Allergology 1. a. b. c. d. e.

Characteristics of urticarial syndrome are those listed below, EXCEPT: Always have an allergic cause In 50% of cases is associated with angioedema In 25% of population occurs at least once throughout the life Its more frequent in female It is a cutaneous-mucosal syndrome characterized by papules, adjacent erythema and pruritus

A 2. a. b. c. d. e. D 3. a. b. c. d. e. E 4. a. b. c. d. e. A 5. a. b. c. d. e. B H1-antihistamines are used in: Gastric ulcer Urticaria The crisis of angina The crisis of hypertension Acute glaucoma Mechanism of action of Sodium cromoglycate is: Inhibition of mast cell degranulation Reduction of airway inflammation Anticholinergic effect Stimulation of beta-adrenergic receptors Inhibition of phosphodiesterase Characteristics of neurotic angioedema are those listed below, EXCEPT: Represents the clinical and histopathological equivalent of urticarial element extended in surface and depth It is an asymmetric giant urticaria with a typical burning sensation Is developed mainly in the deep tissues containing lax tissue, affecting more often lips, periorbital area, tongue, genitals and limbs Affects mucosa of pharynx, glottis and gastrointestinal tract Regresses promptly to diuretics For chronic urticaria the following statements are correct, EXCEPT: Urticarial elements persist or recur for more than 6 weeks Etiologic agent is established up to 30% of cases It is met in 30% of cases managed by general practice doctor Represents an mandatory continuation of acute urticaria Causes discomfort and cosmetic troubles

6.

H1-antihistamines: 1

a. b. c. d. e. A 7. a. b. c. d. e. E 8. a. b. c. d. e. E 9. a. b. c. d. e. A

Predominantly influence immediate allergic reactions Significantly decrease gastric secretion Are not effective in motion sickness Does not affect histamine bronchial asthma attack May be given only orally

Histamine has the following effects EXCEPT: bronchoconstriction increases the capillary permeability increases intestinal motility stimulates gastric secretion increases blood pressure

The following statements about H1-antihistamines are true, EXCEPT: prevents bronchial, intestinal or uterine spasm inhibits spontaneous gastric secretion have anti-allergic action can suppress CNS may produce CNS stimulation

H1-antihistamines have no: Anti-asthmatic effect CNS depressant effect Hyposecretor effect on gastric mucosa Anticholinergic effect Potentiation effect of other CNS depressants

10. H1-antihistamines can have the following effects, with one exception: a. antialergic b. antiasthmatic c. SNC inhibitor d. gastric secretion inhibitor e. anticholinergic A 11. a. b. c. d. e. A Pollinosis is an allergic condition due to hypersensitivity to the following allergens: Pollen Alimentary household and epidermal Medicines Infections

12. a. b. c. d. e. E 13. a. b. c. d. e. A 14. a. b. c. d. e. C 15. a. b. c. d. e.

Diagnostic criteria of pollinosis are: Worse allergological anamnesis Clinical manifestations Positive skin tests Specific IgE antibodies All of the above

Select the types of allergic reactions involved in the pathogenesis of pollinosis: Type I (anaphylactic) Type II (cytotoxic) Type III (immune complex) Type IV (delayed type) Type I (with the participation of Ig M)

"Atopic triad" is defined by: allergic rhinitis, allergic conjunctivitis, atopic asthma allergic rhinitis, acute urticaria, atopic asthma atopic dermatitis, allergic rhinoconjunctivitis, atopic asthma atopic dermatitis, acute urticaria, atopic asthma allergic rhinoconjunctivitis, urticaria, acute atopic asthma

Anaphylactic shock requires differential diagnosis with: Faintness Hypertension Epilepsy Cardiogenic shock Traumatic shock

A,C,D,E 16. a. b. c. d. e. Pathogenetic treatment in allergic diseases include the following groups of drugs: Mast membrane stabilizers Antihistamines Corticosteroids NSAIDs Beta-blockers

A,B,C 17. a. b. c. d. e. The urticarial reaction involves the following cells: Mastocyte Eosenophil Basophils Monocyte Phagocyte A,B,C,D 3

18. a. b. c. d. e.

Pathophysiological mechanisms of allergic urticaria are: Type I immune reactions Type II immune reactions Type III immune reactions Insufficiency of C1 inhibitor Type IV immune reactions A, C

19. a. b. c. d. e.

In case of urticarial syndrome, the activation mechanisms of mast cell are: Immediate reaginic type hypersensitivity Lack of C1complement inhibitor Activation of plasmatic kinine system Direct activation of mast cells Complement activation through alternate pathway A, D

20. a. b. c. d. e.

The immune forms of urticarial syndrome are: Cholinergic urticaria Heat contact urticaria Vibration Urticaria Atopic urticaria Urticaria in serum sickness D, E

21. a. b. c. d. e.

Cholinergic urticaria is induced by: Exercise Massive intake of foods rich in tyramine Acute psychological stress UV irradiation Warm environment

A,C,E 22. a. b. c. d. e. For the diagnosis of urticaria syndrome of alimentary genesis a primordial importance have: Anamnesis (the effect of elimination) Compliance with basic hypoallergenic diet Making food diary Perform skin tests with food allergens Ultrasonography of abdominal organs A,B,C,D 23. Drugs of choice in controlling urticaria symptoms are: a. Cholinomimetics b. Adrenomimetics c. Ganglioblockers 4

d. e.

Antihistamines Adrenoblockers B, D

24. a. b. c. d. e.

Clinical symptoms of pollinosis are manifested: Only during cold weather Only in the autumn season Arent seasonal Are seasonal Decreased after rain D,E

25. a. b. c. d. e.

What clinical signs are most commonly found in pollinosis pollen-induced seasonal atopic rhinitis pollen-induced seasonal allergic conjunctivitis pollen-induced atopic asthma atopic dermatitis allergic alveolitis A,B,

26. a. b. c. d. e.

The severity of seasonal exacerbations in pollinosis depends on: The concentration of pollen in the air Type of plants The degree of individual sensitivity Pollination season Barometric pressure A,C

27. a. b. c. d. e.

Basic principles in the treatment pollinosis are: Elimination of allergen Alergen-specific immunotherapy Antihistaminic medication Antibiotics Cholinomimetics A,B,C

28. a. b. c. d. e.

Pharmacotherapy of pollinosis includes the following groups of drugs Antibiotics Antihistamines Sedatives Mast membrane stabilizers Topical corticosteroids B,D,E

Pneumology Pneumonia 1. The most common pathogen involved in community acquired pneumonia and causing typical pneumonic syndrome is: a. Mycoplasma pneumoniae b. Streptococcus pneumoniae c. Staphylococcus aureus d. Pseudomonas aeruginosa e. Pneumocystis jiroveci B 2. Atypical pneumonic syndrome is usually determined by: a. Mycoplasma pneumoniae b. Streptococcus pneumoniae c. Pseudomonas aeruginosa d. Pseudomonas aeruginosa e. Gram negative enteric bacilli A 3. Which of the following germs cannot be cultured by routine methods (common culture media): a. Mycoplasma pneumoniae b. Chlamydophila pneumoniae c. Pneumocystis jiroveci d. Mycobacterium tuberculosis e. All of the germs above E 4. The drug of choice in the treatment of Pneumocystis jiroveci pneumonia is: a. Amoxicillin/ clavulanate b. Ceftriaxone c. Trimethoprim-sulfamethoxazole d. Ceftazidime e. Amikacin C 5. Which are the causative germs of franc lobar pneumonia a. Stafilococus aureus b. Streptococus viridans c. Pneumococci d. Mycoplasma pneumoniae e. Influenza viruses C 6. Class of antibiotics of choice for the treatment legionellosis: 6

a. b. c. d. e.

penicillin macrolide aminoglycoside cephalosporins fluoroquinolones B

7. Complications of pneumococcal pneumonia are the following, except: a. Septicemia b. Meningitis c. Pleural empyema d. Pneumothorax e. Renal amyloidosis E 8. Pneumonia, occurred in patients with intravenous catheters infections, are most often caused by: a. Staphylococcus aureus b. Mycoplasma pneumoniae c. Pseudomonas aeruginosa d. oral anaerobes e. Haemophylus influenzae A 9. "Atypical" pneumonic syndrome in a patient with HIV infection suggests involvement of: a. Legionella pneumophila b. Chlamydophila pneumoniae c. Mycoplasma pneumoniae d. Pneumocystis jiroveci e. Haemophylus influenzae D 10. For the etiological treatment of pneumonia caused by Mycoplasma pneumoniae could be used the following drugs except: a. Cefazolin b. Erythromycin c. Clarithromycin d. Tetracycline e. Azithromycin A 11. In patients hospitalized for community acquired pneumonia, among the most frequent pathogens are: a. Pseudomonas aeruginosa b. Streptoccocus pneumoniae c. Gram Negative enteric bacilli d. Haemophilus influenzae e. Legionella pneumophila

BDE 12. In patients with hospital-acquired pneumonia more than 50% of cases are caused by: a. Gram negative enteric bacilli b. Mycoplasma pneumoniae c. Pseudomonas aeruginosa d. Haemophilus influenzae e. Chlamydophila pneumoniae AC 13. Which of the following are not criteria for hospitalization of patients with pneumonia: a. Age> 65 years b. Significant comorbidities (renal, cardiac, pulmonary, etc.). c. fever 38 C d. pneumonia caused by Streptoccocus pneumoniae e. tachypnea (> 30 breaths / minute) CD 14. Criteria for hospitalization of patients with pneumonia are: a. Tachypnea> 20 respirations / minute b. Tachycardia> 90/minute c. Systolic BP <90 mmHg d. PaO2> 80 mmHg e. Failure of treatment administered at home CE 15. Infectious causes of lung cavities are: a. Pseudomonas aeruginosa b. Staphylococcus aureus c. Streptococcus pneumoniae type I d. Histoplasma capsulatum e. Wegener's granulomatosis ABD 16. In a patient with pneumonia a chest X-rays are useful for: a. Detection of possible pulmonary cavities b. Determining the etiology of pneumonia c. Confirmation of pulmonary infiltrates d. Assessment of the extent of inflammation e. Determining the microbial resistance to antibiotic ACD 17. Strains of methicillin resistant Staphylococcus aureus are resistant to: a. Clindamycin b. Erythromycin c. Ofloxacin d. Vancomycin e. Penicillin ABCE 8

18. In the etiology of pneumonia are involved: a. Bacteria b. Mycoplasmas c. Viruses d. Rickettsiae e. Plasmodium falciparum ABCD 19. Radiological manifestations of uncomplicated pneumonia are: a. alveolar opacity with air bronchogram b. silhouette sign c. interstitial opacity d. ring opacity e. all mentioned above ABC 20. Peculiarities of clinical course of pneumonia due to Staphylococcus aureus are: a. Potential pulmonary destruction b. Empyema c. Mild clinical course d. Rounded opacities e. Unchanged complete blood count ABD

21. For the treatment of pneumonia due to methicillin-resistant Streptococcus pneumoniae are recommended: a. oxacillin b. amoxicillin / clavulanate c. clindamycin d. vancomycin e. linezolid DE 22. Risk factors for pneumonia due to Pseudomonas aeruginosa are: a. Cystic fibrosis b. Bronchiectasis c. Recent completion of a course of broad spectrum antibiotics d. Malnutrition e. Contracting pneumonia at home ABCD 23. More frequently interstitial pneumonias are caused by: a. viruses b. atypical agents c. bacteria d. rickettsiae e. Pneumocystis jiroveci ABDE 24. What drugs are not indicated for the treatment of pneumococcal pneumonia: 9

a. b. c. d. e. BCD

Benzylpenicillin Ketokonazol Gentamicin Amphotericin B Erythromycin

25. What drugs could be administered in treatment of bronchopneumonia: a. Penicillin b. Oxacillin c. Meticillin d. Nitroxolina e. Gentamicin ABC

Asthma 1. Which of the following statements best describes the functional residual capacity of the lung? A. The volume of gas at which the tendency of the lungs to collapse (elastic recoil pressure) and the tendency of the chest wall to expand are equal. B. The volume of gas remaining in the lungs at the end of a normal tidal exhalation C. The volume of gas remaining in the lungs after a maximal expiratory effort D. A and B E. A and C D. 2. The most common cause of a pleural effusion is A. cirrhosis B. left ventricular failure C. malignancy D. pneumonia E. pulmonary embolism B. 3. In a patient with severe bullous emphysema, the most appropriate method for measuring lung volumes is A. body plethysmography B. diffusing capacity of carbon monoxide C. spirometry D. helium dilution E. transdiaphragmatic pressure A. 4. What causes wheezing in asthma? a. bronchial spasms 10

b. swelling of the bronchial tubes c. buildup of mucus d. all of the above D. 5. What are nebulizers? a. A stationary air pump that pushes inhaled medication into the lungs b. A portable device for administering inhaled medication into the lungs c. Another word for air purifiers d. Similar to turbohaller A 6. Which one of the following effects is NOT associated with smoking? a. decreased ability of the blood to transport oxygen b. Increased risk of developing 'smokers cough' c. Decreased risk of acquiring pneumonia and bronchitis d. Decreased risk of lung cancer D 7. Which is correct about vesicular breath sounds? a. Inspiratory sounds last longer than expiratory ones. b. Inspiratory and expiratory sounds are about equal. c. Expiratory sounds last longer than inspiratory ones. d. Inspiratory and expiratory sounds are indistinguishable. A 8. A 35 year old woman tells you that she woke up once with her asthma in the last week and needed to use her reliever 3 times during the week. She gets wheezy when she does her washing and cannot rush for the taxi. She has had no exacerbations during the last year. Her PEF is 75% of predicted. What is her level of control? a. Well controlled b. Partly controlled c. Uncontrolled B. 9. A 28 year old woman tells you that she has used her reliever twice in the last week for asthma. Both times was during the day and she has had no nocturnal problems. She has not lost any days at work and has had no exacerbations in the last year. Her PEF is 85% of predicted. What is her level of control? a. Well controlled b. Partly controlled c. Uncontrolled A. 10. Asthma symptoms include: A. coughing, fever, shortness of breath B. coughing, wheezing, chest tightness, and shortness of breath C. haemoptysis, wheezing, jaundice D. All of the above B

11

11. Asthma triggers include: a. Allergens (pollen, mold, dust, pet dander) b. Strong odors (perfumes, paints, cleaners) c. Colds, flu, and respiratory infections d. All of the above D 12. Diurnal variability is calculated as follows: a. (PEF max PEF min)/ [ (PEF max PEF min)/2]x100 b. (PEF max PEF min)/ [ (PEF max + PEF min)/2]x100 c. (PEF max + PEF min)/ [ (PEF max PEF min)/2]x100 d. PEF max PEF min)/ [ (PEF max + PEF min)x2]x100 B 13. What of the following statements regarding inhaled corticosteroids are true: a. They significantly decrease airway inflammation b. They reduce bronchial hyperresponsiveness c. They lead to fewer symptoms and exacerbations d. They relax bronchial smooth muscle e. They may prevent long term fibrosis of the airways a,b,c,e 14. Medications used as a rescue medication (inhaler) in asthma are: a. b. c. d. e. b,d 15. Criterias for mild persistent asthma are: a. b. c. d. e. a, b, c, Symptoms more than once a week but less than once a day Exacerbations may affect activity and sleep Nocturnal symptoms more than twice a month FEV 1 or PEF 60-80% predicted PEF or FEV 1 variability > 30% Salmeterol Salbutamol Theophylline Fenoterol Budesonide

16. What of the following statements regarding long acting beta 2 agonists (LABA) are true: a. They enhance the intracellular action of corticosteroids b. They have a prolonged bronchodilatation, lasting for 12 hours or longer. c. Inhaled corticosteroids increase the number of receptors for LABA action d. They should be used as monotherapy instead of inhaled corticosteroids e. Concerns regarding increased mortality have been aproved a, b, c 17. Criterias for mild persistent asthma are: 12

a. Symptoms daily b. Frequent exacerbations c. Frequent nocturnal asthma symptoms d. FEV 1 or PEF 80% predicted e. FEV 1 or PEF 60% predicted f. PEF or FEV 1 variability < 20% a, b, c, e 18. What of the following statements regarding asthma are true: a. Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. b. The chronic inflammation is not associated with airway hyperresponsiveness c. recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. d. airflow obstruction within the lung that is often reversible either spontaneously or with treatment e. airflow obstruction within the lung that is often ireversible c, d 19. What of the following statements regarding asthma are true: a. Asthma is a problem worldwide, with an estimated 300 million affected individuals. b. Clinical manifestations of asthma can' t be controlled with appropriate treatment. c. A number of factors that influence a person's risk of developing asthma have been identified: host factors (primarily genetic) and environmental factors. d. The presence of airway inflammation remains a consistent feature. a, c d 20. The terms variability refer to: a. improvement or deterioration in symptoms and lung function occurring over time. b. may be experienced over the course of one day (when it is called diurnal variability), from day to day, from month to month, or seasonally. c. a history of variability is an essential component of the diagnosis of asthma. d. variability is not a part of the assessment of asthma control e. variability form a part of the assessment of asthma control a, b, c, e 21. What of the following statements regarding asthma treatments are true: a. Medications to treat asthma can be classified as controllers or relievers. b. Controllers are medications taken daily on a long-term basis to keep asthma under clinical control chiefly through their anti-inflammatory effects. c. Relievers are medications used on an as-needed basis that act quickly to reverse bronchoconstriction and relieve its symptoms. d. Relievers are medications taken daily on a long-term basis to keep asthma under clinical control chiefly through their anti-inflammatory effects. e. Inhaled glucocorticosteroids are the most effective controller medications currently available. a, b, c, e

COPD 1. Pulmonary emphysema in most of the cases can be diagnosed precisely using: 13

a. b. c. d. e. B, D 2. a. b. c. d. e. A, C

Patients history HRCT Laboratory tests Histological examination of lung specimens Spirometry

Pulmonary emphysema is: Permanent distention of airspaces distal to terminal Permanent distention of airspaces distal to segmental bronchioles Rupture of alveolar septa Condition associated with mucus hypersecretion in bronchial wall Condition associated with productive cough

3. Small airways in COPD: a. Are frequently the place of obstruction b. Present hyperplasia of goblet cells c. Present inflammatory cells in the mucosa and submucosa d. Presents peribronchial edema and fibrosis e. Smooth muscle hypertrophy A, B, C, D In COPD: The main site of obstruction are small airways The inflammation is similar to the inflammatory process form asthma The inflammation is due to IL-8 The affected epithelium can release small amounts of regulatory substances like angiotensin converting enzyme or endopeptydase e. There is no correlation between inflammatory reaction and bronchial reactivity A, C, D 5. In the pathogenesis of COPD a important: a. Smoking b. Air pollutants c. Allergens d. -1 antitrypsin deficiency e. sex and race A, B, C, D 6. Smoking: a. Is the most frequent pathogenic factor that correlates with chronic bronchitis and degree of emphysema extent b. long term smoking affects airway cilia activity c. long term smoking leads to goblet cell hypertrophy and hyperplasia d. passive smoking is not noxious e. in association with mild viral infections can contribute or aggravate temporarily the obstruction A, B, C, E 7. Smoking cessation: a. Leads to complete reversibility of severe obstruction 14 4. a. b. c. d.

b. Is useless after obstruction is installed c. Slows significantly the pulmonary function alteration d. Can lead to disappearance of obstruction in case of young smokers e. Is never to late C, D, E 8. COPD, the emphysematous type is characterized by: a. Severe dispnea b. Age over 50 c. Small amounts of mucoid sputum d. Less frequent respiratory infections e. Normal diffusion capacity, with a tendency to decrease A, C, D 9. COPD, the emphysematous type: a. Also called Blue bloater b. Tachypnea c. Box sound on percussion d. Decreased breath sound in auscultation e. Normal TLC and RV B, C, D 10. COPD, the bronchitis type is characterized by: a. Pa CO2 is most of the time 50-60mmHg b. Hematocrit is 50-55% c. Lung compliance severely decreased d. Increased resistance e. Rare bronchial infections A, B, D 11. The patient with COPD, the bronchitis type is: a. Hard smoker b. Overweight and cyanotic c. Less susceptible to mucupurulent infections then the emphysematous type d. Is also called blue bloater e. Rare episodes of respiratory failure A, B, D 12. Prevention in COPD includes: a. Change of work-place, in cases when occupational exposure is important b. Annual flu vaccination c. Avoidance of air pollutants d. Annual vaccination against pneumococcus e. Smoking reduction A, B, C 13. Select the bronchodilators: a. Methilxantines b. Antileukotriens c. Beta-2 adrenomimetics d. Corticosteroides e. Anticolinergics A, C, E 15

14. Methilxantines side effects are: a. Insomnia b. Nervousness c. Periferic neuritis d. Deafness e. Seizures A, B, E 15. Corticosteroids: a. Are indicated to all patients with COPD b. Are indicated only after treatment with bronchodilators and pulmonary drainage failed c. Are monitored by spirometry and gas exchange d. Are administered in dose of 50mg/day e. Are decreased till a minimum dose that allows a satisfactory pulmonary function B, C, E

16. The pathogenic mechanism by which smoking contributes to chronic bronchitis excludes: a. increased cilia movement b. mobilization of pulmonary macrophages c. hyperplasia of goblet cells d. bronchial mucosal infiltration with eosinophils e. citokine release C 17. Which of the following are not risk factors in COPD etiology: a. Smoking b. Genetic factors c. Alcoholism d. Bronchial infections e. Chronic inhalation of various bronchial irritants C 18. The most important pathogenetic factor in COPD is: a. Exposure to cold b. Intermittent exposure to occupational hazards c. Crowded places d. Smoking e. Respiratory viral infections D 19. In patients with COPD, flebotomy is indicated when hematocrit is: a. 30% b. >40% c. >50% d. >55% e. At any value of hematocrit D 20 Second stage in COPD classification (GOLD) is characterized by: a. FEV 1<50% 16

b. c. d. e.

50%< FEV1< 80% 30%< FEV1< 50% FEV 1<30% FEV180%

B 21. Select the correct answer: a. Treatment of COPD is identical to that of asthma b. Corticosteroids are indicated in patients with COPD stage II c. In patients with COPD, Ipratropium is contraindicated d. Smoking cessation is the most effective and cost efficient method that slows down the disease progression e. Patients with COPD are treated with long term oral corticosteroids D 22. Select the wrong answer with correspondence to exacerbation criteria of COPD: a. Increasing dispnea, increasing amount of sputum b. Cough, rinoreea c. Age >60% d. Fever e. Wheezing C 23. Nonfarmacological treatment of COPD excludes: a. Pulmonary rehabilitation b. Oxygen administration c. Mechanical ventilation d. Inhaled bronhodilators e. Surgery D 24. With correspondence to home treatment of COPD exacerbation, select the wrong answer: a. Increase the frequency and/or dose of inhaled bronchodilators b. Short term oral corticosteroids c. Antibiotics for 10 days d. Ipratropium can be added e. Vaccination is needed E 25. Low level or absence of one of the following substance is associated with early onset of emphysema: a. Glucose-6 phosphate- dehydrogenase b. Pyruvate kinase c. Alpha-1- antitrypsin d. Lipoprotein lipase e. LDH C

17