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Asthma 1. Factors that can contribute to asthma or airway hyperreactivity may include any of the following: 1. Chronic sinusitis or rhinitis 2. Aspirin or nonsteroidal anti-inflammatory drug hypersensitivity 3. Use of beta-adrenergic receptor blockers 4. All of above 2. Mechanism of bronchoconstriction during asthma attack includes all, except: 1. mucus plugs 2. airway spasm 3. proliferation 4. swollen middle layer 3. Which statement about asthma is wrong? 1. Asthma is a chronic inflammatory disorder of the airways 2. Airway obstruction is often caused by abnormal sensitivity of cholinergic and peptidergic receptors 3. In asthma, airway obstruction is irreversible 4. Cigarette smoke, cold air, and viral infections can provoke asthma attacks 4. Step 1 – Intermittent asthma is characterized by all except: 1. Intermittent symptoms occurring less than once a week 2. Nocturnal symptoms occurring less than twice a week 3. Asymptomatic with normal lung function between exacerbations 4. FEV1 or PEF rate greater than 80%, with less than 20% variability 5. Step 2 - Mild persistent asthma is characterized by all except: 1. Symptoms occurring more than once a week but less than once a day 2. Nocturnal symptoms occurring more than twice a month 3. Brief exacerbations 4. FEV1 or PEF rate greater than 80% predicted, with variability of 20-30% 6. Step 3 - Moderate persistent asthma is characterized by all except: 1. Weekly symptoms 2. Exacerbations affect activity and sleep 3. Nocturnal symptoms occurring more than once a week 4. FEV1 or PEF rate 60-80% of predicted, with variability greater than 30% 7. Step 4 - Severe persistent asthma is characterized by all except: 1. Symptoms occurring more than once a week but less than once a day 2. Frequent exacerbations 3. Frequent nocturnal asthma symptoms 4. FEV1 or PEF rate less than 60%, with variability greater than 30% 8. A diagnosis of asthma can be confirmed using all investigation, except: 1. Spirometry tests 2. Skin testing 3. A chest x-ray 4. Exhaled nitric oxide (NO) 9. Symptoms of asthma may include the following: 1. Chest tightness 2. Sputum production 3. Decreased exercise tolerance 4. All of above 10. . Pharmacologic treatment of Intermittent asthma include: 1. long-term oral corticosteroid therapy 2. The controller medication is an inhaled corticosteroid (800-2000 mcg) 3. The controller medication is an inhaled corticosteroid (200-500 mcg) 4. A controller medication is not needed 11. Pharmacologic treatment of Mild persistent asthma include: 1. The controller medication is an inhaled corticosteroid (200-500 mcg), cromolyn, nedocromil, or a leukotriene antagonist 2. The controller medication is an inhaled corticosteroid (800-2000 mcg) 3. A controller medication is not needed 4. Long-term oral corticosteroid therapy 12. Pharmacologic treatment of Moderate persistent asthma include: 1. The controller medication is an inhaled corticosteroid (200-500 mcg), cromolyn, nedocromil, or a leukotriene antagonist 2. The controller medication is an inhaled corticosteroid (800-2000 mcg) and a long-acting bronchodilator (either beta-agonist or sustained-release theophylline) 3. The controller medication is an inhaled corticosteroid (800-2000 mcg), a long-acting bronchodilator (beta-agonist and/or theophylline), and long-term oral corticosteroid therapy 4. Long-term oral corticosteroid therapy 13. Pharmacologic treatment of Severe persistent asthma include: 1. The controller medication is an inhaled corticosteroid (500-1000 mcg) 2. The controller medication is an inhaled corticosteroid (800-2000 mcg) 3. The controller medication is an inhaled corticosteroid (800-2000 mcg), a long-acting bronchodilator (beta-agonist and/or theophylline), and long-term oral corticosteroid therapy 4. The controller medication is an inhaled corticosteroid (200-500 mcg) and a long-acting bronchodilator (either beta-agonist or sustained-release theophylline) 14. The short-acting Beta-adrenergic agonists is: 1. Salmeterol 2. Albuterol 3. Theophylline 4. Ipratropium 15. The long-acting Beta-adrenergic agonists is: 1. Salmeterol 2. Ventolin 3. Cromolyn 4. Ipratropium 16. Mast cell stabilizer is: 1. Beclomethasone 2. Ventolin 3. Cromolyn 4. Ipratropium 17. Corticosteroid is: 1. Fluticasone 2. Salmeterol 3. Cromolyn 4. Ipratropium 18. Complications associated with long-term corticosteroid used for asthma may include: 1. Osteoporosis 2. Immunosuppression 3. Weight gain 4. All of above COPD 1. Risk factors for COPD include: 1. Cigarette smoking 2. Lung infections 3. Exposure to pollutants 4. All the Answers 2. Which statement about COPD is not true? 1. a chronic, slowly progressive disorder characterised by airways obstruction (FEV1 < 80% predicted and FEV1/FVC ratio < 70%) 2. COPD is an important cause of activity limitation in the population 3. obstructive syndrome is completely reversible by bronchodilator 4. The first symptoms of chronic bronchitis are cough and mucus production 3. Mild COPD is characterized by: 1. airflow limitation (FEV1/FVC < 0.70; 50% < FEV1 < 70% predicted) 2. airflow limitation (FEV1/FVC < 0.70; FEV1 70% predicted) 3. airflow limitation (FEV1/FVC < 0.70; 30% < FEV1 < 60% predicted) 4. airflow limitation (FEV1/FVC < 0.70; FEV1 80% predicted) 4. Moderate COPD is characterized by: 1. airflow limitation (FEV1/FVC < 0.70; 50% < FEV1 < 80% predicted) 2. airflow limitation (FEV1/FVC < 0.70; FEV1 . 80% predicted) 3. airflow limitation (FEV1/FVC < 0.70; 30% < FEV1 < 60% predicted) 4. airflow limitation (FEV1/FVC < 0.70; FEV1 < 40% predicted ) 5. Severe COPD is characterized by: 1. airflow limitation (FEV1/FVC < 0.70; 50% < FEV1 < 80% predicted) 2. airflow limitation (FEV1/FVC < 0.70; 40% < FEV1 < 60% predicted) 3. airflow limitation (FEV1/FVC < 0.70; 30% < FEV1 < 50% predicted) 4. airflow limitation (FEV1/FVC < 0.70; FEV1 . 80% predicted) 6. Very Severe COPD is characterized by: 1. airflow limitation (FEV1/FVC < 0.70; 30% < FEV1 < 50% predicted) 2. airflow limitation (FEV1/FVC < 0.70; FEV1 < 40% predicted 3. airflow limitation (FEV1/FVC < 0.70; FEV1 < 30% predicted 4. airflow limitation (FEV1/FVC < 0.70; FEV1 < 50% predicted 7. Complications of COPD include: 1. Pulmonary bullae 2. pneumothorax 3. Respiratory failure 4. All the Answers 8. The physical sighs of Emphysema are all, except: 1. decrease vesicular breath 2. tympanic sound 3. dullness on percussion 4. shortness of breath on exertion 9. Management of Stable COPD includes: 1. Smoking Cessation 2. Pharmacological Therapy 3. Long-Term Oxygen Therapy 4. All the Answers 10. The Management of Mild COPD includes: 1. Smoking Cessation 2. oxygen therapy 3. corticosteroids 4. long-time bronchodilator 11. The Management of Severe COPD includes: 1. Smoking Cessation 2. oxygen therapy 3. corticosteroids 4. All the Answers 12. A diagnosis of COPD can be confirmed using all investigation, except: 1. Pulmonary function test 2. Skin testing 3. A chest x-ray 4. Blood gas levels Pneumonia 1. Wich of the following organisms should be suspected in patients with community-acquired pneumonia: 1. mycobacterium tuberculosis 2. histoplasma capsulatum 3. p.carinii 4. Steptococcus 2. Nosocomial pneumonia is: 1. Tuberculosis in a a patient suffering from AIDS 2. infection of a nasal cavity in immuno compromised patient. 3. Hospital acquired pneumonia 4. A type of community acquired pneumonia 3. Which of the following condition predispose to Aspiration pneumonia ? 1. head trauma 2. all the answers 3. altered conciousness 4. cerebrovascular accident 4. Wich of the following organisms should be suspected in an immunocompromised patient which shows diffused infiltrates on the chest Xray? 1. p.carinii 2. legionalle 3. herpes zoster virus 4. All the Answers 5. Which of the following condition predispose to pneumonia in immuno compromised patients? 1. head trauma 2. all the answers 3. AIDS 4. cerebrovascular accident 6. Risk factors for Hospital-acquired pneumonia? 1. mechanical ventilation, 2. prolonged malnutrition, 3. underlying heart and lung diseases 4. All the Answers 7. Which is the most common cause of hospital-acquired pneumonia? 1. str.pneumonіae 2. All the Answers 3. S. aureus 4. malignancy 8. Wich of the following organisms should be suspected in patient whith homogeneous opacity localised to the one lobe on the chest Xray? 1. p.carinii 2. str.pneumonіae 3. herpes zoster virus 4. All the Answers 9. Which is the most common cause for a focal lesion on a chest x ray? 1. benign lesion 2. All the Answers 3. bacterial infection. 4. malignancy 10. Pneumatoceles is a feature of pneumonia due to: 1. H. influenza 2. E. coli 3. S. aureus 4. Abscess formation 11. Complications of pneumonia includes: 1. Respiratory and circulatory failure 2. acute respiratory distress syndrome 3. pleural effusion 4. All the Answers 12. Complications of pneumonia includes all except: 1. septic shock 2. lung abscess 3. sepsis 4. rheumatoid arthritis 13. Drug of choice in mycoplasma pneumonia 1. streptomycin 2. tetracycline 3. erythromycin 4. moxalactam 14. Drug of choice in patient with I gr. of Community-acquired pneumonia is: 1. streptomycin 2. tetracycline 3. Trimethoprim-sulfamethoxazole 4. amoxicillin 15. Drug of choice in patient with II gr. of Community-acquired pneumonia is: 1. tetracycline 2. erythromycin 3. cefuroxim 4. Trimethoprim-sulfamethoxazole Lung abscesses and bronchiectasis 1. Bronchiectasis associated with tuberculosis is usually called dry bronchiectasis and is seen most commonly in the: 1. Lower lobes 2. Upper lobes 3. Middle lobes 4. all the answers 2. The diagnostic modality of choice for demonstrating or ruling out bronchiectasis is: 1. Chest radiography 2. High-resolution computed tomography 3. Bronchography 4. Results of sputum culture 3. The first generation cephalosporins include: 1. cefaclor, 2. cefamandole 3. cefazolin 4. cefixime 4. The second generation cephalosporins include: 1. cefaclor 2. cefadroxil 3. cefoperazone, 4. cefotaxime 5. The third generation cephalosporins include: 1. cefaclor 2. cefadroxil 3. cefoperazone 4. cephalothin 6. The fourth generation cephalosporins include: 1. cefaclor, 2. cefamandole 3. cefepime 4. cefixime 7. Fluoroquinolones include all, except: 1. ciprofloxacin 2. cefquinome 3. levofloxacin 4. lomefloxacin 8. Macrolide antibiotics are all, except: 1. erythromycin, 2. clarithromycin, 3. doxycycline, 4. roxithromycin 9. Which of the following is/are a cause of acquired bronchiectasis 1. Marfan syndrome 2. Williams-Campbell syndrome 3. Foreign Body 4. Cystic Fibrosis 10. In a patient with long standing, severe, bronchiectasis and infection, which of the following would be elevated? 1. WBC 2. RBC 3. Hematocrit 4. All the above 11. Mucolytics agents are commonly used to enhance the mobilization of secretions in patients with bronchiectasis. Which of the following is/are classified as a mucolytic agent(s)? 1. Acetylcysteine 2. Cromolyn Sodium 3. Beclomethasone 4. Trimethoprim-sulfamethoxazole 12. Which of the following is a cause of acquired bronchiectasis 1. Marfan syndrome 2. Young syndrome 3. bronchopulmonary aspergillosis 4. Cystic Fibrosis 13. The treatment bronchiectasis includes: 1. Antibiotics 2. Surgical Care 3. Bronchodilators 4. All of the above Pleuritis 1. The causes of pleural transudates are all except: 1. Congestive heart failure 2. Cirrhosis (hepatic hydrothorax) 3. Atelectasis (which may be due to malignancy or pulmonary embolism) 4. Parapneumonic causes 2. The causes of pleural transudates are all except: 1. Hypoalbuminemia 2. Asbestos exposure 3. Nephrotic syndrome 4. Peritoneal dialysis 3. The causes of pleural exudates are all except: 1. Congestive heart failure 2. Malignancy (carcinoma, lymphoma, mesothelioma) 3. Pulmonary embolism 4. Collagen-vascular conditions (rheumatoid arthritis, lupus) 4. The causes of pleural exudates are all except: 1. Myxedema 2. Trauma 3. Postcardiac injury syndrome 4. Esophageal perforation 5. The clinical picture of pleuritis may include: 1.Pleuritic chest pain, 2.Vague discomfort 3.Sharp pain that worsens on inspiration 4.All of above 6. The clinical picture of pleuritis may include all except: 1.Dyspnea 2.A pleural friction rub 3.Absent tactile fremitus 4.Bronchial sound above dulness 7. Which of the following investigations would be of greatest use in establishing a diagnosis of pleural effusion? 1. Lateral chest X-ray 2. Serum rheumatoid factor, anti-nuclear factor and anti-DNA antibodies 3. Pleural aspiration 4. Arterial blood gas 8. Light's criteria of Exudative Pleural Effusions include all except: 1. Fluid LDH* ≥ 2/3 ULN for serum LDH 2. Fluid total protein ≥ 3 g/dL 3. Fluid cholesterol ≥ 80 mg/dL 4. Pleural fluid: serum total protein ratio ≥ 0.5 9. Light's criteria of Exudative Pleural Effusions include all except: 1. Fluid LDH* ≥ 2/3 ULN for serum LDH 2. Fluid total protein ≥ 5 g/dL 3. Fluid cholesterol ≥ 60 mg/dL 4. Pleural fluid: serum total protein ratio ≥ 0.5 10. Light's criteria of Exudative Pleural Effusions include all except: 1. Fluid LDH* ≥ 2/3 ULN for serum LDH 2. Fluid total protein < 3 g/dL 3. Fluid cholesterol ≥ 60 mg/dL 4. Pleural fluid: serum total protein ratio ≥ 0.5 Anemia 1. In Ukraine normal Hb concentration for men is: A. 120-140 g/L B. 140-160 g/L C. 150-170g/L D. 160-180 g/L 2. Which anemia is Macrocytic: A. Aplastic anemia B. Anaemia of chronic disease C. Vitamin B12 deficiency D. Iron deficiency 3. The signs of Sideropenic syndrome include all, except: A. concave nails (koilonychias) B. cheilosis, angular stomatitis C. altered taste D. dyspnea 4. The iron transporting protein, which can transport iron from cells (intestinal, macrophages) to specific receptors on erythroblasts and liver cells, is: A. hemosiderin B. transferrin C. ferritin D. all of above 5. Laboratory Studies in diagnostic of iron deficiency: A. low serum iron and ferritin with an elevated total iron-binding capacity B. low serum iron and high ferritin with an decreased total iron-binding capacity C. high serum iron and ferritin with an elevated total iron-binding capacity D. low serum iron and ferritin with an decreased total iron-binding capacity 6. The most common causes of megaloblastic anemias are, exclude: A. iron deficiency B. disturbances in folic acid metabolism C. folic acid deficiency D. deficiency of vitamin B12 7. Neurological symptoms of Vitamin B12 deficiency megaloblastic anemias include: A. loss of proprioception B. Optic atrophy - blindness C. Glove and stocking paraesthesiae all of above 8. Blood film of megaloblastic anemia exclude: A. neutrophil hypersegmentation B. oval macrocytosis C. hypochromic red cells D. decreased reticulocyte count 9. The most dangerous side effect of parenteral use of iron-carbohydrate complexes is: A. anaphylactic reactions B. dyspepsia C. constipation D. all of above 10. Pica chlorotica is characterized by: A. altered taste B. dry, hyperemic or “geographic” tongue C. sparse hair, falling out D. concave nails (koilonychias) 11. The most important storage pool of iron is: A. Transferrin B. hemosiderin ferritin myoglobin 12. Drugs that can cause megaloblastic anemia are, except: A. Amyodarone B. 6-Mercaptopurine C. Methotrexate D. 5-Fluorouracil, 5-azacytidine 13. Anaemic (hypoxic) Syndrome exclude: A. Fatigue, weakness B. Bradycardia C. Dyspnea D. Dizziness 14. Hemolysis produce: A. Unconjugated (indirect) hyperbilirubinemia B. Decrease LDH serum levels C. Direct bilirubinemia D. Discolored, acholic stool 15. The signs of hemolytic anemia include all, except: A. Jaundice B. Gallstones C. Altered taste D. General pallor 16. The direct Coombs' test is used to detect: A. IgG antibodies against RBCs in a patient's serum B. RBC-binding antibody IgG is present on RBC membranes of patient C. IgG antibodies against complement D. Deficiency of IgG antibodies in a patient's serum 17. Specific treatment for Hereditary spherocytosis is: A. azathioprine B. splenectomy C. cyclophosphamide D. prednisolone 18. Vaso-occlusive crisis are typical sign of: A. Sickle Cell Anemia B. Thalassaemia C. Hereditary spherocytosis D. Autoimmune haemolytic anaemia 19. Target cells are the most specific for: A. Sickle Cell Anemia B. Thalassaemia C. Acquired aplastic anemia D. Autoimmune haemolytic anaemia 20. The drug for the treatment of Sickle Cell Anemia is: A. Hydroxyurea B. azathioprine C. prednisolone D. cyclophosphamide 21. The most common syndromes in patients with aplastic anemia are all, except: A. Hepatosplenomegaly B. Recurrent infections C. Anemia D. Haemorrhagic syndrome 22. Bone marrow biopsy in middle-aged individuals with aplastic anemia is: A. >30% cellular B. <50% cellular C. <30% cellular D. <20% cellular 23. The criteria of the International Aplastic Anemia Study Group includes: A. Neutrophils < 1 x 109/L Platelets < 100 x 109/L B. Neutrophils < 1 x 109/L Platelets < 20 x 109/L C. Neutrophils < 0.5 x 109/L Platelets < 20 x 109/L D. Neutrophils < 0.5 x 109/L Platelets < 10 x 109/L 24. The criteria of the International Aplastic Anemia Study Group includes: A. Neutrophils < 1 x 109/L Platelets < 20 x 109/L B. Neutrophils < 0.1 x 109/L Reticulocytes < 10 x 109/L C. Neutrophils < 0.5 x 109/L Reticulocytes < 2 x 109/L D. Neutrophils < 0.5 x 109/L Reticulocytes < 1 x 109/L Acute leukemias 1. The most common symptoms of Acute leukemias are: C. fever, malaise, weight loss D. petechiae, easy bruising, epistaxis, C. pallor, fatigue, tachycardia D. all of above 2. Symptoms of bone marrow failure in patients with Acute leukemias include all, except: A. bone pain B. multiple eccymoses C. fatigue D. fever 3. Specific sign in CBC and peripheral smear in patients with Acute leukemias: A. pancytopenia B. high WBC count C. peripheral blasts cells D. high platelets 4. Symptoms of organ infiltration with leukemic cells in patients with Acute leukemias include all, except: A. splenomegaly B. bone pain C. bleeding D. gingivitis 5. Leukostasis is: A. leukemic gap B. palpable lymphadenopathy C. respiratory distress and altered mental status due to markedly elevated WBC counts D. gingivitis due to neutropenia with swollen gums 6. CBC count with Peripheral blood smear in Acute Myeloid Leukemia don’t show: A. circulating blasts B. anaemia with a normal or raised MCV C. leukemic gap D. increase of different midstage progenitor cells 7. Induction therapy of Acute Myeloid Leukemia "3 and 7" include: A. Vincristine B. Daunorubicin C. Azathioprine D. Methotrexate 8. Chemotherapy for Acute Lymphoid Leukemia include phases: A. Consolidation B. Remission induction C. CNS prophylaxis D. all of above 9. Induction therapy of ALL - 5-drug regimen - doesn’t include: A. L -asparaginase B. Mercaptopurine C. Vincristine D. Prednisone 10. Small, punctate, hemorrhagic rashes that are not palpable are: A. petechiae B. ecchymoses C. purpura D. all of above 11. AML is defined as the presence in the bone marrow of: A. different midstage progenitor cells B. < 20% blasts C. > 20% blasts D. > 50% blasts 12. CNS prophylaxis and treatment of ALL doesn’t include: A. intrathecal methotrexate B. corticosteroids C. IV vincristine D. cytosine arabinoside 13. Induction therapy of ALL - 4-drug regimen - doesn’t include: A. Vincristine B. Cyclophosphamide C. Azathioprine D. Methotrexate 14. Leukemic gap is: A. severe leukocytopenia with blast cells in the peripheral blood B. blast cells with absence of different midstage progenitor cells (myelocytes, metamyelocytes) in the peripheral blood C. very low blast cells count in the peripheral blood comparatively with bone marrow D. all of above Chronic leukemias 1. Philadelphia (Ph) chromosome is the most common find in patients with: A. Chronic lymphoid leukaemia B. Polycythaemia rubra vera C. Chronic myeloid leukaemia D. Myelofibrosis 2. Chronic myeloid leukemia is characterized by: A. increased number of granulocytes and their immature precursors B. decrease of different midstage progenitor cells C. increased number of granulocytes with leukemic gap D. circulating blasts 3. Signs of chronic lymphocytic leukemia include, except: A. splenomegaly B. asymptomatic lymphadenopathy C. autoimmune hemolytic anemia D. plethora 4. According to the Binet staging system of Chronic lymphocytic leukemia: Absolute lymphocytosis of > 10,000/μL in blood and ≥ 30% lymphocytes in bone marrow, Hb ≥ 10 g/dL; Platelets ≥ 100,000/μL with 3-5 involved sites of lymphoid enlargement is: A. Stage A B. Stage B C. Stage C D. Stage III 5. Acute phase, or blast crisis of Chronic myeloid leukaemia is characterized by: A. peripheral blood blasts of 10% B. peripheral blood blasts of 20% C. peripheral blood blasts of 30% D. peripheral blood blasts of 50% 6. CBC count with peripheral blood smear in patients with Chronic myeloid leukaemia isn’t characterized by: A. absolute eosinophilia and basophilia B. presence of the different midstage progenitor cells C. leukemic gap D. myeloblasts 7. The first-line therapy in chronic phase Chronic myeloid leukaemia is: A. Hydroxyurea B. Busulfan C. Vincristine D. Imatinib 8. Initial therapy of CLL include: A. cyclophosphamide B. chlorambucil C. rituximab D. all of above 9. Symptoms of Polycythemia vera don’t include: A. Plethora B. Pruritus C. Pallor D. Splenomegaly 10. Criteria for Diagnosis of Polycythemia Vera include, except: A. Splenomegaly B. Enlarged megakaryocytes C. Panmyelosis D. Plethora 11. Chronic lymphocytic leukemia is a monoclonal disorder, which is characterized by: A. progressive accumulation of functionally competent B-lymphocytes B. progressive accumulation of functionally incompetent nonproliferative lymphocytes C. progressive accumulation of T-lymphocytes with increase immunoglobulin production D. progressive accumulation of lymphocytes precursor 12. Chronic lymphocytic leukemia hallmark don’t include: A. sustained, absolute peripheral mature lymphocytosis > 5 × 109/l B. autoimmune hemolytic anemia C. increased lymphocytes (> 30%) in the bone marrow D. signs duration > 3 months 13. According to the Rai-Sawitsky staging system of Chronic lymphocytic leukemia: Absolute lymphocytosis of > 10,000/μL in blood and ≥ 30% lymphocytes in bone marrow plus hepatomegaly or splenomegaly is: A. Stage 0 B. Stage I C. Stage II D. Stage IV 14. Complete cytogenetic response in patients with Chronic myeloid leukaemia is produced by: A. Busulfan B. Imatinib C. Vincristine D. Cytosine arabinoside 15. Criteria for Diagnosis of Polycythemia Vera include: A. Erythrocytosis B. Platelet count < 400,000 μL A. asymptomatic lymphadenopathy B. Plasma erythropoietin level < 4 mUnits/mL Lymphomas, Multiple myeloma 1. Multiple myeloma is a malignant proliferation of: A. functionally competent B-lymphocytes B. atypical megakaryocytes C. atypical plasma cells that produce monoclonal immunoglobulin D. typical plasma cells that produce polyclonal immunoglobulin 2. The most common organ involvement of Multiple myeloma include, except: A. kidney B. bone C. bone marrow D. gastrointestinal system 3. The most common Laboratory Studies result of Multiple myeloma is high: A. RBC B. WBC C. platelet counts D. ESR 4. Bence Jones protein is: A. free monoclonal κ or λ light chains in the urine B. heavy chains γ or α in the serum C. monoclonal immunoglobulin in the serum D. polyclonal immunoglobulin 5. In patients without serum M protein, myeloma is indicated by, except: A. absolute peripheral lymphocytosis > 5 × 109/l B. Bence Jones proteinuria > 300 mg/24 h C. osteolytic lesions D. sheets or clusters of marrow plasma cells 6 According to the Salmon-Durie staging system for multiple myeloma: Calcium level > 2,75 mM/L, X-ray showing advanced lytic bone disease, Plasma cell in bone marrow > 60% of nuclear cells is: A. Stage I B. Stage II C. Stage III D. Stage IV 7 The most appropriate treatment of Skeletal lesions in patient with Multiple myeloma is: A. Allopurinol B. phluossen C. vit. D3 D. bisphosphonate 8 "B symptoms" in patient with Hodgkin lymphoma include, except: A. fever B. night sweats C. jaundice D. unexplained weight loss 9 The main Symptom of Hodgkin lymphoma is: A. pallor B. painless lymphadenopathy C. bleeding, purpura D. bone pain 10. According to the Ann Arbor classification for Hodgkin lymphoma 2 or more lymph node areas on the same side of the diaphragm is: A. Stage I B. Stage II C. Stage III D. Stage IV 11. A mediastinal mass greater than one third of the intrathoracic diameter (on a chest radiograph) according to the Ann Arbor classification for Hodgkin lymphoma is denoted as: A. "A" designation B. "B" designation C. "E" designation D. "X" designation 12. Treatment of Hodgkin lymphoma include: A. Chemotherapy B. stem cell transplantation C. Radiation therapy D. all of above 13. According to the Ann Arbor classification for Hodgkin lymphoma the involvement of the spleen is denoted as: A. "S" designation B. "B" designation C. "E" designation D. "X" designation 14. Pathognomic sign of Hodgkin lymphoma in Biopsy is: A. Bence Jones protein B. Target cells C. Reed-Sternberg cells D. Clusters of plasma cells Platelet and coagulation disorders 1. The most common hereditary coagulation disorder is: A. von Willebrand's disease B. haemophilia C. disseminated intravascular coagulation D. Immune thrombocytopenic purpura 2. Hemophilia A is a congenital deficiency of: A. factor VIII B. factor IX C. factor VIII and IX D. factor V 3. Coagulation factor VIII is: A. Prothrombin B. Christmas factor C. Fibrinogen D. Antihemophilic globulin 4.The most common symptoms of hemophilia are, except: A. recurrent haemarthroses B. prolonged bleeding C. petechiaes D. muscle haematomas 5. In a patient presenting with a bleeding disorder, which of the following clinical features would be most suggestive of a coagulation defect as opposed to a platelet disorder? A) Epistaxis B) Haemarthrosis C) Menorrhagia D) Purpura 6 In hemophilia: A. fibrinogen level is increased B. platelet count are decreased C. prothrombin times is shortened D. activated partial thromboplastin times (aPTTs) is prolonged 7. In Moderate hemophilia factor VIII or IX level is: A. < 1% of normal B. 1 to 5% of normal C. 5 to 25% of normal D. 10 to 50% of normal 8. Long-term Complications of Hemophilia exclude: A. Hepatosplenomegaly B. Arthropathy of large joints C. Atrophy of muscles secondary to haematomas D. Mononeuropathy resulting from pressure by haematomas 9. The best treatment of hemophilia is: A. Fresh frozen plasma B. Replacement of the deficient factor C. desmopressin D. antifibrinolytic drug 10. Petechiae is a result of: A. easy bruising B. bleeding C. extravasation of blood from capillaries into skin and mucous membranes D. muscle hematoma 11. The hallmark of Immune thrombocytopenic purpura is: A. thrombocytopenia, neutropenia B. isolated thrombocytopenia C. thrombocytopenia, anemia D. pancytopenia 12. The symptoms of Immune thrombocytopenic purpura don’t include: A. Widespread petechiae and ecchymoses B. gingival bleeding C. Konchalovsky syndrome D. Haemarthrosis 13. Immune thrombocytopenic purpura may occur due to: A. NSAIDs B. viral upper respiratory infection C. hepatitis virus D. all above 14. Treatment of chronic Immune thrombocytopenic purpura doesn’t includes: A. Splenectomy B. Rituximab, a monoclonal antibody C. Methylprednisolone D. Cephalosporins Gastritis 1. The aetiological factor of gastritis are, except: A. Klebsiella B. non-steroidal anti-inflammotory drugs C. Helicobacter pylori D. smoking 2. Helicobacter pylori produce enzyme: A. lipase B. somatostatin C. lactase D. urease 3. The effects of Helicobacter pylori are, except: A. reduce gastric mucosal resistance B. reduce gastrin release from G cells C. release cytotoxins D. increase acid secretion 4. The production of ammonia from urea by Helicobacter pylori: A. reduce the pH around the bacterium B. raise the pH around the bacterium C. raise gastric mucosal resistance D. reduce acid load to duodenum 5. The best diagnostic test for Helicobacter pylori is: A. histology B. serology C. urea breath test D. rapid urease test 6. Helicobacter pylori exclusively colonises: A. gastric-type epithelium B. intestinal epithelium C. duodenum epithelium D. esophageal epithelium 7. The urea breath test is useful in the diagnosis of which one of the following conditions? A. Bacterial overgrowth B. Helicobacter pylori infection C. Lactose intolerance D. Coeliac disease 8. For urea breath test are used: A. C14 B. C13 C. J131-hyppuran D. Tc99-sulphur 9. H2-receptors antagonists drugs are used: A. 6-hourly B. 8-hourly C. 12-hourly or at night E. once weakly 10. H2-receptors antagonists drugs are, except: A. ranitidine B. omeprazole C. cimitidine D. famotidine 11. Misoprostol is: A. H2-receptors antagonists B. syntetic prostaglandin analogues C. antacid D. H+/K+ ATPase inhibitor 12. Autoimmune gastritis is characterized by: A. hyperacidity B. severe pain C. mucus hypertrophy D. hypoacidity 13. The most powerful inhibitors of gastric secretion are: A. antacids B. proton pump inhibitors C. H2-receptors antagonists drugs D. M-cholin-receptor antagonists drugs 14. Which one of the following statements concerning the bacterium Helicobacter pylori is true? A. It is a Gram-positive rod B. It produces an enzyme called 'urease' that lowers the surrounding pH C. It exclusively colonises gastric-type epithelium D. On colonising the stomach it induces increased secretion of somatostatin from D cells Peptic ulcer disease 1. The etiological factor of peptic ulcer is: A. Candida B. -hemolytic streptococcus C. Helicobacter pylori D. all answers are true 2. Invasive diagnostic test for Helicobacter pylori is: A. serology B. rapid urease test C. urea breath test D. all answers are true 3. Abdominal pain in the patients with the gastric or duodenal ulcer is characterized by, except: A. relationship to food B. localization to the epigastrium C. permanent D. episodic occurrence 4. Abdominal pain in the patients with the duodenal ulcer isn’t: A. nocturnal painB. late painC. hunger painD. early pain5. The generalized “board-like” rigidity of abdomen is observed in: A. gastric cancer B. gastric bleeding C. perforation D. gastric outlet obstruction 6. Upper GI radiography with a double-contrast barium study shows the only direct symptom of ulcer:A. Radiating foldsB. Ulcer craterC. Nitch symptom D. Pyloristenosis 7. Complications of the peptic ulcer is, except: A. bleeding B. perforation C. gastric outlet obstruction D. ascitis 8. Free air beneath the diaphragm in erect chest radiograph is observed in: A. perforation B. gastric cancer C. gastric outlet obstruction D. gastric bleeding 9. The cornerstone of therapy for peptic ulcers is: A. prokinetic effect B. enhance mucosal defence C. inhibit acid secretion D. Helicobacter pylori eradication 10. Primary (first-line) H. pylori eradication therapy include, except: A. clarithromycin B. omeprazole C. bitsmuth D. amoxicillin 11. The most optimal Management of Upper gastrointestinal bleeding to provide Hemostasis is:A. Dicinon B. Rheopolyglucini C. Fresh frozen plasmaD. Ac. Aminocapronici 12. The cardinal features of gastric outlet obstruction are, except: A. nausea B. vomiting C. abdominal distension D. ascitis 13. Primary (first-line) H. pylori eradication therapy include: A. omeprazole, amoxicillin or metronidazole, clarithromycin B. clarithromycin, misoprostol, bitsmuth C. aspirin, amoxicillin or tetracycline, clarithromycin D. omeprazole, tetracycline, ranitidine 14. Treatment of non-Hp ulcer include: A. PPI for 4 weeksB. PPI for 8 weeks C. PPI for 52 weeksD. Bismuth for 2 weeks 15. Quadruple therapies for H pylori infection include, except: A. Bismuth 525 mg qid, Metronidazole 500 mg qid, PPI bid, clarithromycin 500 mg qid B. Bismuth 525 mg qid, PPI bid, Metronidazole 500 mg qid, Tetracycline 500 mg qid C. Metronidazole 500 mg qid, PPI bid, clarithromycin 500 mg qid D. PPI bid, Bismuth 525 mg qid, Tetracycline 500 mg qid, 16. Maintenance therapy of peptic ulcer include, except: A. Long-term treatment B. On-demand treatment C. Prolong 52-weeks treatment D. Week-end therapy CHOLECYSTITIS 1. An overweight 41-year-old woman with a body mass index of 32 presents with a 5-day history of severe right upper quadrant pain. Initially the pain was intermittent, lasting for 2 hours then subsiding, but for the past 12 hours it has been constant. On examination she is pyrexial (38.5°C) and there is tenderness and rigidity in the right upper quadrant. Her white cell count is 18 × 109/l and C-reactive protein 130 mg/l. Liver function tests (LFTs) and amylase are within the normal range. Which of the following diagnoses is most likely? 1. Biliary colic 2. Acute pancreatitis 3. Acute cholecystitis 4. Choledocholithiasis 2. Which one of the following hormones causes contraction of the gallbladder and release of bile acids in the fed state? 1. Insulin 2. Cholecystokinin 3. Glucagon 4. Noradrenaline (norepinephrine) fed 3. Which of the following patterns of symptoms is most characteristic of acute blockage of the cystic duct by a gallstone? 1. Recurrent epigastric pain, radiating to the back, lasting 2 hours then subsiding spontaneously 2. Constant severe epigastric pain and recurrent vomiting 3. Intermittent burning epigastric pain relieved by drinking milk 4. Crushing, heavy epigastric pain radiating to the jaw associated with sweating, nausea and a terror of imminent death 4. Which of the following investigations is most appropriate for the initial diagnosis of acute symptomatic gallstone disease? 1. CT of the abdomen 2. Abdominal ultrasound scan 3. Chest X-ray 4. Plain abdominal X-ray 5. Risk factors for calculous cholecystitis are all except: 1. Male sex 2. Obesity or rapid weight loss 3. Drugs (especially hormonal therapy in women) 4. Pregnancy 6. Complications of acute cholecystitis are all except: 1. Empyema of gallbladder 2. Emphysematous cholecystitis 3. Perforated gallbladder 4. Primary sclerosing cholangitis 7. Which one of the following statements concerning biliary colic is incorrect: 1. Sudden and complete obstruction of the cystic duct by stone 2. Severe pain, the patient twists in agony until the pain resolves 3. A bout of vomiting often precedes the beginning of the attack 4. History of previous similar episodes 8. Which one of the following statements concerning cholecystitis is incorrect: 1. Physical examination may reveal fever, tachycardia, and tenderness in the RUQ or epigastric region 2. A palpable gallbladder or fullness of the RUQ is present in 30-40% of cases. 3. Jaundice may be noted in approximately 15% of patients. 4. The absence of physical findings rules out the diagnosis of cholecystitis. Intestine diseases 1. Functions of the small intestine are, except: A. absorption B. digestion C. protection against ingested toxins D. production of bile 2. Diarrhoea is: A. frequent porridge-like stool B. watery stool C. the passage of more than 200 g of stool daily D. pellety stool 3. The symptoms of malabsorption related to deficiency of iron are, except: A. anaemia B. angular stomatitis C. koilonychia D. proximal myopathy 4. The symptoms of malabsorption related to deficiency of vitamin B12 are, except: A. peripheral oedema B. peripheral neuropathy C. anaemia D. angular stomatitis 5. The symptom of night blindness related to deficiency of: A. iron B. vitamin D C. vitamin A D. albumin 6. The symptom osteomalacia in malabsorption related to deficiency of: A. zink B. calcium C. protein D. vitamin K 7. The symptoms of malabsorption related to deficiency of protein are, except: A. peripheral oedema B. poor wound healing C. muscle-wasting D. follicular hyperkeratosis 8. The sings of malabsorption are, except: A. hypoalbuminaemia B. increased prothrombin time C. hypocalciaemia D. increased hemoglobin 9. An immunologically mediated inflammatory disorder of the small bowel occurring in genetically susceptible individuals is: A. celiac disease B. Whipple’s disease C. Crohn’s disease D. ulcerative colitis 10. A multisystem disease with fat malabsorption, protein-losing enteropathy and gastrointestinal, nervous, pulmonary and musculoskeletal involvement is: A. ulcerative colitis B. celiac disease C. Whipple’s disease D. Crohn’s disease 11. Whipple’s disease is characterized by, except: A. constipation B. low-grade fever C. arthropathy D. steatorrhoea 12. A lifelong gluten-free diet - the only known effective treatment of : A. ulcerative colitis B. celiac disease C. Whipple’s disease D. Crohn’s disease 13. An idiopathic chronic recurring inflammatory process of the bowel that often leads to segmental transmural granulomatosis, fibrosis and obstructive symptoms, which can affect any part of the gastrointestinal tract is: A. ulcerative colitis B. celiac disease C. Whipple’s disease D. Crohn’s disease 14. The most common gastrointestinal tract involvement in Crohn’s disease is: A. esophagus B. pylorus and duodenum C. sigmoid and rectum D. terminal ileum 15. Which disease is characterized endoscopically by segmental lesions, separated by healthy areas cobblestone: A. celiac disease B. ulcerative colitis C. Crohn’s disease D. Tropical sprue 16. Complications of Crohn's Disease don’t include: A. Hypersplenism B. Fistulae C. Acute toxic megacolon D. Intestinal obstruction Bowel diseases 1. Functions of the colon are, except: A. absorption water B. protein digestion C. absorption electrolytes D. propelling the faecal bolus 2. The bowel frequency of the normal population ranges: A. once day B. from 2 movements per day to 1 bowel action every second day C. from 3 movements per day to 1 bowel action every third day D. from 3 movements per day to 1 bowel action every week 3. In the assessment of diarrhoea, which one of the following clinical features most strongly suggests a colonic aetiology? 1. Right iliac fossa pain 2. Undigested food in stool 3. Blood and mucus in stool 4. Large-volume stool 4. Which one of the following physical consequences of malabsorption is incorrectly matched with the corresponding vitamin or mineral deficiency? 1. Acrodermatitis enteropathica - Zinc 2. Purpura and bruising - Vitamin K 3. Peripheral neuropathy - Vitamin C 4. Night blindness - Vitamin A 5. Which of the following would be least expected to provoke a relapse ('flare') of ulcerative colitis? 1. Loss of job 2. Cigarette smoking 3. Viral laryngitis 4. Course of antibiotics for falsely suspected urinary tract infection 6. A 19-year-old male presents with a 10-day history of bloody diarrhoea and lower abdominal pain associated with fever, malaise and anorexia. Which of the following investigations would be least helpful in establishing a diagnosis? 1. Stool culture and microscopy 2. Sigmoidoscopy and rectal biopsy 3. Blood cultures and serological tests of infection 4. Serum albumin 7. Which one of the following statements concerning intestinal complications of inflammatory bowel disease (IBD) is incorrect? 1. In ulcerative colitis, colonic perforation may occur without the development of toxic megacolon 2. The risk of developing colon cancer in ulcerative colitis is related to both the extent and the duration of colitis 3. Both conditions may present with acute life-threatening haemorrhage 4. Diarrhoea in ulcerative colitis may be due to enteroenteric fistulae 8. Which one of the following systemic complications of inflammatory bowel disease is not related to the activity of bowel disease? 1. Conjunctivitis 2. Primary sclerosing cholangitis 3. Arthralgia 4. Pyoderma gangrenosum 9. Which one of the following clinical features is least suggestive of irritable bowel syndrome (IBS)? 1. Colicky abdominal pain relieved by defaecation 2. Sensation of incomplete defaecation 3. Symptoms disturbing sleep 4. Alternating diarrhoea and constipation 10. Regarding the management of irritable bowel syndrome (IBS), which one of the following statements is true? 1. Patients with constipation as the predominant symptom benefit most from tricyclic antidepressant therapy 2. Elimination diets are the mainstay of treatment 3. Reassurance alone may lead to resolution of symptoms 4. All patients should be advised to increase dietary fibre 11. A functional bowel disorder in which abdominal pain is associated defaecation or a change in bowel habit with features of disordered defaecation and distension: A. ulcerative colitis B. Whipple’s disease C. celiac disease D. irritable bowel syndrome 12. Irritable bowel syndrome is characterized by, except: A. depression B. colicky abdominal pain C. bowel bleeding D. feeling of incomplete defaecation 13. Irritable bowel syndrome is wide overlap with, except: A. non-ulcer dyspepsia B. fever C. chronic fatigue syndrome D. dysmenorrhoea 14. The patient has severe ulcerative colitis with bloody diarrhoea and lower abdominal pain associated with fever, malaise and anorexia.. Which one of the following is true regarding the management? 1. Nutritional support, if required, should be provided intravenously rather than enterally 2. The patient should be treated with intravenous corticosteroids 3. Surgery should not be considered until he has had at least 10 days of maximal medical therapy 4. Sulfasalazine overcomes the need for surgery in around 80% of patients who fail to respond to corticosteroids Hepatitis 1. Which of the following is not a function of the liver? 1. Synthesis of clotting factors 2. Production of vitamin K 3. Production of glucose during fasting 4. Storage of copper 2. What a maintenance dose of prednisolone in chronic autoimmune hepatitis? 1. 100 mg 2. 0,1 mg 3. 1 mg 4. 10 mg 3. Which of the following viruses is not capable of causing infection without concurrent infection with another hepatitis virus? 1. B) Hepatitis B 2. C) Hepatitis C 3. D) Hepatitis D 4. E) Hepatitis E 4. Which is the morphological feature of alcoholic liver disease? 1. Gystiolymfoplazmocyt’s infiltration of portal fields 2. The presence of eosinophylic hyaline alcohol particles (Melory’s particles ) 3. Moderate fibrosis combined with degeneration of liver cells 4. Hyperplasia of stellate retikuloendoteliots 5. What are the normal sizes of liver (by Kurlov?) 1. . 14-14-15 см 2. 7-6-6 см 3. 14-9-12 см 4. 10-9-8 см 6. Which antibiotics are most hepatotoxic? 1. Natural penicillins 2. Semisynthetic penicillins 3. Cephalosporins 4. Tetracyclines 7. Raising of wich lab test isn’t apply to cytolytic syndrome? 1. ALT 2. LDD 3. C-reactive protein 4. GGT 8. Which one of the following statements about hepatitis B infection is true? 1. The route of infection does not affect clinical course 2. It is caused by an RNA virus 3. No vaccine is available 4. It may cause cirrhosis 9. The drug of choice for treatment of chronic viral hepatitis in the phase of virus replication? 1. -interferon 2. Voltaren 3. Vinpocetine 4. Cyclophosphan 10 Which drug is the drug of choice for treatment of autoimmune hepatitis? 1. Perlinganit 2. Prednisolone 3. Papaverine 4. Prazozin 11. What morphological change is not characteristic of chronic hepatitis B? 1. Gistiolimfoplazmotsit’s infiltration of portal fields 2. Hyperplasia of stellate retikuloendoteliots 3. Moderate fibrosis combined with degeneration of liver cells 4. Lesion of lobular structure of liver 12. A hospital inpatient is noted to have an elevated gamma-glutamyl transferase (GGT) with otherwise normal liver function tests. She is taking the following regular medications. Which one is most likely to have caused this abnormality? 1. Omeprazole 2. Paracetamol 3. Phenytoin 4. Ibuprofen 13. Of the following conditions, which is the most likely cause of jaundice accompanied by a seven-fold elevation of alanine aminotransferase and two-fold elevation of alkaline phosphatase? 1. Viral hepatitis 2. Acute cholecystitis 3. Gilbert's syndrome 4. Pancreatic carcinoma 14. Which one of the following is most suggestive of haemolysis as the cause of jaundice? 1. Raised alanine aminotransferase (ALT) 2. Presence of spider naevi 3. Bilirubinuria 4. Raised reticulocyte count 15. Which one of the following coagulation factors depends on vitamin K for complete synthesis in the liver? 1. Factor V 2. Factor VIII 3. Factor IX 4. Factor XI 16. A patient notices that the whites of her eyes have become yellow, her urine has been very dark for several days. Which of the following diagnoses is the most likely explanation for these symptoms? 1. Cholestatic jaundice 2. Hyperbilirubinaemia secondary to Gilbert's syndrome 3. Rhabdomyolysis 4. Dehydration 17. Which one of the following statements is true of hepatitis C infection? 1. It is usually sexually transmitted 2. Once infected, cure is impossible 3. Liver transplantation is contraindicated due to the risk of reinfection of the transplanted liver 4. Acute infection is usually asymptomatic 18. World-wide, which of the following is the most important risk factor for hepatocellular carcinoma? 1. Alcoholic liver disease 2. Haemochromatosis 3. Non-alcoholic steatohepatitis (NASH) 4. Chronic viral hepatitis 19. A 34-year-old woman is referred to the gastrointestinal clinic after her GP discovers abnormal liver function tests. She denies alcohol abuse or sexual risk factors. She received a blood transfusion in the UK in 2002 following a road traffic accident. Her past medical history includes obesity (body mass index = 42), type 2 diabetes mellitus and anxiety/depression. What is the most likely cause of her deranged LFTs? 1. Occult drug overdose 2. Alcoholic liver disease 3. Non-alcoholic fatty liver disease 4. Hepatitis B infection Cirrosis 1. What is the normal level of serum total protein? 1. 60-85 g /l 2. 20-45 g /l 3. 80-105 g /l 4. 100-125 g /l 2. Which of the following tests provides the most information about hepatic synthetic function within the last 12 hours? 1. Activated partial thromboplastin time (APTT) 2. Albumin 3. Fibrinogen 4. Prothrombin time (PT) 3. Which of the following is the first-line drug of choice to treat chronic ascites secondary to hepatic cirrhosis? 1. Furosemide 2. Spironolactone 3. Digoxin 4. Vasopressin 4. Which of the following statements about primary biliary cirrhosis is true? 1. It is more common in men 2. Pruritus is a more common presenting feature than jaundice 3. A positive antinuclear antibody is diagnostic 4. Immunosuppression prevents disease progression 5. Group designation B of Criteria for Child-Pugh classification includes Serum bilirubin (µmol/L): A. 20-34 B. 30-45 C. 34.2-51 D. 40-55.5 6. Group designation B of Criteria for Child-Pugh classification includes Serum albumin (g/L): A. 20-30 B. 30-35 C. 35-40 D. 35-55 7. Hypersplenism result in: A. Spleen enlargement B. hypoproteinemia C. pancytopenia D. cholestasis 8. Complications of cirrhosis don’t include: A. secondary erytrocytosis B. variceal hemorrhage C. ascites D. hepatic coma 9. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy is: A. Xanthelasmata B. spider nevi C. fetor nepaticus D. Asterixis 10. The hallmark of Primary biliary cirrhosis: A. serum antimitochondrial antibodies B. cholesterol C. bilirubin D. alkaline phosphatase 11. Management of Primary biliary cirrhosis don’t include: A. Ursodeoxycholic acid B. Corticosteroids C. Cholestyramine D. Omeprasol 12. According to Grading of Hepatic encephalopathy: Subtle personality change; gross deficits in ability to perform mental tasks with intermittent disorientation for time or place is: A. Mild confusion B. Lethargy or apathy C. Somnolence to semistupor D. Coma 13. According to Grading of Hepatic encephalopathy: Marked confusion; gross disorientation, unable to perform mental tasks, disorientation to time and place, amnesia is: A. Mild confusion B. Lethargy or apathy C. Somnolence to semistupor D. Coma 14. Management of Hepatic encephalopathy includes: A. Lactulose B. Antibiotics C. Aminosteril-N-hepa D. all of above 15. Lactulose is: A. Enzymatic drug without bile acids B. Antibiotic C. diuretic D. osmotic laxative Pancreatitis 1. The most-common symptoms of chronic pancreatitis: 1. Abdominal pain 2. Steatorrhea 3. Nausea 4. All symptoms 2. The specific pancreatic enzymes: 1. Amylase 2. Elastase-1 3. Lipase 4. Phosphatase 3. The normal level of ph of pancreatic juice: 1. 1,0-1,2 2. 3,0-3,5 3. 7,5-9,0 4. 5,0-6,5 4. The daily volume of pancreatic juice: 1. 0,2-0,4 2. 0,8-1,2 3. 1,5-2,0 4. 0,6-0,8 5. The main symptoms of endocrine pancreatic insufficiency: 1. Hyperinsulinizm 2. Hypercorticoidism 3. Gipokortitsizm 4. Gipoinsulinizm 6. The main causes of chronic pancreatitis: 1. Alcoholism 2. Stenosis of the ampulla of Vater 3. Hereditary 4. All causes 7. The main tests to establish the diagnosis of chronic pancreatitis: 1. Ultrasound 2. CT 3. Abdominal X-ray 4. All tests 8. The main tests of pancreatic function: 1. Collection of pure pancreatic juice after secretin injection 2. Faecal pancreatic chymotrypsin or elastase 3. Oral glucose tolerance test 4. All tests 9. The complications of chronic pancreatitis: 1. Pseudocysts and pancreatic ascites 2. Extrahepatic obstructive jaundice 3. Duodenal stenosis 4. All complications 10. The complications of chronic pancreatitis: 1. Goblet cell intestinal metaplasia or Barretts esophagus 2. Portal or splenic vein thrombosis 3. Esophageal adenocarcinoma 4. All complications 11. The basic principles of the treatment of chronic pancreatitis: 1. Pain control 2. Bowel rest and hutritional support 3. Antibiotics 4. All 12. The diet for chronic pancreatitis: 1. A diet low in fat and high in protein and carbohydrates. 2. Include a daily diet of 2000-3000 calories, consisting of 1.5-2.0 g/kg of protein, 5-6 g/kg of carbohydrates, and 20-25% of total calories consumed as fat (about 50-75 g) per day. 3. Oral supplementation of fat soluble vitamins (A, D, E, and K) and vitamin B-12 is recommended. 4. All recommendations 13. Which of the following tests is most useful in the assessment of pancreatic exocrine function? 1. Faecal elastase 2. CT scan of abdomen 3. Fasting blood glucose 4. Lactose hydrogen breath test 14. A 55-year-old male presents with a 6-hour history of severe, constant upper abdominal pain radiating to the back. He drinks approximately 80 units of alcohol per week. On examination there is marked epigastric tenderness but no guarding or rebound tenderness. Which of the following tests is likely to be most useful in reaching a positive diagnosis? 1. Plain abdominal X-ray 2. C-reactive protein 3. ECG 4. Serum amylase Gastro-oesophageal reflux disease (GORD) 1. The most-common symptoms of gastroesophageal reflux disease: 1. Heartburn 2. Regurgitation 3. Trouble swallowing (dysphagia) 4. All symptoms 2. The most-common complications of gastroesophageal reflux disease: 1. Esophageal strictures 2. Barrett's esophagus 3. Esophageal adenocarcinoma 4. All complications 3. The atypical symptoms of gastroesophageal reflux disease: 1. Chronic cough, laryngitis, asthma 2. Jaundice 3. Ascites 4. All symptoms 4. The atypical symptoms of gastroesophageal reflux disease: 1. Erosion of dental enamel 2. Dentine hypersensitivity 3. Sinusitis 4. All symptoms 5. Factors that can contribute to gastroesophageal reflux disease: 1. Hiatal hernia 2. Obesity 3. Zollinger-Ellison syndrome 4. All factors 6. Factors that can contribute to gastroesophageal reflux disease: 1. Cachexia 2. Hypercalcemia 3. Portal hypertension 4. All factors 7. Medications of gastroesophageal reflux disease: 1. Proton pump inhibitors 2. Gastric H2 receptor blockers 3. Antacids 4. All 8. Medications of gastroesophageal reflux disease: 1. Glucocorticosteroids 2. Prokinetics 3. Hepatoprotectors 4. All 9. The standard surgical treatment of gastroesophageal reflux disease: 1. The Nissen fundoplication 2. Highly selective vagotomy 3. Transoral incisionless fundoplication 4. All 10. The surgical treatment of gastroesophageal reflux disease: 1. The Nissen fundoplication 2. Highly selective vagotomy 3. Transoral incisionless fundoplication 4. All 11. Another names of gastroesophageal reflux disease: 1. Gastro-oesophageal reflux disease (GORD) 2. Gastric reflux disease 3. Acid reflux disease 4. All names 12. The main investigations of gastroesophageal reflux disease: 1. Ambulatory esophageal pH monitoring 2. Barium swallow X-rays 3. Esophagogastroduodenoscopy 4. All investigations 13. Biopsies of gastroesophageal reflux disease may show: 1. Lymphocytic inflammation 2. Neutrophilic inflammation 3. Eosinophilic inflammation 4. All kinds of inflammation 14. Biopsies of gastroesophageal reflux disease may show: 1. Edema and basal hyperplasia 2. Goblet cell intestinal metaplasia or Barretts esophagus 3. Dysplasia or pre-cancer 4. All 15. GERD is caused by: 1. Failure of the cardia of the stomach 2. Incompetence of the higher esophageal sphincter 3. Changes in the barrier between the duodenum and the stomach 4. All 16. Which one of the following factors does not predispose to gastro-oesophageal reflux disease (GORD)? 1. Pregnancy 2. High intake of coffee 3. Weight loss 4. Hiatus hernia