State Exam_Obg And Surg_Tal

Front 1

OBG-5.1
The most prevalent cause of maternal mortality is:
A) toxemia
B) infection
C) cardiac disease
D) hemorrhage
E) diabetes

Back 1

hemorrhage

Front 2

OBG-5.4.
In a normal pregnancy, carbohydrate metabolism changes as follows:
A) glucose tolerance is reduced
B) there is a tendency for the development of glycosuria
C) the glomerular filtration rate of glucose is increased
D) all of the above
E) none of the above

Back 2

all of the above

Front 3

OBG-5.5.
An abnormal hemorrhage complicating a delivery occurs most freqently:.
A) in the third stage of labor
B) during the development of a hematoma which causes the placenta
to separate
C) in the first stage of labor
D) at the time of complete cervical dilation
E) in the first hour following the delivery of the placenta

Back 3

in the first hour following the delivery of the placenta

Front 4

OBG-5.6.
Perinatal care of the neonate should include:
A) the removal of the vernix
B) intubation
C) oxygen administration
D) removal of the mucus from the mouth and pharynx of the
neonate .
E) all of the above

Back 4

removal of the mucus from the mouth and pharynx of the
neonate

Front 5

OBG-5.7.
The first step in the care of a patient with eclampsia is:
A) phlebotomy
B) termination of the pregnancy
C) the transfusion of blood
D) correction of the hemoconcentration (volume depletion)
E) the intravenous administration of diazepam

Back 5

the intravenous administration of diazepam

Front 6

OBG-5.8.
Prior to the surgical extraction of the placenta:
A) any shock must be completely corrected
B) blood for any required transfusion should be made available
C) any performed blood transfusions must have been completed
before the extraction
D) all of the above
E) none of the above

Back 6

blood for any required transfusion should be made available

Front 7

OBG-5.9.
Currently, the most effective contraceptive method is the:
A) oral (hormonal) contraceptive
B) condom
C) cervical diaphragm
D) calendar rhythm method (periodic abstinence)
E) intrauterine device

Back 7

oral (hormonal) contraceptive

Front 8

OBG-5.13.
The correct gynecologic history should contain the following data:
A) menstrual history
B) previous deliveries
C) family history
D) previous diseases
E) all of the above

Back 8

all of the above

Front 9

OBG-5.16.
Case Study:
A 39-year-old nulliparous woman presents with a one-week delay of
her last expected menstrual period. The patient has never taken any
contraceptives and was married 6 months ago. She has always had a
regular menstrual cycle. On examination, the cervix is soft and of a
bluish-purple color and the adnexal structures are not palpable. Which
of the following methods is suitable for the earliest possible recognition
of pregnancy?
A) β-hCG radioimmunoassay
B) ultrasonography
C) a measurement of the basal body temperature
D) "palm leaf' arborization (ferning) of the cervical mucus
E) progesterone withdrawal

Back 9

β-hCG radioimmunoassay

Front 10

OBG-5.18.
Case Study:
You are attending to a 36 year-old gravida in the 8 the week of gestation
(the patient had 6 pregnancies and 5 deliveries previously). The patient
is concerned about delivering a baby with congenital abnormalities. In
which week of the pregnancy should amniocentesis be performed?
A) immediately (in the 8th week)
B) in the 10th week
C) in the 12th week
D) in the 15th week
E) in the 24th week

Back 10

in the 15th week

Front 11

OBG-5.19.
Case Study:
A 41-year-old multiparous (7 pregnancies ,7 deliveries) woman is undergoing
a vaginal hysterectomy and reconstructive surgery for
uterovaginal prolapse. She has been taking oral contraceptives for the
last 10 years. Which of the following potential complications is the
most likely associated with contraceptive use?
A) pneumonia
B) pulmonary embolism
C) retinal detachment
D) periorbital cellulitis
E) ileus

Back 11

pulmonary embolism

Front 12

OBG-5.21.
Case Study:
A 29-year-old multiparous woman (4 pregnancies, 4 deliveries) undergoes
laparoscopic fulguration of the oviducts. Thirty-six hours after
the operation, the patient begins to complain about abdominal pain
and nausea. Her body temperature is 38.3 °C and slight abdominal
distention is palpated. The most likely diagnosis is:
A) pelvic inflammation
B) hemorrhage from the uterine tube
C) thermal injury to the gut
D) a perforating injury to the gut resulting from a stab wound
E) tubal abortion

Back 12

thermal injury to the gut

Front 13

OBG-5.22.
Case Study:
You are attending to an 18-year-old unmarried girl admitted to the
intensive care unit with shaking chills, 39.4 °C fever, 80/40 mmHg
blood pressure, moderate vaginal bleeding, abdominal tenderness and
a history of having lost her consciousness twice. The pelvic examination
denotes a slightly enlarged and softened uterus. Which of the
following procedures is not indicated?
A) a complete blood count
B) a blood culture and peripheral blood smear
C) a chest x-ray and plain abdominal x-ray in the standing position
D) dilation and curettage
E) laparoscopy

Back 13

laparoscopy

Front 14

OBG-5.23.
Case Study:
In a 26-year-old pregnant woman, uterine growth stops abruptly in
the 4th month of gestation. The uterus begins to involute but 6 weeks
later a spontaneous abortion has still not occurred. Which of the following
parameters should be primarily monitored?
A) the hematocrit and hemoglobin levels
B) the fibrinogen level
C) the blood urea nitrogen (BUN) level
D) the serum creatinine level
E) the bilirubin level

Back 14

the fibrinogen level

Front 15

OBG-5.24.
Which of the following conditions is characterized by the classic syndrome
of amenorrhea with or without abnormal vaginal bleeding,
pelvic-abdominal pain and an adnexal mass?
A) a tubo-ovarian abscess
B) intermenstrual pain (Mittelschmerz)
C) an ectopic pregnancy
D) a twisted ovarian cyst
E) diverticulitis

Back 15

an ectopic pregnancy

Front 16

OBG-5.35
Which of the following cells produces follicle-stimulating hormone (FSH)?
A) the chromophobic cells of the anterior pitutary
B) the basophilic cells of the anterior pituitary
C) the acidophilic cells of the anterior pituitary
D) the internal thecal cells
E) none of the above

Back 16

the basophilic cells of the anterior pituitary

Front 17

OBG-5.39.
Which of the following methods is appropriate for the detection of
pregnancy at the earliest time possible?
A) a pelvic examination
B) a progesterone level determination
C) the erythrocyte sedimentation rate
D) the erythrocyte agglutination-inhibition test
E) a measurement of the hCG β-subunit serum levels

Back 17

a measurement of the hCG β-subunit serum levels

Front 18

OBG-5.40.
Following exposure to excessive heat, the previously normal sperm
count will begin to reduce within:
A) a day
B) 7 days
C) 10 days
D) 75 days
E) 300 days

Back 18

75 days

Front 19

OBG-5.41
The average volume of menstrual blood loss is:
A) 5 to 10 ml
B) 10 to 15 ml
C) 25 to 50 ml
D) 150 to 200 ml
E) 250 to 300 ml

Back 19

25 to 50 ml

Front 20

OBG-5.42.
Which of the following sequences specify the order of contraceptive
methods in decreasing efficacy?
A) oral contraceptives, diaphragm, intrauterine devices,
spermicidal agents, calendar rhythm method
B) intrauterine devices, oral contraceptives, diaphragm,
spermicidal agents, calendar rhythm method
C) calendar rhythm method, oral contraceptives, intrauterine devices,
diaphragm, spermicidal agents
D) oral contraceptives, intrauterine devices, spermicidal agents,
diaphragm, calendar rhythm method
E) oral contraceptives, intrauterine devices, diaphragm,
spermicidal agents, calendar rhythm method

Back 20

oral contraceptives, intrauterine devices, diaphragm,
spermicidal agents, calendar rhythm method

Front 21

OBG-5.47
All the following are contraindications to nursing, EXCEPT:
A) a maternal hepatitis B infection
B) a surgical reduction of the breast with autotransplantation of
the nipple
C) breast engorgement
D) lithium carbonate therapy of the mother
E) tetracycline therapy of the mother

Back 21

breast engorgement

Front 22

OBG-5.51.
Maternal mortality reflects the number of maternal deaths during
the reproductive process per:
A) 1000 deliveries
B) 10,000 deliveries
C) 100,000 deliveries
D) 10,000 live births
E) 100,000 live births

Back 22

100,000 live births

Front 23

OBG-5.52.
Case Study:
A 23-year-old woman (2 pregnancies, 2 deliveries) presents with bloody
vaginal discharge persisting for 7 days after delivery. The patient should
be reassured that bloody puerperal discharge normally lasts for:
A) 2 days
B) 5 days
C) 8 days
D) 11 days
E) 14 days

Back 23

14 days

Front 24

OBG-5.57.
According to the experience of Masters and Johnson as well as other
sexual-therapists, the success-rate of therapy is the lowest in:
A) premature ejaculation
B) vaginismus
C) primary impotence
D) secondary impotence
E) inhibited orgasm

Back 24

primary impotence

Front 25

OBG-5.60
Case Study:
A 46-year-old woman experiences the following symptoms: depression,
hot flushes, nocturnal sweating and recurrent headaches. The
clinical evaluation denotes anovulation. The most likely diagnosis is:
A) psychosomatic disorder
B) depression and mania
C) uremia
D) tuberculosis
E) menopause (climacteric)

Back 25

menopause (climacteric)

Front 26

OBG-5.61.
Which of the following describes the chronologic sequence of pubertal
events correctly?
A) accelerated growth, breast budding, pubarche, menarche
B) accelerated growth, pubarche, breast budding, menarche
C) breast budding, pubarche, menarche, accelerated growth
D) pubarche, breast budding, accelerated growth, menarche

Back 26

accelerated growth, breast budding, pubarche, menarche

Front 27

OBG-5.62.
During oral contraceptive use, unexpected pregnancy most often
develops due to:
A) midcycle breakthrough ovulation
B) frequent sexual intercourse
C) the inappropriate use of oral contraceptives
D) reduced gastrointestinal absorption of the contraceptives
E) the development of antibodies

Back 27

the inappropriate use of oral contraceptives

Front 28

OBG-5.63.
All of the following are appropriate for terminating a pregnancy in
the second trimester, EXCEPT:
A) dilation and curettage
B) the administration of prostaglandin-E 2vaginal suppositories
C) the intra-amniotic administration of oxytocin
D) dilation and oxytocin infusion
E) the intra-amniotic administration of 30% urea

Back 28

the intra-amniotic administration of oxytocin

Front 29

OBG-5.65.
Vacuum-curettage has all the following advantages over conventional
dilatation and curettage, EXCEPT:
A) it is less time-consuming
B) it can be performed on outpatients
C) it carries a lower risk of injury to the uterus
D) it is also applicable in the termination of pregnancies approaching
the end of the second trimester

Back 29

it is also applicable in the termination of pregnancies approaching
the end of the second trimester

Front 30

OBG-5.69.
All of the following statements are valid regarding polyhydramnios,
EXCEPT:
A)acute polyhydramnios is a frequent cause of premature delivery
occurring before the 28th week of pregnancy
B) polyhydramnios is associated with congenital abnormalities in
20% of cases
C) edema is common, particularly of the lower extremities and of
the vulva
D) polyhydramnios is associated with ureteral obstruction in almost
50% of cases
E) it can be complicated by the premature separation of the placenta,
uterine dysfunction and postpartum hemorrhage

Back 30

polyhydramnios is associated with ureteral obstruction in almost
50% of cases

Front 31

OBG-5.70.
All of the following statements are valid regarding progesterone production
during pregnancy, EXCEPT:
A) during the first 10 weeks of pregnancy, the corpus luteum is
the primary source of progesterone
B) following the 12th week of gestation, the placenta is the primary
source of progesterone
C) maternal cholesterol is a major precursor of the progesterone
synthetized by the placenta
D) progesterone levels rise abruptly after death of the fetus
E) progesterone is an essential substrate of maternal cholesterol
synthesis

Back 31

progesterone levels rise abruptly after death of the fetus

Front 32

OBG-5.74.
Which of the following statements regarding suppurative mastitis is valid?
A) the symptoms usually present in the 10th postpartum week
B) herpesvirus is the most common causitive pathogen
C) the most common cause of masititis is poor personal hygiene
of the mother
D) the pathogen can never be cultured from breast milk
E) the source of infection is almost invariably the nose and throat
of the nursing infant

Back 32

the source of infection is almost invariably the nose and throat
of the nursing infant

Front 33

OBG-5.75.
The anteroposterior diameter of the pelvic rim is the shortest along the:
A) interspinous diameter
B) anatomical conjugate
C) diagonal conjugate
D) obstetric conjugate
E) none of the above

Back 33

obstetric conjugate

Front 34

OBG-5.79.
Case Study:
A 19-year-old woman is referred to the emergency room for a sudden
loss of consciousness at her job. The examination reveals slight vaginal
bleeding; the abdomen is distended and diffusely tender. The patient
complains of shoulder- and abdominal pain. Body temperature: 36.4
°C; heart-rate: 120/min; blood-pressure: 96/50 mmHg. Which of the
following diagnostic procedures should be performed to verify the tentative
diagnosis established by evaluating the available clinical data?
A) a pregnancy test
B) posterior colpotomy
C) dilation and curettage
D) diagnostic puncture of the cul-de-sac
E) hysteroscopy

Back 34

diagnostic puncture of the cul-de-sac

Front 35

OBG-5.80.
Case Study:
A 24-year-old pregnant woman is in the 8th week of gestation. Her
medical history includes a pulmonary embolism that occurred 7 years
ago during her previous pregnancy. She was given intravenous heparin
at that time followed by oral warfarin (coumarin) therapy for several
months. The patient has not experienced any signs of thromboembolism
for the last 6 years. Which of the following statements is correct regarding
the current condition of the patient?
A) considering the 5-year-long disease-free period, the risk of a recurrent
thromboembolism is not higher than in normal cases
B) in pregnancy, impedance plethysmography is unsuitable for
the evaluation of deep-vein thrombosis
C) in pregnancy, Doppler -ultrasonography is unsuitable for the
evaluation of deep-vein thrombosis
D) low-dose heparin therapy should be started and continued
throughout the pregnancy and puerperium
E) the risk of a recurrent thromboembolism is the highest in the
second trimester of pregnancy

Back 35

low-dose heparin therapy should be started and continued
throughout the pregnancy and puerperium

Front 36

OBG-5.85.
Which of the following statements regarding placenta previa is valid?
A) the incidence of this condition decreases with advancing maternal age
B) the incidence of this condition is not influenced by previous
deliveries or abortions
C) the inital bleeding is painless and seldom causes death
D) vaginal surgery is the therapy of choice
E) immediate vaginal examination is mandatory when placenta
previa is suspected

Back 36

the inital bleeding is painless and seldom causes death

Front 37

OBG-5.86.
Viremia as well as the presence of rubella virus in the pharynx of an
infected individual is related to the appearance of the characteristic skin rash
by:
A) their occurrence 5-7 days before the development of the rash
B) their occurrence 1-2 days before the development of the rash
C) their simultaneous occurrence with the rash
D) their occurrence 1-2 days after the development of the rash
E) there is no correlation between their occurrence and the development
of the rash

Back 37

their occurrence 5-7 days before the development of the rash

Front 38

OBG-5.87.
Which of the following is a potential, associated risk in patients developing
eclampsia during their first pregnancy?
A) diabetes mellitus
B) chronic hypertension
C) habitual abortion
D) chronic liver disease
E) delivery of a dead fetus in the third trimester of pregnancy

Back 38

chronic hypertension

Front 39

OBG-5.90.
All df the following statements regarding polyhydramnios are valid,
EXCEPT:
A) therapeutic amniocentesis is indicated solely for the alleviation
of maternal distress
B) in polyhydramnios, the incidence of major congenital abnormalities
is 20%
C) occasionally, it can be treated safely and effectively with diuretics
as well as restricting the intake of water and dietary salt
D) polyhydramnios is associated with an increased incidence of
premature separation of the placenta, uterine dysfunction and
post-partum bleeding
E) the rapid removal of amniotic fluid is contraindicated

Back 39

occasionally, it can be treated safely and effectively with diuretics
as well as restricting the intake of water and dietary salt

Front 40

OBG-5.92
What is the earliest time when a multiple pregnancy can be detected
by ultrasonography?
A) between the 4th and 6th week of gestation
B) between the 8th and 10th week of gestation
C) between the 14th and 15th week of gestation
D) between the 15th and 16th week of gestation
E) between the 15th and 16th week of gestation

Back 40

between the 8th and 10th week of gestation

Front 41

OBG-5.96.
In the second trimester of pregnancy, ultrasonography is suitable
for:
A) the measurement of fetal dimensions
B) intrauterine detection of congenital abnormalities
C) the assessment of fetal position and presentation
D) all of the above
E) only answers (A) and (B) are true

Back 41

only answers (A) and (B) are true

Front 42

OBG-5.97.
Which of the following fetal abnormalities are detectable by
ultrasonography?
A) anencephaly
B) hydrocephalus
C) large abdominal neoplasms
D) all of the above
E) only answers (A) and (B) are true

Back 42

all of the above

Front 43

OBG-5.98
Which of the following conditions should be suspected if the abdominal
circumference is greater than normal?
A) multiple pregnancy
B) polyhydramnios
C) large fetus
D) all of the above
E) ptotic abdome

Back 43

all of the above

Front 44

OBG-5.100.
From which week of pregnancy does the fetal skull show with full
certainty, on ultrasonography?
A) 6 weeks
B) 7-8 weeks
C) 12-14 weeks
D) 16-18 weeks
E) 18-20 weeks

Back 44

12-14 weeks

Front 45

OBG-5.102.
On ultrasonography, the diameter of which of the following fetal organs
yields valuable information on the growth-rate of the fetus?
A) the biparietal diameter of the skull (BPD)
B) the diameter of the thorax
C) the diameter of the abdomen
D) all the above if assessed simultaneously
E) only answers (A) and (B) are true

Back 45

all the above if assessed simultaneously

Front 46

OBG-5.103.
In which of the following conditions is the measurement of the placental
thickness important?
A) diabetes
B) Rh-incompatibility
C) polyhydramnios
D) all of the above
E) only answers (A) and (B) are true

Back 46

nly answers (A) and (B) are true

Front 47

OBG-5.105.
Which of the following radiologic procedures is contraindicated
during pregnancy?
A) chest x-ray
B) chest fluoroscopy
C) therapeutic irradiation
D) radiography of the pelvis
E) fluoroscopy of the pelvis

Back 47

therapeutic irradiation

Front 48

OBG-5.106.
From which week of pregnancy is the radiolucency of fetal bones detectable
on radiography?
A) 8 weeks
B) 16 weeks
C) 20 weeks
D) 24 weeks
E) 28 weeks

Back 48

16 weeks

Front 49

OBG-5.107.
Which of the following congenital abnormalities is detectable by
radiograph?
A) anencephaly
B) hydrocephalus
C) gross abnormalities of the extremities
D) syphilitic osteochondritis
E) all of the above

Back 49

all of the above

Front 50

OBG-5.112.
What is hysterosalpingography used for?
A) for the diagnosis of ectopic pregnancy
B) to assess the patency of the Fallopian tubes and detect the
morphologic abnormalities of the uterine cavity
C) for the diagnosis of ovarian neoplasms
D) to assess the motility of the Fallopian tubes
E) to measure the size of the ovaries

Back 50

to assess the patency of the Fallopian tubes and detect the morphologic abnormalities of the uterine cavity

Front 51

OBG-5.113.
Which of the following describes Nagele's method for estimating the
duration of a pregnancy?
A) 9 months + 3 days starting from the last day of the last regular
menses
B) 9 months + 7 days starting from the first day of the last regular
menses
C) 9 months starting from the first day of the last regular menses
D) 9 months + 7 days starting from the time of conception
E) 5 months starting from the time when fetal motion is detected

Back 51

9 months + 7 days starting from the first day of the last regular menses

Front 52

OBG-5.115.
The duration of a normal pregnancy from the first day of the last
regular menses is:
A) 266 days
B) 280 days
C) 300 days
D) 310 days
E) 320 days

Back 52

280 days

Front 53

OBG-5.116.
The average duration of a normal pregnancy from the day of conception is:
A) 200 days
B) 266 days
C) 300 days
D) 310 days
E) 320 days

Back 53

266 days

Front 54

OBG-5.117.
Which of the following is taken into consideration when the term of
delivery is calculated?
A) Nagele's method for estimating the duration of the pregnancy
B) the date when fetal motion is first detected
C) the ascension rate of the uterine fundus
D) the date when the uterine fundus descends
E) all of the above

Back 54

all of the above

Front 55

OBG-5.118.
Which of the following tests should be performed at each follow-up
visit during pregnancy?
A) urinalysis
B) blood pressure measurement
C) measurement of body weight
D) all of the above
E) only answers (A) and (B) are true

Back 55

all of the above

Front 56

OBG-5.119.
Which of the following tests is unnecessary during the first trimester
of pregnancy?
A) a urinalysis
B) blood pressure measurements
C) measurements of the body weight
D) measurements of the abdominal circumference
E) vaginal examinations

Back 56

measurements of the abdominal circumference

Front 57

OBG-5.120.
Which of the following is not a routine test at follow-up visits during
pregnancy?
A) serologic tests for syphilis (STS)
B) hematocrit measurements
C) measurements of the hemoglobin level
D) urinalysis
E) liver function tests

Back 57

liver function tests

Front 58

OBG-5.121
Which of the following urinary parameters is/are mandatory when
being tested at follow-up visits during pregnancy?
A) the presence of any pus
B) the glucose level
C) the concentration of protein
D). all of the above
E) only answers (A) and (C) are true

Back 58

all of the above

Front 59

0BG-5.122
The optimal monthly gain of body weight during pregnancy is:
A) 0.5-0.6 kg
B) 1.0-1.5 kg
C) 1.5-2.0 kg
D) 2.0-2.5 kg
E) 2.5-3.0 kg

Back 59

1.0-1.5 kg

Front 60

OBG-5.125.
The daily fat requirement of pregnant woman is as high as:
A) 60-80 g/day
B) 100-150 g/day
C) 150-200 g/day
D) 200-300 g/day
E) 300-350 g/day

Back 60

60-80 g/day

Front 61

OBG-5.126.
The proper method for preparing the nipples for breastfeeding is:
A) washing the nipples with soap every morning and evening
B) massage of the nipple and the areola
C) only answers (A) and (B) are true
D) no preparation is necessary

Back 61

only answers (A) and (B) are true

Front 62

OBG-5.128.
Which of the following drugs is contraindicated during pregnancy?
A) coumarins
B) oral antidiabetic agents
C) actinomycin D
D) cytotoxic agents
E) all of the above

Back 62

all of the above

Front 63

OBG-5.129
Which of the following drugs is contraindicated during pregnancy?
A) thalidomide
B) methimazole
C) vitamin K in high doses
D) all of the above
E) only answers (A) and (B) are true

Back 63

all of the above

Front 64

OBG-5.131.
Which of the following drugs should not be administered during
pregnancy?
A) streptomycin
B) sulfonamides
C) carbutamide
D) all of the above
E) only answers (A) and (C) are true

Back 64

all of the above

Front 65

OBG-5.132.
In which weeks of pregnancy is ultrasonography recommended for
monitoring the condition and development of the fetus?
A) on weeks 8 and 32
B) on weeks 24 and 32
C) on weeks 8, 24 and 38
D) on weeks 8, 24 and 32
E)on weeks 8, 18, 28 and 32

Back 65

on weeks 8, 18, 28 and 32

Front 66

OBG-5.133.
What is the influence of pregnancy on epilepsy?
A) seizure threshold is lower
B) seizure threshold is higher
C) there is no relation between pregnancy and seizure threshold

Back 66

seizure threshold is lower

Front 67

OBG-5.149.
Why is it contraindicated to let pregnancy develop to full term in patients
with heart valve implants?
A) because the risk of congestive heart failure is high
B) because the rejection of the implant is common during pregnancy
C) because the associated permanent anticoagulant therapy carries
the risk of abortion, intrauterine fetal death and bleeding
D) because thrombus formation is common despite ongoing anticoagulant
therapy

Back 67

because the associated permanent anticoagulant therapy carries the risk of abortion, intrauterine fetal death and bleeding

Front 68

OBG-5.152
Should a mother with active tuberculosis nurse her baby?
A) no
B) yes
C) only if she has been receiving antituberculotic chemotherapy
during her pregnancy

Back 68

no

Front 69

OBG-5.153.
What is the effect of pregnancy on bronchial asthma?
A) it has no influence
B) the condition of the patient improves
C) the condition of the patient deteriorates
D) its effects are inconsequential

Back 69

its effects are inconsequential

Front 70

OBG-5.162.
Which of the following drugs will you not prescribe for constipation
associated with pregnancy?
A) sennoside A+B (Tisasen A + B)
B) phenolphthalein
C) bisacodyl (Videx)
D) drastic cathartics
E) osmotic laxatives

Back 70

drastic cathartics

Front 71

OBG-5.163.
Which of the following factors facilitate the development of
choletithaiassis during pregnancy?
A)a high serum cholesterol level
B)reduced muscle tone of the gall bladder
C)constipation and reduced excursions of the diaphragm
D)all of the above
E)only answers (B) and (C) are true

Back 71

all of the above

Front 72

BG-5.164.
What should be done if significant, recurrent asymptomatic
Bacteriuria develops during pregnancy ?
A)identification of the pathogen by cultures
B)antibiotic susceptibility testing
C)antibiotic therapy
D)all of above
E)no intervention is necessary

Back 72

all of above

Front 73

OBG-5.165.
What is the possible route for pathogens in renal infections developing
during pregnancy?
A) an ascending infection originating from the urinary bladder
B) the hematogenous spread from distant foci of infection
C) the lymphogenic spread from the intestines
D) all of the above
E) only answers (A) and C) are true

Back 73

all of the above

Front 74

OBG-5.166.
Which of the following conditions predisposes to pyelonephritis becoming
apparent during pregnancy?
A) diabetes
B) toxemia
C) acute pyelonephritis in the past medical history
D) infectious diseases
E) all of the above

Back 74

all of the above

Front 75

OBG-5.167.
In mild anemia during pregnancy, the serum hemoglobin is in the range of
A) 150-430 g/1
B) 110-130 g/1
C) 90-110 g/l
D) 80-90 g/1

Back 75

110-130 g/1

Front 76

OBG-5.168.
In moderately severe anemia during pregnancy, the serum
hemoglobin is in the range of:
A) 130-150 g/l
B) 110-130 g/l
C) 90-110 g/1
D) 80-90 g/1

Back 76

90-110 g/1

Front 77

OBG-5.171.
In moderately severe anemia during pregnancy, the serum
hemoglobin is in the range of:
A) 8.0-9.27 mmo/1
B) 6.8-8.0 mmo/I
C) 5.6-6.8 mmo/I
D) 0.6 mmo/1

Back 77

5.6-6.8 mmo/I

Front 78

OBG-5.172.
In severe anemia during pregnancy, the serum hemoglobin is in the
range of:
A) 8.0-9.27 mmo/1
B) 6.8-8.0 mmo/1
C) 5.6-6.8 mmo/I
D) 0.6 mmo/1

Back 78

0.6 mmo/1

Front 79

OBG-5.181.
The complications of toxoplasmosis developing during pregnancy include:
A) abortion
B) premature delivery
C) intrauterine fetal death
D) all of the above
E) none of the above

Back 79

all of the above

Front 80

OBG-5.183.
In listeriosis, the pathogen can be cultured from the:
A) blood
B) cerebrospinal fluid
C) feces
D) urine
E) all of the above

Back 80

all of the above

Front 81

OBG-5.188.
Fetal affects of syphilis include:
A) intrauterine fetal death
B) abortion
C) premature birth
D) all of the above
E) none of the above

Back 81

all of the above

Front 82

OBG-5.189.
In pregnancy, Treponema pallidum can penetrate the placenta in week:
A) 6
B) 12
C) 20
D) 28
E) 36

Back 82

20

Front 83

OBG-5.190.
In which of the following cases is the performance of serologic tests
for syphilis justified?
A) if the mother is not married
B) if the symptoms of the father suggest syphilis
C) if the family history contains any offspring born with anomalies
suggesting congenital syphilis
D) in case of intrauterine fetal death of unknown etiology
E) in all cases without exception

Back 83

in all cases without exception

Front 84

OBG-5.192.
In pregnancy, gonococcal infection becomes established in:
A) the urethra
B) Skene's glands
C) the cervical canal
D) an obstruction of the ducts of Bartholini's glands
E) all of the above

Back 84

all of the above

Front 85

OBG-5.193.
The therapy of gonorrhea during pregnancy includes the administration of
A) sulfonamides
B) penicillins
C) tetracyclines

Back 85

penicillins

Front 86

OBG-5.194.
Which of the following demonstrate the diabetogenic effect of pregnancy?
A) estrogen, prolactin and cortisol are insulin-antagonists
B) the blood glucose level is elevated by growth hormone,
prolactin and TSH
C) the placenta metabolizes a portion of circulating insulin
D) all of the above
E) only answers (A) and (B) are true

Back 86

all of the above

Front 87

OBG-5.196.
Characteristic features of latent (gestational) diabetes include?
A) the presence of symptoms; high blood-glucose levels
B) the absence of clinical symptoms; normal blood-glucose levels,
impaired glucose tolerance
C) the absence of clinical symptoms; normal blood-glucose levels and
glucose tolerance, however, the enhanced glucose tolerance test yields
abnormal results
D) clinical symptoms are absent; blood-glucose levels and the results
of both the glucose tolerance test and .the enhanced glucose
tolerance tests are normal

Back 87

the absence of clinical symptoms; normal blood-glucose levels and glucose tolerance, however, the enhanced glucose tolerance test yields abnormal results

Front 88

OBG-5.197.
Which of the following may suggest potential diabetes?
A) the delivery of a neonate of over 4,000 g body weight
B) either parent or both of them are diabetics
C) obesity, sudden weight-gain
D) all of the above
E) only answers (A) and (B) are true

Back 88

all of the above

Front 89

OBG-5.198
Which of the following jeopardize women with gestational diabetes?
A) the derangement of carbohydrate metabolism
B) the derangement of water- and electrolyte balance
C) toxemia, urinary tract infection and vaginitis develop frequently
D) all of the above complications
E) only answers (A) and (B) are true

Back 89

all of the above complications

Front 90

OBG-5.199.
Which of the following is more prevalent in pregnant diabetics?
A) toxemia
B) polyhydramnios
C) abortion
D) intrauterine fetal death
E) all of the above

Back 90

all of the above

Front 91

OBG-5.200.
Which of the following is suggested by the delivery of a neonate of
over 4,000 g of body weight?
A) an improper diet during pregnancy
B) a latent diabetes
C) Rh isoimmunization
D) toxemia

Back 91

a latent diabetes

Front 92

OBG-5.201.
During the first 24 hours following delivery, the blood glucose level
of a neonate born to a diabetic mother is:
A) normal
B) hyperglycemia is common
C) hypoglycemia is common
D) no characteristic changes occur

Back 92

hypoglycemia is common

Front 93

OBG-5.202.
Which of the following fetal consequences should be considered in
pregnant diabetics?
A) congenital malformations and polyhydramnios are common
B) premature birth is more prevalent in these patients
C) macrosomia
D) all of the above
E) only answers (A) and (C) are true

Back 93

all of the above

Front 94

OBG-5.206.
Which of the following is a possible complication of an uterine
myoma during pregnancy?
A) abortion, premature delivery
B) impairment of placental separation
C) myomatous foci may obstruct delivery
D) all of the above
E) only answers (A) and (C) are true

Back 94

all of the above

Front 95

OBG-5.209.
The term "hypersalivatio gravidarum" means:
A) permanent salivation that impairs normal feeding
B) ordinary morning sickness with nausea, vomiting and salivation
C) increased gastric secretion following meals
D) frequent vomiting unrelated to meals and the fullness of the
stomach
E) nausea precipitated by strange odors

Back 95

permanent salivation that impairs normal feeding

Front 96

OBG-5.210.
The term "vomitus matutinus" means:
A) permanent salivation that impairs normal feeding
B) ordinary morning sickness with nausea, vomiting and salivation
C) vomiting occurring following meals
D) frequent vomiting unrelated to meals and the fullness of the stomach
E) vomiting precipitated by strange odors or flavors

Back 96

ordinary morning sickness with nausea, vomiting and salivation

Front 97

BG-5.211.
The term "emesis gravidarum" means:
A) permanent salivation that impairs normal feeding
B) ordinary morning sickness with nausea, vomiting
C) vomiting occurring 2-3 times a day, following meals
D) starvation and consequent toxicosis resulting from a malignant
vomiting syndrome unrelated to meals
E) vomiting precipitated by strange odors or flavors

Back 97

vomiting occurring 2-3 times a day, following meals

Front 98

OBG-5.212.
The term "hyperemesis gravidarum" means:
A) permanent salivation that impairs and precludes normal feeding
B) ordinary morning sickness with nausea, vomiting
C) vomiting occurring 2-3 times a day, following meals
D) starvation and consequent toxicosis resulting from a malignant
vomiting syndrome unrelated to meals
E) vomiting precipitated by strange odors or flavors

Back 98

starvation and consequent toxicosis resulting from a malignant vomiting syndrome unrelated to meals

Front 99

OBG-5.214.
Which of the following belong to the pathomechanism of hyperemesis in pregnancy?
A) hormonal factors
B) neural factors
C) metabolic factors
D) hormonal and neural factors
E) hormonal, neural and metabolic factors

Back 99

E. \hormonal, neural and metabolic factors

Front 100

OBG-5.215.
Which of the following hormonal changes is responsible for the development
of hyperemesis in pregnancy?
A) excessive progesterone production
B) high hCG levels
C) high hCG and progesterone levels
D) excessive production of adrenal corticosteroids
E) prolactin, produced only during pregnancy

Back 100

high hCG levels

Front 101

OBG-5.216.
A diagnosis of early toxemia can be established if the symptoms develop
in the following period:
A) before week 20
B) between weeks 20 and 28
C) between weeks 28-36
D) between weeks 36-40

Back 101

before week 20

Front 102

OBG-5.217.
The principal sign of hyperemesis of pregnancy is:
A) considerable weight-loss
B) significant exsiccosis (fluid depletion)
C) acetone positivity and increased urobilinogen levels in the
urine as well as the appearance of casts and leucine- or
tyrosine crystals
D) weight-loss, alkalosis
E) only answers (A), (B) and (C) are true

Back 102

only answers (A), (B) and (C) are true

Front 103

OBG-5.219.
Which of the following laboratory tests should be performed in
hyperemesis of pregnancy?
A) urine volume; specific gravity; protein, acetone and
urobilinogen content
B) urinary sediment examination
C) measurement of the hematocrit and hemoglobin levels
D) measurement of the serum bilirubin level
E) all of the above

Back 103

all of the above

Front 104

OBG-5.220.
In hyperemesis gravidarum, hematocrit and hemoglobin values are:
A) elevated
B) reduced
C) unchanged

Back 104

elevated

Front 105

OBG-5.221.
The therapy of hyperemesis gravidarum includes:
A) bed rest
B) parenteral fluid therapy, and nutrition
C) administration of antiemetics
D) administration of sedatives
E) all of the above

Back 105

all of the above

Front 106

OBG-5.223.
What is the ranking of toxemia of pregnancy among the causes of
maternal mortality?
A) first
B) second
C) third
D) fourth
E) fifth

Back 106

first

Front 107

OBG-5.226.
Which of the following conditions predisposes to toxemia of pregnancy?
A) hypertension
B) diabetes mellitus
C) chronic glomerulonephritis
B) all of the above
E) only answers (A) and (C) are true

Back 107

all of the above

Front 108

OBG-5.228.
Pathophysiologic features of late occurring toxemia of pregnancy include:
A) generalized vasoconstriction
B) increased capillary permeability
C) increased retention of water and sodium in the tissues
D) all of the above
E) only answers (A) and (B) are true

Back 108

all of the above

Front 109

OBG-5.230.
Which of the following factors contribute to the development of
edema in toxemia of pregnancy?
A) increased capillary permeability
B) vasoconstriction of arterioles
C) tissue hypoxia
D) increased effusion of plasmaproteins into the interstitial space
E) all of the above

Back 109

all of the above

Front 110

OBG-5.231.
What are the consequences of generalized vasoconstriction in
toxemia occurring late in pregnancy?
A) hypertension
B) tissue ischemia
C) hypoxia
D) all of the above
E) only answers (A) and (C) are true

Back 110

all of the above

Front 111

OBG-5.237.
Which of the following is an appropriate method for detecting latent
edema in pregnancy?
A) monitoring the balance of fluid intake and loss
B) monitoring the changes in body weight
C) pressing the skin over the tibia
D) determination of fluid compartment volumes by radionuclide
studies
E) only answers (A) and (B) are true

Back 111

only answers (A) and (B) are tru

Front 112

OBG-5.238.
Which blood pressure reading is more important in the assessment
of the severity of late occurring toxemia of pregnancy?
A) systolic blood pressure
B) diastolic blood pressure
C) the changes of both pressure values should be evaluated simultaneously

Back 112

diastolic blood pressure

Front 113

OBG-5.239.
Which of the following conditions should eclamptic seizures be differentiated
from?
A) epilepsy
B) hysteric attack
C) uremic seizures
D) all of the above
E) only answers (A) and (B) are true

Back 113

all of the above

Front 114

OBG-5.240.
The stages of eclamptic seizures are as follows:
A) tonic-clonic seizures
B) prodromal stage, tonic-clonic seizures, coma
C) tonic-clonic seizures, coma
D) clonic seizure, coma
E) prodromal stage, clonic seizure, coma

Back 114

prodromal stage, tonic-clonic seizures, coma

Front 115

OBG-5.241
Eclamptic seizures may develop:
A) in pregnancy
B) at delivery
C) during the puerperium
D) all of the above
E) during pregnancy and at birth only

Back 115

all of the above

Front 116

OBG-5.242
The term "primary (genuine) toxemia of pregnancy" means:
A) condition with cumulative occurrence within the family
B) that no organic disease can be detected
C) toxemic symptoms associated with hypertension as well as renal
and vascular disease
D) symptoms developing in the first half of pregnancy
E) symptoms associated with.multiple pregnancy

Back 116

that no organic disease can be detected

Front 117

OBG-5.243.
" The term "superimposed toxemia"means:
A) condition with cumulative occurrence within the family
B) that no organic disease can be detected
C) toxemic symptoms associated with hypertension as well as renal
and vascular disease
D) symptoms precipitated by improper diet or life-style
E) symptoms associated with multiple pregnancy

Back 117

symptoms precipitated by improper diet or life-style

Front 118

OBG-5.245.
Which of the following methods is appropriate for evaluating the severity
of late occurring toxemia of pregnancy?
A) the measurement of blood pressure
B) the measurement of urinary protein concentration
C) assessing the severity of edema as well as the patient's subjective
symptoms
D) all of the above
E) only answers (B) and (C) are true

Back 118

all of the above

Front 119

OBG-5.247.
In which of the following cases should polysymptomatic toxemia be
considered severe?
A) if the blood pressure is higher than 180/130 mmHg and
retinopathy is present
B) if the grade of proteinuria exceeds 5
0
/
000

C) if gerenalized edema is present
D) in all of the above cases
E) only answers (A) and (B) are true

Back 119

in all of the above cases

Front 120

OBG-5.249
Late consequences of eclamptic seizures include:
A) neurovegetative disturbances, psychosis
B) epilepsy and memory disturbances
C) permanent renal and vascular damage
D) all of the above
E) only answers (B) and (C) are true

Back 120

only answers (B) and (C) are true

Front 121

BG-5.250.
Which of the following indicates the severity and prognosis of
eclampsia correctly?
A) the time of the onset of toxemia
B) the number and frequency of seizure-attacks as well as the
depth of ensuing coma
C) the rate of diuresis
D) all of the above
E) only answers (B) and (C) are true

Back 121

only answers (B) and (C) are true

Front 122

OBG-5.251.
The maternal risks of late occurring toxemia of pregnancy include:
A) death
B) afibrinogenia, premature separation of the placenta
C) permanent renal and vascular damage
D) all of the above
E) only answers (B) and (C) are true

Back 122

all of the above

Front 123

OBG-5.252.
Fetal risks of late occurring toxemia of pregnancy include:
A) premature birth
B) dysmaturity
C) intrauterine fetal death
D) only answers (A) and (B) are true
E) all of the above

Back 123

all of the above

Front 124

OBG-5.258.
Which of the following drugs is inappropriate for the alleviation of
eclamptic seizures?
A) hypnotics
B) magnesium sulphate
C) diazepam
D) dextran (Rheomacrodex)
E) lytic cocktail

Back 124

dextran (Rheomacrodex)

Front 125

OBG-5.260
The term "spontaneous abortion" means:
A) one or more subsequent pregnancies terminating spontaneously
B) the spontaneous termination of a pregnancy
C) that an intact pregnancy.is terminated by artificial instrumentation
D) that an intact pregnancy is terminated by an illegal, prohibited
procedure
E) that fetal death is not followed by an abortion

Back 125

the spontaneous termination of a pregnancy

Front 126

BG-5.261.
The term "habitual abortion" means:
A) one or more subsequent pregnancies terminating spontaneously
B) three or more subsequent pregnancies terminating spontaneously
C) an intact pregnancy is terminated by artificial instrumentation
D) an intact pregnancy is terminated by an illegal, prohibited
procedure
E) fetal death is not followed by an abortion

Back 126

three or more subsequent pregnancies terminating spontaneously

Front 127

OBG-5.264.
The term "missed abortion" means:
A) one or more subsequent pregnancies terminating spontaneously
B) an intact pregnancy is terminated by a legal procedure
C) an intact pregnancy is terminated by an illegal, prohibited procedure
D) fetal death is not followed by an abortion

Back 127

fetal death is not followed by an abortion

Front 128

OBG-5.265.
Which of the following may cause spontaneous abortion?
A) maternal diseases
B) anomalies of the ovum
C) diseases of the father
D) all of the above
E) only answers (A) and (B) are true

Back 128

all of the above

Front 129

OBG-5.268.
Which of the following forms of abortion represents the most advanced
stage of this condition?
A) imminent abortion
B) incomplete abortion
C) complete abortion
D) incipient abortion

Back 129

complete abortion

Front 130

OBG-5.269.
Which type of abortion is characterized by cramping lower abdominal
pain, vaginal bleeding and a closed cervix?
A) incipient abortion
B) imminent abortion
C) incomplete abortion
D) missed abortion
E) post-abortion residue

Back 130

incomplete abortion

Front 131

OBG-5.270.
Which type of abortion is characterized by cramping lower abdominal
pain, vaginal bleeding, an open cervix but no passage of the
products of conception?
A) incipient abortion
B) imminent abortion
C) incomplete abortion
D) missed abortion
E) post-abortion residue

Back 131

incipient abortion

Front 132

OBG-5.271.
Which type of abortion is characterized by cramping lower abdominal
pain, vaginal bleeding, an open cervix and the passage of the
products of conception?
A) incipient abortion
B) imminent abortion
C) incomplete abortion
D) missed abortion
E) habitual abortion

Back 132

incomplete abortion

Front 133

OBG-5.272.
Which of the following is the most important feature for distinguishing
between imminent and incipient abortion?
A) the volume of blood loss
B) cramps
C) the bore of the dilated cervix
D) the results of the biological pregnancy test
E) serum progesterone level

Back 133

the bore of the dilated cervix

Front 134

OBG-5.273.
Which of the following is the most important feature for distinguishing
between incipient and incomplete abortion?
A) the volume of blood loss
B) the bore of the dilated cervix
C) the passage of the products of conception
D) the results of the biological pregnancy test
E) serum progesterone level

Back 134

the passage of the products of conception

Front 135

OBG-5.274.
In which of the following conditions can the administration of
progestogenic
agents be considered reasonable for the therapy of imminent abortion?
A) if the history contains spontaneous abortion
B) if lower abdominal cramps are present
C) if bleeding is present
D) if the serum progesterone level is low
E) in all patients with lower abdominal pain

Back 135

if the serum progesterone level is low

Front 136

OBG-5.275.
The risks of terminating spontaneous abortions by curettage include:
A) infection
B) bleeding resulting from intrauterine residue
C) uterine perforation and surgical injury
D) all of the above
E) only answers (A) and (B) are true

Back 136

all of the above

Front 137

OBG-5.281.
In obstetrical terms, premature delivery means the termination of
pregnancy:
A) between weeks 12-16 of gestation
B) between weeks 16-28 of gestation
C) between weeks 28-37 of gestation
D) between weeks 38-40 of gestation
E) when the weight of the fetus is 2499 grams or less

Back 137

between weeks 28-37 of gestation

Front 138

OBG-5.283.
Is active immunization against mumps and varicella permitted during
pregnancy?
A) yes
B) no
C) it is permitted under certain condition

Back 138

no

Front 139

OBG-5.284.
Is passive immunization against mumps and varicella permitted
during pregnancy?
A) yes
B) no
C) it is permitted under certain conditions

Back 139

yes

Front 140

OBG-5.285.
Is passive immunization against rubella permitted during pregnancy?
A) yes
B) no
C) it is permitted under certain conditions

Back 140

no

Front 141

OBG-5.286.
When does labour start?
A) at the time of full dilation and effacement of the cervix
B) at the time when the maximum circumference of the fetal head
has descended below the pelvic rim
C) at the time when rhythmic, expulsive uterine contractions resulting
in the dilation of the cervix begin
D) at the time of complete cervical dilation
when the patient begins to feel the urge to bear down

Back 141

at the time when rhythmic, expulsive uterine contractions resulting in the dilation of the cervix begin

Front 142

OBG-5.287.
When does the 1st stage of labor start and end?
A) from the time of full cervical effacement to the delivery of the fetus
B) from the delivery of the fetus to the expulsion of the placenta
C) from the start of uterine contractions to the effacement of the
cervix
D) this period corresponds to the first 2 hours following the delivery
of the placenta
E) from the start of uterine contractions to the delivery of the fetus

Back 142

from the start of uterine contractions to the effacement of the cervix

Front 143

OBG-5.288.
When does the 2nd stage of labor start and end?
A) from the time of full cervical effacement to the delivery of the
fetus
B) from the delivery of the fetus to the expulsion of the placenta
C) from the start of uterine contractions to the effacement of the
cervix
D) this period corresponds to the first 2 hours following the delivery
of the placenta
E) from the start of uterine contractions to the delivery of the fetus

Back 143

from the time of full cervical effacement to the delivery of the fetus

Front 144

OBG-5.289.
When does the 3rd (placental) stage of labor start and end?
A) from the time of full cervical effacement to the delivery of the
fetus
B) from the delivery of the fetus to the expulsion of the placenta
C) from the delivery of the fetus to the end of a 2-hour period following
the expulsion of the placenta
D) this period corresponds to the first 2 hours following the delivery
of the placenta
E) from the start of uterine contractions to the delivery of the fetus

Back 144

from the delivery of the fetus to the expulsion of the placenta

Front 145

OBG-5.290.
When does the postplacental stage of labor start and end?
A) from the time of full cervical effacement to the delivery of the
fetus
B) from the delivery of the fetus to the expulsion of the placenta
C) from the delivery of the fetus to the end of a 2-hour period following
the expulsion of the placenta
D) this period corresponds to the first 2 hours following the delivery
of the placenta
E) from the start of uterine contractions to the delivery of the fetus

Back 145

from the delivery of the fetus to the end of a 2-hour period following the expulsion of the placenta

Front 146

OBG-5.291.
"Predictory contractions":
A) propel the fetus along the osseous and soft tissue passage after the complete effacement of the cervix
B) are uterine contractions resulting in the effacement of the cervix
C) induce the separation and delivery of the placenta
D) are contractions occurring during the first days of the puerperium
E) brief uterine contractions occurring at irregular intervals during
the last weeks of pregnancy

Back 146

brief uterine contractions occurring at irregular intervals during the last weeks of pregnancy

Front 147

OBG-5.295.
The mechanism of action of oxytocin is:
A) it reduces the resting membrane potential of the myocytes
B) it prevents the transmission of the impulses from one myocyte
to the other
C) it increases the resting membrane potential of the myocytes
D) it stimulates the synthesis of actomyosin in the muscle
E) it stimulates the synthesis of ATP and ADP

Back 147

it reduces the resting membrane potential of the myocytes

Front 148

OBG-5.299.
The action of progesterone on the pregnant uterus is that:
A) it depolarizes the membranes of myocytes
B) it hyperpolarizes the membranes of myocytes
C) it mobilizes intracellular calcium
D) it facilitates potassium efflux from the intracellular compartment
E) it facilitates sodium influx into the intracellular compartment

Back 148

it mobilizes intracellular calcium

Front 149

OBG-5.304.
The term "intensity of uterine contraction" means:
A) the rise of intrauterine pressure during contractions
B) the lowest intrauterine pressure measured between contractions
C) the frequency of contractions
D) the product of multiplying the intensity and the frequency of
contractions
E) the rise of pressure generated by bearing down

Back 149

the rise of intrauterine pressure during contractions

Front 150

OBG-5.307.
The optimal frequency of uterine contractions during the 1st stage of
labor is:
A) 0-1 contraction/ 10 minutes
B) 3-4 contractions/ 10 minutes
C) 6-8 contractions/ 10 minutes
D) 10-12 contractions/ 10 minutes
E) 15-20 contractions/ 10 minutes

Back 150

3-4 contractions/ 10 minutes

Front 151

OBG-5.308.
The average intensity of uterine contractions during the 1 st stage of
labor is:
A) 10-12 mmHg
B) 14-16 mmHg
C) 50-55 mmHg
D) 70-80 mmHg
E) 81-90 mmHg

Back 151

50-55 mmHg

Front 152

OBG-5.316.
Factors contributing to the development of caput succedaneum include:
A) the effect of negative pressure exerted by the cervix on the fetal
head
B) the strangulation caused by the contact ring
C) fetal hypoxia
D) all of the above
E) only answers (A) and (B) are true

Back 152

all of the above

Front 153

OBG-5.317.
Caput succedaneum may develop in:
A) a live fetus
B) a dead fetus only
C) both in the live and dead fetuses
D) in premature neonates only

Back 153

a live fetus

Front 154

OBG-5.318.
Preparatory contractions:
A) propel the fetus along the osseous and soft tissue passage after the complete effacement of the cervix
B) are uterine contractions resulting in the effacement of the cervix
C) induce the separation and delivery of the placenta
D) are contractions occurring during the first days; of the puerperium
E) brief uterine contractions occurring at irregular intervals during
the last weeks of pregnancy

Back 154

brief uterine contractions occurring at irregular intervals during the last weeks of pregnancy

Front 155

OBG-5.319.
Propulsive contractions:
A) propel the fetus along the osseous and soft tissue passage after
the complete effacement of the cervix
B) are uterine contractions resulting in the effacement of the cervix
C) induce the separation and delivery of the placenta
D) are contractions occurring during the first days of the puerperium
E) brief uterine contractions occurring at irregular intervals during
the last weeks of pregnancy

Back 155

propel the fetus along the osseous and soft tissue passage after the complete effacement of the cervix

Front 156

OBG-5.320.
Placental contractions:
A) propel the fetus along the osseous and soft tissue passage after the complete effacement of the cervix
B) are uterine contractions resulting in the effacement of the
cervix
C) induce the separation and delivery of the placenta
D) are contractions occurring during the first days of the puerperium
E) brief uterine contractions occurring at irregular intervals during
the last weeks of pregnancy

Back 156

induce the separation and delivery of the placenta

Front 157

OBG-5.321.
The term "premature rupture of membranes" means:
A) that membranes rupture after the effacement of the cervix
B) that membranes rupture before the beginning of uterine contractions
C) that membranes rupture after the start of uterine contractions
but before the effacement of the cervix
D) that membranes rupture before the fetal head has engaged the
pelvic brim

Back 157

that membranes rupture before the beginning of uterine contractions

Front 158

OBG-5.322.
The term "early rupture of membranes" means:
A) that membranes rupture after the effacement of the cervix
B) that membranes rupture before the beginning of uterine contractions
C) that membranes rupture after the start of uterine contractions
but before the effacement of the cervix
D) that membranes rupture before the fetal head has engaged the
pelvic brim

Back 158

that membranes rupture after the start of uterine contractions but before the effacement of the cervix

Front 159

OBG-5.325.
What is the average duration of the 1 st stage of labor in nulliparous
women?
A) 1-2 hours
B) 3-4 hours
C) 6-8 hours
D) 16-20 hours
E) 20-24 hours

Back 159

6-8 hours

Front 160

OBG-5.326.
What is the average duration of the 1st stage of labor in multiparous
women?
A) 1-2 hours
B) 4-6 hours
C) 6-8 hours
D) 8-10 hours
E) 10-12 hours

Back 160

4-6 hours

Front 161

OBG-5.332.
In which section of the birth canal does the fetal skull perform its
second rotation during cephalic position delivery?
A) at the pelvic brim
B) in the cavity of the pelvis
C) at the pelvic outlet
D) outside the vulva

Back 161

in the cavity of the pelvis

Front 162

OBG-5.333.
In which section of the birth canal does the fetal skull perform its
third rotation during cephalic position delivery?
A) at the pelvic brim
B) in the cavity of the pelvis
C) at the pelvic outlet
D) outside the vulva

Back 162

at the pelvic outlet

Front 163

OBG-5.334.
In which section of the birth canal does the fetal skull perform its
fourth rotation during cephalic position delivery?
A) at the pelvic brim
B) in the cavity of the pelvis
C) at the pelvic outlet
D) outside the vulva

Back 163

outside the vulva

Front 164

OBG-5.336.
The signs of complete placental separation include:
A) ridging of the uterus
B) the umiblical cord is not retracted by pressure applied to the
lower abdomen above the symphysis
C) the umbilical cord is not retracted after bearing down
D) all of the above suggest separation of the placenta
E) only answers (A) and (B) are true

Back 164

all of the above suggest separation of the placenta

Front 165

OBG-5.337.
The Tsukhaloff-Kiistner's sign
A) is elicited by pressing the lower abdomen while observing the
retraction of the umbilical cord
B) means that the uterus loses its globoid shape and becomes
flattened and flaccid
C) means that the umbilical cord is not retracted after bearing
down
D) means that the separated placenta is expressed from the
uterine cavity like a seed of a plum by applying pressure to the
uterine fundus
E) means rubbing the fundus in order to elicit uterine contraction

Back 165

is elicited by pressing the lower abdomen while observing the
retraction of the umbilical cord

Front 166

OBG-5.338.
Klein's sign
A) means that the umbilical cord is not retracted when pressure
is applied to the lower abdomen above the symphysis
B) means that the uterus loses its globoid shape and becomes
flattened and flaccid
C) means that the umbilical cord is not retracted after bearing
down if the separation of the placenta is complete
D) means that the separated placenta is expressed from the
uterine cavity like a seed of a plum by applying pressure to the
uterine fundus

Back 166

means that the umbilical cord is not retracted after bearing
down if the separation of the placenta is complete

Front 167

OBG-5.339.
Where can the upper pole of the uterine fundus be found after delivery
of the placenta?
A) at the umbilical level
B) about 3 centimetres above the symphysis
C) about 6 centimetres above the symphysis
D) at the level of the symphysis
E) in the pelvic cavity

Back 167

about 6 centimetres above the symphysis

Front 168

OBG-5.340.
Where can the upper pole of the uterine fundus be found on the first
day of the puerpuerium?
A) about 3 centimetres above the umbilicus
B) at the umbilical level
C) about 6 centimetres above the symphysis
D) at the level of the symphysis
E) in the pelvic cavity

Back 168

at the umbilical level

Front 169

BG-5.341.
Which of the following should be determined on admission to the
delivery room?
A) the presenting part should be identified and its relative location
to the pelvic brim should be determined
B) the integrity of the fetal membranes and the color of the amniotic
fluid
C) fetal cardiac function and the dilation of the cervix should be
assessed
D) uterine contractions should be evaluated
E) all of the above

Back 169

all of the above

Front 170

OBG-5.342.
Which of the following features of expulsive contractions can be assessed
by palpation?
A) frequency
B) duration
C) intensity
D) basal tone
E) all of the above

Back 170

all of the above

Front 171

OBG-5.343..
Which of the following cannot be determined by vaginal examination
performed during labor?
A) the degree of dilation and effacement of the cervix
B) the integrity of fetal membranes
C) neither the presenting part nor its position in the birth canal
can be determined
D) the risk of fetal hypoxia
E) the location of the governing point and path

Back 171

the risk of fetal hypoxia

Front 172

OBG-5.344.
In which of the following cases is vaginal examination indicated during
labor?
A) if the progress of the presenting part is inadequate despite
normal uterine activity
B) it is mandatory before obstetrical surgery
C) if abnormal engagement, presentation or position is suggested
by the findings of rectal digital examination
D) all of the above

Back 172

all of the above

Front 173

OBG-5.345.
The essentials of active management of the 3rd stage of labor include:
A) after the delivery of the fetus, the uterine fundus is rubbed in
order to aid in the firm contraction of the uterus
B) after the delivery of the fetus, the placenta is removed by
Crede's maneuver
C) an oxytocic drug is given immediately after the delivery of the
fetus
D) after the delivery of the fetus, the separation and expulsion of
the placenta is aided by exerting traction on the umibilical
cord
E) the separation of the placenta should be patiently waited for,
without rubbing or massaging the uterus

Back 173

an oxytocic drug is given immediately after the delivery of the
fetus

Front 174

OBG-5.347.
In which of the following cases should the delivered placenta be examined?
A) if the separation of the placenta was difficult
B) if the 3rd stage of labor was abnormal during a previous pregnancy
C) if the delivered placenta is fragmented
D) if there are multiple abortions in the past medical history
E) meticulous examination is mandatory in all cases

Back 174

meticulous examination is mandatory in all cases

Front 175

OBG-5.349.
Pain associated with labor is caused by:
A) the dilation of the cervix
B) traction of the uterine ligaments and the peritoneum
C) compression of blood vessels and associated ischemia of
uterine tissues
D) all of the above
E) only answers and (B) are true

Back 175

all of the above

Front 176

OBG-5.351.
The term "secondary contraction failure" means:
A) that contractions are adequate initially but weaken as labor
progresses
B) contractions are weak and ineffective from the start of labor
C) low basal tone of the uterine musculature
D) high basal tone of the uterine musculature

Back 176

that contractions are adequate initially but weaken as labor
progresses

Front 177

OBG-5.353.
The term "normotonic contraction failure" means:
A) that the intensity of contractions gradually decreases during
the progress of labor
B) that contractions are ineffective from the start of labor
C) that contractions occur infrequently, their amplitude is low
just as the basal tone of the uterine musculature
D) that contractions occur infrequently, their amplitude is low
but the basal tone of the uterine musculature is normal

Back 177

that contractions occur infrequently, their amplitude is low
but the basal tone of the uterine musculature is normal

Front 178

OBG-5.354.
The term "hypotonic contraction failure" means:
A) that the intensity of contractions gradually decreases during
the progress of labor
B) that contractions are ineffective from the start of labor
C) that contractions occur infrequently, their amplitude is low
just as the basal tone of the uterine musculature
D) that contractions occur infrequently, their amplitude is low
but the basal tone of the uterine musculature is normal

Back 178

that contractions occur infrequently, their amplitude is low
just as the basal tone of the uterine musculature

Front 179

OBG-5.355.
The term "hypertonic contraction failure" means:
A) that the intensity of contractions gradually decreases during
the progress of labor
B) that contractions are ineffective from the start of labor
C) that contractions occur infrequently, their amplitude is low
just as the basal tone of the uterine musculature
D) that contractions occur infrequently, their amplitude is low
but the basal tone of the uterine musculature is normal

Back 179

that contractions occur infrequently, their amplitude is low
but the basal tone of the uterine musculature is normal

Front 180

OBG-5.367.
The consequences of prolonged labor include:
A) ascending uterine infection
B) intrauterine asphyxia
C) bleeding resulting from uterine atony
D) all of the above
E) only answers (A) and (B) are true

Back 180

all of the above

Front 181

OBG-5.368.
The prevalence of breech presentation in premature labor is:
A) 1-2%
B) 3-4%
C) 10-12%
D) 30-40%

Back 181

10-12%

Front 182

OBG-5.369.
The prevalence of breech presentation in all deliveries is:
A) 1-2%
B) 4-5%
C) 15-20%
D) 30-40%

Back 182

4-5%

Front 183

0BG-5.373.
Which of the following is the presenting part in single feet presentation?
A) the buttocks and one of the feet
B) both knees
C) one of the knees
D) one of the legs
E) both legs

Back 183

one of the legs

Front 184

OBG-5.374.
Which of the following is the presenting part in double feet presentation?
A) the buttocks and one of the feet
B) both knees
C) one of the knees
D) both legs
E) one of the legs

Back 184

both legs

Front 185

OBG-5.377.
Which of the following is the presenting part in incomplete breechfeet
presentation?
A) the buttocks
B) the buttocks and both feet
C) the buttocks and one of the feet
D) both knees
E) one of the knees

Back 185

the buttocks and one of the feet

Front 186

OBG-5.379.
Which of the following is the presenting part in single knee presentation?
A) the buttocks and both knees
B) . both knees
C) one of the knees only
D) one of the knees and the contralateral foot

Back 186

one of the knees only

Front 187

OBG-5.380.
Which of the following methods is appropriate for the detection of
breech presentation?
A) vaginal examination
B) ultrasonography
C) radiography
D) fetal ECG
E) all of the above

Back 187

all of the above

Front 188

OBG-5.381.
Compared to cephalic presentation delivery, which of the following
represent an increased disadvantage during breech delivery?
A) the fetal head compresses the umbbilical cord
B) the fetal head has no chance to mold to fit pelvic size
C) upward displacement of the fetals arms may cause fracture
D) all of the above
E) breech presentation carries no additional disadvantage over
cephalic presentation delivery

Back 188

) all of the above

Front 189

OBG-5.382.
Where does venous and arterious blood mix in the fetal circulation?
A) the umbilical vein supplies the liver and coalesces to form the
branches of the hepatic vein then joins the inferior vena cava
B) considered an extension of the umbilical vein the ductus
venosus of Arandi joins the inferior vena cava
C) both the inferior and the superior vena cava empty into the
right atrium and their blood is mixed there
D) the ductus arteriosus (Botallo's duct), a branch of the pulmonary
artery, empties int6 the aorta

Back 189

considered an extension of the umbilical vein the ductus
venosus of Arandi joins the inferior vena cava

Front 190

OBG-5.384.
How many days does the postnatal obliteration of the ductus venosus
take?
A) it is obliterated immediately after birth, during the first breath
B) 1-2 days
C) 2-3 days
D) 5-10 days
E) 20-30 days

Back 190

5-10 days

Front 191

OBG-5.383.
By which postnatal week is the closure of the foramen ovale complete?
A) week 1-2
B) week 2-3
C) week 4-8
D) week 16-20
E) week 20-24

Back 191

week 4-8

Front 192

OBG-5.385.
What is the cause of the increased heat loss off neonates and their
susceptibility to hypothermia?
A) the ratio of body surface area to body mass is significantly
higher in neonates than in adults
B) the subcutaneous fat layer is relatively thin
C) the activity of the thermoregulation centre is unstable
D) all of the above have a role in the development of hypothermia
E) only answers (A) and (B) are true

Back 192

all of the above have a role in the development of hypothermia

Front 193

OBG-5.393.
The term "embryopathy" means:
A) fetal damage sustained between week 13 of gestation and the
time of birth
B) fetal damage susteined between weeks 2 and 13 of gestation
C) fetal damage sustained between the time of conception and
day 14 of gestation
D) damage to the ovum before fertilization resulting in the development
of various congenital malformations

Back 193

fetal damage susteined between weeks 2 and 13 of gestation

Front 194

OBG-5.394.
The term "fetopathy" means:
A) fetal damage sustained between week 13 of gestation and the
time of birth
B) fetal damage susteined between weeks 2 and 13 of gestation
C) fetal damage sustained between the time of conception and
day 14 of gestation
D) damage to the ovum before fertilization resulting in the development
of various congenital malformations

Back 194

fetal damage sustained between week 13 of gestation and the
time of birth

Front 195

OBG-5.401.
What is the risk of the recurrence of the congenital malformations of
the musculoskeletal system?
A) 1:5
B) 1:10-20
C) 1:50
D) 1:100
E) 1:200

Back 195

1:10-20

Front 196

OBG-5.406.
Congenital dysplasia of the hip is more prevalent in:
A) boys
B) girls
C) there is no gender-specific difference

Back 196

girls

Front 197

OBG-5.407.
The chromosomal abnormality characteristic of Down's syndrome
includes:
A) trisomy G21
B) D/G translocation
C) G/G translocation
D) all of the above
E) only answers (A) and (B) are true

Back 197

all of the above

Front 198

OBG-5.408.
The chromosomal abnormality characteristic of Patau's. syndrome
includes:
A) trisomy G21
B) trisomy D
C) D/G translocation
D) G/G translocation
E) 45,X0 caryotype

Back 198

trisomy D

Front 199

OBG-5.415.
What is the prevalence of congenital malformations in neonates born
to diabetic mothers?
A) 1%
B) 2%
C) 10%
D) 30%
E) 60%

Back 199

10%

Front 200

OBG-5.416.
In Rh-isoimmunization, exhange transfusion is indicated if the serum
bilirubin level is higher in the first 24 hours than:
A) 10 mmol/1
B) 20 mmol/1
C) 50 mmol/1
D) 137 mmol/1
E) 250 mmol/1

Back 200

137 mmol/1

Front 201

OBG-5.418.
What is the time limit for effective anti-D IgG administration to Rhnegative
women after delivery?
A) 1 day
B) 2 days
C) 3 days
D) 4 days
E) 5 days

Back 201

3 days

Front 202

OBG-5.420.
Which of the following factors induces the differentiation of the gonads?
A) testosterone
B) estrogens
C) androgens produced by the adrenal cortex
D) sex chromosomes
E) pituitary hormones

Back 202

sex chromosomes

Front 203

OBG-5.421.
Which of the following factors induces the deveopment of the genital
tract and external genitalia in male fetuses?
A) testosterone
B) the combined effect of estrogen and testosterone
C) sex chromosomes
D) pituitary hormones
E) neither hormonal nor chromosomal effects are needed as male
sexual differentation is always the default

Back 203

testosterone

Front 204

OBG-5.422.
Which of the following factors induces the deveopment of the genital
tract and external genitalia in female fetuses?
A) testosterone
BY the combined effect of estrogen and testosterone
C) sex chromosomes
D) pituitary hormones
E) neither hormonal nor chromosomal effects are needed as female
sexual differentation is always the default

Back 204

neither hormonal nor chromosomal effects are needed as female
sexual differentation is always the default

Front 205

OBG-5.423.
Which of the following features of gender develop during intrauterine
life in humans?
A) chromosomal and gonadal gender
B) gonadal and genital gender
C) chromosomal, gonadal and genital gender
D) chromosomal, gonadal, genital and somatic gender
E) gonadal, genital and somatic gender

Back 205

chromosomal, gonadal and genital gender

Front 206

OBG-5.424.
Which of the following features of gender develop during extrauterine
life in humans?
A) genital and somatic gender
B) gonadal, genital and somatic gender
C) genital, somatic and psychosexual gender
D) somatic and psychosexual gender

Back 206

somatic and psychosexual gender

Front 207

OBG-5.425.
Which of the following describe types of intersexuality?
A) ovarian and testicular
B) ovarian, testicular and ovotesticular
C) ovarian and conditions with gonadal dysgenesis
D) ovarian, testicular and conditions with gonadal dysgenesis
E) ovarian, testicular, ovotesticular and and conditions with gonadal
dysgenesis

Back 207

ovarian, testicular, ovotesticular and and conditions with gonadal
dysgenesis

Front 208

OBG-5.426.
Which of the following gonads can be found in a patient with true
hermaphroditism?
A) the testes
B) the ovaries
C) both the ovaries and the testes
D) "streak" gonads
E) the testes and "streak" gonads

Back 208

both the ovaries and the testes

Front 209

OBG-5.432.
The karyotype characteristic of testicular feminisation is:
A) 46, XX
B) 46, XY
C) 45, XO
D) 47, XXY
E) 47, XYY

Back 209

46, XY

Front 210

OBG-5.447.
The karyotype characteristic of pure gonadal dysgenesis is:
A) 46, XX
B) 46, XY
C) 45, XO
D) 47, XXY
E) 47, XYY

Back 210

46, XX

Front 211

OBG-5.450.
The most frequent cause of precocious puberty is:
A) hormone producing ovarian neoplasm
B) adrenal neoplasm
C) brain tumor
D) dysfunction of the adrenal cortex
E) hypothyroidism

Back 211

hormone producing ovarian neoplasm

Front 212

OBG-5.451.
In delayed puberty, no signs of sexual maturation manifest themselves
until the age of:
A) 12
B) 13
C) 14
D) 15
E) 16

Back 212

15

Front 213

OBG-5.456.
Which of the following therapeutic methods should be applied for
controlling bleeding in juvenile metropathia?
A) curettage
B) hysteroscopy
C) hormonal (chemical) abrasion
D) suction curettage
E) no therapy is necessary, as this condition is transitory and selflimiting

Back 213

hormonal (chemical) abrasion

Front 214

OBG-5.457.
Which of the following drugs is inappropriate for (chemical) hormonal
abrasion?
A) ethinylestradiol (Mikrofollin)
B) norethisteron (Norcolut)
C) lynestrenol (Orgametril)
D) methylestrenolon (Orgasteron)
E) progesterone (Glanducorpin)

Back 214

ethinylestradiol (Mikrofollin)

Front 215

OBG-5.459.
Which of the following may cause vaginal discharge of non-infectious
origin in puberty?
A) estrogen deficiency
B) psychogenic factors
C) sideropenia
D) all of the above
E) only answers (A) and (B) are true

Back 215

all of the above

Front 216

OBG-5.473.
What is the likely cause of vaginal bleeding if the estrogen and
estrogen-progesteron challenge tests as well as gonadotropin levels
are normal and the absence of pregnancy is certain?
A) hypothalamic dysfunction
B) pituitary dysfunction
C) ovarian dysfunction
D) uterine dysfunction
E) dysregulatory dysfunction

Back 216

uterine dysfunction

Front 217

OBG-5.487.
Which of the following gynecologic endocrinopathies is treated by
the wedge resection of the ovaries?
A) anovulatory cycles
B) Stein-Leventhal syndrome
C) gonadotropin resistant ovary
D) ovarian hypoplasia
E) ovarian endometriosis

Back 217

Stein-Leventhal syndrome

Front 218

OBG-5.488.
Case Study:
A woman with oligomenorrhea has regular menses, deferes contraception,
does not want to be pregnant and has a prolonged follicular phase with
biphasic cycles. Which of the following is the appropriate therapy for this
condition?
A) ovulation induction
B) menstruation precipitation by the administration of estrogen
and progesterone
C) ovulation induction by estrogen administration
D) postponement of ovulation by estrogen administration
E) no therapy is necessary

Back 218

no therapy is necessary

Front 219

OBG-5.492.
Case Study:
A patient with polymenorrhea has regular, low-volume menses, she is
not anemic, would like a child but fails to conceive. Which of the following
is the appropriate therapy for this condition?
A) ovulation induction
B) menstruation precipitation by the administration of estrogen
and progesterone
C) postponement of ovulation by estrogen administration
D) cyclic administration of estrogen and progesterone for 2-3 months
E) no therapy is necessary, this is a self-limiting condition

Back 219

ovulation induction

Front 220

OBG-5.597.
Stage II ovarian carcinoma neoplastic disease involves:
A) one of the ovaries and fallopian tubes only
B) one or both ovaries
C) one or both ovaries and the pelvis
D) one or both ovaries and various intraabdominal organs
E) one or both ovaries and gives metastases to distant sites

Back 220

one or both ovaries and the pelvis

Front 221

OBG-5.598.
Stage III ovarian carcinoma neoplastic disease involves:
A) one of the ovaries and fallopian tubes only
B) one or both ovaries
C) one or both ovaries and the pelvis
D) one or both ovaries and various intraabdominal organs
E) one or both ovaries and gives metastases to distant sites

Back 221

one or both ovaries and the pelvis

Front 222

OBG-5.599.
Stage IV ovarian carcinoma neoplastic disease involves:
A) one of the ovaries and fallopian tubes only
B) one or both ovaries
C) one or both ovaries and the pelvis
D) one or both ovaries and various intraabdominal organs
E) one or both ovaries and gives metastases to distant sites

Back 222

one or both ovaries and various intraabdominal organs

Front 223

OBG-5.600.
Carcinoma of the ovary is most frequently treated by:
A) cytotoxic chemotherapy
B) surgery only
C) surgery followed by irradiation
D) surgery followed by cytotoxic chemotherapy
E) irradiation only

Back 223

surgery followed by cytotoxic chemotherapy

Front 224

OBG-5.602.
Dysgerminoma of the ovary develops from:
A) cells of the ovarian stroma
B) hilar Leydig-cells of the ovary
C) undifferentiated cells of the germinal epithelium
D) granulosa cells of atretic follicles
E) undifferentiated chorionic cells

Back 224

undifferentiated cells of the germinal epithelium

Front 225

OBG-5.607.
Which of the following screening methods is appropriate for the detection
of ovarian neoplasms?
A) a gynecologic examination every 6-12 months
B) ultrasonography every 6-12 months
C) lavage and aspiration cytology of the cul-de-sac every 12 months
D) methods (A) and (B) are used primarily
E) there is` no reliable method for the detection of ovarian neoplasms

Back 225

methods (A) and (B) are used primarily

Front 226

OBG-5.612.
The characteristic signs of intrauterine endometriosis include:
A) dysmenorrhea
B) hypermenorrhea
C) sterility
D) a firm, uniformly enlarged uterus
E) all of the above
F) only answers (A) and (C). are true

Back 226

all of the above

Front 227

OBG-5.614.
The contents of the ovarian cyst resembles chocolate or tar in:
A) fibromyoma
B) adenocarcinoma
C) endometriosis
D) necrotized dysgerminoma
E) hemorrhagic corpus luteum cyst

Back 227

endometriosis

Front 228

OBG-5.615.
Which ofthe following drugs is inapprorpiate for the therapy of
endometriosis?
A) danazol (DTIC-DOME) (a synthetic androgen)
B) lynestrenol (Orgametril)
C) norethisteron (Norcolut)
D) ethinylestradiol (Mikrofollin forte)
E) hydroxyprogesterone acetate

Back 228

ethinylestradiol (Mikrofollin forte)

Front 229

OBG-5.616.
Which ofthe following drugs is recommended for the therapy of
endometriosis?
A) stilbene derviatives
B) natural estrogens
C) progestogenic norsteroid compounds (19-nortestosterorone
derivatives)
D) natural progesterone derivatives
E) natural androgens

Back 229

progestogenic norsteroid compounds (19-nortestosterorone
derivatives)

Front 230

OBG-5.619.
The ratio between the length of the uterine corpus and the cervix is
normally:
A) 1:1
B) 2:1
C) 3:1
D) 1:2
E) 1:3

Back 230

2:1

Front 231

OBG-5.620.
In uterine hypoplasia, the ratio between the length of the uterine
corpus and the cervix is normally:
A) 1:1
B) 2:1
C) 3:1
D) 1:2
E) 1:3

Back 231

2:1

Front 232

OBG-5.622.
Excessive anteflexion of the uterus:
A) is expressed by the blunt angle of the uterine corpus and the
cervix
B) means that the angle of the uterine corpus and the cervix is
less than normal
C) means that the uterus is located ventrally to the longitudinal
axis of the pelvis
D) means that the uterus is located dorsally to the longitudinal
axis of the pelvis

Back 232

means that the angle of the uterine corpus and the cervix is
less than normal

Front 233

OBG-5.628.
Congenital malformations of the genitals are freqently associated
with congenital abnormalities of the:
A) urinary tract
B) kidneys
C) rectum
D) all of the above
E) only answers (A) and (B) are true

Back 233

only answers (A) and (B) are true

Front 234

OBG-5.626.
In partial uterine prolapse:
A) the uterus descends beneath the level of the hymenal ring and
the portio vaginalis of the cervix appears in the vaginal
introitus
B) despite the descensus of the uterus, the portio vaginalis of the
cervix does not sink beneath the level of the hymenal ring
C) the uterus is found before the introitus, in the prolapsed vaginal
sac
D) the position of the uterine corpus is normal but the cervix is
significantly elongated

Back 234

the uterus descends beneath the level of the hymenal ring and
the portio vaginalis of the cervix appears in the vaginal
introitus

Front 235

OBG-5.627.
In total uterine prolapse:
A) the uterus descends beneath the level of the hymenal ring and
the portio vaginalis of the cervix appears in the vaginal
introitus
B) despite the descensus of the uterus, the portio vaginalis of the
cervix does not sink beneath the level of the hymenal ring
C) the uterus is found before the introitus, in the prolapsed vaginal
sac
D) the position of the uterine corpus is normal but the cervix is
significantly elongated

Back 235

the uterus is found before the introitus, in the prolapsed vaginal
sac

Front 236

OBG-5.640.
In puerperal mastitis, the pathogen most often cultured from the
excretions of the mammary glands is:
A) Escherichia cola
B) Staphylococcus aureus
C) Streptococcus fecalis
D) Staphylococcus epidermidis
E) Bacteriodes species

Back 236

Staphylococcus aureus

Front 237

OBG-5.644.
Preeclampsia is defined as:
A) hypertension developing before the 20th week of pregnancy
B) proteinuria associated with edema during pregnancy
C) hypertension with proteinuria or edema or both during pregnancy
D) papilledema developing during pregnancy
E) the occurrence of seizures of non-neurologic origin during
pregnancy

Back 237

hypertension with proteinuria or edema or both during pregnancy

Front 238

OBG-5.645.
All of the following statements are valid regarding the amniotic fluid,
EXCEPT:
A) fetal maturity can be assessed by evaluating the properties of
the amniotic fluid
B) the volume of amniotic fluid is increasing constantly during
pregnancy
C) oligohydramnios is associated with the risk of Potter's syndrome
D) congenital malformations are likely to develop in about 50% of
polyhydramnios cases
E) the amniotic fluid has antibacterial properties

Back 238

the volume of amniotic fluid is increasing constantly during
pregnancy

Front 239

OBG-5.650.
Certain signs of pregnancy include:
1) the detection of active fetal motions by the examiner
2) Hegar's sign
3) detection of the fetus by ultrasonography
4) a blowing murmur from the uterus

Back 239

B

Front 240

OBG-5.654.
Premature delivery starting without cervical dilation or early rupture
of the fetal membranes can probably be stopped by the administration
of:
1) morphine sulphate
2) intravenous alcohol
3) barbiturates
4) ritodrine

Back 240

C

Front 241

OBG-5.656.
n patients with vulvar carcinoma, lymphatic drainage from regions
other than the clitoris is accumulated by the:
1) external iliac lymph nodes
2) superficial inguinal lymph nodes
3) deep fermoral inguinal lymph nodes
4) paraaortic lymph nodes

Back 241

A

Front 242

OBG-5.658.
Methods appropriate for the study of fetal chromosomes include:
1) amniocentesis
2) cordocentesis
3) chorionic villous sampling
4) echo-Doppler duplex flowmetry

Back 242

A

Front 243

OBG-5.669.
Characteristic features of uterus bicornis unicollis include:
1) absence of the complete unification of the Miillerian ducts
2) it is associated with an increased incidence in obstetrical complications
3) it is associated with an increased incidence in genitourinary
malformations
4) congenital anomalies of the cervix and vagina

Back 243

A

Front 244

OBG-5.689.
Which of the following factors may induce ureteral dilation during
pregnancy?
1) compression exerted by the pregnant uterus
2) external compression due to the dilated right ovarian vein
3) the effect of progesterone
4) increasesd glomerular filtration rate

Back 244

A

Front 245

OBG-5.691.
Maternal reactions induced by nursing include:
1) oxytocin release
2) reduced production of prolactin inhibiting factor
3) reduction of hypothalamic dopamine levels
4) increased production of luteinizing hormone-releasing factor

Back 245

A

Front 246

OBG-5.706.
Absolute contraindications to the use of oral contraceptives include:
1) thromboembolisc disorders
2) congenital hyperlipidemia
3) obesity and smoking for 35 years
4) ectopic pregnancy in the patient's history

Back 246

A

Front 247

OBG-5.707.
Contraindications to the insertion of an IUD include:
1) pelvic inflammatory disease in the patient's history
2) previous conception despite IUD use
3) abnormal genital bleeding
4) previous wedge resection of the cervix

Back 247

B

Front 248

OBG-5.714.
Ultrasonography performed in the third trimester detects:
1) anencephaly and major neural tube defects
2) fetal death
3) polyhydramnios
4) the accurate age of pregnancy

Back 248

A

Front 249

OBG-5.716.
Risks associated with smoking during pregnancy and the puerperium
include:
1) the delivery of a low birth-weight neonate
2) spontaneous abortion
3) premature delivery
4) sudden infant death syndrome

Back 249

E

Front 250

OBG-5.717.
Severe fetal or neonatal disease may result from maternal infection
by which of the following viruses?
1) Coxsackie B virus
2) Rubellavirus
3) Smallpox virus
4) type 2 Herpesvirus hominis

Back 250

E

Front 251

OBG-5.718.
The fetal or neonatal consequences of maternal diabetes include:
1) macrosomia
2) delayed pulmonary maturation
3) hypoglycemia
4) hypocalcemia

Back 251

E

Front 252

OBG-5.719.
Valid statements regarding toxoplasmosis developing in pregnancy
include:
1) the infection is contracted by the consumption of raw meat
2) the infection is contracted by contact with feline feces
3) infection occurring in the early stage of pregnancy may result
in abortion
4) the incidence of this condition is 1:2,000-2,500 pregnancies

Back 252

A

Front 253

OBG-5.720.
Hormones produced by the human placenta include:
1) gonadotropin
2) somatomammotropin (hCS)
3) progesterone
4) hydrocortisone

Back 253

A

Front 254

OBG-5.723.
Which of the following drugs are appropriate for the therapy of
postpartum bleeding?
1) ergometrine
2) oxytocin injection
3) ergotamine
4) prostaglandins

Back 254

E

Front 255

OBG-5.740.
The imperforate hymen may result in the development of:
1) hematocolpos
2) dysuria
3) hematometra
4) periodic lower abdominal pain

Back 255

E

Front 256

OBG-5.741.
Acute urinary retention may result from:
1) retroflexion of the pregnant uterus
2) uterine obstruction caused by a myoma
3) hematocolpos
4) pelvic hematocele

Back 256

E

Front 257

OBG-5.742.
Laparoscopy is CONTRAINDICATED:
1) during menstruation
2) in patients with descensus of the pelvic floor
3) in pelvic tuberculosis
4) in intestinal obstruction

Back 257

D

Front 258

OBG-5.760.
Characteristic features of Turner syndrome (45, XO) include:
1) a low stature
2) a female gender with bilateral inguinal hernia
3) hypergonadotropic amenorrhea with low estrogen levels
4) elevated gonadotropin levels, the presence of ovarian follicles
and amenorrhea

Back 258

B

Front 259

OBG-5.761.
Valid statements regarding the maturation of oocytes include:
1) available information suggests that the eleveation of estradiol
levels in the late follicular pahse induce the fluctuation of
gonadotropin levels
2) exogenous estrogen replacement does not influence the release
of gonadotrophic hormones
3) abnormal androgen levels may suppress the pulse generator
and GnRH release
4) follicles mature independently of pituitary prolactin secretion

Back 259

B

Front 260

OBG-5.764.
Hemodynamic changes associated with the shifting from fetal to
neonatal circulation result in:
1) the constriction of umbilical vessels and the gradual obliteration
of the foramen ovale as well as the ductus venosus
2) the fall of systemic blood pressure
3) expansion of the fetal lung
4) reversal of the direction of blood flow in the ductus arteriosus

Back 260

E

Front 261

OBG-5.766.
Case Study:
A patient displays mild uterine irritability in the 35th week of her pregnancy
despite avoiding exertion as much as possible and her blood
pressure is also significantly elevated. Although prompt hospitalization
reversed these symptoms, intensive monitoring was institued.
Which of the following symptoms is/are of concern in week 36?
1) urinary estriol levels are below the tenth of the normal value of
the hospital's laboratory
2) according to the results of serial ultrasonographies, the
growth-rate of the fetus is below 10%
3) amniocentesis yielded clear amniotic fluid (with an L/S ratio of
2.2 and a 2.0 mg% creatinine level)
4) the maternal serum prolactin level decreased below 4 mg/ml

Back 261

E

Front 262

OBG-5.767.
Associate the following term(s) with their corresponding statement(s)!
A) Genital tubercle
B) Genital bud
C) Urogenital sinus
D) Urethral folds
E) Müllerian ducts
1) labia minora
2) labia majora
3) clitoris
4) lower third of the vagina
5) oviducts

Back 262

D,B,A,C,E

Front 263

OBG-5.768.
Associate the following term(s) with their corresponding statement(s)!
A) Uterine vein
B) B) Right ovarian vein
C) Left ovarian vein
D) Uterine artery
E) Ovarian artery
1) hypogastric artery (emerges from the internal iliac artery)
2) joins the internal iliac veins
3) joins the inferior vena cava
4) emerges from the abdominal aorta
5) joins the left renal vein

Back 263

D,A,B,E,C

Front 264

OBG-5.769.
Associate the following term(s) with their corresponding statement(s)!
A) Spontaneous abortion
B) Threatened abortion
C) Habitual abortion
D) Therapeutic abortion
E) Elective abortion
1) termination of the pregnancy on maternal indication before the
fetus attains viability
2) termination of the pregnancy before the fetus attains viability
on indication other than the protection of maternal health or
from causes other than fetal disease
3) spontaneous termination of gravidity occurring in about 10%
of all pregnancies
4) spontaneous termination of gravidity associated with chromosomal
abnormalities in 50-60% of cases
5) spontaneous termination of gravidity that is unfeasible in the
case of the first pregnancy .

Back 264

D,E,A,A,C

Front 265

OBG-5.770.
Associate the following statement(s) with their corresponding term(s)!
A) oral contraceptive use should be suspended for 7 days then
reinstituted
B) oral contraceptives should be continued as ususal
C) oral contraceptives should be continued and a supplemental
contraceptive method should be applied in addition
D) an extra tablet should be taken
E) oral contraceptive use should be abandoned and a diagnostic
workup is necessary
1) Nausea occurring in the first cycle during oral contraceptive use
2) Menstruation is absent during the 7 days following the 21-day
long period of proper oral contraceptive use
3) The patient has forgotten to take one tablet
4) The patient has forgotten to take oral contraceptives for 10
consecutive days
5) Slight bleeding at midcycle during the first month of oral contraceptive
use
6) Hemoptysis

Back 265

B,B,C,C,B,E

Front 266

OBG-5.771.
Associate the following term(s) with their corresponding statement(s)!
A) Ectopic pregnancy
B) Cortisol excess
C) 21-Hydroxylase deficiency
D) 19-Nortestosterone-progestins
E) Toxic inflammatory endometritis
1) centripetal obesity, moon-face, purple striae
2) 10% incidence of ectopic tubal pregnancy
3) congenital adrenal hyperplasia
4) supresses luteinizing hormone-releasing factor secretion
5) Arias-Stella phenomenon

Back 266

B,E,C,D,A

Front 267

OBG-5.493.
In dysmenorrhea:
A) abdominal cramping is the leading symptom, seldom associated
with nausea and vomiting, etc.
B) nausea and vomiting, etc. are the primary symptoms, not abdominal
cramps
C) the symptoms develop after the first delivery
D) symptoms are present from the time of the menarche
E) initially, menstruation is normal becomes associated with
cramps subsequently

Back 267

symptoms are present from the time of the menarche

Front 268

OBG-5.499.
Which of the following describes the characteristic features of infertility
correctly?
A) the failure to conceive after 2 years of unprotected intercourse
B) pregnancy develops but terminates before normal delivery
C) intercourse is not associated with sexual pleasure and does
not elicit orgasm
D) intercourse is impossible due to anatomical abnormalities of the
vagina
E) the failure to conceive after a year of unprotected intercourse

Back 268

pregnancy develops but terminates before normal delivery

Front 269

OBG-5.512.
When should curettage and endometrial histology be performed in
order to verify the occurrence of ovulation?
A) at the time of menstruation
B) on the week following menstruation
C) at midcycle
D) on the week preceeding menstruation
E) this method is not applicable in the diagnostics of the menstrual
cycle

Back 269

on the week preceeding menstruation

Front 270

OBG-5.518.
Which of the following methods is appropriate for the detection of
the anatomical abnormalities of the uterus and Faloppian tubes?
A) hysterosalpingography
B) ultrasonography
C) laparotomy (laparoscopy)
D) all of the above
E) only answers (A) and (C) are true

Back 270

all of the above

Front 271

OBG-5.519.
The term "birth rate" means:
A) the number of live.births per 100 inhabitants
B) the number of live births per 1,000 inhabitants
C) the number of live births per 10,000 inhabitants
D) the percentage of pregnancies ending with delivery
E) the percentage of pregnancies where live, healthy neonates are
delivered

Back 271

the number of live births per 1,000 inhabitants

Front 272

OBG-5.532.
Which of the following Hungarian preparations is a combined contraceptive?
A) Rigeuidon
B) Tri-Regol
C) Ovidon
D) all of the above

Back 272

all of the above

Front 273

OBG-5.533.
Which of the following is a minipill contraceptive containing progesterone
only?
A) Tri-Regol
B) Marvelon
C) Ovidon
D) Rigevidon
E) Continum

Back 273

Continum

Front 274

OBG-5.535.
What should be done if breakthrough bleeding occurs dining the use of oral contraceptives?
A) nothing, as this condition resolves spontaneously
B) the patient should suspend the use of contraceptives for 7
days then restart taking the tablets
C) the number of tablets taken should be increased; perhaps the actual regimen should be supplemented by an estrogen preparation
D) switch to another contraceptive preparation
E) oral contraceptives should be stopped and an IUD should be
Inserted

Back 274

the number of tablets taken should be increased; perhaps the actual regimen should be supplemented by an estrogen preparation

Front 275

OBG-5.537.
The most appropriate protocol for the minipill is:
A) to start always from the first day of menstruation and continue
taking the tablets for the next 21 days
B) 21 days on tablets followed by a 7-day pause
C) the tablets should be taken continuously, without interruption
D) the tablets should be taken according to the calendar, from the
first day of the month to the 21 st day

Back 275

the tablets should be taken continuously, without interruption

Front 276

OBG-5.538.
The contraindications to oral contraceptive use include:
A) thromboembolism
B) liver disease
C) endocrine disorders
D) all of the above
E) only answers (A) and (B) are true

Back 276

all of the above

Front 277

OBG-5.540.
Which of the following contraceptives are appropriate for nursing
mothers?
A) ethinyl estradiol / norgestrel
B) ethinyl estradiol/ desogestrel
C) ethynodiol diacetate
D) none of the above

Back 277

ethynodiol diacetate

Front 278

OBG-5.545.
What type of contraception is appropriate for nulliparous women?
A) oral contraceptives
B) intrauterine device
C) conventional methods
D) only answers (A) and (C) are true
E) there is no effective method

Back 278

only answers (A) and (C) are true

Front 279

OBG-5.547.
Which of the following belongs to the requirements for inserting
IUDs?
A) all licensed family practitioners are allowed to insert IUDs
B) all specialists are allowed to insert IUDs at a polyclinic
C) IUDs should be inserted only at the hospital
D) IUDs should be inserted by the professionals at university .
clinic gynecologic care and consulting services
E) family and gynecologic care services with an institutional
background are allowed to insert IUDs

Back 279

family and gynecologic care services with an institutional
background are allowed to insert IUDs

Front 280

OBG-5.548.
In women of reproductive age, the optimal period for inserting an
IUD is:
A) the first day of menstruation
B) between days 4 and 6 of the menses
C) 2-3 days before the expected time of menstruation
D) the IUD can be inserted at any time

Back 280

between days 4 and 6 of the menses

Front 281

OBG-5.549.
When should the IUD be inserted during lactation?
A) only if regular menstruation has already returned
B) if at least one menstruation has occurred since delivery
C) 6-8 weeks after the delivery, if the possibility of pregnany can
be excluded
D) only 5 months after the delivery
E) the use of IUDs is contraindicated in the period of lactation

Back 281

6-8 weeks after the delivery, if the possibility of pregnany can
be excluded

Front 282

OBG-5.554.
The onset of menopause is premature before the age of:
A) 40 years-old
B) 43 years-old
C) 50 years-old
D) 52 years-old
E) 55 years-old

Back 282

50 years-old

Front 283

OBG-5.555.
The menopause is delayed if uterine bleeding due to the cyclic
changes of ovarian hormones occurs before the age of:
A) 45 years-old
B) 48 years-old
C) 50 years-old
D) 52 years-old
E) 55 years-old

Back 283

55 years-old

Front 284

OBG-5.558.
Case Study:
A 45-year-old female presents with metrorrhagia. The proper therapy
of this condition includes:
A) no intervention is necessary as failing ovarian function normally
results in metrorrhagia at this age
B) oxytocic agents should be administered to control bleeding
C) chemical curettage by hormone therapy, followed by cyclic administration
of estrogen and progesterone
D) fractional curettage should be performed to exclude malignancy
E) hysterectomy is indicated as the incidence of uterine malignancies
is extremely high at this age

Back 284

fractional curettage should be performed to exclude malignancy

Front 285

OBG-5.562.
Which of the following drugs is the most appropriate for the treatment of
climacteric symtpoms (e.g. hot flushes, perspiration, palpitation, etc.)?
A) conjugated estrogens
B) gestogens
C) synthetic estrogens
D) androgens
E) the combination of androgens and estrogens

Back 285

conjugated estrogens

Front 286

OBG-5.564.
Which of the following estrogen preparations acts on the vaginal epithelium
primarily?
A) ethinyl estradiol (Mikrofollin)
B) estradiol (Akrofollin)
C) estriol (Ovestin)
D) dienestrol (Dienoestrol)

Back 286

estriol (Ovestin)

Front 287

OBG-5.565.
Case Study:
A 25-year-old woman with premature menopause would like to have
a child. Which of the following would you recommend?
A) pregnancy would be feasible by in vitro fertilization
B) therapy with clomiphene citrate as this is successful in most cases
C) Pergonal (FSH+LH) therapy is the only chance
D) there is no remedy for this condition as it represents irrevers-
ible infertility
E) laparotomy and wedge resection of the ovaries

Back 287

there is no remedy for this condition as it represents irrevers-
ible infertility

Front 288

OBG-5.572.
Which of the following is the pathogen of condylomata acuminata
(moist warts)?
A) bacteria
B) viruses
C) fungi
D) Trichomonas vaginalis
E) Treponema pallidum

Back 288

viruses

Front 289

OBG-5.575.
Characteristic macroscopic features of vaginal discharge in
Trichomonas vaginalis infection include:
A) thin and milky discharge
B) frothy, greenish and purulent discharge
C) the vaginal wall is covered by easily removable, whitefish-grey
material
D) thin, whitefish-grey discharge from the cervix
E) there are no characteristic macroscopic features

Back 289

frothy, greenish and purulent discharge

Front 290

OBG-5.576.
Characteristic macroscopic features of vaginal discharge in fungal
infections include:
A) thin and milky discharge
B) frothy, greenish and purulent discharge
C) the vaginal wall is covered by easily removable, whitefish-grey
material
D) thin, whitefish-grey discharge from the cervix
E) there are no characteristic macroscopic features

Back 290

the vaginal wall is covered by easily removable, whitefish-grey
material

Front 291

OBG-5.577.
Which of the following drugs is used for the treatment of vaginal
trichomoniasis?
A) metronidazol (Klion) tablets and vaginal suppositories
B) natamycine (Pimafucin) vaginal tablets
C) clotrimazole (Canesten) tablets
D) all of the above
E) only answers (A) and (B) are true

Back 291

metronidazol (Klion) tablets and vaginal suppositories

Front 292

OBG-5.578.
Which of the following lesions is considered a precancerous stage of
chorionic carcinoma?
A) cystic adenomatous hyperplasia of the endometrium
B) leukoplakia of the portio vaginalis of the cervix
C) hydatidiform mole
D) chronic cervicitis
E) placenta residues

Back 292

hydatidiform mole

Front 293

OBG-5.579.
Which of the following hormones is secreted by chorionic carcinomas?
A) estrogen
B) progesterone
C) androgens
D) human chorionic gonadotropin
E) follicle stimulating hormone

Back 293

human chorionic gonadotropin

Front 294

OBG-5.580.
Which of the following gynecological malignancies are associated
with the positivity of pregnancy tests?
A) endometrial carcinoma
B) cervical carcinoma
C) chorionic carcinoma
D) hormonally active ovarian tumors
E) ovarian cystadenocarcinomas

Back 294

chorionic carcinoma

Front 295

OBG-5.583.
Which of the following tests is the most reliable for diagnosing
chorionic carcinoma at the earliest possible time?
A) Rana reaction
B) Gravimun test
C) Menotest
D) detection of hCG b-subunits by RIA
E) Ascheim-Zondek reaction

Back 295

detection of hCG b-subunits by RIA

Front 296

OBG-5.584.
Which of the following organs is involved in the metastatic spread of
chorionic carcinoma most fregently?
A) the vagina
B) the lung and brain
C) the liver and the kidneys
D) all of the above
E) the vagina, lung and brain only

Back 296

all of the above

Front 297

OBG-5.587.
Cytotoxic chemotherapy gives the best results in the therapy of:
A) ovarian cystadenocarcinoma
B) endometrial adenocarcinoma
C) mesonephroid tumors
D) chorionic carcinoma
E) sarcoma

Back 297

chorionic carcinoma

Front 298

OBG-5.591.
Characteristic signs of Meigs' syndrome include:
A) pleural effusion
B) ascites
C) ovarian fibromyoma
D) all of the above
E) bilateral, smooth and firm mobile ovarian tumors

Back 298

all of the above

Front 299

OBG-5.596.
Stage I ovarian carcinoma neoplastic disease involves:
A) one of the ovaries and fallopian tubes only
B) one or both ovaries
C) one or both ovaries and the pelvis
D) one or both ovaries and various intraabdominal organs
E) one or both ovaries and gives metastases to distant sites

Back 299

one or both ovaries

Front 300

OBG-5.66.
The risk of congenital heart defects due to exposure to teratogenic
substances is the highest:
A) if the exposure occurs 1-2 weeks after menstruation
B) if the exposure occurs 2-3 weeks after menstruation
C) if the exposure occurs 6-8 weeks after menstruation
D) if the exposure occurs 9-12 weeks after menstruation
E) all of the above
F) none of the above

Back 300

if the exposure occurs 6-8 weeks after menstruation

Front 301

OBG-5.109.
Radiological features of hydrops fetalis include:
A) sprawled arms
B) radiolucency of the skull
C) the cranial bones override each other along the sutures
D) all of the above
E) only answers (A) and (B) are true

Back 301

only answers (A) and (B) are true

Front 302

OBG-5.158.
A In which of the following cases is the termination of pregnancy indi-
cated in ulcerative colitis?
A) in ulcerative colitis developing at the beginning of pregnancy
and showing progression despite drug therapy
B) acute exacerbation of the long-standing chronic disease during
pregnancy
C) if any indication for corticosteroid therapy occurs
D) all of the above
E) only answers (A) and (B) are true

Back 302

only answers (A) and (B) are true

Front 303

OBG-5.358.
The consequences of hypertonic contraction disorders include:
A) rupture of the uterus
B) fetal death
C) abnormal engagement of the presenting part
D) all of the above
E) only answers (A) and (B) are true

Back 303

only answers (A) and (B) are true

Front 304

OBG-5.486.
Which of the following drugs is appropriate for the treatment of the
Stein-Leventhal syndrome?
A) clomiphene citrate
B) corticosteroids
C) bromocriptine
D) all of the above
E) only answers (A) and (B) are true

Back 304

only answers (A) and (B) are true

Front 305

OBG-5.34.
The most common defect in the adrenogenital syndrome (congenital
adrenal hyperplasia) is:
A) none, as it is an idiopathic disorder
B) an 11-hydroxylase deficiency
C) a 17-hydroxylase deficiency
D) a 21-hydroxylase deficiency
E) 3-β-ol-dehydrogenase deficiency

Back 305

D

Front 306

OBG-5.114.
Nagele's method for estimating the duration of a pregnancy takes the
following under consideration:
A) the date of ovulation
B) the date of conception
C) the first day of the last menses
D) the last day of the last regular menses
E) the date when fetal motion is first detected

Back 306

C

Front 307

OBG-5.225.
The cause of generalized vasoconstriction developing in late occurring
toxemia of pregnancy is:
A) vasopressor substances produced in the placenta
B) increased sensitivity of small arterioles to pressor agents
C) only answers (A) and (B) are true
D) adrenal hyperfunction
E) altered sensitivity of the blood-pressure regulating centre

Back 307

C

Front 308

OBG-5.235.
Symptoms of late toxemia of pregnancy include:
A) hypertension
B) proteinuria
C) edema
D) all of the above
E) only answers (B) and (C) are true

Back 308

D

Front 309

OBG-5.253.
Which of the following determines the severity of fetal damage due to
toxemia of pregnancy?
A) the severity of toxemia
B) the duration of toxemia
C) the character of toxemia, i.e. whether it is primary or superimposed
D) all of the above
E) only answers (A) and (B) are true

Back 309

D

Front 310

OBG-5.248
Which of the following methods is appropriate for the diagnosis of
late occurring toxemia of pregnancy?
A) the measurement of blood pressure
B) urinalysis
C) body weight monitoring
D) all of the above
E) only answers (A) and (B) are true

Back 310

D

Front 311

OBG-5.255.
Essential principles of therapy of late occurring toxemia of pregnancy
include:
A) the provision of appropriate rest
B) the prescription of a protein-rich diet and abstinence from
spicy food
C) the alleviation of edema
D) the administrationof antihypertensives and sedatives
E) the combination of all the above

Back 311

E

Front 312

OBG-5.256.
The therapeutic objective in severe toxemia and eclampsia is:
A) the alleviation of vasoconstriction, the reduction of blood pressure
and the enhancement of organ perfusion
B) to increase seizure threshold
C) the alleviation of water and sodium retention
D) all of the above
E) only answers (A) and (B) are true

Back 312

D

Front 313

OBG-5.257.
The emergency medical therapy of eclampsia includes:
A) the administration of 1-2 ampules of diazepam to increase the
seizure threshold
B) the insertion of an appropriate object between the teeth to prevent
biting of the tongue and lips
C) the maintenance of patent airways
D) referral to hospital
E) all of the above

Back 313

E

Front 314

OBG-5.262.
The term "artificial abortion" means:
A) one or more subsequent pregnancies terminating spontaneously
B) the pregnancy terminates without any intervention
C) an intact pregnancy is terminated by artificial instrumentation
D) an intact pregnancy is terminated by an illegal, prohibited procedure
E) fetal death is not followed by an abortion

Back 314

C

Front 315

OBG-5.263.
The term "criminal abortion" means:
A) one or more subsequent pregnancies terminating spontaneously
B) an intact pregnancy is terminated by a legal procedure
C) an intact pregnancy is terminated by an illegal, prohibited procedure
D) fetal death is not followed by an abortion

Back 315

C

Front 316

OBG-5.303.
The term "uterine tone" during labor means:
A) the rise of intrauterine pressure during contractions
B) the lowest intrauterine pressure measured between contractions
C) the frequency of contractions
D) the product of multiplying the intensity and the frequency of
contractions
E) the rise of pressure generated by bearing down

Back 316

B

Front 317

OBG-5.405.
Which of the following conditions should be considered if meconium
ileus develops?
A) duodenal atresia
B) intestinal atresia
C) cystic fibrosis
D) phenylketonuria
E) biliary atresia

Back 317

C

Front 318

OBG-5.444.
The karyotype characteristic of Turners syndrome is:
A) 46, XX
B) 46, XY
C) 45, XO
D) 47, XXY
E) 47, XYY

Back 318

C

Front 319

OBG-5.378.
Which of the following is the presenting part in double knee presentation?
A) the buttocks and both knees
B) both knees
C) one of the knees only
D) one of the knees and the contralateral foot

Back 319

B

Front 320

OBG-5.445.
Which of the following gonads can be found in a patient with Turner's
syndrome?
A) the ovaries
B) the testes
C) ovotestis
D) "streak" gonad

Back 320

D

Front 321

OBG-5.507.
In which phase of the menstrual cycle should hysterosalpingography
be performed?
A) in the early follicular phase
B) at the time of ovulation
C) in the early secretory phase
D) in the late secretaory phase

Back 321

A

Front 322

OBG-5.508.
Which of the following methods is appropriate for the detection of
uterine malformations?
A) hysterosalpingography
B) hysteroscopy
C) laparotomy (laparoscopy)
D) all of the above
E) only answers (A) and (B) are true

Back 322

D

Front 323

OBG-5.559.
Which of the following hormones has the greatest importance in the
atrophization of the genitals in climacteric women?
A) estrogens
B) progesterone
C) androgens
D) follicle stimulating hormone
E) luteinizing hormone

Back 323

A

Front 324

OBG-5.571.
Which of the following infections is associated with vaginal discharge
and itching?
A) gonococcal infection
B) Trichomonas vaginalis infection
C) fungal infections
D) bacterial infections
E) viral infections

Back 324

C

Front 325

OBG-5.581.
Which of the following obstetrical events are associated with the
subsequent development of chorionic carcinoma most frequently?
A) delivery
B) abortion
C) hydatidiform mole
D) ectopic pregnancy
E) missed abortion

Back 325

C

Front 326

OBG-5.589.
Which of the following is a complication of benign ovarian tumors?
A) torsion of the pedicle of the cyst
B) infection, abscess formation
C) malignant transformation
D) all of the above
E) benign ovarian tumors cause no complications

Back 326

D

Front 327

OBG-5.586.
Tumor regression induced by the cytotoxic chemotherapy of
chorionic carcinoma is best evaluated by:
A) the measurement of serum LH levels
B) the measurement of serum FSH levels
C) the measurement of serum hCG levels
D) all of the above
E) only answers (B) and (C) are true

Back 327

C

Front 328

OBG-5.161.
The cause of constipation developing frequently in pregnancy is:
A) reduced intestinal muscle tone
B) pressure exerted by the gravid uterus
C) altered diet
D) all of the above
E) only answers (A) and (B) are true

Back 328

E

Front 329

OBG-5.789.
Case Study
A 55-year-old nulliparous, postmenopausal woman presents with
bloody vaginal discharge present for the last 7 days.
Status: The portio vaginalis of the cervix and the vaginal wall is covered
ered by atrophic epithelium that bleeds easily. The uterus is hypoplastic, smaller than normal,
no adjacent abnormality is palpated.

5.789/ 1.
The most likely cause of the bleeding is:
A) cervical polyp
B) senile vaginitis
C) cervical carcinoma
D) endometrial carcinoma
E) hormone secreting ovarian neoplasm

5.789/2.
What should be done next?
A) the bleeding should be controlled by estrogen administration
B) fractional curettage should be performed
C) oncocytology testing is recommended
D) chemical curettage is necessary
E) nothing should be done

5.789/3.
Curettage yields copious medullary tissue from the uterine cavity.
The most likely diagnosis is:
A) senile endometritis
B) submucous myoma
C) endometrial carcinoma
D ervical

5.789/4.
Which of the following conditions are associated with an increased'
risk of endometrial carcinoma?
A) obesity
B) hypertension
C) diabetes
D) functional sterility in the history (anovulation)
E) all of the above

5.789/5.
Which of the following methods should be applied as the first choice
therapy of endometrial carcinoma?
A) irradiation
B) surgery (hysterectomy)
C) norsteroid therapy
D) cytotoxic chemotherapy
E) the combination of (A), (B) and (C)

Back 329

DBCEB

Front 330

OBG-5.777.
Case Study
A 20-year-old female presents at the clinic with lower abdominal pain.
Her menstruation cycle is regular and she has not been pregnant yet.
At present, she is taking an oral contraceptive.
Colposcopy: ectopic tissue on the portio vaginalis of the cervix.
Pelvic examination: average vaginal capacity, smooth, firm portio
vaginalis, regular, large uterine corpus in avf. The uterus is mobile,
palpation is normal on the right side. On the left side, ventrally, a
semisolid, clearly delineate mobile mass is palpated.

5.777/ 1.
The most likely diagnosis is:
A) ovarian endometriosis
B) malignant ovarian neoplasm
C) uterine myoma
D) dermoid cystoma
E) paraovarian cyst


5.777/2.
What can be seen on an anteroposterior radiograph of the pelvis?
A) calcification
B) phleboliths
C) psammoma bodies
D) a soft-tissue shadow
E) calcification within a soft-tissue shadow

5.777/3.
What is the percentage of neoplasms occurring in both ovaries simultaneously?
A) 1%
B) 15%
C) 25%
D) 40%
E) 60%

5.777/4.
Which of the following is a possible complication of this neoplasm?
A) torsion of the pedicle of the cyst
B) suppuration and peritonitis
C) malignant transformation
D) all of the above
E) only answers (A) and (C) are true

5.777/5.
What is the prognosis of this tumor?
A) good, as malignant transformation seldom occurs
B) extremely good, as malignant transformation does not occur
C) malignant transformation is common, thus it cannot be detected
at an early stage
D) poor, beacuse it is a malignant lesion

5.777/6.
The appropriate therapy is:
A) puncture and aspiration of the contents via the vaginal route
B) laparoscopic aspiration of the contents
C) laparotomy to remove the tumor selectively with the preservation
of functional ovarian remnants
D) laparotomy with oophorectomy in all cases
E) laparotomy with bilateral oophorectomy as bilateral occurrence
is common

Back 330

DEAEAC

Front 331

OBG-5.776.
Case Study
A 24-year-old primigravida presents in the 28th week of her pregnancy
with spider nevi, palmar erythema and diffuse pruritus.
Liver function test results: alkaline phosphatase: 190 IU/l (normal
value: 29-91 IU/1); SGOT: 38 IU/1 (normal value: 6-18 IU/1); total
bilirubin: 1.8 mg% (normal value: 0.3-1.0 mg%); direct bilirubin: 1.0
mg% (normal value 0.1-0.3 mg%).

5.776/ 1.
The most likely diagnosis is:
A) liver cirrhosis
B) infectious hepatitis
C) cholestasis
D) acute pancreatitis
E) cholecystitis

5.776/2.
After delivery, the doctor should recommend to the patient:
A) not to have any more babies
B) to abstain from food with a high fat content and not to take
oral contraceptives
C) to avoid exertion
D) to undergo a cholecystectomy
E) none of the above

Back 331

CB

Front 332

OBG-5.772.
Associate the following statement(s) with their corresponding term(s)!
A) 47 XXY
B) 45 XO
C) trisomy 21
D) Tay-Sachs disease
E) testicular feminization
1) Down's syndrome
2) Klinefelter syndrome
3) Turner's syndrome
4) The most prevalent XY female-syndrome
5) Amniocentesis

Back 332

CABED

Front 333

OBG-5.755.
Hormonal replacement is recommended in climacteric women:
1) for the prevention of atherosclerotic heart disease
2) for the alleviation of vasomotor symptoms
3) to reverse osteoporosis
4) for the treatment of the atrophy of the vaginal mucosa

Back 333

C

Front 334

OBG-5.721
The risk of fetal morbidity and mortality is maternal diabetes is increased
by:
1) maternal ketoacidosis
2) maternal ketonuria occurring without diabetic ketoacidosis
3) maternal hyperglycemia
4) maternal hypoglycemia

Back 334

E

Front 335

OBG-5.722.
An increased risk of postpartum bleeding should be expected after/
in:
1) prolonged delivery
2) rapid delivery
3) the stimulation of uterine contractions with oxytocin
4) multiple pregnancy

Back 335

E

Front 336

OBG-5.724.
Antibiotics contraindicated during pregnancy include:
1) tetracyclines
2) penicillin
3) chloramphenicol
4) ampicillin

Back 336

B

Front 337

OBG-5.712.
Valid statements regarding identical twins include:
1) identical twins often result after the use of intrauterine devices
2) identical twins often result after ovulation induction with
clomiphene citrate
3) the development of identical twins is more common than that
of fraternal twins
4) the incidence of this condition is 1:250 pregnancies

Back 337

D

Front 338

OBG-5.704.
Permanent estrogen replacement may be dangerous or explicitly
contraindicated in women with:
1) liver dysfunction
2) thromboembolic disorders
3) estrogen dependent neoplasms
4) have a mother or siblings with osteoporosis

Back 338

A

Front 339

OBG-5.681.
The pharmacological effects of oral contraceptives containing the
combination of estrogen and progesterone include:
1) the inhibition of the maturation of the oocyte
2) the prevention of the penetration of sperm into the cervical mucus
3) the inhibition of implantation by the induction of atrophic
changes of the endometrium
4) the induction of uterotubal hypermotility inhibits sperm motility

Back 339

A

Front 340

OBG-5.679.
Valid statements regarding menopause include:
1) it usually starts between the age of 40 to 50 years
2) is characterized by the absence of menstruation for 12 months
in women older than 45 years
3) menopause is always preceded by hot flushes
4) FSH and LH levels are elevated

Back 340

C

Front 341

OBG-5.677.
Which problems of postmenopeusal women deserve special attention?
1) vaginitis
2) depression
3) osteoporosis
4) sexual dysfunction

Back 341

E

Front 342

OBG-5.652.
Sexually transmitted diseases include:
1) type II Herpesvirus infection
2) Trichomonas infection
3) non-gonococcal urethritis
4) condylomata acuminata

Back 342

E

Front 343

OBG-5.648.
Case Study:
The history of a 28-year-old patient contains freqently recurring
adnexitis. Her last regular menses occurred 37 days before admission.
Complaints: slight, brownish vaginal discharge occurred 10 days be-
*fore, at the time of the last menses. On the morning of her admission
the patient "felt ill" and lost her consciousness for a few minutes. The
pregnancy test performed several days earlier had been positive. On
admission: her face is pale, sweating, her extremities are cold and she
is complaining about dizzines, weakness, severe pain in the left-lower
abdomen associated with a slight urge to defecate. Heart rate: 120/
min, blood pressure 90/60 mmHg, body temperature 36.8 °C; WBC:
7,300/µl, Hb: 5,9 mmol/l, Hct: 28%. Gynecologic examination: local
bulging of the abdomen, moderate tenderness up to the umbilical level;
small-volume brownish vaginal discharge, the portio vaginalis of the
cervix is cyanotic, tender to motion, the uteris is in anteflexionanteversion,
it is slightly enlarged and softened. The right adnexum is
not palpable; a vague, moderately tender adnexal mass of a size of a
plum is palpable on the right side. The cul-de-sac is bulging and yields
a large volume of clotted blood on diagnostic puncture.
What is the most likely diagnosis?
A) perforation of the gall-bladder
B) acute appendicitis
C) nephrolithiasis
D) ectopic pregnancy
E) acute adnexitis

Back 343

D

Front 344

OBG-5.611.
In which of the following periods of life is endometriosis of
significance?
A) in the neonatal age
B) in infancy
C) in the reproductive age
D) in the postmenopausal age
E) in advanced age

Back 344

C

Front 345

OBG-5.608.
The diganosis of endometriosis refers to:
A) fibrosis resulting from chronic endometritis
B) the presence of extrauterine endometrium implants
C) the precancerous stage of endometrial carcinoma
D) viral endometritis
E) endometrial lesions caused by IUDs

Back 345

B

Front 346

OBG-5.609.
The diganosis of endometriosis refers to:
A) fibrosis resulting from chronic endometritis
B) the presence of extrauterine endometrium implants
C) the precancerous stage of endometrial carcinoma
D) viral endometritis
E) endometrial lesions caused by IUDs

Back 346

B

Front 347

OBG-5.603.
Ovarian calcification is visible on anteroposterior radiographs of the
pelvis in:
A) endometriosis of the ovary
B) parovarian cyst
C) cystic ovarian adenocarcinoma
D) dermoid tumors of the ovary
E) sarcoma

Back 347

D

Front 348

OBG-5.601.
In metastatic tumors of the ovary, the primary neoplasm is found
most frequently in the:
A) breast
B) pancreas
C) gastrointestinal tract
D) lung
E) trachea

Back 348

C

Front 349

OBG-5.550.
Contraindications to IUD insertion inlcude:
A) pelvic inflammatory disease
B) genital malignancies
C) pregnancy
D) all of the above
E) only answers (A) and (C) are true

Back 349

D

Front 350

OBG-5.531.
What are the components of the "minipill"?
A) estrogen only
B) progesterone only
C) all tablets contain both estrogen and progesterone in small doses
D) the first 14 pills contain estrogen, the next 7 pills contain
estrogen and progesterone

Back 350

B

Front 351

OBG-5.534.
How does the menses change under the effect of combined oral contraceptives?
A) it becomes more copious
B) it becomes reduced in volume
C) it remains unchanged
D) it becomes reduced in volume, and the intensity of cramping is
also reduced
E) the discharge of menstrual secretions becomes prolonged

Back 351

D

Front 352

OBG-5.536.
The most appropriate protocol for oral contraceptive use is:
A) to always start from the first day of menstruation and continue
taking the tablets for the next 21 days
B) 21 days on the pill followed by a 7-day pause
C) the tablets should be taken continuously, without interruption
D) depending on the length of the menstrual cycle, 18-35 days on
the pill followed by a 7-day pause
E) the tablets should be taken according to the calendar, from the
first day of the month to the 21 st day

Back 352

B

Front 353

OBG-5.539.
The contraindications to oral contraceptive use include:
A) malignant neoplasms of the breast or the genitals
B) diabetes
C) hypertension and advanced renal disease
D) pregnancy
E) all of the above

Back 353

E

Front 354

OBG-5.541.
Intrauterine devices:
A) reduce the motility of the uterine tubes
B) prevent the implantation of the ovum
C) enhance uterine contractions and promote the rejection of the
implanted ovum
D) reduce the penetration of the cervical mucus by sperm

Back 354

B

Front 355

OBG-5.542.
Should the IUD be considered an abortive agent considering its
mechanism of action?
A) yes because it precludes the implantation of the ovum
B) no because pregnancy is considered to start at the time of implantation
C) no because it exerts its action by precluding conception

Back 355

B

Front 356

OBG-5.543.
The efficacy of intrauterine devices can be enhanced by:
A) covering the device with a copper layer
B) covering the device with a zinc layer
C) perparing the device with progestogenic hormones
D) all of the above
E) only answers (A) and (B) are true

Back 356

D

Front 357

OBG-5.544.
The adverse effects of intrauterine devices include:
A) bleeding
B) pain
C) pelvic inflammatory disease
D) all of the above
E) only answers (A) and (C) are true

Back 357

D

Front 358

OBG-5.529.
What are the components of combined oral contraceptive preparations?
A) estrogen only
B) progesterone only
C) all tablets contain both estrogen and progesterone
D) the first 14 pills contain estrogen, the next 7 pills contain
estrogen and progesterone

Back 358

C

Front 359

OBG-5.516.
Which of the following drugs is not effective for ovulation induction?
A) human menopausal gonadotropin
B) clomiphene citrate
C) LH-releasing hormone
D) synthetic oxytocin
E) human pituitary gonadotropin

Back 359

D

Front 360

OBG-5.477.
A hyperprolactinoma of the pituitary causes:
A) gigantism and acromegalia
B) Cushing's disease
C) hyperprolactinemia
D) Sheehan's syndrome
E) Cushing's syndrome

Back 360

C

Front 361

OBG-5.462.
In which of the following cases is amenorrhea considered normal?
A) in pregnancy and during lactation
B) in postmenopausal women
C) before the onset of menarche
D) in all of the above cases
E) only answers (A) and (B) are true

Back 361

D

Front 362

The most appropriate method for maintaining patent airways in a
patient with multiple trauma resulting from a car accident due to
drunken driving is:
A) oropharyngeal intubation
B) endotracheal intubation
C) thrusting the jaw and lifting the chin
D) intubation with a cuffed endotracheal tube
E) tracheostomy

Back 362

SUR-8.1.
D

Front 363

Which of the following is the most common site of aortic injury in
the thorax?
A) at the origin of the aortic arch
B) just above the origin of the innominate artery
C) at the fusion ofthe thoracal and abdominal segments of the aorta
D) just distal to the ligamentum arteriosum
E) between the origin of the left common carotid artery and that
of the left subclavian artery

Back 363

SUR-8.5.
D

Front 364

The most appropriate therapy for clean, fresh lacerations of peripheral
nerves is
A) debridement of the wound only
B) the administration of antibiotics only
C) immediate approximation of separated nerve endings
D) delayed suture
E) immobilization of the limb only

Back 364

SUR-8.6.
C

Front 365

Which of the following drugs could cause acute adrenal insufficiency
in the postoperative period?
A) vitamin C
B) aspirin
C) heparin
D) meperidine / pethidine (Dolargan)
E) cephalothin (Keflin)

Back 365

SUR-8.8.
C

Front 366

UR-8.18.
Numbness and paresthesias developing in the region between the
index finger and thumb in a patient having sustained a fracture of
the radius at the typical site (Colles' fracture) indicates:
A) displacement of fractured bone ends
B) excessive callus formation
C) compression of the median nerve
D) compression of the radial nerve
E) compression of the ulnar nerve

Back 366

C

Front 367

SUR-8.20.
The displacement occurring in Monteggia's fracture is characterized
by the:
A) angulation of the ulna
B) angluation of both bones of the forearm
C) angulation of the radius and the luxation of the ulna
D) the luxation of the head of the radius
E) angulation of the ulna and the luxation of the head of the radius

Back 367

E

Front 368

UR-8.23.
A non-impacted fracture of the femoral neck causes a characteristic
deformity of the lower extremity, that is:
A) shortening and external rotation
B) shortening only
C) external rotation only
D) flexion, adduction and internal rotation
E) flexion, adduction and external rotation

Back 368

A

Front 369

SUR-8.26.
The therapy of osteogenic sarcoma is:
A) irradiation
B) administration of antimetabolites
C) amputation
D) curettage
E) excision

Back 369

C

Front 370

SUR-8.34.
The primary source of metastatic spread of malignancies affecting
the spine is most often:
A) the kidney
B) the prostate
C) the breast
D) the lung
E) some other bone

Back 370

C

Front 371

SUR-8.39.
All of the following features are characteristic of bone pathology in
rickets, EXCEPT:
A) a widened epiphyseal zone
B) a wide and abnormal metaphysis
C) blood vessel fragility
D) cartilage proliferation
E) deformed costochondral syndesmoses ('rickety rosary')

Back 371

C

Front 372

SUR-8.48.
A solitary mass in the lung of a middle-aged patient is most likely a:
A) granuloma
B) malignancy
C) adenoma
D) tuberculotic lesion
E) secondary neoplasm

Back 372

A

Front 373

SUR-8.55.
All of the following are manifestations of the superior vena cava
syndrome,
EXCEPT:
A) increased venous pressure
B) edema of the head and neck
C) enlarged veins which are visible on the anterior chest wall
D) cyanosis
E) dyspnea

Back 373

E

Front 374

SUR-8.64.
The 5-year survival of all lung cancer cases is not higher than:
A) 10%
B) 20%
C) 30%
D) 40%
E) 50%

Back 374

A

Front 375

SUR-8.66.
A small volume/easily compressible radial pulse is characteristic of
A) aortic valve stenosis
B) coarctation of the aorta
C) a patent ductus arteriosus
D) stenosis of the mitral valve
E) Tetralogy of Fallot

Back 375

A

Front 376

SUR-8.67.
All of the following are associated with the formation of aneurysms
of the descending aorta, EXCEPT:
A) Marfan's syndrome
B) injury
C) syphilis
D) atherosclerosis
E) cystic median necrosis (Erdheim's cystic median necrosis)

Back 376

B

Front 377

SUR-8.71.
A possible etiologic factor in the development of pleural
mesothelioma is:
A) pneumoconiosis
B) asbestosis
C) anthracosis
D) hereditary disposition
E) peritoneal mesothelioma

Back 377

B

Front 378

SUR-8.73.
Which of the following cardiac disorders causes hemoptysis:
A) mitral valve stenosis
B) tricuspid valve incompetency
C) Tetralogy of Fallot
D) aortic stenosis
E) anomaly of the pulmonary veins

Back 378

A

Front 379

SUR 8.80.
All of the following signs are present in mesenteric artery obstruction,
EXCEPT:
A) a sudden pain around the umbilicus
B) that the pain is disproportionally intense compared to the severity
of physical signs
C) an urge to defecate
D) bloody stool
E) bowel sounds reflecting permanently hyperactive peristalsis

Back 379

E

Front 380

SUR-8.92.
The therapy of intestinal carcinoid tumours is comprised of:
A) irradiation
B) chemotherapy
C) administration of serotonin antagonists
D) surgery followed by irradiation
E) intestinal resection

Back 380

E

Front 381

SUR-8.112.
All of the following are present in long-standing ulcerative colitis,
EXCEPT:
A) a shortening of the gut
B) shrinkage and thickening of the mesentery
C) enlarged masses comprised of lymph node conglomerates
D) a dull, greyish mucosal surface
E) perforation and abscesses along the mesenteric margin

Back 381

C

Front 382

SUR-8.115.
Characteristic features of ischemic colitis are influenced by all of the
following factors, EXCEPT:
A) the extent of vascular obstruction
B) the duration of obstruction
C) the patency of the collateral circulation
D) the extent of bacterial invasion
E) the intensity of the inflammation

Back 382

E

Front 383

SUR-8.117.
Which of the following is the most appropriate therapeutic measure
following the resection of a carcinoma of the descending colon?
A) colonoscopy which should be repeated every 6 months
B) a barium enema repeated every 6 months
C) monitoring of the serum CEA (carcinoembryonic antigen) level
every 3 months
D) sulfasalazine (Salazopyrine) and prednisone therapy
E) checking the stool for occult bleeding regularly

Back 383

C

Front 384

SUR-8.118.
All of the following drugs can induce gastrointestinal bleeding, EXCEPT:
A) salicylates
B) corticosteroids
C) alcohol
D) phenothiazines
E) anticoagulants

Back 384

D

Front 385

SUR-8.125.
Which of the following compounds is contraindicated following a
liver resection?
A) carbohydrates
B) albumin
C) vitamin K
D) hypnotic analgesics
E) antibiotics

Back 385

D

Front 386

SUR-8.128.
All of the following are characteristic features of acute suppurative
cholangitis, EXCEPT:
A) jaundice
B) fever and chills
C) shock
D) hemorrhagic diathesis
E) CNS depression

Back 386

D

Front 387

SUR-8.129.
Which of the following features reflect a poor prognosis in acute
pancreatitis?
A) high surges of serum amylase levels
B) hyperglycemia and glycosuria
C) a high urinary amylase level
D) a prolonged coagulation time
E) a reduced serum calcium level

Back 387

E

Front 388

SUR-8.130
All of the following factors cause acute pancreatitis, EXCEPT:
A) alcohol
B) hypercalcemia associated with parathyroid dysfunction
C) biliary calculi
D) hyperlipidemia
E) hemochromatosis

Back 388

E

Front 389

SUR-8.134.
All of the following statements are valid regarding thrombosed
hemorrhoids,. EXCEPT:
A) the abrupt appearance of a painful external bulge in the
anal region
B) the appearance of a tense, bluish, tender induration on the
anal border
C) an untreated lesion has a tendency to ulcerate and bleed
D) hemorrhoids usually resolve within 24 hours
E) prompt surgical decompression brings symptomatic relief

Back 389

D

Front 390

SUR-8.136.
The operation of choice for congenital megacolon is:
A) a colostomy
B) an enterostomy
C) a splanchnicectomy
D) a total colectomy
E) none of the above

Back 390

E

Front 391

SUR-8.137.
The most prevalent type of colorectal polyps are:
A) villous polyps
B) postinflammatory polyps
C) tubular adenomas
D) juvenile polyps
E) hereditary multiple polyps

Back 391

C

Front 392

SUR-8.139.
Colonic obstruction due to a carcinoma of the recto-sigmoidal junction
is best treated by:
A) a primary abdomino-perineal amputation
B) decompression by colostomy only
C) a primary anterior resection
D) resection and a colostomy
E) decompression by the insertion of a tube above the level of obstruction
and delayed elective surgery

Back 392

D

Front 393

SUR-8.147.
The most frequently occurring gynecologic lesion is:
A) a cervical infection
B) a vaginal infection
C) endometrial cancer
D) cervical cancer
E) Bartholini-abscess

Back 393

A

Front 394

SUR-8.149.
All of the following statements are valid regarding an in situ'carcinoma
of the cervix, EXCEPT:
A) cellular changes in the squamous epithelial lining of the cervix
represent the development of cancer
B) this type of carcinoma is asymptomatic
C) the diagnosis can be established by the histologic examination
of biopsy specimens
D) this carcinoma is best treated by a radical hysterectomy
E) the 5-year survival rate equals 100%

Back 394

D

Front 395

SUR-8.151.
The most prevalent malignant neoplasm of the uterine body is:
A) adenoacanthoma
B) adenocarcinoma
C) squamous cell carcinoma
D) melanoma
E) leiomyosarcoma

Back 395

B

Front 396

SUR-8.157.
The most prevalent type of parathyroid cancer is a:
A) follicular carcinoma
B) papillary carcinoma
C) anaplastic carcinoma
D). medullary carcinoma
E) secondary carcinoma

Back 396

B

Front 397

SUR .158.
All of the following belong to skeletal changes occurring in
hyperparathyroidism, EXCEPT:
A) osteitis fibrosa cystica
B) osteopetrosis
C) solitary or multilocular bone cysts
D) pathologic fractures
E) osteoporosis

Back 397

B

Front 398

SUR-8.160.
The treatment of choice for Cushing's disease is:
A) a hypophysectomy
B) irradiation of the pituitary gland
C) a unilateral adrenalectomy
D) a subtotal adrenalectomy
E) a total adrenalectomy

Back 398

B

Front 399

SUR-8.165.
The least prevalent symptom(s) of uterine myomas is(are):
A) irregular bleeding
B) pain
C) tenderness of the urinary bladder
D) malignant transformation
E) infertility and miscarriage

Back 399

D

Front 400

SUR-8.166.
All of the following are examples of APUD-cell (amine precursor uptake
and decarboxylation) tumors, EXCEPT:
A) medullary carcinoma of the thyroid gland
B) the Zollinger-Ellison syndrome
C) parathyroid adenoma
D) pheochromocytoma
E) Cushing's syndrome associated with lung cancer

Back 400

V

Front 401

SUR-8.170.
Which of the following elements of the genitourinary tract is removed
during a routine prostatectomy?
A) the urethral mucosa
B) the enlarged, adenomatous portion of the prostate
C) the sphincter musculature
D) the prostate itself
E) the verumontanum (colliculus seminalis)

Back 401

B

Front 402

SUR-8.199.
Which of the following tissues regenerates by mitosis of the same
cells?
A) fat
B) bone
C) peripheral nerves
D) skin
E) skeletal muscle

Back 402

D

Front 403

UR-8.200.
A severe burn injury is associated with all of the following factors,
EXCEPT:
A) a significant loss of body mass
B) a hypermetabolic reaction
C) hemoconcentration
D) potassium retention
E) a negative nitrogen balance

Back 403

D

Front 404

SUR-8.203.
The most valuable information for the assessment of fluid replacement
in burned patients is:
A) diuresis is maintained at 30-50 ml/hour
B) the patient regains a normal level of consciousness
C) an adequate capillary filling time (tested under the fingernails)
D) physiologic arterial blood gases measurements
E) the development of mild pulmonary edema

Back 404

A

Front 405

SUR-8.209.
All of of the following statements are valid regarding tenosynovitis,
EXCEPT:
A) poor natural resistance of the region is characteristic
B) starting from the wound of the thumb, the infection spreads to
the radial bursa and the interinterstitial spaces of the thenar
C) the infection of the other four fingers spreads to the ulnar
bursa
D) early surgical drainage is essential
E) postoperative physiotherapy must be started early to preserve
tendon functions

Back 405

C

Front 406

SUR-8.213.
What is the treatment of choice for internal malignancies of the larynx?
A) irradiation
B) a median laryngectomy
C) a total laryngectomy
D) a total laryngectomy and radical cervical block-dissection
E) the local application of radium

Back 406

A

Front 407

SUR-8.217.
Carcinoma of the lip
A) readily gives metastases
B) occurs more frequently in females
C) develops more frequently in the lower lip
D) is usually a basal-cell carcinoma
E) propagates via the blood stream

Back 407

C

Front 408

UR-8.220.
Supraclavicular lymph nodes are often involved in:
A) the metastatic spread of primary malignancies
B) gastric and lung cancer
C) following injury to the anterior two-thirds of the tongue
D) a neuroblastoma
E) carcinoma of the lip

Back 408

B

Front 409

SUR-8.230.
The most frequent cause of an epileptic seizure in a middle-aged patient
with an otherwise fair condition is:
A) an idiopathic seizure
B) arteriosclerosis
C) a brain tumor
D) Parkinson's disease
E) previous cerebral trauma

Back 409

C

Front 410

SUR-8.231.
The coincidence of headache, vomiting and papilledema in the same
patient is suggestive of.
A) a brain concussion
B) bulbar paralysis
C) a brain tumor
D) a migraine headache
E) a subarachnoid hemorrhage

Back 410

C

Front 411

SUR-8.234.
The estimated rate of axon regeneration following a peripheral nerve
injury is:
A) 1 millimetre per day
B) 1 millimetre per week
C) 3 millimetres per week
D) 1 centimetre per week
E) 10 centimetres per week

Back 411

A

Front 412

SUR-8.236.
All of the following congenital abnormalities cause hydrocephalus in
infancy, EXCEPT:
A) Chiari type II malformation
B) meningocele
C) myelomeningocele
D) Dandy-Walker syndrome
E) malformation of the aqueduct

Back 412

B

Front 413

SUR-8.239.
All of the following are appropriate for the treatment of stasis ulceration
after venous thrombosis, EXCEPT:
A) elevation of the leg
B) compression dressing of varicose veins
C) skin grafting
D) correction of any underlying varicose veins
E) venous bypass surgery

Back 413

E

Front 414

SUR-8.251.
The most frequent cause of arterial occlusion is:
A) embolism
B) arteriosclerosis
C) varicose veins
D) all of the above

Back 414

B

Front 415

SUR-8.265.
Case Study:
A child has suffered a "torsion" injury by putting his hand into the
washing-machine. The therapy of choice is:
A) elevation of the injured limb; hot or warm compression and
observation
B) watching out for the signs of swelling and the application of an
Ace-type elastic bandage on the swollen extremity
C) early elevation and an Ace-bandage; plus observation
D) elevation of the hand
E) elevation; ice packs and observation; a surgical elastic bandage

Back 415

E

Front 416

SUR-8.268.
Paronychia of the finger is best treated by which of the following
types of incisons?
A) halfway between the unguicular margin and the pulp of the
finger
B) at a considerable distance from the distal unguicular margin
C) any incision that ensures adequate drainage from the phalanx
D) a "J-shaped" incision at a 3 mm distance from the distal
unguicular margin
E) a wide "fishmouth" shaped incision

Back 416

D

Front 417

SUR-8.279.
What is the percentage of breast cancer among the malignancies occurring
in females?
A) 5%
B) 10%
C) 25%
D) 20%
E) 30%

Back 417

C

Front 418

SUR-8.283.
Most cases of acute subdeltoid bursitis are associated with which of
the following?
A) slight subluxation of the joint
B) periarticular calcification of the tendons of the rotator muscles
C) none of the above

Back 418

B

Front 419

SUR-8.285.
Mild infections of the hand can progress to potentially severe
infections, as:
A) the skin of the hand is a particularly heavily contaminated
area of the body
B) the hand often sustains injury when it is infected
C) there are numerous tendons with a poor blood supply and the
maintenance of any required immobilization is difficult

Back 419

C

Front 420

SUR-8.290.
Cardiac arrest due to atrial fibrillation is more likely in:
A) hypokalemia
B) an excessively fast intravenous administration of potassium

Back 420

B

Front 421

SUR-8.292.
Case Study:
You are summoned to an emergency at a nearby café. Arriving on the scene,
you find a middle-aged, obese man sagging in his chair. Bystanders inform
you that the patient had ordered a coffee and two croissants. After he had
been served, he began to make forceful and wild gestures, swept
everything off from his table, howled incoherently, then collapsed back into his
chair.
On physical examination he is still uttering incoherent sentences. The pa-
tient resists physical examination and beats about with his arms. Ifis
skin and mucous membranes are of normal colour, but the patient is streaming
- with perspiration. Me chest and abdomen are normal on physical examination.
A Babinski-tendency is observed on the left side and patellar clonus
can be elicited on the right. Breath: no characteristic odour is scented.
Pulse: 88/min with sporadic extrasystoles. Blood pressure: 190/ 100 mmHg.
The most likely diagnosis is:
A) acute psychosis
B) alcoholic psychosis
C) a cerebral embolism
D) hypoglycemia
E) a transient cerebral ischemic attack

Back 421

hypoglycemia

Front 422

SUR-8.306.
All of the following statements are valid regarding an adamantinoma
of the mandible, EXCEPT:
A) this is the most prevalent solid, hard neoplasm of the mandible
B) it develops at the junction of the mandibular body and the ramus
C) tt grows slowly but may invade soft-tissues eventually
D) the therapy of choice is a segmental resection of the mandible
E) recurrence is likely if the adjacent soft-tissues have not been
removed

Back 422

recurrence is likely if the adjacent soft-tissues have not been
removed

Front 423

SUR-8.331.
The treatment of hyperkalemia and its sequelae include all of the
following, EXCEPT:
A) full restriction of potassium administration
B) administration of glucose with insulin
C) administration of ion-exchange resins
D) magnesium administration
E) dialysis

Back 423

magnesium administration

Front 424

SUR-8.351.
All of the following belong to the clinical features of the thoracic
outlet syndrome, EXCEPT:
A) paresthesias along the ulnar edge of the forearm
B) atrophy of the thenar muscles
C) cervical and shoulder pain
D) disappearance of the radial pulse on elevating the arm
E) ischemic gangrene of the fingers

Back 424

atrophy of the thenar muscles

Front 425

UR-8.356.
Case Study:
A 65-year-old male patient passes tarry and loose stools (melena)
three days after aortobifemoral bypass surgery. The most likely
cause of this condition is:
A) a bleeding stress ulcer
B) ulcerative colitis
C) ischemic colitis
D) an aortoduodenal fistula
E) DIC (disseminated intravascular coagulation) related to a
Transfusion

Back 425

ischemic colitis

Front 426

SUR-8.359.
All of the following methods are appropriate for the diagnosis of
deep-vein thrombosis, EXCEPT:
A) phlebography
B) a radioisotope labelled fibrinogen uptake test
C) Doppler -ultrasonography
D) measurement of the venous flow-rate
E) impedance plethysmography

Back 426

measurement of the venous flow-rate

Front 427

SUR-8.362.
Which of the following is an etiologic factor of intestinal atresia?
A) maternal diabetes
B) maternal drug addiction
C) intrauterine vascular disorders of the intestine
D) birth trauma
E) hydramnios

Back 427

intrauterine vascular disorders of the intestine

Front 428

SUR 8.363.
Appendicitis developing in small children is different from that occurring
in adults, because:
A) the symptoms are often caused by mesenteric lymphadenitis
B) perforation is a more prevalent complication
C) it usually follows a parotid flare
D) Meckel's diverticulum is more prevalent
E) interval appendectomy' is often feasible (in the d froid phase)

Back 428

perforation is a more prevalent complication

Front 429

SUR 8.369.
Where does Wilms' tumor originate from?
A) the renal capsule
B) the renal tubules
C) the epithelium of the renal pelvis
D) the renal cortex
E) the embryonal tissues of the kidney

Back 429

the embryonal tissues of the kidney

Front 430

SUR-8.385.
Nausea, vomiting and malaise experienced by patients with viral
hepatitis are usually less distressing than in patients with
choledocholithiasis.

Back 430

F

Front 431

SUR-8.391.
Which of the following parameters is useful for the recognition of
mounting intracranial pressure following head trauma?
1) a reduction in the level of consciousness
2) an increasing bradycardia
3) an elevation of the blood pressure
4) cardiac arrhythmia

Back 431

A

Front 432

SUR-8.416.
Surgical treatment of congenital hip dysplasia:
1) is unnecessary under 1 year of age
2) is indicated in all forms of dysplasia
3) is mandatory in cases with soft-tissue interposition in the joint
space
4) often consists of open reduction in older children

Back 432

B

Front 433

SUR-8.427.
Factors contributing to an increased risk of developing lung cancer
include:
1) smoking
2) exposure to radioactive substances
3) exposure to chromium compounds
4) exposure to asbestos

Back 433

A

Front 434

SUR-8.432.
Indications for the surgical treatment of aortic stenosis include:
1) a valvular pressure gradient >50 mmHg
2) stenosis associated with the angina
3) any associated cardiac defects
4) all patients with aortic stenosis

Back 434

A

Front 435

SUR-8.443.
The presence of air in the biliary tract is a diagnostic feature of:
1) a choledochoduodenal fistula
2) intestinal obstruction
3) emphysematous cholecystitis
4) viral hepatitis

Back 435

B

Front 436

SUR-8.458.
The characteristic features of Zollinger-Ellison's syndrome include:
1) massive gastric hypersecretion
2) untreatable and recurring peptic ulcer(s)
3) non-beta islet cell neoplasm of the pancreas
4) diarrhea

Back 436

E

Front 437

SUR-8.462.
The characteristic features of stress ulcers include:
1) stress ulcers developing most freqently in the stomach
2) flat, shallow lesions
3) multiple lesions
4) perforation

Back 437

A

Front 438

SUR-8.465.
What is the mechanism of the metastatic spread of malignancies to
the liver?
1) through the portal vein
2) through the hepatic artery
3) through the portal lymphatic vessels
4) by direct propagation

Back 438

A

Front 439

SUR-8.468.
Causes of extracellular hypovolemia developing in intestinal obstruction
include:
1) fluid sequestration in the lumen of the obstructed intestinal loops
2) fluid sequestration in the intestinal wall
3) vomiting and the suction of gastric content through a
nasogastric tube
4) fluid loss into the abdominal cavity as peritoneal fluid

Back 439

E

Front 440

SUR-8.477.
In carcinoma of the gall bladder:
1) most of the patients are females
2) the presenting symptoms are characteristic and of diagnostic
value
3) gallstones are detected in 90% of the cases
4) the five-year survival rate is 50%

Back 440

B

Front 441

SUR-8.481.
The clinical features of intestinal angina include:
1) postprandial pain
2) weight loss
3) steatorrhea
4) recurrent midline abdominal pain

Back 441

A

Front 442

SUR-8.482.
Case Study:
A 2.5 cm node was detected in the left lobe of the thyroid gland of a
female patient and a partial thyroidectomy was performed. A histological
examination demonstrated a papillary carcinoma of the thyroid.
The subsequent therapy includes:
1) periodic follow-up examinations
2) a total thyroidectomy
3) external irradiation
4) a modified radical cervical block-dissection

Back 442

C

Front 443

SUR-8.493.
After a partial mastectomy or focal excision, the therapy of breast
cancer should include:
1) chemotherapy
2) adrenalectomy
3) oophorectomy
4) irradiation

Back 443

D

Front 444

SUR-8.495.
The histopathologic features of the thyroid gland in Graves' disease
include:
1) papillary processes in the acini
2) the accumulation of colloid in large quantities within the gland
3) an increased vascularization of the gland
4) the reduction of lymphoid conglomerates

Back 444

B

Front 445

SUR-8.512.
In leukoplakia of the oral cavity:
1) 5% of the lesions eventually undergo malignant transformation
2) the thin, early lesion requires surgical excision
3) patients with early hyperplasia and hyperkeratosis must abstain
from smoking and the consumption of alcoholic beverages
4) irradiation is indicated in cases where the size of the lesions
precludes total extirpation of the mucosa

Back 445

B

Front 446

SUR-8.516.
Second-degree burns:
1) damage the epidermis and corium
2) are characterized by blister formation
3) heal by epithelial regeneration starting from the sweat glands
4) heal by scarring

Back 446

E

Front 447

SUR-8.517.
In third-degree burns:
1) the skin and subcutaneous tissues are destroyed by coagulation
necrosis
2) flushing is a characteristic feature
3) early escharotomy and skin grafting precludes the development
of contractures
4) associated physiological abnormalities are minimal

Back 447

B

Front 448

SUR-8.534.
Valid statements about the potassium requirements of postoperative
patients include:
1) the serum potassium level must be measured before supplementation
2) normal renal function is a prerequisite to parenteral potassium
supplementation
3) the daily potassium requirement of a normal adult is 30-40
mEq/litre
4) the urinary potassium level must be measured before the administration
of any potassium containing preparatio

Back 448

A

Front 449

UR-8.535.
Complications of immunosuppressive therapy include:
1) infection
2) hypotension
3) malignant transformation
4) a predisposition to infertility

Back 449

B

Front 450

SUR-8.543.
The clinical features of aortoiliac vascular disease include:
1) symptoms develop only when the occlusion of the vascular lumen
reaches 90%
2) the formation of aneurysms is common
3) the incidence of coronary or cerebral vascular disease is 30-50%
4) complete occlusion of the aorta has become prevalent during
the nineties

Back 450

A

Front 451

SUR-8.560.
Associate the following term(s) with their corresponding statement(s)!
A) Atrophy of the muscles of the hand
B) Wrist paralysis
C) Boutonniere deformity
D) Hammer toes

1) injury to the ulnar nerve at the level of the wrist
2) injury to the extensor tendon at the terminal phalanx
3) injury to the extensor tendon near its insertion at the middle
phalanx
4) injury to the radial nerve in the upper arm

Back 451

ADCB

Front 452

SUR-8.564.
Associate the following term(s) with their corresponding statement(s)!
A) Peutz-Jeghers' syndrome
B) Familial polyposis
C) Gardner's syndrome
D) Multiple polyps

1) hamartomas
2) malignant transformation in all patients
3) osteomas and fibromas
4) pigmentation of the mucosa is absent

Back 452

ABCD

Front 453

SUR-8.571.
Associate the following term(s) with their corresponding statement(s)!
A) Varicocele
B) Hydrocele
C) Spermatocele
D) Ureterocele

1) cobra-head deformity
2) it is usually left-sided
3) a cyst of the epididymis
4) it is prevalent in children

Back 453

DACB

Front 454

SUR-8.572.
Associate the following term(s) with their corresponding statement(s)!
A) Embryonal carcinoma
B) Seminoma
C) Interstitial cell tumor
D) Chorioepithelioma.
E) Teratoma

1) elevated urinary gonadotropin levels
2) precocious puberty in boys
3) the most prevalent testicular tumor in childhood
4) it may contain a cartilage component
5) the least malignant testicular neoplasm

Back 454

DCAEB

Front 455

SUR-8.573.
Associate the following term(s) with their corresponding statement(s)!
A) Dislocated shoulder
B) Valgus deformity of the elbow
C) Laceration of the wrist
D) Fracture of the humerus

1) the ulnar nerve is damaged
2) the median nerve is damaged
3) the axillary nerve is damaged
4) the radial nerve is damaged

Back 455

BCAD

Front 456

SUR-8.575.
Associate the following term(s) with their corresponding statement(s)!
A) A brain tumor in adults
B) A brain tumor in children
C) Both of the above
D) None of the above

1) it is often located supratentorially
2) it resides in the posterior fossa (scala posterior)
3) a malignant glioma
4) it usually develops in the midline
5) a low-grade astrocytoma

Back 456

ABABB

Front 457

SUR-8.579.
Associate the following term(s) with their corresponding statement(s)!
A) Spondylosis
B) Spondylolysis
C) Spondylolysthesis
D) Spondylitis

1) a bone defect of the vertebral arch
2) inflammation of the vertebra
3) the slippage of one vertebral body over the body of the adjacent
lower vertebra
4) hypertrophic bone lesions where exophytes may extend into
the intervertebral foramen and exert pressure on the nerve radix

Back 457

BDCA

Front 458

When treating fractures:
A) immobilization of adjacent joints is unnecessary
B) adjacent joints are occasionally immobilized
C) immobilization of the joints results in the development of contractures
D) only the proximal joint is immobilized
E) both the joint proximal and the one distal to the fracture site
should be immobilized

Back 458

SUR-8.14.
E

Front 459

Case Study:
Two hours following the application of a plaster splint for a
supracondylar fracture, of the radius, a patient returns to the clinic
complaining of severe pain in his injured hand. The fingers are
swollen and cyanotic on examination. The most appropriate solution
would be to:
A) monitor the patient
B) administer vasodilators
C) administer analgesics
D) cut and loosen the splint at the fingers
E) cut the splint in its whole length immediately

Back 459

SUR-8.15.
E

Front 460

Clavicular fractures of children under 10 years of age should be
treated as follows:
A) no therapy is necessary in most cases
B) reduction and the application of a "figure-of-eight" splint
dressing
C) open reduction is appropriate
D) the medial third of the clavicle should be removed
E) open fixation by a medullary rod is necessary

Back 460

SUR-8.17.
A

Front 461

The principle of treatment for radial and ulnar fractures:
A) the angulation of the ulna must be reduced
B) the angulation of the radius must be reduced
C) the overriding of fractured ends must be reduced
D) the proper relationship of the radius and the ulna must be restored
E) only the elbow should be immobilized

Back 461

SUR-8.19.
D

Front 462

The most helpful information in the diagnosis of acute osteomyelitis
of 1 week duration in infants is provided by:
A) a bone x-ray
B) a hemoculture
C) a radiologic examination of the adjacent joint
D) local tenderness of the bone
E) general systemic dysfunction

Back 462

SUR-8.21.
D

Front 463

What is the usual position of the lower extremity after habitual
luxation of the hip?
A) the hip is in flexion and adduction
B) the hip and the knee are both extended
C) the hip is flexed, the knee is extended
D) in the neutral position
E) the hip is rotated externally

Back 463

SUR-8.25.
A

Front 464

Case Study:
A 20-year-old football player presents with a "locked up" knee after a
torsion injury to his lower extremity. The most likely diagnosis is:
A) avulsion of the tibial tuberosity
B) fracture of the distal portion of the femur
C) meniscus injury
D) disruption of the tibial collateral ligament
E) disruption of the anterior cruciate ligament

Back 464

SUR-8.27.
C

Front 465

All of the following conditions belong to bone development disorders
due to altered cartilage proliferation and calcification, EXCEPT:
A) achondroplasia
B) osteogenesis imperfecta
C) metaphyseal aclasis
D) polyostotic fibrous dysplasia
E) dyschondroplasia

Back 465

SUR-8.36.
B

Front 466

The most frequent cause of lung a abscess is:
A) the aspiration of infective material from the oral cavity or pharynx
B) a blood-borne infection
C) lymphatic spread from an infective focus
D) a penetrating chest injury
E) bronchogenic carcinoma

Back 466

SUR-8.43.
A

Front 467

The most frequent cause of thoracic empyema is:
A) pneumonia of the ipsilateral lung
B) the rupture of an emphysematous bleb
C) a penetrating chest injury
D) a subphrenic abscess
E) ruptures of the thoracic segments of the esophagus

Back 467

SUR-8.50
A

Front 468

All of the following statements are valid regarding lung cancer, EXCEPT:
A) lung cancer is never symptom-free
B) on roentgenograms, it can occur as a coin lesion (round
shadow) on the periphery of the lung
C) hemoptysis is common in lung cancer
D) a dry, distressing, unproductive cough is often the only symptom
of lung cancer
E) a partial or complete airway obstruction may predispose to
lung infection

Back 468

SUR 8.54.
A

Front 469

All of the following are diagnostic signs of cardiac tamponade,
EXCEPT:
A) increased venous pressure
B) shock
C) a reduced cardiac output
D) increased filling volume of the heart during diastole
E) a reduced blood pressure

Back 469

SUR-8.56.
D

Front 470

The main contraindication to surgery in patent ductus arteriosus is:
A) a left-to-right shunt
B) shunting of blood from the aorta to the pulmonary artery
C) shunting of blood from the pulmonary artery to the aorta
D) cardiomegaly
E) hilar pulsation on fluoroscopy

Back 470

SUR-8.58.
C

Front 471

The most common congenital heart abnormality is:
A) a ventricular septal defect
B) an atrial septal defect
C) a patent ductus arteriosus
D) transposition of the great vessels
E) Tetralogy of Fallot

Back 471

SUR-8.65.
A

Front 472

What percent of the small intestine can be removed without severe
consequences on digestive capacity and the subsequent risk of
metabolic disorders?
A) 5%
B) 10%
C) 30%
D) 70%
E) 90%

Back 472

SUR 8.77.
D

Front 473

Intestinal diverticula develop most frequently in the:
A) duodenum
B) jejunum
C) transverse colon
D) descending colon
E) sigmoid colon

Back 473

SUR-8.79.
E

Front 474

The single most important sign of appendicitis is:
A) vomiting
B) an elevated body temperature
C) leukocytosis
D) tenderness in the right lower abdominal quadrant
E) hyperesthesia in the right lower abdominal quadrant

Back 474

SUR-8.82.
D

Front 475

In Crohn's disease, the most frequent indication for surgery is:
A) an intra-abdominal fistula
B) an external fistula
C) an intra-abdominal mass (intestinal conglomerate)
D) stagnant bowel syndrome
E) intestinal obstruction

Back 475

SUR-8.90.
E

Front 476

The principal factor in the etiology of acute appendicitis is:
A) bacterial infection
B) mechanical obstruction
C) local circulatory insufficiency
D) the role of chemical substances
E) the lymphatic tissue of the processus vermiformis

Back 476

SUR-8.102.
B

Front 477

All of the following statements are valid regarding the destruction of
erythrocytes in the spleen, EXCEPT:
A) a reduction of enzymatic and metabolic activity can be observed
in association with the ageing of erythrocytes
B) elderly erythrocytes travel through the spleen slowly
C) local hypoxia and an acidic environment contribute to the degradation
of erythrocytes in the spleen
D) the ATP-content of erythrocytes is reduced to an extremely low level
E) the ageing of erythrocytes is influenced by the overall functioning
of the spleen

Back 477

SUR-8.105.
E

Front 478

Mechanical ileus due to obstruction by a biliary stone develops most
frequently in the:
A) duodenum
B) jejunum
C) ileum
D) sigmoid colon
E) anorectal junction

Back 478

SUR 8.127.
C

Front 479

The most appropriate surgical intervention for a rectal carcinoma
located 4 centimetres above the anal orifice is:
A) an anterior resection
B) a rectal resection with the "pull-through" procedure
C) an abdominoperineal amputation of the rectum
D) a posterior resection
E) a two-stage resection

Back 479

SUR-8.131.
C

Front 480

Which of the following procedures is appropriate for the definitive
diagnosis of congenital megacolon?
A) a stool culture and parasitology
B) a rectal biopsy
C) a radiographic examination
D) pancreatic enzyme activity measurements in stool specimens
E) a sweat test

Back 480

SUR-8.135.
B

Front 481

The anatomical border between the anus and the rectum is the:
A) lateral hemorrhoidal groove
B) interhemorrhoidal groove
C) dentate line
D) pecten
E) anorectal ring

Back 481

SUR-8.138.
C

Front 482

Acute mastitis is prevalent at/in:
A) birth
B) puberty
C) pregnancy
D) breast feeding
E) menopause

Back 482

SUR-8.152.
D

Front 483

The most frequent symptom of a carcinoma of the renal parenchyma
in adults is:
A) an abdominal mass
B) hematuria
C) a fever of unknown origin
D) anemia
E) hemoptysis resulting from lung complications

Back 483

SUR-8.184.
B

Front 484

All of the following are indications for a prostatectomy in benign
prostatic hyperplasia, EXCEPT:
A) a weak urinary stream
B) distressing pollakiuria and nocturia
C) a considerable volume of infected residual urine
D) an enlarged prostate
E) secondary diverticula or urinary calculi

Back 484

SUR-8.193.
D

Front 485

Exploration of the kidney through the transabdominal route is indicated
in:
A) pyelonephritis
B) tuberculosis
C) neoplastic disease
D) cystic disease
E) hydronephrosis

Back 485

SUR-8.195.
C

Front 486

All of the following statements are valid regarding mandibular fractures,
EXCEPT:
A) mandibular fractures are often complicated
B) mandibular fractures cause numbness in the lip
C) malocclusion of the teeth is an ordinary sign
D) the masseter muscles prevent further displacement of fracture
fragments
E) dental fixation is appropriate in most cases

Back 486

SUR-8.207.
D

Front 487

All of the following statements are valid regarding syndactylia,
EXCEPT:
A) males are afflicted more often. than females
B) this condition shows an autosomal dominant inheritance in
many families
C) syndactylia always affects the bones
D) a correct surgical plan is a prerequisite to the prevention of
contractures
E) the operation must be performed at 1-2 years of age

Back 487

SUR-8.208.
C

Front 488

During an examination of the scalenus anticus syndrome:
A) all movements resulting in the relaxation of the anterior
scalenus muscle aggravate pain
B) pain can be elicited by pressing the shoulder passively down
while turning the head excessively to the contralateral side
C) pain can be elicited by pressing the shoulder passively down
while turning the head excessively to the ipsilateral side
D) passive flexion of the biceps muscle evokes severe pain
E) pain is aggravated by lifting the shoulder

Back 488

SUR-8.214.
C

Front 489

The primary therapy for pulmonary embolism is:
A) anticoagulant therapy
B) ligation of the inferior vena cava
C) thrombectomy
D) pulmonary embolectomy

Back 489

SUR-8.241.
A

Front 490

The leading cause of death during the first three decades of life is:
A) inadvertent poisoning
B) heart disease
C) drug addiction
D) trauma

Back 490

SUR-8.252.
D

Front 491

The first and most important step in the care of a severely injured
patient is:
A) the maintenance of patent airways
B) antishock therapy by parenteral volume replacement
C) the immediate immobilization of fractures

Back 491

SUR-8.253.
A

Front 492

Which of the following heart diseases most often leads to
hemoptysis?
A) mitral regurgitation
B) tricuspid regurgitation
C) patent ductus arteriosus
D) mitral stenosis with pulmonary infarction

Back 492

SUR-8.259.
D

Front 493

In which of the following conditions is the presence of Sternberg-
Reed cells a characteristic feature?
A) leukemia
B) multiple myeloma
C) liposarcoma
D) Hodgkin's disease
E) none of the above

Back 493

SUR-8.273.
D

Front 494

Metastatic tumours rarely develop at which of the following sites?
A) the long bones
B) the bones distal to the knee or elbow
C) the skull
D) the vertebrae
E) the pelvis

Back 494

SUR-8.274.
B

Front 495

In the case of clean, closed wounds, the most common source of a
Staphylococcus infection is:
A) the ambient air of the operating theatre
B) bedside instruments
C) dust
D) bedclothes
E) bacterial flora of the patient or personnel

Back 495

SUR-8.276.
E

Front 496

Mammography is a particularly valuable method for the reduction of
breast cancer mortality, because:
A) it does not frighten female patients away from being examined
B) it detects most of the cases with stage I disease
C) there are no false positive results
D). it is a painless procedure
E) it is a particularly specific test in young females

Back 496

SUR-8.278.
B

Front 497

The most prevalent cause of mortality due to a duodenal ulcer can be:
A) hemorrhage
B) peritonitis resulting from acute perforation
C) pyloric obstruction and inanition
D) an untreatable disease
E) an esophageal rupture associated with the regurgitation of the
acidic gastric contents

Back 497

SUR-8.281.
A

Front 498

The commonly occurring paronychia of the fingers is caused by:
A) frequent injury to the delicate skin of the fingers
B) extremely heavy contamination of the skin of the hand
C) excessive use and exposure of the hand and fingers during work

Back 498

SUR-8.286.
A

Front 499

Which of the following must be given a priority in the treatment of
head and neck injuries?
A) any airway obstruction and hemorrhage
B) periorbital injuries with the potential of visual loss
C) any head trauma inducing intracranial hemorrhage
D) any injuries to the cervical spine

Back 499

SUR-8.288.
A

Front 500

Flat T-waves on the ECG are suggestive of:
A) hypokalemia
B) hyperkalemia
C) a normal serum potassium level

Back 500

SUR-8.289.
A

Front 501

In which of the following cases does incomplete conjoining of fracture
fragments frequently occur?
A) in comminuted fractures
B) in infected fractures
C) in insufficient immobilizations
D) all of the above
E) none of the above

Back 501

SUR-8.291.
D

Front 502

All of the following are characteristic features of full-blown traumatic
(hypovolemic) shock, EXCEPT:
A) oliguria
B) peripheral vasoconstriction
C) an increased blood viscosity
D) stupor
E) bradycardia

Back 502

SUR-8.293.
E

Front 503

Which of the following diseases can be most likely transmitted by a
blood transfusion?
A) serum hepatitis
B) lymphoblastic leukemia
C) myeloblastic leukemia
D) erythrocytosis
E) Hodgkin's lymphoma

Back 503

SUR-8.294.
A

Front 504

Which of the following is the characteristic feature of the Mallory-
Weiss syndrome?
A) mucosal rupture in the esophagus
B) rupture of the gastric mucosa
C) rupture of the esophageal mucosa and the gastric mucosa in
the region of the cardia
D) bleeding from a gastric polyp
E) portwine stains (naevus flammeus) of the stomach

Back 504

SUR-8.298.
C

Front 505

The most common indication for renal transplantation is:
A) hydronephrosis
B) end-stage glomerulonephritis or pyelonephritis
C) renal tuberculosis
D) Wilms' tumor
E) "staghorn stones"

Back 505

SUR-8.304.
B

Front 506

The most common nerve injury associated with trauma to the humerus
is damage to the:
A) radial nerve
B) median nerve
C) ulnar nerve
D) axillary nerve
E) musculocutaneous nerve

Back 506

SUR-8.308.
A

Front 507

The primary treatment for osteogenic sarcoma is:
A) irradiation
B) antimetabolites
C) radical amputation
D) abrasion
E) immunotherapy

Back 507

SUR-8.310.
C

Front 508

The therapy of choice for patients with tension pNEUmothorax associated
with dyspnea is:
A) intravenous volume replacement
B) administration of oxygen by mask
C) immediate aspiration of the air from the pleural cavity
D) administration of analeptic drugs
E) intubation

Back 508

SUR 8.312.
C

Front 509

All of the following statements are valid regarding lung cancer, EXCEPT:
A) lung cancer is never asymptomatic
B) lung cancer may be detected on roentgenograms as a coinsized
shadow on the periphery of the lung
C) hemoptysis is a common sign of lung cancer
D) a dry, distressing, improductive cough may be the only symptom
of lung cancer
E) partial or complete bronchial obstruction due to lung cancer
may predispose the patient to lung infections

Back 509

SUR-8.313.
A

Front 510

Acute mastitis is common in:
A) neonates
B) adolescents
C) pregnancy
D) lactation
E) menopause

Back 510

SUR-8.321.
D

Front 511

Case Study:
A 45-year-old female patient has undergone a cholecystectomy.
Three days following the proceedure, she developed a deep-vein
thrombosis. The treatment of choice is:
A) elevation of the lower extremities
B) active exercises
C) anticoagulant therapy
D) thrombolytic therapy with streptokinase or urokinase
E) ligation of the great saphenous vein

Back 511

SUR-8.323.
C

Front 512

The immunosuppressive drug that has improved the results of organ
transplantation significantly is:
A) azathioprine (Imuran)
B) pyrmidine derivatives
C) corticosteroids
D) 0 cyclosporine A
E) actinomycin D

Back 512

SUR-8.324.
D

Front 513

Which of the following facilitates collagen deposition during the
process of wound healing?
A) epithelial cells
B) endothelial cells
C) fibroblasts
D) capillary network
E) none of the above

Back 513

SUR 8.327.
C

Front 514

All of the following may lead to the thoracic outlet syndrome, EXCEPT:
A) a cervical rib
B) the scalenic anticus syndrome
C) costoclavicular compression
D) Raynaud's disease
E) a hyperabduction syndrome

Back 514

SUR 8.350.
D

Front 515

The most important cause of the mortality of patients with a
tracheoesophageal fistula is/are:
A) pulmonary complications
B) diarrhea
C) vomiting
D) malnutrition, feeding incapability
E) other congenital abnormalities

Back 515

SUR-8.361.
A

Front 516

In general, the treatment of fractures is less complicated in pediatric
patients than in adults.

Back 516

SUR-8.388.
T

Front 517

Establishing the diagnosis of an articular "sprain" exclusively by
clinical examination imposes a certain risk for the patient.

Back 517

SUR-8.389.
T

Front 518

The most valuable proceedures indicated for the diagnosis of an expanding
intracranial hematoma include:
1) a spinal tap
2) encephalography
3) electroencephalography (EEG)
4) a CT-scan

Back 518

SUR-8.399.
D

Front 519

In polyomyelitis:
1) paralysis ensues on the 3rd or 4th day following the onset of
symptoms
2) some patients do not become paralyzed
3) the regeneration of muscle power may take as long as 2 years
4) sensory loss always resolves

Back 519

SUR-8.414.
A

Front 520

The Pancoast tumor:
1) is a form of lung cancer
2) causes brachial neuralgia
3) causes Horner's syndrome
4) is usually bilateral

Back 520

SUR-8.421.
A

Front 521

When multiple ribs sustain double fractures simultaneously, a large
region of the chest wall is destabilized, that is, "flail chest" develops.
The significance of this condition is that:
1) it is difficult to diagnose
2) the affected side of the chest wall moves paradoxically with
ventilation
3) it is often associated with pericardiac tamponade
4) it leads to respiratory insufficiency

Back 521

SUR-8.422.
C

Front 522

Indications for coronary bypass surgery include:
1) severe angina resisting drug therapy
2) a progressively deteriorating angina
3) a previous myocardial infarction and coronary disease
4) a previous myocardial infarction and coronary disease confined
to a single vessel

Back 522

SUR-8.430.
A

Front 523

Which of the following is not contraindicated in a patient with a
suspect tetanus wound?
1) toxoid
2) antitoxin
3) debridement of the wound
4) penicillin G

Back 523

SUR-8.438.
E

Front 524

Signs and symptoms of a perforated duodenal ulcer include:
1) an abrupt onset
2) severe abdominal pain
3) muscular rigidity (guarding)
4) pneumoperitoneum

Back 524

SUR-8.446.
E

Front 525

The principal symptoms of a ruptured Fallopian tube pregnancy include:
1) a missed menstrual period
2) an abrupt onset of abdominal and pelvic pain
3) a unilateral adnexal mass
4) shock

Back 525

SUR-8.449
E

Front 526

Indications for the surgical treatment of a duodenal ulcer include:
1) perforation
2) hemorrhage
3) obstruction
4) resistance to adequate and permanent medical (conservative)
therapy

Back 526

SUR-8.454.
E

Front 527

The clinical features of choledocholithiasis include:
1) jaundice
2) gallstone
3) fever
4) ascites

Back 527

SUR-8.463.
A

Front 528

What are the effects of parathyroid hormone (PTH)?
1) it has a direct effect on the bones, resulting in bone resorption
2) it increases the absorption of calcium from the small intestine
3) it reduces the tubular resorption of phosphates
4) it increases the tubular resorption of calcium

Back 528

SUR-8.499.
E

Front 529

Which of the following is an important diagnostic aid in the treatment
of a spontaneous subarachnoid hemorrhage?
1) spinal tap
2) emergency craniotomy

3) CT-scan
4) ventriculography

Back 529

SUR-8.520.
B

Front 530

Torsion of the testis is suspected:
1) in young patients
2) when sudden pain strikes in the inguinal region
3) if the testis is enlarged and soft
4) if hematuria is present

Back 530

SUR-8.524
A

Front 531

Associate the following term(s) with their corresponding statement(s)!
A) Ulcerative colitis
B) Granulomatous colitis
C) Both of the above
D) None of the above

1) the small intestine is often involved
2) the risk of cancer is high
3) intestinal fistulas are a complication
4) a proctocolectomy is required

Back 531

SUR-8.561.
BABA

Front 532

Associate the following term(s) with their corresponding statement(s)!
A) Ulcerative colitis
B) Crohn's disease
C) Both of the above
D) None of the above

1) bleeding is common
2) malignant transformation is possible
3) it causes intestinal stricture
4) it is caused by an infection
5) it has extraintestinal manifestations
6) it involves both the small and large intestines

Back 532

SUR-8.566.
AABDCB

Front 533

Hemorrhagic diathesis developing after multiple transfusions is predominantly
the consequence of:
A) thrombocytopenia
B) a reduced fibrinogen level
C) a reduced prothrombin level
D) an increased fibrinolytic activity
E) a reduced serum calcium level

Back 533

SUR-8.10.
A

Front 534

All of the following features are characteristic of achondroplasia,
EXCEPT:
A) 'trident' (3 fingered) hand
B) mental disorders
C) ball shaped/globular skull
D) dwarfism
E) prognathism

Back 534

SUR-8.37.
B

Front 535

The incidence of biliary calculi increases after which of the following
operations?
A) the resection of a liver lobe
B) a subtotal gastrectomy
C) a splenectomy
D) a resection of the jejunum
E) a resection of the ileum

Back 535

SUR-8.126
E

Front 536

Cystic hygromas are:
A) congenital malformations
B) may undergo malignant transformation
C) do not develop before the second year of life
D) can develop as multifocal lesions
E) are benign neoplasms of the lymphatic system

Back 536

SUR-8.375.
A

Front 537

Case Study:
A needle aspiration of the knee yields a relatively thick, clear and
viscous fluid. The patient has had vague complaints for several
weeks. What is the proper action?
1) the fluid should be cultured
2) the fluid should be inspected and discarded
3) the viscosity of the fluid should be measured to decide
whether it is a transudate or an exudate
4) protein electrophoresis should be performed

Back 537

SUR-8.556.
B

Front 538

Case Study
A 22-year-old man is admitted to the hospital with injuries sustained
in an automobile accident. A lefet-sided hemothorax is detected
on the chest x-ray.

8.585/ l.
The emergency treatment is:
A) aspiration of the left pleural cavity (thoracocentesis)
B) intercostal blockade and fixation with adhesive tape
C) bilateral tube thoracostomy
D) pericardiocentesis
E) endotracheal intubation, mechanical ventilation and drainage
of the pleural cavity

8.585/2.
An x-ray taken three weeks after the injury denotes no improvement.
The next therapeutic step is:
A) a thoracotomy and evacuation of the hematoma
B) the intrapleural administration of tetracycline
C) the intrapleural injection of streptokinase
D) an exploration of the mediastinum
E) the maintenance of mechanical ventilation for another 2 weeks

Back 538

SUR-8.585.
AA

Front 539

Case Study
There are three victims following a road accident; two of them have
sustained moderately severe injuries and one is severely injuried.

8.586/ l.
As the first doctor on the scene, what would you do first?
A) patients with the least severe injuries are treated first as they
have the best chance for survival
B) it is best not to'do anything until an ambulance arrives
C) you should make a report of what happened
D) you transport all three victims to the hospital with the help of
bystanders
E) provided that neither of the patients with moderate injuries is
in life-threatening condition, you start treating the patient
with the most severe injury immediately

8.586/2.
The skin of the severly injured patient is unusually pale, his breathing
is gasping and shallow, the peripheral and carotid pulses are
unpalpable. The right pupil is dilated in comparison to the left one.
Does this condition satisfy the criteria of clinical death?
A) yes, because peripheral pulses are not palpable
B) no, beacause the diameter of the pupils is different
C) yes, because muscle rigidity is also present
D) no, because respiration and circulation, though insufficient,
are detectable
E) yes, because the patient is hyperventilating

8.586/3.
Which of the following combinations represent the optimal sequence
of cardiopulmonary resuscitation?
A) the maintenance of patent airways, the administration of 100%
oxygen through a mask, external cardiac compression, drug
therapy, electric defibrillation, volume replacement
B) external cardiac compression, the maintenance of patent airways,
the administration of oxygen, drug therapy, volume replacement
C) volume replacement, external cardiac compression, drug
therapy, the maintenance of patent airways
D) the administration of 100% oxygen through a mask, the maintenance
of patent airways, external cardiac compression, drug
therapy, volume replacement
E) the maintenance of patent airways, simultaneous mechanical
ventilation and external cardiac compression, volume replacement
through a large-bore canule, the intravenous administration
of 8.4% NaHCO3, drug therapy, defibrillation depending
on the ECG findings.

8.586/4.
Which of the following agents is unsuitable in influencing the cardiac
and circulatory functions?
A) atropine
B) calcium
C) epinephrine
D) isoproterenol
E) calcium gluconate

8.586/5.
Two minutes later the heart of the patient stops functioning, the pupils
dilate progressively. Cardiopulmonary resuscitation must be
started immediately, because this progressively deteriorating condition
leads to death if left untreated.
A) both the statement and the explanation are true and a causal
relationship exists between them
B) both the statement and the explanation are correct but there
is no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is correct
E) both the statement and the explanation are false

8.586/6.
The detection of biologic death renders cardiopulmonary resuscitation
unnecessary, because there is no chance of restarting circulatory
and respiratory functions 4 minutes after the commencement of
clinical death.
A) both the statement and the explanation are true and a causal
relationship exists between them
B) both the statement and the explanation are true but there is
no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

8.586/7.
Before starting cardiopulmonary resuscitation, it must be decided
whether respiratory or cardiac damage has ensued first, because
this determines further actions as well as the sequence of measures
to be taken.
A) both the statement and the explanation are true and a causal
relationship exists between them
B) both the statement and the explanation are true but there is
no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

8.586/8.
The patient regains consciousness as a result of undelayed, effective
resuscitation, because unconsciousness persisting after
successful resuscitation can only be the consequence of brain
damage.
A) both the statement and the explanation are true and a causal
relationship exists between them
B) both the statement and the explanation are true but there is
no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Back 539

SUR-8.586.
EDEBACEE

Front 540

Case Study
A victim of a road accident is brought to the emergency room. On admission,
the patient is exhausted, pale, sweating and lip cyanosis is
visible. The abdomen is distended; percussion sounds are shortened
on the left side; hepatic dullness is intact, bowel sounds are hypoactive.
Heart rate: 140/min, the pulse is thready. Blood pressure: 60/0 mmHg.

8.588/1.
Which of the following signs contradicts the possibility of circulatory
shock?
A) tachycardia
B) bradycardia
C) the abrupt onset of hypotension
D) emtpy and collapsed veins

8.588/2.
The patient in shock should be transferred to the:
A) operating theatre
B) patients' ward
C) radiology department
D) intensive care unit

8.588/3. Single Choice Question
What is the essential pathophysiology of a shock syndrome? Mark
the incorrect one among the following definitionsl
A) an acute disparity between the circulating blood volume and
the capacity of the vascular bed
B) the fall of the blood pressure and the central venous pressure
due to the reduction of the cardiac volume
C) the discrepancy between the oxygen supply and the demand of
peripheral tissues
D) an acute microcirculatory failure

8.588/4.
Select the emergency measures required for the hospital treatment
of a patient in shock!
1) the administration of laxatives and stimulants of
gastrointestinal motility
2) an analysis of the blood gases
3) a measurement of the body temperature
4) the emptying of the stomach
5) monitoring of the patient's NEUrologic status
6) monitoring of the patient's blood pressure and heart rate
7) monitoring of the patient's central venous pressure
8) securing a patent vein for volume replacement
9) measurement of the patient's height and weight
10) monitoring the diuresis

A) answers (1), (3), (4), (5) and (9) are correct
B) answers (2), (4) and (9) are correct
C) answers (3), (4) and (5) are correct
D) only answer (4) is correct
E) answers (2); (6), (7), (8) and (10) are correct
F) all the above answers are correct

8.588/5.
Which of the following findings is characteristic of circulatory
shock?
A) metabolic alkalosis
B) metabolic acidosis
C) respiratory alkalosis
D) respiratory acidosis

8.588/6.
Which of the following solutions is not used for the treatment of
shock?
A) Ringer's solution
B) dextran
C) human plasma
D) mannitol

8.588/7.
Is circulatory shock a contraindication for surgical intervention?
Mark the incorrect answer!
A) yes, because anesthetic agents would cause the collapse of the
centralized circulation of the patient
B) yes, with the exception of cases where the precipitating cause
of shock can be eliminated by surgery only
C) surgery is appropriate for all patients in shock if volume replacement
is adequate
D) all patients in shock must be operated upon if the operation is
a component of antishock therapy

Back 540

SUR-8.588.
BDDEBDA

Front 541

Case Study
You are called to attend to a middle-aged male patient found sitting
in the driver seat of his pickup van (6-7 minutes before your arrival).
The patient is unconscious, his skin is pale, there are no signs of
respiration or circulation, the carotid pulse is unpalpable, his pupils
are dilated. There are food remnants left in his mouth. Witnesses
inform you that the patient has had a seizure, groaned for a while,
then fell silent just before your arrival.

8.590/ 1.
The tentative diagnosis is:
A) the patient has epilepsy and he is in a postconvulsion coma
B) a cerebrovascular crisis
C) a syndrome associated with recent brain damage
D) clinical death
E) anaphylactic shock
F) the aspiration of a foreign object

8.590/2.
The immediate action to be taken is:
A) an EEG examination
B) to start volume replacement
C) to perform coniotomy
D) to perform proper cardiopulmonary resuscitation

8.590/3.
Determine the correct sequence of the phases of cardiopulmonary
resuscitation)
1) endotracheal intubation
2) external cardiac coompression
3) rescue breathing (mouth-to-mouth)
4) the removal of foreign bodies from the pharynx
5) notifying the rescue service
6) to remove the patient from the vehicle
7) a precordial thump on the chest
8) mechanical ventilation with an appropriate device
9) to set up an intravenous line for infusion

A) the correct sequence is (1), (7), and (9)
B) the correct sequence is (1), (8), (2), and (5)
C) the correct sequence is (6), (4), (3), (2), (5), (1), (8), (9), and
D) the correct sequence is (2), (3), (4), and (5)
E) the correct sequence is (7), (8), and (9)
F) only step (6) should be taken

Back 541

SUR-8.590.
.DDC

Front 542

Case Study
A 67-year-old male patient is found unconscious by his neighbour,
who calls the family practitioner immediately. The history of the patient
includes an ulcer disease. The skin of the patient is extremely
pale, cold and cyanotic. Skin turgor is poor, the tongue is dry. The
capillary refill, assessed by pressing the fingernails, is slow. Auscultation
reveals bronchial breath sounds. The abdomen is slightly distended,
tender. Blood pressure: 6G/40 mmHg. Heart rate: 140/min.
Respiratory rate: 40/min.

8.592/1.
What would be your tentative diagnosis?
A) pneumonia
B) hyperglycemic coma
C) shock syndrome
D) acute heart failure
E) hypoglycemic coma

8.592/2.
What is the leading sign that your diagnosis can be based on?
A) pale skin; tachypnea; bronchial breath sounds
B) bronchial breath sounds; tachycardia
C) the lack of signs indicating any external trauma
D) hypotension; tachycardia; signs of poor peripheral perfusion
E) poor skin turgor and a tender abdomen

8.592/3.
Which of the following drugs is contraindicated for the adjunctive
therapy of the diagnosed disease?
A) digitalis
B) calcium gluconate
C) 8.4% sodium bicarbonate
D). methylprednisolone
E) insulin

8.592/4. Relation Analysis
The insertion of an indwelling bladder catheter is recommended by
all means, because the measurement of diuresis is required for the
establishment of a more accurate diagnosis.
A) both the statement and the explanation are true and a causal
relationship exists between them
B) both the statement and the explanation are true but there is
no causal relationship between them
C) the statement is true, but the explanation is false
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Back 542

SUR-8.592.
CDEA

Front 543

Case Study
A 45-year-old female patient is suspected of having colon cancer.

8.594/ 1.
Which of the following sets of signs and symptoms is characteristic
of a neoplasm of the descending colon?
A) occult bleeding; lower abdominal pain
B) constipation alternating with diarrhea, blood and mucus containing
stools, abdominal cramps
C) fever; recurrent diarrhea accompanied by vomiting, colicky abdominal
pain
D) recurrent tenesmus; blood and mucus containing stools; the
patient complains of incomplete emptying of the rectum even
by repeated attempts

8.594/2.
Which of the following procedures is hazardous in mechanical intestinal
obstruction due to a suspected neoplasm of the colon?
A) percussion of the abdomen
B) colonoscopy
C) a GI series of x-rays
D) rectoscopy
E) a digital rectal examination
F) a barium enema

Back 543

SUR-.594.
BC

Front 544

8.599

Back 544

8.599
ABDBDEBBGABB

Front 545

Case Study
A 65-year-old male patient has a 2-month history of slight perianal
pain associated with the passage of bloody stools, periodic constipation
and diarrhea. He has not had fever; his appetite and bodyweight
are unchanged.

8.608/1.
Considering the history, which of the following conditions is most
likely?
A) internal and external hemorrhoids
B) Crohn's disease
C) neoplasm of the rectum
D) anal fissure
E) anorectal abscess

8.608/2.
Which of the following can be found on a digital rectal examination?
A) hyperemic, inflamed hemorrhoids
B) an inflamed, fluctuating mass adjacent to the anal orifice
C) chronic outer fistulas
D) dehiscence of the anal mucosa in the posterior commissure
E) a mass bulging into the rectal lumen can be palpated

8.608/3.
Which of the following diagnostic studies is indicated?
A) a GI series of x-rays
B) rectoscopy and barium enema
C) fistulography
D) ultrasonography
E) diagnostic puncture

8.608/4.
Laboratory tests reveal:
A) no significant abnormalities
B) eosinophilia
C) leukocytosis with a "shift to the left"
D) anemia
E) an elevated serum creatinine level

8.608/5.
The surgical therapy of choice is:
A) a right hemicolectomy with ileotransversostomy
B) a hemorrhoidectomy according to Milligan-Morgan or Parks
C) a Récamier -dilation
D) incision and drainage
E) an abdominoperineal resection of the rectum

Back 545

SUR-8.608.
CEBDE

Front 546

Case Study
A 65-year-old male patient presents with a small white spot detected
in the anterolateral region of his tongue. He is a pipe smoker since
early adulthood. The lesion was painless for a month, than gradually
became tender due to exulceration.

8.614/1.
What is the most likely diagnosis?
A) benign aspecific ulcer
B) benign leukoplakia
C) epulis
D) lingual cancer
E) lingual ranula

8.614/2.
Which of the following diagnostic tests is appropriate for the verification
of the tentative diagnosis?
A) a positive Wassermann-test
B) a positive LE phenomenon
C) a biopsy of the lesion
D) radiography of the mandible and the maxilla
E) close observation for any progression

8.614/3.
The most common sequel of this condition is:
A) metastatic spread to the supraclavicular lymph nodes
B) propagation to the collar lymph nodes
C) metastatic spread to the internal mammary nodes .
D) metastatic spread occurs in the terminal phase only
E) metastatic spread never occurs

8.614/4.
The treatment of this patient includes:
A) local radioisotope implantation
B) high-voltage radiotherapy
C) radical oral and cervical dissection
D) therapy is futile if propagation has reached the cervical lymph
nodes
E) surgical therapy and irradiation

Back 546

SUR-8.614.
DCBE

Front 547

Case Study
A 3-year-old child is investigated for constipation present since
birth. The child experiences frequent attacks associated with abdominal
distension. On examination: the abdomen is distended and
the colon contains feces and gas in large volumes. The rectum is
empty.

8.618/ 1.
The most likely diagnosis is:
A) enterocolitis
B) massive intestinal worm infestation
C) congenital megacolon
D) idiopathic sprue
E) duodenal atresia

8.618/2.
This condition is freqently associated with:
A) Meckel's diverticulum
B) familial polyposis
C) abdominal distension
D) rectal hemorrhage
E) intestinal atresia

8.618/3.
The characteristic pathology of this condition includes:
A) infarction of the large bowel
B) multiple diverticula of the colon
C) hypertrophy of the intramural neural plexuses of the colon
D) absence of the neural plexuses of the colon
E) hypertrophy of the longitudinal muscle layer of the colonic wall

Back 547

SUR-8.618.
CCD

Front 548

Case Study
A 2-year-old infant is admitted for colicky abdominal pain of abrupt
onset associated with crying and frequent vomiting. The patient is
asymptomatic between the painful attacks. The mother informs you
that the child has passed bloody-mucous stools.

8.619/1.
The most likely diagnosis is:
A) intussusception/invagination
B) gastroenteritis
C) congenital pyloric stenosis
D) gastritis
E) renal stone

8.619/2.
The characteristic finding detected on physical examination is:
A) a sausage-like mass in the right upper abdominal quadrant
B) general abdominal tenderness
C) virtually no abnormality is found
D) epigastric tenderness
E) costovertebral angle tenderness


8.619/3.
A likely finding on the plain abdominal x-ray is:
A) the absence of the cecal "gas cap" in the right iliac region
B) a patchy small intestine distended with gas
C) nothing in particular can be noted
D) a dilated stomach
E) radiolucent stone in the kidney

8.619/4. Single Choice Question
The most valuable supplemental diagnostic study is:
A) a barium enema
B) an upper GI series
C) intravenous urography
D) a CT-scan
E) serial radiography of the small intestine

Back 548

SUR-8.619.
AAAA

Front 549

Case Study
A 27-year-old female patient is brought to the surgery department of
the outpatient clinic. According to the rescue personnel, she has fallen
down some slippery stairs and knocked her head to the ground. Even
though the patient denies the loss of her consciousness she does not
remember the preceding events accurately. She has had nausea but
no vomiting. Further, none of the acute conditions associated with
unconsciousness nor any other type of trauma are present in her history.
Her blood pressure has been always normal. Physical status:
vital organ functions are normal. Blood pressure: 130/80 mmHg, heartrate:
86/min. A 5 cm subcutaneous hematoma is visible in the middle
of the patient's forehead with a 2 cm excoriation at the centre of the
injury. The left nostril is covered by crusted blood; thin bloody discharge
is leaking from the right nostril. Neurologic examination: reveals
intact mental status, nuchal rigidity is absent. Cranial nerves
are normal. Olfactory tests are not feasible. Tendon reflexes are normal,
with no other abnormal reflexes. Motor functions are intact, sensory
loss is absent. Signs of cerebral lobe injury are absent. Normal
psychomotor function. Coordination is intact, tests of cerebellar function
reveal instability during the Romberg test. No fractures are seen
on bidirectional skull films and roentgenograms of the base of the skull.
Air is detected on the 'face-up' film. One day following admission
periorbital suffusion (racoon's eyes) develops.

8.621 / 1.
What is the most likely diagnosis?
1) cerebral concussion
2) contusion of the head and excoriations of the forehead
3) cerebral contusion
4) basal skull fracture
5) intracerebral hemorrhage
6) suturolysis

A) answers (1), (4), and (5) are correct
B) answers (4), (5), and (6) are correct
C) answers (3), (5), and (6) are correct
D) answers (1), (2), and (4) are correct
E) none of the answers are correct

8.621/2.
What kind of roentgenograms would you order?
A) bidirectional skull film
B) basal skull film
C) face up film
D) all of the above

8.621/3.
Which of the following tests are suitable for the identification of the
source of the discharge leaking from the nostril?
1) pneumoencephalography
2) the appearance of a ring developing around a droplet of the
discharge dropped on filter-paper
3) measuring the glucose content of the discharge
4) the determination of the difference between radiation activity
of nasal and pharyngeal swabs during isotope cysternography
5) carotid angiography
6) injection of contrast material into the cisterna magna and the
observation of the route of elimination by serial radiography

A) answers (2), (3), (4), and (6) are correct
B) answers (1), (2), and (3) are correct
C) answers (3), (4), and (5) are correct
D) answers (4), (5), and (6) are correct
E) none of the answers are correct

8.621/4.
What is the appropriate action to be taken in the case of
liquorrhea?
A) discharge of the patient after proper wound care has been delivered,
strict bed rest, follow-up examination 1 week later
B) observation, antibiotic therapy
C) observation, antibiotic therapy, repeated spinal taps until the
cessation of cerebrospinal fluid leakage
D) observation, antibiotic therapy, repeated spinal taps for 8-10
days; surgery if leakage is permanent

8.621/5.
What are the possible risks and complications associated with this
condition?
1) headaches resulting from the permanent leakage of
cerebrospinal fluid
2) meningitis
3) damage to the olfactory nerve
4) brain abscess
5) intracranial hemorrhage associated with increased intracranial

Back 549

SUR-8.621.
DDADB

Front 550

Case Study
A 58-year-old male patient has felt a sudden crack in his right shoulder
while lifting his coat from the rack. He could not move his right
arm anymore, the limb was fixed in the elevated position. Passive reposition
was unsuccessful. The right shoulder assumed a sloped contour
and the axis of the right humerus pointed to the axillary fossa
instead of the humeroscapular joint. Peripheral pulses are readily palpable,
no signs of damaged innervation to the arm or hand are detected.

8.622/1.
What is the most likely diagnosis?
A) fracture of the surgical neck of the humerus
B) pathologic fracture of the humerus
C) dislocation of the shoulder
D) acromioclavicular dislocation

8.622/2.
Which of the following studies is the most objective in verifying the
diagnosis?
A) bidirectional roentgenograms of the right humerus
B) bidirectional roentgenograms of the right shoulder joint
C) physical examination and inspection
D) laboratory tests including the determination of the alkaline
phosphatase activity

8.622/3.
Which of the following is the appropriate therapy for the above diagnosis?
A) plaster cast
B) reposition and plaster cast
C) surgical reduction, stable osteosynthesis
D) surgical treatment involving the resection of the proximal end
of the humerus

Back 550

SUR-8.622.
CBB

Front 551

Case Study
A 58-year-old male patient has been kicked by a horse. The hoof of the
animal has hit the patient at the level of the left costal margin. On
admission: the patient is complaining about severe abdominal pain in
the upper-left quadrant. The hematocrit and the WBC are normal;
the circulation is stable. Continuous monitoring of circulatory parameters
are uncharacteristic of internal bleeding. The Hct is stable, however,
the WBC count is slightly elevated. On the third day following
admission shock develops abruptly during defecation. Blood pressure
falls and can not be corrected by infusion or transfusion.

8.623/1.
The most likely diagnosis is:
A) perforated gastric ulcer
B) mechanical intestinal obstruction
C) rupture of the spleen
D) fractue of the 9-10th ribs associated with injury to the
subcostal artery

8.623/2.
Which of the following studies inappropriate in verifying the diagnosis?
A) a chest x-ray
B) plain abdominal radiography
C) emergency surgical exploration
D) laboratory tests for the monitoring of the Hct and the WBC
Count

8.623/3.
What is the therapy of choice?
A) a massive transfusion
B) a laparotomy and closure of the perforation
C) a laparotomy and the control of any bleeding
D) a gastric resection

Back 551

SUR-8.623.
CCC

Front 552

Case Study
A 35-year-old female presents with rectal bleeding and mucous discharge
from the anus associated with tenesmus.
Rectosigmoidoscopy reveals a neoplasm that bleeds easily, located
14 centimetres from the dentate line. A biopsy is performed.

8.596/1.
Histology would suggest the following:
A) a juvenile polyp
B) an adenomatous polyp
C) a villous adenoma
D) a pseudopolyp associated with ulcerative colitis
E) endometriosis

8.596/2.
These neopolasms are extremely prevalent in the:
A) appendix
B) cecum
C) transverse colon
D) rectum and sigmoid colon
E) anal canal

8.596/3.
The treatment of choice if the lesion proves to be malignant is:
A) fulguration
B) local excision
C) anterior resection
D) abdominoperineal amputation of the rectum
E) excision by colonoscopy

Back 552

SUR-8.596.
CDC

Front 553

Case Study
A 68-year-old male patient has been treated in the hospital recently
for a myocardial infarction. He starts complaining about a sudden,
colicky pain felt in the periumbilical and epigastric region. His skin
is greyish pale and is covered with sweat; the patient is in apparent
distress. An hour later the pain subsides. Then the abdominal pain
returns in the right lower quadrant and distension ensues, bowel
sounds are absent. The condition culminates in the development of
shock.

8.598/ 1.
The most likely diagnosis is:
A) acute cholecystitis
B) occlusion of the superior mesenteric artery due to embolism
C) diverticulosis
D) carcinoma of the transverse colon
E) none of the above

8.598/2.
Based on the correct diagnosis, the characteristic finding in the peripheral
blood count is:
A) early leukopenia
B) leukocytosis
C) a significant rise of the eosinophil cell count
D) lymphocytosis
E) none of the above

8.598/3.
Which of the following diagnostic procedures is appropriate for the
verification of the tentative diagnosis?
A) plain abdominal radiography
B) barium enema
C) selective angiography of the mesenteric artery
D) abdominal ultra-sound
E) none of the above

8.598/4.
Therapy may include:
A) early exploration and embolectomy
B) an emergency cholecystectomy
C) colostomy of the transverse colon
D) observation for at least 6 hours before deciding about the indication
for surgery
E) none of the above

Back 553

SUR-8.598.
.BBAA

Front 554

Case Study
A 45-year-old male patient complains about aching pains in his left
upper arm which are aggravated by active movements of the extremity.
Any prolonged usage of her arm result in dizziness and
fainting. On examination: the volume and amplitude of the peripheral
pulses are different in the upper extremities and the systemic
blood pressure is lower in the right arm.

8.615/1.
The most likely diagnosis is:
A) angina pectoris
B) subclavian steal syndrome
C) congenital abnormality of the radial artery
D) thoracic outlet syndrome
E) brachial neuralgia

8.615/2.
The pathology of this condition includes:
A) coronary arteriosclerosis
B) occlusion of the left subclavian artery proximal to the origin of
the vertebral artery
C) hypoplasia of the left radial artery
D) cervical rib
E) prolapse of a cervical intervertebral disc

8.615/3.
The most valuable procedure for the establishment of the diagnosis is:
A) carotid angiography
B) angiography of the aortic arch
C) angiography of the brachial artery
D) a CT-scan of the brain
E) radiography of the cervical spine

Back 554

SUR-8.615.
BBB

Front 555

SUR-8.29.
The most severe complication of an open fracture is usually:
A) hemorrhage
B) limb shortening
C) infection
D) comminuted fracture
E) muscle contracture

Back 555

C

Front 556

SUR-8.72.
Hemoptysis can result from all of the following, EXCEPT:
A) bronchial carcinoma
B) bronchial asthma
C) bronchiectasia
D) pulmonary infarction
E) pulmonary tuberculosis

Back 556

B

Front 557

SUR-8.153.
The risk of bilateral breast cancer is high when the primary lesion
(having developed in the breast affected first) is a(n):
A) comedo carcinoma
B) inflammatory carcinoma
C) lobular carcinoma
D) Paget's disease
E) carcinoma of the papillary duct

Back 557

C

Front 558

SUR-8.229.
The rupture of an intervertebral disk in the cervical spine:
A) causes pain radiating to the medial surface of the forearm
B) immobilization of the head alleviates the pain
C) it occurs most frequently between the 5th-6th and 6th-7th
vertebrae
D) pain is a more prevalent symptom than numbness and
paraesthesias
E) pain in the fourth finger of the hand is a useful localizing sign

Back 558

C

Front 559

SUR-8.235.
The most malignant neoplasm of the brain is:
A) glioblastoma multiforme
B) astrocytoma
C) oligodendroglioma
D) spongioblastoma
E) ependymoma

Back 559

A

Front 560

SUR-8.611.
Case Study
A 63-year-old female patient presents at the emergency room during
duty hours. She complains of an inability to pass stools for the past 3
days and significant abdominal distension and pain in the left half of
the abdomen. Her bowel habits have changed considerably over the
last 1-2 months plus hiccups have started 4 hours before her admission;
at present she is feeling feeble. Physical status: soft, palpable
abdomen, regional tenderness to the right of the umbilicus with local
muscular guarding. Rectal digital examination: the right wall of the
cul-de-sac is tender on palpation. Body temperature: 38.5 °C, WBC:
15 G/1, urinalysis: negative.

8.611/1.
Which of the following is the most likely tentative diagnosis?
A) acute appendicitis
B) acute pancreatitis
C) perforation of the ascending colon
D) mesenteric lymphadenitis

8.611/2.
Which of the following procedures aids in establishing the correct
diagnosis?
A) plain abdominal radiography (detection of free air)
B) a gynecologic examination
C) an emergency barium enema
D) a CT-scan

8.611/3.
What kind of treatment would you recommend?
A) closer observation
B) vigorous parenteral volume replacement and the application of
ice packs on the abdomen
C) emergency surgical exploration
D) intensive antibiotic therapy

Back 560

CAC

Front 561

SUR-8.613.
The patient is a 66-year-old female in good general condition. She has
never been treated in a hospital, does not smoke and drinks alcohol
only occasionally. She has had no diseases other than common colds.
About a year ago, she has begun to experience moderate, colicky, right
subcostal pain related to fatty meals. These colicky periods were associated
with bilious vomiting but resolved spontaneously. For the last 2
months, she felt her bowels more distended. Constipation, a permanent
feature of her bowel habits has been alternating with mucous,
odoriferous, occassionally bloody diarrhea. Fever or subfebrility did
not occur. Despite her good appetite and unchanged bodyweight she
feels weak. Diagnostic studies: performed at the outpatient clinic revealed
cholelithiasis with several stones in the gall bladder. The results
of the laboratory studies were normal.

8.613/ 1.
Are the diagnostic studies performed so far sufficient for the establishment
of the diagnosis?
A) yes, because the studies verified suspected cholelithiasis
B) no, stool culturing should have been done because there is
mucous-bloody diarrhea in the history
C) no, because there is a strong suspicion of colorectal malignancy
and this can be verified by further investigations only

8.613/2.
Analyzing the information available, the most likely diagnosis is:
A) cholelithiasis + chronic colitis
B) cholelithiasis + amebic dysentery
C) cholelithiasis + chronic pancreatitis
D) cholelithiasis + colorectal neoplasm causing partial obstruction

8.613/3.
Which of the following diagnostic studies should be performed (in
addition to physical examination)?
1) ERCP
2) barium meal
3) barium enema
4) ultrasonography
5) rectoscopy, colonoscopy

A) answers (1), (3), and (4) are correct
B) answers (2) and (4) are correct
C) answers (3), (4), and (5) are correct
D) only answer (2) is correct
E) all of the answers are correct

8.613/4.
In addition to cholelithiasis, the diagnostic studies detected a neoplasm
in the rectosigmoidal junction. What is the treatment of choice?
A) surgical treatment of the symptomatic cholelithiasis; decompression
colostomy and interval resection of the rectosigmoidal
tumor 1-2 months later
B) surgical treatment of the rectosigmoidal neoplasm;
cholecystectomy should be postponed
C) simple complete excision of the rectosigmoidal neoplasm with
cholecystectomy if the latter is not contraindicated by the patient's
limited tolerance to surgical stress

Back 561

CDCC

Front 562

SUR-8.617.
Case Study
A 3 week-old infant is admitted because of recurrent projectile vomiting
occurring after feeding since the age of 2 weeks. The weight of
the neonate decreased despite his good appetite.

8.617/ 1.
The most likely diagnosis is:
A) neonatal peptic ulcer
B) tracheoesophageal fistula
C) hypertrophic pyloric stenosis
D) leukemia
E) esophageal atresia

8.617/2.
A common physical symptom of this condition is:
A) a scaphoid (concave) abdomen
B) visible peristalsis
C) a "tumor" with a size of an olive is palpable through the abdominal
wall
D) rales are audible over the lung
E) a distended, meteoristic abdomen

8.617/3.
Which of the following diagnostic signs is important to verify the diagnosis?
A) bilious vomiting
B) gastric dilation detected by radiography
C) Faber-test for the detection of meconium
D) alkalosis
E) a full-thickness biopsy of the gastric wall

Back 562

CCB