Question no. 1 W.N
INTERNAL MEDICINE PNEUMONOLOGY
1. The conventional site for pleural aspiration (thoracentesis) is located:
A/ posteriorly, approximately 10 cm lateral to the spine (mid-scapular line) and 1-2 intercostal spaces below the upper level of the fluid
B/ posteriorly, approximately 10 cm lateral to the spine (mid-scapular line) and 1-2 intercostal spaces above the upper level of the fluid
C/ posteriorly, approximately in the middle between the spine and anterior scapular line and 1-2 intercostal spaces below the upper level of the fluid
D/ only after radiological or ultrasound guidance, in the widest part of the effusion
E/ in second intercostal space, in parasternal line, because of the lowest risk of pneumothorax
Source: Harrison's Principles of Internal Medicine, 17th Edition, chapter 257, pp. 1658-1659
Correct answer: A
Question no. 2 W.N.
2. Respiratory system is not the cause of transudate in pleural cavity. This statement is:
A/ false
B/ true, but in rare cases exudate can be observed in pulmonary embolism
C/ false, because when ejection fraction in cardiac ECHO is within normal range the fluid can't arise
D/ false, because parapneumonic fluid is in most cases transudate
E/ false, because if there is fluid in pleural cavity, it is evidence for illness of respiratory system
Source: Harrison's Principles of Internal Medicine, 17th Edition, chapter 257, pp. 1658
Correct answer: B
Question no. 3 W.N.
3. False negative PPD test in tuberculosis is observed in following clinical situations:
A/ severe tuberculosis, immunocompromised patients, malnutrition, sarcoidosis, kidney disease, pertussis
B/ obesity, mild tuberculosis, Churg-Strauss syndrome, extrinsic allergic alveolitis
C Wegener's granulomatosis, familial intestinal polyposis, Raynauld disease, Löeffler's syndrome
D/ glomerular nephritis, mycobacteriosis, during anti-TB therapy, pneumoconiosis
E/ overdose of anti-TB agents, which can cause inhibition of cell-mediated immunity
Source: Harrison's Principles of Internal Medicine, 17th Edition, chapter 158, pp. 1019
Correct answer: A
Question no 4 W.N.
4. Elderly patient, aged 80, with confirmed arterial hypertension and atrial fibrillation has been admitted to emergency unit. In anamnesis nocturnal dyspnoea for few days, productive cough with expectorating pink, frothy sputum. In physical examination peripheral cyanosis, wheezing, bilateral crackles at the base of lungs, pitting feet edemas. Additional examination necessary to make a diagnosis are:
A/ high resolution chest CT, sputum examination for M. tuberculosis, Doppler ultrasonography of lower limbs
B/ ECG, chest X-ray, CRP, blood morphology and electrolytes, clotting parameters
C/ chest ultrasonography, spirometry, ECG, gastroscopy
D/ microbiological sputum examination, pletysmography, chest CT
E/ blond morphology and smear, cholesterol, TSH, spirometry, sputum smear
Source: Harrison's Principles of Internal Medicine, 17th Edition, chapters 245, 246, 247, pp. 1583-1595
Correct answer: B