gos22 new.txt

----------------------- Вопрос 1----------------------- 15 year old girl presents with Primary amenorrhea off and on abdominal pain. On per rectal examination it is confirmed that swelling is in lower vagina - complete Mulllerian agenesis - Cervical atresia - Foreign Body ----------------------- Вопрос 2----------------------- Dose of levonorgestrel used for emergency contraception: - 1-3 mg within 72 hours - 3 mg within 72 hours - 1.5 mg within 72 hours - 1.5 mg within72 hours ----------------------- Вопрос 3----------------------- All of the following sling operations are done for uterine prolapse except:- - Sling operation - Vaginal Hysterectomy \* McDonalds cerclage - Manchester repair ----------------------- Вопрос 4----------------------- Pessaries can be used for temporary treatment of prolapse uterus. How do we know that the pessary is properly placed or not? - Patient feels discomfort - Do not comes out during voiding - On strainingthe pessarydoesn't comeout - One finger gap between vagina and ring ----------------------- Вопрос 5----------------------- Which of the following is the best parameter to assess in case of male infertility? - The number of sperm - Quantity of semen - Motility of sperms \* The morphology of sperms ----------------------- Вопрос 6----------------------- All of the following are mechanisms of action of emergency contraception except: - Delaying ovulation. - Inhibiting fertilization. - Preventing implantation of the fertilized egg. \* Aborting early pregnancy. ----------------------- Вопрос 7----------------------- A infertile female on treatment presents with six weeks amenorrhea. HCG levels 1000.No sac is visible either in the uterus or in the tubes. Next management is? - Repeat HCG after 2 weeks - Medical management - Laparotomy and salpingectomy ----------------------- Вопрос 8----------------------- Hormone therapy is not indicated in: - Hot flashes Prevention of Coronaryartery Disease ------------------------------------ Osteoporosis ------------ Vaginal atrophy ----------------------- Вопрос 9----------------------- Heterotrophic pregnancy is - Pregnancy occurring in both tubes \* Extrauterine and intrauterine pregnancy - Ovarian and tubal pregnancy - Cervical pregnancy ----------------------- Вопрос 10----------------------- A postmenopausal woman who is obese, hypertensive and diabetic, presents with postmenopausal bleeding. The probable cause is:¬ - Malignant ovarian tumour \* Endometrial cancer - Cervical cancer - Brenner tumour ----------------------- Вопрос 11----------------------- Nanovalent vaccine offers protection against which type of HPV virus: - Types 6,8, 10, 11,31,33,45,52 & 58 - Types 6, 11, 16, 18,31,35,45,52,58 - Types 6, 11, 16, 18, 19,31,32,33,34 ----------------------- Вопрос 12----------------------- Sequential order of sperm formation: 1. Spermatogonia 2. Spermatocyte 3. Spermatids 4. Spermatozoa - BCAD - CBAD - CABD - ABCD ----------------------- Вопрос 13----------------------- A 39-year-old patient is contemplating discontinuing birth control pills in order to conceive. She is concerned about her fertility at this age, and inquires about when she can anticipate resumption of normal menses. You counsel her that by 3 months after discontinuation of birth control pills, the following proportion of patients will resume normal menses - 99% - 95%80% - 50% ----------------------- Вопрос 14----------------------- Investigation of choice for Asherman syndrome is: - USG --- HSG Hysteroscopy ------------ Sonosalphingography ----------------------- Вопрос 15----------------------- A 17 years old female has primary amenorrhea, undeveloped breasts, hypoplastic uterus and short stature. The likely diagnosis is? - Testicular feminization syndrome - Klinefilter's syndrome \* Turner'ssyndrome - Mixed gonadal dysgenesis ----------------------- Вопрос 16----------------------- 35 year old woman comes with postcoital bleeding. What is the next step? - PAP smear - Conisation - Cryotherapy \* Colposcopic biopsy ----------------------- Вопрос 17----------------------- Young28 yrs old lady , multigravida presenting with post coital bleeding, vagina -normal , cervix-grossly normal, Next step? - Pap smear - Cone biopsy - Cryotherapy ----------------------- Вопрос 18----------------------- Of the following supports of uterus, which is the best? - Transcervical ligament - Uterosocralligmant - Levator Ani ----------------------- Вопрос 19----------------------- Which of the following surgical procedure has the highest incidence of ureteric injury: - Abdominal hysterectomy - Vaginal hysterectomy \* Radical abdominal hysterectomy - Adnexectomy ----------------------- Вопрос 20----------------------- The treatment of choice for Vesicular mole is: - Medically induced expulsion of mole \* Suction Evacuation - Local excision - Hysterectomy ----------------------- Вопрос 21----------------------- One of the following has amenorrhea with a normal female phenotype - Turner's syndrome \* Mullerian agenesis - Congenital adrenal hyperplasia - Klienfelter's syndrome ----------------------- Вопрос 22----------------------- The major cause of unplanned pregnancies in women using oral contraceptives is - Breakthrough ovulation at midcycle - Incorrect use of oral contraceptives ------------------------------------ Gastrointestinal malabsorption ----------------------- Вопрос 23----------------------- The progestasert IUD prevents the pregnancy primarily by - Suppressing ovulation - Making endometrium unre¬ceptive \* Making cervical mucusthick - Making inflammatory changes within endometrium ----------------------- Вопрос 24----------------------- What is the most common ovarian tumour to have pseudomyxoma peritonei? \* Mucinous cystadenoma ----------------------- Serous ,cystadenoma ------------------- Dermoid ------- Brenner tumour ----------------------- Вопрос 25----------------------- In which one of the following conditions is sling operation is the best option? - Multiparous prolapsed - Nulliparous prolapse - Cystocoele. - Rectocele ----------------------- Вопрос 26----------------------- During Pomeroy's method of female sterilization, which portion of tube is ligated? - Isthmus - Ampullary - Isthmo-ampullary - Cornual ----------------------- Вопрос 27----------------------- A 20-year old girl was raped around 13th day of her regular cycle. The best possible emergency contracep¬tion to be offered would be - Misoprostal vaginally - Cu - T insertion \* Levonorgestrel tablets - Ethinylestradiol tablets ----------------------- Вопрос 28----------------------- Which one of the following is the most suitable situation for prescribing the progestin only pill? - Perimenopausal patients - Emergency contraception - Lactational mother - Diabetic mother ----------------------- Вопрос 29----------------------- Fern test is due to: - Inhibin - Est & Progesterone - Progesterone \* Estrogen ----------------------- Вопрос 30----------------------- Woman 33 year old with heavy menstrual bleeding for 6 months not responding to hormonal therapy \"..next best step - Endometrial histopathology - Hysterectomy - Tranexemic acid - Observation ----------------------- Вопрос 31----------------------- Elasticity of cervical mucus max in - Ovulatory phase - Pre follicular phase - Menstrual phase - Post ovulatory phase ----------------------- Вопрос 32----------------------- Branches of anterior division of internal iliac arteries include the following except - Superior gluteal - Uterine - Obturator - Clitoral ----------------------- Вопрос 33----------------------- Cryptomenorrhea is seen in: - Asherman's syndrome - Testicular feminizing syndrome \* Transverse Vaginal Septum - Uterine agenesis ----------------------- Вопрос 34----------------------- Nulliparous female presents with unruptured ectopic pregnancy, 5 cm size. Best management includes - Salpingostomy \* Salpnigectomy - Milking of tube - Inject Methotrexate ----------------------- Вопрос 35----------------------- Of the following postmenopausal women, which is the safest patient to start an HRT ? - Mild essential hypertension - Liver disease with abnormal liver function tests - Treated stage III endometrial cancer - Undiagnosed genital tract bleeding ----------------------- Вопрос 36----------------------- A-54-year-old woman underwent a total abdominal hysterectomy for uterine leiomyoma. The day after surgery, the patient's temperature is 38.4。C ( 101.2。F) and she complains of pelvic pain, chills and rectal pressure. Your bedside exam-ination of this patient reveals a pelvic abscess. The most likely source of bacteria that caused this infection is- - Incompletely sterilized surgical instruments \* Vaginal vault - The surgeon's skin - Residual peritoneal fluid ----------------------- Вопрос 37----------------------- All of the following is used for the staging of Ca-endometrium is indicated in all of the following except: - Myometrial involvement - Pelvic lymph node involvement - Size of uterine cavity - Vaginal involvement ----------------------- Вопрос 38----------------------- Most common site of recurrence of endometrial cancer is - Ureters - Parametrium - Liver \* Vaginal vault ----------------------- Вопрос 39----------------------- The most important indication for surgical repair of a double uterus, such as a septate or bicornuate uterus, is \* Recurrent abortion - Premature delivery - Menometrorrhagia - Dyspareunia ----------------------- Вопрос 40----------------------- XX female with congenital adrenal hyperplasia what is the most common deficiency? - 11hydroxylase ------------- 18hydroxylase \* 21 OH lase - 17 OH lase ----------------------- Вопрос 41----------------------- An infertility treated female presents with ruptured ectopic pregnancy.She is in shock. Best management includes - Laparotomy & Salpingectomy - Laparoscopic Salpnigectomy - Rsection anastomosis - inject Methotrexate ----------------------- Вопрос 42----------------------- The bhCG values after complete molar pregnancy evacuation returns to normal by - 6 weeks - 7 weeks - 8 weeks \* 9 weeks ----------------------- Вопрос 43----------------------- Luteal phase defects are ovulatory disorders that can be a cause of infertility. Which of the following studies performed in the second half of the menstrual cycle is helpful in making this diagnosis? - Serum estradiol levels - Urinary pregnanetriol levels - Endometrial biopsy - Serum follicle-stimulating hormone (FSH) levels and then Serum luteinizing hormone (LH) levels ----------------------- Вопрос 44----------------------- A lady presents with postmenopausal bleeding, it needs to be investigated if endometrial thickness on TVS is - \>2mm - \>7mm \* ≥5mm - =8mm ----------------------- Вопрос 45----------------------- All are indicators of Intra Uterine Insemination except - Anti Sperm antibodies in cervix - Thick cervical Mucus - Oligospermia \* Tubal Blockade ----------------------- Вопрос 46----------------------- Danazolis used in the treatment of all of the following except ? - Cyclical mastalgia \* Hirsutisim - Endometriosis - Benign breast diseases ----------------------- Вопрос 47----------------------- Which is an epithelial cancer? - Brenner tumor - Dysgerminoma - Granulose cell tumor - Leydig cell tumor ----------------------- Вопрос 48----------------------- Meigs Syndrome is commonly associated with: - Theca cell tumor - Teratoma - Fibroma - Molar Pregnancy ----------------------- Вопрос 49----------------------- Azoospermic male on examination has a normal Phenotype with normal FSH and Testosterone levels, likely due to? - Klinefelters syndrome - Undesended testes - Kallmns Syndrome - Vas Obstruction ----------------------- Вопрос 50----------------------- Blood collection in the uterus is known as ? - Haematocolpos \* Hematometra - Pelvic abscess - Tuboovarian mass ----------------------- Вопрос 51----------------------- A 45-year-old woman expresses the desire to become pregnant. She is presently not having periods since the last 3 months. Which of the following tests is next indicated in the evaluation of this patient's amenorrhea? - Sr. B hcg - Endometrial biopsy - Thyroid function tests - LH and FSH levels ----------------------- Вопрос 52----------------------- A 35 years old woman with dysmenorrhea and menorrhagia of 6 months duration showed an enlarged uterus of 20 weeks which was tender. The possible diagnosis is: - Adenomyosis \* Fibroid - Carcinoma endometrium - PID ----------------------- Вопрос 53----------------------- Which of the following is not an abdominal method of tubal occlusion - Irving method - Essure coil - Pomeroys - Parklands ----------------------- Вопрос 54----------------------- An 18-year-old college student who has recently become sexually active is seen for severe primary dysmenorrhea. She does not want to get pregnant, and has failed to obtain resolution with heating pads and mild analgesics. Which of the following medications is most appropriate for this patient? - Prostaglandin inhibitors - Narcotic analgesics - Oxytocin \* Oral contraceptives ----------------------- Вопрос 55----------------------- Which of the following assisted reproductive technique is used for treatment of infertilie women with blocked tubes - Ovulation induction alone helps \* IVF - IUI - Vasal reconstruction ----------------------- Вопрос 56----------------------- Male Partner need not be treated in - Bacterial vaginosis - T. Vaginitis - Candidiasis - LGV ----------------------- Вопрос 57----------------------- A lady has amenorrhea with a hypothalamic lesion and anosmia. Diagnosis - Asherman's syndrome \* Kallman's syndrome - Steir Levinthal syndrome - Sheehan's syndrome ----------------------- Вопрос 58----------------------- The risk of sarcoma developing in a fibroid uterus is approximately: - \38。C - WEC count of 15,000 - ESR - 10 mm/hour - tenderness on the movement of the cervix ----------------------- Вопрос 167----------------------- During laparoscopy preferred site for obtained cultures in a patient with acute PID is: - Endocervix - Endometrium - Pouch of Douglas - Fallopian tubes ----------------------- Вопрос 168----------------------- Asymptomatic carriage of gonococcal infection in a female is commonly seen in: - endocervix - vagina - urethra - fornix ----------------------- Вопрос 169----------------------- Gonococcal vaginitis occurs in: - Adults - Children - Infants - Adolescents ----------------------- Вопрос 170----------------------- Which of the following cannot be detected by a wet film - candida - trichomonas - chlamydia - bacterial vaginosis ----------------------- Вопрос 171----------------------- The most sensitive method for detecting cervical chlamydia trachomatis infections is: - direct fluorescent antibody test - enzyme immunoassay - polymerase chain reaction - culture on irradiated McConkey cells ----------------------- Вопрос 172----------------------- What is the most common cause of primary amenorrhea? - Kallmann syndrome - Gonadal dysgenesis - Müllerian agenesis - Anorexia nervosa ----------------------- Вопрос 173----------------------- A 17-year-old female presents with Tanner stage IV breast development but no menses. Ultrasound confirms a blind vaginal vault and no uterus or cervix. What laboratory test would be most helpful in determining the etiology of her problem? - Pathologic examination of her gonads - Serum thyroid-stimulating hormone level - Serum prolactin level \* Karyotype ----------------------- Вопрос 174----------------------- What is the most common mode of transmission for complete androgen insensitivity? - X-linked - Sporadic - Autosomal recessive - Autosomal dominant ----------------------- Вопрос 175----------------------- Which cause of amenorrhea is classified as a primary pituitary disorder? - Kallmann syndrome \* Mayer-Rokitansky-Kuster-Hauser syndrome - Sheehan syndrome - Anorexia nervosa ----------------------- Вопрос 176----------------------- A 20-year-old sexually active woman has had no vaginal bleeding for 6 months. She is obese, slightly hypertensive, has excess hair growth on her chin and galactorrhea. What diagnosis should you consider first? - Hypothyroidism - Androgen-secreting tumor - Pituitary adenoma \* Pregnancy ----------------------- Вопрос 177----------------------- What percentage of secondary amenorrhea is due to premature ovarian failure? - 50% - 30% \* 10% - 1% ----------------------- Вопрос 178----------------------- Which of the following is not a plausible explanation for the amenorrhea seen with hypothyroidism? - Thyroxine increases estrogen and progesterone secretion by granulosa cells, so thyroxine deficiency leads to deficient production of these hormones - Increased prolactin secretion inhibits pulsatile GnRH secretion \* Thyrotropin-releasing factor secretion is increased and leads to elevated prolactin secretion - Exaggerated pulsatile GnRH secretion causes elevated LH and an increased LH : FSH ratio ----------------------- Вопрос 179----------------------- Which statement is true of the regulation of prolactin secretion? \* Estrogen stimulates prolactin secretion - Negative feedback from target organs leads to decreased prolactin secretion - Dopamine stimulates prolactin secretion - Thyrotropin-releasing hormone inhibits prolactin secretion ----------------------- Вопрос 180----------------------- Which is the most common primary pituitary cause of hyperprolactinemia? - Cushing disease \* Prolactin-secreting adenoma - Acromegaly - Nonsecreting adenomas ----------------------- Вопрос 181----------------------- Which of the following represents the typical order of physical and physiologic changes of puberty in females? - Menarche, thelarche, andrenarche, peak growth velocity \* Thelarche, andrenarche, peak growth velocity, menarche - Peak growth velocity, adrenarche, menarche, thelarche - Adrenarche, menarche, thelarche, peak growth velocity ----------------------- Вопрос 182----------------------- Which hormones initiate the growth of pubic and axillary hair? - ACTH - FSH and LH - IGF- 1 \* DHEA and DHEA-S ----------------------- Вопрос 183----------------------- Besides the maturation of the hypothalmic-pituitary-ovarian axis, what other factor is suspected to be related with the onset of menarche? - Testosterone - Prolactin - Body fat - Oxytocin ----------------------- Вопрос 184----------------------- Branches of the internal iliac (hypogastric) arteries supply blood to all of the following, EXCEPT? - Vulva - Ovaries - Uterus - Cervix ----------------------- Вопрос 185----------------------- Which of the following describes the correct progression of the endometrium through the menstrual cycle? - Secretory phase, ovulation, proliferative phase, decidualization, menstruation - Proliferative phase, ovulation, secretory phase, decidualization, menstruation - Menstruation, secretory phase, decidualization, proliferative phase, ovulation - Secretory phase, menstruation, ovulation, proliferative phase, decidualization ----------------------- Вопрос 186----------------------- A 25-year-old woman undergoing laparoscopy is noted to have a cyst on her ovary. The cyst is described as a "blister" on the surface of the ovary. Which of the following is this most consistent with? - Corpus luteum - Cancer - Impending ovulation - Ectopic pregnancy ----------------------- Вопрос 187----------------------- A 28-year-old woman is evaluated for premature ovarian failure. She asks you about the ovaries and egg production. You tell her that in human females the greatest number of oocytes is found in the ovary at: - Birth - Puberty - Menopause - During ovulation ----------------------- Вопрос 188----------------------- Which hormones are produced by the posterior pituitary? - FSH, ADH and ACTH \* Oxytocin and ADH - LH, prolactin and oxytocin - LH, ADH and growth hormone ----------------------- Вопрос 189----------------------- Which of the following statements is true regarding inhibin and activin? - They are both exclusively produced by the ovary and testes - Inhibin increases gonadotrope function and activin inhibits it - Inhibin appears to be the most biologically important regulator of the FSH gene - Activin is structurally similar to follistatin ----------------------- Вопрос 190----------------------- The ovary has a two-cell, two-gonadotropin model of steroidogenesis. Which of the following statements best describe this system of production? - Granulosa cells produce androgens which then diffuse to the theca cells where they are converted to estrogens \* Theca cells produce androgens which then diffuse to the granulosa cells where they are converted to estrogens - Theca cell-derived testosterone is the primary androgen used by the granulosa cell to produce estrogen - Stimulation of aromatase activity in the granulosa cell is drive ----------------------- Вопрос 191----------------------- Which of the following statements is FALSE? - Gonorrhea is more symptomatic in men than women - Gonorrhea is more destructive in men than women - The two most common pathogens found in women with positive cultures and pelvic inflammatory disease are Neisseria gonorrhoeae and Trichomonas vaginalis - Approximately one in four heterosexual men with gonococcal urethritis will also be infected with Chlamydia trachomatis ----------------------- Вопрос 192----------------------- Which type of cell is most likely to be infected by Neisseria gonorrhoeae and Chlamydia trachomatis? - Germ cells - Columnar epithelial cell - Squamous cells - Endothelial cells ----------------------- Вопрос 193----------------------- In polycystic ovary syndrome, estrogen levels are elevated, increasing the risk of which of the following? - Metabolic syndrome - Endometrial cancer - Hirsutism --------- Hypertension ----------------------- Вопрос 194----------------------- Acanthosis nigricans (areas of thickened, darkened skin), a symptom of polycystic ovary syndrome, is caused by which of the following? - Increased serum estrogen levels - Increased serum progesterone levels - Insulin resistance - Obesity ----------------------- Вопрос 195----------------------- 45 yrs old female complains of lower abdominal pain and vaginal discharge. On examination, there is cervicitis along with a mucopurulent cervical discharge. The gram smear of the discharge shows the presence of abundant pus cells, but no bacteria The best approach to isolate the possible causative agent would be: - culture on chocolate agar supplemented with hemin - culture on McCoy cells - culture on a bilayer human blood agar - culture on Vero cell lines ----------------------- Вопрос 196----------------------- Drug of choice of chlamydia in pregnancy: - doxycycline - tetracycline - erythromycin - penicillin ----------------------- Вопрос 197----------------------- Which hormone is increased in PCOS: - LH - FSH - Inhibin - Estrogen ----------------------- Вопрос 198----------------------- Which of the following makes polycystic ovary syndrome an unlikely diagnosis? - Hyperinsulinemia -.Normal BMI - Premature adrenarche - Regular menses for a time after menarche ----------------------- Вопрос 199----------------------- The cysts in Polycystic Ovarian syndrome are formed by: - Failure of atretic follicles to undergo apoptosis - Oocyte proliferation - Multiple corpus lutea - Cystic degeneration of ovarian cortex ----------------------- Вопрос 200----------------------- Causes of postmenopausal bleeding include: - Endometrial carcinoma - Endometrial hyperplasia +/- atypia and polyps - Cervical carcinoma - Atrophic vaginitis ----------------------- Вопрос 201----------------------- Hydrocele is labeled 'vaginal' when it is: - Limited to scrotum - Upto inguinal canal - Communicating into peritoneal cavity - Upto deep inguinal ring ----------------------- Вопрос 202----------------------- Congenital hydrocele is best treated by: - Eversion of sac - Excision of sac - Lords procedure \* Herniotomy ----------------------- Вопрос 203----------------------- Which is false about vaginal hydrocele? - Almost always fluid is transudate - Get above the swelling - Testis is separate from swelling - Inguino-scrotal swelling ----------------------- Вопрос 204----------------------- A 3-year-old child presents with red scrotal swelling which shows self resolution by next day morning and is maximum in evening with positive transillumination test. What is the diagnosis? - Scrotal abscess \* Congenital hydrocele - Secondary abscess - Infantile hydrocele ----------------------- Вопрос 205----------------------- A 28-year-old patient presents with on and offpain in right scrotum and then gradual onset swelling develops over the duration of 2 years. Trans illumination test is positive. Top of testis can be reached. The probable diagnosis is? - Right hydrocele - Right inguinal hernia - Right epididymal cyst - Right encysted hydrocele of cord ----------------------- Вопрос 206----------------------- Hydrocele is labeled 'vaginal' when it is: - Limited to scrotum - Upto inguinal canal - Communicating into coelomic cavity - Upto deep inguinal ring ----------------------- Вопрос 207----------------------- Treatment of a large hydrocele in an infant: - Repeated aspirations - Ligation of sac at the opening of inguinal canal - Herniotomy - Eversion of sac ----------------------- Вопрос 208----------------------- Cause of hydrocele in infants: - Patent processus vaginalis - Patent gubernaculums - Impaired drainage - Epididymal cyst ----------------------- Вопрос 209----------------------- Lord's and Jaboulay's operation is done for: - Rectal prolapsed - Fistula in ano - Inguinal hernia - Hydrocele ----------------------- Вопрос 210----------------------- Lords placation is done for: - Inguinal hernia - Testicular cancer \* Hydrocele - Testicular varices ----------------------- Вопрос 211----------------------- Classical treatment of hydrocoele: - Aspiration - Aspiration and sclerosant agent - Surgery - Tapping ----------------------- Вопрос 212----------------------- A young boy 18 years of age presents with pain in groin for 2 days. On examination the testis seems high and cremasteric reflex is absent. Elevation of testis worsens the pain. What is the probable diagnosis? - Right testicular torsion ------------------------ Right strangulated hernia ------------------------- Right inguinal hernia --------------------- Right epididymo-orchitis ----------------------- Вопрос 213----------------------- True about torsion of testis is all except: - Presents with sudden pain in testis - Commonly associated with pyuria - Doppler U/S shows decreased blood flow to the testis - Simultaneous orchiopexy of the other side should also be done ----------------------- Вопрос 214----------------------- All are true regarding torsion of the testis, except: - Common in adolescents and young adults - Inversion of testis is the most common predisposing cause - Elevation of testis reduces the pain - If diagnosis is doubtful, prompt exploration is the rule ----------------------- Вопрос 215----------------------- Torsion of testis has to be treated within: - Immediately - 6 hours - 12 hours - 15 hours ----------------------- Вопрос 216----------------------- In testicular torsion, surgery within how much time can save viability of testis? - 6 hours - 12 hours - 24 hours - 1 weeks ----------------------- Вопрос 217----------------------- All the following statements are true regarding torsion of testis except: - Most common between 10 and 25 years of age - Prompt exploration and twisting & fixation is the only way to save the torted testis \* Anatomical abnormality is unilateral and contralateral testis should not be fixed - Inversion of testis is the most common predisposing cause ----------------------- Вопрос 218----------------------- True about torsion of testis is all except: - Presents with sudden pain in testis - Commonly associated with pyuria - Doppler U/S shows decreased blood flow to the testis - Simultaneous orchiopexy of the other side should also be done ----------------------- Вопрос 219----------------------- A 30-years old male patient presents with sudden onset swelling and pain over the right hemiscrotum. On examination the scrotum is reddened and tender. Which of the following statement about the affecting condition is not true? - Probable diagnosis is torsion - The right testis is likely to ride high in the scrotal compartment - If torsion confirmed, treat with antibiotics and analgesics and perform corrective surgery immediately - If torsion confirmed, treat with antibiotics and analgesics and perform corrective surgery after 14 days ----------------------- Вопрос 220----------------------- All of the following abnormalities are predisposing causes for torsion of the testis except: - Inversion of testis - Low investment of tunica vaginalis - Between 10 to 25 years of age - Separation of the epididymis. ----------------------- Вопрос 221----------------------- A 40-years old man in suffering from fever and pain in scrotum which is not relieved by elevation of testis, 3 days before had sexual contact with a young female: - Testicular tumor - Acute epididymitis - Torsion of testis - Acute orchitis ----------------------- Вопрос 222-----------------------. Prostatic artery is a branch of: - Superior vesical artery - Middle vesical artery \* Inferior vesical artery - Superior rectal artery ----------------------- Вопрос 223----------------------- During TURP, surgeon takes care to dissect above the verumontanum to prevent injury to: - External urethral sphincter - Urethral crest - Prostatic utricle - Trigone of bladder ----------------------- Вопрос 224----------------------- Most common site of BPH: - Peripheral zone - Middle zone \* Transition zone - Central zone ----------------------- Вопрос 225----------------------- Benign Prostatic hypertrophy results in obstruction of the urinary tract. This specific condition is associated with enlargement of the: - Entire prostate gland --------------------- Lateral lobes \* Median lobe - Posterior lobes ----------------------- Вопрос 226----------------------- False statement regarding investigations of BPH - Serum PSA is usually normal \* Urinary flow rate more than 15 is regarded as obstruction - Post Void residual urine more than 20 % of MCC is significant - Minimum 150 ml of urine should be voided for valid interpretation of uroflometry ----------------------- Вопрос 227----------------------- Which is the earliest symptom of benign hypertrophy of prostate? - Frequency - Hematuria - Incontinence - Strangury ----------------------- Вопрос 228----------------------- The drug that has the fastest onset of action in benign prostatic hyperplasia is: - Finasteride - Tamsulosin - Dutasteride ----------- Flutamide ----------------------- Вопрос 229----------------------- In the management of symptomatic benign prostatic hyperplasia with finasteride the period of trial required for determining a satisfactory response is: - 1 month - 2 months - 4 months - 6 months ----------------------- Вопрос 230----------------------- Mechanism of action of Silodosin: \* Alpha antagonist - Beta antagonist - Anticholinergic - PDE5 inhibitor ----------------------- Вопрос 231----------------------- Which of the following drug can decrease the size of prostate? - Tamsulosin -. Sildenafil \* Finasteride - Prazosin ----------------------- Вопрос 232----------------------- The following statements regarding finasteride are true except: - It is used in the medical treatment of benign prostatic hypertrophy - Impotence is well documented after its use - It blocks the conversion of dihydrotestosterone to testosterone - It is a 5-α reductase inhibitor ----------------------- Вопрос 233----------------------- Indication for surgery in benign prostatic hypertrophy are all except: - Severe symptoms/prostatism - Chronic retention - Hemorrhage \* Enlarged prostate ----------------------- Вопрос 234----------------------- 65 years old male is diagnosed as a case of BPH with failed medical management. USG shows prostate size 100 gm. Best treatment option for this patient - Transurethral incision of the prostate (TUIP) - Transurethral resection of the prostate (TURP) \* Holmium laser enucleation of the prostate (HoLEP) - Transurethral microwave thermotherapy (TUMT) ----------------------- Вопрос 235----------------------- The most common complication of transurethral resection of prostate (TURP): - Erectile dysfunction - Retrograde ejaculation - Urinary incontinence - Impotence ----------------------- Вопрос 236----------------------- A 70 years old patient benign prostatic hyperplasia underwent transurethral resection of prostate under spinal anaesthesia. One hour later, he developed vomiting and altered sensorium. The most probable cause is: - Over dosage of spinal anesthetic agent - Rupture of bladder - Hyperkalemia \* Water intoxication ----------------------- Вопрос 237----------------------- Delirium, mental confusion and nausea in patients who had undergone transurethral resection of prostate suggests: - Hypernatremia - Sepsis - Bladder perforation - TUR syndrome ----------------------- Вопрос 238----------------------- Which one of the following is used as an irrigation solution during transurethral resection of the prostate? - 1.5% glycine - Physiological Saline - Ringer's lactate - ----------------------- Вопрос 239----------------------- In the management of symptomatic benign prostatic hyperplasia with finasteride the period of trial required for determining a satisfactory response is: - 1 month - 2 months - 4 months \* 6 months ----------------------- Вопрос 240----------------------- Assessment of patient with prostatism (LUTS) includes all except: - Rectal examination - Serum prostate specific antigen \* Pressure flow urodynamic studies - Transrectal ultrasound scanning ----------------------- Вопрос 241----------------------- A 35-years old female presented with a swelling in the neck for the past 2 months, she had the treatment for Hodgkin's lymphoma when she was 22 years with irradiation. On, examination, her vitals were normal, there was a single, firm, irregular nodule, moving with deglutition in the left side of midline. Clinical examination also revealed a single node in the left side of the neck. The most likely clinical diagnosis of this condition is: - Recurrence of lymphoma \* Malignant goiter - Benign multinodular goiter - Toxic nodular goiter ----------------------- Вопрос 242----------------------- Most probable pathological diagnosis would be: - Anaplastic carcinoma - Follicular carcinoma - Medullary carcinoma \* Papillary carcinoma ----------------------- Вопрос 243----------------------- The FNAC of the lesion should reveal: - 'Orphan-Annie eye' nucleus cells - Amyloid deposits - Epitheloid cells and giant cells - Follicular cells ----------------------- Вопрос 244----------------------- The ideal treatment of the above condition would be: - Total thyroidectomy with lymph nodal dissection of the same side - Radiotherapy -. Lobectomy - Lobectomy with isthmusectomy ----------------------- Вопрос 245----------------------- False statement realted to Papillary carcinoma thyroid: - Most common thyroid cancer - Psammoma bodies seen - Encapsulated - Blood borne metastasis is common ----------------------- Вопрос 246-----------------------. Which of the following would be the best treatment for a 2cm thyroid nodule in a 50 year old man with FNAC revealing it to be a papillary carcinoma? - Hemithyroidectomy \* Total thyroidectomy with left sided modified neck dissection - Near total thyroidectomy with radiotherapy - Hemithyroidectomy with modified neck dissection ----------------------- Вопрос 247----------------------- Psammoma bodies may be seen in all of the following, except: - Follicular carcinoma of thyroid - Papillary carcinoma of thyroid - Meningioma - Serous cystadenocarcinoma of ovary ----------------------- Вопрос 248----------------------- False statement about papillary carcinoma ;: - Radiation is a risk factor - Multifocal \* Hematogenous spread is common - Distant metastasis is seen ----------------------- Вопрос 249----------------------- Most common thyroid malignancy is: - Anaplastic carcinoma - Follicular carcinoma - Medullary carcinoma \* Papillary carcinoma ----------------------- Вопрос 250----------------------- A 10-years old boy presented with cervical lymph adenopathy. Needle biopsy from the nodes revealed secondaries from papillary carcinoma of thyroid. The child under went complete removal of tumor near total thyroidectomy and radical neck dissection. What should be the immediate next line of management? - Start thyroxine suppression therapy - I- 131 whole body scan to assess the extent of disease - Bone scan to evaluate secondaries - CECT scan to assess any residual disease ----------------------- Вопрос 251----------------------- Orphan Annie-eye nuclei seen in: \* Papillary carcinoma of thyroid -. Medullary carcinoma of thyroid - Anaplastic carcinoma of thyroid - Follicular carcinoma of thyroid ----------------------- Вопрос 252----------------------- Psammoma bodies are seen in following except: - Serous cystadenoma of ovary \* Mucinous cystadenoma of ovary - Meningioma - Papillary carcinoma of thyroid ----------------------- Вопрос 253----------------------- Which of the following would be the best treatment for a 2 cm thyroid nodule in a 50-years old man with FNAC revealing it to be a papillary carcinoma? - Hemithyroidectomy - Subtotal thyroidectomy with modified neck dissection \* Near total thyroidectomy with modified neck dissection - Hemithyroidectomy with modified neck dissection ----------------------- Вопрос 254----------------------- True regarding papillary carcinoma of thyroid: - Undifferentiated carcinoma - Blood-borne metastasis is commoner - Excellent prognosis - Capsulated ----------------------- Вопрос 255----------------------- True about papillary carcinoma thyroid is: - Comprises 10- 15% of all thyroid cancers - Cells have intranuclear vacuolation - Amyloid deposition seen - Encapsulated ----------------------- Вопрос 256----------------------- Papillary carcinoma thyroid usually presents as: - Diffuse nodular swelling - Only lymphadenopathy - Hormonal disturbance \* Single nodule + local lymph node ----------------------- Вопрос 257----------------------- Which type of thyroid carcinoma has the best prognosis? - Papillary carcinoma - Anaplastic carcinoma - Follicular carcinoma - Medullary carcinoma ----------------------- Вопрос 258----------------------- One of the following is not correct in papillary carcinoma of thyroid: - Can be reliably diagnosed using fine needle aspiration cytology - Always unifocal - Typically spreads to the cervical lymph nodes - Requires a total thyroidectomy for large tumors ----------------------- Вопрос 259----------------------- Occult thyroid malignancy with nodal metastasis is: - Medullary carcinoma - Follicular carcinoma \* Papillary carcinoma - Anaplastic carcinoma ----------------------- Вопрос 260----------------------- Least malignant thyroid cancer is: - Papillary carcinoma - Follicular carcinoma - Anaplastic carcinoma - Medullary carcinoma ----------------------- Вопрос 261----------------------- Lateral aberrant thyroid refers to: - Congenital thyroid abnormality \* Metastatic foci from primary in thyroid - Struma ovarii - Lingual thyroid ----------------------- Вопрос 262----------------------- Treatment of papillary carcinoma of thyroid with bony metastasis: - Radiotherapy - Radioiodine - Near total thyroidectomy with radiotherapy - Near total thyroidectomy with radioiodine and radiotherapy ----------------------- Вопрос 263----------------------- Cervical lymph node involvement in papillary carcinoma thyroid, best treatment is: - Radioactive iodine - Chemotherapy \* Radical neck dissection - Steroid ----------------------- Вопрос 264----------------------- Which of the following is used in the treatment of differentiated thyroid cancer? - I- 131 - 99mTc - P-32 - I- 131 MIBG ----------------------- Вопрос 265----------------------- In treatment of papillary carcinomas thyroid, radioiodine predominantly by: destroys the neoplastic cells - X-rays - Beta rays - Gamma rays - Alpha particles ----------------------- Вопрос 266----------------------- A 21-years old woman has 3 cm node in the lower deep cervical chain on the left. The biopsy is interpreted as revealing normal thyroid tissue in a lymph node. The most likely diagnosis is: - Subacute thyroiditis - Metastatic carcinoma thyroid - Hashimoto's disease \* Lateral aberrant thyroid ----------------------- Вопрос 267----------------------- All of the following regarding papillary carcinoma thyroid is true except: - Multicentric origin - Secondaries to lymph nodes - Slowing growing \* Bony metastasis in early stage ----------------------- Вопрос 268----------------------- Thyroid carcinoma with pulsating vascular skeletal metastasis is: - Follicular - Anaplastic - Medullary - Papillary ----------------------- Вопрос 269----------------------- A well differentiated follicular carcinoma of thyroid can be best differentiated from a follicular adenoma by: - Hurthle cell change - Lining of tall columnar and cuboidal cells - Vascular invasion - Nuclear features ----------------------- Вопрос 270----------------------- FNAC is useful in all the following types of thyroid carcinoma except: -. Papillary \* Follicular - Anaplastic - Medullary ----------------------- Вопрос 271----------------------- Most probable malignancy that develops in a case of long standing goiter is: - Follicular carcinoma - Anaplastic carcinoma - Papillary carcinoma - Medullary carcinoma ----------------------- Вопрос 272----------------------- Bone metastasis is common in which thyroid tumor: - Follicular - Papillary --------- Hurthle cell tumour ------------------- Anaplastic ----------------------- Вопрос 273----------------------- Thyroid nodule of 4 cm size, mobile but causing compressive symptoms. All are true except: - FNAC is investigation of choice - FNAC cannot distinguish follicular adenoma from carcinoma - Managed by sub-total thyroidectomy \* Cold nodules are diagnostic of malignancy ----------------------- Вопрос 274----------------------- In case of adenomatoid goiter which carcinoma is commonest to occur: - Medullary carcinoma \* Follicular carcinoma - Papillary carcinoma -. Anaplastic carcinoma ----------------------- Вопрос 275----------------------- Carcinoma thyroid with blood borne metastasis is: - Follicular - Papillary \* both a and b - None ----------------------- Вопрос 276-----------------------. Lymph node metastasis is least commonly seen with: ---------------------------------------------------- Papillary CA Thyroid -------------------- Medullary CA Thyroid \*. Follicular CA Thyroid - Anaplastic CA Thyroid ----------------------- Вопрос 277----------------------- A 20-years old female patient presented with a thyroid needle aspiration cytology will not diagnose: swelling. Most probably, the fine - Papillary carcinoma of thyroid - Medullary carcinoma of thyroid - Non-Hodgkin's lymphoma of thyroid - Follicular carcinoma of thyroid ----------------------- Вопрос 278----------------------- Hurthle cells tumour is: - Papillary carcinoma thyroid \* Follicular carcinoma thyroid - Medullary carcinoma thyroid - Anaplastic carcinoma ----------------------- Вопрос 279----------------------- Metastasis from follicular carcinoma should be treated by: - Radioiodine - Surgery - Thyroxine - Observation ----------------------- Вопрос 280----------------------- True regarding follicular carcinoma of thyroid: - Hematogemous spread - Commonly multifocal - Readily diagnosed by face - Most commonly carcinoma of thyroid ----------------------- Вопрос 281----------------------- Screening method of medullary carcinoma thyroid is: - Serum calcitonin - Serum calcium - Serum alkaline phosphate - Serum acid phosphatase ----------------------- Вопрос 282----------------------- Treatment of medullary carcinoma thyroid: - Surgery and Radiotherapy -. Radiotherapy and Chemotherapy \* Surgery only - Radioiodine ablation ----------------------- Вопрос 283----------------------- False statement about feature of MTC: ------------------------------------- Familial MTC may presents in 2nd decade --------------------------------------- It has characteristic amyloid stroma ------------------------------------ Secrete serotonin \* Take up radioiodine ----------------------- Вопрос 284----------------------- Thyroid radioiodine ablation therapy is useful in all except: - Recurrent papillary carcinoma - Residual papillary carcinoma \* Anaplastic carcinoma - Follicular carcinoma ----------------------- Вопрос 285----------------------- Feature(s) of medullary carcinoma thyroid: - Arises from parafollicular cells - Amyloid stroma is present on histology - all - Diarrhea occurs ----------------------- Вопрос 286----------------------- Age for prophylactic thyroidectomy in MEN IIB syndrome? - 1 month - 2 months - 4 months \* 6 months ----------------------- Вопрос 287----------------------- Recommended age for prophylactic thyroidectomy for MEN-2 is: - 5 years - Before 1 year - At the time of diagnosis - Any time ----------------------- Вопрос 288----------------------- Medullary carcinoma thyroid arises from: - Parafollicular cells - Cells lining the acini - Capsule of thyroid - Stroma of the gland ----------------------- Вопрос 289----------------------- Which of the following is true regarding medullary carcinoma of the thyroid? - Arises from parafollicular cells - Secretes calcitonin - Occurs in families \* all ----------------------- Вопрос 290----------------------- A 26-years women presents with a palpable thyroid nodule, and needle biopsy demonstrates amyloid in the stroma of the lesion. A cervical lymph node is palpable on the same side as the lesion. The preferred treatment should be: - Removal of the involved node, the isthmus, a portion of the opposite bone and he enlargedlymph node - Removal of the involved lobe, the isthmus, a portion of the opposite lobe, and he enlarged lymph node - Total thyroidectomy and modified neck dissection on the side of the enlarged lymph node - Total thyroidectomy and irradiation of the cervical lymph nodes ----------------------- Вопрос 291----------------------- Amyloid stroma is seen in which carcinoma thyroid: - Papillary carcinoma \* Medullary carcinoma - Anaplastic carcinoma - Follicular carcinoma ----------------------- Вопрос 292----------------------- A patient has pituitary tumour and pheochromocytoma and a thyroid nodule. Which carcinoma is most likely to occur? - Follicular carcinoma \* Medullary carcinoma - Papillary carcinoma - Anaplastic carcinoma ----------------------- Вопрос 293----------------------- Local anesthetics produce: - Analgesia, amnesia, loss of consciousness \* Blocking pain sensation without loss of consciousness - Alleviation of anxiety and pain with an altered level of consciousness - A stupor or somnolent state ----------------------- Вопрос 294----------------------- A good local anesthetic agent shouldn't cause: - Local irritation and tissue damage - Systemic toxicity \* Fast onset and long duration of action - Vasodilatation ----------------------- Вопрос 295----------------------- Most local anesthetic agents consist of: - Lipophylic group (frequently an aromatic ring) - Intermediate chain (commonly including an ester or amide) - Amino group \* All of the above ----------------------- Вопрос 296----------------------- Which one of the following groups is responsible for the duration of the local anesthetic action? \* Intermediate chain - Lipophylic group ---------------- Ionizable group --------------- All of the above ----------------------- Вопрос 297----------------------- Indicate the local anesthetic agent, which has a shorter duration of action: - Lidocaine \* Procaine - Bupivacaine - Ropivacaine ----------------------- Вопрос 298----------------------- Which one of the following groups is responsible for the potency and the toxicity of local anesthetics?Ionizable group - Intermediate chain \* Lipophylic group - All of the above ----------------------- Вопрос 299----------------------- Indicate the drug, which has greater potency of the local anesthetic action: - Lidocaine \* Bupivacaine - Procaine - Mepivacaine ----------------------- Вопрос 300----------------------- Ionizable group is responsible for: - The potency and the toxicity - The duration of action - The ability to diffuse to the site of action - All of the above ----------------------- Вопрос 301----------------------- Which one of the following local anesthetics is an ester of benzoic acid? - Lidocaine - Procaine - Ropivacaine \* Cocaine ----------------------- Вопрос 302----------------------- Indicate the local anesthetic, which is an ester of paraaminobenzoic acid: - Mepivacaine - Cocaine \* Procaine - Lidocaine ----------------------- Вопрос 303----------------------- Which of the following local anesthetics is an acetanilide derivative? - Tetracaine \* Lidocaine - Cocaine - Procaine ----------------------- Вопрос 304----------------------- Indicate the local anesthetic, which is a toluidine derivative: - Lidocaine - Bupivacaine - Prilocaine - Procaine ----------------------- Вопрос 305----------------------- Which of the following local anesthetics is a thiophene derivative? - Procaine \* Ultracaine - Lidocaine - Mepivacaine ----------------------- Вопрос 306----------------------- Local anesthetics are: \* Weak bases - Weak acids - Salts - None of the above ----------------------- Вопрос 307----------------------- For therapeutic application local anesthetics are usually made available as salts for the reasons of: - Less toxicity and higher potency - Higher stability and greater lipid solubility - Less local tissue damage and more potency \* More stability and greater water solubility ----------------------- Вопрос 308----------------------- Which of the following statements is not correct for local anesthetics? - In a tissue they exist either as an uncharged base or as a cation \* A charged cationic form penetrates biologic membranes more readily than an uncharged form - Local anesthetics are much less effective in inflamed tissues - Low ph in inflamed tissues decreases the dissociation of nonionized molecules ----------------------- Вопрос 309----------------------- Which one of the following statements about the metabolism of local anesthetics is incorrect? \* Metabolism of local anesthetics occurs at the site of administration - Metabolism occurs in the plasma or liver but not at the site of administration - Ester group of anesthetics like procaine, are metabolized systemically by pseudocholinesterase - Amides such as lidocaine, are metabolized in the liver by microsomal mixed function oxidases ----------------------- Вопрос 310----------------------- Indicate the anesthetic agent of choice in patient with a liver disease: - Lidocaine - Bupivacaine \* Procaine - Etidocaine ----------------------- Вопрос 311----------------------- Which of the following local anesthetics is preferable in patient with pseudocholinesterase deficiency? ----------- Procaine \* Ropivacaine - Tetracaine - Benzocaine ----------------------- Вопрос 312----------------------- The primary mechanism of action of local anesthetics is: - Activation of ligand-gated potassium channels \* Blockade of voltage-gated sodium channels - Stimulation of voltage-gated N-type calcium channels - Blockade the GABA-gated chloride channels ----------------------- Вопрос 313----------------------- Which of the following local anesthetics is more water-soluble? - Tetracaine - Etidocaine \* Procaine - Bupivacaine ----------------------- Вопрос 314----------------------- Indicate the local anesthetic, which is more lipid-soluble: \* Bupivacaine - Lidocaine - Mepivacaine - Procaine ----------------------- Вопрос 315----------------------- The more lipophylic drugs: - Are more potent - Have longer duration of action - Bind more extensively to proteins \* All of the above ----------------------- Вопрос 316----------------------- Which of the following fibers is the first to be blocked? - Type A alpha fibers \* B and C fibers - Type A beta fibers - Type A gamma fibers ----------------------- Вопрос 317----------------------- Indicate the function, which the last to be blocked: - Pain, temperature - Muscle spindles \* Motor function - Touch, pressure ----------------------- Вопрос 318----------------------- Which of the following fibers participates in high-frequency pain transmission? \* Type A delta and C fibers - Type A alpha fibers - Type B fibers - Type A beta fibers ----------------------- Вопрос 319----------------------- Which of the following local anesthetics is an useful antiarrhythmic agent? - Cocaine \* Lidocaine - Bupivacaine - Ropivacaine ----------------------- Вопрос 320----------------------- Indicate the route of local anesthetic administration, which is associated withinstillation within epidural or subarachnoid spaces: - Topical anesthesia - Infiltrative anesthesia - Regional anesthesia \* Spinal anesthesia ----------------------- Вопрос 321----------------------- The choice of a local anesthetic for specific procedures is usually based on: - The duration of action - Water solubility - Capability of rapid penetration through the skin or mucosa with limited tendency to diffuse away from the site of application \* All of the above ----------------------- Вопрос 322----------------------- Which of the following local anesthetics is a short-acting drug? \* Procaine - Tetracaine - Bupivacaine - Ropivacaine ----------------------- Вопрос 323----------------------- Indicate the local anesthetic, which is a long-acting agent: - Lidocaine \* Bupivacaine - Procaine - Mepivacaine ----------------------- Вопрос 324----------------------- The anesthetic effect of the agents of short and intermediate duration of action can not be prolonged by adding: - Epinephrine - Norepinephrine \* Dopamine - Phenylephrine ----------------------- Вопрос 325----------------------- A vasoconstrictor does not: - Retard the removal of drug from the injection site - Hence the chance of toxicity - Decrease the blood level \* Reduce a local anesthetic uptake by the nerve ----------------------- Вопрос 326----------------------- Vasoconstrictors are less effective in prolonging anesthetic properties of: --------------------------------------------------------------------------- Procaine \* Bupivacaine - Lidocaine - Mepivacaine ----------------------- Вопрос 327----------------------- Which of the following local anesthetics is only used for surface or topical anesthesia? \* Cocaine - Tetracaine - Procaine - Bupivacaine ----------------------- Вопрос 328----------------------- Indicate the local anesthetic, which is mainly used for regional nerve block anesthesia: - Dibucaine \* Bupivacaine - Tetracaine - Cocaine ----------------------- Вопрос 329----------------------- Which of the following local anesthetics is used for infiltrative and regional anesthesia? - Procaine - Lidocaine - Mepivacaine \* All of the above ----------------------- Вопрос 330----------------------- Indicate the local anesthetic, which is used for spinal anesthesia: \* Tetracaine - Cocaine - Dibucaine - Bupivacaine ----------------------- Вопрос 331----------------------- Which of the following local anesthetics is called a universal anesthetic? - Procaine - Ropivacaine \* Lidocaine - Bupivacaine ----------------------- Вопрос 332----------------------- Most serious toxic reaction to local anesthetics is: - Seizures - Cardiovascular collapse - Respiratory failure \* All of the above ----------------------- Вопрос 333----------------------- Correct statements concerning cocaine include all of the following EXCEPT: - Cocaine is often used for nose and throat procedures - Limited use because of abuse potential \* Myocardial depression and peripheral vasodilatation - Causes sympathetically mediated tachycardia and vasoconstriction ----------------------- Вопрос 334----------------------- Which of the following local anesthetics is more cardiotoxic? - Procaine \* Bupivacaine - Lidocaine - Mepivacaine ----------------------- Вопрос 335----------------------- Most local anesthetics can cause: - Depression of abnormal cardiac pacemaker activity, excitability, conduction - Depression of the strength of cardiac contraction - Cardiovascular collapse \* All of the above ----------------------- Вопрос 336----------------------- Which one of the following local anesthetics causes methemoglobinemia? \* Prilocaine - Procaine - Lidocaine - Ropivacaine ----------------------- Вопрос 337----------------------- Procaine has all of the following properties EXCEPT: - It has ester linkage - Its metabolic product can inhibit the action of sulfonamides - It readily penetrates the skin and mucosa - It is relatively short-acting ----------------------- Вопрос 338----------------------- Correct statements concerning lidocaine include all of the following EXCEPT: - It is an universal anesthetic \* It has esteratic linkage - It widely used as an antiarrhythmic agent - It is metabolized in liver ----------------------- Вопрос 339----------------------- Which of the following local anesthetics is more likely to cause allergic reactions? - Lidocaine - Bupivacaine \* Procaine - Ropivacaine ----------------------- Вопрос 340----------------------- Tetracaine has all of the following properties EXCEPT: - Slow onset \* Low potency - Long duration - High toxicity ----------------------- Вопрос 341----------------------- Correct statements concerning bupivacaine include all of the following EXCEPT: \* It has low cardiotoxicity - It has amide linkage - It is a long-acting drug - An intravenous injection can lead to seizures ----------------------- Вопрос 342----------------------- Acetylcholine is not a specific neurotransmitter at: - Sympathetic ganglia *Sympathetic postganglionic nerve endings - Parasympathetic ganglia - Parasympathetic postganglionic nerve endingsMuscarinic receptors are located in: - Autonomic ganglia - Skeletal muscle neuromuscular junctions* Autonomic effector cells - Sensory carotid sinus baroreceptor zone ----------------------- Вопрос 344----------------------- Indicate the location of M2 cholinoreceptor type: \* Heart - Glands - Smooth muscle - Endothelium ----------------------- Вопрос 345----------------------- The symptoms of mushroom poisoning include all of the following EXCEPT: - Salivation, lacrimation, nausea, vomiting \* Dryness of mouth, hyperpyrexia, hallucination - Headache, abdominal colic - Bradycardia, hypotension and shock ----------------------- Вопрос 346----------------------- Which of the following cholinomimetics activates both muscarinic and nicotinic receptors? - Lobeline - Pilocarpine - Nicotine \* Bethanechol ----------------------- Вопрос 347----------------------- Indicate a cholinomimetic agent, which is related to direct-acting drugs: - Edrophonium - Physostigmine \* Carbachol - Isoflurophate ----------------------- Вопрос 348----------------------- Characteristics of carbachol include all of the following EXCEPT: - It decreases intraocular pressure \* It causes mydriasis - It exerts both nicotinic and muscarinic effects - It is resistant to acethylcholiesterase ----------------------- Вопрос 349----------------------- Acetylcholine is not used in clinical practice because: - It is very toxic - The doses required are very high - It is very rapidly hydrolyzed - It is very costly ----------------------- Вопрос 350----------------------- Parasympathomimetic drugs cause: - Bronchodilation - Mydriasis \* Bradycardia - Constipation ----------------------- Вопрос 351----------------------- Which of the following direct-acting cholinomimetics is mainly muscarinic in action? \* Bethanechol - Carbachol - Acetylcholine - None of the above ----------------------- Вопрос 352----------------------- Which of the following direct-acting cholinomimetics has the shortest duration of action? \* Acetylcholine - Methacholine - Carbachol - Bethanechol ----------------------- Вопрос 353----------------------- Bethanechol has all of the following properties EXCEPT: - It is extremely resistant to hydrolysis - Purely muscarinic in its action - It is used for abdominal urinary bladder distention - It exerts both nicotinic and muscarinic effects ----------------------- Вопрос 354----------------------- A M-cholinimimetic agent is: - Carbachol \* Pilocarpine - Acetylcholine - Bethanechol ----------------------- Вопрос 355----------------------- Characteristics of pilocarpine include all of the following EXCEPT: - It is a tertiary amine alkaloid - It causes miosis and a decrease in intraocular pressure \* Causes a decrease in secretory and motor activity of gut - It is useful in the treatment of glaucoma ----------------------- Вопрос 356----------------------- Which of the following cholinomimetics is a plant derivative with lower potency than nicotine but with a similar spectrum of action? \* Lobeline - Pilocarpine - Carbochol - Acetylcholine ----------------------- Вопрос 357----------------------- Which of the following cholinomimetics is indirect-acting? - Lobeline \* Edrophonium - Pilocarpine - Carbachol ----------------------- Вопрос 358----------------------- The mechanism of action of indirect-acting cholinomimetic agents is: - Binding to and activation of muscarinic or nicotinic receptors \* Inhibition of the hydrolysis of endogenous acetylcholine - Stimulation of the action of acetylcholinesterase - Releasing acetylcholine from storage sites ----------------------- Вопрос 359----------------------- Indicate a reversible cholinesterase inhibitor: - Isoflurophate - Carbochol \* Physostigmine - Parathion ----------------------- Вопрос 360----------------------- Which of the following cholinesterase inhibitors is irreversible? - Physostigmine - Edrophonium - Neostigmine \* Isoflurophate ----------------------- Вопрос 361----------------------- Indicate cholinesterase activator: - Pralidoxime - Edrophonium - Pilocarpine - Isoflurophate ----------------------- Вопрос 362----------------------- Isofluorophate increases all of the following effects except: - Lacrimation \* Bronchodilation - Muscle twitching - Salivation ----------------------- Вопрос 363----------------------- Indicate a cholinesterase inhibitor, which has an additional direct nicotinic agonist effect: - Edrophonium - Carbochol \* Neostigmine - Lobeline ----------------------- Вопрос 364----------------------- Сholinesterase inhibitors do not produce: - Bradycardia, no change or modest fallin blood pressure - Increased strength of muscle contraction,especially in muscles weakened by myasthenia gravis - Miosis and reduction of intraocular pressure \* Dramatic hypertension and tachycardia ----------------------- Вопрос 365----------------------- Which of the following cholinomimetics is commonly used in the treatment of glaucoma? \* Pilocarpine - Lobeline - Acethylcholine - Neostigmine ----------------------- Вопрос 366----------------------- Indicate the organophosphate cholinesterase inhibitor, which can be made up in an aqueous solution for ophthalmic use and retains its activity within a week: - Physoctigmine - Edrophonium \* Echothiophate - Neostigmine ----------------------- Вопрос 367----------------------- Which of the following cholinomimetics is most widely used for paralytic ileus and atony of the urinary bladder? - Lobeline \* Neostigmine - Pilocarpine - Echothiophate ----------------------- Вопрос 368----------------------- Chronic long-term therapy of myasthenia is usually accomplished with: - Edrophonium \* Neostigmine - Echothiophate - Carbachol ----------------------- Вопрос 369----------------------- Which of the following cholinomimetics is a drug of choice for reversing the effects of nondepolarizing neuromuscular relaxants? - Echothiophate - Physostigmine \* Edrophonium - Pilocarpine ----------------------- Вопрос 370----------------------- Indicate the reversible cholinesterase inhibitor, which penetrates the blood-brain barrier: \* Physostigmine - Edrophonium - Neostigmine - Piridostigmine ----------------------- Вопрос 371----------------------- Which of the following cholinomimetics is used in the treatment of atropine intoxication? - Neostigmine - Carbochol \* Physostigmine - Lobeline ----------------------- Вопрос 372----------------------- The symptoms of excessive stimulation of muscarinic receptors include all of the following EXCEPT: - Abdominal cramps, diarrhea - Increased salivation, excessive bronchial secretion - Miosis, bradycardia \* Weakness of all skeletal muscles ----------------------- Вопрос 373----------------------- The excessive stimulation of muscarinic receptors by pilocarpine and choline esters is blocked competitively by: - Edrophonium \* Atropine - Pralidoxime - Echothiophate ----------------------- Вопрос 374----------------------- The toxic effects of a large dose of nicotine include all of the following EXCEPT: \* Hypotension and bradycardia - Convulsions, coma and respiratory arrest - Skeletal muscle depolarization blockade and respiratory paralysis - Hypertension and cardiac arrhythmias ----------------------- Вопрос 375----------------------- The dominant initial sights of acute cholinesterase inhibitors intoxication include all of the following except: - Salivation, sweating \* Mydriasis - Bronchial constriction - arrhythmias ----------------------- Вопрос 376----------------------- A 5 year old male child had acute otitis being treated with ear drops,oral antibiotics and analgesics. Two weeks after he presented with a swelling over the mastoid, pain in the ear with pulsatile ear discharge and fever. Now treatment of this child would include: - IV antibiotics - Cortical mastoidectomy - Analgesics - All of the above ----------------------- Вопрос 377----------------------- A 38 year old gentlemen reports of decreased hearing in the right ear for the last 2 years. On testing with a 512Hz tuning fork, the Rinne's test is negative on the right ear and positive on the left ear. With the Weber's test the tone is perceived louder in the left ear. The patient mostly likely has: - Right conductive hearing loss - Right sensorineural hearing loss - Left sensorineural hearing loss - Left conductive hearing loss ----------------------- Вопрос 378----------------------- A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice? ------------------------------------------------------- An intact canal wall mastoidectomy ---------------------------------- Simple mastoidectomy with tympanoplasty \* Canal wall down mastoidectomy - Mastoidectomy with cavity obliteration ----------------------- Вопрос 379----------------------- A 25 year old woman suffering from bilateral hearing loss 6 years which became profound with pregnancy. On tympanogram, which of the following curve is obtained? - AD \* AS - B - A ----------------------- Вопрос 380----------------------- A patient presents with bleeding from ear, pain tinnitus and progressive deafness. On examination, there is a red swelling behind the intact tympanic membrane which blanches on pressure with pneumatic speculum. Management include all except: - Radiotherapy - Surgery - Interferon - Pre-operative embolisation ----------------------- Вопрос 381----------------------- A 5 year old boy has been diagnosed to have postero-superior retraction pocket with cholesteotoma. All would retraction pocket with cholesteatoma.All would constitute part of management except: - Audiometry - Mastoid exploration - Tympanoplasty - Myringoplasty ----------------------- Вопрос 382----------------------- A 10 year old child present with a preauricular sinus.There is no discharge or inflammation. Similar sinus was also observed in his mother who got treated at the age of 30 years. What will be your line of management? - Education and observation of the patient - Order a sonogram after injection of a radiopaque dye - Order a CT in axial plane - Order an MRI to exclude a cyst ----------------------- Вопрос 383----------------------- A young boy of 18 years gets recurrent bust of otitis externa after swimming. Which of the following methods should be recommended? - Not to swim \* Use 2% acetic acid after swimming - Use ear drops containing an antibiotic and steroid - Use if antifungal ear drops after swimming ----------------------- Вопрос 384----------------------- A 7 year child developed acute otitis media. He was treated with antibiotics after 10 days. His pain and fever subsided completely but still had conductive hearing loss. Your next line of treatment is: - Give another course of a different antibiotic - Do a myringotomy and culture the middle ear fluid - Do a myringotomy and insert a grommet \* Wait and watch for 3 months for fluid to drain spontaneously ----------------------- Вопрос 385----------------------- A 5 year old male child had acute otitis being treated with ear drops, oral antibiotics and analagesics. Two weeks after he presented with a swelling over the mastoid, pain in the ear with pulsatile ear discharge and fever. Now treatment of the child would include: - IV antibiotics, Cortical mastoidectomy,Analgesics - Modified radical mastoidectomy - Antihistamines - All of the above ----------------------- Вопрос 386----------------------- A pregnant woman in third trimester complains of hearing her own sounds. Examination of the ear shows movements of the tympanic membrane synchronus with respiration and especially exaggerated when nostril on the contralateral side is occluded. Your diagnosis is: - Eustachian tube obstruction - Patulous Eustachian tube - Otitis media with effusion - Otosclerosis ----------------------- Вопрос 387----------------------- A 30 year old woman with family history of hearing loss from her mother's side developed hearing problem during pregnancy. Hearing loss is bilateral, slowly progressive, with bilateral tinnitus that bothers her at night. Pure tone audiometry shows conductive hearing loss with an apparent bone conduction hearing loss at 2000Hz. What is the most likely diagnosis? \* Otosclerosis - Acoustic neuroma - Otitis media with effusion - Sigmoid sinus thrombosis ----------------------- Вопрос 388----------------------- A 31 year old female patient complains of bilateral impairment of hearing for the past 5 year. On examination, tympanic membrane (TM) is normal and audiogram shows bilateral conductive loss. Impedance audiometry show AS type of curve and absent acoustic reflex. All constitute part of treatment except: - Hearing aid - Stapedectomy - Sodium fluoride - Gentamicin therapy ----------------------- Вопрос 389----------------------- A 55 ear old female presents with tinnutis, dizziness and history of progressive deafness. Differential diagnosis includes all except: - Acoustic neuroma - Endolymphatic hydrops - Meningioma \* Histiocytosis X ----------------------- Вопрос 390----------------------- A child aged 3 years presented with severe sensorineural deafness, he was prescribed hearing aids but showed no improvement. What is the next line of management? - Fenestration surgery - Stapes mobilization \* Cochlear implant - Conservative ----------------------- Вопрос 391----------------------- An elderly man had long standing ear discharge and now presented with facial palsy, pain in the ear which is worse at night and a friable polyp in the ear with tendency to bleed. The likely diagnosis is: - CSOM with polyp - Malignant of middle ear \* Ca of middle ear - Glomus tumour ----------------------- Вопрос 392----------------------- Which of the following conditions causes the maximum hearing loss? - Ossicular disruptions with intact TM - Disruptions of malleus and incus as well TM - Partial fixation of the stapes footplate - Otitis media with effusion ----------------------- Вопрос 393----------------------- Which of the following is not a typical feature of malignant otitis externa? - Caused by P.aeruginosa - Pt are usually old \* Mitotic figures are high - Pt is immune compromised ----------------------- Вопрос 394----------------------- Operation of choice for coalescent mastoiditis is: - Cortical mastoidectomy - Modified radical mastoidectomy - Radical mastoidectomy - Fenestration operation ----------------------- Вопрос 395----------------------- Tympanic membrane develops from: - Ectoderm - Mesoderm - EndodermOnly (a) and (c) ----------------------- Вопрос 396----------------------- True about tympanic membrane? - Attached to oval window \* Forms an angle of 55 degree with external auditory canal - Chordae tympani nerve passes through pars tensa - Cone of light forms on anteriosuperior quadrant ----------------------- Вопрос 397----------------------- Stapes footplate covers: - Round window - Oval window - Sinus tympani - Pyramid ----------------------- Вопрос 398----------------------- Pinna attains 90-95% of adult size by: - Birth - 5-6 years - 9- 10 years - 11- 12 years ----------------------- Вопрос 399----------------------- Nerve supply of tympanic membrane is derived from: - Auriculotemporal nerve - Auricular branch of vagus - Glossopharyngeal nerve \* All of the above ----------------------- Вопрос 400----------------------- A 20 year old boy with had running nose followed by severe ear ache.One day later he had mucupurulent discharge from ear. Diagnosis is: - Malignant otitis externa \* Acute suppurative otitis media - Eustachean tube catarrhal - Myringitis Bulbosa ----------------------- Вопрос 401----------------------- The Female presents with a history of progressive breathlessness. Histology shows heterogeneous patchy fibrosis with several fibroblastic foci. The most likely diagnosis is - Cryptogenic organizing pneumonia - Non-specific interstitial pneumonia \* Usual interstitial pneumonia - Desquamative interstitial pneumonia ----------------------- Вопрос 402----------------------- The most common source of pulmonary embolism is - Amniotic fluid embolism - Renal artery embolism \* Large veins of the lower limb - Cardiothoracic surgery ----------------------- Вопрос 403----------------------- Alpha I antitrypsin deficiency is associated with \* Panacinar - emphysema - Centriacinar - emphysema - Paraseptal - emphysema - Irregular - emphysema ----------------------- Вопрос 404----------------------- A patient of pneumonia develops sputum expectoration. What is the stage of pneumonia? - Congestion - Red hepatization - Grey hepatization \* Resolution ----------------------- Вопрос 405----------------------- Bronchopneumonia means - Inflammatory involvement of a lobe of a lung \* Inflammatory involvement of the airways; the bronchus & the lung parenchyma - Dilatation of the bronchioles - Inflammatory involvement of the lymphatics ----------------------- Вопрос 406----------------------- True about pulmonary infarct is - Occurs in otherwise normal lungs - Occurs commonly with fat embolism \* Mostly red infarct with hemorrhagic exudate - The hemorrhagic effusion may occur ----------------------- Вопрос 407----------------------- Pleural effusion in cirrhosis all are true except - Pleural LDH serum LDH \* Protein 10g/L - Glue 80 mg - S G below 1.012 ----------------------- Вопрос 408----------------------- The following image is the lung biopsy of a middle lobe lung lesion of an HIV patient with fever. What is the diagnosis - small cell cancer \* CMV pneumonia - cryptococcal pneumonia - tuberculosis ----------------------- Вопрос 409----------------------- The histologic entity that has the worst prognosis is interstitial lung disease is - Non-specific interstitial pneumonia - Desquamative interstitial pneumonia \* Acute interstitial pneumonia - Usual interstitial pneumonia ----------------------- Вопрос 410----------------------- The most common termination of lobar pneumonia is - Consolidation \* Resolution - Abscess formation - Empyema ----------------------- Вопрос 411----------------------- Heart failure cells are seen in - Pulmonary infarction \* Pulmonary edema - Pneumonia - Pulmonary embolism ----------------------- Вопрос 412----------------------- Transudative pleural effusion is due to - SLE \* Peritoneal dialysis - Pancreatitis - Asbestosis ----------------------- Вопрос 413----------------------- A 56-year-old male who presented with severe respiratory distress high-grade fever and streaks of blood in sputum dies 7 days after hospitalization in ICU. Lung autopsy has been shown below. Identify the pathology - Lobar Pneumonia - Bronchopneumonia - Tuberculosis - Bronchogenic carcinoma ----------------------- Вопрос 414----------------------- B/L Exudative pleural effusion seen in ? - SLE - Lymphoma - CCF - Nephrotic syndrome ----------------------- Вопрос 415----------------------- Which of the following is not true about pulmonary embolus? \* Most of the emboli cause infarction - Most lesions affect are in the lower lobes - Small arterioles are blocked - Saddle embolus may cause sudden death ----------------------- Вопрос 416----------------------- Which is not an inflammatory stage in pneumonia - \* Organization - Congestion - Resolution - Hepatisation ----------------------- Вопрос 417----------------------- In primary atypical pneumonia, inflammatory cells accumulate in - - Alveolar lumen - Bronchioles \* Alveolar wall - Pleural space ----------------------- Вопрос 418----------------------- The percentage of pulmonary emboli, that proceed to an infraction, is approximate - - 0-5% \* 5- 15% - 20-30% - 30-40% ----------------------- Вопрос 419----------------------- In the stage of Grey hepatization - - WBC's fill the alveoli - RBC's fill the alveoli - Organisms fill the alveoli \* Accumulation of fibrin ----------------------- Вопрос 420----------------------- D-dimer is the most sensitive test for- \* Pulmonary embolism - Acute pulmonary edema - Cardiac tamponade - Acute MI ----------------------- Вопрос 421----------------------- The normal amount of pleural fluid is approximately - 5ml \* 15 ml - 50 mL ----- 100m1 ----------------------- Вопрос 422----------------------- Which of the listed symptoms are observed in patients with pleural effusion? - Displacement of the trachea to the affected side - Crackles on the affected side - Intercostal retraction on affected side \* Reduced or vanished Fremitus pectoralis on affected side ----------------------- Вопрос 423----------------------- Which of listed chest X-ray opacities are a sign of pleural effusion? - Intensive opacity in one segment of the lung with volume loss - Intensive opacity in one lobe of the lung with volume loss \* Intensive opacity in meniscus shape in lower/lateral part of lung - Total opacity with displacement of mediastinum to affected side ----------------------- Вопрос 424----------------------- 46-year-old man with a history of frequent alcohol use is hospitalized. He has fever, cough with green and foul smelling sputum for the last 10 days. What is the most possible diagnosis? - Community acquired pneumonia. - Empyema. \* Lung abscess. - none of the above ----------------------- Вопрос 425----------------------- The main radiological sign of spontaneous pneumothorax is: - No lung markings - Horizontal pleural effusion level - Homogeneous opacity - Inhomogeneous opacity ----------------------- Вопрос 426----------------------- Which of the listed symptoms can occur in case of pneumonia? - Cough with sputum. - Crackles in lungs - Consolidation on chest X-ray. \* All mentioned symptoms ----------------------- Вопрос 427----------------------- What pathological lung process is characterized by dullness of percussion, severely diminished fremitus pectoralis, bronchophony and breath sounds? - Pneumothorax - Emphysema - Pneumonia \* Pleural effusion ----------------------- Вопрос 428----------------------- In type -II respiratory failure, there is: - Low pO2 and low pCO2 \* low pO2 and high pCo2 - Normal pO2 and high pCO2 - Low pO2 and normal PCO2 ----------------------- Вопрос 429----------------------- False statement about type I respiratory failure is: \* decreased PaO2 - decreased PaCO2 - normal PaCO2 - normal A -a gradient ----------------------- Вопрос 430----------------------- Which of the following a sign of Pulmonary embolism? - Westermark sign - Palla's sign - Hampton's Hump \* All of the above ----------------------- Вопрос 431----------------------- Tuberculous pleural effusion is characterized by all of the following features except: - Hemorrhagic effusion - Pleural fluid LDH more than 60% that of serum LDH - Increased deaminase \* Increased mesothelial cells ----------------------- Вопрос 432----------------------- A feature of P.E.? - Tachycardia - Paradoxical bradycardia - Hypotension \* All are true ----------------------- Вопрос 433----------------------- Left-sided pleural effusion seen in - Pancreatitis - Rheumatoid arthritis - Esophageal rupture \* all of the above ----------------------- Вопрос 434----------------------- Which of the following is the most common symptom of Acute pulmonary embolism? - Hemoptysis \* Dyspnea - Pain chest - Dizziness ----------------------- Вопрос 435----------------------- Which one of the following conditions may lead to exudative pleural effusion? - Cirrhosis - Nephrotic syndrome - Congestive heart failure \* Bronchogenic carcinoma ----------------------- Вопрос 436----------------------- All of the following are causes of transudative pleural effusion except: \* Rheumatoid arthritis - Constrictive pericarditis - Myxedema - Pulmonary embolism ----------------------- Вопрос 437----------------------- All of the following condition may predispose to pulmonary embolism except\|: - Protein S deficiency - Malignancy - Obesity \* Progesterone therapy ----------------------- Вопрос 438----------------------- All of the following is a characteristic feature of primary spontaneous pneumothorax except? - Male gender \* Old age - Tall stature - History of smoking ----------------------- Вопрос 439----------------------- Which of the following condition is the least common cause of pneumothorax? - Emphysema - Asthma - Marfan syndrome \* Chronic bronchitis ----------------------- Вопрос 440----------------------- Caisson's disease is? - Gas embolism - Fat embolism - Amniotic fluid embolism - Tumor embolism ----------------------- Вопрос 441----------------------- Mc Connell Sign is seen in? - Ca lung - Sarcoidosis \* Pulmonary embolism - Asbestosis ----------------------- Вопрос 442----------------------- The best investigation when there is clinical suspicion of pulmonary embolism in a patient is? - D-Dimmer Assay \* Multidetector CT angiography - Doppler ultrasound - Catheter angiography ----------------------- Вопрос 443----------------------- D-dimer is the most useful diagnostic test for which condition? - Pulmonary embolism - Acute pulmonary edema - Cardiac tamponade - Acute myocardial infarction ----------------------- Вопрос 444----------------------- D-Dimer values may be increased in all of the following except: - Pulmonary embolism \* Pneumonia - Thrombolytic therapy - Pregnancy ----------------------- Вопрос 445----------------------- In an adult patient with pleural effusion, the most appropriate site for pleurocentesis done by inserting a needle is in: - 5th intercostals space in the midclavicular line \* 7th intercostal space in the mid-axillary line - The 2nd intercostal space adjacent to the sternum - 10th intercostal space adjacent to the vertebral column ----------------------- Вопрос 446----------------------- All of the following are true about pleural effusion, Except? - Decreased lung volume - Decreased heart sounds - Decreased chest movement \* Succussion splash ----------------------- Вопрос 447----------------------- Which of the following is a cause of hemothorax? - Trauma - Malignancy ---------- Pulmonary embolism \* All of the above ----------------------- Вопрос 448----------------------- Amylase increased in pleural fluid is seen in following except? - Rheumatoid - Esophageal perforation - Malignancy - Gallstone pancreatitis ----------------------- Вопрос 449----------------------- A high amylase level in pleural fluid suggests a diagnosis of? - Tuberculosis \* Malignancy - Rheumatoid arthritis - Pulmonary infarction ----------------------- Вопрос 450----------------------- Decreased Glucose in a pleural effusion is seen in? - Rheumatoid arthritis - SLE - Pneumococcal infection - P.carinii infection ----------------------- Вопрос 451----------------------- A pleural fluid having low glucose is seen in all, except? - Tuberculosis - Empyema - Mesothelioma - Rheumatoid arthritis ----------------------- Вопрос 452----------------------- A 40 years-old alcoholic develops a cough and fever. Chest x-ray shows an air-fluid level in the superior segment of the right lower lobe. The most likely etiologic agent is - Streptococcus pneumonia - Haemophilus influenza - Legionella \* Anaerobes ----------------------- Вопрос 453----------------------- The most common cause of empyema is: - Bronchopleural fistula - Tubercular pneumonia \* Bacterial pneumonia - Pleurisy ----------------------- Вопрос 454----------------------- Pneumothorax occurs in? - Chronic bronchitis \* Emphysema - Both - None ----------------------- Вопрос 455----------------------- Indication for prophylaxis in pneumocystis carini pneumonia include? - CD4 count \< 200/ µ - Tuberculosis - Viral load \> 25,000 copies/ml - Oral candidiasis ----------------------- Вопрос 456----------------------- A most important cause of nosocomial pneumonia is? - Streptococcus - Haemophilus influenza - Moraxella catarrhal \* Gram-negative enterobacteria ----------------------- Вопрос 457----------------------- True about legionella pneumonia is? - Interstitial pneumonia - Dry cough - Diarrhea \* All of the above ----------------------- Вопрос 458----------------------- Devi a 28-year female, has diarrhea, confusion, high-grade fever with bilateral pneumonitis. The diagnosis is? \* Legionella - Neisseria meningitis - Streptococcus pneumonia - H.influenze ----------------------- Вопрос 459----------------------- Patient with spontaneous primary pneumothorax should be referred to thoracic surgeon if: 1. Pneumothorax persist \>5 days. 2. Patient himself wants a surgical treatment. 3. Lung is collapsed totally. 4. Patient is passenger aircraft flight attendant. 5. Patient is army aircraft pilot. - 1, 2, 3. - 1, 2, 4, 5 - 2, 3, 4. - 2, 3, 4, 5 ----------------------- Вопрос 460----------------------- All are the histological features of Pulmonary hypertension - a) Capillaritis of alveolar septa b) Saddle thrombi in the pulmonary trunk c) Thrombi in the pulmonary vasculature d) Vaso-occlusive disease e) Arterial wall thicken - cde - acd - bde - ade ----------------------- Вопрос 461----------------------- Which of the following symptoms is observed in case of severe pneumonia? - Cough - Elevated body temperature - Elevated CRP level \* Possible all listed symptoms ----------------------- Вопрос 462----------------------- Pleural effusion in a 70-year-old patient is possible due to: - Lung tumor - Heart failure. - Pulmonary embolism \* All of the above. ----------------------- Вопрос 463----------------------- Most frequent cause of chronic Cor pulmonale is: - Extreme adiposity. - Recurrent pulmonary embolism. - Pulmonary arterial hypertensionCOPD ----------------------- Вопрос 464----------------------- Which is the most effective antibacterial agent against methicillin resistant staphylococcus? - Gentamycin - Cefamezine - Clarithromycin \* Vankomycin. ----------------------- Вопрос 465----------------------- Which of the following statements about peak flow meter is incorrect? - Measures only the peak expiratory flow - Results are measured in L/sec - Diurnal peak flow-metry changes more than 15-20% are characteristic for asthma. \* Lung auscultation allows better objective evaluation of the severity of bronchial obstruction ----------------------- Вопрос 466----------------------- Which of the following statements about pneumothorax is incorrect? - Breathing sounds over the area of pneumothorax are diminished - Percussion note over the area of pneumothorax is accented (hyperresonant, drum-like sound) - Fremitus pectoralis is decreased over the area of pneumothorax \* Lung collapse on the side of pneumothorax is always total - partial pneumothorax is not possible ----------------------- Вопрос 467----------------------- In case of uncomplicated community-acquired pneumonia, caused by Streptococcus pneumoniae, first line antibiotic would be: - Gentamycin \* Amoxicillin - Doxycycline - Ceftriaxone. ----------------------- Вопрос 468----------------------- The most appropriate antibacterial agent to treat pneumonia, caused by atypic pathogens (e.g., mycoplasma), is: - Streptomycin. - Penicillin. - Clarithromycin. - Metronidazole. ----------------------- Вопрос 469----------------------- The following symptoms are characteristic to chronic respiratory failure except: - Erytrhocytosis. - Elevation of serum hemoglobin concentration \* Increased circulatory blood volume - Enhanced blood flow through pulmonary capillaries ----------------------- Вопрос 470----------------------- Which symptom is not characteristic for the perforation of the abscess to bronchus? - Enlarged amount of sputum. - Increased circulatory blood volume - Formation of cavity with air-fluid level seen on X-ray. C. Exacerbation of cough \* Increase in body temperature. ----------------------- Вопрос 471----------------------- The possibility of a formation of lung abscess is pointed out by: - Cavity with air/fluid level - Rise of CRP level. - Increase in body temperatureAll these symptoms are prognostically essential. ----------------------- Вопрос 472----------------------- The most common reason for exudative pleural effusion is: --------------------------------------------------------- Tuberculosis \* Pneumonia with pleural involvement - Pulmonary infarction. - Chest trauma ----------------------- Вопрос 473----------------------- The most common subjective symptom of spontaneous secondary pneumothorax is: \* Dyspnea. - Retrosternal pain - Haemoptysis - Dizziness. ----------------------- Вопрос 474----------------------- The risk of destructive pneumonia is elevated in all of these pathogens except: - Klebsiella. - Staphylococcus - Pseudomona. \* Mycoplasma. ----------------------- Вопрос 475----------------------- The risk of formation of lung abscess is elevated in all of the mentioned patient groups except: - Alcoholics \* Patients with asthma - Patients after cerebral stroke - Patients with diabetes taking insulin therapy ----------------------- Вопрос 476----------------------- Patient with cough and elevated body temperature have a dull note on percussion, weakened vesicular breathing and few inspiratory crackles can be heard over the left side lower part of lung. These findings are most common for: \* Pneumonia - Pleural effusion - Tuberculosis. - Bronchiectasis ----------------------- Вопрос 477----------------------- In the case of acute respiratory failure the following signs can be observed: - Patient awareness and behavioral disorders - Respiratory frequency, depth, rhythm disturbance. - Changes in the ventilation, blood gases and acid-alkaline composition scores. \* All the signs can be observed ----------------------- Вопрос 478----------------------- Beginning period of typical pneumonia is characterized by the following symptoms, except: - Rapid increase of body temperature - Chest pain, worse when breathing \* Eosinophilia. - Marked intoxication ----------------------- Вопрос 479----------------------- Respiratory failure measurement of the following is: - Decreased peak expiratory flow rate capacity. - Central cyanosis. - Blood pH - All are equally plausible ----------------------- Вопрос 480----------------------- In which of the patients with 3 days of painful cough and febrile temperature will you start treatment with amoxicillin? \* X-ray -consolidation of the right middle lung lobe, Streptococcus pneumoniae antigen in urine positive - Swab from the throat is influenza A RNA positive. - X-ray - consolidation of the right middle lung lobe, in sputum grows Pseudomonas aeruginosa - Sputum microscopy detects acido-resistant bacteria ----------------------- Вопрос 481----------------------- In which of the patients with 3 days of painful cough and febrile temperature will you start a treatment with Ceftazidime? - X-ray -consolidation of the right middle lung lobe, Streptococcus pneumoniae antigen in urine positive. - Swab from the throat is influenza A RNA positive \* X-ray - consolidation of the right middle lung lobe, in sputum grows Pseudomonas aeruginosa. - Sputum microscopy detects acido-resistant bacteria ----------------------- Вопрос 482----------------------- A 78-year-old man presents with fever, cough productive of green sputum and shortness of breath.On examination his respiratory rate is 30 breath/min, and there are coarse crackles and bronchial breathing auscultated at the right mid zone, with stoney dullness on percussion at the right lower zone. What is most likely diagnosis? - Pneumonia - Tuberculosis - Pulmonary infarction - Cardiac failure ----------------------- Вопрос 483----------------------- The main symptom, which helps to differentiate acute bronchitis from pneumonia: - New focal opacities in X-ray. - Auscultation rales at inhalation - Cough more than 14 days - Increased temperature. ----------------------- Вопрос 484----------------------- During fibrobronchoscopy the following cannot be assessed: \* Parietal pleura - Vocal chords. - Tracheal bifurcation area - Proximal part of segmental bronchi. ----------------------- Вопрос 485----------------------- The virtual bronchoscopy is a/an: - Radiological method - Endoscopic method - Clinical method. - Laboratory method ----------------------- Вопрос 486----------------------- The oxygen saturation in the peripheral blood can be measured by: - Lip cyanosis intensity - Assessment of respiration rate - Patient complaints. \* Pulse oximetry. ----------------------- Вопрос 487----------------------- Normal pleural cavity content is: - Air \* Liquid in small quantities. - There is no pleural cavity in a healthy person - Pulse oximetry ----------------------- Вопрос 488----------------------- The fluid in the pleural cavity most accurately can be diagnosed with: - Auscultation - Pulse oximetry. \* Ultrasonography. - Pulse oximetry. ----------------------- Вопрос 489----------------------- The air in the pleural cavity most accurately can be diagnosed with: - Pulse oximetry - Ultrasonography. \* Chest X-Ray. - Auscultation. ----------------------- Вопрос 490----------------------- For pleural cavity puncture is necessary: - Anesthetizing agents, a large-gauge needle and open container to collect the fluid \* Anesthetizing agents, closed pleural puncture system - Needle, drain and pump. - Ultrasonography ----------------------- Вопрос 491----------------------- In order to determine the most accurate pleural puncture site: - Patient should be auscultated beforehand - Take a Chest X-ray the day before \* Pleural cavity should be investigated before puncture by ultrasound. - Palpation of the patient's chest, to find the most painful place, and there should the pleural pu

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