTEINURIA > 3.5 G/24H, HYPERCHOLESTEROLEMIA >8, HYPOALBUMINEMIA <30 G/L, EDEMA
What means BMI?
BODY MASS INDEX
Which basic pharmacological first aid in a patient with stenocardia should be applied?
NITROGLYCERINE, ASA (acetylsalicylic acid) 
Which cardiomyopathy is genetically determined?
HYPERTROPHIC
What treatment should be instituted in a patient with adrenal (Addisonian) crisis?
100MG BOLUS HYDROCORTISONE + 100MG 6-8H I.V.
What does hepatorenal syndrome mean?
RENAL DYSFUNCTION DUE TO LIVER CIRRHOSIS AND PORTAL HT, CAUSED BY VASOCONSTRICTION OF RENAL ARTERIES AND IMPAIRED RENAL PERFUSION THAT RESULTS
What is the typical auscultation finding in the patient with atrial septal defect?
SYSTOLIC MURMUR AND FIXED WIDE SPLIT OF S2 SOUND OVER PULMONARY ARTERY
What is the time-course of pain due to imflammation?
PERSISTENT
What is the warning sign in a patient with aortic aneurysm (imminent rupture)?
Abdominal: lower back pain, pulsatile abdominal mass at or above umbilicus. Thoracic: thoracic back pain, feeling of pressure in chest 
What is the first therapeutic measure in case of adverse reaction to blood transfusion?
STOP TRANSFUSION
What is the basic therapetic measure in patient with type 1 diabetes mellitus?
INSULIN THERAPY
What is the most common pathogen causing pneumonia in AIDS patients?
Pneumocystis Jirovecii
Describe the complication of long QT interval.
Ventricular tachycardia (torsade de pointes). (Ventricular fibrillation, Asystole, Sudden cardiac death)
What lab test do you use for monitoring the efficacy of low-molecular weight heparin treatment?
FACTOR Xa (ANTI Xa) 
What is the most significant clinical sign of periphery artery disease?
CLAUDICATION, ISCHEMIA
Which biochemical parameter do we have to examine in young adults with severe form of COPD?
Alpha 1 antitrypsin
Is the phrase "There is a steady increase of lung cancer incidence in CR in both men and women" true? Please justify.
No, only in women
What is a typical clinical sign of diabetes sensitive polyneuropathy in lower extremities?
DYSESTHESIA, PARESTHESIA, ANESTHESIA
List 3 diagnostic procedures that are necessary to diagnose infectious endocarditis.
Blood culture. Transthoracic Echocardiography. (Serology? Tranesophageal US? CBC? Murmur? Fever? Im not sure what they want exactly)
What does the term "tubular proteinuria" mean?
PROTEINURIA DUE TO DECREASED TUBULAR REABSORPTION OF NORMAL PROTEINS
What are typical symptoms of acute myocardial infarction?
CHEST PAIN, FATIGUE, DYSPNEA 
Could be fresh LBBB an expression of acute myocard infarction?
Yes
Describe RBBB at the ecg.
An rsr', rsR', or rSR' complex (forming a characteristic “rabbit ears” or M shape) in leads V1, V2. Tall secondary R wave in lead V1. Wide, slurred S wave in leads I, V5, V6
Which two groups of medication significantly improve the prognosis of patients with congestive heart failure?
ACE-I or ARB + BETA BLOCKERS 
What tests are used to evaluate metabolic control and overall health status of patients treated for diabetes? Name at least seven of them.
GLYCATED HB, oGTT, CHOLESTEROL (LDL, HDL, TAGs), BLOOD GLUCOSE, urine glucose,  blood insulin, BP, MICROALBUMINURIA , urin ketones
What are the indications for initiation of the cardiopulmonary resuscitation?
APNEA, ASYSTOLE, CARDIAC ARREST, VENTRICULAR FIBRILLATION 
What parameters (and what arbitrary value of them) signalize that the patient with acute gastrointenstinal bleeding is hemodynamically unstable?
BP < 90/60 mmHg, HR > 100 bpm, COLLAPSE STATE
Which type of ventilation change is typically present in idiopathic pulmonary fibrosis?
Restrictive
Describe the mechanism of vitamin B12 absorption
STOMACH: B12 binds to haptocorrin. DUODENUM: B12 binds to IF. TERMINAL ILEUM: IF+B12 complex is absorbed → B12 is transported in blood bound to transcobalamin
What does the term "abdominal angina" mean?
POSTPRANDIAL SHARP ABDDOMINAL PAIN DUE TO CHRONIC MESENTERIC ISCHEMIA
What cancers can develop uranium miners (list at least 2)
Lung carcinoma, Leukemia, Basal cell carcinoma
What is rheumatoid factor?
AUTOAb AGAINS Fc FRAGMENT OF IgG MOLECULE
Could reaction antigen–antibody trigger disseminated intravascular coagulation?
YES 
Which laboratory test do we use for confirmation of autoimmune hemolytic anemia?
COOMBS TEST 
List all five basic antituberculotic drugs.
Rifampin. Isoniazid. Pyrazinamid. Ethambutol. Streptomycin
What is the most serious arrythmia in the course of myocard infarction?
VENTRICULAR FIBRILLATION 
What is the definition of nosocomial pneumonia?
Pneumonia acquired in a Hospital setting, more than 48h post admission and within 2 weeks of hospital discharge.
What clinical and laboratory parametr are specific for pyelonephritis ?
complicated and uncomplicated / upper and lower. Lab parameter?
What drug is "the first choice" for treatment of hypertension during pregnancy?
METHYLDOPA
What is the normal range of HbA1c in healthy subjects according to IFCC calibration?
20-45 mmol/mol (4-5.6%)
Which organ is severely affected and often fails in paracetamol poisoning?
LIVER
What beam orientation should be applied during X-ray examination in recumbent position of patient to diagnose ileus?
HORIZONTAL
List at least three measures belonging to non-pharmacological intervention in patients with PAD?
STOP SMOKING, AEROBIC EXERCISE, AVOID EXTREME COLD, WEAR APPROPRIATE SHOES, REDUCE FAT INTAKE, PTA + STENTS
At what concentration of hemoglobin do we administer blood transfusion in cardiac patients?
<100g/L (from the ppt)
Use of iodinated contrast media in patients suffering from chronic nephropathy is associated with a risk. Define this risk.
IODINE CONTRAST NEPHROTOXICITY (WITH PRE-EXISTING RISK) – CHANGES IN HEMODYNAMICS AND DIRECT TUBULAR TOXICITY
Define the common therapeutic dose of intravenous hydrocortisone administred during an acute situation. In which acute situation this treatment should be applied?
ADDISON CRISIS. 100MG BOLUS + 100 MG 6-8H (MAX 300-400 MG/24H). APPLIED IN SURGERY, PNEUMONIA, SEPSIS, TRAUMA
What is the definition of diarrhoea?
INCREASED FREQUENCY OF BOWEL MOVEMENTS, > 3 LIQUID STOOLS/DAY
What is the laboratory definition of parathyreoid gland adenoma ?
Hypercalcemia, hyperparathyroidism (elevated parathormon in blood), hypophosphatemia, high or normal amt of vitD
What is the shape of P pulmonale on an ECG record?
P>2.5mm IN LEADS II, II AND aVF 
Describe the typical finding in blood cell count and biochemistry lab in pernicious anemia
CBC: low Hb, high MCV, high MCH, high RDW, low reticulocytes, leukopenia and thrombocytopenia. Low B12.
Characterise the typical and general course of hepatitis C acute phase?
INNAPPARENT, ASYMPTOMATIC
What does the term "all-in-one parenteral nutrition" mean?
ALL COMPONENTS IN ONE FORMULA (FATS, SUGAR, PROTEINS). The All-in-One (AIO, 3-in-1) system means that all components of parenteral nutrition are mixed in one container. This enables to infuse all daily needs for nutrients, water, electrolytes, trace elements and vitamins from one bag.
How to calculate anion gap ?
(Na + K) – (Cl + HCO3) 6-16mmol/l
Describe the typical finding in blood cell count and biochemistry lab in anemia of chronic disease
CBC: low Hb, Low Hct, MCV - N/Low, MCH: N/Low, low reticulocytes. IRON PROFILE: low serum iron, low iron saturation, low total iron binding capacity (TIBC), serum ferritin N/High,
List at least four symptoms of pulmonary embolism.
PLEURAL CHEST PAIN, TACHyPNEA, DYSPNEA, COUGH, HEMOPTYSIS
Which preparation is essential to treat a trombocytopenic patient when an emergent surgery is required?
PLATELETS
Specify the neurological disease which is frequently observed in patients suffering from thymoma (in 30-50%).
Myasthenia gravis
Which test serves as a preventitive screening for colon cancer?
FECAL OCCULT BLOOD TEST AND COLONOSCOPY
What does paradoxic embolism mean?
EMBOLI THAT GOES FROM RIGHT HEART THROUGH FORAMEN OVALE TO ARTERIAL CIRCULATION 
In walking patient where is the aspiration pneumonia localised?
Right lower lobe
What is the most frequent underlying cause of lymphadenopathy?
Benign reasons - Infections
What malignancy can be caused by benzene?
Leukemia, Lymphoma
List signs of right ventricle overload at the ecg.
Right axis deviation. Dominant R wave in lead V1 (R wave > 0.6 mV or R/S > 1)
What is the course of chemoprophylactic treatment of TBC in CR?
Isoniazid 5mg/kg 6months
Define uremic syndrome ?
SYNDROME WITH INCREASED NITROGENEOUS SUBSTANCES IN URINE (ACCOMPANYING RENAL FAILURE)
When we use dual antiplatelet therapy?
To reduce risk of thrombosis after arterial stenting ( ex. PCI ) and for secondary prevention of stroke
What procedures are used to recognize the proximal type of aortic dissection?
CT angiography 
What organ damage in addition to neurotoxicity causes ethylene glycol (antifreeze, brake fluids)
GASTROTOXIC, NEPHROTOXIC
List 4 basic medications which should be used as a secondary prevention in a patient after an acute myocardial infarction.
ASA, STATINS, ACE-I, SARTANS, BETA BLOCKERS 
The most frequent occupational disease due to vibrations nad overload of upper extremities is
Carpal tunnel syndrome
What kind of pain does the patient with ischemic pain in lower limbs in rest describe?
DIFFUSE BURNING LIKE PAIN AT NIGHT ESPECIALLY IN TOES, alleviation when the limb is lowered and worsening with elevation of the limb
What is the typical X-ray finding in Kahler´s disease?
= multiple myeloma. OSTEOLYSIS, FRACTURES 
Which new treatment can we use in patients with familiar hypercholesterolemia?
Combination of statins, bile acid sequestrants, cholesterol absorption inhibitors, PCSK9- inhibitors 
List 4 parts of Fallot´s tetralogy.
Right ventricular outflow tract obstruction (RVOTO) due to pulmonary infundibular stenosis. Right ventricular hypertrophy (RVH). Ventricular septal defect (VSD). Overriding aorta (above the VSD)
Which two pathophysiological causes determine the development of type 2 diabetes mellitus?
INSULIN RESISTANCE, DECREASED SECRETION
What is the typical sound on auscultation in asbestosis nad extrinsic allergic alveolitis?
INSPIRATORY CREPITUS
List at least five adverse effects of NSAID treatment.
ULCER BLEEDING + PERFORATION, HEPATHOPATHY, BRONCHOCONSTRICTION, CARDIOTOXICITY, ARS, NEPHROPATHY
What are two basic types of ileus?
OBSTRUCTIVE (MECHANIC) AND PARALYTIC
Which imaging method should be performed to prove the intracerebral haemorrhage?
CT
When during the day is the highest cortisol level in plasma?
MORNING (6-8H)
What morphological abnormality of erythrocyte in urinary sediment is typical of glomerular lesion?
ACANTHOCYTES
Which disease is characterised by gross bridgeing of interverebral spaces by oseous process, especially in obese patients with DM older than 50years of age?
DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS
What does the abbreviation "LTOT" mean?
LTOT - long term O2 therapy 
What is the laboratory marker of the congestive heart failure?
BNP (brain natriuretic peptide) 
What is the most specific laboratory test used to confirm the myocardial necrosis?
TROPONINS
What is the most frequent cause of dehydration associated with lab abnormalities: hypokalemia, hypochloremia and metabolic alkalosis?
VOMITING
Patients suffering from stenocardia will describe their pain in which ways? (using at least three adjectives)
PRESSURE, SQUEEZING, BURNING 
What disease is the cause for chronic cough in most cases?
Upper airway cough syndrome? Rhinitis in non smokers, smoking (COPD)
In which leads do we observe changes on ECG record in patient with inferior myocardial infarction?
II, III AND aVF 
List at least three symptoms of hyperglycemia.
POLYURIA, POLYDIPSIA, LOSS OF APPETITE, DEHYDRATION, LOSS OF WEIGHT, BLURRED VISION, CONSCIOUSNESS CHANGES
What is the basic medication for the treatment of polymyalgia rheumatica?
PREDNISONE
Which patients with cholecystolithiasis are not indicated for cholecystectomy?
ASYMPTOMATIC
Which kind of polyp in large intestine is associated with hypokalemia?
VILLOUS COLON ADENOMA
List at least three causes for development of mitral insufficiency.
DILATED CARDIOMYOPATHY, MYXOMATOUS DEGENERATION, LHF, RUPTURE OF PAPILLARY MUSCLE AFTER MI
What is the definition of 1st type of nephrotic syndrome?
MINIMAL CHANGE DISEASE, SELECTIVE PROTEINURIA > 5G/24H WITHOUT ERYTHROCYTURIA
What is an usual hydrocortison dose (range) used for substituion in a patient suffering from Addison's disease?
30 MG/DAY
Which medication is used as a basic treatment for a patient with newly diagnosed type 2 diabetes mellitus?
METFORMIN
Which basic medications are used for the treatment of acute heart failure?
DIURETICS, VASODILATORS 
What kind of change could we observe on ECG record in patient with hyperkalemia?
HIGH PEAKED T WITH NARROW BASE
What is the most important contra-indication of metformine in type 2 diabetic patients?
RENAL INSUFFICIENCY
Which part of the musculoskeletal system is affected in Bechterew's disease (ankylosing spondylitis)?
SACROILIAC JOINT, SPREAD PROXIMALLY ALONG THE SPINE, CAN AFFECT SMALL PERIPHERAL JOINTS
What is the sodium deficit in patient with body weight=74kg and serum concentration of Na=115mmol/l.?
Sodium deficit (meq) = Normal TBW * (140 - sNa) Normal TBW (L) = fractionWater * wtKg Where wtKg = Weight in kg Where fractionWater Child: 0.6 for males, 0.6 for females Adult: 0.6 for males, 0.5 for females Elderly: 0.5 for males, 0.45 for females. THEREFORE Sodium deficit (meq)= (74*0.6)*(140-115) = 1110 mmol for males (925 if female)
List at least two contraindications for administration of digoxin
Kidney failure v fib, electrolytes disorders, pregnancy, Bradycardia, AV BLOCKADE (II, III), WPW SYNDROME, hypokalemia, hypercalcemia, ACUTE MI
List at least three acquired hypercoagulable states?
HORMONAL CONTRACEPTIVES, MALIGNANCY, PREGNANCY, EXTENDED IMMOBILIZATION, SMOKING 
How many patients (in percentage) have an asymptomatic course of myocard infarction (silent ischemia)?
20-30% 
In patient suffering from obstruction of iliac arteries where is claudicatory pain localized?
THIGHS + BUTTOCKS 
In rheumatology what does the term "DAS" mean?
DISEASE ACTIVITY SCOOP
Explane CKD stage G4A3
IDK. KDOQI classificatio - decreased GFR (15-30 ml) and albuminuria (>300mg/dl)??
Which groups of patients are at increased risk of nosocomial pneumonia?
Ventilated, surgery (abd/chest), immobilized, immunosuppressed
What is a typical sign of ileus in X-ray examination (plain films of the abdomen)?
AIR FLUID LEVELS
Which proportion (in percentage) of myocardial wall must be destroyed by necrosis to develop a cardiogenic shock?
40% 
Which two diagnostic methods are used to prove left ventricle hypertrophy in daily practice?
ECHO + ECG 
List 3 most frequent complications after heart transplant.
Post-transplant infection. Graft rejection. Pulmonary hypertension
What is the definition 3rd type of nephrotic syndrome?
MEMBRANOPROLIFERATIVE GN, NON-SELECTIVE PROTEINURIA > 5G/24H WITH ERYTHROCYTURIA (100), MODERATE HT
What does the term "complicated infection of urinary tract" mean?
CYSTITIS OR PYELONEPHRITIS IN PATIENTS WITH INCREASED RISK FOR UTIs
List at least two antibodies associated with myositis.
ANTI-JO-1, ANTI-MI-2, ANTI-SRP, ANTI-PM-Scl
What factors increase risk for the transition of "latent TBC" into active form?
The risk is 5-15% during the whole lifetime, affects immunocompromised (HIV, ISuppr treatment, TNFalpha inhib T, GC)
What is the typical laboratory finding in patients with hyperaldosteronism (Conn's syndrome)?
SERUM – DECR. K (HYPOKALEMIA), URINE – INCR. K, INCR. Na, MET. ALKALOSIS
What does the term "ischemic kidney disease" mean?
DECREASED GFR CAUSED BY RENAL ISCHEMIA DUE TO ATHEROSCLEROSIS IN RENAL VESSELS
What auscultation site is used for systolic murmur in patient with ventricular septal defect?
Left lower sternal border 
What kind of diuretics could we use in the treatment of hypertension? (List at least two.)
FUROSEMIDE, THIAZIDES, POTASSIUM SPARING DRUGS
What kind of drugs is considered as a therapy of choice in a patient with acute exacerbation of idiopathic proctocolitis?
METHYLPREDNISONE 32-48 MG
Which is the typical finding during physical examination in the case of acute pericarditis sicca? (without effusion)?
PERICARDIAL FRICTION RUB
What are the clinical manifestations of gout?
ARTICULAR: ACUTE GOUT ATTACK, CHRONIC GOUTI TROPHI. EXTRA-ARTICULAR: GOUTY INTERSTITIAL NEPHRITIS, NEPHROLITHIASIS
What is the definition of nephrotic proteinuria?
> 3.5 G/24H
What is the typical clinical presentation of cardiac tamponade?
DECREASED BP AND HEART SOUNDS, INCREASED JVR, PULSUS PARADOXUS, DYSPNEA
List at least three therapeutic measures used for correction of hyperphosphatemia.
Reduction of phosphate intake, furosemide, PHOSPHATE BINDERS (calcium acetate, calcium carbonate)
What two test are important to provide the diagnosis of gastroesophageal reflux disease?
pH MONITORING (24H) + ENDOSCOPY (EGD) 
What long-term therapeutic measures should be instituted in patient with chronic atrial fibrillation?
ANTICOAGULATION, ANTIAGGREGANTS, ACE-I, ARB, RHYTHM CONTROL (amiodarone) 
Holosystolic murmur heard over the apex is typical for which valvular heart defect?
MITRAL REGURGITATION
What material is examined in cases when the patient is unable to expectorate sputum?
Induced sputum, gastric lavage, bronchoalveolar lavage 
What does the term "incidence of TBC" mean?
Number of newly diagnosed TB cases per year, per 100.000 people 
To diagnose occupational asthma, following examinations are crucial (at least 2):
SPIROMETRY, BRONCHOPROVOCATION TEST, ALLERGY SKIN PRICK TEST
What is the first choice treatment in patient suffering from ST elevation myocardial infarction?
PTCA
Describe the AV blockade of 1st degree at the ecg.
PR interval > 200 ms
What should we perform during the diagnostic process for functional disorders of GI tract?
EXCLUDE ORGANIC CAUSES (LABS, X-RAY, US, ENDOSCOPY)
What characteristics of antibiotics are considered necessary for succesful treatment of cholangitis?
ATB EXCRETED IN BILE + AGAINST GRAM + ENTEROCOCCI (PIPPERACILIN + TAZOBACTAM)
What examination is considered as the most important in patients presented with unidentified cause of renal failure ?
EXCRETION FRACTON OF Na + US
Which bacterial antigens are commonly examined in a urine sample?
Strep., Legionella 
Which gastric neoplasma is the most frequently observed?
ADENOCARCINOMA
What is the evaluation of Mantoux II test?
Evaluates the size of induration on skin, normal until 5cm, 5-15 positive, >15cm active infection
When asymptomatic bacteriuria must be treated ?
no treatment required except during pregnancy (fosfomycin p.o. - single dose)
Which tumour marker is typical of hepatocellular carcinoma?
AFP
What symptoms could tell us about possible pheochromocytoma?
PAROXYSMAL HT WITH BP CRISIS (50%), PERSISTENT HT (50%), HEADACHE, PALPITATIONS, PALLOR, SWEATING, NAUSEA, DYSPNEA, NERVOUSNESS
The laboratory marker, whose negativity excludes the presence of pulmonary embolism is:
D-DIMER 
What are diagnostic features (clinical + lab and ancillary procedures) for polymyositis?
1. SYMETRICAL PROXIMAL MUSCLE WEAKNESS, 2. ELEVATED SERUM LEVELS OF MUSCLE ENZYMES (CK, LDH, ALT, AST, MG), 3. MULTIFOCAL MYOPATHIC EMG CHANGES, 4. BIOPSY- INFLAMMATORY INFILTRATES IN MUSCLE FIBERS
What does the term "primary TBC" mean?
Initial infection in a non-infected individual 
What disease (from the rank of internal medicine) is nycturia typical for?
Congestive heart failure
What are the most characteristic deformities in rheumatoid arthritis?
‘SWAN NECK’ FINGERS ON PIP AND DIP JOINTS, ‘WANDER KNEE’ AND HALLUX VALGUS
Which morphologic characteristic is important for differentiation of anemias?
MCV , MCH, RDW, reticulocyte count 
Is ventricular tachycardia life-threatening?
YES
Why is abrupt interruption of long-term corticosteroid treament (with medium or high doses) dangerous?
ACUTE ADRENAL INSUFFICINECY – DEPRESSIN OF HPA AXIS (hypothalamic-pituitary-adrenal axis)
Describe the typical finding in blood cell count and biochemistry lab in irondeficiency anemia
CBC: low Hb, low Hct, low MCV, low MCH, high RDW. IRON PROFILE: low serum iron, low serum ferritin, low transferrin saturation, high transferrin and transferrin binding capacity, high soluble transferrin receptor (sTfr)
Which disease is suspicious in a patient with spleen infarction?
thromboembolic disease and infiltrative hematologic diseases (Or maybe they want sickle cell disease)
What are the risk factors for transformation of IBD into CRC?
INFLAMMATORY ACTIVITY + DISEASE DURATION
What are clinical signs and symptoms telling us about suddenly developed anemia?
Dyspnea, weakness, pallor, tachycardia, orthostatic hypoT, syncope, vertigo 
List at least three major causes of clinically significant hypergammaglobulinemia.
More than 20g/l. MULTIPLE MYELOMA, WALDENSTROM’S MACROGLOBUMINEMIA, MONOCLONAL GAMMOPATHY, SLE, SARCOIDOSIS
What is the reason for insertion of nasojejunal tube?
UNABLE TO GET FOOD per os, STOMACH DYSFUNCTION, IMPAIRED GASTRIC MOTILITY, GASTRIC REFLUX, VOMITING
Which kind of disorder could we assume in patients with prolonged protrombin time and cirrhosis of liver.
DECREASED PRODUCTION OF COAGULATION FACTORS (coagulopathy?) 
What is the incidence of TBC in Czech Republic in recent years and what is the trend of this parameter?
Incidence is decreasing steadily <8/100.000
There is a necessity to treat a patient with autoimmune hemolytic anemia by blood transfusions. What kind of transfusion preparation would you prefer?
WASHED OUT RBCs, 37ºC
What is necessary to take into the consideration in patient with proven PAD? What other diagnostic angiological procedures do you recommend?
ATHEROSCLEROTIC INVOLVEMENT OF OTHER ARTERIES. CHECK CORONARY (coronarography) and CAROTID (Doppler US) arteries
List risk factors of aortic dissection.
Congenital: CT-disease (Marfan syndrome, ED syndrome), bicuspid aortic valve, coarctation of aorta. Acquired: Hypertension!!!, trauma, deceleration injury, syphilis, cocaine, pregnancy 
What is the difference between pneumonia and bronchopneumonia?
Pneumonia: 90% streptococcal, 30-40y with chronic disease. Bronchopneumonia- kids and elderly, lighter, spotted consolidations, staph+
List all branched essential aminoacids.
LEUCINE, ISOLEUCINE, VALINE
Anti-citrullinated protein antibody are characteristic for which disease?
RHEUMATOID ARTHRITIS
What is the normal efficiency of the left ventricle?
LVEF = (LV stroke volume / LV end-diastolic volume) x 100. The normal LVEF is >55%.
Which external factor causes the diabetic foot ulcer in most cases?
PRESSURE DUE TO INCORRECT SHOES
What factors contribute very often to lithogenesis? List at least two of them.
DECREASED FLUIDS INTAKE, INCREASED NaCl AND PROTEINS INTAKE
What is the "in-hospital" mortality rate in patients suffering from myocardial infarction treated by PCI?
6-10% (<5%??)
Which clinical stage of PAD do we consider angiography in?
FONTAINE III – PAIN AT REST 
List other endocrine diseases associated with type 1 diabetes. (at least one)
AUTOIMMUNE THYROIDITIS, GASTRITIS, CELIAC DESEASE
What are rheumatoid nodules?
FIRM, PAINLESS, SUBCUTANEOUS NODULES OF BONE. EXTENSOR PARTS OF LIMBS
Define parameters of sufficient oxygenation (SaO2, paO2) in a patient with COPD exacerbation.
SaO2 90%. PaO2 8kPa
Which imaging method is the best one for cardiac tamponade diagnosis?
ECHO
What is the most frequent form of vascular nephropathy in population?
HYPERTENSIVE NEPHROSCLEROSIS
Which are the two basic histological types of pulmonary carcinoma?
SCLC, NSCLC
What is the most frequent cause of transsudate in pleural cavity?
CHF (cirrhosis, nephrotic sy)
What examinations are considered as "gold-standard" in suspicion for deep venous thrombosis?
DUPLEX US (B-mode + DOPPLER) 
In patient suffering from obstruction of superficial femoral artery where is claudicatory pain localized?
CALF 
What is the name for class of drugs used for treatment of productive cough and expectoration of viscous mucus?
Mucolytics and expectorants 
What is the justification for TBC vaccination?
Can prevent severe forms: basilar meningitis and miliary tb (Children with 1) household member has/had activeTB.    2) household member from a country with high incidence TB.    3) Indication by regulation - socially excluded groups )
Which antidotes are used to treat poisoning with lead or mercury - group name (specifically DMSA, DMPS)?
CHELATORS, DMSA
What is the upper limit of normal body weight expressed by BMI?
24
What method, used in evaluation of bioptic renal sample, is important for differential diagnosis of rapidly progressive glomerulonephritis.
IMMUNOFLUORESCENCE
What is the most frequent type of anemia in pregnant women?
SIDEROPENIA
What is the cause of pseudomembranous enterocolitis?
CLOSTRIDIUM DIFFICILE AFTER ATB THERAPY
What does the term "Bence-Jones protein" mean?
PARAPROTEIN COMPOSED OF MONOCLONAL Ig LIGHT CHAIN (MULTIPLE MYELOMA). PRODUCE CRYSTALS DEPOSITED IN TUBULES
Which adverse effect is the most common during the ACEi treatment?
COUGH
What does the term "goitre" mean?
ENLARGED THYROID GLAND
What drug is used as "the first aid" in patients with significant A-V blockade?
ATROPINE (0,5-1mg I.V.)
Where is the ischemic chest pain (angina pectoris) located?
RETROSTERNAL (SHOULDER, NECK, RIGHT ARM)
List two main causes of hypercalcemia
INCREASED PTH, MALIGNANCY, SARCOIDOSIS
What is the formula for calculation of base deficit?
Base deficit  = 0.4 x weight (KG) x (24- serum HCO3) 
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