State Exam_Tal

Front 1

True-False Type Question
Distension is the only natural stimulus which can increase gastric
emptying.

Back 1

INT-7.1.
T

Front 2

True-False Type Questions
Fats are not effective in slowing down gastric emptying.

Back 2

INT-7.2
F

Front 3

The following statements are all true for Exanthematous Typhus,
EXCEPT:
A) a severe drug-resistant headache typically occurs following the
7- to l4-day incubation period
B) hypotension occurs in the most seriously ill patients
C) exanthema develops at the end of the second week
D) splenomegaly occurs in some cases
E) small pink macules appear on the 4th to 6th day
F) severe diarrhea occurs at the onset of the disease

Back 3

INT-7.11.
F

Front 4

All of the following are true for coccidioidomycosis, EXCEPT:
A) acute bronchitis
B) erythema nodosum
C) leukopenia
D) arthritis
E) a positive complement-binding test and a negative skin-test in
cases of a disseminated infection

Back 4

INT-7.12.
C

Front 5

All of the following can cause osteoporosis, EXCEPT:
A) a calcium deficiency
B) a phosphate deficiency
C) hypercortisonism
D) hypogonadism

Back 5

INT-7.16.
B

Front 6

Which of the following can cause demineralization of the bones?
A) tumors
B) bone marrow diseases
C) hyperparathyroidism
D) a vitamin D deficiency
E) all of the above

Back 6

INT-7.17.
E

Front 7

All of the following are used to treat osteoporosis, EXCEPT:
A) calcium
B) vitamin D
C) sodium fluoride
D) calcitonin when estrogen therapy is contraindicated
E) potassium

Back 7

INT 7.18.
E

Front 8

All of the following are typical of Wiskott-Aldrich syndrome EXCEPT:
A) chronic eczema
B) thrombocytopenic purpura
C) a sex-dependent recessive inheritance pattern
D) anemia
E) thymus aplasia

Back 8

INT-7.20
E

Front 9

Rheumatoid factor usually occurs together with the following symptoms
EXCEPT:
A) subcutaneous nodules
B) splenomegaly
C) vasculitis
D) neuropathy
E) juvenile rheumatoid arthritis
F) Sjorgen's syndrome

Back 9

INT-7.21.
E

Front 10

Impetigo is a superficial infection caused by one of the following bacteria:
A) hemolytic staphylococcus
B) hemolytic streptococcus group A
C) both of the above
D) none of the above

Back 10

INT-7.30.
C

Front 11

Which site (excluding the lung) is mainly affected by childhood pulmonary
tuberculosis?
A) the mediastinal lymph nodes
B) the kidney
C) the spine
D) the pericardium
E) the peritoneum

Back 11

INT-7.33.
A

Front 12

All of the following alterations occur in syphilis, EXCEPT:
A) condyloma latum
B) mucocutaneous pustular lesions
C) gumma
D) meningitis
E) uveitis
F) condyloma acuminatum

Back 12

INT-7.34.
F

Front 13

If the mother has measles during the first trimester of pregnancy all
of the following can occur in the newborn, EXCEPT.
A) cardiac disorders
B) cataracts
C) thrombocytopenic purpura
D) deafness
E) the measles virus cannot be identified in newborns

Back 13

INT-7.47.
E

Front 14

All of the following are contraindications of the viable measles vaccine,
EXCEPT:
A) pregnancy
B) leukemia
C) active tuberculosis
D) simultaneous steroid therapy
E) polio vaccination performed 4 weeks before

Back 14

INT-7.48.
E

Front 15

All of the following are useful symptoms which help to differentiated
acute pancreatitis from a perforated peptic ulcer, EXCEPT:
A) hypertension develops in acute pancreatitis
B) a perforated ulcer is more pressure sensitive
C) intestinal sounds are typical of acute pancreatitis
D) in perforated peptic ulcer air is visible under the diaphragm,
while in acute pancreatitis pleural effusion is typical
E) an elevated serum amylase level

Back 15

INT-7.49.
E

Front 16

Which of the following can cause postoperative hypokalemic,
hypochloremic alkalosis?
A) dehydration due to artificial nutrition
B) acute renal insufficiency
C) unrecognized diarrhea
D) nasogastric catheter
E) overnutrition

Back 16

INT-7.53.
D

Front 17

In gastric fluid loss, all of the following can occur, EXCEPT:
A) an increased urine pH
B) a decreased urine potassium level
C) an increased urine bicarbonate level
D) a decreased urine chloride level
E) increased renin secretion

Back 17

INT-7.55.
B

Front 18

Metabolic alkalosis occurs in all of the following, EXCEPT:
A) diabetes mellitus
B) pyloric stenosis
C) Bartter's syndrome
D) after administration of calcium carbonate
E) as a side-effect of ethacrynic acid therapy

Back 18

INT 7.56.
A

Front 19

Which of the following can occur if the pCO2
is 70 mmHg and the
bicarbonate level is 33 mmol/L?
A) chronic respiratory acidosis
B) acute respiratory acidosis
C) respiratory and metabolic acute acidosis
D) respiratory acidosis and metabolic alkalosis
E) none of the above

Back 19

INT-7.62.
A

Front 20

Which of the following statements about uric acid transport is FALSE?
A) uric acid is reabsorbed and secreted by the renal tubules
B) transport mainly occurs in the proximal part of the nephron
C) changes in glomerular filtration do not significantly regulate
the urate clearance
D) urate clearance increases with the increase of urine flow
E) urate is mainly transported by diffusion

Back 20

INT-7.70.
E

Front 21

Which of the following statements about glucose reabsorption is FALSE?
A) glucose is reabsorbed with limited active transport
B) the glucose carrier is unknown
C) the Tin glucose value is about 300 mg/min
D) phlorhizin decreases the glucose/insulin ratio
E) under normal conditions only trace amounts of glucose appear
in the urine

Back 21

INT-7.86.
D

Front 22

In diabetic ketoacidosis, the normalization of dehydration affects
glucosuria in the following way:
A) it increases glucosuria
B) it decreases glucosuria
C) the glucosuria remains unchanged
D) the glucosuria decreases if the blood glucose level decreases
E) the glucosuria disappears

Back 22

INT-7.87
A

Front 23

Which of the following physiological sequences indicates the effect of
a diuretic on the proximal tubule?
A) a significant phosphaturia
B) adecreased free water clearance
C) hyperkalemia
D) the fractional bicarbonate excretion is under 0.2
E) a metabolic alkalosis

Back 23

INT-7.89.
A

Front 24

Which of the following statements about the antihypertensive effect
of diuretics is FALSE?
A) a decreased plasma renin level
B) . a decreased cardiac output
C) decreased extracellular fluid
D) decreased peripheral resistance
E) a decreased sensitivity to vasoconstrictor agents

Back 24

INT-7.93.
A

Front 25

All of the following are side-effects of thiazide diuretics EXCEPT:
A) transient myopia
B) hearing loss
C) central visual disorders
D) agranulocytosis
E) thrombocytopenia

Back 25

INT-7.96
B

Front 26

Which of the following agents is not contraindicated in severe renal
insufficiency?
A) furosemide
B) spironolactone
C) triamterene
D) amiloride
E) potassium tablets (with a long-term effect)

Back 26

INT 7.103.
A

Front 27

Chronic thiazide therapy can cause all of the following symptoms,
EXCEPT:
A) an increased excretion of bicarbonate
B) a decreased excretion of calcium
C) a decreased excretion of uric acid
D) a decreased excretion of potassium
E) an increased excretion of chloride

Back 27

INT-7.106.
D

Front 28

The chronic administration of furosemide can cause all of the following
symptoms, EXCEPT:
A) hypokalemia
B) hypochloremia
C) hypomagnesiemia
D) hypocalcemia
E) hyperchloremia

Back 28

INT 7.110.
E

Front 29

Spironolactone-induced full-scale sodium excretion occurs:
A) within 10-30 min.
B) within 2-4 hours
C) within 12-20 hours
D) within several days
E) none of the above

Back 29

INT-7.114.
D

Front 30

Case Study:
A 25-year-old unconscious female patient was admitted to the hospital.
No friends or witnesses could give any further information on what
had happened Centrifugation of the urine obtained by catheter revealed
fat drops in the sample. Which of the following diagnoses is
possible?
A) eclampsia
B) bone fracture
C) CO intoxication
D) all of the above
E) none of the above

Back 30

INT-7.117.
D

Front 31

Case Study:
A 26-year-old female patient is admitted due to a suspected nephrotic
syndrome. The determination of the different molecular mass protein
clearance indicated an albumin predominance. High molecular-mass
globulins were not found in the urine. Select a possible diagnosis:
A) membranous glomerulopathy
B) proliferative glomerulonephritis
C) a "minimal change" process
D) membranoproliferative glomerulonephritis
E) focal glomerulonephritis

Back 31

INT-7.121.
C

Front 32

Case Study:
A 47-year-old diabetic patient developed oliguria after intravenous
urography. The urine osmolarity was 480 mOsm. The most probable
diagnosis is:
A) acute renal insufficiency
B) prerenal azotemia
C) papillary necrosis
D) diabetic nephropathy
E) obstructive uropathy

Back 32

INT-7.129.
A

Front 33

Case Study:
In a patient with severe hypertension a normal creatinine level and a
4 g/24h proteinuria were found. Urography revealed an enlarged (16
cm) right kidney and a smaller (7 cm) left kidney with a blurred border.
Results of arteriography suggest stenosis of the right renal artery.
Which of the following should be the next adequate study?
A) a bilateral retrograde urography
B) a right-sided percutaneous renal biopsy
C) left-sided percutaneous renal biopsy
D) a right-side biopsy with surgical approach
E) the determination of the renin concentration in the renal veins

Back 33

INT-7.136.
E

Front 34

Which of the following statements about hypertension is FALSE?
A) if the diastolic pressure is over 90 mmHg, life expectancy is
always reduced in all patients
B) the official WHO definition of normotension is: systolic pressure
140-160 mmHg; diastolic pressure 90-95 mmHg
C) the rate of pressure increase is higher in pre-existing hypertension
D) females tolerate hypertension better than males
E) 15-20% of the adult population in the USA is hypertensive

Back 34

INT-7.148
B

Front 35

Which of the following statements is true for a "borderline" hypertension?
A) the cardiac output is usually increased
B) the blood volume is usually increased
C) the peripheral vascular resistance is usually increased
D) there is an increased role of the alpha-adrenergic nervous system
E) these patients are usually resistant to beta-blockers

Back 35

INT-7.149
A

Front 36

Which of the following pressure ranges is considered "borderline hypertension"
in young patients?
A) 140/90-160/95 mmHg
B) 120/80-140/90 mmHg
C) 120/80-165/90 mmHg
D) 130/85-140/95 mmHg
E) 130/85-139/89 mmHg

Back 36

INT 7.151.
A

Front 37

The blood pressure can increase:
A) in obesity
B) after consumption of substantial amounts of alcohol
C) due to smoking
D) in gout
E) all of the above

Back 37

INT-7.152.
E

Front 38

All of the following hormones participate in the regulation of blood
pressure in humans, EXCEPT:
A) adrenaline
B) noradrenaline
C) renin
D) vasopressin
E) aldosterone

Back 38

INT-7.163
C

Front 39

Which of the following statements is true for angiotensin I?
A) it is the most potent vasoconstrictor known
B) it is activated by the liver converting enzymes
C) it consists of 10 aminoacids
D) it stimulates aldosterone release
E) it is formed from the "big renin"

Back 39

INT-7.168.
C

Front 40

Which of the following statements about angiotensinogen (renin
substrate) is FALSE?
A) it is mainly produced in the liver
B) its concentration is markedly increased after bilateral
adrenalectomy
C) its concentration remains unchanged after bilateral adrenalectomy
D) its concentration decreases in liver cirrhosis
E) estrogens increase its level

Back 40

INT-7.170.
B

Front 41

The aldosterone level is always increased in:
A) essential hypertension
B) malignant hypertension
C) pheochromocytoma
D) Liddle's syndrome
E) polycystic kidney disease

Back 41

INT-7.176.
B

Front 42

In which of the following diseases does the plasma renin level always
remain low?
A) essential hypertension
B) aortic coarctation
C) pheochromocytoma
D) Conn's syndrome
E) Cushing's syndrome

Back 42

INT-7.185.
D

Front 43

What is the most common cause of cerebral hemorrhage in hypertension?
A) atheroma
B) berry aneurysm
C) Charcot-Bouchard aneurysm
D) rupture of arteriosclerotic vessels
E) a thrombosis

Back 43

INT-7.187.
C

Front 44

Which of the following renal biopsy findings is the least probable in
a patient with severe hypertension, papilla edema, and uremia?
A) glomerular proliferation
B) focal necrotizing glomerulonephritis
C) marginal leukocytosis
D) arteriolar hyaline formation
E) fibrinoid deposits and polymorphonucleocytes in the arteriolar
wall

Back 44

INT-7.188.
C

Front 45

Case Study:
The blood pressure of a pregnant woman (24th week of gestation)
was 170/ 100 mmHg. Select a possible explanation:
A) borderline or mild hypertension
B) pseudohypertension of pregnancy
C) hyperkinetic syndrome
D) severe hypertension
E) sustained hypertension

Back 45

INT-7.192.
D

Front 46

Which drugs or drug combinations should be avoided in the therapy
of pheochromocytoma?
A) dibenzyline
B) beta-blockade followed by alpha blockade
C) alpha-blockade followed by beta blockade
D) prazosin
E) clonidine

Back 46

INT 7.193
B

Front 47

Which of the following studies will yield pathological values in
neurofibromatosis with hypertension?
A) the determination of the concentration of metanephrine in a
24-hour urine sample
B) the plasma renin activity
C) the serum cortisol level
D) the determination of the concentration of aldosterone in a 24-
hour urine sample
E) the fractional potassium excretion

Back 47

INT-7.194.
A

Front 48

In which of the following diseases, (which are accompanied with
orthostatic hypertension), does hyperglycemia, glucosuria,
hypermetabolism, and type-II multiple endocrine neoplasm occur?
A) Cushing's disease
B) essential hypertension
C) malignant hypertension
D) pheochromocytoma
E) cerebellar hemangioblastoma

Back 48

INT-7.195
D

Front 49

Single Choice Question Renal vein thrombosis can be a complication of all of the following
EXCEPT:
A) hypernephroma
B) congestive cardiac failure
C) in a patient in the terminal state of papillary necrosis
D) nephrosclerosis
E) nephrosis syndrome

Back 49

INT-7.204
D

Front 50

Primary renal impairment in disseminated intravascular thrombosis
is due to:
A) a hyaline thrombus
B) swelling of the endothelial cells
C) the formation of "half-moon" lesions
D) the rupture of basal membrane
E) the proliferation of mesangial cells

Back 50

INT 7.206.
B

Front 51

Which of the following changes is considered a late complication of
the hemolytic-uremic syndrome of infants?
A) anemia
B) thrombocytopenia
C) hypertension
D) intravascular coagulation
E) none of the above

Back 51

INT-7.207
C

Front 52

Which of the following substances does not occur in the urine in
Hartnup disease?
A) histidine
B) tryptophan
C) phenylalanine
D) methionine
E) arginine

Back 52

INT-7.215.
E

Front 53

Which of the following remarks about proximal tubular acidosis is FALSE?
A) a decreased proximal maximum bicarbonate reabsorption
B) an intact distal acidifying system
C) after administration of ammonium chloride the urine pH value
becomes less than 5.4
D) an increased bicarbonate excretion in the urine
E) an impaired distal acidifying system

Back 53

INT-7.216.
E

Front 54

Case Study:
A 55-year-old patient has a primary carcinoma of unknown origin.
Which of the following is totally resistant to therapy?
A) adenocarcinima of the prostate
B) adenocarcinoma of the lung
C) adenocarcinoma of the breast
D) germinal cell carcinoma
E) carcinoma of the thyroid gland

Back 54

INT-7.221
B

Front 55

Eosinophilia primarily occurs in:
A) enterobiasis
B) diarrhea due to Giardiasis (lambliasis)
C) Schistosomiasis
D) measles
E) corticosteroid therapy

Back 55

INT-7.222.
C

Front 56

All of the following can occur as a complication of chronic obstructive
pulmonary disease EXCEPT:
A) cor pulmonarye
B) polycythemia
C) respiratory insufficiency
D) left ventricular insufficiency
E) bronchogenic carcinoma

Back 56

INT-7.223.
D

Front 57

Chronic obstructive pulmonary disease (COPD) can be either
emphysematous or bronchitic, depending on the character of the pathological
alterations in the lung. Though they rarely occur as autonomous
forms, the two diseases can be differentiated on the basis of
their clinical manifestation. Select the most common feature characteristic
of emphysematous and bronchitic COPD:
A) polycythemia
B) bronchodilators can improve the airflow
C) dyspnea
D) a chronic cough
E) hypercapnia

Back 57

INT-7.224.
C

Front 58

Immune deficiency is diagnosed if:
A) the functional activity of the T lymphocytes cannot be identified
neither in vivo, nor in vitro
B) there is a decrease of antibody production
C) the T cells cannot change the yellow color of nitro-blue
tetrazolium into blue
D) neutrophil and macrophage migration is lower than the
chemotaxis stimulus
E) no hemolysis can occur if the serum of the patient is added to
an RBC-anti-RBC antibody system

Back 58

INT-7.226.
A

Front 59

Which of the following findings permits a differentiation between
painless thyroiditis and Graves disease?
A) an enlarged thyroid gland
B) a low serum TSH level
C) an increased serum thyroxine level
D) a low uptake of radioactive iodine
E) pressure tenderness and pain in the thyroid gland

Back 59

INT-7.231.
D

Front 60

Which of the following statements is the most typical feature of an
amebic liver abscess?
A) that surgical drainage is necessary
B) it can be caused by one of the six ameba types
C) in the USA it commonly occurs among homosexuals and hospital
patients
D) it usually indicates an intestinal amebic infection
E) it usually occurs in patients with normal serum alkalic
phosphatase levels but elevated transaminase levels

Back 60

INT-7.232.
C

Front 61

All of the following participate in the pathomechanism of an immediate
type hypersensitivity reaction EXCEPT:
A) serotonin
B) bradykinin
C) anaphylactic eosinophilic chemotactic factor
D) basophilic chemotactic factor
E) neutrophilic chemotactic factor

Back 61

INT-7.233.
D

Front 62

All of the following clinical alterations occur in patients with pulmonary
embolism EXCEPT:
A) hypoxia
B) insufficiency of the right heart
C) cyanosis
D) deep vein thrombosis
E) bradycardia

Back 62

INT-7.234
E

Front 63

Case Study:
A patient with chronic renal insufficiency due to severe chronic hypertension
is examined for chest pain. For the last 2 years the patient
has been undergoing hemodialysis twice a week. Hypotensive episodes
occurred several times during dialysis. The chest pain is localized above
the trapezius muscle; in an orthostatic position it decreases, and during
deep inspiration it increases. Select the most probable cause of
this chest pain:
A) pericarditis
B) coronary disease
C) diffuse esophageal spasm
D) pulmonary embolism
E) costochondritis

Back 63

INT-7.235.
A

Front 64

Which of the following cardiac surgical interventions causes jaundice?
A) pulmonary valve repair
B) aortic valve repair
C) mitral valve repair
D) tricuspid valve repair

Back 64

INT-7.243.
D

Front 65

All of the following can cause mechanical ileus EXCEPT:
A) cholera
B) hernia
C) carcinoma
D) volvulus
E) gallstones

Back 65

INT-7.245.
A

Front 66

All of the following can be caused by a gallstone EXCEPT:
A) biliary cirrhosis
B) acute pancreatic necrosis
C) atrophic cirrhosis
D) chronic cholecystitis

Back 66

INT-7.246.
C

Front 67

Select the correct localization of a concretion in case of hydrops
vesica felleae:
A) the hepatic duct
B) the cystic duct
C) the common bile duct
D) Vater's papilla
E) Wirsungian's duct

Back 67

INT-7.251.
B

Front 68

Combined tumors of the salivary gland:
A) usually have a submaxillary localization
B) are usually malignant
C) usually develop in the parotid gland
D) usually cause facial nerve paralysis
E) typically cause sialolithiasis

Back 68

INT-7.252.
C

Front 69

Select the correct term for transplantation of tissue-friendly foreign
materials:
A) replantation
B) alloplasty
C) homologous transplantation
D) autogenous transplantation
E) isologous transplantation

Back 69

INT-7.253.
B

Front 70

Select the single correct statement:
A) preblastomatosis is a pathological alteration preceding skin
cancer
B) preblastomatosis is a pathological alteration which leads to the
development of a tumour
C) preblastomatosis is a long-term pathological alteration which
does not lead to malignancy
D) preblastomatosis means pre-invasive cancer
E) hematologic myeloid tumors are defined as preblastomatosis

Back 70

INT-7.254.
B

Front 71

Pneumothorax can be caused by all of the following EXCEPT:
A) trauma
B) bullous emphysema
C) damage of the thoracic duct
D) intersitial emphysema
E) positive pressure artificial ventilation

Back 71

INT-7.255
C

Front 72

Case Study:
A round-shaped shadow of 3 cm in diameterwas found on an X-ray screening
of a 65-year-old, complaint-flee, smoking male patient. 15 years ago
the patient had undergone a successful operation for colon carcinoma.
Select the most probable diagnosis:
A) tuberculosis
B) carcinoma metastasis
C) aspiration pneumonia
D) bronchial carcinoma
E) pulmonary abscess

Back 72

INT 7.256.
D

Front 73

All of the following are typical of Graves' disease, EXCEPT:
A) obesity
B) goiter
C) left ventricular hypertrophy
D) exophthalmus

Back 73

INT-7.257.
A

Front 74

The most common cause of Addison's disease is:
A) autoimuune adrenal atrophy
B) amyloid accumulation in the adrenals
C) tumor metastasis in the adrenals
D) bilateral adrenal apoplexia
E) adrenal tuberculosis

Back 74

INT-7.258.
A

Front 75

Which of the following hormones is increased in Conn's syndrome?
A) cortisol
B) adrenaline
C) noradrenaline
D) aldosterone
E) cortisone

Back 75

INT-7.259.
D

Front 76

Case Study:
Marked hypertension and its sequels, as well as polyuria and pplydipsia
were found in a middle-aged patient. serum Na: 152 mmol/L; serum
K: 2,2mmo1/L. Select the correct diagnosis:
A) Cushing's syndrome
B) diabetes mellitus
C) Addison's disease
D) Conn's syndrome
E) phaeochromocytoma

Back 76

INT-7.260.
D

Front 77

Xanthoma is common in:
A) diabetes insipidus
B) acute hemorrhagic pancreatitis
C) diabetes mellitus
D) diffuse acute glomerulonephritis
E) liver cirrhosis (Laennec's)

Back 77

INT-7.261.
C

Front 78

Case Study:
A patient's auricular cartillage has a brownish color, the urine sample
turns brown after a while, and the patient complains of
arthralgia. Select a correct diagnosis:
A) erythropoietic porphyria
B) gout
C) ochronosis
D) cystinosis
E) hemoglobinuria

Back 78

INT-7.262.
C

Front 79

Which of the following statements is not typical of post-hepatic jaundice?
A) acholic stool
B) direct positive diazo-reaction
C) cholemia
D) increased bilirubin in the urine
E) increased urobilinogen in the urine

Back 79

INT 7.263
E

Front 80

In all of the following melanine is accumulated in the skin, EXCEPT:
A) Mongolian spot
B) vitiligo
C) nevus coeruleus (blue nevus)
D) ephelis (freckle)
E) chloasma (melasma)

Back 80

INT-7.264.
B

Front 81

Define the term vitiligo:
A) a generalized lack of melanin in the skin
B) a circumscribed lack of melanin in the skin
C) lipopigment
D) reaction in the peritraumatic areas
E) a degeneration of trophoblasts

Back 81

INT-7.265.
B

Front 82

Which of the following can occur in chronic systemic congestion?
A) thickening of the alveolar walls
B) esophagus varicosity
C) pulmonary edema
D) spot-like hemorrhages of the gastric mucosa
E) kidney micro-infarctions

Back 82

INT-7.270.
D

Front 83

In which of the following should generalized mycosis be suspected?
?r) hypertensive disease
B) cardiac decompensation
C) gastric ulcer
D) long-term antibiotic therapy
E) diabetes insipidus

Back 83

INT-7.277.
D

Front 84

In which of the following vascular beds does Buerger's disease commonly
occur?
A) basilar artery
B) arteries of the limbs
C) coronary artery
D) renal artery
E) branches of the mesenteric artery

Back 84

INT-7.279
B

Front 85

Hematuria is typical of all of the following diseases, EXCEPT:
A) acute glomerulonephritis
B)acute pyelonephritis
C) renal tuberculosis
D) renal calculus
E) renal cancer

Back 85

INT-7.281.
B

Front 86

The most pronounced enlargement of the lymph nodes occurs in one
of the following types of leukemia:
A) acute lymphoid leukemia
B) chronic myeloid leukemia
C) chronic lymphoid leukemia
D) acute myeloid leukemia
E) erythroleukemia

Back 86

INT-7.290.
B

Front 87

Which of the following red blood cells alterations is typical of irondeficient
anemia?
A) poikilocytosis
B) anisocytosis
C) hypochromia
D) fragility
E) polychromasia

Back 87

INT-7.291.
C

Front 88

Which of the following is typical of Hodgkin's disease stage II?
A) the involvement of lymph nodes of a single region and the spleen
B) the involvement lymph nodes of a single region on both sides
of the diaphragm
C) the involvement of lymph nodes of several regions on both
sides of the diaphragm
D) the involvement of lymph nodes of several regions on both
sides of the diaphragm, and alterations in the spleen
E) the involvement of lymph nodes of several regions on one side
of the diaphragm

Back 88

INT-7.294.
E

Front 89

Pulmonary emboli originate from:
A) the femoral artery
B) the femoral vein.
C) one of the pulmonary veins
D) the brachiocephalic trunk
E) none of the above

Back 89

INT-7.297
B

Front 90

All of the following occur in Goodpasture's syndrome, EXCEPT:
A) focal glomerulonephritis
B) septic spleen
C) pulmonary fibrosis; induration
D) cutaneous purpura
E) positive berlin-blue staining in the lung parenchyma

Back 90

INT-7.302.
B

Front 91

In which of the following parts of the gastrointestinal tract does
diverticulosis primarily develop?
A) in the esophagus
B) in the duodenum
C) in the jejunum and ileum
D) in the ascending colon
E) in the sigmoid colon

Back 91

INT-7.304.
E

Front 92

Define Crohn's disease:
A) regional enteritis
B) tabes mesaraica (tuberculosis of the mesenteric glands)
C) stercoral abscess
D) intestinal cystoid pneumatosis
E) necrotizing enteritis

Back 92

INT 7.306.
A

Front 93

Select the correct name for a gastroduodenal ulcer developing together
with a gastrin-secreting pancreatic tumor:
A) Zollinger-Ellison's syndrome
B) Mallory-Weiss's syndrome
C) Waterhouse-Fridrichsen's syndrome
D) Stein-Leventhal's syndrome
E) Sheehan's syndrome

Back 93

INT-7.307.
A

Front 94

Which of the following substances causes coagulation necrosis of
the gastric mucosa?
A) sodium hydroxide (NaOH)
B) phosphorus
C) lead
D) mercury
E) arsenic

Back 94

INT-7.308.
D

Front 95

Case Study:
A patient complains of frequent blushing fits. Asthmatic fits and
profuse diarrhea are also frequent. A physical examination revealed
a harsh murmur above the heart. Select the correct diagnosis:
A) Basedow's disease
B) Carcinoid syndrome
C) Tetralogy of Fallot
D) Polycythemia rubra vera
E) Peutz-Jeghers syndrome

Back 95

INT-7.309.
B

Front 96

The Zollinger-Ellison syndrome is caused by:
A) an adenoma of the pancreatic beta cells
B) an adenoma of the pancreatic alpha cells
C) an adenoma of the pancreatic gamma cells
D) a carcinoma of the exocrine pancreas
E) mucoviscidosis

Back 96

INT-7.310.
C

Front 97

A dilated, rigid, painless gallbladder (Courvoisier's s sign) and jaundice
is typical of one of the following:
A) infectious hepatitis
B) hepatocellular carcinoma
C) cancer of the pancreas head
D) cancer of the pancreas tail
E) calculus in the Wirsungian's duct

Back 97

INT-7.311.
C

Front 98

Which of the following cells primarily infiltrate the portal tract in
acute viral hepatitis?
A) neutrophils
B) eosinophils
C) lymphocytes
D) plasma cells
E) giant cells

Back 98

INT-7.312.
C

Front 99

Coagulopathy developing in obstructive jaundice is due to:
A) secondary thrombocytopenia
B) thrombocytopenia due to decreased vitamin K absorption
C) increased capillary fragility
D) thrombasthenia
E) a low activity of tissue thromboplastin

Back 99

INT-7.313.
B

Front 100

Which of the following can cause priapism?
A) syphilis
B) urethritis
C) induratio penis plastica (penal prosthesis)
D) increased libido
E) epispadiasis

Back 100

INT-7.314.
B

Front 101

Define the term priapism:
A) an extrapyramidal disorder
B) a mental disease
C) pathological erection
D) penis inflammation
E) penis gangrene

Back 101

INT-7.315.
C

Front 102

The most important etiological factor of epididymitis is:
A) syphilis
B) gonorrhea
C) brucellosis
D) blastomycosis
E) listeriosis

Back 102

INT-7.316.
B

Front 103

Asbestos causes cancer in which of the following organs?
A) the kidneys
B) the pleura
C) the brain
D) the adrenals

Back 103

INT-7.319.
B

Front 104

All of the following comprise different histologic forms of Lupus nephritis,
EXCEPT:
A) focal glomerulonephritis
B) membranous glomerulonephritis
C) membranoproliferative glomerulonephritis
D) microscopic polyarteritis
E) mesangioproliferative nephritis

Back 104

INT-7.326.
D

Front 105

All of the following are criteria and symptoms of Mixed Connective
Tissue Disease (MCTD), EXCEPT:
A) Raynaud's symptom
B) swollen hands and fingers
C) myositis
D) esophageal dysmotility
E) xerostomia

Back 105

INT-7.327.
E

Front 106

All of the following polysystemic autoimmune diseases contribute to the
development of Mixed Connective Tissue Disease (MCTD), EXCEPT
A) systemic lupus erythematosus (SLE)
B) rheumatoid arthritis
C) progressive systemic sclerosis (scleroderma)
D) Sjörgen's syndrome
E) polymyositis/dermatomyositis

Back 106

INT-7.328.
D

Front 107

All of the following are among the glandular symptoms of Sjörgen's
syndrome, EXCEPT:
A) pharyngitis - bronchitis
B) vulvitis
C) vaginitis
D) pyelitis
E) conjunctivitis

Back 107

INT-7.329.
D

Front 108

All of the following are atopic diseases, EXCEPT:
A) allergic rhinitis
B) allergic bronchial asthma
C) gastrointestinal allergy
D) allergic conjunctivitis
E) hypertensive pneumonitis

Back 108

INT-7.337.
E

Front 109

All of the following occur in progressive systemic sclerosis
(scleroderma), EXCEPT:
A) pulmonary fibrosis
B) the incidence of antinuclear autoantibodies in the serum is
about 90%
C) chronic active hepatitis
D) dysmotility of the lower esophageal segment
E) Raynaud's syndrome

Back 109

INT-7.344.
C

Front 110

All of the following diseases can occur in the neonatal period,
EXCEPT:
A) thrombopenia (ITP)
B) myasthenia gravis
C) Basedow's disease
D) pernicious anemia
E) systemic lupus erythematosus (SLE)

Back 110

INT-7.346
D

Front 111

The first heart sound is loud in:
A) first degree AV block
B) the Wolff-Parkinson-White (WPW) syndrome
C) mitral stenosis due to calcification
D) aortic stenosis
E) hypertrophic obstructive cardiomyopathy

Back 111

INT-7.350.
B

Front 112

Which of the following ECG changes are typical of Printzmetal's angina
during a fit?
A) ST depression in a localized area
B) ST elevation in a localized area
C) diffuse ST depression
D) diffuse ST elevation
E) none of the above

Back 112

INT-7.352.
B

Front 113

Select the most important effect of a normal dose of nitroglycerin in
angina pectoris (apart from coronary dilation!):
A) relaxation of bronchial smooth muscles
B) dilation of the peripheral vessels
C) constriction of the peripheral arterioles
D) constriction of the peripheral venules
E) none of the above

Back 113

INT-7.353.
B

Front 114

Select the drug of primary choice in supraventricular tachycardia
with narrow ventricular QRS complexes:
A) digoxin
B) procainamide
C) dopamine
D) verapamil
E) propranolol

Back 114

INT-7.354.
D

Front 115

The typical symptom of ischemic colitis in its acute phase is:
A) steatorrhea
B) a normal X-ray picture after a barium meal
C) nausea and vomiting
D) symptoms of generalized peritonitis
E) hemorrhagic diarrhea

Back 115

INT-7.356.
E

Front 116

Which of the following statements is typical of chronic
granulomatosis?
A) neutrophils cannot phagocyte the bacteria
B) chronically enlarged lymph nodes
C) recurrent candidiasis
D) a dominant inheritance pattern
E) hypogammaglobulinemia

Back 116

INT-7.357.
B

Front 117

All of the following can increase the normal insulin requirement, EXCEPT:
A) pregnancy
B) infections, fever, sepsis
C) idiopathic spontaneous exacerbations
D) hypothyroidosis
E) burns due to irradiation and ultraviolet damage of the deep
tissues

Back 117

INT-7.358.
D

Front 118

All of the following can induce systemic lupus erythematosus (SLE),
EXCEPT:
A) chlorpromazine
B) phenytoin
C) aspirin
D) procainamide

Back 118

INT-7.359.
C

Front 119

Which of the following antibiotics can form unsoluble chelates with
the aluminium of antacids, which would then impair their absorption?
A) penicillins
B) tetracyclines
C) erythromycin
D) sulfonamides
E) none of the above

Back 119

INT-7.361
B

Front 120

Case Study:
Select the drug of choice in .a 2-year-old girl with fever and
polyarthritis (diagnosis: juvenile rheumathoid arthritis):
A) cytozan
B) prednisolone
C) aspirin
D) chloroquine
E) penicillinamine

Back 120

INT-7.363.
C

Front 121

Which of the following facilitates the antiocoagulant effect of
coumarin?
A) phenylbutazone
B) multivitamins containing vitamin K
C) high-dose salicylate
D) quinine and quinidin

Back 121

INT-7.364
B

Front 122

All of the following increase the blood glucose level, EXCEPT:
A) corticosteroids
B) clofibrate
C) diazoxide
D) lithium carbonate

Back 122

INT 7.365.
B

Front 123

Where does hypernephroma develop?
A) in the glomerular epithelial cells
B) in the tubular epithelial cells
C) in the epithelial cells of the calyx
D) in the glomerular endothelial cells
E) in the juxtaglomerular apparatus

Back 123

INT-7.370.
B

Front 124

Which of the following diseases does not usually lead to the development
of the nephrotic syndrome?
A) glomerulonephritis
B) polycystic kidney
C) renal vein thrombosis
D) - lupus nephritis
E) Kimmensteil-Wilson syndrome

Back 124

INT-7.376.
B

Front 125

In which of the following diseases does pulmonary hemorrhage occur?
A) systemic lupus erythematosus (SLE)
B) Henoch-Sch6nlein purpura
C) hypersensitive vasculitis
D) Legionnaires' disease
E) all of the above
F) none of the above

Back 125

INT-7.385.
E

Front 126

Case history:
A 45-year-old male patient suffers for years from rheumatoid arthritis.
Nephrotic edema has recently developed. Urine analysis revealed red
blood cells present in the urine; a 2-hour postprandial serum glucose
was 11 mmol/L. After a 6-week steroid therapy, the proteinuria remained
unchanged. Which of the following diseases is the least probable?
A) amyloidosis
B) chronic membranous nephropathy
C) normal glomeruli as evident by a light microscopic study
D) renal vein thrombosis
E) nodular glomerulonephritis

Back 126

INT-7.387
C

Front 127

Which of the following statements about urinary tract infections in
female patients is FALSE?
A) the occurrence of bacteriuria increases with age
B) a shorter urethra better protects against infections
C) urethral discharge increases the occurrence of bacteriuria
D) a sedentary life-style promotes infection
E) the growing occurrence of bacteriuria with age has no relation
to sexual activity

Back 127

INT-7.389.
B

Front 128

Which of the following statements about catheter-induced urinary
tract infections is FALSE?
A) it is the most common nosocomial infection
B) a bladder lavage has a beneficial effect
C) in candida infections systemic amphotericin-B therapy is always
recommended
D) infection induced by short-term catheterization does not require
therapy
E) in candida infections oral therapy with 5-flucytozin is effective

Back 128

INT-7.390.
C

Front 129

Which of the following findings indicates analgetic-induced nephropathy?
A) red blood cells-casts
B) oval adipose bodies
C) sterile pyuria
D) phenacetine crystals
E) pigmented hyaline casts

Back 129

INT-7.391.
C

Front 130

Which of the following drugs does not cause renal disease?
A) penicillin
B) gentamycin
C) erythromycin
D) sulfonamides
E) cephalosporins

Back 130

INT-7.392.
C

Front 131

Plasma or tissue erythropoietin-like substances are accumulated in
all of the following diseases, EXCEPT:
A) hypernephroma
B) cerebellar hemangioma
C) hepatoma
D) solitary renal cyst
E) gastric carcinoma

Back 131

INT-7.393.
E

Front 132

Case Study:
A 50-year-old agricultural worker was admitted with nausea, vomiting with
a peculiar aftertaste of metal, and diarrhea. He had been working with
insecticides and disinfectants. The serum urea nitrogen value was 25 mmol/L.
The urine volume excreted in 24 h. was 300 ml. Proteinuria, red blood
cellsand epithelial cell casts were observed. Select the correct therapy:
A) monitoring of fluid and electrolyte balance with fluid and electrolyte
replacement therapy if needed
B) high dose steroid therapy
C) a dimercaptol (BAL) injection (3 mg/kg/24 h.)
D) gastric lavage
E) dimercaptol (BAL) injection 3 mg/kg followed by hemodyalisis

Back 132

INT-7.394.
E

Front 133

Case Study:
A 30-year-old male patient suffers from recurrent renal calculi. An
abdominal X-ray study revealed bilateral nephrocalcinosis. Which of
the following is the least probable?
A) hyperparathyroidism
B) sarcoidosis
C) primary hyperoxaluria (oxalosis)
D) renal tubular acidosis
E) cystinuria

Back 133

INT-7.401.
E

Front 134

Which of the following renal calculi are the most common?
A) urate
B) calcium-phosphate
C) mixed calcium-oxalate and calcium-phosphate
D) magnesium ammonium phosphate
E) calcium oxalate

Back 134

INT-7.402.
C

Front 135

Which of the following diseases commonly occurs in pregnant
women with renal calculi?
A) pre-eclampsia
B) urinary tract infections
C) spontaneous abortions
D) congenital anomalies
E) renal insufficiency

Back 135

INT-7.403.
B

Front 136

Which of the following drugs causes neuropathy in uremic patients?
A) vibramycin
B) chloramphenicol
C) trimethoprim
D) nitrofurantoin
E) cephalosporins

Back 136

INT-7.405.
B

Front 137

Which of the following gastrointestinal symptoms of renal insufficiency
is not improved by hemodialysis?
A) uremic gastritis
B) uremic fetor
C) peptic ulcer
D) uremic colitis
E) nausea and vomitus

Back 137

INT-7.407.
C

Front 138

Which of the following drugs should be markedly decreased in
uremia?
A) gentamycin
B) lincomycin
C) nafcillin
D) oxacillin
E) novobiocin

Back 138

INT-7.409.
A

Front 139

All of the following occur in pregnancy, EXCEPT:
A) an increased body water content
B) a decreased blood volume
C) an increased cardiac output
D) an increased renal blood flow
E) an increased GFR

Back 139

INT-7.410.
B

Front 140

In pregnancy, limb edema is due to one of the following:
A) salt retention
B) hypoalbuminemia
C) an increased capillary permeability
D) an increased venous pressure
E) an increased blood pressure

Back 140

INT-7.411.
D

Front 141

Which of the following usually causes symptom-free bacteriuria during
pregnancy?
A) anemia
B) a premature delivery
C) a congenital anomaly
D) pyelonephritis
E) toxemia

Back 141

INT-7.412.
D

Front 142

Which of the following causes cessation of toxemia after delivery?
A) delivery of the placenta
B) delivery of the fetus
C) uterus decompression
D) urether decompression
E) the loss of amniotic fluid

Back 142

INT-7.415.
A

Front 143

Which of the following intra-abdominal organs does not move with
respiration?
A) the kidney
B) the pancreas
C) the spleen
D) the transverse colon
E) the stomach

Back 143

INT-7.419.
B

Front 144

Which of the following substances is the most potent stimulant of
gastric acid secretion?
A) proteins
B) fats
C) carbohydrates

Back 144

INT-7.422.
A

Front 145

A 5-fold elevation of serum amylase level strongly suggests:
A) parotitis
B) pancreatitis
C) intestinal obstruction
D) pancreatic carcinoma
E) penetrating ulcer

Back 145

INT-7.423.
B

Front 146

A characteristic symptom of pyloric obstruction is:
A) bile vomiting
B) abdominal murmurs
C) resonance above Traube's space
D) succussion (splashing sound)
E) visible peristalsis

Back 146

INT-7.424.
D

Front 147

In which of the following diseases does a massive gastrointestinal
hemorrhage rarely occur?
A) esophageal varicosity
B) reflux esophagitis
C) gastric ulcer
D) erosive gastritis

Back 147

INT-7.426
B

Front 148

The diagnosis of malaria is based on:
A) a stained blood smear for the identification of the pathogenic
agent
B) a hemoculture
C) identification of the pathogenic agent on the skin
D) a fluorescent antibody study

Back 148

INT-7.432.
A

Front 149

Liver transplantation is a new method for the therapy of fatal liver
diseases. Which of the following markedly improves the post-transplantation
survival rate?
A) a better selection of patients
B) the early recognition of malignant diseases
C) a better understanding of the pathomechanism of liver insufficiency
D) cyclosporine A

Back 149

INT-7.435.
D

Front 150

Which part of the colon is the largest feces reservoir?
A) the cecum
B) the transverse colon
C) the descending colon
D) the sigmoid colon
E) the rectum

Back 150

INT-7.436.
D

Front 151

The defecation stimulus is triggered by:
A) contraction of the external anal sphincter
B) contraction of the internal anal sphincter
C) distension of the sigmoid colon
D) distension of the rectum
E) contraction of the rectum

Back 151

INT-7.437.
D

Front 152

The anatomic anomaly which causes congenital megacolon
(Hirschsprung's disease) is:
A) hypertrophy of the descending colon
B) lack of colon peristalsis
C) absence of the autonomic plexuses in the colon
D) rectal atresia
E) lack of the internal rectal sphincter

Back 152

INT-7.438
C

Front 153

How often (% incidence) does ulcerative colitis affect the
rectosigmoidal mucosa?
A) 10-20%
B) 25-30%
C) 50-70%
D) 70-85%
E) 85-100%

Back 153

INT-7.440.
E

Front 154

The most common site of diverticulosis in the colon is:
A) the rectum
B) the sigmoid colon
C) the descending colon
D) the transverse colon
E) the cecum

Back 154

INT-7.442.
B

Front 155

The most common cause of chronic relapsing pancreatitis is:
A) gallstones
B) alcohol consumption
C) Whipple's disease
D) trauma
E) infection

Back 155

INT-7.445.
B

Front 156

Which of the following proteins is not produced by the liver?
A) albumin
B) alphal-globulin
C) alpha 2-globulin
D) beta-globulin
E) gamma-globulin

Back 156

INT-7.451.
E

Front 157

If a patient with classic reflux esophagitis shows no reaction to
cimetidine or a therapeutic elevation of his bed then therapy must
be supplemented with metoclopramide because:
A) it stimulates gastric evacuation, which is impaired in 50% of
these patients
B) it increases the lower esophageal sphincter tone
C) it improves the acid clearance
D) it improves gastritis which occurs in 75% of these patients
E) all of the above

Back 157

INT-7.452.
E

Front 158

The enzyme metabolizing alcohol is:
A) alcohol reductase
B) alcohol oxidase
C) alcohol dehydrogenase
D) alcohol synthetase
E) glucose- 6-phosphatase

Back 158

INT-7.453.
C

Front 159

The most common endocrinopathy occurring in the Zollinger-
Ellison Syndrome is:
A) pheochromocytoma
B) hyperthyroidism
C) hypopparathyroidism
D) hypoparathyroidism
E) Cushing's syndrome

Back 159

INT-7.454.
C

Front 160

How does the vagal tone affect the basal gastrin level?
A) it elevates the gastrin level
B) it lowers the gastrin level
C) it has no effect on the gastrin level

Back 160

INT-7.455.
A

Front 161

Which of the following statements supports the diagnosis of
hemolytic jaundice?
A) an elevated non-conjugated bilirubin level in the plasma
B) the presence of bilirubin in the urine
C) an elevated reticulocyte count
D) both (A) and (C) are true
E) none of the above

Back 161

INT-7.461.
D

Front 162

Case Study:
In a patient with primary biliary cirrhosis, polyclonal gammopathy
was established by protein-electrpphoresis. The immunoglobulin
found is predominantly:
A) IgA
B) IgM
C) IgG
D) IgD
E) IgE

Back 162

INT-7.462.
B

Front 163

Which of the following agents inhibits vitamin B12 absorption?
A) phenytoin
B) methotrexate
C) cycloserine
D) trimethoprim
E) all of the above.,

Back 163

INT-7.464
E

Front 164

A manifestation of Crohn s disease can occur in:
A) the oral cavity
B) the esophagus
C) the stomach
D) the ileum
E) all of the above

Back 164

INT-7.465.
E

Front 165

Which of the following endocrine alterations can be accompanied by
an exudative ascites?
A) hyperparathyroidism
B) hyperthyroidism
C) hypothyroidism
D) Addison's disease
E) acromegaly

Back 165

INT-7.467.
C

Front 166

Case Study:
2 weeks after a coronary bypass operation the patient's SGOT/SGPT
was 30/350 with a normal liver function. 3 months later the patient
complained of fatigue and weakness, his SGPT level increased over
300. Which of the following is the most probable diagnosis?
A) delta-hepatitis
B) B-type hepatits
C) non-A non-B hepatitis
D) CMV hepatitis
E) activation of a chronic hepatitis

Back 166

INT-7.471.
C

Front 167

Which of the following alterations is not characteristic of immunodeficient
diseases (AIDS)?
A) lymphoid depletion in the cortical and paracortical areas of
lymph nodes
B) viral inclusions in the histiocytes of lymph nodes
C) gammaglobulinemia
D) an inverted ratio of T-helper/T-inductor cells
E) common pneumocystis carni infections

Back 167

INT-7.477.
C

Front 168

Case Study:
Which of the following is the most probable diagnosis in a 24-year-old
male patient suffering from arthritis, conjunctivitis and urethritis?
A) rheumatoid arthritis
B) Reiter's syndrome
C) pseudo-gout
D) gonorrhea
E) ankylosing spondylitis

Back 168

INT-7.491.
B

Front 169

Which of the following is a dead vaccine?
A) pertussis immunization
B) BCG immunization
C) measles immunization
D) rubella immunization
E) yellow fever immunization

Back 169

INT-7.496.
A

Front 170

Case Study:
A 30-year-old patient with chronic active hepatitis (type B) converted
from hepatitis E-antigen+ to hepatitis E antibody+. His
transaminase values became normal and a liver biopsy showed inactive
postnecrotic cirrhosis. What should be done next?
A) comfort the patient; inform him that he is in complete remission
B) inform the patient that no relationship exists between the E
antibodies and the transaminase values
C) observe the patient, since spontaneous seroconversion to Eantigen
would reactivate the disease
D) none of the above

Back 170

INT-7.501.
C

Front 171

The adequate therapy of anemia developing in the cecal loop syndrome
is:
A) surgery
B) folic acid supplementation
C) vitamin B12 supplementation
D) wide-spectrum antibiotics
E) iron supplementation

Back 171

INT-7.505.
D

Front 172

Which of the following diseases has the same sigmoidoscopic findings
as those in shigellosis?
A) amebiasis
B) salmonellosis
C) granulomatous colitis
D) idiopathic ulcerative colitis
E) diverticulitis

Back 172

INT-7.509.
D

Front 173

Case Study:
A 24-year-old female patient has a 2-year history of mild non-erosive
arthritis. The patient also suffers from severe depression, which developed
when she had started taking oral contraceptive pills. The patient
is penicillin-sensitive. At examination a pericardial friction sound and
proteinuria (over 3.5g) were found. Select the most probable diagnosis:
A) rheumatoid arthritis
B) rheumatic fever
C) mixed connective tissue disease
D) systemic lupus erythematosus (SLE)
E) polyarteritis nodosa

Back 173

INT-7.512.
D

Front 174

Which of the following mitral prolapse-induced arrhythmias (usually occurring
at night during increased vagal tone) is the most dangerous?
A) ventricular extra-systole
B) non-sustained ventricular tachycardia
C) sustained ventricular tachycardia
D) torsade de points
E) atrial tachycardia

Back 174

INT-7.520.
D

Front 175

Which of the following statements concerning Goodpasture's syndrome
is FALSE?
A) a synonym for glomerulonephritis caused by antiglomerular
basement membrane antibodies
B) pulmonary hemorrhage always disappears after a bilateral
nephrectomy
C) antiglomerular basement membrane antibodies show crossreactivity
with alveolar membrane
D) pulmonary hemorrhage is sometimes not recognized
E) agressive plasma replacement therapy can stop the pathological
process in the lung

Back 175

INT-7.527.
B

Front 176

Which type of renal calculi is the most common?
A) apatite concrement
B) magnesium-ammonium-phosphate concrement
C) urate concrement
D) cystine concrement
E) calcium oxalate with or without calcium phosphate

Back 176

INT-7.532.
E

Front 177

70-80% of a renal calculus is comprised of:
A) calcium
B) phosphate
C) uric acid
D) oxalic acid
E) ammonium

Back 177

INT-7.533.
A

Front 178

Cardiovascular complications comprise about 10% of the annual
mortality of dialysed patients. Which of the following is another substantial
mortality factor in this group of patients?
A) sepsis
B) neuropathy
C) cerebral complications
D) metabolic disorders
E) anemia

Back 178

INT-7.537.
C

Front 179

If a patient with ulcerative colitis develops thromboembolic complications,
which of the following statements concerning such related
coagulation disorders is true?
A) an increased platelet count is a causative factor
B) an elevated fibrinogen level is a causative factor
C) a decreased factor V is a causative factor
D) an elevated factor VII is a causative factor

Back 179

INT-7.538.
C

Front 180

Lyme disease is caused by:
A) Streptobacillus moniformis
B) Borrelia recurrentis
C) Borrelia burgdorferi
D) Bartonelle baciliformis
E) none of the above

Back 180

INT-7.539.
C

Front 181

Case Study:
A 22-year-old male patient has a painless swollen ankle. Swelling developed
during a 2 month period. The patient also reported a 9 year
history of bilateral pleural pain, and recurrent, 3-9 day-periods of a
swollen painful right knee and fever. Select the cause of the edema:
A) amyloidosis
B) phlebitis
C) cor pulmonale
D) rheumatic cardiac disease
E) chronic glomerulonephritis

Back 181

INT-7.541.
A

Front 182

Cerebral metastatic carcinomas usually originate from the:
A) prostate gland
B) esophagus
C) bones
D) lungs
E) salivatory glands

Back 182

INT-7.542.
D

Front 183

Case Study:
In a 23-year-old patient with idiopathic ulcerative colitis (in remission
due to drug therapy) re-activation of the disease occurred. The patient
had hemorrhagic diarrhea with straining. Sigmoidscopy revealed ulceration
at 40 cm. Which examination should be performed next?
A) cglonoscopy
B) air-contrast barium enema
C) feces examination for enteric pathogens
D) eosinophilic feces examination

Back 183

INT-7.544.
C

Front 184

Hemochromatosis:
A) is more common in women than in men
B) is rare before middle age
C) results from an autosomal recessive trait
D) hepatomas occur with increased frequency in patients with
longstanding hemochromatosis
E) none of the above

Back 184

INT-7.549.
BCD

Front 185

The fourth heart sound:
A) can be physiological if it occurs in young individuals under 30-
years-old
B) starts simultaneously with the "a" wave of the jugular vein
pulse curve
C) occurs on the sudden opening of the mitral valve
D) is related to ventricular distensibility
E) is a sign of systemic hypertension

Back 185

INT-7.559.
BDE

Front 186

A protruding pulmonary artery on the chest X-ray indicates:
A) a ventricular septal defect
B) valvular pulmonary stenosis
C) Tetralogy of Fallot
D) severe mitral stenosis
E) a massive pulmonary embolism

Back 186

INT-7.561.
ABDE

Front 187

Under normal conditions, the stroke volume increases:
A) during increased sympathetic activity
B) during increased parasympathetic activity
C) in an increased ventricular end-diastolic volume
D) in changing from the recumbent position to the upright position
E) in high ambient temperatures

Back 187

INT-7.562.
ACE

Front 188

Which of the following is characteristic of mitral stenosis?
A) an "opening snap"
B) a shifted apical beat
C) it is a complication of infective endocarditis
D) it is more common in women
E) a history of rheumatic fever is frequently found in this disorder

Back 188

INT-7.565.
ADE

Front 189

Typical features of severe aortic stenosis include:
A) syncope induced by physical load
B) a louder second sound over the aorta
C) a blood pressure of 180/120 mmHg
D) left ventricular hypertrophy on the ECG/Echocardiography
E) the systolic gradient between the left ventricle and the aorta
exceeds 60 mmHg

Back 189

INT-7.567.
ADE

Front 190

Which of the following ECG changes develop in the early stage of an
acute transmural myocardial infarction?
A) a dome-like ST-elevation
B) a pathological Q wave
C) negative T waves
D) ST depression in the infarcted area
E) none of the above

Back 190

INT-7.574.
AB

Front 191

Drugs inducing goiter include:
A) aminosalicylic acid
B) digoxin
C) lithium
D) propylthiouracil
E) streptomycin

Back 191

INT-7.577.
ACD

Front 192

Which of the following statements are characteristic of
pheochromocytoma?
A) the intravenous administration of beta-mimetic agents is necessary
in an acute hypertensive crisis
B) remote metastases have already developed by the time of diagnosis
C) the diagnosis is usually based on paroxysmal hypertensive fits
D) an excessive renal excretion of 5-hydroxy-indolacetic acid
E) the maximum incidence is between the third and fifth decades

Back 192

INT-7.585.
CE

Front 193

Which of the following is observed in severe pyloric stenosis?
A) hypokalemia
B) an elevated urea concentration
C) a low urine pH value
D) hypochloremia
E) tetany

Back 193

INT-7.591.
ABCDE

Front 194

Characteristic findings in polycythemia vera rubra include:
A) a decreased plasma volume
B) a tendency to hemorrhage easily
C) an increased RBC sedimentation rate
D) itching and pruritis
E) an increased neutrophilic activity of alkaline phosphatase

Back 194

INT-7.600.
BDE

Front 195

Which of the following drugs can cause skin pigmentation as a
side-effect?
A) chlorpromazine
B) phenylbutazone
C) chlorochine
D) streptomycin
E) busulfan

Back 195

INT-7.606.
ACE

Front 196

Which of the following drugs can cause pulmonary fibrosis?
A) amiodarone
B) bleomycin
C) colchicine
D) phenytoin
E) nitrofurantoin

Back 196

INT-7.607.
ABE

Front 197

Which of the following drugs can decrease the efficiency of oral contraceptives?
A) rifampin
B) coumarin derivatives
C) phenytoin
D) furosemide
E) hydralazine

Back 197

INT-7.608.
AC

Front 198

Which of the following drugs can cause hirsutism?
A) spironolactone
B) phenytoin
C) minoxidil
D) digoxin
E) clomiphene

Back 198

INT-7.613.
BC

Front 199

Which pattern of regional enteritis (Crohn's disease) is most often
recognized?
A)obstruction
B) diffuse jejunoileitis
C) abscess formation
D) inflammation
E) fistulas

Back 199

INT-7.623
ABCDE

Front 200

Mechanical intestinal obstruction is assumed if the physical examination
reveals:
A) visible peristalsis
B) a lack of intestinal sounds
C) a "tympanitic" abdomen
D) loud peristaltic sounds
E) decreased liver dullness

Back 200

INT-7.624.
ACD

Front 201

Which of the following methods are used in the differential diagnosis
of congenital megacolon?
A) sigmoidoscopy
B) study of the distal rectum
C) rectum biopsy
D) barium enema
E) stool cultivation

Back 201

INT-7.627.
CD

Front 202

A lesion of which of the following parts of the gastrointestinal tract
can cause tarry stool?
A) the esophagus
B) the stomach
C) the jejunum
D) the cecum
E) the sigmoid colon

Back 202

INT-7.629.
ABCD

Front 203

An elevated SGOT value can occur in which of the following cases?
A) liver necrosis
B) myocardial disease
C) opiate administration
D) muscle lesions
E) only (A) and (B) are true

Back 203

INT-7.638.
ABCD

Front 204

Typical endoscopic findings in a benign gastric ulcer show:
A) sharp regular edges
B) a clear, smooth base
C) a nodular base
D) rigid folds
E) none of the above

Back 204

INT-7.642
AB

Front 205

In which of the following does erythema nodosum occur?
A) lymphoma
B) sarcoidosis
C) Streptococcal infections
D) ulcerative colitis
E) when oral contraceptives are taken over an extended period

Back 205

INT-7.657.
BCDE

Front 206

Which of the following are true for a 0 blood group patient?
A) the patient has anti-A antibodies
B) the patient has anti-B antibodies
C) the patient's parents have blood group A or B
D) the patient has a higher risk of developing a duodenal ulcer
E) the patient has a higher risk of developing a gastric carcinoma

Back 206

INT-7.663.
ABCD

Front 207

Which of the following indicate hemolysis due to an incompatible
blood transfusion?
A) pulmonary edema
B) lumbar pain
C) headache
D) urticaria
E) hemoglobinuria

Back 207

INT-7.664.
BCE

Front 208

Which of the following statements about hemolytic anemia of,
newborns are true?
A) it occurs if the father is Rh-positive and the mother is Rhnegative
B) it is more probable if ABO incompatibility occurs
C) it never occurs in the first newborn
D) the most frequent pairing resulting in sensitivity is maternal
blood group O and fetal blood group A
E) it can be prevented by injecting a high-titer anti-Rh gammaglobulin
preparation within 72 hours after delivery

Back 208

INT-7.665.
ABDE

Front 209

Which of the following causes Coombs-positive hemolysis?
A) dapsone
B) methyldopa
C) penicillin
D) Clostridium perfringens sepsis
E) cephalosporins

Back 209

INT-7.666.
BCE

Front 210

When are specific human immunoglobulins used?
A) for hepatitis A
B) for hepatitis B
C) for rabies
D) for varicella zoster
E) for diphteria

Back 210

INT-7.670.
BCD

Front 211

Which of the following are associated with pulmonary eosinophilia?
A) Ascaris lumbricoides
B) Strongyloides stercoralis
C) Ancylostoma braziliense
D) nickel carbonate
E) chlorpropamide

Back 211

INT-7.677
ABCDE

Front 212

Though endoscopic study-induced infections are rare, such a possibility
must be considered if postendoscopic fever occurs. Which of
the following infections can develop following gastroscopy?
A) Salmonella typhi
B) Mycobacterium tuberculosis
C) Hepatitis B
D) Stercoralis
E) Pseudomonas aeruginosa

Back 212

INT-7.683.
ACDE

Front 213

Which of the following features are characteristic of Bence-Jones
protein?
A) it is found in the urine of 70% of patients with myeloma
B) it precipitates at 37
0
C and is redissolved at higher temperatures
C) it is comprised of both kappa and lambda chains
D) the "Albustix" test is positive
E) when it is present the risk of renal symptoms is increased

Back 213

INT-7.714.
AE

Front 214

Secondary osteoporosis can develop in:
1) steroid therapy
2) hyperthyroidism
3) acromegaly
4) postmenopause
5) Cushing's syndrome
6) starvation due to an absorption disorder
A) 1, 3, and 4 are true
B) 2 and 5 are true
C) 4 and 5 are true
D) only 3 is true
E) all of the above

Back 214

INT-7.715.
E

Front 215

Which of the following is characteristic of "shock lung"?
1) congestive lung
2) hemorrhage
3) atelectasia
4) edema
5) capillary thrombosis

A) 1 and 3 are true
B) 2, 4, and 5 are true
C) 1 and 4 are true
D) only 3 is true
E) all of the above

Back 215

INT-7.717.
E

Front 216

Schistosomiasis has the following characteristic clinical symptoms:
1) fever and allergic symptoms
2) abdominal pain and diarrhea
3) portal hypertension
4) cor pulmonale
5) myocarditis

A) 1, 3, and 4 are true
B) 2 and 4 are true
C) 1 and 5 are true
D) only 5 is true
E) all of the above

Back 216

INT-7.719.
E

Front 217

Which of the following characterizes the cerebrospinal fluid in aseptic
meningitis?
1) a turbid fluid
2) a low glucose content
3) a polymorphonuclear reaction at the onset of the disease
4) an elevated protein level

A) 1 and 4 are true
B) 2 and 4 are true
C) 1 and 3 are true
D) 3 and 4 are true
E) all of the above
F) none of the above

Back 217

INT-7.721.
D

Front 218

Hypothermia occurs in:
1) myxedema
2) high-dose sedatives
3) alcohol intoxication
4) hyperthyroidism

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 218

INT-7.722.
A

Front 219

Which of the following methods is used in the therapy of opiate
intoxication?
1) gastric lavage in case of an oral opiate intake
2) naloxone iv.
3) meperidine

A) 1 and 2 are true
B) 1, 2, and 3 are true
C) only 2 is true
D) only 1 is true

Back 219

INT-7.723.
A

Front 220

Case Study:
An elderly patient with severe airway obstruction and chronic
bronchitis is treated with digitalis for circulatory insufficiency. During
therapy he suddenly develops a supraventricular paroxysmal
tachycardia (160/min) which was terminated with physical interventions.
Which of the following medications should be used for the
therapy of this arrhythmia?
1) digoxin iv.
2) pindolol iv.
3) metoprolol (Betaloc, cardioselective beta-blocker) iv.
4) quinidine p.o.
5) verapamil iv.

A) 1, 3, and 4 are true
B) 3 and 5 are true
C) 3 and 4 are true
D) 1 and 4 are true
E) 2, 4, and 5 are true

Back 220

INT-7.725.
B

Front 221

In which of the following do pulmonary abscesses develop?
1) pneumococcus type-III pneumonia
2) mitral stenosis
3) pulmonary infarction
4) scleroderma
5) regional enteritis

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 221

INT-7.726.
B

Front 222

Which of the following methods help in the diagnosis of lung cancer?
1) bronchoscopy
2) a scalene lymph node biopsy
3) a cytological smear from the sputum
4) angiography
5) ultrasound

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 222

INT-7.729.
A

Front 223

Case Study:
A blood pressure value of 170/120 was found on four occasions in a
25-year-old female patient who takes no antihypertensives. A physical
study showed no alterations. What should be done next?
1) nothing, because women are less susceptible to the sequels of
hypertension
2) to prescribe a high potassium diet and recheck the patient after
6 weeks
3) measure the sodium content of the red blood cells
4) check for secondary hypertension

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 223

INT-7.732.
D

Front 224

Case Study:
In a weak male patient with sinus bradycardia one doctor repeatedly
measured blood pressure values of 170/ 100 mmHg, while an other
doctor always obtained 160/ 100 mmHg. Which of the following
might have caused this difference?
1) the cuff is too wide
2) digital devices have different accuracies ("silent" range)
3) the emotional liability of the patient
4) the two doctors released the air with different speeds

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 3 and 4 is true
E) all of the above

Back 224

INT-7.733
D

Front 225

Which of the following alterations can be found in the fundus in
both hypertension and arteriosclerosis?
1) blurred disk margins
2) narrowed vessels
3) crossing of the vessels
4) copper-wire arteries

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true ,
E) all of the above

Back 225

INT-7.734.
E

Front 226

Select the characteristic features of hypertension in end-stage renal
disease:
1) the hypertension is usually volume-dependent
2) the plasma renin level is usually low
3) the hypertension can be controlled with adequate dialysis
4) the hypertension is of a low-volume type

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 226

INT-7.736.
A

Front 227

Case Study:
A 14-year-old boys blood pressure is 140/ 100 mmHg. Two weeks ago he complained
of a sore throat Which ofthe following studies should be performed
next?
1) a urine sediment study
2) a urine cultivation for the presence of any microbes
3) a urine study with sulfosalicylic acid
4) the determination of the urine pH value

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 227

INT-7.737
B

Front 228

Case Study:
A 32-year-old male patient has paroxysmal hypertension and headaches,
but the repeated values of the urine and plasma levels of
vanilinmandelic acid, catacholamines and metanephrine are always
normal. Which of the following can be assumed?
1) inadequate urine sampling techniques
2) aberrant adrenal tissue
3) an inactive adrenal tumor
4) a cerebral astrocytoma

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 228

INT-7.747
D

Front 229

Select the differential criteria of renal and non-renal progressive hypertension:
1) proteinuria
2) red blood cells casts
3) a high serum creatinine level
4) none of the above

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 229

INT-7.748.
D

Front 230

Case Study:
A 55-year-old patient on antihypertensive therapy complains of palpitation
and headache. He also has accompanying signs of fluid retention. Which
of the followIng antihypertensive agents can cause these symptoms?
1) hydralazine
2) phentolamine
3) minoxidil
4) bumetanide

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 230

INT-7.752.
B

Front 231

Which of the following statements about calcium channel blocking
agents is true?
1) verapamil and diltiazem block the intracellular calcium influx
2) diltiazem enhances calcium outflux from the cell
3) a combination of calcium entry blockers with beta blockers
can lead to cardiac insufficiency
4) the direct effect of sublingual nifedipine administration lasts
for 3 hours

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 231

INT-7.758.
E

Front 232

Which of the following statements about antihypertensive drugs is tunie?
1)chlorthalidone, metolazone, and triamterene are ali diuretics
and have a similar effect on the potassium balance
2) captopril and saralasin are ACE inhibitors
3) propranolol, timolol, and atenolol are all lipid-soluble betablockers
4) minoxidil, hydralazine, diazoxide, and nitroprusside are all
vasodilators and elevate the plasma renin activity

A) 1,2, and 3 are true
B) l and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 232

INT-7.762.
D

Front 233

Dynamic ileus can be caused by the following:
1) chronic lead intoxication
2) acute diffuse peritonitis
3) biliary colic
4) renal colic
5) intermittant acute porphyria

A) 1, 2, and 4 are true
B) 2, 3, and 4 are true
C) all of the above
D) 2, 3, 4, and 5 are true
E) 1, 2, 3, and 4 are true

Back 233

INT-7.771.
C

Front 234

Early metastases of gastric cancer can develop in the following organs:
1) the axillary lymph nodes
2) the supraclavicular lymph nodes
3) the inguinal lymph nodes
4) the liver
5) the testis

A) 1, 3, and 5 are true
B) 2, 4, and 5 are true
C) 1 and 3 are true
D) 2 and 4 are true
E) 2 and 5 are true

Back 234

INT-7.772.
D

Front 235

Prostatitis can be caused by the following:
1) gonorrhea
2) syphilis
3) tularemia
4) tuberculosis
5) brucellosis

A) 1, 3, and 5 are true
B) 1 and 4 are true
C) 2, 3, and 5 are true
D) only 3 is true
E) all of the above

Back 235

INT-7.773.
B

Front 236

In which of the following does hypercalcemia occur?
1) in steatorrhea
2) in an overdose of vitamin D
3) in hypoparathyroidism
4) in hyperparathyroidism
5) in multiple myeloma

A) 1, 2, 4. and 5 are true
B) all of the above
C) 2 and 4 are true
D) 1, 3, and 4 are true
E) 2, 4, and 5 are true

Back 236

INT-7.784.
E

Front 237

Which of the following can cause an air embolism?
1) damage of the pulmonary veins
2) damage of the systemic veins
3) inhalation of hyperbaric oxygen
4) opened veins following the abruption of the placenta
5) damage of the lymphatic vessels

A) 1, 2, and 4 are true
B) 3 and 5 are true
C) only 3 is true
D) 1 and 5 are true
E) all of the above

Back 237

INT-7.787.
A

Front 238

Select the dangers of immunosuppressive therapy:
1) the occurrence of intercurrent infections
2) the development of a malignant tumor
3) a decreased titer of auto-antibodies
4) anemia
5) prolonged wound healing

A) 1, 3, and 5 are true
B) 2 and 3 are true
C) 3 and 4 are true
D) 1, 2, 4, and 5 are true
E) only 3 is true

Back 238

INT-7.791.
D

Front 239

Which of the following diseases can lead to the development of
chronic cor pulmonale?
1) aortic coarctation
2) mitral insufficiency
3) patent foramen ovale
4) emphysema
5) silicosis

A) 1, 3, and 5 are true
B) 2, 4, and 5 are true
C) 3 and 4 are true
D) only 3 is true
E) all of the above

Back 239

INT-7.794.
B

Front 240

Secondary cardiomyopathy can be caused by:
1) hyperthyroidism
2) pheochromocytoma
3) beriberi
4) amyloidosis
5) glycogenosis

A) 1, 3, and 5 are true
B) 2 and 4 are true
C) 4 and 5 are true
D) only 3 is true
E) all of the above

Back 240

INT-7.796.
E

Front 241

Right-sided heart hypertrophy can be caused by:
1) emphysema
2) silicosis
3) mitral stenosis
4) carcinoid syndrome
5) Adams-Stokes syndrome

A) 1 and 2 are true
B) 1, 2 and 3 are true
C) 1, 2 and 4 are true
D) 1, 2, 3, and 4 are true
E) all of the above

Back 241

INT-7.797.
D

Front 242

Hydronephrosis can occur in:
1) urethral stricture
2) prostatic hypertrophy
3) diabetes insipidus
4) spinal damage
5) the lodging of a concrement in the urinary tract

A) 1, and 2 are true
B) 1, 2, and 3 are true
C) all of the above
D) 1, 2, 4, and 5 are true
E) 2 and 5 are true

Back 242

INT-7.801.
D

Front 243

Where do ulcers typically occur in the Zollinger-Ellison syndrome?
1) in the limbs
2) in the soft palate
3) in the stomach
4) in the duodenum
5) in the rectum

A) 1, 2, 3, and 4 are true
B) 2, 3, and 4 are true
C) 3 and 4 are true
D) 3, 4, and 5 are true
E) 2 and 3 are true

Back 243

INT-7.806.
C

Front 244

Obstructive jaundice can be caused by:
l) carcinoma of Vater's papilla
2) a concrement in the common bile duct
3) obstruction of the Wirsungian duct
4) a carcinoma of the gallbladder
5) a carcinoma of the pancreatic tail

A) 1, 2, and 5 are true
B) 1 and 2 are true
C) 1, 2, 3, and 5 are true
D) all of the above
E) 1, 2, 4, and 5 are true

Back 244

INT-7.807.
B

Front 245

Which of the following factors markedly contributes to the development
of head and neck cancer?
1) alcohol
2) smoking
3) the Epstein-Barr virus
4) the hepatitis B virus

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 245

INT-7.811
A

Front 246

Which of the following histocompatibility antigens predisposes
to rheumatoid arthritis?
1) HLA/DRI
2) HLA/DR2
3) HLA/DR3
4) HLA/DR4

A) 1 and 2 are true
B) 1 and 3 are true
C) 1 and 4 are true
D) 2 and 3 are true
E) 2 and 4 are true
F) 3 and 4 are true

Back 246

INT-7.823.
C

Front 247

Select the cytokines which play a primary role in the activation of
endothelial cells:
1) IL-3
2) IL-1
3) TNF-alpha
4) IL-10
5) interferon-gamma

A) 1, 2, and 3 are true
B) 1, 2 and 4 are true
C) 1, 2, and 5 are true
D) 1, 3, and 4 are true
E) 1, 3 and 5 are true
F) 1, 4, and 5 are true
G) 2, 3 and 4 are true
H) 2, 4, and 5 are true
I) 2, 3, and 5 are true
J) 3, 4, and 5 are true

Back 247

INT-7.833.
H

Front 248

Associate the following statement(s) with their corresponding term(s)!
A) potassium excreting kidney
B) difficulties in the initiation of movements; slow relaxation
C) during such a fit the serum potassium level decreases
D) athletes

1) Familial hypokalemic paralysis
2) Thomsen's syndrome
3) Primary hyperaldosteroneism
4) Ossifying myositis

Back 248

INT-7.839.
CBAD

Front 249

Associate the following statement(s) with their corresponding term(s)!
A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis -
angina pectoris

1) Paget's disease
2) Hyperostosis
3) Osteoporosis
4) Fibrotic dysplasia
5) Ollier's syndrome
6) Relapsing polychondritis
7) Tietze's syndrome

Back 249

INT-7.840.
BACDFE

Front 250

Associate the following statement(s) with their corresponding term(s)!
A) hypertension
B) hypotension
C) both of the above
D) none of the above

1) Vasopressin
2) Prostaglandins
3) Renin
4) Aldosterone
5) Glucagon
6) Bradykinin

Back 250

INT-7.846.
ACDADB

Front 251

Associate the following statement(s) with their corresponding term(s)!
A) an increased venous capacity
B) sympathetic blockade
C) an inhibition of the converting enzyme
D) a low plasma volume
E) short-term alpha blockade

1) Nitroprusside
2) Captopril
3) Methyldopa
4) Amiloride
5) Phentolamine
6) Chlorthalidone

Back 251

INT-7.847.
ACBDED

Front 252

Associate the following term(s) with their corresponding statement(s)!
A) Nephrosclerosis
B) Nephrosis
C) Chronic pyelonephritis
D) Renovascular disease
E) Conn's syndrome

1) the 24 hour protein excretion is 3.8 g; normal iv. urogram
2) the 24 hour protein excretion is 400 mg; normal iv. urogram
3) the 24 hour protein excretion is 400 mg; iv. urogram reveals
the symmetrically shortened, deformed calyx
4) the 24 hour protein excretion is 800 mg; iv. urogram shows the
left kidney to be 7cm long and the right kidney to be 10 cm long

Back 252

INT-7.849
BACD

Front 253

Associate the following term(s) with their corresponding statement(s)!
A) 11-hydroxylase defect
B) 3-beta-dehydrogenase defect
C) Both of the above
D) None of the above

1) hypertension
2) hypokalemia
3) hyperkalemia
4) glucocorticoid therapy
5) metyrapone therapy
6) hypogonadism
7) virilisation
8) usually associated with fatal outcome in pediatric patients

Back 253

INT-7.850.
CCDCDA

Front 254

Associate the following statement(s) with their corresponding term(s)!
A) cholestyramine has a beneficial effect
B) a good response to a gluten-free diet
C) a good response to wide-spectrum antibiotics
D) a good response to the withdrawal of milk
E) the administration of digestive enzymes decreases steatorrhea

1) Lactase deficiency
2) Celiac disease
3) Enteropathy caused by bile acid salts
4) Chronic pancreatitis
5) Whipple's disease

Back 254

INT-7.855.
DBAEC

Front 255

Associate the following term(s) with their corresponding statement(s)!
A) Pancreas
B) Lung
C) Kidney
D) Muscle
E) Breast

1) Zenker's waxy necrosis
2) enzymatic fatty necrosis
3) traumatic fatty necrosis
4) anemic infarction
5) hemorrhagic infarction

Back 255

INT-7.858.
DAECB

Front 256

Associate the following term(s) with their corresponding statement(s)!
A) Digoxin
B) Lidocaine
C) Propranolol
D) Albuterol

1) a sudden withdrawal in patients with angina pectoris can
cause angina
2) it is an efficient bronchodilator
3) it should not be given to asthmatic patients
4) it lowers the increased ventricular rate in atrial fibrillation
5) it affects only ventricular arrhythmias

Back 256

INT-7.864.
CDCAB

Front 257

Associate the following term(s) with their corresponding statement(s)!
A) Tubular type colonic polyp
B) Intermediate form of colonic polyp
C) Villous adenoma

1) a 53% probability of malignancy
2) a 35% probability of malignancy
3) a 46% probability of malignancy

Back 257

INT-7.869.
CAB

Front 258

Glomerulonephritis is common in systemic lupus erythematosus
because the circulating antigen-antibody complexes precipitate in
the walls of the glomerular capillaries.

Back 258

INT-7.875.
D

Front 259

Prostate hyperplasia leads to the retention of urine, therefore a bacterial
infection can easily occur in prostatic hyperplasia.

Back 259

INT-7.876.
A

Front 260

An embolus is always solid because fluids and gases cannot cause
obstruction of the vascular lumen.

Back 260

INT-7.878.
E

Front 261

Anaerobic glycolysis is enhanced in the body's tissue during hypoxia,
therefore glycogen accumulates in the hypoxic hepatic tissue.

Back 261

INT-7.879.
C

Front 262

Melanin accumulation occurs in Addison's disease because
hydrocortisone fails to inhibit the pituitary melanocyte-stimulating
hormone (MSH) secretion.

Back 262

INT-7.880.
A

Front 263

Aortic stenosis markedly contributes to the left ventricular load,
therefore left ventricular hypertrophy is a sequel of aortic stenosis.

Back 263

INT-7.885
A

Front 264

Fluid transudation across the lymphatic vessel walls occurs in
lymphedema because in lymphedema the permeability of the lymphatic
vessels increases.

Back 264

NT-7.888.
C

Front 265

Heparin exhibits an antithrombin effect because the heparin molecule
is comprised of acidic mucopolysaccharides.

Back 265

INT-7.889.
B

Front 266

Inflammatory hyperemia is an active process because the vascular
permeability is increased in a focus of inflammation.

Back 266

INT-7.890.
B

Front 267

Gelatinous pneumonia is an exudative form of pulmonary tuberculosis
because a specific granuloma is the most typical tuberculotic reaction.

Back 267

INT-7.892.
B

Front 268

The left ventricular blood supply is inadequate in mitral insufficiency,
therefore. the left ventricle can exhibit a slight hypertrophy
in mitral insufficiency

Back 268

INT-.895.
E

Front 269

In mitral insufficiency the congestion can spread to the pulmonary
circulation, therefore the right atrium and ventricle will undergo
dilation and hypertrophy in mitral insufficiency.

Back 269

INT-7.897.
A

Front 270

Renal papillary necrosis mostly occurs in diabetic patients because the
Kimmelstiel- Wilson's syndrome is a typical renal disease in diabetes.

Back 270

INT-7.899.
B

Front 271

A marked cell decomposition occurs in leukemic patients following
irradiation, therefore the renal accumulation of urate salts is expected
in post-radiation therapy in leukemic patients.

Back 271

INT-7.900
A

Front 272

A partial or intermittant urethra occlusion can lead to the development
of hydronephrosis because urine retention in the pyelon usually
leads to a bacterial infection.

Back 272

INT-7.901.
B

Front 273

Acute glomerulonephritis is accompanied by albuminuria, therefore the
edema typical of acute glomerulonephritis is due to hypoproteinemia.

Back 273

INT-7.902.
C

Front 274

The red blood cells are more vulnerable in the spherocytic-type of
anemia because the red blood cells' osmotic resistance is decreased
in the spherocytic type of anemia.

Back 274

INT-7.906.
A

Front 275

Metaplasia of the bronchial epithelium can occur in bronchiectasis,
therefore adeno-carcinoma is common in patients with
bronchiectasis.

Back 275

INT-7.907.
C

Front 276

Dyspnea is one of the leading symptoms of emphysema because the
surface of the emphysematous lung is decreased.

Back 276

INT-7.909.
A

Front 277

Pulmonary alterations elicited by silicosis are irreversible because
the lung cannot eliminate the absorbed silicon.

Back 277

INT-7.910.
A

Front 278

Male patients with liver cirrhosis frequently develop gynecomastia
because the hepatic estrogen inactivation system is progressively
destroyed.

Back 278

INT-7.914.
A

Front 279

A gallstone can sometimes impact itself in the hepatic duct, therefore
acute hemorrhagic pancreatic necrosis can develop as a complication
of cholelithiasis.

Back 279

INT-7.915.
B

Front 280

Portal congestion develops due to liver cirrhosis, therefore an
intermittant jaundice can occur as a complication of liver cirrhosis.

Back 280

INT-7.916.
B

Front 281

A 37-year-old female patient was urgently admitted due to abdominal
seizures. During childhood the patient had been treated for jaundice
in an infectious diseases ward. She has had 3 pregnancies; one was
terminated by abortion. During the first pregnancy the patient complained
of abdominal seizures on the right side. She took drotaverin
(No-Spa) and was on a diet for a long time. Then the patient became
symptom-free. She took oral contraceotive (norgestrol ethynil-estradiol
- Ovidon) for three years. Two months before admission the oral contraceptive
had been replaced by an IUD. The patient frequently
compained of headaches and nausea. Before admission she had fever,
vomited and developed abdominal seizures under the right costal arch,
in the area of the cardia of the stomach. Spasmolytics relieved the
pain, but not completely. The urine of the patient had a slightly darker
color than normal.
Physical status (most important findings): subicterus, enlarged (2 fingers),
tender liver. Pressure tenderness under the right costal arch.
Laboratory findings: temperature: 38.9
o
C. red blood cell sedimentation
rate: 39 mm/h. Serum bilirubin: 45 mol/L. SGOT: 210 IU; SGPT:
180 IU. ALP: 99 IU/L; GGT: 130 IU/L. WBC: 12900. Smear: Stab cells:6,
Segm.: 83, Lymph.: 11%. Urine: norm. Specific density:. 1024. Prot.:
(++). Ubg.: norm., Bilirubin: positive. Precipitate: several WBC/visual
field.
7.919/ 1. Single Choice Question
The most probable diagnosis is:
A) adrug-induced cholestasis
B) viral hepatitis
C) acute pyelonephritis
D) calculous cholecystitis
E) adnexitis

7.919/2. Select One Of The Key Combinations
Which of the following studies should be performed in the acute
phase of the disease to support the diagnosis?
1) an ERCP study
2) a HbsAg determination
3) a serum amylase determination
4) an ultrasound study
5) cholecystography

A) (1),( 2), and (5) are true
B) (3), (4), and (5) are true
C) (2), (3), and (4) are true
D) all of the above
E) none of the above

7.919/3. Select One Of The Key Combinations
Which of the following laboratory parameters should be regularly
monitored during the diasease?
1) serum Fe, Cu, and ferritin
2) bacteriological and parasitologic bile tests
3) WBC and serum amylase level
4) serum bilirubin, GOT, GPT, ALP
5) Weber's stool test

A) (1), ( 2). (4), and (5) are true
B) (3), (4), and (5) are true
C) (3) and (4) are true
D) all of the above
E) none of the above

7.919/4. Select One Of The Key Combinations
Which of the following complications is the most probable?
1) coagulation disorders
2) chronic active hepatitis
3) pancreatitis
4) empyema vesicae felleae
5) hydronephrosis

A) (2), (3), and (4) are true
B) (1), (4), and (5) are true
C) (3) and (4) are true
D) all of the above
E) none of the above

7.919/5. Select One Of The Key Combinations
Which of the following studies supporting the diagnosis should be
performed?
1) if a liver disease due to a long-term use of oral contraceptive is
suspected, a liver biopsy should be done
2) if the fever is further elevated an acute cholecystography
should be done
3) an ultrasonic study should always be done first, since this
non-invasive method yields important information
4) if a hydrops develops, ERCP should be done
5) palpation of hydrops is an indication for surgery

A) (1), (3), and (5) are true
B) (2), (4), and (5) are true
C) (3) and (5) are true
D) all of the above
E) none of the above

Back 281

INT-7.919.
DCCCC

Front 282

Case Study
A 42-year-old female patient complained for 3 months of sustained
headaches. Mild analgetics she subsequently received were successful
for the headaches. No other symptoms were found in the history.
The patient had three normal pregnancies, but during the third trimester
of the fourth pregnancy the patient had to take diuretics. The
only disease she had recently, was a cystitis which was treated with
antibiotics. The patient's father and uncle both died of a heart attack
at the age of 43 and 46 years old respectively. Physical examination:
the patient is slim, her blood pressure taken at rest on both arms is
180/120 mmHg. Vein "notching" was observed during examination of
the fundus. No other alterations could be observed. The initial laboratory
tests showed trace amounts of protein in the urine. The ECG, and
chest X-ray findings were normal.

7.920/ 1. Single Choice Question
The most probable cause of the hypertension is:
A) pheochromocytoma or renal artery disease
B) renal artery disease or brain tumor
C) cerebral tumor or Cushing's syndrome
D) Cushing's syndrome or primary hypertension
E) primary hypertension or chronic pyelonephritis

7.920/2. Single Choice Question
All of the following diagnostic studies should be performed, EXCEPT:
A) intravenous pyelography
B) a bone marrow puncture
C) a creatinine clearance test
D) the plasma renine activity

7.920/3. Single Choice Question
If hypokalemia is found then all of the following can be assumed, EXCEPT:
A) pheochromocytoma
B) primary aldosteronism
C) Cushing's syndrome
D) renal perenchymal disease
E) antidiuretic drug abuse

7.920/4. Single Choice Question
If a patient has primary hypertension, the primary therapeutic interventions
comprise all of the following, EXCEPT:
A) rest
B) intravenous hydralazine
C) hydrochlorothiazide
D) a low salt diet
E) sedatives

Back 282

INT-7.920.
EBAB

Front 283

Case Study
A 28-year-old male patient was admitted to an intensive care unit for
chest pain (which had lasted for two hours), cough, and dyspnea. He
had had several similar fits in the past. Such fits were usually
elicited by emotional factors or strain. The patient(also has hay fever. Furthermore,
the members of his family also have similar symptoms and fits.
Physical examination: dyspnea, orthopnoea and cyanosis. A whistlingstridorous
sound was found on auscultation of the lungs. Heart rate:
130/min, regular. Sputum: sticky, mucous. Arterial P02: 65 mmHg.
7.921 / 1. Single Choice Question
The most probable diagnosis is:
A) right heart insufficiency
B) left heart insufficiency
C) intrinsic bronchial asthma
D) extrinsic bronchial asthma
E) pneumoconiosis

7.921/2. Single Choice Question
All of the following can cause this disease, EXCEPT:
A) antigens, allergens
B) excessive salt intake
C) emotional stress
D) infection
E) analeptics

7.921/3. Single Choice Question
The most probable respiratory functional finding during a fit is:
A) a decreased FEV 1
B) an increased vital capacity
C) a decreased residual volume
D) a decreased airway resistance
E) an increased arterial P02

7.921/4. Single Choice Question
The best therapeutic step is:
A) fluid restriction
B) cardioversion
C) beta-mimetics, bronchodilators
D) beta-adrenergic blockers
E) diuretics

Back 283

INT-7.921.
DBAC

Front 284

Case Study
A 64-year-old male patient was admitted complaining of frequent urination
urges, anxiety, and nocturia. The symptoms have been persisting
for 6 months. Apart from the afore mentioned symptoms, the patient
also had two episodes of burning dysuria, which was treated
with antibiotics. Furthermore, the patient also has a one-year history
of angina pectoris and takes nitroglycerin when needed.
Physical examination: blood pressure: 130/90, heart rate 90/min.
Rectal examination revealed an enlarged prostate. Laboratory and ECG
findings were not contraindictory for surgery. The prostate was removed
by a transurethral resection with minimal blood loss. Six hours
following surgery the patient started shivering, his temperature increased
to 40 C and his blood pressure fell to 90/60 mmHg.
7.922/1. Single Choice Question
The most probable diagnosis is:
A) gram-negative sepsis
B) a myocardial infarction
C) a post-operative hemorrhage
D) arrhythmia
E) lobular pneumonia

7.922/2. Single Choice Question
A further study of the hypotension will reveal all of the followIng,
EXCEPT:
A) lactic acidosis
B) cold, wet skin
C) an increased level of fibrin-degradation products
D) sinus tachycardia on the ECG
E) an increased urine output

7.922/3. Single Choice Question
Bacteriemia due to urinary tract infection is caused by:
A) Salmonella typhi murium
B) Shigella sonnei
C) Vibrio cholerae
D) Hemophilus influenza
E) Escherichia coli

7.922/4. Single Choice Question
The most important intervention is:
A) cardioversion
B) the monitoring of the central venous pressure
C) an electric pacemaker
D) salt restriction
E) potassium infusion

Back 284

INT-7.922.
AEEB

Front 285

Case Study
A 56-year-old female patient complains of weakness and fatigue that have
been persisting persisting for about half a year. The patient sweats at
night and is sometimes febrile. During this period she has lost 10 kg. A month
ago she complained of pressure under the left costal arch. The patient sometimes
has palpitations and pain which radiates to her left arm.
Physical examination: the patient's skin and mucosa are pale. Percussion
causes sternal pain. The liver is palpable. The spleen is enlarged
exceeding the left costal arch by 4 cm.
Laboratory findings: Hb: 100 g/L; Hct: 0.29; WBC: 100 g/L; platelets:
350 g/L; blood smear: myeloblasts: 0.01; promyelocytes: 0.03;
myelocytes: 0.06; juvenile: 0.08; bands: 0.10; segmented: 0.60; eo: 0.02;
ba: 0.06; ly: 0.04; red blood cells: sustained hypochromia and
anisocytosis. Normoblasts: 1 / 100 WBC; platelets: anisocytosis.
7.924/ 1. Single Choice Question
The most probable diagnosis is:
A) myelofibrosis
B) leukemoid reaction
C) chronic granulocytic leukemia
D) thrombocytemia
E) polycythemia vera

7.924/2. Single Choice Question
Keeping in mind the above noted diagnosis, select the stage of the
disease:
A) the initial stage
B) the CML accelerated stage
C) the CML inactive stage
D) the blastic stage

7.924/3. Single Choice Question
Which of the following is a characteristic laboratory finding?
A) a chromosome analysis will demonstrate the Philadelphia chromosome
B) the morphology of the blood cells is abnormal
C) monocytosis
D) the leukocyte alkaline phosphate score is high
E) a low reticulocyte count

7.924/4. Single Choice Question
Select the therapeutic drug of first choice:
A) tamoxifen (Zitazonium)
B) cyclophosphamide (cytoxan)
C) busulfan (Myleran)
D) melphalan (Alkeran)

7.924/5. Select One Of The Key Combinations
Select the most common causes of death in the above noted disease:
1) disorders of pacemaker function
2) blast crisis
3) busulfan-induced bone marrow aplasia
4) pathologic fractures
5) infections

A) (1), (2), and (5) are true
B) (2},- (3), and (5) are true
C) (1) and (4) are true
D) only (3) is true
E) all the above

Back 285

INT-7.924.
CCACB

Front 286

Case Study
A 32-year-old female patient felt a sudden retrosternal pain, which
radiated to the shoulder and neck. The patient had an asphyxia episode
and coughed. The patient takes oral contraceptives for 2 years.
Physical examination: dyspnea, cyanosis, tachycardia (130 /min). The
left ankle is slightly swollen and tender. No other pathological signs
were found. Blood pressure: 110/80 mmHg, red blood cell sedimentation
rate: 8 mm/h. WBC: 6200; Ht: 41%. Urine: negative findings.
7.926/ 1. Select One Of The Key Combinations
Which of the following studies are the most important in supporting
the diagnosis:
1) ECG
2) blood smear
3) lung scintigraphy
4) echocardiography
5) heart catheterization
6) coronary angiography
7) urinalysis

A) (2), (4), (6), and (7) are true
B) (4), (6), and (7) are true
C) (1) and (3) are true
D) (2) and (5) are true
E) all of the above

7.926/2. Single Choice Question
Select the most probable correct diagnosis:
A) myocardial infarction
B) pulmonary embolism
C) pericarditis
D) lung tuberculosis
E) acute pancreatitis

7.926/3. Single Choice Question
Select the correct therapy:
A) antibiotics
B) immune suppression
C) anticoagulants
D) rest and diet
E) antituberculotics

Back 286

INT-7.926.
CBC

Front 287

Case Study
A 55-year-old male patient suffers for years from chronic bronchitis
which causes obstructive ventilation disorders. He also has diabetes
mellitus. The patient was urgently admitted with fever, cough, substantial
amount of purulent sputum, dyspnea, and cyanosis. The arterial
blood gas analysis was as follows: P02: 51 mmHg; PC02: 54
mmHg; pH: 7.28; St. bicarbonate: 31 mmol/L.
7.928/ 1. Single Choice Question
Select the correct acid-base disorder:
A) metabolic acidosis
B) metabolic alkalosis
C) respiratory acidosis
D) respiratory alkalosis

7.928/2. Single Choice Question
The patient required oxygen therapy and received 4 L 02/min via a
nasal catheter. After 24 hours the blood gas analysis showed the following
changes: P02: 65 mmHg; PC02: 81 mmHg; pH: 7.20; St. bicarbonate:
36 mmol/L. Select the correct therapy:
A) increase the oxygen via the nasal catheter
B) decrease the oxygen via the nasal catheter
C) artificial respiration is required
D) inhalation of 100% (pure) oxygen

Back 287

INT-7.928.
CC

Front 288

A 50-year-old alcoholic male patient has complained for several months
of fatigue, weakness, and abdominal swelling. The swelling was at first
intermittant, later it became constant. The day before, his hindlimbs
became swollen too. The patient lost his appetite and his body weight
decreased.
Physical examination: jaundice, free abdominal fluid, liver: a four -fin--
ger enlargement, uneven surface.
Laboratory findings: Se-bilirubin: 50; direct bilirubin 40 mol/1; GOT:
50 IU; GPT: 22 IU; gamma-GT: 580 IU; ALP: 40 IU/L. Urine: bilirubin:
positive, UBG: increased.
7.930/ 1. Single Choice Question
Select the correct diagnosis:
A) alcoholic hepatitis
B) liver metastases
C) hepatic cirrhosis
D) right heart insufficiency

7.930/2. Select One Of The Key Combinations
Which of the following studies should be done in the acute phase of
the disease to verify the diagnosis?
1) duodenal tube
2) liver scintigraphy
3) cholecystography
4) liver biopsy

A) (1, (2), and (3) are true
B) (1) and (3) are true
C) (2) and (4) are true
D) only (4) is true
E) all of the above

7.930/3. Select One Of The Key Combinations
Select the possible complications of the disease:
1) esophageal varicous bleeding
2) hepatoma
3) coagulation disorders
4) empyema vesicae felleae

A) (1, (2), and (3) are true
B) (1) and (3) are true
C) (2) and (4) are true
D) only (4) is true
E) all of the above

Back 288

INT-7.930
CCA

Front 289

Case Study
A month ago a patient became subfebrile. He also complained of a sore
throat, poor general condition, pain in the limbs and in the chest, and
cough. At present he complains of dyspnea, sensation of pressure in
the liver, tachycardia. He can sleep only with an elevated pillow.
Physical examination: mild lip cyanosis. Respiration is accompanied
by flaring of the nostrils. Bilateral protruding jugular veins, tachycardia.
A third heart sound at the apex was noted; decreased heart sounds.
The relative dullness of the heart is shifted toward the lateral chest
wall. Harsh respiration. The liver is enlarged by 4 flngers. The spleen
is not palpable. Adequate pulsation of the peripheral arteries. Blood
pressure: 120/70 mmHg.
ECG: sinus tachycardia, low-voltage. Left axis deviation. Diffuse, flattened
T waves.
Chest X-ray (+ 2-D imaging of the heart): "cor bovinum". Low pulsation
along the heart contoure.
Laboratory findings: We: 30 mm/h. AST: 120 U; SGOT, GPT, and alkaline
phosphatase - normal. Pharynx: bacteria + . A high titer of the
anti-Coxsackie virus antibodies.
WBC count: Se: 59%; Ly: 40%; Mo: 1%.
7.934/ 1. Single Choice Question
The most probable diagnosis is:
A) a pulmonary embolus
B) a left ventricular aneurysm following a myocardial infarction
C) an exudative pericarditis with a substantial amount of fluid
after a viral infection
D) a combined mitral defect
E) rheumatic carditis
F) viral hepatitis

7.934/2. Single Choice Question
Which of the following non-invasive studies should be done to support
this diagnosis?
A) echocardiography
B) lung scintigraphy
C) phono-mechanocardiography
D) bronchoscopy

7.934/3. Select One Of The Key Combinations
Select the correct therapy:
1) salicylates, steroids and rest (if necessary)
2) implantation of an artificial valve
3) digitalis
4) hepatoprotective therapy; diet; bed-rest
5) anticoagulant therapy
6) diuretics; pericardial puncture if necessary

A) (1) and (6) are true
B) (1), (2), and (5) are true
C) (3), (5), and (6) are true
D) (1) and (5) are true
E) (3) and (6) are true

Back 289

INT-7.934.
CAA

Front 290

Case Study
A 26-year-old female patient complained for 3 years of hypogastric,
spastic pain accompanied by abdominal swelling. Every year the patient
has 5-6 bouts of diarrhea, each lasting for 2-3 months. The stool
contains fresh red blood and mucus. The patient also complains of
frequent occasions of tenesmus. She has lost weight and complains of
arthralgia. The symptoms worsen after consumption of milk. Physical
examination: slightly anemic mucosa; hypogastric tenderness. Other
findings negative.
7.936/1. Single Choice Question
The most probable diagnosis is:
A) a rectal tumor
B) Crohn's disease
C) the irratable bowel syndrome
D) a severe form of ulcerative colitis
E) salmonellosis

7.936/2. Select One Of The Key Combinations
Which of the following should be done to support this diagnosis:
1) a stool cultivation for amebiasis and dysenteria
2) rectoscopy; biopsy; stool cultivation
3) only irrigoscopy
4) a digital rectal exploration
5) stool cultivation; colonoscopy; biopsy

A) (2) and (5) are true
B) (1), (2), (3), and (4) are true
C) (1), (3), and (5) are true
D) (2), (3), (4), and (5) are true
E) (1), (2), (3), and (5) are true

7.936/3. Single Choice Question
Select the etiology and pathogenesis of this disease:
A) a viral infection
B) a bacterial infection
C) can be an autoimmune disorder
D) unknown
E) an allergy to milk and other food products

7.936/4. Single Choice Question
Select the most characteristic complication of this disease:
A) liver and pulmonary metastases
B) intestinal perforation
C) fistula formation
D) sooner or later ileus will develop
E) since the patient is in a precancerous state, cancer might develop
in the future

7.936/5. Single Choice Question .
Select the prognosis of this disease:
A) uncurable, with a fatal outcome
B) it does not affect the life-style of the patient
C) cancer will develop
D) it can be controlled with conservative therapy
E) secondary infections will markedly reduce the life-span of the
Patient

7.936/6. Single Choice Question
Select the most characteristic form of the disease:
A) continuous deterioration
B) exacerbations and remissions are typical
C) it has a sudden onset with severe toxic state
D) spontaneously heals in several weeks
E) lasts for years, with constant activity

7.936/7. Single Choice Question
Select the most relevant therapy for this disease:
A) diet; spasmolytics
B) surgery
C) surgery; X-ray therapy
D) sulfosalazine; steroids
E) antibacterial and symptomatic therapy

Back 290

INT-7.936.
DACEDBB

Front 291

Case Study
An 18-year-old female patient complains for about a month of fatigue,
dyspnea after exercise, and swollen limbs. Three days before admission
the patient had an upper respiratory infection. The patient is pale.
A palm-size dullness was detected over the left side of the diaphragm.
Chest X-ray: fluid (a 5-finger sized area) over the left diaphragm. Edema
of both lower limbs. Clear heart sounds, rhythmic contractions. Pleural
puncture: straw-yellow color fluid: 1.5% protein; specific density:
1012. BP: 130/80; sedimentation: 65 mm/h; cholesterol: 6.6 mmol/L;
se-creatinine: 96 mmol/L; urine protein excretion: 2.8 g/24h; se total
protein: 52 g%.
7.937/1. Single Choice Question
The most probable diagnosis is:
A) cardiac insufficiency
B) lymphedema
C) the nephrotic syndrome
D) acute glomerulonephritis
E) diabetic glomerulosclerosis

7.937/2. Select One Of The Key Combinations
Which of the following data support the assumed diagnosis?
1) hypercholesterolemia
2) anuria
3) proteinuria
4) leukemic cells
5) edema

A) (1), (2) and (5) are true
B) (2) and (4) are true
C) (1), (4), and (5) are true
D) (2), (3), and (5) are true
E) (1) and (5) are true

7.937/3. Select One Of The Key Combinations
Which of the following studies should be done to support the diagnosis?
1) ECG
2) a kidney concentrating ability test
3) abdominal lymphography
4) renal ultrasonography
5) renal biopsy

A) (1), (3) and (5) are true
B) (2) and (4) are true
C) (1), (4), and (5) are true
D) (1) and (4) are true
E) (4) and (5) are true

7.937/4. Select One Of The Key Combinations
Select the typical findings of this disease:
1) a decreased glomerular filtration rate
2) sinus arrhythmia
3) metabolic acidosis
4) hypoproteinemia
5) an increased red blood cell sedimentation rate

A) (1), (3), and (5) are true
B) (2) and (4) are true
C) (1), (4), and (5) are true
D) (2), (4), and (5) are true
E) (1), (2), (4), and (5) are true

7.937/5. Select One Of The Key Combinations
Select the correct therapy?
1) cardiac therapy
2) immunosuppressive therapy
3) steroids
4) the patient does not require drug therapy
5) peritoneal dialysis

A) (1), (3), and (5) are true `
B) (2) and (5) are true
C) (2) and (3) are true
D) only (4) is true
E) (1), (2), and (3) are true

7.937/6. Select One Of The Key Combinations
Which of the following parameters should be checked during therapy?
1) the serum transaminase levels
2) urine protein excretion
3) the red blood cell sedimentation rate
4) the total se protein
5) Weber's test (feces)

A) (1), (3), and (4) are true
B) (1), (2), (3), and (4) are true
C) (2), (3), and (5) are true
D) (2), (3), and (4) are true
E) (1), (3), and (5) are true

7.937/7. Single Choice Question
Select the most probable prognosis of this disease:
A) a total cure within two years
B) a progression of the process
C) the development of diabetic retinopathy
D) cor pulmonale

Back 291

INT-7.937.
CAECCDA

Front 292

Case Study
A 40-year-old female patient lost 6 kg in 3 months. She complains of
fatigue, vertigo and headaches. In one month the patient had 4 occasions
of orthostatic vertigo and fainted twice. The patient also complains
of a constant abdominal pain. She has lost her appetite, frequently vomits,
and has had diarrhea for several days. The patient observed an
axillary and pubic hair loss and complains of decreased libido despite a normal
menstruation cycle. Six weeks ago she sunbathed for several hours and
got a tan of a surprisingly intensive color; she still has the tan of the
same and even darker color. The patient is dysthymic and excitable.
Physical examination: the patient is adynamic and has increased skin
pigmentation without cyanosis. Blood pressure is 100/70 mmHg (lower
than the usual value mentioned by the patient). Heart and lungs -
negative; free abdomen; ptosis of the liver (one finger beyond the costal
arch). The liver is smooth, not edgy. The spleen is not palpable. No.
tenderness in the renal region. No edema. Loss of axillary hair.
7.940/ 1. Single Choice Question
The most probable diagnosis is:
A) a prolactin-secreting adenoma of the anterior pituitary
B) hypothyroidism
C) primary adrenal insufficiency
D) the first signs of menopause
E) post-partum pituitary damage (Sheehan's syndrome)
F) anorexia nervosa
G) porphyria cutanea tarda (urocoproporphyria)

7.940/2. Select One Of The Key Combinations
Select the most relevant clinical study for this diagnosis:
1) "Cold-pressor" test
2) the presence or absence of orthostatic hypotension
3) palpation of the lymphatic nodes
4) a simple equilibrium test (Romberg's)
5) examination of the buccal mucosa
6) examination of the palms

A) (1), (2), and (3) are true
B) (2), (5), and (6) are true
C) (3, (4), and (6) are true
D) (1), (3), 5), and (6) are true
E) all of the above

7.940/3. Select One Of The Key Combinations
Select the relevant questions which can support the diagnosis:
1) Did the patient have sarcoidosis?
2) When was thelast pregnancy, if any?
3) Did the patient have antituberculotic therapy?
4) Did the patient have a cranial injury?
5) Did the patient take hormonal contraceptives?

A) (1), (3), and (5) are true
B) (2), (3), and (4) are true
C) (1), (2), (3), and (4) are true
D) (1) and (3) are true
E) all of the above

7.940/4. Select One Of The Key Combinations
Considering the diagnosis, select the most important accompanying
diseases or symptoms:
1) chronic thyroiditis
2) fatty degeneration of the liver
3) polyglobulinemia; an elevated red blood cell count
4) increased susceptibility to vein thrombosis
5) chronic atrophic gastritis; hypoacidity

A) (1), (3), (4), and (5) are true
B) (1) and (5) are true
C) (2), (3), and (5) are true
D) (3), (4), and (5) are true
E) all of the above

7.940/5. Select One Of The Key Combinations
Which of the following should be done:
1) Ask for admittance to an internal ward
2) Define the patient as unfit to work; a control examination
should be done after a 6-8 week rest. The following steps
depend on the state of the patient (improved - deteriorated)
3) Ask for a consultation with a gynecologist
4) Ask for admittance to a special endocrinologic ward
5) Explain to the patient that her problem is not so serious.
Prescribe oxedrine (Sympathomin) drops and appetite improving
therapy - cyproheptadine (Peritol). The patient should
avoid sunlight, because photosensitivity indicates proneness
to autoimmune diseases.

A) (1) and (4) are true
B) (2), (3), and (4) are true
C) (1), (2), and (5) are true
D) (2), (4), and (5) are true
E) all of the above

7.940/6. Select One Of The Key Combinations
If you have a chance to perform certain simple and quick tests,
which of the following would confirm your diagnosis?
1) an X-ray of the sella turcica
2) the blood glucose level
3) the red blood cell sedimentation rate
4) a cholesterol and triglycerin test (information on the thyroid
function)
5) determination of the Se Na+, K-, and Cl- levels
6) an ECG

A) (1), (4), and (6) are true
B) (2), (3), and (5) are true
C) (2) and (5) are true
D) (1), (2), (3), and (4) are true
E) all of the above

Back 292

INT-7.940.
CBDBAC

Front 293

Case Study
A 58-year-old male patient complains for 3-4 weeks of heartburn, belching,
a burning epigastric pain relieved by sodium bicarbonate or milk;
the pain never radiates elsewhere. The patient has no fever. He has
lost his appetite and 3 kg. He has stool only every second day. The
patient is normacidic. Gastric X-ray: filling excess is observed at the
lesser curvature and irregular folds in the adjacent area.
Laboratory findings: We: 26 mm/h; WBC: 8.4 G/L; Hb: 8.81 mmol/L; Ht: 0.40.
7.942/1. Single Choice Question
Which of the following steps would you recommend:
A) immediate admission to an internal ward, because the disease
requires hospitalization
B) immediate admission to a surgical ward, because the patient
must soon undergo immediate surgery
C) prescribe an immediate diet for patients with ulcer, as well as a
therapy aimed at neutralization and decrease of acid production
D) outpatient gastrofiberoscopy, because the clinical signs and
the X-ray findings suggest the possibility of a ventricular
malignant ulcer. Until the histological data are ready, prescribe
a diet for patients with ulcer, as well as a therapy aimed at
neutralization and decrease of acid production
E) same as in (C); 4-5 weeks later repeat control X-ray study. If
the ulcer is healed the therapy can be terminated. If no healing
tendency is found perform a gastrofiberoscopy and/or refer the
patient to a surgical ward.

7.942/2. Single Choice Question
Select the adequate diet if the patient is treated conservatively:
A) hunger diet: tea or milk with 1-2 cakes in the morning and
evening; some unseasoned, lean soup and mashed potatoes
B) the patient should avoid alcohol consumption, seasoned
meals, and meat, and should eat three times a day
C) the patient should avoid seasoned, fatty, smoked and other
heavy meals, alcohol, and coffee. Otherwise the diet should
guarantee a normal daily energy requirement, and adequate
vitamin, and fat consumption. Between the three main meals
recommend to the patient to have milk and dry cakes.
D) avoid seasoned food and alcohol, restrict the amount of consumed
food; the diet should be low in fiber and fat. Recommend
to the patient to eat every hour
E) let the patient keep his own diet (it is the recent trend in
dietology); recommend him to avoid food which causes him
complaints and to consume everything that does not cause
him symptoms of any kind.

Back 293

INT-7.942.
DC

Front 294

Case Study
A 27-year-old female patient was urgently admitted due to complaints
of dyspnea and pleuritic chest pain. Four days before the patient observed
swelling and pressure tenderness in the right leg. Clinical signs
suggest deep vein thrombosis which might have caused pulmonary
embolism.
7.943/ 1. Select One Of The Key Combinations
Select data in the history which support the diagnosis of deep vein
thrombosis:
1) oral contraceptives
2) long-term immobilization of the lower limbs
3) injury of the lower extremity
4) hypertension

A) (1), (2), and (3) are true
B) (1) and (3) are true
C) (2) and (4) are true
D) only (4) is true
E) all of the above

7.943/2. Select One Of The Key Combinations
Which of the following methods help in the verification of deep vein
thrombosis:
1) Doppler's ultrasonography
2) contrast venography
3) impedance plethysmography
4) nuclear scanning with 125-iodine labelled fibrinogen

A) (1), (2), and (3) are true
B) (1) and (3) are true
C) (2) and (4) are true
D) only (4) is true
E) all of the above

Back 294

INT-7.943.
AE

Front 295

Case Study
A 47-year-old female patient presented with a complaint of arthralgia
which started about 6 months ago. The joints of her fingers are red
and swollen; in the morning she complains of joint rigidity in the fingers,
toes, wrists and knees. The pain decreases after an hour. Physical
examination: red, swollen interphalangeal proximal joints and
multiple small nodes on the extensor surface of the elbow.
7.945/1. Single Choice Question
The most probable diagnosis is:
A) osteoarthritis
B) gout
C) scleroderma
D) psoriatic arthritis
E) rheumatoid arthritis

7.945/2. Single Choice Question
All of the following parameters are pathologically altered, EXCEPT.
A) bone marrow iron stores
B) red blood cell sedimentation rate
C) latex agglutination test
D) immunoglobulin levels
E) X-ray of the hands

Back 295

INT-7.945.
AE

Front 296

Case Study
A 60-year-old female patient complains of progressive weakness in
both hindlimbs which started three days ago. Several hours before the
examination the patient became incontinent. Physical examination:
bilateral plantar reflex (Babinski positive), bilateral weakness in the
legs and decreased sensory function up to the middle of the abdomen.
7.946/ 1. Single Choice Question
Select the most important urgent study:
A) myelography
B) CT study of the brain
C) cystoscopy
D) CT scan of the whole body
E) EEG

7.946/2.
All of the following diagnoses are possible, EXCEPT:
A) cerebral tumor
B) spinal meningeoma
C) multiple sclerosis
D) transverse myelitis
E) spinal epidural abscess

Back 296

INT-7.946.
AA

Front 297

Select the localization of regional enteritis relapsing after
surgery:
A) the jejunum
B) the site of the anastomosis
C) the colon
D) at any site of the gastrointestinal tract
E) the rectum

Back 297

INT-7.448.
B

Front 298

Which of the following processes can cause serous pleuritis?
A) bronchopneumonia
B) lobar pneumonia
C) tuberculosis
D) lung cancer
E) pulmonary abscess

Back 298

INT-7.300.
C

Front 299

All of the following changes are typical of tabes dorsalis, EXCEPT:
A) piercing pain
B) ataxia
C) neurogenic bladder
D) Argyll-Robertson's pupil
E) most of the serological reactions of the serum and CSF are
positive

Back 299

INT-7.35.
E

Front 300

In all of the following renal calculi can be formed, EXCEPT:
A) in urinary tract obstruction
B) in congenital metabolic disorders
C) in constant substantial fluid loss
D) along with gallstones
E) in pyelitis

Back 300

INT-7.289
D

Front 301

In alcoholic cirrhosis and esophageal varicosities:
A) the presence and size of the varices is related to the extent of
hypertension
B) the risk of gastrointestinal hemorrhage correlates with the severity
of portal hypertension
C) the risk of gastrointestinal hemorrhage correlates with the size
of the varices
D) all of the above
E) none of the above

Back 301

INT-7.447.
C

Front 302

Furosemide inhibits:
A) chloride transport in the ascending loop of Henle
B) potassium transport in the distal tubules
C) sodium transport in the collecting ducts
D) potassium transport in the proximal tubules
E) potassium transport in the collecting duct

Back 302

INT-7.111.
A

Front 303

Case Study:
Nephrosis was diagnosed in a 15-year-old boy. A renal biopsy revealed
a "minimal change" process. The creatinine clearance determined from
a timed urine sample while the patient remained recumbent was 150
ml/min. Select the possible cause of the high creatinine clearance rate:
A) an increased permeability of glomeruo-capillary surface
B) inaccurate urine sampling
C) a decreased plasma osmotic pressure in the glomeruli
D) an increased renal blood flow (RBF)
E) an increased transcapillary hydrostatic pressure

Back 303

INT-7.118.
C

Front 304

Associate the following statement(s) with their corresponding term(s)!
A) rash, pruritis, arthritis, neurologic disorders
B) hemorrhagic necrosis caused by endotoxins
C) deficiency of the inhibitor of the first complement component

1) Schwartzman's reaction
2) Serum disease
3) Inherited angio-edema

Back 304

INT-7.843.
BAC

Front 305

The most common histological type of thyroid carcinoma is:
A) medullary carcinoma
B) undifferentiated small-cell carcinoma
C) undifferentiated large-cell carcinoma
D) papillary carcinoma
E) follicular carcinoma

Back 305

INT-7.479.
D

Front 306

Which of the following cardiac disorders can elicit cyanosis in the
early neonatal period:
1) Tetralogy of Fallot
2) an atrial septal defect
3) transposition of the major vessels
4) endocardial fibroelastosis

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 306

INT-7.838
B.

Front 307

Which of the following statements about uric acid transport is FALSE?
A) interstitial uric acid concentration is highest in the
juxtamedullary region
B) in proximal tubuh the uric acid transport occurs in both
directions
C) hyperthyroidosis increases the uric acid clearance
D) pyrazinoate mainly decreases the uric acid secretion
E) acetazolamide slightly increases the uric acid excretion

Back 307

INT-7.73
A

Front 308

Which of the following is affected in Dupuytren's contracture?
A) the tendons
B) the muscles
C) the palmar fascia
D) the joint
E) the meniscus

Back 308

INT-7.247.
C

Front 309

Which of the following can cause right-sided heart hypertrophy?
1) emphysema
2) silicosis
3) an old fibrotic tuberculosis infection
4) mitral stenosis
5) kyphoscoliosis

A) 1, 3, and 4 are true
B) 2 and 4 are true
C) 3 and 5 are true
D) only 4 is true
E) all of the above

Back 309

INT-7.795.
E

Front 310

Case Study
A 30-year-old female patient had fever and observed red, coin-size,
tender nodes on the extensor surface of both hindlimbs 3 months after
delivery. The family doctor recommended further examination. A
chest X-ray showed lobular opacity in the hilus of both lungs. Blood
analysis, ESR, and other laboratory studies were negative.
7.929/1. Single Choice Question
Select the correct diagnosis:
A) Hodgkin's disease
B) tuberculosis
C) sarcoidosis
D) leukemia
E) infectious mononucleosis

7.929/2. Select One Of The Key Combinations
Which of the following endoscopic studies should be performed to
verify the diagnosis?
1) bronchoscopy
2) Klassen-biopsy
3) pleural biopsy
4) mediastinoscopy
5) thoracotomy

A) (1) and (3) are true
B) (1) and (4) are true
C) (2) and (4) are true
D) (1) and (5) are true
E) (3) and (5) are true

7.929/3. Single Choice Question
Select the correct therapy:
A) combined antibiotic
B) combined antituberculotic
C) cytostatic
D) steroid
E) antibiotics+steroids
F) antituberculotic+steroid

Back 310

INT-7.929.
CBF

Front 311

Select the most important restricting side-effect of chloroquine,
when used for systemic lupus erythematosus (SLE) therapy:
A) cardiotoxicity
B) hepatotoxicity
C) ocular toxicity
D) peripheral neuropathy
E) drug fever

Back 311

INT-7.26.
C

Front 312

Streptococcus infections can cause the following diseases EXCEPT:
A) lymphangitis
B) puerperal infections
C) erysipelas
D) pyelonephritis

Back 312

INT-7.32.
D

Front 313

All of the following are opiate withdrawal symptoms, EXCEPT:
A) yawning and rhinorrhea
B) sweating and lacrimation
C) dilated pupils
D) piloerection
E) myalgia
F) hypothermia

Back 313

INT-7.41.
F

Front 314

Select the pCO2 value characteristic of pure metabolic alkalosis if
the serum bicarbonate value is 34 mmol/L?
A) 20 mmHg
B) 30 mmHg
C) 40 mmHg
D) 60 mmHg
E) 70 mmHg

Back 314

INT-7.54
C

Front 315

Case Study:
A patient with chronic metabolic acidosis treated with alkalic
equivalents to correct the acidosis kept hyperventilating for several
days. Which of the following is the most typical finding in this case?
A) pH 7.4; pCO2 40; HCO3 24
B) pH 7.5; pCO2 40; HCO3 30
C) pH 7.5; pCO2 20; HCO3 16
D) pH 7.3; pCO2 30; HCO3 14
E) pH 7.5; pCO2 50; HCO3 36

Back 315

INT-7.61.
C

Front 316

According to data obtained in many hospital patients, hyperuricemia
is primarily caused by:
A) chronic renal insufficiency
B) poorly treated hypertension
C) chronic diuretic therapy
D) obesity and an increased consumption of purines
E) diabetes mellitus in adults

Back 316

INT-7.71.
C

Front 317

Which of the following statements about furosemide is FALSE?
A) in a maximum dose furosemide is more effective than the
thiazides
B) furosemide is efficient even at very low filtration rates
C) it increases RBF and GFR if severe hypovolemia is not present
D) it maintains the concentrating capacity of the kidney
E) other diuretics potentiate it's effect

Back 317

INT-7.108.
D

Front 318

Which of the following statements about the baroreceptors of the
carotid sinus and the aortic arch is FALSE?
A) in animals full denervation causes constant hypertension
B) the baroreceptor sensitivity slightly decreases in essential hypertension
C) the baroreceptor activity can increase in young individuals
with "borderline hypertension"
D) at decreased baroreceptor activity, the peripheral resistance
and diastolic pressure can markedly increase in the
orthostatic position
E) a higher pressure is necessary to activate baroreceptors in hypertension

Back 318

INT-7.162.
D

Front 319

Catecholamines exhibit all of the following effects, EXCEPT:
A) anxiety followed by hyperventilation, palpitation and tremor
B) a long-term elevation of blood pressure
C) an increased cardiac output
D) an increased muscle blood flow
E) an increased renal blood flow

Back 319

INT-7.164.
E

Front 320

Case Study:
A 32-year-old male patient complains of various fits of hypertension
and headaches. The repeatedly determined urine and plasma
vanillylmandelic acid, catecholamine, and metanephrine values were
normal. Select a possible explanation:
A) cerebral astrocytoma
B) a non-functioning adrenal tumor
C) aortic coarctation
D) aberrant adrenal tissue
E) an inadequate sampling of the urine

Back 320

INT-7.191.
A

Front 321

All of the following symptoms occur in renal vein thrombosis, EXCEPT:
A) severe lumbar pain
B) ureter incisure on the intravenous pyelogram
C) hematuria
D) proteinuria
E) medial deviation of the ureter

Back 321

INT-7.203.
E

Front 322

Case Study:
A 50-year-old female patient complains of redness, swelling and rigidity
of the distal interphalangeal joints. She has no other
arthralgias. The most probable diagnosis is:
A) erosion osteoarthritis
B) rheumatoid arthritis
C) systemic lupus erythematosus (SLE)
D) ankylosing spondylitis
E) systemic sclerosis

Back 322

INT-7.228.
A

Front 323

Initial gonococcemia causes gonorrheal urethritis plus one of the
following:
A) myocarditis
B) endocarditis
C) encephalitis
D) meningitis
E) hepatitis

Back 323

INT-7.285.
B

Front 324

Case Study:
A 25-year-old female patient is admitted with metabolic alkalosis. The
chloride concentration in the urine exceeds 110 mmol/L. This fording
can occur in all of the following, EXCEPT:
A) severe vomiting
B) diuretic therapy
C) severe potassium loss
D) Bartter's syndrome
E) Cushing's syndrome

Back 324

INT-7.141.
A

Front 325

Which of the following statements is typical of albinism?
A) a,tyrosinase enzyme deficiency
B) a decreased level of glucuronide-transferase
C) a decreased level of ceruloplasmin
D) a Kayser-Fleischer circle
E) liver cirrhosis

Back 325

INT-7.266.
A

Front 326

Case Study:
A middle-aged male patient is examined for back pain. The X-ray study
showed round-shaped hypodense regions in the lumbar vertebra. Laboratory
findings also include an increased sedimentation rate and high
levels of serum alkaline phosphatase. Select the most probable diagnosis:
A) prostate carcinoma metastasis
B) gastric carcinoma metastasis
C) hypernephroid carcinoma metastasis
D) osteolytic osteosarcoma
E) benign osteoblastoma

Back 326

INT-7.250.
C

Front 327

Define the term "phlebolith":
A) an organized thrombus
B) a venous stone
C) calcification of the venous wall
D) inflammation of the vein wall
E) the inflammation of a thrombus

Back 327

INT-7.275.
B

Front 328

The incubation period of rabies shows individual differences and is
related to the:
A) infecting dose of the virus
B) type of the vector
C) history of vaccination
D) distance between the wound and the brain or spinal cord
E) clinical form of the vector

Back 328

INT-7.483.
D

Front 329

In all of the following thrombosis can develop, EXCEPT:
A) leukemia
B) polycythemia
C) systemic lupus erythematosus
D) potassium chlorate intoxication
E) echidnotoxin intoxication

Back 329

INT-7.273.
c

Front 330

In which of the following does hematuria occur?
A) acute pyelonephritis
B) chronic pyelonephritis
C) acute glomerulonephritis
D) membranous glomerulonephritis
E) amyloid nephrosis

Back 330

INT-7.282.
C

Front 331

Vinyl chloride causes cancer in which organs?
A) the liver
B) the adrenals
C) the colon
D) the thyroid
E) the thymus

Back 331

INT-7.317.
B

Front 332

Case Study
A 65-year-old female patient complains of progressive abdominal distension.
lasting for two weeks. In a period of a half-a-year the patient
lost 5.5 kg, but regained 3 kg during the past two weeks.
Physical examination: a thin woman with visible ascites and pale mucosa. Ht: 0.30; WBC:
9.8 g/L; left inguinal lymph nodes are enlarged but not tender.
7.944/ 1. Single Choice Question
Select the most relevant method of examination:
A) a liver biopsy
B) a lymph node biopsy
C) a diagnostic ascites puncture
D) intravenous pyelography
E) an X-ray of the upper part of the GI tract

7.944/2. Multiple Choice Question
Which of the following can cause a milk-like ascites?
A) pus
B) chylus
C) trauma
D) all of the above
E) none of the above

7.944/3. Multiple Choice Question
Chylus ascites was found. Select the most probable diagnosis:
A) lymphoma
B) pancreatic carcinoma
C) syphilis
D) tuberculosis
E) none of the above

7.944/4. Single Choice Question
Which of the following methods help in establishing the final diagnosis:
A) gastrointestinal studies
B) a lymph node biopsy
C) a rectal biopsy
D) intravenous pyelography
E) arteriography

7.944/5. Single Choice Question
The most probable diagnosis is:
A) colon carcinoma
B) lymphoma
C) syphilis
D) gastric carcinoma
E) pneumococcal peritonitis

Back 332

INT-7.944.
CABABCDBB

Front 333

The most common cause of gastrointestinal obstruction by a foreign
body is:
A) bezoars
B) parasites
C) intestinal calculi
D) iron-containing calculi
E) gallstones

Back 333

INT-7.431.
E

Front 334

Associate the following term(s) with their corresponding statement(s)!
A) Meckel's diverticulum
B) Hirschprung's disease
C) Pyloric stenosis
D) Cystic fibrosis
E) Enteric cyst

1) no ganglion cells are found in a rectal biopsy
2) surgical resection of the involved, non-hypertrophic segment
3) a rudimentary omphalomesenteric duct
4) inflammation elicits symptoms which cannot be differentiated
from appendicitis
5) surgical resection of the hypertrophic muscle has a beneficial effect
6) meconium ileus

Back 334

INT-7.867.
BBAACD

Front 335

The disease frequently misdiagnosed as regional enteritis is:
A) acute pyelonephritis
B) irritable colon
C) diverticulosis
D) appendicitis
E) gastritis

Back 335

INT-7.439.
D

Front 336

Which of the following states increase the incidence of arteriosclerosis?
1) obesity
2) gastric cancer
3) diabetes mellitus
4) hypothyroidism
5) lymphoid leukemia

Back 336

INT-7.792.
A

Front 337

The most common complaint in carcinoma of the rectum is:
A) diarrhea
B) anal pain
C) abdominal pain
D) constipation
E) melena

Back 337

INT-7.443.
E

Front 338

Which of the following hormones can elevate the serum calcium level?
1) thyroxine
2) calcitonin
3) parathyroid hormone
4) glucocorticoids
5) testosterone

A) 2, 3, 4, and 5 are true
B) only 3 is true
C) 1, 2, and 3 are true
D) 3 and 4 are true
E) all of the above

Back 338

INT-7.785.
C

Front 339

Liver cirrhosis is the most common, but not the sole cause of portal
hypertension and esophageal varicosities. Which varices can be
treated with a splenectomy?
A) schistosomiasis
B) thrombosis of the splenic veins
C) nodular regenerative hyperplasia
D) none of the above

Back 339

INT-7.463.
B

Front 340

Steatorrhea can be caused by:
1) decreased lipase production
2) bile secretion disorders
3) damage of the intestinal epithelium
4) celiac disease
5) tropical sprue

A) 1, 3, 4, and 5 are true
B) 4 and 5 are true
C) 1, 2, 4, and 5 are true
D) 2 and 5 are true
E) all of the above

Back 340

INT-7.780.
E

Front 341

In which of the following malignancies does parathyroid hormone
overload occur?
A) oat-cell carcinoma of the lung
B) thyroid carcinoma
C) epithelial carcinoma of the lung
D) fibrosarcoma
E) lymphoma

Back 341

INT-7.543.
C

Front 342

The initial lesion caused by rheumatoid arthritis:
A) remains in the articular cartilage
B) remains in the articular cavity
C) remains in the synovia
D) remains in the bones comprising the joint
E) remains in the secondary ligaments and tendons

Back 342

INT-7.482.
C

Front 343

Bacterial overgrowth following extensive intestinal resection can cause:
A) hepatic steatosis
B) arthritis
C) colon pseudo-obstruction
D) lactate acidosis
E) all of the above

Back 343

INT-7.500.
E

Front 344

Case Study:
A 48-year-old male patient is treated for Zollinger-Ellison's syndrome
with cimetidine and anticholinergic agents. The disease is well maintained
with this therapy, however gynecomastia and marked impotence
have developed. Due to these side-effects the patient asks for a
different therapy. Which of the following can be recommended?
A) a total gastrectomy
B) a reduced cimetidine dose and an elevation of the
anticholinergic dose
C) a shift from cimetidine to ranitidine
D) to reassure and comfort the patient
E) a vagotomy and a decreased cimetidine dose

Back 344

INT-7.498.
B

Front 345

Which of the following can lead to the development of chronic cor
pulmonale?
A) lobar pneumonia
B) thromboembolism of the pulmonary vein
C) lung edema
D) chronic pulmonary emphysema
E) bronchopneumonia

Back 345

INT-7.301.
D

Front 346

Which study should be performed if infectious arthritis is suspected?
A) X-ray study
B) scintigraphy
C) articular puncture
D) antibiotic therapy

Back 346

INT-7.343.
C

Front 347

Case Study:
A 40-year-old worker had a massive upper gastrointestinal hemorrhage
accompanied by splenomegaly. He never consumed alcohol. Which of the
following could have caused this gastrointestinal bleeding?
A) a peptic ulcer
B) gastritis
C) esophageal varices
D) gastric carcinoma
E) esophagitis

Back 347

INT-7.446.
C

Front 348

All of the following are clinico-pathological symptoms of lead intoxication,
EXCEPT:
A) anemia with basophilic granules in the red blood cells
B) membranous nephropathy with nephrotic syndrome
C) increased renal excretion of aminolevulinic acid and
coproporphyrin
D) lethargy, stupor, mental retardation and encephalopathy

Back 348

INT-7.473.
B

Front 349

Which of the following should be the drug of choice in idiopathic
hypercalciuria?
A) ascorbic acid
B) trichlormethiazide
C) oral orthophosphate
D) cortisone
E) cellulose phosphate

Back 349

INT-7.535.
B

Front 350

The intensity of cardiac murmurs:
A) increases on the right side during expiration
B) amyl nitrate increases the murmur in aortic stenosis
C) increases during Valsalva's maNEUver in hypertrophic obstructive
cardiomyopathy
D) in mitral stenosis the intensity of the murmur depends on the
extent of the stenosis
E) increases during a physical load in aortic insufficiency

Back 350

INT-7.560.
BCE

Front 351

A left ventricular aneurysm:
A) is a common sequel of rheumatic fever
B) causes recurrent ventricular tachycardia
C) causes ST depression on the ECG
D) leads to cardiac insufficiency
E) correlates with a higher incidence of systemic embolization

Back 351

INT-7.563.
BDE

Front 352

Typical alterations in Paget's disease include:
A) increased bone resorption and bone formation
B) stronger than normal bones
C) an increased serum parathormone level
D) high-output cardiac insufficiency is the usual cause of death
E) a high level of urinary hydroxyproline excretion

Back 352

INT-7.580.
AE

Front 353

Associate the following term(s) with their corresponding statement(s)!
A) Carcinoma of the pancreas body
B) Mild, chronic pancreatitis
C) Pancreatitis related to alimentary and metabolic factors
D) Carcinoma of the pancreas head with complete obstruction
E) Pancreatic disease related to hemochromatosis

1) a lack or markedly decreased amount of fluid, low bicarbonate
and amylase level
2) a decreased amount of fluid, with normal bicarbonate and
amylase level
3) a normal amount of fluid, with low bicarbonate and normal or
low amylase level
4) a normal amount of fluid, with normal bicarbonate and low
amylase level
5) an increased amount of fluid, low bicarbonate and normal
amylase level

Back 353

INT-7.856.
DABCE

Front 354

Anemic infarction does not always develop after an occlusion of the
mesenteric artery because an impairment of the venous outflow is another
important factor in the development of hemorrhagic infarction.

Back 354

INT-7.891.
E

Front 355

Case Study
A 32-year-old obese female patient was admitted due to an epigastric
pain on the right side. After a 5-hour observation the symptoms indicated
appendicitis and appendectomy was subsequently performed.
The postoperative period and the next day were uneventful. When the
patient tried to stand up she complained of pain in the right lower
limb accompanied by a period of dyspnea. After rest however, the symptoms
disappeared. Physical examination: sustained tachycardia. On
the 3rd day the patient had a severe stabbing pain in the chest during
walking with marked dyspnea, cough, and hemorrhagic sputum. The
most important observations in the status were: dyspnea, marked
cyanosis, protruding neck veins, a circumscribed pleural friction sound
above the left diaphragm, subfebrility, several cm difference in the diameter
of the lowe limbs, and hypotension.
X-ray: lung opacity over the left diaphragm. ECG: P pulmonale and
signs of right heart strain. The patient had tuberculosis in the past.
The patient never took any medications other than oral contraceptives
(for three years).
7.939/1. Single Choice Question
The most probable diagnosis is:
A) pneumonia
B) pulmonary tuberculosis
C) superficial thrombophlebitis
D) thrombosis of the deep veins with subsequent pulmonary embolism
E) cardiac insufficiency

7.939/2. Single Choice Question
All of the following studies can verify the diagnosis EXCEPT:
A) a chest X-ray
B) ECG
C) venography
D) laboratory studies (hemostasis, enzymes)
E) a lung-scan
F) lymphography

7.939/3. Single Choice Question
Select the most helpful therapy:
A) combined antibiotic therapy
B) cardiac support
C) low-dose heparin therapy
D) high-dose intravenous heparin therapy
E) diuretics

7.939/4. Single Choice Question
How long should the patient be treated after disappearance of the
acute symptoms?
A) until improvement is noted
B) until the patient is complaint-free
C) for 2-3 weeks after disappearance of the complaints
D) for half a year or a year after disappearance of the complaints

7.939/5. Single Choice Question
Select the drug of choice for prolonged therapy:
A) aspirin (Colfarit) tabl.
B) heparin
C) rutoside (Venoruton)
D) coumarin (Syncumar)
E) antibiotics

7.939/6. Single Choice Question
Select the laboratory studies indicated in controlling this patient's
state:
A) a platelet count
B) the bleeding time
C) the prothrombin time
D) the coagulation time
E) the partial thromboplastin time

7.939/7. Single Choice Question
Which of the following does not contribute to the development of
this disease?
A) immobilization
B) obesity
C) varicosity
D) surgery
E) hypertension
F) oral contraceptives

Back 355

7.939
939.DFDDDCE

Front 356

Case Study:
A 60-year-old female patient is admitted to an intensive care unit for
dyspnea. The patient has been treated with digoxin and diuretics. A
month later she developed a syncopal episode. What should be done?
1) an ECG should be taken
2) nifedipine therapy should be initiated
3) a determination of the serum potassium level
4) a determination of the serum calcium and magnesium levels

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 356

INT-7.757.
B

Front 357

Select the complications of chronic acute cholecystitis which require
early surgical intervention:
1) gallbladder empyema
2) ileus
3) emphysematous cholecystitis
4) jaundice

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 357

INT-7.770.
B

Front 358

Associate the following statement(s) with their corresponding term(s)!
A) macroglobulin, vascular insufficiency, plasmapheresis
B) occurs in multiple myeloma, macroglobulinemia, systemic
lupus and peripheral vascular insufficiency
C) macroglobulin which causes hemolytic anemia

1) Increased viscosity
2) Cryoglobulins
3) Cold agglutinins

Back 358

INT-7.842.
ABC

Front 359

A 28-year-old female patient had a tonsilectomy at the age of 6, and an
operation due to otitis media at the age of 9. Since that time she has
had recurrent otitis media and consequently received the appropriate
drug therapy. A month before admission the patient had rhinitis and
took oxytetracycline (Tetran). A day before admission she complained
of otalgia in the right ear. Next morning the patient had nausea and
fever (39
o
C). By that time her husband reported that he could not
communicate with her.
At examination: occipital stiffness; Kernig-positivity; narrow pupils only
slight reactivity to light. Central facial paralysis on the left side. Increased
flexor tone in the upper limbs. Lower limbs are also flexed at
knees. Stupor. Lumbar puncture: colorless cerebrospinal fluid. Cell
count: 51 000/mm
3
. Pandy's test (globulin in the CSF): positive.

7.918/ 1. Single Choice Question
The most probable diagnosis is:
A) choriomeningitis
B) cerebral abscess
C) purulent meningitis
D) epidemic encephalitis
E) basilar tuberculous meningitis

7.918/2. Single Choice Question
The most typical symptom of the disease is:
A) an increased flexor tone of the upper limbs
B) a central facial paralysis
C) an impaired light reaction of the pupil
D) disorientation
E) meningeal signs

7.918/3. Single Choice Question
The typical CSF finding is:
A) dissociation of the cell proteins
B) compression CSF
C) a high cell count with a granulocyte prevalence
D) a mixed cell finding
E) an increased lymphocyte count

7.918/4. Single Choice Question
Medication and therapy include:
A) surgery
B) antibiotics + steroids
C) aimed antibiotic therapy
D) antituberculotic therapy
E) anti-inflammatory therapy

Back 359

INT-7.918.
CECC

Front 360

Case Study
A 31-year-old female patient consults her family doctor. She complains
of a strong pain under the right costal arch and in the lumbar area
which has persisted for several weeks. The pain lasts from several minutes
to several hours and is not related to meals or the quality of the
consumed food. Sometimes she feels pain when travelling by bus. When
the pain is very intense, it is accompanied by nausea and swelling.
The patient was afebrile at all times. Sometimes she felt a more frequent
urge to urinate, but urination was never accompanied by a burning
sensation. Her menstruation cycle is normal. The patient takes no
medications.
7.931 / 1. Single Choice Question
Which of the following questions should be asked on the basis of the
above complaints?
A) Have you experienced intense sweating?
B) Have you had dark stools?
C) Have you had dark urine?
D) Do you have an appetite?
E) Do you feel disgusted by certain meals?

7.931/2. Select One Of The Key Combinations
Which of the following laboratory tests should be performed to verify
the diagnosis?
1) the red blood cell sedimentation rate
2) a complete WBC count
3) the urine amylase concentration
4) any urine precipitate
5) the urine bilirubin concentration

A) (1, (2), and (3) are true
B) (4) and (5) are true
C) (2), (3), and (4) are true
D) all of the above
E) none of the above

7.931/3. Single Choice Question
After having done these laboratory tests, which of the following studies
should be performed?
A) liver scintigraphy
B) an X-ray of the stomach
C) a native abdominal X-ray
D) abdominal ultrasonography
E) a CT

7.931/4. Single Choice Question
Select the appropriate therapy:
A) antibiotics
B) sedation
C) spasmolytics
D) diuretics
E) antacids

7.931/5. Select One Of The Key Combinations
Which of the following recommendations would you give your patient?
1) Check your body weight regularly!
2) Check your stools regularly!
3) Check your urine regularlyl
4) Check your menstruations regularly!
5) Check your body temperature regularly!

A) (1), (2), (3), and (4) are true
B) (2), (4), and (5) are true
C) (3) and (5) are true
D) all of the above
E) none of the above

7.931/6. Single Choice Question
Which specialist should the patient consult if the complaints persist?
A) a gynecologist
B) a surgeon
C) a urologist
D) an internist
E) a rheumatologist

Back 360

INT-7.931.
CBDCCC

Front 361

The highest secretin secretion occurs in the:
A) stomach
B) duodenum
C) jejunum
D) ileum
E) none of the above

Back 361

INT-7.468.
B

Front 362

Which of the following can develop after long-term antibiotic
therapy?
A) esophageal candidiasis
B) esophageal stricture
C) corrosive esophagitis
D) achalasia
E) diffuse scleroderma

Back 362

INT-7.303.
A

Front 363

Which of the following substances induces urinary bladder cancer
in humans?
A) p-aminodiphenyl (aniline dyes)
B) benzene
C) hydramine
D) aflatoxin
E) vinyl chloride

Back 363

INT-7.318
A

Front 364

All of the following drugs can elicit systemic lupus erythematosus,
EXCEPT:
A) procainamide
B) hydralazine
C) isoniazide
D) chlorpromazine
E) gold salts

Back 364

INT-7.322.
E

Front 365

Which of the following most probably occured in the history of a 16-
year-old boy with diabetes mellitus?
A) a recent viral infection
B) an insulin response to a glucose load is about 50% of the normal
C) a decreased energy uptake is required
D) an initiation of biguanide treatment before starting insulin
therapy
E) the patient can participate in physical training lessons and
can participate in other games requiring physical performance

Back 365

INT-7.355.
E

Front 366

Nephrosis occurs in all of the following, EXCEPT:
A) right heart insufficiency
B) constrictive pericarditis
C) obstruction of the inferior caval vein above the renal artery
D) polycystic kidney disease
E) amyloidosis

Back 366

INT-7.373.
D

Front 367

The nephrotic syndrome occurs in all of the following, EXCEPT:
A) membranous glomerulonephritis
B) thrombosis of the renal vein
C) paraproteinemic nephrosis
D) cholemic nephrosis
E) Kimmelstiel-Wilson's syndrome

Back 367

INT-7.288.
D

Front 368

Initial gonococcemia causes gonorrheal urethritis plus one of the
following:
A) myocarditis
B) osteomyelitis
C) arthritis
D) parotitis
E) meningitis

Back 368

INT-7.286.
C

Front 369

Marked splenomegaly occurs in which of the following types of
leukemia?
A) acute lymphoid leukemia
B) acute myeloid leukemia
C) chronic lymphoid leukemia
D) chronic myeloid leukemia
E) polycythemia

Back 369

INT-7.292.
D

Front 370

Case Study:
A 35-year-old male patient complains of a resistant limb edema which
has persisted for many years. He spent most of his life in tropical
countries. His urine is milk-like. Which of the following explains the
pathological changes of his urine?
A) lipiduria
B) a urinary tract infection
C) gonorrhea
D) chyluria
E) an increased consumption of milk

Back 370

INT-7.116.
D

Front 371

All of the following are typical of endogenous pyrogens, EXCEPT:
A) they are low molecular weight proteins
B) they are similar to lysozyme
C) they are heat labile
D) they elicit fever
E) they are inhibited by an endotoxin

Back 371

INT-7.38.
E

Front 372

All of the following are true for osteogenesis imperfecta, EXCEPT:
A) progressive deafness
B) blue sclerae
C) a soft skull with "wormian" bones
D) multiple fractures
E) cataracts

Back 372

INT-7.28.
E

Front 373

Case Study:
A 45-year-old patient's blood pressure is 140/95 (stage 4); the patient
has no other risk factors. Which of the following should be performed
after a 6-month observation period?
A) propranolol therapy should be started
B) potassium chloride therapy should be started
C) diuretic therapy combined with a reduced sodium uptake
should be started
D) the stage-5 diastolic pressure should be checked
E) a larger cuff should be used and the patient's ECG should be taken

Back 373

INT-7.145.
D

Front 374

All of the following tissues contain alkaline phosphatase, EXCEPT:
A) skin
B) bone
C) leukocytes
D) placenta
E) liver

Back 374

INT-7.494
A

Front 375

The main mechanism of action of the thiazide diuretics is on:
A) the thin segment of the loop of Henle
B) the pyramids
C) the collecting duct
D) the whole nephron
E) the early portion of the distal tubule

Back 375

NT-7.99.
E

Front 376

Case Study
A 67-year-old female patient complains of arthralgia which started
about 3 months ago. She has swollen wrists, spindle-like
interphalangeal joints, swollen knees (first left, then right) and ankles.
In the morning she complains of joint rigidity. The patient has no appetite,
fever, and has lost 10 kg. She coughs, and the sputum is sometimes
hemorrhagic. Chest X-ray: on the left side a round-shaped opacity
with blurred edges and hypodense area in the middle is observed.
7.941 / 1. Select One Of The Key Combinations
Select the correct diagnosis:
1) uric arthritis
2) rheumatoid arthritis
3) Caplan's-syndrome (pneumoconiosis)
4) bronchial cancer
5) paraneoplastic syndrome

A) (1), (3), and (5) are true
B) (4), and (5) are true
C) (1), (3), and (4) are true
D) (2) and (5) are true
E) all of the above

7.941/2. Select One Of The Key Combinations
Which of the following methods support the diagnosis:
1) the red blood cell sedimentation rate
2) the complement level
3) Waaler-Rose's latex test
4) determination of the antinuclear factor
5) bronchoscopy-cytology-biopsy
6) the serum uric acid level

A) (1), (3), and (4) are true
B) (2), (4), (5), and (6) are true
C) (1), (3), (5), and (6) are true
D) (3), (4), and (5) are true
E) all of the above

7.941/3.
Select the adequate primary therapy:
A) steroids
B) non-steroid antiinflammatory agents
C) cytostatics in an immunosuppressive dose
D) combined cytostatic therapy in tumor dose
E) surgery

Back 376

INT-7.941.
BEE

Front 377

Which of the following symptoms does not occur in nephroptosis?
A) abdominal seizures in the orthostatic position
B) postural hypertension
C) postural hyperaldosteronism
D) abdominal pain in Trendelenburg's position
E) renal insufficiency

Back 377

INT-7.202.
E

Front 378

Dupuytren's contracture:
A) is a congenital pathology
B) causes extension contracture of the fingers
C) occurs in pseudosarcomatous fibromatosis
D) is caused only by mechanical factors
E) is more common in women

Back 378

INT-7.248.
C

Front 379

Case Study:
Laboratory findings in a patient with an assumed diagnosis of
pertussis showed a 25000 leukocyte count and 75% lymphocytosis.
However nasopharyngeal cultivation did not support the diagnosis.
Which of the following diagnosis can be assumed?
A) an adenovirus infection
B) an unidentified viral infection
C) Rickettsiosis
D) none of the above

Back 379

INT-7.487
A

Front 380

In which of the following is the angiotensinogen (renin substrate)
level abnormally high?
A) during estrogen therapy
B) Hodgkin's disease
C) colitis
D) essential hypertension
E) leukemia

Back 380

INT-7.175.
A

Front 381

Which of the following statements is not typical of membranous
glomerulonephritis?
A) proteinuria but not so pronounced that it causes edema
B) microhematuria
C) a normal complement level
D) non-selective proteinuria
E) hypertonia

Back 381

INT-7.525.
A

Front 382

Which of the following pathological states is accompanied by hypertension?
1) aortic insufficiency
2) hyperthyroidism
3) beriberi disease
4) aortic calcification

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 382

INT-7.741.
E

Front 383

Which of the following is accompanied by a low uric acid level?
A) diabetes without glucosuria
B) diabetic ketoacidosis
C) diabetic nephropathy
D) Hodgkin's disease
E) none of the above

Back 383

INT-7.81.
D

Front 384

The most pronounced gastrointestinal fluid absorption occurs in
the:
A) duodenum
B) jejunum
C) ileum
D) colon
E) none of the above

Back 384

INT-7.238
B

Front 385

A ball on the foot develops in patients with:
1) a bronchogenic carcinoma
2) a lung abscess
3) bronchiectasia
4) chronic obstructive pulmonary disease

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

Back 385

INT-7.767.
A

Front 386

The most common hepatic lesion in cystic fibrosis is:
A) postnecrotic cirrhosis
B) fat atrophy
C) multinodular biliary cirrhosis
D) Laennec's cirrhosis
E) none of the above

Back 386

INT-7.242.
C

Front 387

The anion gap can be increased in:
A) ammonium chloride intoxication
B) pyloric stenosis
C) bromide intoxication
D) multiple myeloma
E) liver cirrhosis

Back 387

INT-7.63.
B

Front 388

Case Study:
A routine test has revealed proteinuria in a 35-year-old male patient.
Electrophoresis of the urine proteins showed low molecular proteins
at high concentration and only sustained albuminuria. RIA
(radioimmunoassay) identifiedthe predominance of beta 2-
microglobulins. Which of the following caused the proteinuria?
A) cadmium intoxication
B) mercury intoxication
C) penicillin intoxication
D) glomerulonephritis
E) none of the above

Back 388

INT-7.125.
A

Front 389

In which of the following diseases does kallikrein secretion decrease?
A) essential hypertension
B) pheochromocytoma
C) primary aldosteronism
D) all of the above
E) none of the above

Back 389

INT-7.166.
A

Front 390

In which disease is a pacemaker usually implanted?
A) total AV block
B) hyperesthesia of the carotid sinus
C) sick sinus syndrome
D) SA node block
E) none of the above

Back 390

INT-7.514.
C

Front 391

All of the following statements about drugs for iron-deficiency
anemia are true, EXCEPT:
A) oral iron preparations contain ferrous iron
B) iron dextran contains ferric iron
C) ferrous sulfate is the drug of choice for iron-deficiency anemia
D) ferrous sulfate contains more than 90% elementel iron
E) diarrhea or constipation can occur with oral iron preparations

Back 391

INT-7.545.
D

Front 392

Which segment of the colon most commonly shows signs of toxic
megacolon or toxic dilation due to ulcerative colitis?
A) the cecum
B) the transverse colon
C) the descending colon
D) the sigmoid colon
E) the rectum

Back 392

INT-7.441.
B

Front 393

What percent of the total cortical surface is comprised by the frontal
lobe?
A) 20%
B) 40%
C) 60%
D) 70%
E) 90%

Back 393

NEU-6.136.
B

Front 394

A bilateral lesion of the feeding center in the lateral hypothalamus
causes:
A) aphasia
B) aphagia
C) hyperphagia
D) polyuria

Back 394

NEU-6.169.
B

Front 395

Select the most typical feature of synaptic transmission:
A) conduction is not unidirectional
B) it is a combination of electrical and chemical transmission
C) norepinephine is always involved
D) synaptic transmission cannot be blocked

Back 395

NEU-6.172.
B

Front 396

A long period between the onset of the symptoms and the diagnosis
of an intracranial tumor occurs in cases of.
A) melanoma metstasis
B) medulloblastoma
C) multiforme glioblastoma
D) pituitary adenoma
E) melanosarcoma

Back 396

NEU-6.537.
D

Front 397

At high doses all barbiturates exhibit an anticonvulsive effect.

Back 397

NEU-6.2.
T

Front 398

The electric stimulation of certain areas of the brain can mimic normal
sleep.

Back 398

NEU-6.3.
T

Front 399

Phenytoin strongly inhibits the post-tetanic increase of excitation.

Back 399

NEU-6.4.
T

Front 400

Local anesthetics inhibit the depolarization and propagation of
physiological stimuli.

Back 400

NEU-6.5
T

Front 401

D-tubocurarine is a non-specific inhibitor of the motor end-plate.

Back 401

NEU-6.6.
F

Front 402

Phenytoin increases the intracellular sodium level.

Back 402

NEU-6.7.
F

Front 403

impaired liver function affects the metabolism of phenytoin leading
to the subsequent accumulation of this component.

Back 403

NEU-6.8.
T

Front 404

Phenothiazines and Rauwolfia alkaloids induce Parkinson-like
symptoms.

Back 404

NEU-6.9.
T

Front 405

It is generally accepted that the dopaminergic pathways of the extrapyramidal
system are damaged in Parkinson's disease.

Back 405

NEU-6.12.
T

Front 406

Tumors never induce spike activity.

Back 406

NEU-6.18.
F

Front 407

In tuberculous meningitisthe tuberculin test is usually negative.

Back 407

NEU-6.24
F

Front 408

A cerebellar abscess can occur in chronic mastoididtis.

Back 408

NEU-6.30
T

Front 409

A decreased serum ceruloplasmin level is typical of Wilson's disease.

Back 409

NEU-6.45.
T

Front 410

Clinical symptoms alone are not sufficient to differentiate Friedreich's
ataxia from multiple sclerosis.

Back 410

NEU-6.56.
F

Front 411

Mark the prognosis of the following pediatric tumors as favorable (F)
or unfavorable (U):

1. cerebellar astrocytoma
2. cerebral astrocytoma
3. medulloblastoma
4. tumor of the medulla

Back 411

NEU-6.83.
FUUU

Front 412

Mark the following as causing hydrocephalus of a communicating
(C) or non-communicating type (NC):
1. subdural hematoma
2. post-inflammatory hydrocephalus
3. basilar impression
4. thrombosis of the lateral sinus

Back 412

NEU-6.84.
CCCC

Front 413

Mark the following alterations as either of muscular (A) or NEUrogenic
(B) origin:
1. frequent fasciculations
2. predominantly proximal weakness
3. predominantly distal weakness
4. lack of fasciculations
5. fibrillations
6. muscle irritability at percussion

Back 413

NEU-6.85.
NMNMNN

Front 414

Herpes infection of the geniculate ganglion usually causes a facial
paralysis.

Back 414

NEU-6.92.
T

Front 415

In some cases herpes zoster spares the nuclei and causes paralysis
of only the nerve.

Back 415

NEU-6.93.
T

Front 416

Parenteral histamine is the therapy of choice in migraine fits.

Back 416

NEU-6.100.
F

Front 417

In most cases the site of pain helps to differentiate a migraine from
trigeminal neuralgia.

Back 417

NEU-6.102.
T

Front 418

A Parkinsonian tremor is more pronounced during voluntary motions.

Back 418

NEU-6.103.
F

Front 419

Sensory disturbances can quickly develop in arsenic and alcoholinduced
polyneuritis.

Back 419

NEU-6.105.
T

Front 420

Micturition symptoms develop early in cervical spondylosis.

Back 420

NEU-6.108.
F

Front 421

In case of a well localized cerebral abscess the body temperature is
normal or subnormal.

Back 421

NEU-6.118.
T

Front 422

The cells of the fasciculus cuneatus are localized in the:
A) gelatinous substance
B) ganglia of the dorsal horns
C) nucleus proprius
D) all of the above.
E) none of the above

Back 422

NEU-6.126.
B

Front 423

Fibers enter the gelatinous substance from:
A) the lateral spinothalamic tract
B) the dorsal roots associated with sensation of pain and heat
C) the Clarke nucleus
D) all of the above
E) none of the above

Back 423

NEU-6.127.
B

Front 424

The following two lobes constitute the inferior part of the parietal
lobe:
A) triangular and opercular lobes
B) supermarginal and angular lobes
C) triangular and angular lobes
D) all of the above
E) none of the above

Back 424

NEU-6.129.
B

Front 425

Pigment granules can be observed in:
A) the cells of the substantia nigra
B) the cells of the locus ceruleus
C) the dorsal efferent nuclei of the vagus
D) all of the above
E) none of the above

Back 425

NEU-6.130.
D

Front 426

Which of the following is a parasympathetic nucleus?
A) Edinger-Westphal nucleus
B) Inferior salivatory nucleus
C) Dorsal efferent nucleus of the vagus
D) all of the above
E) none of the above

Back 426

NEU-6.131.
D

Front 427

Which types of cells can be found in the brain cortex?
A) pyramidal cells
B) stellate cells
C) Cajal's cells
D) all of the above
E) none of the above

Back 427

NEU-6.133.
-

Front 428

The recurrent artery (Heubneri) originates from:
A) the internal carotid artery
B) the anterior communicating artery
C) the anterior choroid artery
D) all of the above
E) none of the above

Back 428

NEU-6.134.
E

Front 429

Cerebral posterior arteries:
A) originate from the basilar artery
B) can join with the superior cerebellar artery
C) supply the occipital lobe
D) all of the above
E) none of the above

Back 429

NEU-6.140
D

Front 430

The "genu" of the internal capsule carries the following fibers:
A) fibers from the anterior thalamic nuclei
B) frontoparietal fibers
C) corticobulbar fibers
D) all of the above
E) none of the above

Back 430

NEU-6.142.
C

Front 431

Following the occlusion of the saggital sinus:
A) the ventricles dilate
B) the CSF pressure increases
C) both of the above
D) none of the above

Back 431

NEU-6.145.

Front 432

The blood-brain barrier is composed of.
A) capillary endothelium
B) basal membrane
C) podocytes of the astrocytes
D) all of the above

Back 432

NEU-6.149.
D

Front 433

Which of the following is a neurotransmitter in the parasympathetic
postganglionic synapses?
A) muscarine
B) norepinephrine
C) epinephrine
D) acetylcholine
E) buterylcholine

Back 433

NEU-6.164.
D

Front 434

Which of the following is not an intermediate product of norepinephrine
synthesis?
A) tyrosine .
B) epinephrine
C) dopamine
D) DOPA

Back 434

NEU-6.165.
B

Front 435

Which of the following is not a side-effect of antihistamine drugs?
A) supression of sea-sickness
B) alleviation of some symptoms of Parkinson's disease
C) alleviation of symptoms of tertiary syphilis
D) suppression of petit mal epilepsy

Back 435

NEU-6.166.
C

Front 436

The typical memory loss occurring in Korsakoffs syndrome is due to
a lesion of which of the following structures?
A) parietal associative cortex
B) frontal associative cortex
C) mammilary body, limbic cortex
D) habenula

Back 436

NEU-6.167.
C

Front 437

Which fibers convey nociceptive stimuli?
A) unmyelinated C fibers
B) myelinated fibers of small diameter
C) both of the above
D) none of the above

Back 437

NEU-6.168.
C

Front 438

A bilateral lesion of the feeding center in the lateral hypothalamus
causes:
A) aphasia
B) aphagia
C) hyperphagia
D) polyuria

Back 438

NEU-6.169.
B

Front 439

Mark the false statement - the pyramidal tract:
A) a part of it arises from Brodmann's area 4
B) most of it originates from neocortical areas
C) 80-90% of the pathways cross in the inferior part of medulla

Back 439

NEU-6.170.
B

Front 440

The conduction velocity of an axon:
A) increases as the diameter increases
B) is less in axons with lower threshold values
C) both of the above
D) none of the above

Back 440

NEU-6.173.
A

Front 441

The motor unit:
A) consists of the alpha-motor neurons of a given muscle
B) consists of the alpha and gamma-motor neurons of a given
muscle
C) consists of an alpha-motor neuron and the muscle fibres
supplied by this neuron.
D) consists of the muscle fibers supplied by one motor neuron
and a nerve.

Back 441

NEU-6.174.
D

Front 442

The retinal representation of the eye is observed in:
A) the lateral geniculate body
B) the primary visual cortex
C) both of the above
D) none of the above

Back 442

NEU-6.175.
C

Front 443

The membrane potential is created by a:
A) concentration difference on both sides of the membrane and
different permeabilities for individual ions
B) Na+-pump
C) resting potential
D) reduced activity of the ions in the cytoplasm

Back 443

NEU-6.176.
A

Front 444

Typical electric signs of a paradox sleeping behavior are:
A) low amplitude, high frequency
B) high amplitude, high frequency
C) low amplitude, low frequency
D) high amplitude, low frequency

Back 444

NEU-6.177.
A

Front 445

After transection of the, spinal cord in humans:
A) flexion reflexes reappear earlier than the extension reflexes
B) extension reflexes reappear earlier than the flexor reflexes
C) flexor and extensor reflexes reappear at the same time
D) after trauma sweating is a common response to strong
stimuli

Back 445

NEU-6.179.
A

Front 446

Loss of which of the following functions develops in spinal shock
caused by transection of the spinal cord?
A) voluntary movement
B) sensory function
C) spinal reflexes
D) all of the above

Back 446

NEU-6.181.
D

Front 447

The following substrate is mainly metabolized by the human
brain:
A) glutamate
B) albumin
C) glucose
D) none of the above

Back 447

NEU-6.183.
C

Front 448

During generalized seizures brain metabolism:
A) increases
B) decreases
C) remains unchanged

Back 448

NEU-6.184.
A

Front 449

Phosphorylase:
A) does not occur in the brain
B) occurs in the brain in low concentrations
C) occurs in the brain in high concentrations

Back 449

NEU-6.188.
C

Front 450

The most common tumor of the 3rd ventricle is:
A) ependymoma
B) pinealoma
C) colloid cyst
D) medulloblastoma
E) astrocytoma

Back 450

NEU-6.189.
B

Front 451

The most common tumor which causes sella enlargement is:
A) eosinophilic pituitary adenoma
B) basophilic pituitary adenoma
C) chromophobic pituitary adenoma
D) dorsurri sellae meningioma
E) craniopharyngioma

Back 451

NEU-6.193.
C

Front 452

The frequency of the alpha rhythm is:
A) 4-6 cycles/sec
B) 6-8 cycles/sec
C) 8-12 cycles/sec
D) none of the above

Back 452

NEU-6.195.
C

Front 453

In a chronic subdural hematoma:
A) the EEG can be normal
B) the EEG exhibits a slow-wave focus
C) the EEG has decreased amplitude
D) all of the above
E) none of the above

Back 453

NEU-6.196
D

Front 454

Blood in a CSF sample gained with lumbar puncture quickly disappears:
A) if it was caused by subarachnoid bleeding
B) if bleeding was caused by the puncture itself
C) if it was caused by thrombosis of the cerebral vessels
D) if it was caused by an embolism of the cerebral vessels
E) suggests rupture of an intracranial aneurysm

Back 454

NEU-6.204.
B

Front 455

An electrode is considered to be positioned over an epileptic focus if:
A) alpha-activity is observed
B) if the so-called "inversed phase" phenomenon is observed
C) both (A) and (B) are true
D) the rest activity is recorded
E) none of the above

Back 455

NEU-6.205
B

Front 456

Eczema, blond hair, blue eyes and mental retardation are typical of:
A) phenylketonuria
B) cretinism
C) tuberous sclerosis
D) Down's syndrome
E) toxoplasmosis

Back 456

NEU-6.207.
A

Front 457

In acute purulent meningitis, the CSF is NEVER:
A) opalescent
B) clear
C) turbid ("cloudy")
D) purulent
E) flowing at increased pressure

Back 457

NEU-6.208.
B

Front 458

Which of the following are the most common symptoms of an epidural
hematoma in a child?
A) papilledema and stupor
B) retinal bleeding and coma
C) ataxia and hemiparesis
D) hemiparesis and contralateral pupil dilation
E) hyperreflexia and contralateral paresis of cranial nerve VI.

Back 458

NEU-6.219
D

Front 459

If the case history of an infant mentions trauma, vomiting, seizures,
and an enlarged head. What should be done?
A) an EEG
B) a lumbar puncture
C) an X-ray of the skull
D) a CT of the skull
E) a radionuclide scan of the brain

Back 459

NEU-6.220.
D

Front 460

The most common symptom of increased intracranial pressure in
children is:
A) a loss of visual acuity
B) stupor
C) vomiting
D) ataxia
E) diplopia

Back 460

NEU-6.221.
C

Front 461

Wilson's disease:
A) a Kayser-Fleischer ring is observed in nearly all cases,
B) it is usually not inherited
C) it is resistant to all kinds of therapy
D) has only neurologic symptoms
E) can only be diagnosed by a cortex biopsy

Back 461

NEU-6.228.
A

Front 462

The best diagnostic method in pediatric head trauma is:
A) X-ray of the skull
B) pneumoencephalography (PEG)
C) skull CT
D) EEG
E) radionuclide brain scan.

Back 462

NEU-6.230.
-

Front 463

Seizures in pediatric patients:
A) occur most frequently in tumors
B) occur most frequently with high fever
C) rarely occur after the introduction of "Sabin's vaccination
D) rarely occur in subdural hematoma
E) rarely occur in hypocalcemia

Back 463

NEU-6.231.
B

Front 464

Case Study:
Shortly after a penetrating foot injury a pediatric patient developed
trismus, risus sardonicus, opisthotonus, abdominal rigidity. The
most probable diagnosis is:
A) drug allergy
B) hysteria
C) tetanus
D) gas gangrene
E) meningitis

Back 464

NEU-6.232.
C

Front 465

Subdural hematomas in infants are:
A) bilateral and occipital
B) unilateral and frontoparietal
C) bilateral and frontoparietal
D) unilateral and basal
E) unilateral and temporal

Back 465

NEU-6.233.
C

Front 466

Which of the following CSF findings occur in acute purulent meningitis?
A) normal pressure, clear and xanthochromic
B) normal pressure, clear and colorless
C) increased pressure, hemorrhagic
D) increased pressure, turbid
E) increased pressure, clear

Back 466

NEU-6.234
D

Front 467

Which of the following pediatric tumors spreads (is disseminated) in
the CSF prior to surgery?
A) cerebellar astrocytoma
B) medulloblastoma
C) craniopharyngioma
D) glioma of the optic nerve
E) teratoma

Back 467

NEU-6.235.
B

Front 468

After an intramuscular penicillin injection an immediate sciatic
nerve neuropathy develops. What is suspected?
A) an allergic reaction
B) direct injury to the sciatic nerve
C) a toxic effect of penicillin on the nerve tissue
D) none of the above

Back 468

NEU-6.257.
B

Front 469

Case Study:
A deep injury of the foot has been treated with tetanus-antitoxin;
several days later the patient reported weakness and pain in his
arms. What is suspected:
A) tetanus
B) septicemia
C) botulism
D) brachial serum-neuritis
E) none of the above

Back 469

NEU-6.259.
D

Front 470

Duchenne's dystrophy:
A) the symptoms develop at the age of 3-5
B) sometimes mental retardation occurs
C) can be best diagnosed with muscle biopsy
D) the serum creatine-phosphokinase is elevated
E) all of the above

Back 470

NEU-6.264
E

Front 471

Case Study:
A 45-year-old male patient complains of lumbar pain radiating to his
leg.Ipsilateral Achilles areflexia and hypesthesia in the small toe were
found.
At which spinal root level does the patient have a disc hernia
compression?
A) L2 root
B) L3 root
C) L4 root
D) L5 root
E) S1 root

Back 471

NEU-6.271.
E

Front 472

Occlusion of the main trunk of the middle cerebral artery results in:
A) hemiplegia and hemianesthesia
B) hemiparesis
C) hemiplegia, hemianesthesia and homonymous hemianopsia
D) the thalamus syndrome and choreoathetosis

Back 472

NEU-6.283.
C

Front 473

Thrombosis of which artery is the most common vascular lesion of
the brain stem?
A) the anterior chorioid artery
B) the paramedian pontine artery
C) the anterior inferior cerebellar artery
D) the posterior inferior cerebellar artery
E) the superior cerebellar artery

Back 473

NEU-6.284.
D

Front 474

Define the following: emotional lability, dysarthria, dysphagia, hyperactive
mandibular reflex:
A) Wallenberg's syndrome
B) Weber's syndrome
C) Pseudobulbar syndrome
D) Millard-Gubler's syndrome
E) Benedict's syndrome

Back 474

NEU-6.285.
C

Front 475

A sudden development of hemiplegia and contralateral ophthalmoplegia
is most probably due to alterations in the:
A) frontal lobe
B) lateral medulla
C) mesencephalon
D) pons
E) paracentrallobe

Back 475

NEU-6.286.
C

Front 476

The most common site of congenital aneurysms is:
A) between the middle cerebral artery- internal carotid artery
B) between the anterior cerebral artery - anterior communicant artery
C) between the posterior cerebral artery - posterior communicant
artery
D) between the basilar artery - vertebral artery
E) the ophthalmic artery

Back 476

NEU-6.288
A

Front 477

The symptoms of a left-sided epidural hematoma in comatous patients
include:
A) contralateral hemiplegia
B) ipsilateral hemiplegia
C) contralateral hemiplegia and ipsilateral paralysis of CN III
D) contralateral hemiplegia and paralysis of CN III
E) ipsilateral hemiplegia and paralysis of CN III

Back 477

NEU-6.289.
C

Front 478

Case Study:
A male patient complains of diplopia and numbness of one side of his body
and face. Later he became comatous, developed quadriplegia and narrow
pupils not sensitive to light. The most probable site of thrombosis is
the:
A) anterior cerebral artery
B) basilar artery
C) superior cerebellar artery
D) inferior cerebellar artery
E) lenticulostriatal artery

Back 478

NEU-6.290.
B

Front 479

Case Study:
A 64-year-old male patient has mental disorders, abnormal gait and
incontinence. The CT study revealed expanded ventricles and compression
of the subarachnoid space. The most probable diagnosis is:
A) Alzheimer's disease
B) Pick's disease
C) a normal pressure hydrocephalus
D) Jakob-Creutzfeldt disease
E) Quentin's disease

Back 479

NEU-6.291.
C

Front 480

The worst prognosis of the functional restitution of the bladder is expected
in:
A) a thoracic spinal injury
B) a cervical spinal injury
C) a lumbar spinal injury
D) an injury of the sacral plexus
E) a cervical plexus injury

Back 480

NEU-6.292.
D

Front 481

The best diagnostic approach in familial periodic paralysis is:
A) a muscle biopsy
B) an EMG
C) the serum K+
concentration
D) an oral glucose tolerance test
E) the nerve conductance velocity

Back 481

NEU-6.293.
C

Front 482

Nasal discharge of cerebrospinal fluid occurs in:
A) cranial fractures
B) brain tumors
C) congenital defects
D) pseudotumor
E) all of the above

Back 482

NEU-6.294.
A

Front 483

Which structure remains unaffected in multiple sclerosis?
A) the cerebellar tract
B) the pyramidal tract
C) the motoneurons of the ventral horn
D) the spinal dorsal horn
E) the visual tract

Back 483

NEU-6.296
C

Front 484

Lumbar and low extremity pain, peripheral low extremity paresis
and urination disorders occur in:
A) lumbar spondylosis
B) lumbar disc hernia
C) a tumor of the cauda equina
D) all of the above

Back 484

NEU-6.297.
D

Front 485

Cataplexy occurs in:
A) grand mal epilepsy
B) Kleine-Levin's syndrome
C) narcolepsy
D) psychomotor epilepsy
E) "status epilepticus"

Back 485

NEU-6.298
C

Front 486

Which diseases are accompanied by paralysis of the external ocular
muscles?
A) myasthenia gravis
B) multiple sclerosis
C) Tolosa-Hunt's syndrome
D) Wernicke's encephalopathy
E) migraine headache
F) ischemic injury of the brain stem
G) all of the above

Back 486

NEU-6.299
G

Front 487

The therapy of choice in trigeminal neuralgia is:
A) clonezepam (Rivotril)
B) alcohol infiltration
C) carbamazepine
D) retroganglionic neurotomy
E) none of the above

Back 487

NEU-6.300.
C

Front 488

Occlusion of the anterior cerebral artery has the following symptoms:
A) contralateral homonymous hemianopsia
B) contralateral hemihypesthesia
C) Gerstmann's syndrome
D) ipsilateral paresis and sensory disturbances of the lower
extremity.
E) contralateral paresis and sensory disturbances of the lower
extremity

Back 488

NEU-6.301.
E

Front 489

Atrophy of the optic nerve can be caused by:
A) glioma of the optic nerve
B) severe congestion of the fundus
C) Kennedy-Gowers's syndrome
D) optochiasmatic arachnoiditis
E) all of the above
F) none of the above

Back 489

NEU-6.302.
E

Front 490

Atrophy of the optic nerve can occur:
A) as a sequel of glaucoma
B) after rupture of an intracranial aneurysm
C) after papillitis
D) after cerebral commotion
E) none of the above

Back 490

NEU-6.303.
C

Front 491

Which of the following can occur after an ipsilateral occlusion of the
internal carotid artery?
A) no neurologic signs
B) ipsilateral amaurosis and contralateral hemiparesis
C) contralateral hemiparesis and hemihypesthesia
D) contralateral hemiparesis, hemihypesthesia, and homonymous
hemianopsia
E) all of the above

Back 491

NEU-6.304.
E

Front 492

A sudden visual disorder can occur in:
A) temporal arteritis
B) disease of the ipsilateral internal carotid artery
C) ipsilateral embolism of the central retinal artery
D) migraine headaches
E) all of the above

Back 492

NEU-6.305.
E

Front 493

Which of the following is typical of the retrobulbar NEUritis occurring
in multiple sclerosis?
A) it is usually unilateral
B) marked visual disorders
C) later it is accompanied by temporal pallor
D) all of the above
E) none of the above

Back 493

NEU-6.306.
D

Front 494

Embolization of the cerebral vessels occurs:
A) as a sequel of mitral valve prolapse
B) as a seqel of atrial fibrillation
C) if a lateral thrombus develops
D) as a sequel of subacute bacterial endocarditis
E) after cardiac surgery
F) all of the above

Back 494

NEU-6.307.
F

Front 495

Which of thefollowing should be considered in the differential diagnosis
of papilledema?
A) pseudoedema of the papilla
B) papillitis
C) thrombosis of the central vein
D) all of the above
E) none of the above

Back 495

NEU-6.308.
D

Front 496

Which of the following diseases is accompanied by papilledema?
A) Gullain-Barré syndrome
B) lung emphysema
C) anemia
D) hypoparathyroidism in children
E) hypervitaminosis -A
F) all of the above

Back 496

NEU-6.309.
F

Front 497

The most common cause of cerebral vascular thrombosis is:
A) hypertension
B) arteriosclerosis
C) diabetes
D) syphilis
E) collagen disease

Back 497

NEU-6.310.
B

Front 498

When do the symptoms of parainfectional encephalomyelitis develop?
A) 2 weeks before the appearance of exanthemas
B) 1 week before the appearance of exanthemas
C) simultaneously with the exanthemas
D) 2 weeks after the appearance of exanthemas
E) none of the above

Back 498

NEU-6.311.
D

Front 499

Which of the following can accompany infectious mononucleosis?
A) generalized polyneuritis
B) facial paralysis
C) encephalitis
D) a lesion of the oculomotor nerve
E) all of the above

Back 499

NEU-6.312.
E

Front 500

Which of the following is typical of rabies?
A) it develops following different incubation periods
B) it develops within a short time period following a bite from an
infected animal
C) bites of different animals can elicit the disease
D) it causes difficulties in swallowing
E) all of the above

Back 500

NEU-6.313.
E

Front 501

A brain abscess:
A) is a sequel of bronchiectasis
B) is a sequel of frontal sinusitis
C) is similar to other intracranial space occupying processes as it
causes neurologic symptoms
D) is fatal if left untreated
E) all of the above

Back 501

NEU-6.314.
E

Front 502

If meningitis symptoms are accompanied by petechias on the skin,
the most probable pathogenic microorganism is:
A) Staphylococcus
B) Streptococcus
C) Pneumococcus
D) Meningococcus
E) Hemophilus influenzae

Back 502

NEU-6.317.
D

Front 503

Nneurologic symptoms accompanying cardiac diseases are:
A) thrombosis and embolism
B) abscess and aneurysm
C) seizures and syncope
D) all of the above

Back 503

NEU-6.318.
D

Front 504

Hemiplegia developing after a subarachnoid hemorrhage can be
caused by:
A) softening due to vascular spasm
B) an intracerebral hematoma
C) both of the above
D) none of the above

Back 504

NEU-6.321.
C

Front 505

Case Study:
During physical work a 50-year-old male patient had a sudden
headache, neck rigidity, seizures, paralysis of the 3rd cranial nerve
and a rapidly developing coma The most probable diagnosis is:
A) bacterial meningitis spontaneous subarachnoid hemorrhage due to an aneurysm
C) rupture of a brain abscess
D) glioma hemorrhage
E) brain metastasis

Back 505

NEU-6.322.
B

Front 506

Which process is usually followed by hematomyelitis?
A) a blood dyscrasia
B) congenital aneurysm
C) trauma
D) a demyelinizating process
E) all of the above

Back 506

NEU-6.324.
C

Front 507

Which pathological process is usually accompanied by an epidural
hematoma?
A) brain contusion
B) rupture of the medial meningeal artery
C) rupture of the lateral sinus
D) rupture of the pontine veins
E) none of the above

Back 507

NEU-6.326.
B

Front 508

If a head injury is followed by unconsciousness. Which pathological
process is assumed?
A) brain contusion
B) brain commotion
C) an epidural hematoma
D) a subdural hematoma
E) abrain abscess

Back 508

NEU-6.327.

Front 509

The most common neurologic symptoms in amyotrophic lateral
sclerosis are:
A) organic mental syndromes
B) urological symptoms
C) aphasia; agnosia
D) spinal muscle atrophy, spasticity, pyramidal symptoms
E) visual field disturbances

Back 509

NEU-6.328
D

Front 510

Case Study:
A 10-year-old girl with normal gait complains of proximal muscle weakness.
This, as well as atrophy of the proximal muscles of the lower extremities
has been verified during the examination. A weak patellar reflex
and pseudohyperlrophy of the leg muscles are also observed. Muscle
biopsy indicated neurogenic atrophy. The most probable diagnosis is:
A) myasthenia gravis
B) hereditary amyotrophic lateral sclerosis
C) Wolfhart-Kugelberg-Welander's disease
D) Duchenne's dystrophy
E) polymyositis

Back 510

NEU-6.329.
C

Front 511

The most common sequel of a cerebrospinal fluid fistula is:
A) headache
B) meningitis or brain abscess
C) a decrease of the CSF pressure
D) cortical atrophy
E) development of a hygroma

Back 511

NEU-6.330.
B

Front 512

The diagnosis of syringomyelia is primarily based on:
A) myelography
B) the CSF findings
C) localized muscle atrophy, sensory disorders, and impaired
development of the bones
D) an EMG
E) any remissions in the course of the disease

Back 512

NEU-6.331.

Front 513

Which test is of no (less) value in the diagnosis of progressive muscle
dystrophy?
A) a muscle biopsy
B) the serum creatinine phosphokinase level
C) the EMG
D) the muscle histochemistry
E) the EEG

Back 513

NEU-6.333.
E

Front 514

A less typical symptom of myotonic dystrophy is:
A) pseudohypertrophy
B) cataract
C) baldness
D) testis atrophy
E) mental disorders
F) atrophy of the facial muscles

Back 514

NEU-6.335.
A

Front 515

One of the following is not characteristic of Parkinson's syndrome:
A) degeneration of the substantia nigra
B) dopamine deficiency
C) cholinergic substances provoke parkinsonism
D) decreased muscle tone
E) mental symptoms

Back 515

NEU-6.336.
D

Front 516

Which of the following is typical of an alcoholic polyneuropathy?
A) a piercing pain is always present
B) sensory disorders in-the lower extremities
C) absence of autonomic symptoms
D) normal conducting velocity in the peroneal nerve
E) hyperthermia

Back 516

NEU-6.341.
B

Front 517

The rarest symptom in multiple sclerosis is:
A) impaired visual acuity
B) ataxia
C) vertigo
D) paresthesia
E) weakness
F) seizures
G) urinary disorders

Back 517

NEU-6.342.
F

Front 518

The most common CSF finding in multiple sclerosis is:
A) increased pressure
B) a cell count of over 100/mm
3

C) an elevated gamma-globulin level
D) a decreased protein level
E) a decreased glucose level

Back 518

NEU-6.343.
C

Front 519

One of the following is less typical of multiple sclerosis:
A) spastic paraparalysis
B) internuclear ophthalmoplegia
C) nystagmus
D) a concomitantpregnancy should be interrupted
E) retrobulbar neuritis

Back 519

NEU-6.344.
D

Front 520

Which of the following is not true for epilepsy?
A) the diagnosis of epilepsy does not solely depends on the EEG
B) the CT or MRI can be helpful if focal EEG alterations are observed
C) after cessation of a seizure the medication used for its therapy
can be discontinued immediately
D) pathogenic causes can be ruled out in symptomatic epilepsy
E) the dose of the effective drug should be continuously increased

Back 520

NEU-6.346.
C

Front 521

Case Study:
A 45-year-old male patient is being examined for epilepsy. A mild left
facial and left-sided hemiparesis were found. A circumscribed bone
thinning and bone spicules on the right side were also visualized on
the X-ray. What is the most probable diagnosis?
A) occlusion of the right carotid artery
B) medulloblastoma
C) cerebellar astrocytoma
D) withdrawal symptoms
E) meningioma

Back 521

NEU-6.348.
E

Front 522

The most frequent cause of retrobulbar neuritis is:
A) a paranasal sinus infection
B) temporal arteritis
C) multiple sclerosis
D) aneurysm
E) alcohol; smoking

Back 522

NEU-6.349.
C

Front 523

Case Study:
A 30-year-old woman complains of diplopia, disturbances of speech
and swallowing. The symptoms show daily variations. Which of the
following tests is the most relevant?
A) an oral glucose tolerance test
B) the EEG
C) an Edrophonium (Tensilon) test
D) an oligoclonal gamma test
E) the VEP

Back 523

NEU-6.350.
C

Front 524

Case Study:
After sustaining a skull injury a 50-year-old male patient complains
of progressive pulsating exophthalmus and diplopia What could
have happened?
A) a subtemporal hematoma
B) an epidural hematoma
C) a carotid-cavernous fistula
D) an intracerebral hematoma
E) an aneurysm of the basilar artery

Back 524

NEU-6.352.
C

Front 525

Select a lumbar CSF finding typically occurring in viral meningitis:
A) 2 mononuclear cells/mm3, protein 20 mg%, glucose 20 mg%
B) 2 mononuclear cells/mm3, protein 50 mg%, glucose 20 mg%
C) 20 mononuclear cells/mm3, protein 100 mg%, glucose 20 mg%
D) 200 mononuclear cells/mm3, protein 100 mg%, glucose 20 mg%
E) 100-1000 mononuclear cells/mm3, protein 60 mg%, glucose 50 mg%

Back 525

NEU-6.353
E

Front 526

A suddenly developing nystagmus, vertigo, Horner's syndrome,
ataxia without paralysis, and alternating sensory disorder suggest
occlusion of which artery?
A) anterior chorioidal artery
B) posterior chorioidal artery
C) basilar artery
D) inferior posterior cerebellar artery
E) superior cerebellar artery

Back 526

NEU-6.354.
D

Front 527

Case Study:
An 80-year-old alcoholic male patient complains of a headache
probably due to skull injury. He has had left-sided hemiparesis for a
month. The right carotidangiography showed detachment of the
cerebral vessels from the internal surface of the skull. The most
probable diagnosis is:
A) cerebral contusion
B) right-sided glioblastoma of the frontal lobe
C) right-sided subdural hematoma
D) right-sided epidural hematoma
E) occlusion of the right middle cerebral artery

Back 527

NEU-6.355.
C

Front 528

One of the following is not characteristic of the cauda syndrome:
A) it is commonly caused by traumatic alterations in Ll-2
B) it can impair all sensory modalities
C) sphincter paralysis
D) no pyramidal symptoms
E) spastic paralysis

Back 528

NEU-6.357.
E

Front 529

Case Study:
A 40-year-old male patient develops a sudden vertigo, vomiting, and
imbalance. Which disease is the least probable?
A) Meniére's syndrome
B) acute labyrinthitis
C) acoustic neuroma
D) multiple sclerosis
E) vascular disease of the brain stem

Back 529

NEU-6.362.
C

Front 530

Which part of the nervous system is the least affected in multiple
sclerosis?
A) the spinal cord
B) the cerebral cortex
C) the cerebellar tracts
D) the brain stem
E) the visual tract

Back 530

NEU-6.368.
B

Front 531

In optic atrophy which of the following alterations are accompanied
by a bitemporal visual field defect?
A) parachiasmallesion
B) retinal vascular disease
C) chiasmatic lesion
D) tumor of the optic nerve
E) none of the above

Back 531

NEU-6.371.
C

Front 532

The most common intracranial tumor is:
A) meningoma
B) acoustic neuroma
C) glioma
D) pituitary adenoma
E) angioma
F) metastasis

Back 532

NEU-6.372.
C

Front 533

Which disease does not accompany alcoholism?
A) central pontine myelinolysis
B) Pick's psychosis
C) primary degeneration of the corpus callosum
D) Wernicke's syndrome
E) Korsakoffs psychosis
F) parenchymal cerebellar degeneration

Back 533

NEU-6.374.
B

Front 534

Which of the following diseases shows the greatest coincidence with
myasthenia gravis?
A) thymus tumor
B) thymus hyperplasia
C) hyperthyroidism
D) hypothyroidism
E) all of the above

Back 534

NEU-6.375.
E

Front 535

Select the main anastomoses of the cerebral circulation:
A) The circle of Willis
B) supracortical anastomoses of the main cerebral arteries
C) anastomosis between internal and external carotid arteries
D) all of the above
E) none of the above

Back 535

NEU-6.376.
D

Front 536

Continous therapy with phenytoin can cause:
A) peripheral neuropathy
B) visual impairment, ataxia
C) gingival hyperplasia
D) all of the above
E) none of the above

Back 536

NEU-6.378.
D

Front 537

Coma frequently occurs in:
A) thrombosis
B) embolism
C) hemorrhage

Back 537

NEU-6.382.
C

Front 538

Headache frequently occurs in:
A) thrombosis
B) embolism
C) hemorrhage

Back 538

NEU-6.383.
C

Front 539

Blood pressure is usually normal in:
A) thrombosis
B) embolism
C) hemorrhage

Back 539

NEU-6.384.
B

Front 540

Atrial fibrillation frequently occurs in:
A) thrombosis
B) embolism
C) hemorrhage

Back 540

NEU-6.385.
B

Front 541

Anisocoria is frequently observed in:
A) thrombosis
B) embolism
C) hemorrhage

Back 541

NEU-6.386.
C

Front 542

Case Study:
A 54-year-old hypertensive male patient suddenly develops vertigo,
headache, and vomiting. At examination the patient is conscious
and has unilateral ataxia without weakness. Conjugated eye movements
are disturbed. What is suspected?
A) pontine hemorrhage
B) capsule hemorrhage
C) cerebellar hemorrhage
D) subarachnoid hemorrhage
E) aneurysm of the basilar artery

Back 542

NEU-6.387.
C

Front 543

Which symptom is not typical of tabes dorsalis?
A) Argyll-Robertson pupils
B) ataxia
C) hypertonic muscles
D) lack of vibration sensation
E) root pain

Back 543

NEU-6.388.
C

Front 544

The typical course of herpes zoster is:
A) pain-blisters-pigmentation
B) blisters-pigmentation-pain
C) pain-pigmentation-blisters
D) pigmentation-blisters-pain
E) blisters-pain-pigmentation

Back 544

NEU-6.389.
A

Front 545

The most common cause of acute meningitis in adults is:
A) PNEUmococcus
B) Streptococcus
C) Hemophilus influenza
D) Meningococcus
E) none of the above

Back 545

NEU-6.391.
D

Front 546

The onset of bacterial meningitis can be best diagnosed by the
following:
A) the general symptoms of the patient
B) a murmur over the skull
C) central scotoma
D) bitemporal hemianopsia
E) fasciculations

Back 546

NEU-6.393.
A

Front 547

The CSF in case of meningococcal meningitis:
A) is clear and colorless
B) has a normal protein content
C) has a normal pressure
D) has a normal cell count
E) none of the above

Back 547

NEU-6.395.
E

Front 548

Adrenal cortical tumors can cause:
A) recurrent fits of weakness resembling familial periodic paralysis
B) hypertension with hypokalemia, hyponatremia and alkalosis
C) hypertension with hyponatremia but without hypokalemia
D) hyperetension with hypokalemia and acidosis
E) none of the above

Back 548

NEU-6.403.
A

Front 549

Spina bifida means a congenital anomaly of which of the following
structures?
A) the spine and brain stem
B) the cerebellum, but not of the cerebrum
C) the cerebrum but not of the cerebellum
D) the spine but not of the brain stem
E) the brain stem but not of the spine

Back 549

NEU-6.405.
A

Front 550

The typical onset of syringomyelia is:
A) a focal atrophy of the upper extremities, weakness and a lack
of pain sensation to burning
B) pain in the upper extremity
C) sphincter disorders
D) fasciculations
E) none of the above

Back 550

NEU-6.406.
A

Front 551

Amyotrophic lateral sclerosis:
A) usually starts in the proximal muscles
B) usually causes dysphagia and dysarthria
C) rarely causes diffuse hyperreflexia
D) causes fasciculation, the intensity of which correlates with the
severity of the disease
E) none of the above

Back 551

NEU-6.407.
B

Front 552

The recommended therapy of "paralysis agitans" (a form of parkinsonism)
is:
A) L-dopa therapy combined with a peripheral decarboxylase inhibitor
B) surgical treatment in elderly patients with bilateral disease
C) trihexyphenidyl, 20-25 mg/day in split doses
D) atropine and prochlorperazine
E) diphenhydramine, 50 mg daily

Back 552

NEU-6.416.
A

Front 553

Case Study:
A hemorrhagic CSF which rapidly cleared up was obtained after a lumbar
puncture. The first portion of the CSF contained 2000 RBC/mm
3
. The
RBC content of the third portion was only 10 RBC/ mm
3
. The most probable
diagnosis is:
A) cerebral embolization
B) rupture of an intracranial aneurysm
C) subarachnoid hemorrhage
D) artificial CSF hemorrhage
E) cerebral thrombosis

Back 553

NEU-6.429.
D

Front 554

Case Study:
A lumbar puncture revealed an opalescent CSF with increased
pressure. The most probable diagnosis is:
A) the patient is healthy but at strain
B) a brain tumor
C) the alterations are due to trauma caused by the puncture
D) subarachnoid hemorrhage
E) tuberculous meningitis

Back 554

NEU-6.430.
E

Front 555

Case Study:
An infant has lost his appetite, vomits, has seizures and fever. What
should be done?
A) a cultivation of nasal and pharyngeal discharge
B) try to find emotional problems in the family
C) obtaining a urine sample with a catheter
D) a lumbar puncture
E) intravenous pyelography

Back 555

NEU-6.431.
D

Front 556

Case Study:
A 7-year-old child complains of a sore throat, joint pain, and headache.
He has fever and occipital stiffness. What should be done?
A) an ECG
B) an X-ray of the wrists and knees
C) a lumbar puncture
D) a cultivation of nasal and pharyngeal discharge
E) the RBC sedimentation rate

Back 556

NEU-6.432.
C

Front 557

After smallpox vacination any postvaccination encephalomyelitis
ocurs within:
A) 30-40 days
B) 20-25 days
C) 10-12 days
D) 4-6 days
E) 2-3 days

Back 557

NEU-6.433.

Front 558

One of the following occurs in a subdural hematoma.
A) an increased intracranial pressure
B) a xanthochromic CSF
C) an elevated CSF protein level
D) all of the above
E) none of the above

Back 558

NEU-6.434.
D

Front 559

Which of the following rarely occurs in infants in case of a subdural
hematoma?
A) papilledema
B) fever
C) protrusion of the fontanelle
D) a hemorrhage in the retina
E) hemiparesis

Back 559

NEU-6.435.
A

Front 560

When do the symptoms of an epidural hemorrhage in children
develop?
A) weeks after trauma
B) days after trauma
C) seconds after trauma
D) hours after trauma
E) minutes after trauma

Back 560

NEU-6.436.
D

Front 561

Common symptoms of an epidural hemorrhage in a child include:
A) ataxia and hemiparesis
B) papilledema and stupor
C) hyperreflexia and contralateral paralysis of the abducent nerve
D) retinal hemorrhage and coma
E) hemiparesis and contralateral pupil dilatation

Back 561

NEU-6.437.
E

Front 562

The most common symptom of increased intracranial pressure in
children is:
A) ataxia
B) diplopia
C) stupor
D) vomiting
E) impaired visual acuity

Back 562

NEU-6.438.
D

Front 563

A common cause of intracranial hemorrhage in children is:
A) hepatic disease
B) a blood dyscrasia
C) an intracranial aneurysm
D) glomerulonephritis
E) trauma

Back 563

NEU-6.439.
E

Front 564

Case Study:
3 days after a tibial fracture the child became confused, had fever, blood
in the sputum, and developed hemiparesis. The most probable diagnosis is:
A) cerebral fat embolism
B) subdural hematoma
C) metastatic cerebral abscess
D) cortical contusion
E) traumatic cerebral thrombosis

Back 564

NEU-6.440.
A

Front 565

Case Study:
2 weeks after a penetrating hand injury a child developed abdominal
muscle rigidity, trismus, risus sardonicus, and opisthotonus. Diagnosis:
A) meningitis
B) hysteria
C) drug allergy
D) intercurrent peritonsillar abscess
E) tetanus

Back 565

NEU-6.441
E

Front 566

The CSF in acute purulent meningitis:
A) clear; colorless; and has normal pressure
B) increased pressure; clear
C) increased pressure; opaque
D) increased pressure; hemorrhagic
E) normal pressure; clear; xanthochromic

Back 566

NEU-6.442.
C

Front 567

If a child has recurrent otitis the following is assumed:
A) mastoiditis
B) deficient alimentation
C) a dermal sinus duct
D) all of the above
E) none of the above

Back 567

NEU-6.444.
A

Front 568

A postinfection encephalomyelitis can be due to the following:
A) measles
B) varicella
C) mumps
D) rubella
E) all of the above

Back 568

NEU-6.446.
E

Front 569

Which of the following is frequently observed in children after
head injuries?
A) vertigo
B) seizures
C) headaches
D) all of the above
E) none of the above

Back 569

NEU-6.447.
D

Front 570

The first symptoms of a brain tumor in children are:
A) seizures and coma
B) behavior disturbances
C) headaches and vomiting
D) hemiparesis and hyperreflexia
E) none of the above

Back 570

NEU-6.449
C

Front 571

An X-ray study is a valuable tool in the diagnosis of lead intoxication
because:
A) it reveals lead lines along the long bones
B) it reveals suture separation
C) an abdominal image shows lead incorporation
D) all of the above
E) none of the above

Back 571

NEU-6.451.
D

Front 572

A lucid period following a head injury indicates a:
A) subdural hematoma
B) cerebral laceration
C) cerebral contusion
D) cerebral commotion
E) epidural hematoma

Back 572

NEU-6.453.
E

Front 573

Secondary Parkinsonism suggests one of the following intoxications:
A) manganese
B) phenothiazine
C) carbon monoxide
D) all of the above
E) none of the above

Back 573

NEU-6.454.
D

Front 574

Case Study:
A 31-year-old male patient complains of a bifrontal headache and
impaired visual acuity lasting for about 4 weeks. During the previ-
ous 4 months the patient had a mild, intermittant headache. At
present the patient is irritable and difficult to live with. In the previous
months he felt sleepy, sometimes sleeping for 20-30 hours. 8-9
months earlier the patient had an accident, when he had fallen out
from a moving car causing a laceration of the skull skin.
Examination revealed papilledema, a dilated right pupil and leftsided
hemiparesis. The assumed diagnosis is:
A) paralytic dementia
B) a chronic subdural hematoma
C) bromide intoxication
D) a space-occupying process in the brain

Back 574

NEU-6.455.
B

Front 575

Case Study:
A 38-year-old female patient complains of intermitting episodes of
tinnitus, vertigo, and feelings that the auditory passage on the rightside
was closed, which have been persisting for about a year. These
episodes usually last for 3-5 hours. Recently the patient complained
of a hearing impairment on the right side which always got worse
during the fits. Examination performed during one of these fits
revealed right nystagmus while looking to the right and a right-sided
perception hearing impairment. The patient was instable in Romberg's
position. The assumed diagnosis is:
A) petrositis
B) a tumor of the cerebellar-pontine angle
C) Méniére's disease
D) vertebrobasilar insufficiency

Back 575

NEU-6.456.
C

Front 576

Which of the following can be observed in a healthy new-born?
A) patellar clonus and Babinski reflex
B) optikinetic nystagmus
C) suckling and Moro's reflex
D) all of the above
E) none of the above

Back 576

NEU-6.457.
D

Front 577

Case Study:
A patient has a sudden vertigo, swallowing disturbances and subsequently
vomits. Examination reveals Horner's syndrome, analgesia,
thermanesthesia on one side of his face, and sensory disturbances
on the contralateral side. The most likely cause is:
A) thrombosis of the middle or anterior cerebral artery
B) thrombosis of the inferior posterior cerebellar or vertebral
artery
C) hemorrhage affecting the internal capsule
D) embolization of the posterior cerebral artery
E) occlusion of the carotid artery

Back 577

NEU-6.460.
B

Front 578

Acute paralysis of the left lower extremity with only a mild involvement
of the upper extremity suggests:
A) occlusion of the anterior cerebral artery
B) occlusion of the middle cerebral artery
C) occlusion of the posterior cerebral artery
D) occlusion of the inferior posterior cerebellar artery
E) occlusion of the anterior spinal artery

Back 578

NEU-6.461.
A

Front 579

Occlusion of which artery is accompanied by a typical symptom of
homonymous hemianopsia?
A) lenticulostriatal artery
B) Heubner's artery
C) posterior cerebral artery
D) superior cerebellar artery
E) none of the above

Back 579

NEU-6.462.
C

Front 580

Transient unilateral amblyopia with unilateral motor and sensory
deficits is most characteristic of which of the following?
A) internal carotid artery disease
B) vertebrobasilar artery disease
C) middle cerebral artery disease
D) posterior chorioid artery disease
E) the (A) and (C) answers are true

Back 580

NEU-6.463.
A

Front 581

The most common cause of a subarachnoid hemorrhage of nontraumatic
origin is:
A) aneurysm
B) arterio-venous malformation
C) intracranial tumor
D) blood dyscrasia
E) none of the above

Back 581

NEU-6.464.
A

Front 582

The most important factor in the development of cerebral aneurysms is:
A) trauma
B) congenital anomaly
C) syphilis
D) septic embolism
E) none of the above

Back 582

NEU-6.465
B

Front 583

The most common site of an intracranial aneurysm in adults is
between:
A) the anterior communicans artery and the internal carotid
artery
B) the basilar artery and the internal carotid artery
C) the middle cerebral artery and the vertebrobasilar artery
D) the posterior cerebral artery and the basilar artery
E) none of the above

Back 583

NEU-6.466.
A

Front 584

A common cause of cerebral embolization in adults is:
A) cardiac disease
B) air embolism
C) tumor thrombus
D) fat embolism due to fracture
E) septic lung disease

Back 584

NEU-6.470.
A

Front 585

Occlusion of the internal carotid artery:
A) if the internal carotid artery is affected, a murmur is auscultated
on the neck; in case of external carotid artery disease
this finding is absent
B) a hypersensitive carotid sinus reflex is nearly always absent
C) transient unilateral amblyopia usually develops; homonymous
hemianopsia occurs in about 50% of the cases
D) a transient ischemic attack lasting for 5-30 min. can occur
E) pathological ophthalmic findings are as common as in vertebrobasilar disease

Back 585

NEU-6.471.
D

Front 586

Cardiac disturbances accompanying cerebrovascular disease:
A) are rare
B) are unknown
C) sometimes occur
D) are common
E) occur in a ratio of 1:1

Back 586

NEU-6.472.
D

Front 587

The rupture of an intracranial aneurysm usually does not occur
together with the following:
A) severe headache
B) nausea and vomiting
C) unconsciousness
D) occipital stiffness
E). none of the above

Back 587

NEU-6.474.
E

Front 588

The role of hypotension in the development of cerebral infarction:
A) both hypotension and hypertension play an etiological role in
the development of cerebral ischemia and infarction
B) obstruction and the consequent distal decrease of the blood
pressure and blood flow play an important role
C) hypotension due to a cardiac disease is a rare cause
D) in healthy individuals hypotension does not affect cerebral
blood flow unless it gets below 40 mmHg
E) none of the above

Back 588

NEU-6.479.
A

Front 589

Stroking the sole of a foot with a pointed object is a technique for
eliciting:
A) Hoffman's sign
B) Babinski's sign
C) Chaddock's sign
D) Romberg's sign
E) Gordon's sign

Back 589

NEU-6.482.
B

Front 590

Delirium or confusion occur in all of the following EXCEPT:
A) pneumonia
B) thyrotoxicosis
C) congested cardiac failure
D) thiamine deficiency
E) homocystinuria

Back 590

NEU-6.484.
B

Front 591

All of the following are true for amyotrophic lateral sclerosis EXCEPT:
A) it starts at the age of 50-60-years-old
B) it is symmetric
C) it has symptoms of impaired sensory function
D) fasciculations in the upper extremities
E) it should be differentiated from a cervical spine compression
F) there are no signs of a neurogenic bladder or incontinence

Back 591

NEU-6.488.
E

Front 592

Case Study:
A 40-year-old male patient, - occupation: technician. His motorcycle
smashed into a car and the patient was attended to at a traumatology
unit. Commotio cerebri and twisted neck were diagnosed. The
patient was discharged after a 5 day observation period. After a two
week rest period he returned to work. Subsequently 2 months later,
at home, the patient had a left-sided headache, vertigo, transient
impairment of speech, and numbness on the right side of his face
and tongue. His family doctor failed to find any external injures on
his body. A two-dimensional cranial and cervical X-ray did not reveal
any traumatic alterations. Blood pressure 140/90, heart rate 82/min.
Examination: the left pupil was somewhat larger than the right one.
The grip in his right hand was slightly weaker than the left (the
patient is right-handed). Ophthalmic examination: 0.5D congestion
in the left fundus.
What is the suggested diagnosis?
A) hypertensive disease
B) brain tumor
C) post-commotion syndrome
D) chronic subdural hematoma
E) vertebrobasilar insufficiency

Back 592

NEU-6.489
D

Front 593

Complete stroke:
A) in 80-90% of the cases seizure fits will develop in patients with
both embolic or atheromatous infarction
B) a sudden onset is typical of an embolic infarction, while the
atheromatous form is characterized by a gradual onset
C) alternating symptoms suggest supratentorial ischemia
D) anosognosia usually develops in a right-sided paralysis
E) none of the above

Back 593

NEU-6.490.
B

Front 594

The circulatory disturbances of the occipital cerebral regions:
A) comprise about 80% of the cases of cerebral ischemia
B) do not affect head movements (passive moving)
C) a bilateral occipital infarction can be followed by cortical
blindness
D) occipital infarction is always accompanied by the Weber's
syndrome
E) none of the above

Back 594

NEU-6.492.
C

Front 595

Diagnosis of cerebral embolism:
A) a complex examination (EEG, carotid and heart ultrasound
study, complete blood count including hemostasis) is useful
B) an examination of the cerebrospinal fluid is of crucial importance
C) a normal sinus rhythm excludes embolism
D) MRI is the method of choice
E) amnesia is typical

Back 595

NEU-6.497.
A

Front 596

In cerebral vein thrombosis:
A) epileptic fits rarely occur
B) it is usually of a septic or focal origin
C) headache and delirium are common, but confusion and seizures
are not typical
D) headache and vomiting never develop
E) focal neurologic symptoms are rare

Back 596

NEU-6.498.
B

Front 597

If a murmur is detected during the examination of a possible
extracranial vascular obstruction:
A) a murmur below the mandibular angle suggests a disease of
the carotid artery
B) a murmur directly under the clavicle suggests a disease of the
vertebral artery
C) the murmur always accurately reflects the severity of stenosis
D) a loud murmur indicates obstruction
E) none of the above

Back 597

NEU-6.499.
A

Front 598

In a patient with cerebral infarction:
A) the CT study has fully replaced the pneumoencephalography
in radiologicexaminations
B) a CT study does not substitute static brain scintigraphy in the
evaluation
C) a CT study does not substitute echoencephalography in the
evaluation
D) during the first 1-2 hours, a CT study can differentiate between
the intact and infarction area
E) In 50% of the cases a CT study can help to detect any complications
such as hemorrhage into the brain matter

Back 598

NEU-6.500.

Front 599

An ECG is not required in cerebral infarction because:
A) a CT can determine the diagnosis and the cause of this disease
B) this is a false statement becausethe ECG can reveal arrhythmia,
coronary disease, and infarction
C) an isoenzyme study is more important
D) only the ECG under a physical stress test is informative
E) none of the above

Back 599

NEU-6.501.
B

Front 600

Which of the following special examinations should be done in case
of cerebral infarction?
A) angiography, which reveals different vascular changes and
hemodynamic disturbances
B) a brain radionuclide study, which shows a marked isotope
accumulation during the first day followed by a subsequent
decrease
C) echoencephalography, which can differentiate between cerebral
edema and tumor, as well as between tumor and subdural
hematoma
D) angiography because mortality due to this intervention at
present is only 10%
E) none of the above

Back 600

NEU-6.502
A

Front 601

In the differential diagnosis of a cerebral infarction:
A) a hemorrhagic CSF excludes a cerebral infarction
B) an angiographic study visualizes a brain abscess as an
avascular region; and lymphocytes are frequently found in
the CSF
C) if the state of the patient worsens, angiography should be
postponed until an exploration bore is made
D) the CT study helps in the differential diagnosis of infarction,
and subdural or epidural hematoma
E) none of the above

Back 601

NEU-6.503.
D

Front 602

In the prognosis of cerebral infarction:
A) the age of the patient, but not the extent of the nervous system
damage is an important predictive factor of early mortality
B) after the development of a stroke, hypertension and diabetes
do not affect the outcome
C) the severity of a concomitant cardiovascular disease is an
important factor of the survival
D) about 3/4 of the patients die during the first attack
E) About one-half of the patients surviving the first ischemic
infarction will have a hemorrhage within 1-7 years

Back 602

NEU-6.504.
C

Front 603

Antiedematous therapy in cerebral infarction:
A) hypertonic urea is not effective
B) mannitol is effective and has no rebound effect
C) glycerine is not effective
D) dexamethasone is mainly used for the therapy of cytotoxic
edema
E) none of the above

Back 603

NEU-6.505
E

Front 604

In cerebral infarction the cerebral blood flow can be increased with
the use of:
A) aminophylline, tolazoline, histamine
B) papaverine and nicotinic acid
C) a blockade of the stellate ganglion
D) carbon dioxide
E) none of the above

Back 604

NEU-6.506.
E

Front 605

In repeated Transient Ischemic Attacks (TIAs), the following therapy
is recommended:
A) lithium carbonate if neutropenia develops
B) aspirin if an ulcer develops
C) aspirin, 2-3 g/day
D) anticoagulants if cardiogenic stroke develops
E) anticoagulants if endocarditis underlies the ischemia

Back 605

NEU-6.507.
D

Front 606

The therapy of progressive stroke:
A) anticoagulant therapy is of no value
B) multifactorial therapy by itself or if combined with anticoagulant
therapy is of no value
C) surgical correction of arterial obstruction has good results
D) inhibition of platelet aggregation is never effective
E) none of the above

Back 606

NEU-6.508.
E

Front 607

The general treatment of completed stroke, including long-term therapy:
A) multifactorial therapy is of no value
B) surgical intervention in patients with pronounced neurologic
defects alleviates the symptoms
C) long-term anticoagulant therapy is beneficial and has no
significant complications
D) carotid surgery in patients with pronounced neurologic defects
decreases the morbidity in cases of fresh softening
E) none of the above

Back 607

NEU-6.509.
E

Front 608

The therapy of a cerebral embolism of cardiac origin:
A) anticoagulants decrease morbidity and mortality due to the
recurrent embolization
B) anticoagulants are given for 6-12 months after valve prosthesis
surgery
C) cardioversion is always performed in atrial fibrillation to restore
the normal sinus rhythm; this intervention reduces the
danger of re-embolization
D) the incidence of myocardial ischemia is not increased after myocardial infarction
E) none of the above

Back 608

NEU-6.510.
A

Front 609

In considering contraindications to anticoagulant therapy the following
is NEGLIGIBLE:
A) an inadequate laboratory background
B) unsatisfactory patient compliance
C) peptic ulcer, hemorrhagic diathesis, hypertension, sever liver or renal disease
D) hemorrhagic CSF
E) none of the above

Back 609

NEU-6.511.
E

Front 610

Anticoagulant therapy:
A) can be started even in case of hemorrhagic softening
B) as a rule does not cause bleeding, unless the prothrombin
time is 4-5x longer compared to the control
C) can be started in cases of severe ischemia (vast area of softening)
D) can be started in endocarditis lenta (subacute infectious endocarditis)
E) can be very effective in cases of severe ischemic insult if initiated
early

Back 610

NEU-6.512
B.

Front 611

In hypertensive encephalopathy:
A) hypotensive therapy does not markedly affect the outcome
B) visual impairment is rare
C) confusion, seizures and papilledema are typical
D) papilledema is a rare finding
E) the CSF fmding is normal

Back 611

NEU-6.513.
C

Front 612

Which of the following is typical of the rupture of an aneurysm?
A) a sudden headache, vomiting, sometimes confusion
B) it typically starts in the morning
C) a CSF sample has no diagnostic value
D) it has no typical neurologic symptoms
E) the CSF obtained immediately after the hemorrhage is xanthochromic

Back 612

NEU-6.516
A

Front 613

Which of the following is typical of brain tumors?
A) usually progressive symptoms, frequent headaches, increased
intracranial pressure
B) the CSF finding is always abnormal
C) metastases are the most common finding
D) multiform glioblastoma is a malignant, well circumscribed
tumor
E) brain tumors comprise about 1/3 of all occurring tumors

Back 613

NEU-6.517.
A

Front 614

Which of the following possibilities should not be considered in the
differential diagnosis of an intracranial hemorrhage?
A) an overdose of anticoagulants
B) the hemorrhage fully destroying a minor malformation
C) a hemorrhagic infarction with marked softening, hence differing
from a primary hemorrhage
D) leukemia or thrombocytopenia
E) none of the above

Back 614

NEU-6.518.
E

Front 615

Which of the following is typical of an intracerebral hemorrhage?
A) the CT visualizes hyperdense regions even after several
months
B) the CSF is always hemorrhagic
C) it usually. occurs due to a hypertensive vascular disease or a
minor a-v malformation
D) a fresh hemorrhage is not always detectable
E) these patients always have hypnoid confusion

Back 615

NEU-6.521
C

Front 616

After subarachnoid hemorrhage:
A) seizures and headache occur at the onset
B) hypertonic hemiplegia or hemiparesis with Babinski's sign is
the most common neurologic symptom
C) papilledema is the most common symptom
D) no signs of meningeal excitement are observed
E) a CT is of no diagnostic value

Back 616

NEU-6.522.
A

Front 617

Which of the following is important in the diagnosis of hemorrhages
caused by the rupture of arteriovenous malformations?
A) focal seizures in the history, focal neurologic symptoms, hemilateral
headaches, nausea
B) clinical symptoms markedly differ from those occurring in a
ruptured aneurysm
C) murmurs equally occur in aneurysms and arteriovenous
malformations
D) seizures developing at the onset of hemorrhage rather suggest a traumatic origin
E) the CT is of no value

Back 617

NEU-6.524.
A

Front 618

In the diagnosis of an intracerebral hemorrhage:
A) a lumbar puncture nearly always helps to differentiate it from
a hemorrhagic infarction
B) the onset is usually gradual
C) unconsciousness and hypertension are common after the
onset
D) headache is as frequent as in cerebral infarction
E) a CT can differentiate the hemorrhagic area from the intact
tissue only several hours after hemorrhage

Back 618

NEU-6.525.
C

Front 619

In cases of intracerebral bleeding:
A) surgery is the method of choice
B) independently of the applied therapy a high ratio of patients in
deep coma will die
C) surgical removal of intracerebral hematoma due to a ruptured
aneurysm has better results compared to those, in which
hemorrhage was due to a hypertensive vascular event
D) in most cases drug therapy gives satisfactory results
E) patients in coma usually survive if treated by calcium-channel
blockers

Back 619

NEU-6.528.
B

Front 620

Metstatic intracranial tumors:
A) comprise about 80% of all intracranial tumors
B) primarily originate from the lung or breast
C) a supratentorial localization has poor prognosis
D) are common in the cerebrum, but rare in the cerebellum

Back 620

NEU-6.530.

Front 621

The two main causes of cerebral metastases are the:
A) breast and lung
B) lung and colon
C) colon and rectum
D) colon and nasal sinuses
E) uterus and ovaries

Back 621

NEU-6.533.
A

Front 622

The most common pituitary tumor is:
A) chromophobic adenoma
B) chromophilic, adenoma
C) colloid cyst
D) carcinoma
E) none of the above

Back 622

NEU-6.536.
A

Front 623

The most frequent intradural extramedullary spinal tumor is:
A) glioma and angioma
B) meningioma and neurofibroma
C) sarcoma and lipoma
D) glioma
E) cold abscess

Back 623

NEU-6.538.
B

Front 624

Which of the following is typical of a tumor or a disc-compression of
the cauda equina?
A) the processes are above the L1-2 level
B) pain; flaccid paralysis of the lower extremities
C) spastic paralysis
D) Babinski's sign; hyperreflexia
E) none of the above

Back 624

NEU-6.542.
B

Front 625

After cranial injury:
A) an epileptic fit indicates at least a cerebral contusion
B) brain commotion is always accompanied by morphological
symptoms
C) headaches following brain commotion last only for several
hours
D) a CSF sample helps to confirm the diagnosis
E) lucid intervals always occur in epidural hematoma

Back 625

NEU-6.543.
A

Front 626

Which of the following is typical of diabetic polyneuropathy?
A) it develops only in severe diabetes
B) the CSF is always normal
C) a determination of the nerve conduction velocity is not relevant
in the diagnosis
D) a symmetric, distal sensomotor diabetic polyneuropathy is the
most common disorder
E) all of the above
F) none of the above

Back 626

NEU-6.547.
D

Front 627

A subdural hematoma:
A) is not accompanied by epileptic symptoms
B) a xanthochromic CSF is not typical
C) the CSF is always Clear
D) is never isodense on the CT
E) all of the above
F) none of the above

Back 627

NEU-6.548.
F

Front 628

Bell's palsy:
A) Bell's palsy (idiopathic form) comprises about 75% of all cases
of facial palsy
B) rarely occurs in diabetes
C) only 5-10% of the patients will recover
D) hyperacusis does not occur
E) all of the above
F) none of the above

Back 628

NEU-6.549.
A

Front 629

Full recovery after Bell's palsy:
A) occurs in 20% of the cases
B) does not occur in elderly patients, hyperacusis, and cases of
severe muscle weakness at the onset of the disease
C) develops within 10-14 days
D) does not depend on the severity of the lesion
E) surgery should be immediately performed

Back 629

NEU-6.553.
B

Front 630

Epilepsy after head injury:
A) is always accompanied by the same type of seizures
B) usually occurs following closed skull injuries
C) develops within several minutes or hours following the injury
D) the correct therapy indicates a good prognosis
E) all of the above
F) none of the above

Back 630

NEU-6.556.
D

Front 631

An extradural hematoma:
A) affects the middle cerebral artery
B) is usually bilateral
C) the patient always has a lucid interval which is the essential
sign for the correct diagnosis
D) usually accompanies fractures of the ethmoid bone
E) all of the above
F) none of the above

Back 631

NEU-6.558.
F

Front 632

An epidural hemorrhage:
A) is usually localized in the scala media over the hemispheral
convexity
B) the CSF is usually hemorrhagic
C) is usually accompanied by a lucid interval of several days
D) usually elicits a contralateral pupil dilation
E) usually causes ipsilateral hemiplegia

Back 632

NEU-6.559.
A

Front 633

In tuberculous meningitis:
A) the upper cranial nerves are damaged
B) the CSF glucose level is usually normal
C) the WBC count in the CSF usually exceeds several thousand
D) the CSF glucose level is elevated
E) the CSF usually contains several hundred lymphocytes

Back 633

NEU-6.563.
E

Front 634

In the acute phase of bacterial meningitis:
A) the glucose level is normal
B) the cell count is between 50-100
C) the cell count (mainly polymorphonuclear cells) is between
1000-10,000
D) therapy can be started only after evaluation of the antibiogram
E) the CSF pressure is low

Back 634

NEU-6.564
C

Front 635

In acute bacterial meningitis the CSF shows:
A) lymphocytes
B) polymorphonuclear leukocytes comprising 80-90% of the cells
C) a low protein content
D) positive bacteriologic cultivation results
E) all of the above
F) none of the above

Back 635

NEU-6.565.
B

Front 636

In acute bacterial meningitis:
A) clinical symptoms develop over several weeks
B) occipital stiffness and Brudzinsky's sign are not always
present (like in infants, elderly patients)
C) therapy cannot be started before evaluation of the antibiogram
D) a daily dose of 10,000 U of penicillin should be administered
E) all of the above
F) none of the above

Back 636

NEU-6.566.
B

Front 637

The most frequent cause of meningitis:
A) Leptospira; Brucella
B) Salmonella; Listeria
C) E.Coli; Shigella
D) Cocci; Hemophilus influenzae
E) none of the above

Back 637

NEU-6.567.
D

Front 638

Viral meningitis:
A) causes a typical CSF pressure elevation
B) the cell count is usually several thousand
C) polymorphonuclear cells are found in the CSF
D) the pleocytosis in mumps is milder
E) all of the above
F) none of the above

Back 638

NEU-6.570.
F

Front 639

Viral encephalitis:
A) usually accompanies viral meningitis
B) rarely causes headache
C) usually does not cause focal symptoms, seizures
D) the EEG changes are not typical
E) the CT is always normal

Back 639

NEU-6.571.
A

Front 640

Which of the following do not cause any meningeal signs?
A) a high cell count in the CSF
B) a low glucose content in the CSF
C) an increased intracranial blood pressure
D) dehydration

Back 640

NEU-6.573.
B

Front 641

Which symptom is not a sign of meningeal excitement?
A) occipital stiffness
B) "foxhound" posture
C) Kernig's sign
D) Brudzinsky's sign
E) Chaddock's sign

Back 641

NEU-6.574.
E

Front 642

Which pathological process does not elicit any meningeal symptoms?
A) a rupture of an intracranial aneurysm
B) an increase of the intracranial pressure
C) any circumscribed softening of brain tissue
D) leptomeningeal inflammation

Back 642

NEU-6.576.
C

Front 643

Which symptom is not typical of multiple sclerosis?
A) a scanning speech
B) a lack of the abdominal cutaneous reflex
C) flaccid paraparalysis
D) optic atrophy - temporal pallor
E) pyramidal signs

Back 643

NEU-6.578.
C

Front 644

In which of the following can retrobulbar neuritis occur?
A) a tumor of the optic nerve
B) multiple sclerosis
C) a tumor of the occipital lobe
D) Foster-Kennedy's syndrome

Back 644

NEU-6.583.
B

Front 645

Which of the following pathological processes cannot be diagnosed
on the basis of the fundus finding?
A) the presence of an intracranial space occupying process
B) whether the patient had an intracranial space occupying
process at an earlier time
C) an alteration of the vascular system
D) any brain atrophy

Back 645

NEU-6.584.
D

Front 646

Which of the following is typical of multiple sclerosis?
A) it mainly develops in elderly patients
B) it is related to an infection caused by ticks
C) any oligoclonal y-antibidies in the CSF is of diagnostic value
D) a relapsing course with accumulating disability
E) it improves after steroid or cytostatic therapy
F) only (A), (B), and (C) are true
G) only (A), (B), (C), and (D) are true
H) only (C), (D), and (E) are true

Back 646

NEU-6.585.
H

Front 647

Which of the following causes ipsilateral blindness?
A) ipsilateral damage of the optic tract
B) ipsilateral damage of the optic nerve
C) ipsilateral damage of the chiasma
D) contralateral damage of the optic radiation

Back 647

NEU-6.593.
B

Front 648

After a central type of damage to eye movements one of the following
symptoms develop:
A) conjugated deviation
B) diplopia
C) indistinct images

Back 648

NEU-6.610.
A

Front 649

Which of the following is true for a peripheral visual impairment?
A) no diplopia occurs
B) diplopia develops
C) conjugated deviation develops

Back 649

NEU-6.611
B

Front 650

Which of the following types of trigeminal neuralgia does not exist?
A) symptomatic
B) psychogenic
C) genuine

Back 650

NEU-6.622.
B

Front 651

The symptoms of a peripheral facial nerve lesion include:
A) the angle of the mouth on the ipsilateral side is localized
deeper, and ptosis develops
B) the angle of the mouth on the ipsilateral side is localized
deeper, the patient has lagophthalmus and cannot wrinkle his
forehead
C) the angle of the mouth on the contralateral side is localized
deeper.
D) the angle of the mouth on the contralateral side is localized
deeper, the patient has lagophthalmus and cannot wrinkle his
forehead

Back 651

NEU-6.624.
B

Front 652

Which of the following is typical of a peripheral facial nerve lesion?
A) ptosis on the ipsilateral side
B) ptosis on the contralateral side
C) lagophthalmus on the ipsilateral side
D) lagophthalmus on the contralateral side

Back 652

NEU-6.625.
C

Front 653

Which of the following is true for a peripheral facial nerve paralysis?
A) steroid therapy is recommended
B) cytostatic therapy is recommended
C) surgery depends on the EMG diagnostic findings
D) the patient usually recovers in 5-10 days
E) all of the above
F) only (A) and (B) are'true
G) only (B) and (C) are true
H) only (C) and (D) are true
I) only (A) and (C) are true

Back 653

NEU-6.626.

Front 654

Which of the following are symptoms of a peripheral facial nerve
paralysis?
A) ipsilateral paralysis of the facial muscles of the eye, mouth,
and forehead
B) ipsilateral tinnitus
C) ipsilateral lacrimation disorders; hyperacusis
D) flavor sensation disorders on the whole surface of the tongue
E) all of the above
F) only (A), (B), and (C) are true
G) only (B), (C) and (D) are true
H) only (A), (B), and (D) are true.

Back 654

NEU-6.630.

Front 655

The direction of nystagmus is defined:
A) according to its slow component
B) according to its fast component
C) according to the side of the vestibular lesion

Back 655

NEU-6.637.
B

Front 656

Tinnitus is usually caused by:
A) arteriosclerosis
B) hypertension
C) medication
D) a tumor of the cerebello-pontine angle
E) multiple sclerosis
F) all of the above
G) only (A), (B), (C), and (D) are true
H) only (B), (C), (D), and (E) are true

Back 656

NEU-6.638.
G

Front 657

Which of the following is not typical of Méniére's disease?
A) confusion
B) rotation vertigo
C) a feeling of dissolution
D) vegetative symptoms

Back 657

NEU-6.640
A

Front 658

The result of the tuning fork test in a perception-type hearing impairment
is:
A) Weber test: lateralization to the left
B) Rinné test: negative on the right side
C) Weber test: lateralization to the right

Back 658

NEU-6.642.
A

Front 659

The result of the tuning fork test in a right-sided hearing impairment
due to a disease in the middle ear is:
A) Weber test: lateralization to the right
B) Weber test: lateralization to the left
C) Rinné test: positive on the right side

Back 659

NEU-6.643.
A

Front 660

Which of the following statements is false for a central lesion of the
hypoglossal nerve?
A) the tongue deviates towards the side of the cerebral lesion
B) the tongue deviates to the side opposite to that of the cerebral
lesion
C) no fasciculations develop in the tongue
D) no atrophy is observed in the tongue

Back 660

NEU-6.652.
A

Front 661

What does paraneoplasia mean?
A) cerebellar atrophy
B) polyneuropathy
C) encephalitis
D) abscess
E) polymyositis
F) all of the above
G) only (A), (B), and (D) are true
H) only (A), (B), and (E) are true

Back 661

NEU-6.661.
H

Front 662

Tremor at rest is typical of:
A) multiple sclerosis
B) epilepsy
C) parkinsonism
D) neurasthenia

Back 662

NEU-6.667.
C

Front 663

The examination of headaches includes:
A) CT and skull X-ray studies
B) focus examination and psychological studies
C) provocative tests
D) a CSF sample is always taken
E) WBC count, RBC sedimentation rate
F) all of the above
G) only (A), (B), (C), and (D) are correct
H) only (A), (B), (C), and (E) are correct
I ) only (B), (C), (D), and (E) are correct

Back 663

NEU-6.670.
H

Front 664

A patient is considered as epileptic if:
A) an epileptic seizure can be proved
B) a patient had the seizure following a head trauma
C) a patient had a seizure and epilepsy was noted in the family
history
D) a patient has systematic and EEG verified seizures
E) all of the above
F) only (A) and (B) are correct
G) only (C) and (D) are correct

Back 664

NEU-6.671.
D

Front 665

Which spinal segment should remain intact for the patellar reflex?
A) S 1
B) L4
C) S2
D) L5 and S1

Back 665

NEU-6.673.
B

Front 666

Pseudobulbar syndrome is caused by:
A) bilateral damage of the nuclei of the lower cranial nerves
B) bilateral damage of the lower cranial nerves
C) bilateral damage of the pyramidal tracts projecting towards the
nuclei of the lower cranial nerves
D) ipsilateral damage of the pyramidal tracts projecting towards
the nuclei of the lower cranial nerves

Back 666

NEU-6.674.
C

Front 667

The distribution of spastic hypertonia includes:
A) flexors of the upper extremities and extensors of the lower
extremities
B) flexors of the upper and lower extremities
C) extensors of the upper and lower extremities
D) all groups of muscles

Back 667

NEU-6.676.
A

Front 668

Which of the following symptoms does not occur in a lesion of the
pyramidal tract?
A) spastic hypertonia
B) hyperreflexia of the deep reflexes
C) pyramidal symptoms
D) fasciculation

Back 668

NEU-6.681.
D

Front 669

Which of the following symptoms does not belong to those of a
transverse lesion?
A) all sensory modalities are altered beneath the level of injury
B) spasticity or paraparesis of the lower extremities
C) urinary disorders
D) segmental deficiencies (lack or alteration of certain reflexes,
individual atrophy)
E) dissociated sensory disorders

Back 669

NEU-6.682.
E

Front 670

Which of the following does not occur in central motor neuron
damage?
A) global atrophy
B) hyperreflexia of the deep reflexes
C) individual atrophy
D) pyramidal signs
E) decreased surface reflexes

Back 670

NEU-6.683.
C

Front 671

Select a pyramidal sign for the lower extremities:
A) Mayer's reflex of the proximal joints
B) Juster's sign
C) Oppenheim's sign
D) Wartenberg's sign

Back 671

NEU-6.684.
C

Front 672

Select a pyramidal sign for the upper extremities:
A) Chaddock's sign
B) Rossolimo's sign
C) Tr6mner's sign
D) Schaefer's sign

Back 672

NEU-6.685.
C

Front 673

Which of the following is not a pyramidal sign?
A) Babinski's sign
B) Brudzinsky's sign
C) Rossolimo's sign
D) Chaddock's sign
E) Gordon's sign
F) Trömner's sign

Back 673

NEU-6.686.
B

Front 674

Select the definition of an increased deep reflex:
A) hyperreflexia
B) an enlarged reflexogenic zone
C) hyperreflexia accompanied with pyramidal signs
D) hyperreflexia accompanied with a grasping reflex

Back 674

NEU-6.687.
C

Front 675

Paralysis means:
A) cessation of muscle strength
B) decreased muscle strength
C) flaccid muscles
D) coordination disorders
E) decreased muscular mass
F) complete paraplegia

Back 675

NEU-6.689
B

Front 676

The primary motor cortex:
A) is localized in the parietal lobe
B) is localized behind the central sulcus
C) is localized just before the central sulcus
D) is localized in the temporal lobe

Back 676

NEU-6.691
C

Front 677

If a patient with a disc hernia suddenly develops paralysis and
autonomic symptom's, then:
A) the patient should be examined and operated within 6 weeks
B) the patient should be examined and operated within 1 month
C) bed rest, with the patient being examined and operated within
1 week
D) the patient should be examined and operated immediately
E) bed rest, with the patient being examined and operated within
6 weeks

Back 677

NEU-6.694.
D

Front 678

Which symptom does not belong to the cauda syndrome?
A) flaccid paralysis
B) hyporeflexia
C) pyramidal signs
D) assymmetric symptoms

Back 678

NEU-6.696.
C

Front 679

A typical representative of hypertonic hypokinetic disorders includes:
A) Alzheimer's disease
B) Pick's lobe atrophy
C) Korsakoffs syndrome
D) parkinsonism

Back 679

NEU-6.698.
D

Front 680

A typical representative of hypotonic hyperkinetic disorders includes:
A) Wernicke's encephalopathy
B) spastic torticollis
C) Huntington's chorea
D) Foster-Kennedy's syndrome

Back 680

NEU-6.699.
C

Front 681

Cerebellar hemorrhage:
A) is always fatal
B) surgery can be performed depending on the size of the
hemorrhage
C) should always be treated conservatively
D) is easy to diagnose because the CSF is always hemorrhagic in
these cases

Back 681

NEU-6.702.
B

Front 682

Which of the following is not an exteroreflex?
A) the plantar reflex
B) the abdominal cutaneous reflex
C) the conjunctival reflex
D) the cremaster reflex
E) the masseter reflex

Back 682

NEU-6.706.
E

Front 683

Which statement is not true for the therapy of epilepsy?
A) the importance of carbamazepine therapy has grown
B) monotherapy is a method of choice
C) therapeutic surgery should be considered in drug-resistant
epilepsy
D) the drug blood level evaluation is of growing importance
E) the EEG changes are the most important signs for therapy
F) certain antiepileptic drugs interact, decreasing each other's
efficiency and increasing toxicity

Back 683

NEU-6.708.
E

Front 684

Which of the following is not a deep reflex?
A) the conjunctival reflex
B) the masseter reflex
C) the ulnar reflex
D) the biceps reflex

Back 684

NEU-6.712.
A

Front 685

Which reflex has its receptors in the corresponding muscle?
A) the abdominal cutaneous reflex
B) the grasping reflex
C) the mucosal reflexes
D) the plantar reflex
E) the cremaster reflex

Back 685

NEU-6.713
B

Front 686

Which of the following is not considered as hyperkinesis?
A) ballism
B) intention tremor
C) chorea
D) athetosis
E) myoclonus

Back 686

NEU-6.714.
B

Front 687

Which of the following is not a sign of psychic deterioration?
A) oral exploration
B) a tendency to pronate the distal extremities
C) a grasping reflex
D) a loss of initiation

Back 687

NEU-6.717.
B

Front 688

Where should the damaging focus be localized in order to elicit a
central-type paralysis in the upper extremities?
A) a parasaggital localization
B) the precentral gyrus is damaged over the Sylvian fissure
C) the postcentral gyrus is damaged over the Sylvian fissure
D) a damage of the premotor cortex

Back 688

NEU-6.719.
B

Front 689

In which of the following do the deep reflexes remain unchanged?
A) damage of a peripheral nerve
B) damage of the motor neuron of the ventral horn
C) damage of the parietal lobe
D) cerebellar damage
E) damage of the occipital lobe

Back 689

NEU-6.722.
E

Front 690

In which muscle groups is hemiparesis of the upper extremeties
more pronounced?
A) the flexors of the elbow
B) the extensors of the elbow
C) the abductors

Back 690

NEU-6.724
B

Front 691

Assign Parkinson's disease to one of the following:
A) a hypertonic hypokinetic disorder
B) a hypotonic hyperkinetic disorder
C) a hypotonic hypokinetic disorder
D) a hypertonic hyperkinetic disorder

Back 691

NEU-6.725.
A

Front 692

Which of the following does not cause tetraparesis?
A) extensive damage to the basis of the pons
B) parasaggital processes
C) a transverse spinal lesion

Back 692

NEU-6.726.
B

Front 693

Which of the following is not characteristic of a pyramidal tract lesion?
A) hyporeflexia of the surface reflexes
B) spastic hypertonia
C) Achilles clonus
D) patellar clonus
E) myoclonus in the muscles of the upper extremities

Back 693

NEU-6.727.
E

Front 694

Which spinal segment is required for the Achilles reflex?
A) I
B) L3
C) S 1
D) L2

Back 694

NEU-6.728.
C

Front 695

Which of the following is not a pyramidal sign of the upper extremities?
A) Hoffman's sign
B) Oppenheim's sign
C) Tr6mner's sign
D) Juster's sign

Back 695

NEU 6.729.
B

Front 696

In which of the following does cogwheel rigidity develop?
A) Foster-Kennedy's syndrome
B) Parkinson's disease
C) Wernicke's encephalopathy
D) Marchiafava-Bignami's, disease

Back 696

NEU-6.731.
B

Front 697

At what level does the spinal cord end?
A) L2
B) L5
C) S 1
D) S2

Back 697

NEU-6.734.
A

Front 698

A "cerebellar fit" is caused by:
A) an elevated intracranial pressure
B) a congenital cerebellar anomaly
C) alcohol-induced cerebellar atrophy
D) vertobrobasilar insufficiency

Back 698

NEU-6.736.
A

Front 699

Which of the following symptoms is not typical of a hypertonichypokinetic
disorder?
A) rigor
B) tremor
C) akinesis
D) chorea

Back 699

NEU-6.739
D

Front 700

How is Oppenheim's reflex elicited?
A) by pressing the Achilles tendon
B) by pressing the triceps muscle of the calf
C) by drawing a forger along the edge of the tibia
D) by drawing a pointless object along the lateral edge of the
upper surface of the foot

Back 700

NEU-6.741.
C

Front 701

Which of the following is not typical of Lérfs reflex?
A) an asymmetric reflex indicates a lesion of the pyramidal tract
B) bilateral hyperreflexia indicates a lesion of the pyramidal tract
C) it is a negative supporting reflex

Back 701

NEU-6.742.
B

Front 702

The phases of disorientation are:
A) somnolence-stupor-coma
B) stupor-somnolence-coma
C) coma-stupor-somnolence

Back 702

NEU-6.743
A

Front 703

Which of the following is typical of multiple sclerosis?
A) the vision is usually involved
B) diplopia is common
C) a lack of abdominal skin reflexes
D) intention tremor
E) rigid hypertonia
F) only (A), (B), (C), and (D) are true
G) only (A), (B), and (E) are true
H) only (B), (C), (D), and (E) are true

Back 703

NEU-6.745.
F

Front 704

The cause of deep sensation disorders is:
A) a lesion of the spinal ventral horn
B) a lesion of the spinal posterior column
C) a lesion of the area around the central canal
D) a lesion of the ventral root

Back 704

NEU-6.747.
B

Front 705

Where is the primary sensory cortex localized?
A) just behind the central sulcus
B) just before the central sulcus
C) at the opercular area
D) in the temporal lobe

Back 705

NEU-6.751.
A

Front 706

Where does the spinothalamic tract cross?
A) in the spinal cord
B) in the medulla
C) in the pons
D) in the mesencephalon

Back 706

NEU-6.753.
A

Front 707

Which of the following is typical of cervical spondylotic headaches?
A) they are usually ipsilateral
B) they are usually occipital and/or the pain radiates forward
C) there are pathological findings on the X-ray of the neck
D) they can be caused by abnormal (pathological) positions of the
head
E) all of the above
F) none of the above

Back 707

NEU-6.755.
E

Front 708

Which of the following can be used for migraine therapy?
A) hydergine (Imigran)
B) Aspirin
C) dihydroergotamine
D) all of the above

Back 708

NEU-6.757.
D

Front 709

How is Chaddock's reflex elicited?
A) by pressing the Achilles tendon
B) by pressing the triceps surae muscle of the calf
C) by drawing a finger along the edge of the tibia
D) by drawing a pointless object along the lateral edge of the
upper surface of foot

Back 709

NEU-6.760.
D

Front 710

How is Gordon's reflex elicited?
A) by pressing the Achilles tendon
B) by pressing the triceps surae muscle of the calf
C) by drawing a finger along the edge of the tibia
D) by drawing a pointless object along the lateral edge of the
upper surface of foot

Back 710

NEU-6.761.
B

Front 711

Side effects of phenytoin therapy include:
A) gingival hyperplasia
B) anemia
C) alterations in the bones
D) enlarged lymph nodes
E) sleep disorders
F) all of the above
G) only (A), (B), and (E) are true
H) only (A), (C), and (E) are true
I) only (A), (B), (C) and (D) are true

Back 711

NEU-6.762.
I

Front 712

The daily dose of phenytoin is:
A) 0.03-0.07 mg/kg
B) 3-7 mg/kg
C) 30-70 mg/kg
D) 100-150 mg/kg

Back 712

NEU-6.763
B

Front 713

Side-effects of carbamazepine therapy include:
A) allergy
B) leukopenia
C) polycythemia
D) liver disorders
E) all of the above
F) only (A), (B), and (D) are true
G) only (A), (B), and (C) are true
H) only (B), (C), and (D) are true

Back 713

NEU-6.764.
F

Front 714

Which of the following is not a pyramidal sign?
A) hard-palate reflex
B) clonus of the foot
C) tonic dorsal flexion of the big toe
D) corneal hyperreflexia

Back 714

NEU-6.765.
D

Front 715

Which of the following is not a complication of chronic alcoholism?
A) superior hemorrhagic polyencephalitis
B) a lesion of the optic nerves
C) central pontine myelinolysis
D) syringomyelia

Back 715

NEU-6.767.
D

Front 716

The therapy of status epilepticus is:
A) phenytoin (Diphedan) iv.
B) diazepam iv.
C) clonazepam iv.
D) disulfiram
E) all of the above
F) only (B), (C), and (D) are true
G) only (C) and (D) are true
H) only (A), (B), and (C) are true

Back 716

NEU-6.768.
H

Front 717

The medication of primary choice in a grand mal attack is:
A) phenytoin (Diphedan)
B) carbamazepine
C) dipropylacetate
D) nitrazepam
E) only (A), (B), and (C) are true
F) only (A) and (D) are true
G) only (C) and (D) are true
H) all of the above

Back 717

NEU-6.769.
E

Front 718

Which of the following cannot develop as a consequence of alcoholism?
A), polyneuropathy
B) cerebral atrophy
C) Wernicke's encephalopathy
D) central pontine myelinolysis
E) Foster-Kennedy's syndrome
F) Marchiafava-Bignami's syndrome

Back 718

NEU-6.778.
E

Front 719

The causes of aphasia include:
A) damage to the nuclei of the lower cranial nerves
B) damage to the lower cranial nerves
C) a cerebellar lesion
D) a lesion of the dominant hemisphere

Back 719

NEU-6.782.
D

Front 720

Which pathological processes cannot be visualized by a CT?
A) identification of an infarction during the early hours
B) identification of any demyelinization disorders
C) identification of abscesses
D) identification of hemorrhages

Back 720

NEU-6.796.
A

Front 721

Which of the following is not applicable in myelography?
A) the intravenous administration of contrast substance
B) the intrathecal administration of contrast substance
C) the intrathecal administration of air

Back 721

NEU-6.797
A

Front 722

A simple spinal X-ray image cannot reveal:
A) any degenerative alteration of the spine
B) any osteolytic vertebral metastases
C) any osteoplastic vertebral metastases
D) any intramedullary processes

Back 722

NEU-6.798.
D

Front 723

A Doppler study can be used for the identification of.
A) the cause of cerebral circulatory disorders
B) the diagnosis of any space-occupying process in the brain
C) Marchiafava-Bignami's disease
D) Foster-Kennedy's syndrome

Back 723

NEU-6.799.
A

Front 724

Which of the following is commonly used in myasthenia gravis?
A) domperidone (Motilium)
B) papaverine (Meristin)
C) pyridostigmine (Mestinon)
D) mexiletine (Mexitil)
E) moroxydine hydrochloride (Morgalin)

Back 724

NEU-6.804.
C

Front 725

A congested fundus:
A) always indicates a brain tumor
B) is frequently caused by inflammation
C) is common in multiple sclerosis
D) frequently occurs in brain tumors, but can also accompany
other processes (for example obscure encephalopathies or
lymphostatic encephalopathies)
E) is always accompanied by severely impaired vision

Back 725

NEU-6.806.
D

Front 726

The normal cell count in the lumbar CSF is:
A) 20-30/mm3
B) 30-40/mm3
C) 40-50/mm3
D) maximum 8-10/mm3

Back 726

NEU-6.807.
D

Front 727

Which pathologic process is not detectable with a simple skull
X-ray?
A) progressive staging of intrasellar space-occupying processes
B) tumors showing calcification
C) a cranial fracture
D) cerebral atrophy

Back 727

NEU-6.808
D

Front 728

Cerebral angiography cannot be used for the detection of:
A) vascular occlusions
B) malformations
C) the cause of cranial polyneuropathy
D) a subdural hematoma

Back 728

NEU-6.809.
C

Front 729

The EMG is used for the following purpose:
A) a study of the electric activity of the brain
B) evoked potentials due to sensory stimuli
C) the state of the muscles, activity of the motor neurons and
peripheral nerves
D) only intracellular leads are used in clinical practice

Back 729

NEU-6.811.
C

Front 730

Which of the following is the most common complication of chronic
alcoholism?
A) polyneuropathy
B) Marchiafava-Bignami disease
C) central pontine myelinolysis
D) cerebellar vermis atrophy
E) alcoholic hallucinosis

Back 730

NEU-6.815.
A

Front 731

Which symptom is not typical of delirium tremens?
A) tremor
B) increased vegetative symptoms
C) visual and tactile hallucinations
D) olfactory hallucinations

Back 731

NEU-6.817.
D

Front 732

An epileptic patient can drive a car if:
A) the drug level is properly set
B) if the patient is not a professional driver and has attacks only
at night
C) if the patient experienced no attacks for 6 weeks and the
epilepsy is not due to a progressive disease
D) if the patient does not take drugs and is attack-free for at least
2 years and epilepsy is not a sign of a progressive disease
E) if the patient takes drugs and has no attacks
F) if the patients takes drugs and has fits without unconsciousness

Back 732

NEU-6.819.
D

Front 733

Which vessels are primarily damaged in hypertension?
A) the arteries of the circle of Willis
B) arteries of middle caliber
C) capillaries
D) arterioles
E) the collaterals

Back 733

NEU-6.820.
D

Front 734

During which period of the day is thrombosis of the cerebral arteries
manifested for the first time?
A) any time
B) at day time during physical exercise
C) at dawn
D) when the patient goes to bed

Back 734

NEU-6.821.
C

Front 735

Damage of which lobe causes sensory aphasia?
A) the frontal lobe
B) the temporal lobe
C) the parietal lobe
D) the occipital lobe

Back 735

NEU-6.823.
B

Front 736

Which of the following is typical of borreliosis?
A) it can be accompanied by arthralgia and cutaneous symptoms
B) it can be followed by a bilateral paralysis of the peripheral
facial nerve
C) the CSF content is always normal
D) it is caused by a virus
E) only (A), (B), and (D) are true
F) only (A) and (B) are true

Back 736

NEU-6.824.
F

Front 737

How is cerebral hemorrhage differentiated from "brain softening"?
A) by the clinical symptoms
B) by the course of the disease
C) with the EEG
D) by the case history
E) with a CT study

Back 737

NEU-6.825.
E