Internal Medicine 4 Past Paper PDF 2020

IK/IM-GM4/19 40 Internal medicine 4 ZS 2020 password 322 1. Immune System of a geriatric patient is characterized by: improved response to antigenous stimulation no production of auto antigens immune-deficit due to malnutrition keeping functionality of cell imunity...

IK/IM-GM4/19 40 Internal medicine 4 ZS 2020 password 322 1. Immune System of a geriatric patient is characterized by: improved response to antigenous stimulation no production of auto antigens immune-deficit due to malnutrition keeping functionality of cell imunity /T-lymphocytes/ on the same level as young people (1 mark ) 2. An acute state of confusion, which is relatively short and reversible is named: Disorentation State of anxious hopelessness Dementia Delirant state (1 mark ) 3. Ageism means: giving preferentiality to seniors in the society torturing seniors increased interest in senior by young people discrimination of senior in the society (1 mark ) 4. Sleeping disorders in the elderly: do not feature Insomnia exclude Parasomnia do not occur in such age include Hypersomnia (1 mark ) 5. Risk factors of immobility do NOT include: Dementia Sudden coronary stroke Uroinfection Osteoporosis (1 mark ) 6. Potential drug interactions: they are not important they are not recognisable they are not frequent in old people should be searched for at every visit (1 mark ) 7. Prior to planned surgical operation in is not necessary to stop administering: ASA Peroral anticoagulances NSA LMWH /low-molecular heparin/ (1 mark )  8. Average life expectance is now (Resnick, NM, 2006; Harrison´s Internal Disease, 16th Edition, Vol I, s. 44): 11 years at age 75 2 years at age 65 5,5 years at age 65 9 years at age 65 (1 mark ) 9. Certain features of the examination should receive special attention, depending in part on clues from the history: pts (patients) who fall should not be observed standing up from a chair, bending down, reaching up, walking 3 m, turning, returning, and sitting again weigt and postural BP should be measured at most visits; vison and hearing should by checked (cerumen!), the systolic murmur of aortic sclerosis is common and may be difficult to differentiate from aortic stenosis In pts with urinary incontinence-especialy men-a distended bladder must not be looked for since it may be the only finding in urinary retention is not important (1 mark ) 10. Disease presentation in the elderly is: often atypical, especially in those > 65 old; because of increased physiologic reserve, older patients often develop symptoms at an later stage of their desease; there are usually single abnormality amenable to treatment, and large improvements in eac often typical, especially in those > 80 old; because of increased physiologic reserve, older patients often develop symptoms at an later stage of thier disease; there are usually single abnormality amenable to treatment, and large improvements in each often atypical, especially in those > 90 old; because of decreased lphysiologic reserve, older patients often develop symptoms at an later stage of their disease; there are usually single abnormality amenable to treatment, and large improvements in ea often atypical, especially in those >70 to 80 old; because of decreased physiologic reserve, older patients often develop symptoms at an earlier stage of thier disease; there are usually multiple abnormalities amenable to treatment, and small improvem (1 mark ) 11. Some select physiologic changes (or consequences) age related of important organs systems in gastrointestinal: increase colonic motility increase anorectal function decrease gastric acidity increase hepatic function (1 mark ) 12. Some select physiologic changes (or consequencs) age related of important organs systems in cardiovascular: ↑ baroreceptor sensitivity and ↑ SA automacity syncope, atrial fibrillation, heart block, heart failure ↑ arterial compliance and ↓ systolic BP ↑ ß-adrenergic responsiveness (1 mark ) 13. Average disability-free remaining at men/women in 75-80 yers is (Katz S et.al: N Engl J Med 309:1218:, 1983): 3/3 8/8 7/7  9/11 (1 mark ) 14. Some select physiologic changes (or consequences) age related of important organs systems in nervous: ↑ righting reflesex, ↑ stages 4 sleep, better thermal regulation brain atrophy, ↓ brain catechol synthesis, ↓ brain dopaminergic synthesis decrease incidence of delirum and depression none Parkinsone disease, none falls (1 mark ) 15. Changes in the Blood Circulation System of a geriatric patient are chracterized by: keeping elasticity of arteries increased blood flow through all organs worsening the Left Ventricle´s flexuosity lowering burden on the Left Ventricle (1 mark ) 16. Many finding that are abnormal in younger patients are relatively: common in older people e.g., bacteriuria, premature ventricular contractions, low bone mineral density, impaired glucose tolerance, and uninhibited bladder contractions infrequency in older people e.g., bacteriuria, premature ventricular contractions, low bone mineral density, impaired glucose tolerance, ang uninhibited bladder contractions extraordinary in older people e.g., bacteriuria, premature ventricular cintractions, low bone mineral density, impaired glucose tolerance, and uninhibited bladder contractions sometimes in older people e.g., bacteriuria, premature ventricular contractions, low bone mineral density, impaired glucose tolerance, and uninhibited bladder contractions (1 mark ) 17. Most important anatomic and functional changes CVS in old age: number of pacemaker´s cells ↓, number of contractile cardiomyocytes ↓ interstitial connective tissue calcification of the heart fibrous tissue ↓, collagen in the aorta wall and a great arteries ↓ density of adrenergic beta-receptors ↑ (1 mark ) 18. Serum kreatinine in old people is: is briliant index of renal function is not a good index of renal function, however, when is elevated, special care must be taken with the administration of drugs normaly excreted by the kidneys is a good index of renal disease is not a good index of renal function, howeevr, when is elevated concentrations of relevant antibiotics should not be measured directly (1 mark ) 19. Even beyong age 85 (Resnick NM, Dosa D, 2006, in 16th Edithin Harrison´s Internal disease, Vol. I): only 20% of people are impaired in any activitity required for daily living and only 30% reside in a nursing home only 5 % of people are impaired in any activitity required for daily living and only 5 % reside in a nursing home only 10% of people are impaired in any activitity required for daily living and only 10% reside in a nursing home only 30% of people are impaired in any activitity required for daily living and only 20% reside in a nursing home (1 mark ) 20. Evaluation of the older patient (pt) can: be time-consuming, even i tis tailored to the problem observing the pt dress or undress can not enhance detection of impaired cognition, fine motor skills, balance, and judgment initial investment can not reduce subsequent morbidity and resource utilization assessment can nit often be accomplished over several visits (gleaned from questionnaires filled oud by patient-or caregiver) as well as from observation (1 mark ) 21. During nasal provocation test we evaluate: symptom score and rhinomanometry together only rhinomanometry only symptom score rhinomanometry and acoustic rhinometry together (1 mark ) 22. Pneumoconiosis is generally diagnosed using the following examination method: only chest X-ray only bronchoscopy with lung biopsy a combination of: occupational history, clinical symptoms, a physical examination, pulmonary function tests, chest X-ray, HRCT scan of the chest, in special case bronchoscopy and lung biopsy only occupational history (1 mark ) 23. Among the typical occupational cancer belongs: brain cancer pleural mesothelioma colorectal cancer pancreatic cancer (1 mark ) 24. EU Safety and Health at Work are include in: directive recommendation regulation opinion (1 mark ) 25. The most typical occupation with the high risk of vocal cords disorders is: pharmacist manager physician teacher (1 mark ) 26. The most common etiological factors of occupational rhinitis belongs: coal dust isopropyl alcohol silica dust flour (1 mark ) 27. X-ray shadows of small opacities (under 1 cm) accord to International Labour Office Standardisation (ILO) are index:  RU, RM, RL A, B, C Sij, Sil, Sitbc p, q, r (1 mark ) 28. Typical chest X-ray signs of simple silicosis are: enlargement of lymph nodes presence of large conglomerate opacities (shadows with diameter higher than 10 mm) pleural adhesions generally pattern of small and round opacities (shadows with diameter less than 10 mm) (1 mark ) 29. Carpal tunnel syndrome treatment include: endoscopic surgery local pain killers (e.g. procain injection) myorelaxans vasodilatators (e.g. calcium channel blockers) (1 mark ) 30. Early, localized infection of Lyme disease is characterized by: migrant polyarthralgia localized scleroderma erythema migrans Lyme polyradiculitis (1 mark ) 31. Neer test is present during: impingement syndrome of upper extremities acute vein thrombosis isolated ischemic damage of nerve fibres chronic epicondylitis (1 mark ) 32. Typical etiological agent for cancer of the nose and paranasal sinuses is: hard wood dust asbestos soft wood dust radon (1 mark ) 33. Mechanism of plethysmography is in: measurement of carbon dioxide in tissue scanning of electrical potentials from muscle activity measurement of capillary volume changes measurement of capillary return (1 mark ) 34. Gold standard in diagnosis of TBC is: Quantiferon test blood count Mantoux II typical history of night fever (1 mark ) 35. Kussmal trias is clinical manifestation as: stomatitis, eretismus and tremor polyneuropathy, stomatitis and renal colic inadequate laugh, euphory, aggressiveness abdominal colic, grey border on gum and polyneuropathy (1 mark ) 36. Occupational disease from long-term, overused and one-side load affect: heart lung extremities CNS (1 mark ) 37. Etiological factor for liver angiosarcoma is: ionizing radiation polyvinyl chloride asbestos hard wood (1 mark ) 38. The higher EU-27 labour force works at domain: services constructing industry mining agriculture (1 mark ) 39. Typical X-ray signs of complicate silicosis are: bronchiectasis along generalised nodulation presence of shadows with diameter higher than 10 mm pleural adhesions generalised nodulation (shadows with diameter less than 3 mm) (1 mark ) 40. Raynaud phenomena is not component part of: hand arm vibration syndrome rheumatic fewer systematic lupus erythematosus syndrome of upper thoracic aperture (1 mark ) © 2020, UPJS NaN:NaN IK/IM-GM4/19 40 Internal medicine 4 ZS 2020 password 322 1. Some select physiologic changes (or consequences) age related of important organs systems in hematologic/immune: polycythemia ↑ bone marrow reserve ↓ autoantibodies anemia, autoimmune diseases (1 mark ) 2. Part of the elderly regularly use nonprescribed drugs, many of which cause significant symptoms and/or interact with other medications: nearly three-quarters 1 one third 10% (1 mark ) 3. Study HYVET was prematurely ended (before ending follow up in sub-study of cognitive function). In spite of that HYVET demonstrated: substantly increase incidence of dementia cases by active theapy increase incidence of dementia cases by active therapy tendency to reduce incidence of dementia cases by active therapy none effect (1 mark ) 6. Frequent of the elderly use nonsteroidal anti-inflammatory drugs (NSAIDs), which: can make stopping of GI bleeding can make better control of arterial hypertension are bening can hamper control of AH in addition to causing renal dysfunction and GI bleeding (1 mark ) 8. Insomnia is: somatic, not caused by pain iatrogenous, is associated with taking some medicine not associated with depression Parasomnia´s equivalent (1 mark ) 9. Is recommended for presciption some pharmacological drugs: Cyclooxygenase 2 (COX-2) inhibitors are not safer than nonselective NSAIDs for older adults COX-2 inhibitors can not cause fluid retention with consewuent worsening of hypertension Each of these agent should be avoided in the elderly: of the NSAIDs, indomethacin is most likely to induce confusion fluid retention, and GI bleeding. Both propoxyphene and meperidine are not associated with a disproportionate risk of delirium, and p COX-2 inhibitors can not cause nocturnal incontinence (1 mark ) 10. Immobilization Syndrome is associated with: hypoventilation and developing pneumonia  hypertension reducing risk of developing thrombo-embolia improving movement coordination (1 mark ) 11. Fundamental pathophysiologic features of hypertension in the elderly: ↓ production of PG, R All ↑ excretion potency capacity of Na renal elimination structual changes of vessels ( ↑ rigidity, ↓ compiance) lower incidence of atherosclerosis (1 mark ) 12. For several reasons, older pts are 2 or 3 times more likely to have adverse drug reactions. Why? increase in proten binding of some drugs serum albumin levels increase increase in total-body water and relative decrease in body fat drug celarence is often markedly reduced, volume of distribution of drugs is also affected (1 mark ) 13. The highest pre-operation risk in the elderly is represented by: surgical remival of cataract operating on abdomen /laparotomy/ operations on big arteries orthopedic operations on big joints (1 mark ) 14. Hypertension Crisis in old age is a serious issue in which: Coronary Stroke risk is not elevated BP has to be reduced, not necessarily brought to the normal BP is lowered quickly, administration of captoprite is not appropriate BP has to be brought to the normal (1 mark ) 15. Which form of Hypertension is the most common in elderly population? Secondary Hypertensions Isolated Systolic Hypertension Orthostatic Hypotension Isolated Diastolic Hypertension (1 mark ) 16. Some select physiologic changes (or consequences) age related of important organs systems in renal: ↑ GFR impaired excrettion of some drugs, ↑ Serum creatinine none nocturia, none disturbances metabolism of Na ↑ urinae concentration/dilution (1 mark ) 17. Some select physiologic changes (or consequences) age related of important organs systems in eyes and ears: decrease susceptibility of glare better accomodation  improvement high-frequence acuity presbyopia, lens opacification (1 mark ) 19. HYVET Study (HYpertension in Very Elderly Treatment) evidence. Impact of active AH therapy on total mortality in old patients (in age 80 yers and more): results of Study HYVET provide a confirmation, that AH treatment in elderly individuals ? 80 yrs isnot beneficial 21% reduction of heart failure 64 % reduction of total mortality, 30 % reduction of all stroke 21% reduction of total mortality, 30 % reduction of all stroke, 64% reduction of heart failure (1 mark ) 22. Impingement syndrome of shoulders cannot be diagnosed: MRI examination ultrasonography X-ray arthroscopy (1 mark ) 23. Lead intoxication symptom is: abdominal colics insomnia fatigue headache (1 mark ) 25. Deaths attributed by occupational risks is higher at: middle income countries low income countries high income countries does not depend on GDP of countries (1 mark ) 27. Into occupational disease from long-term, overused and one-side load of upper extremities do not belong: osteoarthrosis generalised carpal tunnel syndrome impingement syndrome of upper extremities epicondylitis radialis humeri (1 mark ) 28. Organophosphates intoxication is manifested by cholinergic, muscarinic syndrome anticholinergic syndrome severe colic abdominal pain (saturnine colic) sympathomimetic syndrome (1 mark ) 30. Pneumoconiosis are lung diseases following: inhalation of infection particles mineral oils inhalation of organic dust (e.g. grain) inhalation of mineral dust  (1 mark ) 32. Most common musculoskeletal and neurological occupational diseases is: cubital tunnel syndrome carpal tunnel syndrome ulnar epicondylitis radial epicondylitis (1 mark ) 33. Raynaud syndrome is the present of: ischemic heart disease arterial hypertension Takayasu´s disease hand arm vibration syndrome (1 mark ) 34. An effective vaccination is available against: Hepatitis B AIDS Hepatitis C avian flu (1 mark ) 35. In nonspecific bronchoconstriction test and nasal provocation test we apply: nonspecific chemical substances from workplace physiological solution histamine an allergen (1 mark ) 36. The first choice in pharmacological treatment of Raynaud syndrome are: calcium channel blockers beta-blockers diuretics alpha-blockers (1 mark ) 37. Which of the following intoxication occur most frequently: drug intoxication mushroom intoxication carbon monoxide intoxication pesticides intoxication (1 mark ) 38. Hypersensitivity pneumonitis is caused by repeated inhalation of antigens: organic dust particles air pollution cigarette smoke anorganic mineral dust particles (1 mark ) 39. The most frequent etiological factor of lung cancer in miner is: ionizing radiation heavy water (D2O) tar  coal dust (1 mark ) 40. Which disorder of vocal cords is voice neurosis? severe vocal cord insufficiency nodules of vocal cord serious hyperkinetic dysphonia severe phonaesthesia (for sure) (1 mark ) © 2020, UPJS NaN:NaN 2. Objective of Study HYVET-COG was: to determine whether to determine whether treatment of arterial hypertension in patients ?80s would reduce the incidence of Vascular dementia to determine whether treatment of arterial hypertension in patients ?80s wouldreduce the incidence both, Vascular dementia Alzheimer´s Disease to determine whether treatment of arterial hypertension in patients ? 80s would reduce the incidence of Alzheimer Disease (1 mark ) 8. If nonpharmacologic treatment of insomnia is unsuccessful, may be usefull: benzodiazepines Ginko biloba, increasingly used as a „memory booster“ a tricyclic antidepressant low-dose and short-term or intermittent use of an intermediate-acting whose metabolism is no affected by age (e.g., oxazepam, mg/d) may be useful (1 mark ) 10. Geriatrics´ main task as branch of medicine is to: provide nursing care about long term ill patients who have lost their independence provide diagnostics and treatment of acute reversible illnesses with focus on restoring and retaining independence provide social care about long term ill patients who have lost their independence to substitute for nursing and social services (1 mark ) 12. Nearly three-quarters of the elderly regularly use nonprescribed drugs, many of which cause significant symptoms and/or interact medications. Frequent ofenders include nonprescribed agents for insomnia ( most of which are anticholinergics),and nonsteroidal antiinflammatory drugs (NSAIDs), which can hamper control of AH in addition to causing renal dysfunction and GI bleeding which never can hamper control of AH in addition to causing renal dysfunction and GI bleeding which can improve control of AH in addition to causing renal dysfunction and GI bleeding which can not affect control of AH in addition to causing renal dysfunction and GI bleeding (1 mark ) 13. Which are the most favourable antihypertensive drugs in the elderly? Beta-blockers Calcium Antagonists ACE-inhibitors Alfa-Blockers and Digoxin (1 mark ) 15. Some select physiologic changes (or consequences) age related of important organs systems in musculoskeletal: ↑ lean body mass, muscle none changes better bone density functional impairment, osteopenia, hip fracture (1 mark ) 18. Pharmacotherapy of geriatric patients is characterized by: good patient´s compliance incidence of poly-pragma the fact that good renal clearance for drugs is usually remained low number of drug interaction in poly-morbidity (1 mark ) 19. In addition to impaired drug clearence, which alters pharmacokinetics, older patients (pts) have altered responses to similar serum levels (a phenomen knownas altered pharmacodynamics). They are: less sensitive to some drugs (e.g., opiates, antikoagulans) and more sensitive to others (e.g., ß-adrenergic agents) non sensitive to some drugs (e.g., opiates, antikoagulans) and less sensitive to others (e.g., ß-adrenergic agents) extremly sensitive to some drugs (e.g., opiates, antikoagulans and more sensitive to others (e.g., ß-adrenergic agents) more sensitive to some drugs (e.g., opiates, antikoagulans) and less sensitive to others (e.g., ß-adrenergic agents) (1 mark ) 22. Psychosis (inadequate laugh, euphoria, impulsive negotiation, mixed-upness, aggressively, hallucinations) occurs intoxication Zn Mn Cr Pb (1 mark ) 23. In the diagnosis of dermatosis it is possible to use (select the most appropriate claim): specific IgE antibodies epicutaneous tests (for sure) skin prick tests all claims are correct (1 mark ) 24. Gold standard in the diagnostic algorithm of occupational asthma is: detection of increased eosinophils in blood bronchodilatation test skin prick tests specific bronchoconstriction test (1 mark ) 30. Between complications of pulmonary asbestosis do not belong: lung hypertension mesothelioma lung abscess pulmonary fibrosis (1 mark ) 31. Causal drug for treatment of silicosis is: inhalation corticosteroids cyclosporine we don't know causal drug ß2 - mimetics (1 mark ) 32. Which metal is not neurotoxic: Cr Hg Pb As (1 mark ) 37. Methacholine bronchoconstriction test is positive, if FEV1 will fall minimally … of its basal value: 8% 12% 10% 20% (1 mark ) 38. Relative short latency period (often 3 – 5 years) between the exposition to carcinogen and manifestation of cancer we can see liver angiosarcoma leukaemia lung cancer mesothelioma (1 mark ) some select physiologic changes (or consequences)age related of important organs systems in respiratory: increased cough reflex increased chest wall stiffness increased lung elasticity increased microaspiration, aspiration pneumonia, dysponea, hypoxia 9. Thus, adverse drug reactions and dosage errors are: more likely to occur, especially if the patient has visual, hearing or memory deficit rare to occur not to occur, especially if the patient has visual, hearing or memory deficit occasionally to occur 12. 3rd degree AV block in the eldery should be treated by: Amiodarone implantation of a cardio stimulator prokain digoxin and beta-blockers 21. Typical history in the case of occupational asthma is: worsening of symptoms during the pollen season pesistence of severe dyspnoea despite the application of a bronchodilator exacerbation of symptoms at work with remission during weekend and vacation usually only mild bronchial hyperreactivity in comparing to non occupational asthma 24. the international agency for research on cancer categorizes agents, mixtures and exposures on basic of evidence of carcinogenity in: 3 groups (carcinogen, possible carcinogen or non-carcinogen) 4 groups (group 1- carcinogenic to human, group 2- probably carcinogenic to human, group 3- non-classified, group 4- probably noncarcinogenic to human) 5 groups 2 groups(carcinogen or non-carcinogen) 25. Radon is: X-ray emitter alpha emitter gamma emitter beta emitter 26. Work exacerbated asthma is: asthma that is made worse, but was not initially caused, by workplace conditions typical occupational disease variant of occupational asthma asthma, that is due to sensitization to flour 30. Which occupational oncological disease often occurs due to the exposition to benzene? cancer of paranasal sinuses leukaemia lung cancer mesothelioma 31. Tinel sign is present at: encephalopathy carpal tunnel syndrome radial epicondylitis polyneuropathy 34. pneumoconiosis cannot be caused by: asbestos iron coal dust silica 1)Into definition of occupational health do not blongs: safety at work occupational disease genetic predisposition of some work aggraveted diseases 2)occupational hygiene take care on: A.occupational enviroment B. occupational diseases C. injuries at work 4)Most common risk at work is: noise vibration biological factors 5)in case of loudness risk we can talk if there is average of noise at work over: 130 dB 85dB 100dB 11)under the item of occupational disease’s list. Other disorders from work we can report: low back pain lung cancer ischaemic hearth disease 14)Chronic epicondylitis can be conclude by: x-ray EMG EEG 24. A typical feature of asthma is the daily variability of PEF: 10% 15% 20% 25. Bronchodilatation test id positive, if FEV1 will increase: 8% 12% 20% 28. Functional examination method of upper airways is: nasal lavage rhinomanometry rhinoscopy 3. Decubities are parts of picture of Immobilization syndrome Decubity syndrome Hyperventilation syndrome Orthostatic syndrome 10. Which tools are used to assess mental state of geriatric patient Barthels test MMSE Folsteins test Test of independence 15. Typical feature of geriatric patients illness development is Extremely febrile development of inflammation diseases Extremely painful development of muocardial ischemia Absence of claudicational or anginous pain in patients with osteoarhrosis of lower limbs Rare loss of independence and development of amently childish states 64. select physiologic changes age related of important organs systems in general: decrease body fat and increase total body water increase body fat and decrease total body water only decrease total body water only reduction body fat To health chemical hazards at the work belongs Gases Stress Viruses Noise To the most frequently reported occupational skin diseases belong Skin tuberculosis Solar dermatitis Contact allergic dermatitis Anthrax of skin In older patients Digitales, procainamide and quinidine have prolonged half-lives, narrow therapeutic windows Toxicity digitales, procainamide and quinidine is very low at the usual dosages Digoxin toxicity, especially anorexia, confusion, or depression can not occur with therapeutic digoxin levels Procainamide, and quinidine are absolutely safe drugs Lithium is indicated In the treatment of the rheumatological patients In the treatment of the psychiatric patients In the treatment of the patients with respiratory diseases In the treatment of the hematological patients Most common occupational diseases are Musculoskeletal diseases Cancers Infections Respiratory diseases 15.secondary elimination includes: removal of toxic substance from the body after absorption into the blood (not true) vomitus administration of antidote discontinuation of contact with a toxic substance Finally the older patients with multiple chronic condition: is likely to be taking only one single drugs is likely to be taking any drugs, any nonprescribed agents is likely to be taking only prescribed agents is likely to be taking severant drugs, include nonprescribed agents International labour Organization and World Health Organization definition of Occupational Health is: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations control of occupational disease checkup of the employees measuraments of risk factors at work 9.some select physiologic changes age related of important organ system in genitourinary: vagina/urethral mucosal atrophy, prostatae enlargement non disturbances of residual urine volume, urinary incontinence na durinary retention decrease urinae volume none dyspareunia, bacteriuria, sympotomatic UTI 6. Which pathogenic agent is able to cause an infection of Q fever? A. coxiella burnetii B. borrella burgdoferi C. Rickttesia D.TBC 7.one of the occupational disease that we can report: herniation of lumbar disc with radicular syndrome affection of lumbar, cervical and thoracic spine together scoliosis disorder of spine is not occupational disease, because it is civilisation illness 37. Role and tasks of Occupational Health Services is not: contributing to occupational rehabilitation and treatment of occupational diseases identification, assessment and control of the risks from health hazards at work providing training and education of occupational risks and first aid check up of workers specifically to risk factors of atherosclerosis 44. Latent tuberculosis infection can be confirmed by: tubercolin skin test and interferon gamma release assays test CRP procalcitonin blood count 48. occupational lung cancer is the most frequently induced by: asbestos benzene dust from hard wood radiation 49. The most frequent occupational cancer is: leukaemia cancer of urinary bladder lung cancer cancer of paranasal sinuses 67. some select physiological changes age related of importat organs systems in gastrointestinal: anorectal continecy increased Ca2+ absorptikon on empty stomach cirrhosis, delayed metabolism of some drug, fecal impaction none osteoporosis non vitamine B12 deficiency non costipation 7. This statistic has important demographic and economic implications. And its impact on medical care is also substancial: of all people who have ever lived to age 65, more than …. are now alive: quarter two third to three quarter half third 18. byssinosis is characteristic : is an occupational respiratory disease associated with inhalation of cotton,flax or hernp dust in present it is very frequent occupational disease in industrialized European countries is form of occupational asthma the symptoms are the worst at the end of working week Anemia, neutropenia, thrombocytopenia is typical for: osteoarthritis dermatomyositis gouty arthritis systemic lupus erythematous 2.Back pain can be caused by: Inflammation all the above mentioned disc disease congenital malformation 3. Dermatomyositis is often associated with: pseudohypertrophia of muscle uveitis malignoma typhus infection 16. International labour organization estimates annually world widely over 15% of the annual GDP by direct and indirect costs of occupational accident over 50 million deaths from work-related accidents 1,95 million fatal work related disease less than 100.000 fatal accidents at work RAIDS (reactive airway disfunction syndrome) is: non accepted as occupational disease induced by work place allergens chronic form of occupational asthma acute form of limitant occupational asthma Acute drug induced interstitial nephritis is mostly caused by: antibiotics