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Belarus Medical Specialist Attestation study materials
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Belarus Medical Specialist Attestation practice questions

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Question 1Legislation and normative regulation of healthcare in the Republic of Belarus

Under the Law of the Republic of Belarus on Health Care, which body is designated as the central state body responsible for the implementation of state policy in the field of public health?

  1. The National Assembly of the Republic of Belarus
  2. The Council of Ministers of the Republic of Belarus
  3. The Ministry of Health of the Republic of Belarus Correct answer.
  4. The Ministry of Labour and Social Protection of the Republic of Belarus

Explanation

The Law on Health Care assigns the Ministry of Health the role of the republican state administration body that conducts state policy in public health and manages the subordinate health care system. The Council of Ministers exercises general executive authority, while the National Assembly is the legislative body.

Question 2Legislation and normative regulation of healthcare in the Republic of Belarus

A patient reaches the age of majority and asks who may give informed consent to medical intervention on their behalf. According to Belarusian health legislation, informed consent for medical intervention is given by:

  1. The citizen himself or herself Correct answer.
  2. The patient's close relatives
  3. The head of the health care organisation
  4. The attending physician alone

Explanation

Belarusian law is based on the principle that a capable adult patient gives voluntary informed consent to medical intervention personally. Consent by others applies only in legally defined situations such as minors or persons declared legally incapable.

Question 3Legislation and normative regulation of healthcare in the Republic of Belarus

Which document is the fundamental legislative act regulating the organisation of health care and the rights of citizens in the field of health protection in the Republic of Belarus?

  1. The Civil Code of the Republic of Belarus
  2. The Law on Health Care Correct answer.
  3. The Labour Code of the Republic of Belarus
  4. The Constitution of the Republic of Belarus

Explanation

The Law on Health Care is the sectoral legislative act that sets out the principles of health protection, the rights of patients and the structure of the health care system. The Constitution establishes the general right to health protection, but detailed regulation is contained in the Law on Health Care.

Question 4Legislation and normative regulation of healthcare in the Republic of Belarus

A patient's medical confidentiality is protected by law. Disclosure of information constituting medical confidentiality without the patient's consent is permitted:

  1. Only after a written request from the patient's employer
  2. At the discretion of the attending physician
  3. Whenever a relative of the patient requests it orally
  4. In cases expressly established by legislative acts Correct answer.

Explanation

Medical confidentiality may be disclosed without consent only in the situations directly enumerated in legislative acts, for example at the request of investigative bodies or in defined public-health situations. Any other disclosure requires the patient's consent.

Question 5Legislation and normative regulation of healthcare in the Republic of Belarus

In the Republic of Belarus, first aid to a person in a life-threatening condition may be provided by:

  1. Only nurses on duty in a health care organisation
  2. Any person who has the appropriate training, including bystanders Correct answer.
  3. Only physicians with a specialist certificate
  4. Only staff of the emergency medical service

Explanation

Legislation distinguishes first aid, which may be rendered by persons with appropriate training including lay rescuers, from medical aid, which is provided by medical workers. This allows bystanders to act in life-threatening situations without legal liability when acting in good faith.

Question 6Legislation and normative regulation of healthcare in the Republic of Belarus

A medical worker is asked to perform a medical intervention that the patient refuses after being informed of the possible consequences. According to Belarusian law, the patient's refusal:

  1. Requires approval by the head of the department to be valid
  2. May be disregarded if the physician considers the intervention necessary
  3. Must be documented and the patient must be informed of the possible consequences Correct answer.
  4. Has no legal effect until confirmed by a relative

Explanation

The law grants the patient the right to refuse medical intervention. The refusal is recorded in the medical documents and the patient is informed of the possible consequences of refusing.

Question 7Legislation and normative regulation of healthcare in the Republic of Belarus

Which of the following categories of citizens is entitled under Belarusian legislation to free provision of medicines and medical products on an outpatient basis under the state guarantees programme?

  1. All citizens regardless of income
  2. Persons with certain diseases and categories defined by legislative acts, such as disabled persons of certain groups Correct answer.
  3. Only persons insured under voluntary health insurance
  4. Only citizens employed in the health care system

Explanation

Free or reduced-price medicines are provided to categories expressly defined by legislation, such as persons with particular socially significant diseases and persons with disabilities. The list is determined by normative acts rather than granted universally.

Question 8Legislation and normative regulation of healthcare in the Republic of Belarus

A citizen wishes to appeal against the actions of a health care organisation. According to Belarusian legislation on appeals of citizens and legal persons, an appeal may be submitted:

  1. To the health care organisation and to the superior state body, including in electronic form Correct answer.
  2. Only through a court
  3. Only in person at the Ministry of Health
  4. Only through a lawyer

Explanation

The legislation on appeals provides for submission of appeals to the organisation concerned and to superior bodies, and expressly allows electronic appeals. Judicial appeal remains available but is not the only route.

Question 9Legislation and normative regulation of healthcare in the Republic of Belarus

Medical and pharmaceutical activity in the Republic of Belarus is subject to licensing. The purpose of state licensing in this field is primarily to:

  1. Limit the number of private organisations
  2. Replace clinical protocols with administrative rules
  3. Ensure the safety and quality of medical and pharmaceutical services and protect patients' rights Correct answer.
  4. Increase the revenue of health care organisations

Explanation

Licensing is a state instrument that verifies compliance with licensing requirements and conditions in order to protect the life and health of citizens and ensure the quality of services. It is not a revenue or restriction mechanism.

Question 10Legislation and normative regulation of healthcare in the Republic of Belarus

According to the legislation of the Republic of Belarus, a medical worker is obliged to keep medical confidentiality. This obligation:

  1. Ends when the worker changes employment
  2. Continues after termination of employment and after the patient's death Correct answer.
  3. Applies only to information recorded in the medical card
  4. Applies only during working hours

Explanation

The duty to protect medical confidentiality is not limited to the period of employment or to the patient's lifetime, since it protects the personal and family secret of the citizen. It covers any information obtained in the course of professional duties.

Question 11Legislation and normative regulation of healthcare in the Republic of Belarus

Which of the following is the correct definition of a clinical protocol in the Republic of Belarus?

  1. A commercial contract between a clinic and a patient
  2. A statistical report on morbidity in a region
  3. A normative act establishing general requirements for the diagnosis, treatment and prevention of diseases Correct answer.
  4. An internal order on staff scheduling

Explanation

Clinical protocols are normative legal acts that establish uniform requirements for the provision of medical care, including diagnosis, treatment and prevention, and are binding on health care organisations. They standardise the quality of care.

Question 12Legislation and normative regulation of healthcare in the Republic of Belarus

A patient is diagnosed with a disease that is included in the list of socially significant diseases. Under Belarusian legislation, such patients are entitled to:

  1. Automatic receipt of a disability group
  2. Priority admission to any university
  3. Exemption from all taxes
  4. Free medical observation and provision of medicines under state programmes Correct answer.

Explanation

For socially significant diseases the state provides dispensary observation and medicines within the framework of state programmes. Other benefits such as tax exemptions or disability status are governed by separate legislation and are not automatic.

Question 13Legislation and normative regulation of healthcare in the Republic of Belarus

A foreign citizen temporarily staying in Belarus requires emergency medical care. According to Belarusian legislation, emergency medical care for such persons is:

  1. Provided only in private clinics
  2. Provided only after payment in advance
  3. Provided free of charge as part of the state guarantees Correct answer.
  4. Refused unless the person has insurance

Explanation

Emergency medical care is included in the state guarantees of medical care and is provided to all persons, including foreign citizens, without prior payment. Planned care for foreign citizens may be provided on a paid basis under separate rules.

Question 14Legislation and normative regulation of healthcare in the Republic of Belarus

Which body establishes the procedure for conducting a medical examination to determine the degree of loss of professional ability to work?

  1. The medical-social expert commission acting under the established normative acts Correct answer.
  2. The trade union of the enterprise
  3. The employer's human resources department
  4. The local executive committee alone

Explanation

The degree of loss of professional ability to work is established by the medical-social expert commission in accordance with normative legal acts. The employer and trade union participate in documentation but do not determine the degree.

Question 15Legislation and normative regulation of healthcare in the Republic of Belarus

A physician is asked to disclose information about a patient to police investigating a criminal case. According to Belarusian law, the physician should:

  1. Provide the information upon a lawful written request from the body conducting the criminal proceedings Correct answer.
  2. Provide the information orally to any police officer who asks
  3. Refuse in all circumstances
  4. Provide the information only with the consent of the patient's relatives

Explanation

Legislative acts establish grounds for disclosure of medical confidentiality, including a lawful request from bodies conducting criminal proceedings. The disclosure must follow the procedure and form prescribed by law.

Question 16Legislation and normative regulation of healthcare in the Republic of Belarus

Which of the following principles underlies the organisation of the state health care system of the Republic of Belarus?

  1. Payment for all medical services at the point of delivery
  2. Free choice of a private insurer for every citizen
  3. Universal access to medical care and state guarantees of its provision Correct answer.
  4. Restriction of medical care to employed citizens

Explanation

The Belarusian health care system is built on the principle of universal access to medical care guaranteed by the state, including a defined package of free services. Insurance and paid services exist but do not replace this guarantee.

Question 17Legislation and normative regulation of healthcare in the Republic of Belarus

A nurse notices that a colleague has violated the rules for storing narcotic drugs. According to the normative regulation of circulation of narcotic drugs in health care organisations, the nurse should:

  1. Ignore the situation as it is not her responsibility
  2. Discuss the situation with patients
  3. Report the violation to the responsible person and the head of the organisation in accordance with the internal control procedure Correct answer.
  4. Correct the records herself without informing anyone

Explanation

Narcotic drugs are subject to strict accounting and storage requirements, and violations must be reported through the established internal control procedure to the responsible person and the head of the organisation. Concealment or informal correction would breach accounting discipline.

Question 18Legislation and normative regulation of healthcare in the Republic of Belarus

Medical workers in the Republic of Belarus are subject to mandatory state social insurance. In the event of temporary disability, the benefit is paid:

  1. Only after one year of continuous service
  2. By the employer from its own profit only
  3. Under the state social insurance procedure on the basis of a certificate of temporary disability Correct answer.
  4. Only if the worker has private insurance

Explanation

Temporary disability benefits are paid under the state social insurance system on the basis of a properly issued certificate of temporary disability. The employer processes the payment but the source of financing is the social insurance fund.

Question 19Legislation and normative regulation of healthcare in the Republic of Belarus

Under the legislation on health care, the provision of medical care to a patient without his or her consent is permitted:

  1. Only with the consent of the patient's spouse
  2. When the patient is over 60 years of age
  3. In cases of a condition threatening life, when the patient's will cannot be ascertained, by decision of a council of physicians or the attending physician Correct answer.
  4. Whenever the physician considers the patient unreasonable

Explanation

The law allows medical intervention without consent in exceptional cases where the condition threatens life and the patient's will cannot be established, with the decision taken by a council of physicians or, where impossible, by the attending physician. Such decisions are documented.

Question 20Legislation and normative regulation of healthcare in the Republic of Belarus

Which of the following documents is the main medical record in an outpatient health care organisation in the Republic of Belarus?

  1. The informed consent form
  2. The prescription form
  3. The certificate of temporary disability
  4. The medical card of the outpatient patient Correct answer.

Explanation

The medical card of the outpatient patient is the principal record in which the physician documents the patient's state of health, diagnosis and treatment over time. Other documents are auxiliary forms used for specific purposes.

Question 21Organization of healthcare delivery and medical records management

In Belarus, which document is the primary legal act establishing the fundamentals of healthcare organization and the rights of patients?

  1. The Law on Health Care Correct answer.
  2. The Civil Code
  3. The Law on Consumer Protection
  4. The Labor Code

Explanation

The Law on Health Care is the framework statute governing the organization of the health system, patient rights, and obligations of medical workers in Belarus. Other codes regulate labor and civil relations generally rather than healthcare organization.

Question 22Organization of healthcare delivery and medical records management

A patient's outpatient medical record (medical card) in a Belarusian polyclinic is primarily intended to:

  1. Document staff working hours
  2. Serve as a financial invoice for services
  3. Replace the patient's identity document
  4. Record the continuous history of the patient's health and care Correct answer.

Explanation

The outpatient record is a continuous clinical document capturing the patient's history, diagnoses, and care over time. It supports continuity of treatment and is not a billing or identity instrument.

Question 23Organization of healthcare delivery and medical records management

Which statistical document is used to record each case of a patient's visit to an outpatient facility for later analysis?

  1. The informed consent form
  2. The sick-leave certificate
  3. The statistical coupon (form 025-2/u) Correct answer.
  4. The discharge summary

Explanation

The statistical coupon is the standard form used to capture outpatient visit data for statistical analysis of morbidity and workload. Sick-leave certificates, discharge summaries, and consent forms serve different administrative or clinical purposes.

Question 24Organization of healthcare delivery and medical records management

Medical confidentiality in Belarus obliges healthcare workers to:

  1. Disclose patient data to any relative on request
  2. Share diagnoses freely with the patient's employer
  3. Publish anonymized case data without any restriction
  4. Keep information about a patient's health private except in legally defined cases Correct answer.

Explanation

Medical confidentiality protects health information, and disclosure is permitted only in specific situations defined by law, such as threats to public health or legal proceedings. Routine sharing with employers or relatives is not allowed without proper legal basis.

Question 25Organization of healthcare delivery and medical records management

The main purpose of maintaining medical records in a healthcare institution is to:

  1. Ensure continuity of care and legal accountability Correct answer.
  2. Reduce the need for qualified staff
  3. Replace clinical judgment with paperwork
  4. Increase the number of patient visits

Explanation

Medical records provide a documented clinical history that supports continuity of care and creates a legal record of decisions and interventions. They are not tools for inflating workload or substituting for clinical reasoning.

Question 26Organization of healthcare delivery and medical records management

Which body in Belarus is responsible for state sanitary-epidemiological supervision?

  1. The National Bank
  2. The sanitary-epidemiological service Correct answer.
  3. The Ministry of Internal Affairs
  4. The Supreme Court

Explanation

The sanitary-epidemiological service conducts state supervision over compliance with sanitary norms and epidemiological safety. The other bodies have law-enforcement, financial, or judicial functions unrelated to sanitary supervision.

Question 27Organization of healthcare delivery and medical records management

A polyclinic wants to analyze the distribution of its outpatient visits by month. Which document type should be the primary data source?

  1. Inpatient discharge summaries
  2. Pharmacy dispensing logs
  3. Statistical coupons of outpatient visits Correct answer.
  4. Personnel timesheets

Explanation

Statistical coupons capture each outpatient visit and can be aggregated by period, making them the appropriate source for analyzing visit distribution. Discharge summaries relate to inpatient care, and pharmacy or personnel records do not reflect outpatient visits.

Question 28Organization of healthcare delivery and medical records management

A physician needs to correct an erroneous entry already written in a patient's paper medical record. The correct procedure is to:

  1. Overwrite the text with correction fluid
  2. Tear out the page and start a new one
  3. Erase the entry and rewrite it cleanly
  4. Strike through the error, write the correction, and sign it Correct answer.

Explanation

Corrections in medical records must preserve the original entry so the record remains traceable and legally valid; the standard method is a single strike-through with a signed correction. Erasing, removing pages, or obscuring text destroys the audit trail.

Question 29Organization of healthcare delivery and medical records management

Under Belarusian healthcare organization, primary health care is mainly delivered through:

  1. Outpatient polyclinics and rural health posts Correct answer.
  2. Research institutes only
  3. Forensic medical bureaus
  4. Regional specialized hospitals

Explanation

Primary health care is organized around outpatient polyclinics and rural health posts that provide first-contact, accessible care. Specialized hospitals, forensic bureaus, and research institutes serve other levels or functions.

Question 30Organization of healthcare delivery and medical records management

A patient requests a copy of their medical record. The institution's appropriate response is to:

  1. Forward the request to the patient's employer
  2. Require the patient to pay an arbitrary fee set by the doctor
  3. Provide the copy according to established legal procedure Correct answer.
  4. Refuse because records belong only to the doctor

Explanation

Patients have a legal right to access information about their health, and institutions must provide copies following defined procedures. Refusal, redirection to employers, or arbitrary fees conflict with that right.

Question 31Organization of healthcare delivery and medical records management

Which indicator best measures the average number of days a hospital bed is occupied during a year?

  1. Bed turnover rate
  2. Average annual bed occupancy Correct answer.
  3. Hospital mortality rate
  4. Average length of stay

Explanation

Average annual bed occupancy expresses how many days per year a bed is occupied on average. Bed turnover counts patient episodes per bed, mortality reflects outcomes, and average length of stay measures duration per patient.

Question 32Organization of healthcare delivery and medical records management

A rural outpatient clinic refers a complex case to a regional hospital. This referral reflects which principle of healthcare organization?

  1. Free choice of any hospital without referral
  2. Complete decentralization of specialized care
  3. Self-treatment by the patient
  4. Staged (levels of) care with appropriate routing Correct answer.

Explanation

The system is organized in levels, with primary care facilities referring complex cases to higher-level specialized institutions. This staged approach ensures patients reach the appropriate level of care.

Question 33Organization of healthcare delivery and medical records management

Which document records a case of temporary incapacity for work and entitles the patient to absence from employment?

  1. The informed consent form
  2. The outpatient medical card
  3. The certificate of temporary incapacity for work Correct answer.
  4. The statistical coupon

Explanation

The certificate of temporary incapacity for work is the official document justifying work absence and benefits during illness. The statistical coupon, medical card, and consent form serve documentation or authorization purposes but do not certify incapacity.

Question 34Organization of healthcare delivery and medical records management

A hospital department has high bed turnover but also a high proportion of early readmissions. Which interpretation is most appropriate?

  1. The department is understaffed by definition
  2. Readmissions are unrelated to discharge practice
  3. Rapid discharge may be compromising care quality Correct answer.
  4. The data prove excellent efficiency

Explanation

High turnover combined with frequent early readmissions suggests patients may be discharged before full recovery, indicating a possible quality concern. Turnover alone does not establish efficiency, and readmission patterns are clinically relevant.

Question 35Organization of healthcare delivery and medical records management

In Belarusian medical documentation, the attending physician's entries in the inpatient record should be made:

  1. By nursing staff exclusively
  2. Regularly throughout the stay, with dates and signatures Correct answer.
  3. Only when the patient requests
  4. Only at admission and discharge

Explanation

Inpatient records require regular, dated, and signed entries by the attending physician to document the course of treatment and decisions. Limiting entries to admission and discharge or delegating them entirely to nursing staff fails to meet documentation standards.

Question 36Organization of healthcare delivery and medical records management

A patient refuses a recommended vaccination. The physician's proper action regarding documentation is to:

  1. Report the patient to law enforcement
  2. Omit any mention of the refusal
  3. Record a false consent to meet targets
  4. Record the refusal and inform the patient of the consequences Correct answer.

Explanation

Informed refusal must be documented, and the patient should be advised of the associated risks. Falsifying consent, omitting the refusal, or punitive reporting are improper and violate documentation and ethical standards.

Question 37Organization of healthcare delivery and medical records management

Which of the following is a core function of the nursing documentation in a hospital ward?

  1. Determining the hospital's budget
  2. Issuing sick-leave certificates
  3. Recording observations and interventions to support coordinated care Correct answer.
  4. Setting national health policy

Explanation

Nursing documentation records observations, administered care, and patient status so that the care team can coordinate treatment. Budgeting, national policy, and issuing incapacity certificates are outside the nursing record's function.

Question 38Organization of healthcare delivery and medical records management

A hospital's annual report shows a rising average length of stay while admissions remain stable. Which factor most directly explains this change?

  1. Bed count has increased
  2. Patients are staying longer per admission Correct answer.
  3. Staff numbers have grown
  4. More patients are being admitted

Explanation

Average length of stay is calculated as total bed-days divided by the number of discharged patients, so a rise with stable admissions means each patient stays longer. Admission volume, bed count, and staffing affect other indicators but not this ratio directly.

Question 39Organization of healthcare delivery and medical records management

A physician must disclose information covered by medical confidentiality without the patient's consent. Which situation provides a lawful basis?

  1. A journalist's request for a newsworthy case
  2. A relative's curiosity about the diagnosis
  3. A legally mandated notification to prevent a public health threat Correct answer.
  4. An employer's routine inquiry about an employee

Explanation

Disclosure without consent is permitted when the law specifically requires it, such as reporting to prevent a threat to public health. Media, employer, and relative requests do not by themselves create a lawful basis for breaching confidentiality.

Question 40Organization of healthcare delivery and medical records management

An institution discovers that a paper record was altered after a complaint was filed. From a records-management perspective, the most serious consequence is that:

  1. The patient's treatment is automatically repeated
  2. The hospital's budget is reduced
  3. The statistical coupon becomes invalid
  4. The record loses evidentiary reliability in legal review Correct answer.

Explanation

Records must remain authentic and unaltered to serve as reliable evidence in legal or administrative review; post hoc alteration undermines that reliability. Treatment repetition, statistical coupons, and budgeting are not the direct consequence of tampering.

Question 41Internal medicine (therapy)

Which electrocardiographic finding is the earliest and most reliable sign of acute transmural myocardial infarction?

  1. Deep symmetric T-wave inversion
  2. Pathologic Q waves
  3. Prolonged QT interval
  4. ST-segment elevation in the leads facing the infarct Correct answer.

Explanation

Acute transmural injury produces ST-segment elevation in the leads facing the affected wall, reflecting current of injury, and it appears before necrosis develops. Q waves are a later marker of established necrosis, and T-wave inversion is less specific.

Question 42Internal medicine (therapy)

A 58-year-old man has a fasting plasma glucose of 7.4 mmol/L on two separate occasions. Which diagnosis is most appropriate?

  1. Impaired fasting glucose
  2. Normal glucose tolerance
  3. Diabetes mellitus Correct answer.
  4. Stress hyperglycemia

Explanation

A fasting plasma glucose of 7.0 mmol/L or higher confirmed on a second occasion establishes diabetes mellitus. Impaired fasting glucose corresponds to 6.1–6.9 mmol/L.

Question 43Internal medicine (therapy)

Which pathogen is the most frequent cause of community-acquired pneumonia requiring hospitalization in adults?

  1. Legionella pneumophila
  2. Chlamydia psittaci
  3. Streptococcus pneumoniae Correct answer.
  4. Mycoplasma pneumoniae

Explanation

Streptococcus pneumoniae remains the leading cause of community-acquired pneumonia across all severity levels. Atypical organisms such as Mycoplasma cause a minority of hospitalized cases.

Question 44Internal medicine (therapy)

Which laboratory finding is characteristic of iron-deficiency anemia?

  1. Low serum ferritin with increased total iron-binding capacity Correct answer.
  2. High serum ferritin with low total iron-binding capacity
  3. Normal ferritin with low reticulocyte count
  4. Increased transferrin saturation with normal ferritin

Explanation

Iron deficiency depletes stores, so ferritin falls, while the liver increases transferrin production, raising total iron-binding capacity and lowering transferrin saturation. Ferritin is the most specific single indicator of depleted iron stores.

Question 45Internal medicine (therapy)

Which spirometric pattern defines obstructive ventilatory impairment?

  1. Normal FEV1/FVC ratio with reduced diffusion capacity
  2. Reduced FEV1/FVC ratio below the lower limit of normal Correct answer.
  3. Reduced FVC with a normal FEV1/FVC ratio
  4. Increased FEV1/FVC ratio with reduced total lung capacity

Explanation

Airflow obstruction is defined by a post-bronchodilator FEV1/FVC ratio below the lower limit of normal. A reduced FVC with a preserved ratio indicates a restrictive pattern instead.

Question 46Internal medicine (therapy)

Which drug is first-line for rate control in a patient with atrial fibrillation and preserved left ventricular function?

  1. Verapamil in combination with digoxin
  2. A beta-blocker Correct answer.
  3. Digoxin
  4. Amiodarone

Explanation

Beta-blockers are first-line for ventricular rate control in atrial fibrillation when left ventricular function is preserved. They blunt atrioventricular nodal conduction and are well tolerated in most patients.

Question 47Internal medicine (therapy)

Which symptom pattern is most typical of gastroesophageal reflux disease?

  1. Retrosternal burning worsened after meals and when lying down Correct answer.
  2. Dysphagia with progressive solid-food intolerance
  3. Painless jaundice with dark urine
  4. Epigastric pain relieved by food and awakening the patient at night

Explanation

Reflux disease classically causes retrosternal burning that worsens after meals and in the recumbent position because of impaired antireflux barrier function. Relief with food and nocturnal pain suggest peptic ulcer disease.

Question 48Internal medicine (therapy)

A 45-year-old woman has a blood pressure of 168/104 mmHg on three visits, and secondary causes have been excluded. Which stage of hypertension applies?

  1. Isolated systolic hypertension
  2. Grade 1 hypertension
  3. Grade 2 hypertension Correct answer.
  4. Grade 3 hypertension

Explanation

Grade 2 hypertension corresponds to a systolic pressure of 160–179 mmHg or a diastolic pressure of 100–109 mmHg. Both values here fall in that range, so grade 2 applies.

Question 49Internal medicine (therapy)

A patient with type 2 diabetes on metformin develops acute kidney injury with an estimated glomerular filtration rate of 25 mL/min/1.73 m². What is the most appropriate action regarding metformin?

  1. Discontinue metformin Correct answer.
  2. Add a second biguanide
  3. Double the dose to compensate for reduced absorption
  4. Continue the current dose and monitor creatinine weekly

Explanation

Metformin is contraindicated when the estimated glomerular filtration rate falls below 30 mL/min/1.73 m² because of the risk of lactic acidosis from accumulation. It should be stopped and alternative glucose-lowering therapy used.

Question 50Internal medicine (therapy)

A 30-year-old man presents with sudden pleuritic chest pain, dyspnea, and tachycardia three days after a long flight. Which initial diagnostic test is most appropriate when he is hemodynamically stable?

  1. Computed tomography pulmonary angiography Correct answer.
  2. Exercise stress testing
  3. Immediate thrombolysis
  4. Bronchoscopy

Explanation

In a hemodynamically stable patient with suspected pulmonary embolism, computed tomography pulmonary angiography is the standard confirmatory test because it directly visualizes thrombi in the pulmonary arteries. Thrombolysis is reserved for hemodynamic instability.