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LEKEXAM / 2016 spring

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Question distribution — 2016 spring session

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Internal medicinePediatricsSurgeryGynecology and obstetricsEmergency medicine, AnaesthesiologyFamily medicinePsychiatryMedical law and bioethicsPublic healthMedical certification

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Question 1

Question canceled by CEM:

A 47-year-old patient in a good general condition, without chronic diseases, went to the doctor in an outpatient clinic due to tarry stool a few hours earlier. In the rectal examination, tarry stool was found, in the orthostatic test the blood pressure dropped to 90/60mmHg and the heart rate increased to 100 BPM. In this patient we should urgently:

Amark complete blood count and make further decision about hospitalization dependent on the result
Btreat in the surgical ward
Crefer to the bleeding treatment center
Dthe symptoms indicate a loss of approximately 1000 ml of blood
Eadminister PPI, fluids, mark complete blood count, perform gastroscopy within 24 h

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Question 2

A 76-year-old female patient complaints of persistent diarrhea. For one year she has been taken lansoprazole at a dose of 30 mg daily due to persistent pyrosis. Recently she has been treated with ciprofloxacin together with probiotics because of urinary tract infection. You should widen diagnostic procedures in order to exclude:

1) celiac disease;

2) SIBO (small intestine bacterial overgrowth);

3) microscopic colitis;

4) Clostridium difficile infection;

5) diverticular disease.

The correct answer is:

A1, 2
B2, 3
C3, 4
D4, 5
E3, 4, 5

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Question 3

A 68-year-old patient for several weeks has complained of abdominal cramps, watery diarrhoea with the bowel movements 4-8 daily and bloating. Since then she has lost 4 kg. Periodically she has suffered from lumbar backache and takes diclofenac together with PPI as a gastroprotection. Routine laboratory tests were within normal limits. Ileocolonoscopy did not show any abnormalities. Biopsies taken during colonoscopy from the right half of the colon revealed lymphocyte and plasmocyte infiltration in lamina propria of the colon mucosa. The most probable diagnosis of the patient’s complaints is:

Amicroscopic colitis
Bexudative enteropathy
Csmall intestinal bacterial overgrowth (SIBO)
DWhipple's disease
Ehyperthyroidism

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Question 4

Which of the following factors does not predispose to the progressive loss of renal function?

Alow birth weight
Bhypertension
Cinhibition of the renin-angiotensin-aldosterone system
Dobesity
Ecigarette smoking

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Question 5

The measurement of albuminuria in 24 h urine collection may be replaced by more convenient:

Aalbumin-to-creatinine ratio in 24 h urine collection
Balbumin-to-creatinine ratio in a spot first morning urine sample.
Calbumin-to-creatinine ratio in a spot urine.
Dtotal protein-to-creatinine ratio in 24 h urine collection.
Ealbumin detection in a spot urine using dipstick method.

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Question 6

Which of the following is not characteristic of chronic renal failure:

Ablood volume expansion
Bhyperkalemia
Chypernatremia
Dhyperphosphatemia
Eacidosis

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Question 7

The SCORE chart for assessing a 10-year risk for fatal cardiovascular disease consists of the following risk factors:

Aage, gender, total cholesterol, diastolic blood pressure, smoking status
Bgender, total cholesterol, systolic blood pressure, smoking status, BMI
Cage, gender, LDL-cholesterol, systolic blood pressure, smoking status
Dage, gender, total cholesterol, systolic blood pressure, smoking status
Eage, gender, LDL-cholesterol, diastolic blood pressure, smoking status

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Question 8

During physical examination, the auscultation revealed a diastolic murmur, best audible on the left parasternal line, radiating to Erb’s point and exaggerating while sitting and leaning forward. Which cardiac defect should be suspected?

AMitral regurgitation
BAortic regurgitation
CAortic stenosis
DVentricular septal defect
EAtrial septal defect

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Question 9

A patient receiving lithium for psychiatric indications reported to a GP. Medical history revealed no other chronic disorders. The patient complained of fatigue, decreased exercise tolerance, feeling cold, increased sensitivity to cold and constipation. What could be the reason for the patient’s complaints?

Ahypothyroidism as a side effect of lithium treatment
Bhypoparathyroidism as a side effect of lithium treatment
Cadrenal insufficiency as a side effect of lithium treatment
DA and B are true
EA and C are true

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Question 10

Implantable cardiac pacemakers are marked with a three-letter code (XYZ), in which each letter means:

AX - paced chamber; Y - sensed chamber; Z - mode of pacing.
BX - sensed chamber; Y - paced chamber; Z - mode of pacing.
CX - mode of pacing; Y - sensed chamber; Z - paced chamber.
DX - mode of pacing; Y - paced chamber; Z - sensed chamber.
EX - paced chamber; Y - mode of pacing; Z - sensed chamber

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Question 11

A 62-year-old patient was admitted to the hospital complaining of parasternal pain lasting for approx. 1 hour. ECG revealed negative T waves in leads II, III and aVF. The patient’s condition could be assessed with the use of the following grading scale:

AEHRA
BNYHA
CCCS
DA and C are true
Enone of the above

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Question 12

Screening programs are scientifically justified in practice for the detection of:

1) breast cancer;

2) prostate cancer;

3) cervical cancer;

4) lung cancer;

5) colorectal cancer;

6) melanoma.

The correct answer is:

A1, 3, 5
B1, 2, 3, 5
C1, 3, 4, 5
D1, 2, 3, 4, 5
E1, 3, 5, 6

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Question 13

Signs and symptoms of superior vena cava syndrome may be seen in the course of:

Alymphoma
Blung cancer
Cthrombosis
DA i B are true.
EA, B and C are true.

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Question 14

An increased level of prostate-specific antygen (PSA):

Ajustifies the diagnosis of prostate carcinoma.
Bindicates the need of transrectal ultrasound-guided fine-needle biopsy.
Cindicates the need of transrectal ultrasound with excisions for histologic examination.
Drequires pelvic magnetic resonance imaging
Erequires use of positron emission tomography.

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Question 15

Fever in a patient with breast cancer who recently received a subsequent course of adjuvant postoperative chemotherapy:

Amay be due to treatment-induced neutropenia.
Bis always an indication for the use of granulocyte-colony stimulating agents.
Cis always an indication for the primary use of antifungal agents.
DA and B are true.
EA, B and C are true.

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Question 16

In patients with acute tumor lysis syndrome laboratory abnormalities include:

Auric acid
Bpotassium
Cphosphates
DA and B are true.
EA, B and C are true.

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Question 17

Carcinoembryonic antigen level assessment is of most value in:

ABreast cancer
BLung cancer
CColorectal cancer
DPancreatic cancer
EStomach cancer

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Question 18

A 82-year-old woman has been cured with amlodipine 5 mg daily and ramipril 5 mg per day. She feels well and she has no comorbidities. If the blood pressure in repeated measurements are above 160/85 mmHg, the physician should:

Adiscontinue ramipril.
Bnot change treatment.
Cconsider this as resistant hypertension and include a diuretic.
Dincrease the dose of amlodipine and ramipril.
Erefer the patient to renal artery denervation.

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Question 19

A 45-year-old woman came to the ER with a severe headache radiating to her neck after lifting a heavy object. Witnesses say she lost consciousness (without seizures or urination). The first additional test you will do is:

AEEG
Bhead CT scan without contrast
Ccervical spine MRI
DCerebrospinal fluid analysis
E24-hour video-EEG

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Question 20

Which of the following drugs is contraindicated in the treatment of hypertension in a pregnant woman?

Aperindopril
Blong-acting nifedipine
Cmethyldopa
Dverapamil
Elabetalol

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Question 21

A 40-year-old man with type 1 diabetes comes to the office because of more frequent incidents of hypoglycaemia. He decreased the dose of insulin. What might be the cause of hypoglycaemia in this patient?

Aincreased alcohol consumption
Bincreased physical activity
Cdecreased calorie intake.
Dimpaired renal function.
Eall the above

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Question 22

In a 75-year-old woman in a check-up a serum sodium of 132 mmol/l has been found. The woman does not complain about any symptoms and does not take any drugs. Indicate the proper way of treatment:

AIntravenous administration of 10% NaCl
BIntravenous administration of 3% NaCl
CIntravenous administration 0.9% NaCl
DOral NaCl administration
ERecommend only a healthy and balanced diet

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Question 23

A 56-year-old man comes to the office because of weakness, weight loss, frequent urination, dry mouth, and excessive thirst. The plasma glucose is 264 mg/dl. Indicate the most appropriate diagnostic and therapeutic strategy:

Arepeat a fasting plasma glucose.
Bperform an oral glucose tolerance test.
Cperform a HbA1c test.
Ddiagnose diabetes and start the treatment with diet.
Ediagnose diabetes and start pharmacological treatment

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Question 24

A 28-year-old man complains about bloating after intake of dairy products for the last 5 years. Which of the following is the most appropriate diagnostic and therapeutic strategy?

Aavoid dairy products which cause bloating.
Bperform gastroscopy.
Cperform colonoscopy
Dperform tests for cow’s milk allergy.
Egluten-free diet should be started.

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Question 25

Bone marrow aplasia is characterized by:

Aperipheral blood pancytopenia and myelodysplasia.
Bperipheral blood bipenia and myelodysplasia.
Cperipheral blood pancytopenia, decreased bone marrow cellularity and the absence of neoplastic disease.
Dperipheral blood pancytopenia and lymphopenia.
Eerythrocytopenia and thymus function disorders.

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Question 26

The most typical results for the anemia of chronic disease are:

Adecreased serum iron concentration, increased transferrin concentration, decreased Transferrin saturation, decreased ferritin levels.
Belevated serum iron concentration, increased transferrin saturation, reduced ferritin levels.
Cdecreased serum iron concentration, decreased or normal concentration of transferrin, decreased saturation of transferrin, normal or increased concentration of ferritin.
Dmacrocytosis of red blood cells, decreased serum iron concentration, increased concentration of transferrin, decreased concentration of ferritin
Enormo- or microcytosis of red blood cells, decreased iron concentration, increased transferrin saturation, increased ferritin levels.

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Question 27

Hemolytic anemia is suspected if:

Athere is normal shape and survival time of red blood cells.
Babsolute reticulocyte count is > 150 000/µl.
Cthere is liver damage with an elevated haptoglobin and normal bilirubin level.
DA and B are true.
EB and C are true.

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Question 28

Pancytopenia is defined based on:

Awhite blood cell count.
Bwhole blood cell count.
Cpercentage of CD34+ in bone marrow aspiration biopsy.
Dabsence of blasts in myelogram.
Ered blood cell count in peripheral blood.

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Question 29

An emergency medical team was called to the patient. On arrival, a sudden left side paralysis and blood pressure of 160/110 mm Hg were found. Which of the following, after supporting basic life functions, is the most appropriate next step?

ACollect a detailed interview from the patient or witnesses of the event with the duration of the symptoms and note it in the patient's documentation.
BAdminister 150-300mg of ASA, because the most common cause is ischemic stroke.
CAdminister a prophylactic dose of low-molecular-weight heparin, but not a therapeutic dose (so that later, if necessary, thrombolytic therapy can be administered)
Dlower the blood pressure to <140/90
Eadminister 75mg of clopidogrel because aspirin resistance is common in patients with stroke

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Question 30

A 72-year-old man comes to emergency unit because of diarrhoea and vomiting. The blood pressure is 90/50 mm Hg. The patient takes ramipril and indapamide because of arterial hypertension. Which of the following is the most appropriate next step?

Acontinue the treatment both with ramipril and indapamide
Bstop the treatment with ramipril and continue with indapamide
Ccontinue the treatment with ramipril and stop with indapamide
Dstop the treatment with both ramipril and indapamide
Elower the dose of ramipril and indapamide

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Question 31

Which of the following statements referring to a patient in the acute phase of brain hemorrhagic stroke is correct?

1) supratentorial intracerebral hematoma should be treated with surgery in each case;

2) systolic blood pressure should be quickly reduced to less than 180 mm Hg in each patient with intracerebral hemorrhage, optimally during the first day;

3) posterior fossa hemorrhages need urgent neurosurgery in the case of the deterioration of the neurological condition, such as worsening cerebellar symptoms, hydrocephalus, or awareness disorders;

4) antiepileptic drug should be administered prophylactically in each patient with intracerebral hemorrhage (optimally valproic acid 500-800 mg twice daily) for fear of high risk of epileptic seizures;

5) in the treatment of cerebral oedema secondary to intracerebral hemorrhage intravenous osmotic agents are most commonly used, e.g. mannitol with furosemide or hypertonic salt (usually 3% NaCl).

The correct answer is:

A1, 3, 5
B1, 3, 4
C2, 3, 5
D2, 3, 4
Eall the above.

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Question 32

A 53-year-old female patient was admitted to the hospital because of headache worsening for the last few days, fever (38.8 Celsius), nausea. On examination: lethargy and drowsiness, nuchal rigidity 3 fingers, Kernig’s sign present. Cerebrospinal fluid (CSF) testing: cloudy, opalescent, protein level 220 mg/dL ( 2.2g/L), cytosis 390 white cells per mm (granulocytes 70%), glucose level 40 mg/dL (2.2 mmol/L). Serum glucose level 100 mg/dL (5.55 mmol/L). Which of the following should be done during the first 24-hour in-hospital stay?

Aorder bacteriological examination of the cerebrospinal fluid (CSF) and immediately start empirical wide-spectrum, intravenous antibiotic at a maximum dose (e.g. 3 generation cephalosporin).
Border bacteriological examination of the cerebrospinal fluid (CSF), but due to the lack of information about the etiological factor and stable condition of the patient start antipyretic (paracetamol - acetaminophen) and antioedematous (mannitol) treatment till you get the CSF culture result and antibiogram.
Corder neuroimaging of the head with computed tomography or magnetic resonance technique and decide about treatment after you get the report.
Dstart antiviral drug intravenously (optimally acyclovir) at a maximum dose, because the result of CSF testing indicates viral meningitis.
Eorder digital angiography because the clinical situation described above may suggest subarachnoid hemorrhage.

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Question 33

Indicate unfavorable prognostic factors of acute glomerulonephritis: 1) urine erythrocyturia and blood casts; 2) high antistreptolysin 0 titer; 3) persistent proteinuria above 2 g/day; 4) decreased glomerular filtration < 40 mL/min; 5) decreased hemolytic complement activity and its fraction C3. The correct answer is:

A1,2,3.
B1,3,5
C1,2,5.
D2,5.
E3,4.

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Question 34

A 40-year-old woman suffers from acute kidney injury and anuria. Which of the following parameters suggest urgent hemodialysis?

1) overhydration;

2) pH - 7.2; base deficit - 16 mmol/L;

3) potassium level - 7.4 mmol/L;

4) urea level - 180 mg/dL;

5) creatinine level - 7.2 mg/dL.

The correct answer is:

A1,2,3
B1,3,4.
C1,3,5
D2,3,4.
E2,3,5

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Question 35

A 79-year-old woman with acute kidney injury, oliguria and with severe muscle pain was admitted to the hospital. Which of the drugs taken by this patient should be immediately withdrawn?

1) lisinopril 40 mg/day;

2) simvastatin 40 mg/day;

3) metoprolol 50 mg/day;

4) amlodipine 10 mg/day;

5) telmisartan 80 mg/day.

The correct answer is:

A1, 2, 3
B1, 2, 4
C1, 2, 5
D1, 3, 4
E1, 3, 5

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Question 36

A 30-year-old male complains of colic pain in the left lumbar region with macroscopic hematuria, chills and fever 40 Celsius. Indicate the most probable diagnosis:

Akidney stones
Bkidney stones with accompanying urinary tract infection
Cacute pyelonephritis
DIgA nephropathy
Erenal papillary necrosis

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Question 37

The post-bronchodilator test assesses possible reversibility of bronchoconstriction. It is performed after the administration of bronchodilators. Which of the following drugs are used in this test?

1. ipratropium bromide

2. salbutamol or fenoterol

3. salmeterol

4. formoterol

5. Clenbuterol

A1, 5
B2, 5
C1, 2
D3, 4
E4, 5

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Question 38

A spirometry result showing reduced vital capacity (VC) below the lower reference limit with normal or increased FEV /VC value suggests restriction. Which of the following should be performed in order to clarify the cause of the VC reduction?

Aexercise test
Bpost bronchodilator test
Cimpulse oscillometry
Dlung diffusion testing
Ebody plethysmography

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Question 39

Haemolytic-uraemic syndrome is:

Acorrelated with Streptococcus pneumoniae infection.
Binduced by the deficiency of complement components.
Ccaused by the deficiency of protease that cleaves von Willebrand factor.
Dpreceded by diarrhea caused by enteropathogenic strains of E. coli.
Ecaused by calcineurin inhibitors.

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Question 40

A 3-year-old boy was admitted to the hospital because of oliguria and generalized oedema. Laboratory findings show proteinuria 500 mg/mmol creatinine, albuminemia 15 g/L. The treatment of choice is:

AACE Inhibitor
BCiclosporine
CGlucocorticoids
DDiuretic.
ECyclophosphamide

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Question 41

A 5-year-old girl, healthy and properly developing so far, was referred to the ER because of disturbances of consciousness, poor general condition and significant dehydration with rapid, deep breathing. From anamnesis you find out that she has lost 3 kg of weight for the last 2 weeks, and begun wetting. Previously she used to drink a lot, but the last day she stopped drinking and urinating; she complained of severe abdominal pain and vomiting. Indicate the most probable diagnosis:

Aketoacidosis in the course of previously undiagnosed diabetes mellitus.
Balcohol intoxication.
Cexacerbation of chronic kidney disease previously undiagnosed.
Dadrenal crisis.
Emeningitis.

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Question 42

Indicate false sentences concerning vesico-ureteral reflux (VUR):

1) diagnosis is based on voiding cystourethrography;

2) we identify five grades of VUR;

3) only grade I primary VUR is treated conservatively;

4) refluxes with ureteral distension are treated surgically;

5) grade I, II, III VUR are treated conservatively.

The correct answer is:

Aonly 3
B3 i 4
C1 i 5
D2 i 5
Eonly 2

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Question 43

Mild course tuberculosis includes:

1) cutaneous tuberculosis;

2) osteoarticular tuberculosis;

3) tuberculous spondylitis;

4) miliary tuberculosis;

5) lymphonodular tuberculosis.

The correct answer is:

A1, 2, 5
B1, 2, 3
C2, 4, 5
D2, 3, 4
E1, 3, 5

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Question 44

Live, attenuated vaccines include:

1) BCG

2) DTP

3) MMR

4) OPV

5) IPV

A2,3,4.
B3,4,5
C1,3,4.
D1,3,5.
E2,3,5.

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Question 45

Which of the following is used to diagnose constipation?

1) manometry;

2) Hinton test;

3) hydrogen test;

4) bowel contrast enema;

5) gastrofiberoscopy.

The correct answer is:

A1, 2, 3
B1, 2, 4
C2, 3, 4
D1, 2, 5
E2, 3, 5

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Question 46

Symptoms of peripheral motor neuron damage include:

1) flaccid paresis;

2) spastic paresis;

3) hyperreflexia;

4) hyporeflexia;

5) decreased muscle tone;

6) increased muscle tone

7) fasciculations.

The correct answer is:

A1,4,5,7.
B2,4,5,7.
C1,4,6,7.
D2,3,6,7.
E1,3,6,7.

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Question 47

Indicate true statements concerning the anterior fontanel:

1) immediately after childbirth the skull bones overlap and the fontanel may seem smaller;

2) anterior fontanel correctly closes 6-8 weeks after childbirth;

3) tense fontanel raises suspicion of dehydration;

4) premature ossification (closing) of the anterior fontanel may lead to microcephaly;

5) delayed ossification (closing) of the anterior fontanel is observed, for example in rickets;

6) anterior fontanel correctly closes between 9 and 18 month of life.

The correct answer is:

A1,2,4,5
B1,4,5,6.
C1,3,5,6
D2,3,4,5.
E1,3,4,5.

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Question 48

The symptoms of primary adrenal insufficiency include:

1) increased arterial pressure;

2) lowered arterial pressure;

3) light skin;

4) dark skin;

5) delayed puberty;

6) precocious puberty.

The correct answer is:

A2, 3, 5
B1, 4, 6
C2, 3, 6
D2, 4, 5
E1, 3, 5

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Question 49

The symptoms of asthma in children are:

Awheezing
Bcough
Cexpiratory dyspnoea
Dtightness in chest
Eall of the above

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Question 50

When, after streptococcal infection, do the symptoms of rheumatic fever appear?

Aduring infection
Bimmediately after infection is over.
C3-4 weeks after the infection is over.
D2-3 months after the infection is over.
Ehalf a year after infection is over.

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Question 51

A very high increase in acute phase indicators is typical for

AOligoarticular JIA
BSystemic-onset JIA
CFibromyalgia
DAvascular bone necrosis
EAll listed

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Question 52

Which of the exams is decisive in the differentiation of malignant disease of blood from systemic onset juvenile idiopathic arthritis?

Amorphology.
BESR
Cbone marrow biopsy
DX-ray of affected joints
Eabdominal ultrasound

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Question 53

What drug is used for the treatment of juvenile idiopathic arthritis?

Aacetylsalicylic acid
Bsecond generation cephalosporin.
Cphenoxymethylpenicillin
Dmethotrexate
Enone of the above

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Question 54

The most common cause of food allergy in infants is:

Awheat
Bsoybeans
Ccow's milk protein
Degg white
Ecarrot

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Question 55

Indicate the true statement concerning Credé method:

Ais performed in all children and is based on administration of a 0.5% solution of erythromycin or a 1% solution of tetracycline into each conjunctival sac
Bis not performed in babies delivered through a caesarean section.
Cprevents conjunctivitis caused by Neisseria gonorrhoeae and Chlamydia trachomatis.
Dis based on the instillation of a 1% solution of silver nitrate into each eye.
Eafter the procedure, the eyes should be rinsed with saline.

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Question 56

In the case of which infectious disease it is not possible to apply prevention by vaccination?

Ameasles
Bvaricella.
Crubella (German measles).
Dinfectious mononucleosis
Erotavirus diarrhea

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Question 57

The symptoms of cystic fibrosis include:

Arecurrent obstructive bronchitis and pneumonia.
Bsteatorrhoea
Cchronic cough.
DPoor weight gain
EAll of the above

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Question 58

The symptoms characteristic of streptococcal tonsillitis are:

Asubfebrile body temperature, severe sore throat, cough, runny nose.
Bsubfebrile body temperature, severe sore throat, headache.
Cfever, severe sore throat, painful and difficult urination.
Dfever, severe sore throat, abdominal pain, vomiting.
Enone of the above

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Question 59

Systemic Inflammatory Response Syndrome (SIRS) is characterized by the sudden appearance of at least 2 symptoms:

Abody temperature >39.5 C degrees or <35 C degrees and hyperleukocytosis.
Bbody temperature >39.5 C degrees or <35 C degrees and leukopenia
Cleukopenia or hyperleukocytosis and bradypnea or tachypnea.
Dbody temperature >38.5C degrees or <36 C degrees and tachypnea or tachycardia
Ebody temperature >38.5C degrees or <36 C degrees and bradypnea or bradycardia

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Question 60

Indicate the true sentence regarding infectious mononucleosis.

Ait is caused by a virus of Herpesviridae family, also responsible for diseases running with cell proliferation: malignant granulomatosis and Burkitt lymphoma.
Bincubation lasts about one week, and afterwards high fever, lymph nodes enlargement and strong cough occur.
Cleukopenia and lymphopenia are typical aberrations in blood morphology
Dit should be differentiated mainly from scarlet fever because of rash, lymph nodes enlargement and pharyngitis.
Emacrolides are routinely used in the treatment.

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Question 61

The indication for an urgent hospitalization of a child with bronchial asthma is:

Asaturation < 96%
Btachypnea despite the administration of one dose of short acting beta agonists (SABAs)
Cno response after administrating SABAs twice
Ddifficulties in eating, drinking and speaking.
Enasty cough and fever

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Question 62

Lumbar puncture is contraindicated when the following conditions are present:

1) bradycardia;

2) impaired coagulation;

3) cardio-respiratory insufficiency;

4) tachypnea;

5) high fever;

6) opisthotonus.

The correct answer is

A1, 2, 3
B2, 3, 4
C1,3,5,6.
D2, 3, 5
Eall the above

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Question 63

The elements of primary prophylaxis of atopic dermatitis include:

Abreastfeeding up to 6 months of age
Bnon-smoking during pregnancy.
Cappropriate skin care of the baby.
DA, B are true.
EA, C are true.

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Question 64

In a patient with the symptoms of acute urticaria with no allergy in anamnesis, it is necessary to order :

Awhole blood count with blood smear, CRP
Bskin prick tests
Cphysical tests
Dall the above.
Enone of the above.

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Question 65

Indicate the correct sentence concerning bronchiolitis:

Aoccurs only in premature neonates due to adenovirus.
Boccurs mainly in school-age children exposed to tobacco smoke or smoking children.
Coccurs only in children with a congenital heart defect.
Dit is the most common form of inflammation in the lower respiratory tract in infants
Eit is caused mainly by acapsular bacteria.

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Question 66

When symptoms of anaphylaxis are present, it is necessary to administer adrenaline:

Aat a dilution of 1:1000 at a dose of 0.01 mg/kg bw
Bat a dilution of 1:10000 at a dose of 0.01 mg/kg bw.
Calways at a maximum dose of 0.3 mg
Dalways at a maximum dose of 0.5 mg
Enone of the above is correct.

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Question 67

The diagnosis of urinary tract infection in newborns can be established on the basis of:

Aany number of Gram-negative bacteria in urine taken by suprapubic puncture.
Bany number of Gram-positive bacteria in urine taken by suprapubic puncture
Cnumber of bacteria > 10(2) CFU/mL in urine taken by bladder catheterization.
Dnumber of bacteria > 10 (3)CFU/mL in urine taken by bladder catheterization
Enumber of bacteria > 10 (5)CFU/mL in urine taken into the bag

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Question 68

A 27-year-old patient comes to the emergency department at 29 weeks of her first pregnancy complaining about a fever up to 38.3°C for the last couple of hours, 2 episodes of vomiting and back pain. Ultrasound examination reveals a normally growing living foetus, normal placenta located in the fundus and the full bladder. On palpation, the abdomen is not rigid but tender in the hypogastric area. On bimanual vaginal examination no pain during cervical motion is observed. The percussion of the lumbar area, especially on the left side, is very painful for the patient. What do you suspect?

Aacute appendicitis
Bleft-sided renal calculi.
Cacute pyelonephritis
Dacute cystitis.
Ehydronephrosis due to the pressure of the pregnant uterus on the ureter

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Question 69

In obstetrics, the term position (positio) means:

Arelationship of the foetus’ body parts to the parts of the maternal womb.
Brelationship of the longitudinal axis of the foetus to the longitudinal axis of the maternal womb.
Crelationship of the foetal head to the foetal spine.
Drelationship of the foetus’ body parts to one another.
Erelationship of a presenting part of the fetus to the inter-spinal line.

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Question 70

Which of the following are absolutely contraindicated in the pharmacological treatment of arterial hypertension during pregnancy?

Acalcium blockers.
Bbeta-blockers.
Cthiazide diuretics
DAngiotensin convertase inhibitors
Eclonidine.

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Question 71

The triad of Sabin and Pinkerton (hydrocephalus or microcephaly, chorioretinitis, intracranial calcifications) is typical of the congenital infection with:

Arubella virus
Btoxoplasmosis
Cparvovirus B19
Dcytomegalovirus
Eherpes simplex virus

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Question 72

Which of the following is not an indication for cesarean section?

AMarfan syndrome with aorta dilatation and the coarctation of the aorta that has not been surgically corrected.
Banxiety of a pregnant woman before the delivery.
Csignificant difference of foetal weights of > 20% in twin pregnancy.
Dfoetal weight > 3500 g in the longitudinal foetus breech position.
E. heart failure or significant arrhythmia in a pregnant woman.

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Question 73

Which of the following was the most frequently occurring malignant tumor in Polish women for the 5 years (2010-2014)?

Abreast cancer
Bendometrial cancer.
Ccervical cancer
Dovarian cancer.
Elung cancer

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Question 74

Which of the following is not a physiological cause of increased prolactin secretion in women?

Apregnancy
Bstrenuous activity.
Csleeping
Dstress
Eincreased glucose level

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Question 75

The proliferative phase of the uterine cycle is dependent on:

AProgesterone produced by the corpus luteum.
BProgesterone produced by granulous cells.
CEstrogen produced by the corpus luteum.
DEstrogen produced by granulous cells.
EEstradiol produced by the dominant follicle.

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Question 76

Symptoms of ovarian cancer do not include:

Apain in the lower abdomen or pelvis
Boliguria
Cincrease in the abdominal circumference
Dtympanites, abdominal distention
E. urge incontinence

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Question 77

Which statement regarding the placenta is false?

Aforms the afterbirth together with the umbilical cord and the amniotic sac.
Bits mass is approximately 500g.
Cfully formed placenta is not observed until the second half of the second trimester.
Dcotyledon is the morphological and structural unit of the placenta.
Eright umbilical vein undergoes atrophy in the early stage of foetal development.

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Question 78

Indicate the false statement on interpretation of CTG:

Asporadic accelerations are indicative of a healthy foetus
Bbradycardia within 100-110 bpm does not indicate that foetal health is endangered
Ccardiotocography should be implemented when the foetus is mature enough to survive outside the womb
Ddecelerations are drops in the baseline heart rate lasting 20 seconds or longer with a magnitude of at least 10 bpm
Eearly decelerations mirror uterine contractions

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Question 79

Which of the following is a risk factor for ovarian hyperstimulation syndrome?

Along time of infertility treatment.
Byoung age.
Chypothyroidism.
Dobesity.
Esupplementation of progesterone in the luteal phase

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Question 80

Which of the following decreases men’s fertility by lowering testosterone production?

Aethanol
Bketoconazole
Cspironolactone
Dsulfasalazine
Eall the above

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Question 81

Which of the following may cause retrograde ejaculation?

1) diabetes mellitus;

2) depression;

3) sclerosis multiplex;

4) spinal cord injury;

5) myocardial infarction;

6) femoral bone fracture.

The correct answer is:

A1,3,4
B1,4,5
C2,5,6
D3,4,5
E4.5.6

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Question 82

Low molecular weight heparin during pregnancy:

Ahas tocolytic effect.
Baccelerates foetal lung maturation.
Cprevents miscarriage in women with hereditary thrombophilia
Ddecreases the risk of premature placental abruption.
Eshould not be used due to its teratogenic effect.

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Question 83

A 25-year-old woman was referred to the GP because of secondary amenorrhea. She reports galactorrhoea and periodically blurred vision. Which of the following hormones should be measured?

Aadrenocorticotropic
Bglucagon
CInsulin
Dprolactin
Etestosterone

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Question 84

In patients with polycystic ovary syndrome there is an increased risk of:

Atype 2 diabetes mellitus.
Bhypertension.
Cendometrial cancer.
Dmyocardial infarction.
Eall the above.

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Question 85

A female patient was diagnosed with a lack of ovulation, acne and hirsutism. Those symptoms may suggest polycystic ovary syndrome. However, a presence of striae, a buffalo hump and arterial hypertension may suggest the diagnosis of Cushing’s syndrome. Which of the following should be performed in order to differentiate those disorders?

Aestradiol level.
Bdexamethasone suppression test.
Cmetoclopramide test.
Dlutropin level.
Efollitropin level.

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Question 86

In a pregnant (41 week of pregnancy) CTG test was done. It showed a basic heart rate 145/minute. The heart rate started to drop to 110/minute at the top of each contraction and it has been observed for the last 20 minutes. This record shows:

Autero-placental insufficiency and it is an alarming sign because it precedes intrauterine foetal death.
Bfoetal head compression and vagus nerve irritation and is not an adverse symptom unless it correlates with extended basic changes in the heart rate.
Cit is an indication for shortening the second stage of labour.
Dthreat of intrauterine asphyxia and the need to consider a caesarean section.
Enone of the above.

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Question 87

Ectopic pregnancy relates to the following situations:

1) fallopian pregnancy (ampullary region);

2) abdomen pregnancy;

3) uterine horn pregnancy;

4) intrauterine pregnancy;

5) caesarean section scar pregnancy.

The correct answer is:

A1, 2, 3, 5
B2, 3, 4, 5
C3, 4, 5
D4, 5
Eonly 5

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Question 88

If hypogastric pain appears approx. 2-3 days after the administration of methotrexate in a patient treated for ectopic pregnancy, you should:

Aperform urgent laparotomy with the longitudinal incision - this symptom means that there is haemorrhage because of ectopic pregnancy rupture.
Bperform urgent laparoscopy - this symptom means that there is haemorrhage because of ectopic pregnancy rupture.
Cperform urgent laparotomy with the transverse incision - this symptom means that there is haemorrhage because of ectopic pregnancy rupture.
Dobserve the patient and monitor decrease in the hCG level - this is a typical pain after the treatment with methotrexate.
Edischarge the patient and inform her that the pain is most probably caused by ovulation.

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Question 89

Which of the following situations occurring during pregnancy requires a quick termination of the pregnancy?

Apremature placental abruption
Bcervical cancer in pregnancy
CHIV infection.
Dadnexal torsion.
Eacute appendicitis

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Question 90

The importance of GnRH analogues in gynecology has long been known. They are used in the following situations, except for:

Aendometriosis treatment
Bin vitro fertilization programs
Cuterine myoma treatment
Dprecocious puberty treatment
Egrowth hormone deficiency treatment

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Question 91

Indicate true statements concerning male reproductive system:

1) cycle of the seminiferous epithelium takes approx. 74 days;

2) in the testes FSH acts mainly on Sertoli and LH mainly on Leydig cells;

3) after gonadotropin stimulation Leydig cells produce testosterone;

4) estrogens do not participate in the regulation of male reproductive system.

The correct answer is:

Aall the above
B2,4
C1,2,3
D2,3,4
E3.4

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Question 92

A basic recommendation for a woman with polycystic ovary syndrome, BMI>27, irregular menstrual cycles and infertility is:

Aweight loss (diet)
Bmetformin
Cstimulation of ovulation with clomiphene citrate
Dmetformin and the stimulation of ovulation with clomiphene citrate
Eprogestogens in the second phase of the cycle

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Question 93

Precocious puberty in girls is defined when tertiary sexual features appear before:

Athe age of 8.
Bthe age of 8, but when menstruation starts concomitantly with pubic hair.
Cthe age of 10.
Dthe age of 10, but when menstruation starts concomitantly with pubic hair
Ethe age of 11 regardless of race.

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Question 94

The factors that predispose to anorexia nervosa do not include:

Agenetic factors
Bpersonality factors.
Cspecific family relationships.
Dsomatic illnesses.
Ecultural factors.

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Question 95

Indicate the proper definition of personality:

Acomplex of relatively stable features, characteristics of human which give relative cohesion to his/her behaviour.
Bassigning to yourself or to other people exaggerated negative characteristics or features.
Ccomplex of genes which determine the behaviour and characteristics of man.
Dability to think abstractly.
Eability to think critically about adults as well as oneself.

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Question 96

Agitation is defined as:

Aslowly running, generalized anxiety.
Bintentional exaggeration of current symptoms.
Cintentional coverage of the symptoms that actually do not exist.
Dexcessive physical activity combined with a feeling of inner tension.
Esudden spurt in the course of catatonic stupor.

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Question 97

Psychotherapy may participate to varying degrees in the pharmacological treatment of the following illnesses:

Aanxiety disorders, depression, personality disorders, psychosis
Bdepression, psychosis.
Canxiety disorders, psychosis.
Dpersonality disorders, psychosis
Eanxiety disorders, depression, personality disorders.

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Question 98

Pathological changes within the temporal and parietal cortex and in the limbic system, variable severity of cognitive impairment, perception disorders, parkinsonism, collapses, fainting, depressive syndrome, hypersensitivity to neuroleptics. Which of the following dementias does this description refer to?

Afrontotemporal
Bdementia with Lewy bodies
Cdementia in Parkinson's disease
Dvascular dementia
EAlzheimer's disease

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Question 99

Please indicate the true statements concerning pseudomnesias:

1) these are otherwise known as alleged memories;

2) they include confabulation;

3) they include memory hallucinations;

4) these are otherwise known as identifying memory illusions;

5) these are otherwise known as allomnesias;

6) they include cryptomnesias.

The correct answer is:

A1,2,3.
B1,2,6.
C2,3,4
D2,3,5.
E1,3,6.

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Question 100

Sudden abnormalities of brain function with following symptoms: change of sleep-wake rhythm, cognitive impairment and disorders of perception, attention, concentration and memory suggest the diagnosis of:

AMixed dementia
BDelirium
CAlzheimer's disease
DAcute psychosis
ENone of the above

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Question 101

Anxiety, agitation, psychomotor hyperactivity, aggressive behavior, lack of fatigue, delusions of grandeur, impaired perception with co-existing vegetative symptoms: dilation of the pupils, increased sweating, heart rate increase, hyperthermia, suggest the diagnosis of:

APsychostimulant poisoning
BMania in the course of BD
CParanoid syndrome
DAlcohol withdrawal syndrome
EDepressive disorders

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Question 102

A tendency to self-isolation, emotional withdrawal, keeping distance, no need to involve in close relationships, no or scarce activities aimed at pleasure are the features of:

Aschizoid personality disorder
Bparanoid personality disorder.
Cschizotypal personality disorder.
Davoidant personality disorder.
Eantisocial personality disorder.

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Question 103

The time criterion for diagnosis of insomnia is the persistence of symptoms above:

Aone week
Btwo weeks
Cone month
Dsix months
Eone year

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Question 104

Please indicate the true statements concerning ADHD:

1) typically diagnosed by the age of 3;

2) more frequent in boys;

3) characterized by attention deficit, hyperactivity, impulsiveness;

4) characterized by communication, social interaction, behaviour and play disorders;

5) genetic factors play a significant role;

6) intellectual disability concerns 65-88% of those affected by ADHD;

7) accompanied by developmental disorders of speech.

The correct answer is:

A1,3,5.
B1,2,4,7
C2,3,6
D1,4,5,7.
E2,3,5.

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Question 105

The use of which of the following drug is associated with a high risk of developing metabolic syndrome, a risk which requires patient monitoring?

Asertraline
Bparoxetine
Crisperidone
Dolanzapine
Emianserin

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Question 106

The symptomatic treatment of choice in the case of panic disorder is the administration of:

ADiazepam intravenously
BHaloperidol intramuscularly
Cshort-acting Alprazolam orally
DVenlafaxine orally
EParoxetine orally

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Question 107

Forensic psychiatric opinions in criminal cases are associated with:

1) adjudication on the merits on admission to the hospital;

2) adjudication on insanity;

3) adjudication on the degree of sanity;

4) adjudication on the conscious expression of the will;

5) adjudication on the free expression of the will;

6) adjudication on the mental state tempore criminis.

The correct answer is:

A1, 2, 3
B1, 2, 6
C2, 3, 5
D4, 5, 6
E2, 3, 6

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Question 108

Which type of gastric resection is used in the surgical treatment of morbid obesity?

Asubtotal gastrectomy
Bproximal gastrectomy.
Chemigastrectomy
Dgastric wedge resection
Egastric sleeve resection.

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Question 109

Which of the following must be performed first in the case of a patient with a liver tumor diagnosed incidentally on ultrasound and a suspicion of cancer metastasis?

Aaccurate medical history, contrast enhanced CT of the abdomen, endoscopy of the upper and lower gastrointestinal tract.
Baccurate medical history and core needle biopsy of the tumor for histopathological examination.
Caccurate medical history and PET-CT as soon as possible.
Daccurate medical history, contrast enhanced CT of the abdomen and urgent decision on laparotomy and partial hepatectomy with tumor resection.
Eall the above statements are false.

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Question 110

The access routes for nutritional therapy do not include:

APEG
Bduodenostomy
Csigmoidostomy
Dnasogastric tube
Eall of the above are possible access routes for nutritional therapy

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Question 111

Which of the following clinical symptoms is an indication for urgent surgery in Crohn’s disease?

Arecurrent diarrhea.
Bimpermeable intestinal obstruction.
Cmassive bleeding.
DB and C are true.
EA, B, C are true.

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Question 112

Early stomach cancer:

Aexceeds the muscular layer, lymph node metastases are present, with no distant metastases
Bexceeds the submucosa, but does not exceed the stomach wall
CStage T2 in the TNM classification
DIt infiltrates the mucosa and submucosa, it does not infiltrate the muscular layer
EIt is a stomach cancer in a patient under 50

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Question 113

Which of the following should you suspect in a female patient complaining of cyclic regular hypogastric pain occurring for a longer time and rectal bleeding that accompanies menstruation?

AMeckel's diverticulum
Bhyperthyroidism
Cintestinal tract endometriosis
Dhaemorrhagic diathesis.
Enone of the above

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Question 114

Clinical manifestations related to Zenker's diverticulum include:

Aregurgitation, chest pain, functional obstruction.
Bregurgitation, aspiration, functional obstruction.
Cdysphagia, aspiration, functional obstruction.
Ddysphagia, aspiration, chest pain.
Edysphagia, chest pain, functional obstruction.

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Question 115

In Billroth I gastrectomy the reconstruction is completed with anastomosis between:

Aesophagus and jejunum.
Besophagus and ileum.
Cstomach and jejunum.
Dstomach and duodenum.
Estomach and ileum.

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Question 116

Signs and symptoms of obstructive jaundice include:

Adark urine, increased AST level, elevated unconjugated bilirubin
Bdark urine, high ALT level, raised total bilirubin level.
Cdark urine, white stool, high ALP level.
Dhigh AST level, high ALT level, normal ALP level.
Ehigh AST level, high ALT level, raised total bilirubin level.

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Question 117

Which of the following primarily affects the incidence of postoperative complications after surgical treatment of a peptic ulcer?

Aulcer ethiology.
Bprevious therapy with proton pomp inhibitors.
Cprevious therapy with H2-blockers.
Dtime from the first perforation symptoms to the surgery.
Epatient sex.

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Question 118

The local complications of acute pancreatitis include:

1. portal vein thrombosis

2. true pancreatic cyst

3. pancreatic pseudocyst

4. pancreatic fistula

5. abscess

The correct answer is:

A1, 2, 4, 5
B1, 3, 4, 5
C2, 3, 4, 5
D2, 4, 5
E1, 2, 3

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Question 119

A patient with decompensated diabetes mellitus and severe ketoacidosis complains of abdominal pain, nausea and vomiting. There are no obvious signs of peritonitis on physical examination. The first-line approach in this patient is:

Alaparotomy.
Bminimally invasive exploratory laparotomy.
Cdetailed abdomen diagnostics (CT, MRI).
Dappropriate hydration and correction of metabolic disturbances.
Enone of the above.

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Question 120

A 48-year-old gentleman with sudden severe epigastric pain was referred to the ER. Severe tenderness with a guarding and rebound sign over the upper, middle and lower abdominal regions was found on physical exam. Pulse rate was 120/min and blood pressure 100/60 mmHg. Blood testing revealed WBC 18.3 K/µL; serum amylase 85 U/L; serum lipase 42 U/L; CRP 183 mg/dL; total bilirubin 0.56 mg/dL. On abdominal imaging the empty gall bladder, CBD of 5mm in diameter and normal sized heterogenous pancreas with free fluid in the upper part of the peritoneal cavity. The results of the plain chest x-ray are shown in the picture. Which management would you recommend to this patient?

Aa discharge with prescribed pain killers, proton pump inhibitors and antibiotics and a follow-up visit the next day.
Bin-hospital intensive conservative treatment with pain killers, proton pump inhibitors and antibiotics.
Cin-hospital intensive conservative treatment with pain killers, proton pump inhibitors and antibiotics and performing upper endoscopy if clinical worsening occurs
Din-hospital intensive conservative treatment with pain killers, proton pump inhibitors and antibiotics and performing laparotomy if clinical worsening occurs.
Ein-hospital treatment with urgent surgery with concomitant pain killers, proton pump inhibitors and antibiotics.

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Question 121

Which of the following is the most common malignant tumor found in the liver?

Ahepatocellular carcinoma (HCC)
Bcholangiocarcinoma (CCC)
Cfocal nodular hyperplasia (FNH)
Dcolon cancer metastasis
Ecystadenocarcinoma

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Question 122

Indicate tests that should be ordered before the abdominal puncture in a patient with hepatic cirrhosis:

Aultrasound imaging, whole blood count, PET, AlAT, AspAT, Na, K, Cl.
Bwhole blood count, clotting tests, abdominal ultrasound imaging.
Cwhole blood count, abdominal CT scan, ultrasound imaging, alkaline phosphatase, ammonia.
Dabdominal CT scan, glucose, urea, bilirubin, whole blood count.
Eclotting tests, AlAT, AspAT, bilirubin, albumin.

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Question 123

A Sengstaken-Blakemore tube is used in the management of:

Aesophageal varices bleeding
Bduodenal ulcer bleeding
Cstomach erosion bleeding.
DDieulafoy's lesion bleeding.
Ehepatic cirrhosis.

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Question 124

Abdominal compartment syndrome does not arise as a result of:

Agrowing ascites.
Bexcessive swelling of the intestine wall.
Cbleeding into the peritoneal cavity.
Dintestine distention due to gas accumulation.
Elack of urine outflow.

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Question 125

Which type of intracranial hemorrhage is caused by the injury of the middle meningeal artery?

Aepidural.
Bfrontotemporal.
Csubdural.
Dintracerebral
Eoccipito-parietal.

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Question 126

Which of the following diseases is not associated with the presence of colon polyps?

AGardner syndrome
BPeutz-Jeghers-Touraine’s syndrome
Chereditary non-polyposis colorectal cancer (HNPCC)
Dfamilial adenomatous polyposis
Ejuvenile polyposis syndrome

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Question 127

Choose the correct statement about colon cancer:

Aendoscopic biopsy and histopathological examination are performed to diagnose the colorectal cancer
Bit develops most often from a polyp
Cit metastasizes to the liver rarely and is the most common cause of gastrointestinal obstruction
Dcorrect answers: A, B and C
Ecorrect answers: A and B

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Question 128

Short bowel syndrome may be caused by:

Aextensive resection of the small intestine.
Bfistula between the stomach and the transverse colon.
Ccecum-skin fistula.
DA, B, C are true.
EA and B are true.

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Question 129

What procedure should be implemented in a patient suffering from a perforated sigmoid diverticulum?

Asigmoid resection and end-to-side anastomosis
Bsigmoid resection with the Hartmann's method
Csigmoid resection and end-to-end anastomosis
Dperitoneal drainage
Eabdominoperineal resection of the rectum

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Question 130

Mitotane is used as a complementary treatment of:

Apancreatic cancer
Bgastric cancer
Cmalignant melanoma
Dadrenocortical carcinoma
Ethyroid cancer

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Question 131

Total gastrectomy is one of the surgical methods in the treatment of gastric cancer. Reconstruction of the digestive tract continuity is performed during this procedure. Which type of anastomosis is used in this technique?

Aesophago-duodenal and entero-enteric
Besophago-intestinal and entero-enteric
Cgastroenteric and entero-enteric.
Dentero-enteric only.
Eesophago-transverse and entero-enteric.

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Question 132

In which of the following breast areas breast cancer most frequently resides?

Aretroareolar
Bupper inner quadrant
Clower outer quadrant
Dlower inner quadrant
Eupper outer quadrant

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Question 133

Symptoms suggesting the rectal cancer are:
1) tarry stools
2) bleeding during defecation
3) change in bowel habits
4) pruritus
5) leukocytosis
6) pencil-thin stools.
The correct answers are:

A1, 5, 6
B2, 3, 4
C1, 3, 6
D2, 3, 6
E1, 2, 3

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Question 134

A patient weighing 80 kg had burns of an upper right limb, a lower left limb and a crotch. What amount of fluids should be administered within the first 24 hours?

A1 liter
B9 liters
C15 liters
D18 liters
Ein a patient with such a small area of burns there is no need to administer fluids

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Question 135

A 31-year-old female working at a social care unit has reported to a family doctor complaining about the itchy abdomen skin, escalating during the night and a rash. In physical examination skin lesions in the form of papules and nodules, excoriations and single crusts were found. How should the doctor proceed?

Arecommend observation of the lesion progression
Brefer the patient to the allergist
Cprescribe antihistamines
Devaluate the presence of the burrow tracks and prescribe permethrin cream in the case of their visibility
Enone of the above

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Question 136

Neuroborreliosis can manifest itself as:

1. lymphocytic meningitis,

2. encephalitis,

3. spinal cord inflammation;

4. cranial nerve palsy,

5. chronic encephalopathy,

6. impaired concentration;

7. increased nerve excitability

The correct answer is:

A1, 2, 3
B2, 3, 4
C5, 6, 7
Dall the above
Enone of the above

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Question 137

Fever, lymphadenopathy, inflammation of the upper respiratory tract, conjunctivitis and red, maculopapular rash, are symptoms characteristic of:

Ameasles
Bvaricella
Croseola
Dhand, foot and mouth disease
Enone of the above

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Question 138

Which group of bacteria mainly responsible for the occurrence of a stye (hordeolum) and chalazion?

AStreptococcus
BStaphylococcus
CAcinetobacter
DHaemophilus
EMoraxella

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Question 139

Indicate the true sentence:

AA minor, who has completed 16 years of age, can decide about medical treatment and ask for consultation in the absence of caregivers.
BA minor, who has completed 16 years of age, can't decide about medical treatment and ask for consultation in the absence of caregivers.
CThe parents of a minor, who has completed 16 years of age are not entitled to information on his/her state of health.
DThe parents of a minor, who has completed 16 years of age don't have the right to decide about his/ her medical treatment.
EConsultation and any medical treatment of a minor can be undertaken only in the presence of the caregiver.

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Question 140

Indicate the false sentence about vaccines:

AVaccines against measles, rubella, mumps, varicella, and rotaviruses are alive.
Bvaccines against Meningococcus, Pneumococcus, and Haemophilus influenzae type B are dead.
Cvaccine against rotaviruses are administered orally.
Dmonovalent vaccine contains antigens of a single microorganism.
Ethe polyvalent vaccine contains antigens of at least two different species of microorganisms.

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Question 141

Indicate the true sentence regarding hepatitis B virus (HBV):

AHBV is the RNA virus
BHBV infection is possible only through parenteral route.
CHBV incubation period lasts for 10 - 14 days
DHBV doesn't trigger extrahepatic manifestations
Edetermination of alanine transaminase (ALT) can't be used as a HBV infection diagnostic test.

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Question 142

The GP carried out the Fagerstrom test in person smoking for 3 years. The result of 3 points means:

Alack of motivation to stop smoking
Bhigh level of motivation to stop smoking.
Cweak nicotine addiction.
Dstrong nicotine addiction
Eneed for psychological consultation in addition to pharmacological treatment.

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Question 143

A pregnant woman should not be vaccinated against:

Ahepatitis A
Bhepatitis B
Cchickenpox
DPneumococcal infection
EInfluenza

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Question 144

Which of the following should not be administered In case of streptococcal angina:

APhenoxymethylpenicillin
BBenzathine penicillin
C1st generation of cephalosporin
DTetracycline
EMacrolide

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Question 145

Indicate false sentence regarding acute otitis media (AOM):

Aviruses are the most frequent etiological factor of AOM.
BAdenoid hypertrophy contributes to the development od AOM.
CPassive smoking increases the risk of AOM.
Dage under 2 is always an indication for antibiotic therapy inn the case of AOM diagnosis.
EIntratemporal complication of AOM include mastoiditis.

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Question 146

A patient with streptococcal angina, in accordance with the Centor score modified by McIsaac, will receive 1 additional point to the following age group:

A0-2 years
B3-14 years
C15-44 years
D> 44 years
EA, B are true.

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Question 147

Skin rash appeared in an 11- year- old child with acute tonsillitis after administration of amoxicillin. What is the most probable cause?

Ainfection with Ebstein- Barr virus
Binfection with Coxsackie virus
Cinfection with the herpes simplex virus
Dallergy to amoxicillin
EA and D are true.

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Question 148

Drug-induced hyperkalemia occurs during treatment with the following drugs, except for:

Aamiloride
Bangiotensin converting enzyme inhibitor
Cangiotensin receptor blockers
Daldosterone antagonists
Eglucocorticosteroid

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Question 149

Which of the following drugs can cause benign glandular breast tissue hypertrophy in men (gynecomastia)?

Aspironolactone.
Bcimetidine.
Cdiazepam.
Ddigitalis preparations
Eall the above

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Question 150

The groups at risk for vitamin D deficiency are:

Apreterm babies
Bobese children (BMI> 90 percentile)
Cobese adults (BMI> 30)
Dpeople with dark complexion and working at night
Eall of the above

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Question 151

The first- choice drug in the treatment of giardiasis is:

Ametronidazole
Btynidazole
Cfurazolidone
Derythromycin
Eclarithromycin

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Question 152

Food allergy may manifest itself as:

AUrticaria (hives)
Brhinitis
Cconjunctivitis
DA, B are true
EA, B, C are true.

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Question 153

In case of short-term type 2 diabetes mellitus the recommended HbA1C levels should be kept below:

A8% (64 mmol/mol)
B7,5% (59 mmol/mol)
C7% (53 mmol/mol)
D6,5% (48 mmol/mol)
E6,0% (42 mmol/mol)

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Question 154

In patients with type 2 diabetes mellitus the arterial blood pressure should be kept below:

A140/90 mmHg
B140/85 mmHg
C135/85 mmHg
D130/80 mmHg
E120/70 mmHg

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Question 155

A 38-week-pregnant woman had sudden cardiac arrest. Which of the following will have priority?

Achest compressions
B5 rescue breaths
Cdefibrillation
Dlaying the body on the left side
Eearly intubation

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Question 156

The patient complains of strong, sudden abdominal pain, bloody diarrhoea, vomiting and frequent atrial fibrillation. During the physical examination, you stated only tenderness on deep palpation of the abdomen without muscular defence. Which of the following is the most probable diagnosis?

Aacute ischemia of the small intestine
Bacute pancreatitis
Cintestinal obstruction
Dnephrolithiasis
Eacute appendicitis

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Question 157

The first aid in the case of humerus fracture is to put the immobilizing dressing on:

Athe arm
Bthe arm and the elbow joint
Cthe arm and the shoulder joint
Dthe arm, the elbow joint and the shoulder joint
Ethe arm, the elbow and the shoulder joints, as well as the radiocarpal joint.

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Question 158

A drug administered during ALS at a dose of 300 mg in 20 ml of 5% glucose solution, which is recommended in the treatment of ventricular and supraventricular arrhythmia, as well as in defibrillation-resistant ventricular fibrillation. Which of the following refers to this description?

Aadrenaline
Batropine
Camiodarone
Dlidocaine
Emagnesium sulfate

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Question 159

In the case of the resuscitation of an adult with electric shock injury the recommended ratio of chest compressions to artificial breaths is:

A3:1
B5:1
C5:2
D15:2
E30: 2

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Question 160

In the case of the resuscitation of a newborn the recommended ratio of chest compressions to artificial breaths is:

A3:1
B5:1
C5:2
D15:2
E30: 2

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Question 161

The management of febrile convulsions in children includes:

Aensuring airway patency
Bapplication of anti-pyretic drugs.
Ccold compresses.
Drectal application of diazepam
Eall the above.

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Question 162

Electric defibrillation should be performed during chest compression breaks for a period not longer than:

A5 seconds
B10 seconds
C15 seconds
D20 seconds
Ethe time does not matter.

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Question 163

In which of the following cardiac arrests CPR starts with 5 rescue breaths?

Acaused by drowning.
Bin the pregnant.
Ccaused by myocardial infarction.
Din children
EA, D are true.

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Question 164

Cardio-pulmonary resuscitation should be continued until:

AALS providers take over.
BAED orders to stop resuscitation.
Cvictim starts regular breathing
Drescuer exhaustion.
EA, C, D are true

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Question 165

The so called “golden hour” to use hyperbaric oxygen in a heavy carbon monoxide poisoning is:

A1 hour
B2 hours
C3 hours
D4 hours
E6 hours

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Question 166

Hypovolemic shock develops when the volume of blood loss exceeds:

A1/5
B1/4
C1/3
D1/2
E2/3

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Question 167

You are performing a segregation of patients in the mass event. You use START system. You reach the victim who cannot walk, is breathing (15 breaths per minute), his/her radial artery pulse is palpable, is not responding to commands. You qualify him/her to the group:

Ablue
Bgreen
Cyellow
Dred
Eblack

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Question 168

Which of the blood gas test results shows uncompensated respiratory acidosis?

ApH 7,36 , pCO2 55, HCO3 30
BpH 7,2 , pCO2 60, HCO3 22
CpH 7,48 PCO2 20 HCO3 19
DpH 7,36 pCO2 50, HCO3 28
EpH 7,58 pCO2 18, HCO3 19

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Question 169

The first disorder caused by an overdosage of sodium bicarbonate is:

AMetabolic acidosis
BMetabolic alkalosis
CRespiratory acidosis
DRespiratory alkalosis
EHypoosmolality

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Question 170

Indicate the false sentence concerning hypothermia:

Ahypothermia is diagnosed, when the core body temperature decreases below 35 degrees Celsius.
Bfactor that predisposes to hypothermia is a drop in heat production due to old age.
Cdiagnosis of brain death is possible only after the restoration of core body temperature to normal values.
Dhuman body at a temperature below 20 degrees Celsius is able to tolerate cardiac arrest for more than 1 hour without neurological damage.
Ehypothermic bradycardia is sensitive to atropine treatment.

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Question 171

The standard diagnostic procedure in a patient with multiorgan trauma should include:

Adiagnostic puncture of the pleural cavity
Bdiagnostic puncture of the pericardium
Cdiagnostic puncture of the peritoneal cavity.
Ddiagnostic puncture of the subarachnoid space.
Eultrasound imaging with FAST method.

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Question 172

Cardiac arrhythmia shown in the picture below is

Aasystole
Bventricular fibrillation
Catrial fibrillation
Dventricular tachycardia
Etorsade de pointes

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Question 173

The reversible causes of sudden cardiac arrest include all of the following medical conditions, except for:

Atension pneumothorax
Bclosed pneumothorax
Chypovolemia
Dhypothermia
Edrug overdose

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Question 174

Question canceled by CEM: Placement of AED is recommended in places, where 1 episode of sudden cardiac arrest occurs once in:

A1 year
B2 years
C3 years
D4 years
E5 years

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Question 175

Medical Rescue Team was called to a man who fell down the stairs. The rescue doctor found out that the patient hit himself hard in the back and stays in a lying position on the spot where he fell. The patient refuses to be taken to the hospital. What should the doctor do in light of the medical law?

Ataking into consideration that the patient can be a subject to severe bodily harm, the doctor is allowed to move the patient to the hospital against his will.
Bin the presence of two witnesses the doctor should make sure that the patient maintains his refusal and if so leave him on the spot.
Cprovide information on the potential effects of the injury and suggested diagnostics and then follow the patient’s will.
Dnotify the psychiatrist, appointed by the province governor, who can take a decision about forced hospitalization
Enote down the patient’s refusal in the medical documentation and leave him on the spot.

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Question 176

The doctor stating death is obliged to immediately notify the police or the prosecutor if:
1) they are unable to determine the cause of death;
2) the deceased does not have a next of kin within the meaning of Article 3 of the Act on
Patients’ Rights and the Ombudsman for Patients' Rights;
3) they have a justified suspicion that a crime was the cause of death;
4) they have a justified suspicion that suicide was the cause of death;
5) they are unable to establish the identity of the deceased;
The correct answer is:

A1, 3, 5
B3,4.
C3,4,5.
D1, 2
E2, 3, 4

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Question 177

Medical Rescue Team with the doctor was called to a 32-year-old man who was under the influence of designer drugs. These drugs caused the patient to react aggressively. What are the conditions under which it is possible to apply direct coercion in this patient?

1) it can be applied only if the doctor diagnoses the patient with mental illness;

2) doctor is allowed to apply it if they obtain consent from a medical specialist in psychiatry appointed by the province governor;

3) patient’s behavior poses a threat to his life or health;

4) it is only possible to hold the patient down and to immobilize him. However, the doctor is not allowed to force the patient to take medication;

5) before applying direct coercion the doctor should warn the patient.

The correct answer is:

A1, 3, 5
B2, 3
C3,4,5.
D1,2,4.
E3,5.

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Question 178

A minor may be the transplantation donor under the following conditions:

1. the recipient can only be siblings

2. the recipient can not be a person related to the donor

3. only the donation of paired organs is allowed

4. only bone marrow and hematopoietic cells can be collected

5. positive opinion of the District Ombudsman for Patients is necessary

A1, 4
B2, 4
C3, 5
D1, 3
E2, 5

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Question 179

Parents with their child reports to the Primary Health Care doctor. The child should have protective vaccination done but the parents object. What should the doctor do?

Adoctor should respect the will of the parents because having parental authority they can freely decide whether or not their child should be vaccinated.
Bdoctor has to do the vaccination even against parental will and if necessary, use direct coercion.
Cdoctor should resign from vaccination and inform the Ombudsman for Minors about this fact.
Ddoctor does not perform vaccination but notifies this in his quarterly report forwarded to the State Regional Sanitary Inspector
Edoctor can do vaccination against parental refusal but should consult another doctor possibly of the same specialty

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Question 180

In accordance with the Polish Code of Ethics is the doctor allowed to discriminate against people because of their genetic heritage?

Ayes
Bonly under the law.
Conly in particular instances
Dno
Ethe Polish Code of Ethics does not cover genetic heritage.

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Question 181

What does the Polish Code of Ethics say about human cloning?

Alimits the admissibility of human cloning.
Ballows human cloning.
Cdoes not allow human cloning.
Ddoes not cover this issue.
Edescribes human cloning without taking stance on this issue

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Question 182

One patient, two days before his death was visited by a High Representative of a foreign state, who gave him a decoration. The doctor was a witness to this event because it happened that he examined at this time another patient. According to the Code of Medical Ethics he should:

Ainform the authorities out of concern for his own safety
Binform the authorities out of concern for the safety of his own state.
Cpromptly provide the information for the spokesman of the Hospital.
Dhe can submit the information only after the patient’s death.
Ehe should keep this information in secrecy.

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Question 183

The patient, according to “the American Scientific Society” recommendations, should be treated with drug A, and according to the position of “the European Scientific Society” with drug B. According to the Code of Medical Ethics a physician working in Poland should prescribe:

Adrug A, because “the recommendations” are stronger in form than “the position”.
Bdrug A, if the patient is a US citizen, and the drug B if they are European citizens
Cdrug B, because Poland is in the European Union.
Ddrug which is in line with the guidelines of the Polish Scientific Society.
Ehe is free to choose the drug.

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Question 184

Scientific Societies’ guidelines recommend different methods for the treatment of hypertension according to the race of the patient. This means that the Code of Medical Ethics:

Adoes not contradict this recommendation.
Brequires urgent amendment because it no longer keeps pace with the progress of science.
Crequires changes in the time of massive influx of people of different races and religions.
Ddoes not apply to the treatment of hypertension.
Edoes not allow doctors to use such a recommendation

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Question 185

In accordance with the Law on old-age and disability pensions from the Social Insurance Fund an insured person who has been considerably incapacitated for the work corresponding with that person’s qualifications is:

Apartially incapable to work.
Bcompletely unable to work
Cconsiderably disabled.
Dincapable to do farm work for a prolonged period of time
Edisabled person of the first category

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Question 186

According to the Act on Pensions from the Social Insurance Fund, a person who becomes partially or wholly unable to work is entitled to which of the following benefits from the Social Insurance Institution (ZUS):

Asickness benefit
Binabillity to work pension
Cretirement
Dcompensation
Etraining pension

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Question 187

According to the Act on financial benefits from social insurance in case of illness and maternity, the doctor is entitled to extend the sickness period to 270 days, for which of the following diseases:

Amyocardial infarction
Bheart failure
Ctuberculosis
DCOPD
Echolelithiasis

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Question 188

In accordance with the Law on cash benefits from social insurance in case of sickness and maternity the doctor’s statement on temporary incapacity for work because of sickness or a stay in the hospital contains the information about the circumstances influencing the entitlement to the sickness allowance or its amount marked with letter codes. The incapacity for work during pregnancy is marked with:

Acode A
Bcode B
Ccode C
Dcode D
Ecode E

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Question 189

In accordance with the Law on social insurance benefits provided for in case of work accidents and occupational diseases the insured person who has suffered a permanent or long-lasting health damage due to a work accident or occupational disease is entitled to:

Awork incapacity pension.
Bsick pay
Ctraining pension.
Done-time indemnity.
Enursing allowance.

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Question 190

According to the Act on Pensions from the Social Insurance Fund, a person who has been decided to reclassify due to inability to work in the current profession and who has a relevant insurance period is entitled to a pension from the Social Insurance Fund (FUS):

Arehabilitation pension
Bsick pay
Csocial pension
Dtraining pension
Ecompensatory pension

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Question 191

According to the Act on Pensions from the Social Insurance Fund, a person who has been decided to reclassify due to inability to work in the current profession and who has a relevant insurance period is entitled to a pension from the Social Insurance Fund (FUS):

Asick pay
Brehabilitation pension
Ctraining pension
Dcompensatory pension
Ecarer’s allowance

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Question 192

The risk factors of nosocomial infections include:

Apatient’s age.
Blength of a stay in the hospital (hospitalization).
Cinappropriate antibiotic therapy
DA,B,C are true.
EB,C are true.

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Question 193

The QALY indicator means:

AHuman development index
BHealthy life years indicator
CQuality- adjusted life years
DRoom area indicator
ENumber of aggressive years of life

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Question 194

The HLY indicator means:

Ahuman development index.
Bhealthy life years.
Cquality-adjusted life years.
Dmetric area index.
Ehumanitarian list of the year.

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Question 195

In present-day Poland the main cause of death of adults due to CVD is:

Ahypertension
Bischemic heart disease
Cstroke.
Drupture of an aortic aneurysm.
Econgenital heart disease.

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Question 196

In post-exposure prophylaxis against tetanus in the patient who is at a small risk of infection and vaccinated four years ago, the following is recommended:

Atetanus- diphtheria or tetanus vaccine
Bantitoxin (LIT - specific immunoglobulin 250/500 IU)
Ctetanus vaccine in the 0,1,6 month schedule
Dcorrect answer A and C
Enone vaccination is recommended

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Question 197

Which of the following concerning positive features of screening tests, which justifying their application, is false?

Amethods used in screening usually carry no risk for examined patients.
Bthere is a possibility to verify diagnoses obtained through these tests.
Cmethods used in screening do not have to be accepted by examined patients.
Ddiagnostic tests used in screening are generally fast and easy.
Ecosts of screening tests and possible further treatment are economically justified.

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Question 198

Activities early detecting diseases and their causes make up secondary prophylaxis. Which of the following are part of secondary prophylaxis?

1) active guidance;

2) dispanserization;

3) vaccination;

4) health checks;

5) screening;

6) epidemiological supervision over food production.

The correct answer is:

A1, 3
B2, 3
C4, 5, 6
D1, 2, 4, 5
E2, 3, 5, 6

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Question 199

According to the current law patients have to have a referral from their family doctor (NHF doctor) if they need medical services from:

1) cardiologist;

2) ophthalmologist;

3) dentist;

4) dermatologist;

5) oncologist;

6) psychiatrist;

7) gynecologist.

The correct answer is:

A1, 2, 3
B1, 2, 4
C2,3,5.
D4,5,6.
E3,5,6,7.

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Question 200

Which of the following drugs should not be used to treat arterial hypertension in pregnant women?

Alabetalol.
Bmethyldopa
Cnifedipine.
Denalapril
Eall of the above drugs can be used in the treatment of high blood pressure pregnant women.

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