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LEKEXAM / 2019 spring

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Question distribution — 2019 spring session

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Internal medicinePediatricsSurgeryGynecology and obstetricsFamily medicineEmergency medicine, AnaesthesiologyPsychiatryMedical law and bioethicsPublic healthMedical certification

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Question 1

Indicate the proper management of the patient with type 2 diabetes mellitus treated with gliclazide retard, who presents with sweat, fatigue and trembling hands and his blood glucose concentration as measured by glucose meter is 61 mg/dL:

Aimmediately give 1 mg of glucagon i.m. or s.c. and then 500 mL of 10% glucose solution in intravenous infusion and perform a control measurement of glycemia after 30 minutes.
Bgive slow intravenous infusion of 20% glucose solution in 250 mL of normal saline and perform control measurements of glycemia every 30 minutes.
Cgive simple carbohydrates, e.g. sweetened tea and then complex carbohydrates, e.g. a sandwich of full-grain bread and perform a control measurement of glycemia after an hour.
Dfirst give the patient 50 mL of 20% glucose solution i.v. and then 500 mL of 10% glucose solution with a control measurement of glycemia after 15 minutes.
Ein the case of hypoglycemia related to the use of sulfonylureas it is indicated to use the rule of 15/15.

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Question 2

Which of the following is an indication for the temporal insulin therapy in a patient with type 2 diabetes mellitus treated with metformin and saxagliptin? 1) each glycemia exceeding 300 mg/dL; 2) each pharyngitis; 3) ischemic stroke; 4) surgery; 5) travel across time zone boundaries. The correct answer is:

A1,3.
B2,4.
C2,3.
D2,5.
E3.4.

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Question 3

Numerous interactions between vitamin K antagonists (VKA) and other medications or food must be considered in patients chronically treated with VKA. Which of the following intensify the action of VKA?

1. carbamazepine;

2. ciprofloxacin;

3. amiodarone;

4. spinach;

5. grapefruit juice;

6. mesalazine.

The correct answer is:

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

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Question 4

Which of the following scales are useful for the assessment of the clinical risk of pulmonary embolism? 1) EHRA score; 2) PESI; 3) TIMI risk score; 4) Wells score; 5) revised Geneva score. The correct answer is:

A1,2.
B1,2,3.
C2,4.
Donly 4.
E4.5.

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Question 5

Which of the following is used in an acute attack of gout?

Aallopurinol.
Bfurosemide.
Ccolchicine.
Dβ-blockers.
Efenoterol.

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Question 6

Which of the following is classified as a disease-modifying antirheumatic drug?

Aindomethacin
Bmetotrexate
Ccelecoxib
Detanercept
Erituximab

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Question 7

A 78-year-old patient was transported to the Emergency Department because of general fatigue, peripheral pitting edema of lower limbs and dyspnea increasing for the last month. The patient has a several year history of well-controlled arterial hypertension and rheumatoid arthritis with a sustained moderate disease activity despite the use of non-steroidal anti-inflammatory drugs. Because of the increasing edemas his family doctor gave him furosemide, twice daily, 10 days earlier. The treatment did not alleviate edemas. Which of the following should be first ordered to find the cause of increasing fluid retention?

Ablood testing to determine CRP concentration and ESR to assess the activity of rheumatoid arthritis.
Bblood testing to determine troponin and NT-proBNP concentrations
Ckidney biopsy.
Dcollecting urine for culture.
Eurinalysis and blood testing to determine creatinine concentration.

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Question 8

Which of the following diseases is the most common cause of bilateral pelvicalyceal dilation in an elderly male with lower urinary tract symptoms?

Acancer of the bladder
Bbenign prostatic hyperplasia
Cbilateral ureteral stenosis
Dbilateral ureteral stones
Evesicoureteral reflux

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Question 9

Indicate the site of auscultation of the aortic valve:

Aright second intercostal space at the sternal border
Bleft second intercostal space at the sternal border
Cright fourth or fifth intercostal space at the sternal border
Dleft fifth intercostal space medially from the left midclavicular line
Elocation of the apex beat

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Question 10

Which of the following predispose towards the loud first heart sound?

1) slim body;

2) tachycardia;

3) mitral insufficiency;

4) short PR interval;

5) myocardial infarction.

The correct answer is:

A1,2,5.
B1,2,3.
C1,2,4.
D1,2,3,4.
Eall the above.

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Question 11

Which of the following characterizes pulsus bisferiens?

Apulse when premature ventricular depolarization occurs after each normal cardiac systole; it is observed in ectopic depolarization accompanying the sinus rhythm, in Wenckebach periodicity - atrioventricular 3:2 block or when additional atrial action potential is blocked after every second sinoatrial node action potential.
Bpulse with two positive waves during systole, caused by the presence of an additional wave of blood flow, that occurs in hypertrophic cardiomyopathy with narrowing of the outflow tract and in mixed aortic stenosis and regurgitation.
Cpulse in which one wave occurs in systole and the other at the beginning of diastole, usually observed in cardiac tamponade, severe heart failure or hypovolemic shock.
Dquick and hypokinetic pulse that occurs in the shock, rarely in fever or cardiac tamponade.
Epulse of low amplitude or even absent accompanied by a decrease in systolic pressure >10 mmHg on inspiration.

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Question 12

Non-cardiac conditions that predispose towards atrial fibrillation include:
1) hyperthyroidism;
2) hypothyroidism;
3) acute infection;
4) obstructive sleep apnea;
5) pheochromocytoma.
The correct answer is:

A1, 3, 5
B1, 3, 4, 5
C1, 2, 3, 5
D2, 3, 4, 5
Eall of them

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Question 13

Peripheral cyanosis is not a consequence of:

Asignificant hypothermia.
Baortic stenosis.
CBuerger's disease
Dmethemoglobinemia
Ecardiogenic shock

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Question 14

The correct management of a pregnant woman who first came to a visit to a gynecologist with a result of a blood glucose plasma test of 94 mg / dl is:

Adiagnosis of gestational diabetes and implementation of insulin therapy.
Bimmediate performance of a 75g glucose load test.
Cimplementation of normal eating habits and performing oral glucose tolerance test between 24 and 28 weeks of pregnancy.
Drepeated determination of plasma glucose from venous blood.
Eexplaining to the patient that she is not diabetic and recommending controlling glucose using a glucometer.

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Question 15

Infliximab (anti-TNF alfa antibodies) is used for the treatment of inflammatory bowel diseases in the following cases, except for:

Asteroid refractoriness
Bthiopurine intolerance (azathioprine, 6-mercaptopurine)
Csteroid dependency
Drescue therapy in severe ulcerative colitis
Emanagement of perianal fistulas in Crohn disease

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Question 16

Which of the following conditions predisposes towards recurrent acute pancreatitis?

AHFE gene mutation (C282Y)
Bregular consumption of drinks rich in fructose
Chyperaldosteronism
Dhypertriglyceridemia
Eectopic pancreatic tissue in the stomach

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Question 17

Which of the following conditions may lead to aortic regurgitation?
1) type B aortic dissection in the Stanford classification;
2) dilatation of the aorta caused by long-term arterial hypertension;
3) ischemic cardiomyopathy with the dilated left ventricle;
4) outlet-type ventricular septal defect;
5) acute myocarditis.
The correct answer is:

A1, 2, 3
B1, 3, 5
C4, 5
D2, 4
Eonly 2

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Question 18

The GRACE risk score facilitates decision making in the management of patients with:

AST-segment elevation myocardial infarction (STEMI)
Bnon-ST-segment elevation myocardial infarction (NSTEMI)
Cpulmonary embolism
Dcardiogenic shock
Epulmonary edema

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Question 19

What cardiologic complications may be expected in the course of hyperthyroidism?

1) arrhythmia;

2) aggravation of heart failure;

3) aggravation of coronary disease;

4) myocarditis;

5) atrioventricular blocks.

The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
Donly 1.
Eall the above.

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Question 20

A 77-year-old patient treated for urolithiasis for many years complains of a generalized bone pain. Laboratory tests show: calcium concentration 12.3 mg/dL (N: 8.5-10.5 mg/dL), daily calcium excretion 480 mg/24h (N: 150-300 mg/24h), PTH 227 pg/ml (N: 15-65 pg/mL). The most probable diagnosis is:

Ahypercalcemia of malignancy
Bprimary hyperparathyroidism
Csecondary hyperparathyroidism
Dpseudohypoparathyroidism
Evitamin D overdose

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Question 21

Which of the following should be done in a patient with adrenal incidentaloma of 1.3 cm in diameter, +13 Hounsfield units, in order to exclude pheochromocytoma? 1) determination of the 24-hour urinary methoxy-catecholamines excretion; 2) FNAB of the tumor; 3) 1 mg dexamethasone test; 4) determination of aldosterone and renin; 5) androstenedione determination. The correct answer is:

A1,2,3.
B2,3,4.
C3,4,5.
Donly 1.
Eall the above.

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Question 22

The patient aged 45 stopped menstruating 3 months ago. Indicate the possible cause:

Apregnancy.
Bpituitary prolactinoma.
Cpremature ovarian failure.
Danswers A and C are correct.
Eanswers A, B and C are correct.

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Question 23

A 32-year-old man running a fever of up to 40 °C visited his doctor. The physical examination revealed otitis media and pneumonia of the right lung confirmed with an X-ray. Laboratory tests showed proteinuria and erythrocyturia with predominance of dysmorphic erythrocytes. Which of the following tests should be performed to confirm the probable diagnosis?

Aear swab.
BANA.
Cantibodies against Chlamydia trachomatis.
Dantibodies against Jo-1.
EANCA.

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Question 24

A 18-year-old man comes to the doctor because of a persistent pain of the lumbar spine. He has been diagnosed with spinal disc herniation. Currently, the patient complains of inguinal and gluteal pain and edema of the right Achilles tendon. What examination should be performed to confirm the diagnosis?

Aantinuclear antibodies.
BANCA.
CaCCP.
DHLA B-27.
Eanti-Sa antibodies.

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Question 25

What kind of damage to the kidneys can be observed in the course of multiple myeloma?

1) AL. amyloidosis;

2) focal segmental glomerulosclerosis (FSGS);

3) monoclonal immunoglobulin deposition disease;

4) cast nephropathy;

5) membranous nephropathy.

The correct answer is:

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

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Question 26

The presence of which antibodies is not one of the immunological criteria of the diagnosis of systemic lupus erythematosus?

Aanti-native DNA.
Banti-Sm.
Canti-cardiolipin.
Dagainst Chlamydia trachomatis in high titers.
Eantinuclear in the indirect immunofluorescence test.

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Question 27

178. Which of the following is not one of the signs of osteomalacia caused by vitamin D insufficiency?

Ahigh serum calcium concentration.
Bdecreased calcium urinary excretion.
Cincreased serum PTH concentration.
Dincreased serum ALP activity.
Elow serum phosphate concentration.

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Question 28

According to ISCD the assessment of bone mineral density is indicated in the following cases, except for:

Awomen aged > 65 years.
Bpostmenopausal woman at the age < 65 years with fracture risk factors
Cmale aged > 70 years.
Dadult patient who had a low-energy fracture.
Ewoman after the labor to assess contraindications to breastfeeding.

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Question 29

Which of the following medications should not be used in monotherapy to start the treatment of recent deep venous thrombosis?

Arivaroxaban.
Bapixaban.
Cwarfarin.
Denoxaparin.
Efondaparinux.

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Question 30

Which of the following medications may be used in a pregnant woman treated for arterial hypertension? 1) angiotensin receptor antagonist - valsartan; 2) beta blocker - metoprolol; 3) centrally acting antiadrenergic agent - methyldopa; 4) aldosterone receptor antagonist - spironolactone; 5) calcium channel blocker - amlodipine. The correct answer is:

A1,3.
B2,3.
C2,4,5.
Donly 1.
Eonly 3.

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Question 31

Which of the following are useful in the treatment of hemodynamically stable tachycardia with narrow QRS complexes? 1) Valsalva maneuver; 2) face immersion in the cold water; 3) carotid sinus massage; 4) ivabradine administration; 5) adenosine administration. The correct answer is:

A1,5.
B1,3,5.
C3,4,5.
D1,2,3,5.
Eall of them.

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Question 32

Indicate a false statement about autoimmune pancreatitis:

AIgG4 blood concentration is elevated.
Bdisease may affect other organs (e.g. bile ducts, thyroid).
Cduct of Wirsung is markedly dilated.
Dit may resemble pancreatic cancer.
Eglucocorticosteroids are the treatment of choice.

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Question 33

Indicate the true statement concerning non-alcoholic steatohepatitis (NASH):

ANASH is an intermediate stage between isolated hepatic steatosis and advanced types of non-alcoholic fatty liver disease.
Bthe best examination to diagnose NASH is ultrasound elastography.
Cdiagnosis of NASH in histopathological examination is based on the presence of liver steatosis and fibrosis.
DNASH is related to 50% risk of the development of cirrhosis over 5 years.
Ethere is no connection between NASH and type 2 diabetes mellitus

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Question 34

Helicobacter pylori infection is associated with the mentioned pathologies with the exception of:

Aduodenal ulcer.
Bgastric ulcer.
Cdiffuse gastric B lymphoma.
Datrophic gastritis.
Eimmune thrombocytopenia.

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Question 35

A 20-year-old patient, who had a kidney transplant 4 years ago, with normal transplanted kidney function, reported to the emergency room due to extensive trauma to the lower limb with damage to the skin he had experienced on the wooden pier. Indicate the correct statement regarding tetanus prophylaxis in this case:

Aroutine tetanus vaccination should be recommended.
Bvaccination should not be recommended as the tetanus vaccine is a live vaccine.
Ca patient with immunosuppressive therapy should not be vaccinated with any kind of vaccines after transplantation.
Dthe patient can be vaccinated because 4 years after the transplantation, he does not take immunosuppressive drugs anymore.
Evaccination is only recommended for patients > 55 years of age.

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Question 36

Which of the following should be used in a 26-year-old woman with the diagnosis of gonococcal urethritis?

Atrimethoprim 2x 100mg for 5 days orally
Bdoxycycline 2x 100mg for 7 days orally
Cazithromycin 1 g in a single dose orally.
Dciprofloxacin 2 x 500 mg for 7 days
Efluconazole 400 mg in a single dose orally

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Question 37

An 82-year-old patient was taken to the Emergency Department because of disturbances of consciousness that had been intensifying for the last 24 hours. The laboratory tests showed serum concentration of sodium - 122 mmol/L, potassium - 3.9 mmol/L, creatinine 1.6 mg/mL. Which of the following should be first ordered?

ARinger’s solution 500 mL - infusion for 30 min.
B0.9% NaCl 500 mL solution - infusion for 20 min.
C10% NaCl solution - infusion for 20 min.
D3% NaCl solution - infusion for 20 min.
E5% glucose 500 mL with 40 mEq 8.4% sodium bicarbonate solution - infusion for 15 min.

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Question 38

An 80-year-old resident of the nursing home was brought to the Emergency Room because of the deterioration of contact and decreased strength of her right lower limb lasting for 5 hours. There are no reports on the fever nor abdominal pain. The urinalysis revealed proteinuria 0.1 mg/dL, leukocytes 15-20 per hpf with numerous bacteria present. She has CRP 10 ng/mL (n < 5 ng/ml), normal complete blood count and eGFR 39 mL/min. Indicate the most probable cause of the symptoms:

Aacute pyelonephritis
Bacute glomerulonephritis
Crenal colic caused by nephrolithiasis
Dbladder infection (cystitis)
Edescribed changes in the urine are typical of elder patients and should not be an indication for antibacterial treatment if they are not accompanied by clinical symptoms.

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Question 39

Physical examination of a patient with glomerular filtration rate 25 mL/min/1.73 m and potassium level 6.2 mmol/L showed: heart rate 68/min, blood pressure 145/80 mmHg, signs of significant heart failure. Which of the following should be a first-line treatment?

Ainfusion of 500 mL 10% glucose + 32 u. short-acting insulin.
Bβ2-agonist inhalation
C10% solution of calcium chloride - 20 ml iv
Dfurosemide 40 mg i.v.
Eacute hemodialysis.

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Question 40

Which of the following is not a criterion necessary to diagnose growing pains in children (according to Peterson and Mellson)?

Aage between 4 and 12 years old.
Bpain does not occur daily.
Cpain occurs in the evening and at night, never in the morning.
Dpositive family history of growing pains.
Epain is symmetrical and involves thighs, popliteal regions and lower legs.

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Question 41

Which of the following is not typical of Henoch-Schönlein purpura?

Apathological changes within joints (inflammation, edema, pain with limited range of motion).
Bdiffuse colicky abdominal pain.
Cproteinuria or the presence of albumin in urine collected after the night.
Dhaematuria or erythrocyturia.
Eenlargement of the spleen.

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Question 42

Which of the following diagnostic methods allows the identification of scars in the kidney?

ADMSA scintigraphy.
Bultrasound imaging.
Cvoiding cystography
Durinalysis.
EUSG Doppler.

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Question 43

Juvenile idiopathic arthritis is the most frequently occurring group of chronic inflammatory systemic diseases of connective tissue observed in the developmental age, of unknown aetiology. Which of the following describes the criteria for diagnosing this condition:

Aonset of the disease at the age under 16.
Barthritis affecting at least two joints, lasting for over four weeks.
Conset of the disease at the age under 16, the symptoms of arthritis lasting six weeks minimum and excluding other possible causes of arthritis from the so-called “list of exclusions”
Dexcluding infectious causes of arthritis and the onset of the disease not later than at the age of 18
EB and D are true

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Question 44

Inhaled corticosteroids may be used in the treatment of:

Aacute bronchitis and bronchiolitis
Bexhausting cough accompanying an upper respiratory tract infection
Cacute subglottic laryngitis
Devery kind of asthma regardless of its severity
Eall the above

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Question 45

Which of the following is not a cause of arterial hypertension in neonates?

Arenal artery thrombosis.
Bintracranial hypertension.
Cmaternal thyrotoxicosis
Dcongenital adrenal hyperplasia.
Ehypercalcemia.

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Question 46

Which of these symptoms is the least probable symptom of the extragastric presentation of gastric reflux disease in children?

Adental enamel lesions.
Brickets.
Cgrunting.
Drecurrent sinusitis.
Esleep apnea.

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Question 47

Which of the following tests is not recommended to diagnose celiac disease in children?

Agluten provocation test.
Bmeasurement of anti-reticulin antibodies concentration.
Cmeasurement of anti-endomysium antibodies concentration.
Dmeasurement of anti-transglutaminase antibodies concentration.
Ebiopsy and examination of small intestine cells.

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Question 48

The most common cause of Cushing’s syndrome in children is:

Atreatment with glucocorticosteroids.
BACTH-secreting pituitary adenoma
Cadrenal cancer.
Dadenoma of the adrenal gland.
EMcCune-Albright syndrome.

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Question 49

Which of the following is not a typical symptom of the early phase of Streptococcus agalactiae infection in neonates?

Arespiratory distress requiring intubation and mechanical ventilation.
Bpulmonary hypertension.
Costeitis.
Dseptic shock.
Emeningitis.

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Question 50

Influenza vaccines can be used in children at the age of:

A> 6 months.
B> 1 year.
C> 3 years.
D> 5 years.
E> 7 years.

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Question 51

Invasive meningococcal disease was diagnosed in a 4-year-old child admitted to the hospital. What preventive measure should be implemented in a 2-year-old brother of the hospitalized child living in the same household?

Athere are not effective methods of prevention of a meningococcal infection
Bvaccine against meningococcal infection should be given as soon as possible.
Cone dose of ceftriaxone 125 mg should be given.
Done dose of rifampicin (10 mg/kg) should be given.
Eone dose of ampicillin (25mg/kg) should be given

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Question 52

Which from the antibacterial drugs listed below is not used in the treatment of pertussis?

Atrimethoprim-sulfamethoxazole.
Bazithromycin.
Cerythromycin.
Dpenicillin V (phenoxymethylpenicillin).
Eclarithromycin.

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Question 53

A patient with an enlarging erythema on the arm presented at the doctor’s office. Current diameter of the erythema is about 12 cm. The doctor diagnosed erythema migrans based on the medical history and the appearance of the lesion. Which of the following should be the next step?

AELISA assay to detect antibodies against Borrelia in IgM class.
BELISA assay to detect antibodies against Borrelia in IgG class.
CWestern-Blot assay to detect antibodies against Borrelia in IgM and IgG classes
Dblood examination with PCR method to detect the presence of Borrelia antigens
Estart the treatment with an antibiotic chosen according to recommendations

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Question 54

A 4-month-old infant was admitted to the hospital and diagnosed with bronchiolitis. Prior to the infection the child was healthy. In the rapid test of the smear from the nasopharynx RSV (respiratory syncytial virus) antigens were detected. Indicate the proper treatment in this case:

Asymptomatic treatment
Bspecific immunoglobulins
Cmonoclonal antibodies against RSV
Dribavirin
Eantibiotic penetrating to the respiratory tract

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Question 55

The most common complication of streptococcal pharyngitis in children is:

Ascarlet fever.
Bimpetigo of the face skin
Crheumatic fever.
Dperitonsillar abscess.
Eacute otitis media.

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Question 56

A 3-year-old child suffers from significant pruritus aggravating at night. There are excoriations visible on the foot skin and in the intergluteal area. The probable diagnosis is:

Ascabies.
Bpediculosis.
Cskin allergy.
Dfood allergy to protein.
EBoston exanthem disease

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Question 57

A urine bacterial culture in a neonate should be performed using the urine collected:

1) to sterile container by the „mid-stream” method;

2) through the catheter placed in the urinary bladder;

3) with suprapubic aspiration;

4) with a sterile pouch attached to the skin of the perineum.

The correct answer is:

Aall the above
B1,2,3.
C1,2,4.
D2,3,4.
E1.4.

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Question 58

A 5-year-old girl was hospitalized a dozen times in various pediatric wards because of unspecific symptoms and yet is undiagnosed. Acute symptoms subsided while the mother was absent at the ward. The results of numerous performed test are inconclusive and contradictory. The mother is alert and asks to repeat blood tests and to perform additional imaging examinations. The described picture may suggest:

Aposttraumatic stress disorder
Bpsychosomatic disorders.
CMunchausen syndrome by proxy (factitious disorder).
Dphysical/sexual abuse of the child.
Etroublesome family situation (e.g. reaction to parents’ divorce)

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Question 59

A reaction of the balance system examined in order to assess the psychomotor development of a neonate is called:

ALust reflex..
BLandau reflex.
CLevine's sign.
DLaseque’s sign.
ELeigh’s sign.

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Question 60

Which of the following can be anticipated in a child with Marfan syndrome (mutation in the FBN1 gene encoding fibrillin-1):

1) proportional above-average height;

2) abnormal joint flexibility;

3) male gender;

4) scoliosis;

5) aortic stenosis;

6) cataract.

The correct answer is:

Aall the above
B1,2,4,5,6.
C2,3,4.
D2,5,6.
E2.4.

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Question 61

In a neonate the signs of respiratory distress are observed after the birth: cyanosis, dyspnoe, tachypnoe and scaphoid abdomen. These are indicative of:

Apulmonary aplasia.
Bcyanotic heart defect.
Cumbilical hernia.
Ddiaphragmatic hernia.
Eforeign body in the respiratory tract

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Question 62

Which of the following can be found in a child with somatotropic pituitary insufficiency (growth hormone deficit):

1) low birth-weight;

2) normal bone and dental age;

3) decreased rate of growth at the preschool age;

4) signs of increased intracranial pressure caused by a tumor (e.g. craniopharyngioma).

The correct answer is:

Aall the above
B1,2,3.
C1,3,4.
D2,3.
E3.4.

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Question 63

The most common solid malignant tumor in children is:

Aleukemia
Bprimary bone tumors.
Cbrain tumors.
Dliver neoplasm.
Esoft tissue sarcomas.

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Question 64

Which of the following is the most common cause of blindness in children in Poland?

Acataract.
Bdiabetic retinopathy.
Cretinopathy of prematurity
Dtumors of the organ of sight (including haemangioma, sarcoma, retinoblastoma)
Euveitis (e.g. in the course of prenatal infection).

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Question 65

Cerebral palsy is a non-progressing disorder of motoric and postural functions caused by the defect of

ACNS during its development (during pregnancy, labor or in perinatal period).
BCNS and the peripheral nervous system during its development (during pregnancy, labor or in perinatal period).
CCNS and the peripheral nervous system during the labor.
DCNS during its development, i.e. during the pregnancy
ECNS during the labor.

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Question 66

A 12-year-old dyslectic boy complains of painful nodules on the abdomen. At least 8 spots of cafe au lait type with the diameter of about 10 mm were noted as well as freckle-like dots in the armpits. Which specialist outpatient clinic should he be immediately referred to?

Apedagogical one, to prevent other school problems.
Bdermatological one, because the skin lesions demand regular dermatoscopic assessment.
Crheumatological one, because the signs indicate erythema nodosum.
Dendocrinological one, because the signs indicate insulin resistance.
Eneurological one, because the diagnostic of neurocutaneous conditions is necessary.

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Question 67

The doses of medications in children depending on the substance and the way of administration are calculated:

1) per kilogram of body weight;

2) per square meter of body surface;

3) as in adults for children older than 6 years;

4) as in adults for children older than 10 years;

5) as in adults for children with body weight of 40 kg or more.

The correct answer is:

A1,2,4,5.
B1,2,5.
C1,2,3.
D1,2,4.
E1.3.5.

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Question 68

Indicate the set of heart rate parameters (HR) and blood pressure (RR) normal for a one-year-old child:

AHR: 105 / min, RR: 85/60 mmHg.
BHR: 105 / min, RR: 120/80 mmHg.
CHR: 90 / min, RR: 120/80 mmHg.
DHR: 65 / min, RR: 85/60 mmHg.
EHR: 65 / min, RR: 120/80 mmHg.

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Question 69

The arc of Riolan is an arterioarterial anastomosis between:

Amiddle colic artery and the left colic artery.
Bsuperior mesenteric artery and internal iliac arteries.
Cleft colic artery and the inferior mesenteric artery.
Dinferior mesenteric artery and iliac arteries.
Eiliac arteries and the right colic artery.

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Question 70

Thromboangiitis obliterans is also known as:

ATakayasu disease.
BRiley and Smith syndrome.
CBuerger syndrome.
DSturge-Weber syndrome.
EKlippl-Trénaunay syndrome.

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Question 71

The most common hypothesis on the development of varices refers their pathogenesis to:

Aweakened vein walls.
Bvenous valves dysfunction.
Cincreased hydrostatic pressure in the venous system.
Duse of anti-clotting agents.
EA,B,C are true.

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Question 72

Which of the following is not characteristic of deep vein thrombosis?

AMozes' sign
BPonten's sign
CHomans' sign
Dincreased tension of the tissues beneath the crural fascia
Epain deep in the calf and the popliteal fossa occurring after a passive flexion of the foot

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Question 73

Ménétrier's disease belongs to precancerous condition of:

Astomach.
Bduodenum.
Csmall intestine.
Dlarge intestine.
Egallbladder.

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Question 74

Indicate the minimal BMI value recommended for the qualification to surgical treatment of obesity in patients without comorbidities:

A50.
B45.
C40.
D35.
E30.

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Question 75

Early gastric cancer is defined as:

Alesion limited only to the epithelium only.
Blesion limited only to the mucous membrane without metastases in the lymph nodes.
Clesion limited only to the mucous membrane irrespective of the presence of metastases in the lymph nodes.
Dlesion limited to the mucous membrane and submucosa, regardless of the presence of metastases in the lymph nodes.
Elesion limited to the mucous membrane and submucosa without the presence of metastases in the lymph nodes.

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Question 76

Which of the following is an extraintestinal symptom of Crohn disease?

Aoptic neuritis.
Blupus erythematous.
Cpyoderma gangrenosum
Dchronic venous insufficiency.
Eall the above.

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Question 77

Point out the real statement about Meckel's diverticulum:

Ais a true diverticulum.
Bis the most common developmental defect of the gastrointestinal tract.
Cconsists of all layers of the intestinal wall.
Din its structure may contain elements of the pancreatic tissue.
Eall of them.

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Question 78

Which of the following is the most common cause of short bowel syndrome?

Anecrosis of the incarcerated intestine.
Bvolvulus.
Cradiation exposure.
Dintestinal atresia.
Emesenteric artery embolism.

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Question 79

Which of the following is the most common source of metastases to the liver?

Acolon cancer.
Bpancreatic cancer.
Cgallbladder cancer.
Dgastric cancer.
Elung cancer.

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Question 80

A 70-year-old patient comes to his family doctor complaining of the recurrent bleeding from the lower gastrointestinal tract. He usually has normal stools but occasionally mucous diarrhea occurs. The patient suspects bleeding from the hemorrhoids. Indicate the optimal diagnostics and treatment:

Arectal examination and then referring the patient to colonoscopy in order to exclude pathological lesions in the upper segments of the colon.
Brectal examination, calming the patient down because the symptoms are typical of bleeding hemorrhoids, referral to a surgeon.
Creferral to CT imaging, because it is the most precise examination to assess the colon.
Drectal swab for parasite examination, because the symptoms may suggest enterobiasis.
Ereferral to colonoscopy, as rectal examination may be omitted if the patient is to undergo endoscopic examination.

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Question 81

Indicate the true statement concerning the keloid:

Ait occurs at the place of intense healing of the wound, and it is a hard, elevated reddish scar that develops at the place of the wound healing up to 6 months since the injury and then gradually disappears over the years.
Bit develops at the place of the wound and involves also the surrounding normal skin, it lasts longer than 6 months from the trauma; it most frequently affects the wounds of the upper chest and shoulders.
Cit is a kind of tissue that appears at the place of the healing epidermis.
Dit is a tissue occurring at the bottom of the wound healing by secondary intention.
Eit is a traditional name of the inflammatory infiltration that occurs in the area of an infected wound.

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Question 82

A 35-year-old patient came to the ED complaining of a sever epigastric pain. The symptoms have lasted for over a dozen hours. Laboratory tests showed increased WBC, CRP and bilirubin concentration, decreased calcium ion concentration, increased activity of aminotransferases, amylase, lipase, LDH, GGTP and basic phosphatase. Abdominal ultrasound imaging showed a distension of intrahepatic bile ducts and blurred pancreatic outline. Indicate the correct management of this patient:

Asuspicion of acute hepatitis and diagnostics directed at a viral infection.
Bdiagnosis of the perforation of a peptic ulcer and urgent laparotomy.
Cdiagnosis of acute pancreatitis related to cholelithiasis and the preparation of the patient for ERCP.
Dsuspicion of an aortic rupture based on the blurred outline of the pancreas.
Epresented data are too scarce to formulate the diagnosis.

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Question 83

A patient was admitted to the surgical ward with thermal burns of second degree covering the anterior surface of the chest and both upper limbs. Calculate the extent of the burns according to the rule of nines and the volume of fluids that should be given within 24 hours according to Parkland formula:

Aburn surface amounts to 27% of the total body surface, the volume can’t be calculated because the body weight is not given.
Bburn surface amounts to 27% of the total body surface, the volume of fluids given within first 24 hours should be 2700 mL.
Cburn surface amounts to 36% of the total body surface, the volume can’t be calculated because the body weight is not given.
Dburn surface amounts to 36% of the total body surface, the volume of fluids given within first 24 hours should be 3600 mL.
Eburn surface amounts to 40% of the total body surface, but the Parkland formula does not refer to the infused fluid volume.

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Question 84

In a patient with a head injury after a car accident, the following are found:

- anisocoria L>R

- opening the eyes only to a strong pain stimulus

- the patient makes incomprehensible sounds

- when establishing venous access, the patient withdraws his hand

Indicate the GCS score and whether the patient requires endotracheal intubation.

AGCS 9, the intubation is necessary
BGCS 9, the intubation is not necessary.
CGCS 9, clinical data are not sufficient to determine indications for the intubation.
DGCS 8, the intubation is not necessary.
EGCS 8, the intubation is necessary.

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Question 85

McBurney's point is:

Aplace that marks the attachment of inguinal ligament to the pubic bone - the orientation point important in hernia surgery
Bplace of the greatest pain occurring in acute cholecystitis
Cplace of the connection between the small and large intestines
Dplace at 1/3 of the distance between the anterior superior iliac spine and the umbilicus, that corresponds to the most common location of the base of the appendix.
Eplace where the celiac trunk branches from the abdominal aorta

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Question 86

A Colles’ fracture is a fracture of:

Afemoral neck.
Bdistal epiphysis of the ulna.
Cfirst metacarpal bone.
Ddistal epiphysis of the radius in the typical location.
Ehumerus of the epicondylar type.

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Question 87

A 45-year-old patient, a smoker abusing alcohol, has been admitted to the ED with severe abdominal pain. On admission the patient presents pale, wet skin, and complains of unbearable abdominal pain that intensifies while he moves. On examination the abdominal guarding and absent bowel sounds are noted. The patient reports that the pain started acutely in the epigastric region and then extended to the whole abdomen. Which of the following examinations should be performed in the first place?

Aabdominal ultrasound.
Bchest X-ray and a plain frontal radiograph of the abdomen in erect posture.
Cabdominal CT.
Dgastroscopy.
Enone of the above.

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Question 88

Which of the following is an indication for the surgical treatment of the abdominal aortic aneurysm?

Adiameter of the asymptomatic aneurysm exceeding 5,5 cm.
Bdiameter of the symptomatic aneurysm exceeding 2 cm.
Cruptured aneurysm.
DA,C are true.
EA,B,C are true.

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Question 89

The second most common thyroid cancer is:

Apapillary cancer.
Banaplastic.
Cfollicular.
Dmedullary cancer.
Egiant cell tumor.

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Question 90

Carcinoid is an epithelial tumor derived from cells of the neuroendocrine system and is most commonly located in:

Agastrointestinal tract.
Bpancreas.
Cthyroid.
Dgallbladder.
Eadrenal.

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Question 91

Which of the following is not a possible consequence of a severe injury?

Ahypothermia.
Bhypovolemic shock.
Ccoagulopathy.
Dacute respiratory failure.
Ealkalosis.

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Question 92

Indicate the false statement concerning erysipelas:

Ais a superficial infection of the skin and connective tissue caused by streptococci.
Bis characterized by a lack of a distinct skin injury - the infection may enter the skin even through a minor scratch.
Cit may be complicated by the involvement of deeper tissues (a phlegmon, necrosis of the skin and subcutaneous tissue) and sepsis.
Drecurrent erysipelas of lower limbs may lead to skin hardening and permanent edema of the limb.
Ethere are no general symptoms of the infection.

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Question 93

Colorectal cancer is most commonly located in:

Acecum.
Bascending colon.
Ctransverse colon.
Ddescending colon.
Esigmoid colon and rectum.

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Question 94

Linitis plastica denotes:

Acancer extensively infiltrating the stomach wall, giving early metastases to the lymph nodes.
Bcolon cancer, which causes obstruction of the lower gastrointestinal tract.
Coesophageal cancer, in the course of which the esophagus has the form of a hard, stiff tube.
Dadvanced, unresectable pancreatic cancer.
Erare, primary liver cancer.

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Question 95

Which of the following ranks among tension-free surgical techniques used in inguinal hernia:

AHalstead procedure.
BLichtenstein procedure.
CShouldice procedure.
DBassini’s procedure.
EGirard procedure.

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Question 96

Absence of menstruation after fertilization and implantation of the embryo in the endometrium is caused by:

Aabsence of corpus luteum degeneration and the increased synthesis of progesterone and estrogens because of increasing levels of chorionic gonadotropin.
Babsence of corpus luteum degeneration and the increased synthesis of progesterone and estrogens because of decreasing levels of prolactin.
Cabsence of corpus luteum degeneration because of the placenta taking over the production of progesterone and estrogens.
Ddegeneration of the corpus luteum because of the placenta taking over the production of progesterone and estrogens.
Edegeneration of the corpus luteum because of increasing prolactin levels.

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Question 97

Indicate the estimated date of delivery calculated according to Naegele's rule for a woman with regular menstrual cycles of 32 days if the last menstruation started on 15 July 2018:

A15 April 2019.
B19 April 2019.
C21 April 2019.
D25 April 2019.
E26 April 2019.

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Question 98

An umbilical cord prolapse during the second stage of the labor in a cephalic presentation with a longitudinal lie:

Ais not dangerous.
Bis an indication for the attempt of a manual reduction of the prolapse.
Cis an indication for immediate delivery.
Dis an indication for a manual rotation of the fetus.
Eis an indication for the immediate artificial rupture of membranes.

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Question 99

The range of normal values of Amniotic Fluid Index between 5 and 25 cm may be applied to the patients:

Aduring the whole singleton pregnancy.
Bindependently of the number of fetuses.
Cin singleton pregnancy only after 20 weeks of gestation.
Din singleton pregnancy only after 24 weeks of gestation.
Ein singleton pregnancy only after 32 weeks of gestation.

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Question 100

Which of the following cannot be a consequence of intrauterine infection?

ADown syndrome.
Bhydrocephalus.
Cfetal tachycardia.
Dpreterm labor.
Eprelabor rupture of membranes.

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Question 101

The lower limit of the reference range of hemoglobin concentration below which anemia is diagnosed in a pregnant woman is:

Ahigher than in non-pregnant women because the increase in the volume ofcirculating blood in pregnancy does not keep up with the increase in erythrocyte production.
Blower than in non-pregnant women because the increase in erythrocyte production does not keep up with the increase in the volume of circulating blood.
Cthe same as in non-pregnant women.
Dirrelevant because anemia in pregnancy is diagnosed on the basis of hematocrit.
Edependent on the level of hemoglobin concentration before the pregnancy.

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Question 102

Indicate the correct description of the effect of chorionic gonadotropin on thyroid function:

Athere is no influence.
Bit lowers the TSH production which causes the decrease in thyroxine synthesis in the thyroid gland.
Cit stimulates TSH production which causes the increase in thyroxine synthesis in the thyroid gland.
Dit decreases TSH production and stimulates the thyroid gland to produce thyroxine.
Eit increases TSH production and stimulates the thyroid gland to produce thyroxine.

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Question 103

The diagnosis of endometriosis should be considered in all the following conditions, except for:

Aoligomenorrhea.
Bdyspareunia.
Cpainful menstruation.
Dovarian cyst with dense content.
Epelvic pain.

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Question 104

Which of the following is not a biological effect of progesterone?

Ainduction of endometrial secretory changes during the ovulation cycle.
Bcervical mucus change into impenetrable to sperm.
Cdecrease of the hypoglycemic effect of insulin.
Ddecrease of contractibility of the uterine muscle and fallopian tube peristalsis.
Eincrease in the concentration of coagulation factors II, VII, IX and X.

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Question 105

A 28-year-old woman, with menstrual cycle length of about 35 days, comes to the admission room with pains in the hypogastrium and vaginal bleeding lasting for 3 days. The last menstrual flow occurred 45 days before. The patient also complains of frequent urination and tenderness of the breasts. What diagnosis should be considered first?

Ahemorrhagic ovarian cyst.
Bovarian torsion.
Cextrauterine pregnancy.
Dadnexitis.
Eruptured ovarian cyst.

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Question 106

A 32-year-old patient did the sperm count test for the diagnostics of couple infertility. He avoided ejaculation for 3 days before the test. The test results show: sperm number 18 mln/mL; sperm motility slow and rapid 33% in total; sperm morphology - 5% normally shaped. What conclusion should be formulated?

Anormospermia.
Basthenozoospermia.
Ccryptozoospermia.
Doligoteratozoospermia.
Easthenoteratozoospermia.

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Question 107

A contraindication for breastfeeding is not:

AHIV infection.
Bbreast cancer.
Csevere mental disorder.
Dmother's use of semi-synthetic penicillins.
Eacute heart failure.

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Question 108

Indicate the medications that can be safely used in pregnant patients:

1) aluminum compounds in the treatment of gastroesophageal reflux;

2) non-steroidal anti-inflammatory drugs from the group of non-selective cyclooxygenase inhibitors;

3) nystatin in the treatment of infectious diseases;

4) nitrofurantoin and furazidin in the treatment of urinary tract infections;

5) angiotensin converting enzyme inhibitors in the treatment of hypertension.

The correct answer is:

A1,4.
B1,2,4.
C2,3,5.
D1,3.
Eonly 1.

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Question 109

The ultrasound risk factor for shoulder dystocia is not:

Aestimated fetal weight above 4500g.
Babdominal circumference above 350mm.
Cdifference in the circumference of the abdomen and fetal head over 40 mm.
Ddifference in the transverse abdominal and biparietal diameter over 26 mm.
Edifference in the length of the clavicular bone and the humerus over 50 mm.

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Question 110

Prohibited vaccinations during pregnancy include:

Ameasles.
Bhepatitis B.
Cinfluenza.
Dtetanus.
Eyellow fever.

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Question 111

Indicate the true statements concerning the cardiotocography (CTG) analysis:

1) short-term variability (STV) is particularly helpful in predicting the risk of metabolic acidosis in the fetus;

2) normal fetal heart rate (FHR) is 100 to 160 beats per minute;

3) lack of an acceleration in the record up to 180 minutes is regarded as normal and as a sign of deep sleep of the fetus;

4) correct long-term variability (LTV) is between 5 and 25 beats per minute;

5) sinusoidal rhythm indicates a high degree of fetal distress.

The correct answer is:

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

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Question 112

A contraindication to the safe delivery of the vaginal birth with the breech presentation of the fetus is:

Amultiparity
Bpregnacy term 36-40 weeks
Cfetal frank breech presentation
Dfetal weight from 2000 to 3700g
Efooting breech presentation

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Question 113

A contraindication to sexual activity in pregnancy is not:

Amultiple pregnancy.
Bcervical incompetence.
Cplacenta praevia.
Dinflammatory urinary tract.
Efetal breech presentation.

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Question 114

A feature common for the Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome is:

AXY karyotype.
BXX karyotype.
Clack of the uterus and vagina.
Ddefect of the androgen receptor gene.
Epresence of testicles in the abdominal cavity.

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Question 115

Which of the statements regarding stress urinary incontinence is true?

Aincrease in intra-abdominal pressure is accompanied by involuntary loss of urine.
Binvoluntary leakage of urine is accompanied by a strong but short urinary urgency.
Cvolume of leaking urine is large.
Dfrequency of micturition at night is increased.
Ein urodynamic testing detrusor hyperreflexia is observed.

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Question 116

A 65-year-old patient in good medical condition, with arterial hypertension and type 2 diabetes mellitus treated with oral therapy, comes to the gynecologist because of the moderate hemorrhage from the reproductive tract. Her body weight is 87 kg and the height is 163 cm. The result of the endometrial biopsy is: endometrial adenocarcinoma G1. Transvaginal ultrasound imaging suggests minimal invasion of the endometrium, CT imaging shows no intra-abdominal dissemination nor pathological pelvic or paraaortic lymph nodes. Indicate the optimal treatment for this patient:

Asurgery: hysteroscopic removal of the tumor.
Bsurgery: panhysterectomy.
Cradiotherapy (brachytherapy + teletherapy).
Dchemotherapy (paclitaxel + carboplatin)
Ehormonal (megestrol acetate)

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Question 117

Finding the lambda sign on ultrasound examination in a patient at 9 week of gestation allows diagnosing:

Amissed misscarriage
Bmonoamniotic twin pregnancy.
Cmonozygotic twin pregnancy.
Dsingleton pregnancy.
Edichorionic twin pregnancy.

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Question 118

Which of the following is a non-invasive prenatal test that shows the highest sensitivity in the diagnostics of chromosomal aberrations in a fetus?

Achorionic villus biopsy.
Bamniocentesis.
Ctriple test.
DPAPP-A determination.
Eexamination of cell-free fetal DNA in maternal blood.

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Question 119

What percentage of the patients with diagnosed ovarian cancer are BRCA1/BRCA2 germinal mutation carriers?

A1%.
B5%.
C10%.
D30%.
E50%.

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Question 120

Chemotherapy as a separate therapeutic strategy (not as a part of a combination therapy) is the most effective in the treatment of:

Aserous ovarian tumor.
Bmucinous ovarian tumor.
Cendometrial cancer of the uterus.
Dchoriocarcinoma.
Ecervical squamous cell carcinoma.

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Question 121

The left uterine artery is a direct branch of:

Aaorta.
Bleft common iliac artery.
Cleft external iliac artery.
Dleft internal iliac artery.
Eleft ovarian artery.

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Question 122

Which of the following Helicobacter pylori eradication protocols is preferred in Poland?

Atriple therapy: PPI + amoxicillin + clarithromycin.
Btriple therapy: PPI+ amoxicillin + metronidazole.
Ctriple therapy: PPI + amoxicillin + levofloxacin.
Dquadruple therapy: PPI + bismuth + metronidazole + tetracycline.
Equadruple therapy: PPI + amoxicillin + clarithromycin + metronidazole.

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Question 123

The second-line medication in the outpatient treatment for community-acquired pneumonia is:

Aamoxicillin
Bmacrolide
Ccefuroxime
Dfluoroquinolone
Ebenzylpenicillin

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Question 124

Blood pressure is regarded as normal if the average value of measurements performed for several days as home blood pressure monitoring (HBPM) is under:

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

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Question 125

Heralding symptoms of measles do not include:

Ahigh fever.
Bgeneralized lymphadenopathy.
Cdry cough.
Dmarked rhinitis.
Econjunctivitis.

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Question 126

Alanine (ALT) and aspartate (AST) aminotransferase levels 15- fold above the reference range suggest:

Achronic viral hepatitis.
Bacute viral hepatitis
CNAFLD.
Dalcoholic hepatitis
Ecirrhosis.

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Question 127

Prolonged QRS duration occurs in:

Apre-excitation syndrome.
Bventricular rhythms.
Cleft bundle branch block.
DA, B are true
EA, B, C are true

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Question 128

Which of the following probiotics are used for the prevention of diarrhea related to antibiotic therapy?

ALactobacillus rhamnosus GG
BSaccharomyces boulardii.
CBifidobacterium infantis
DA,B are true
EA,B,C are true.

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Question 129

Endocrine hypertension occurs in the course of:

ACushing syndrome.
Bprimary hyperaldosteronism.
Chyperparathyroidism.
Dpheochromocytoma.
Eall the above

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Question 130

"Recurrent abdominal pain occuring for at least 3 days a month for the last 3 months, subsiding after defecation, and preceded by a change in defecation pattern" is a symptom description of:

Aceliac disease.
Blactose intolerance.
Ccolonic diverticulitis.
Dirritable bowel syndrome.
Ehemorrhoids.

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Question 131

Which of the following is not a risk factor for pancreatic cancer?

Asmoking.
Bobesity.
Cchronic pancreatitis.
Ddiabetes mellitus
Eblood group 0.

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Question 132

"Illness is the most common in the autumn and winter, in children aged 1-3 years. It is caused by viruses, the characteristic symptom is "barking" cough and stridor, the symptoms may be recurrent." This is a description of:

Apharyngitis.
Bepiglottitis.
Ccroup
Dbronchitis.
Epneumonia.

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Question 133

Epiglottitis,that is usually caused by Haemophilus influenzae, typically affects children aged:

A8.-10. years
B6.-8. years
C4.-6. years
D6 months - 5 years.
E1.-3. months.

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Question 134

The causes of the infantile colic include:

Aincreased intestinal gas formation
Blactose intolerance.
Cimmaturity of the central nervous system.
Dbad diet of breastfeeding mother.
Eall the above.

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Question 135

Which of the following is a reddish skin in neonate as a macule, usually on the eyelids, forehead, occiput and nuchal region and disappears around the age of 1 year?

AMongolian spot
Bhemangioma
Cport-wine stain
Dmilium.
Esalmon patch

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Question 136

Indicate the correct set of signs of diabetic fetopathy:

Amacrosomia, increased amount of subcutaneous adipose tissue, vivid red skin, abounded hair of the head
Bmicrosomia, decreased amount of subcutaneous adipose tissue, vivid red skin, abounded hair of the head.
Cmacrosomia, normal amount of subcutaneous adipose tissue, pale skin, abounded hair of the head.
Dmicrosomia, increased amount of subcutaneous adipose tissue, vivid red skin, diminished hair of the head
Emacrosomia, increased amount of subcutaneous adipose tissue, pale skin, diminished hair of the head.

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Question 137

Pulmonary hemorrhage, which is an indication for hospitalization, can be diagnosed if a patient coughs up in a short time more than:

A10 ml of blood
B20 ml of blood
C50 ml of blood
D75 ml of blood
E100 ml of blood

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Question 138

A young obese patient comes by her family doctor. She has thinned hair and seborrheic lesions visible on her face. She complains of the disordered menstruation. Indicate a probable diagnosis:

AKlinefelter syndrome.
Bpolycystic ovary syndrome.
Chyperthyroidism.
Dhypoparathyroidism.
Etertiary hyperparathyroidism.

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Question 139

"Pulmonary interstitium, as well as alveoli are infiltrated by neutrophils, monocytes and lymphocytes. Proliferation occurs locally. Inflammatory lesions disappear and are replaced by collagen, intracellular matrix fibrosis. The sign of this on CT is described as a honeycombing"". This is a description of:

Aprimary pulmonary tuberculosis.
Bidiopathic pulmonary fibrosis.
Ccaseous pneumonia.
Dsarcoidosis.
Eatypical pneumonia.

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Question 140

Some physiotherapeutic methods should be applied with caution in patients with an implanted pacemaker. Which of the following is prohibited?

Aspinal massage.
Biontophoresis.
Csynergistic training
Ddiadynamic therapy.
Eheliotherapy.

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Question 141

Fatigue, nycturia, distension in the right subcostal region, ascites, jugular vein distention are the signs of:

Acardiac arrhythmia.
Bchronic left-sided heart failure
Cchronic right-sided heart failure.
Dchronic kidney disease
Echronic pancreatitis.

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Question 142

The sign that is characteristic of delirium tremens and is positive when a slight pressure on the patient’s eyeballs triggers visual hallucinations is called:

ABell’s phenomenon.
BReichardt’s sign.
CAschaffenburg’s sign.
DLiepmann’s sign.
ECullen’s sign.

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Question 143

Indicate the false statement:

Apatient making confabulations is susceptible to suggestions.
Bemotional satiation in a patient expressing confabulations is athymic, parathymic or catathymic.
Ccontent of confabulations is constant and not evolving.
Demotional satiation in a patient speaking memory hallucinations is synthymic.
Econfabulations and memory hallucinations are types of pseudomnesia.

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Question 144

A 67-year-old woman lives alone in a small apartment. She has been conflicted with her neighbors for 2 years. She threatens them and keeps tapping the pipes and the ceiling. She believes the neighbors let a poisonous gas into her flat. She frequently calls the police asking for an intervention. She complains of the neighbors, ineffectiveness of the police and building authority. She was never treated psychiatrically before. Which of the following is the most probable diagnosis?

Aschizophrenia.
Bschizotypal disorders.
Cpersistent delusional disorders.
Dacute transient psychiatric disorders.
Eschizoaffective disorder.

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Question 145

Nyctophobia is the fear of:

Adarkness.
Bmice, rats.
Csnakes.
Ddirt.
Echange.

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Question 146

According to the diagnostic criteria of bipolar disorder the diagnosis can be made when there are at least 2 episodes of normal mood disruption, including at least 1 episode of hypomania lasting at least for:

A4 days
B7 days
C14 days
D28 days
E2 months

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Question 147

A desirous transformation of experiences, actions, and expectations upon the influence of emotional attitude that does not reflect reality is called:

Asynthymia.
Bcatathymia.
Chypothymia.
Dathymia.
Ehyperthymia.

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Question 148

Mantism is:

Atotal block of the train of thought that has been already slowed down.
Bno verbal response from the patient despite direct commands and encouraging.
Cburdensome feeling of the excess of spontaneously occurring trains of thought or topics, usually disturbing and expressed in the form of limited fluency, clarity and content of speech.
Dpersistent repetition of a single action.
Erepetition of words or consonants that do not form a meaningful entity, but are connected only by a similarity of sounds

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Question 149

A 58-year-old male patient was brought to the psychiatric hospital. The police was called by patient’s wife because he was aggressive to her and to their neighbor. The patient is very jealous of his wife. He traces her, does not allow her to meet friends, and controls her. He threatened the neighbor and even his brother convinced that they were his wife’s lovers. The patient has been addicted to alcohol for 25 years. The most probable diagnosis is the syndrome of:

AFregoli.
BCapgras.
CCotard.
DOthello.
EGanser.

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Question 150

Selective serotonin reuptake inhibitors (SSRI) do not include:

Asertraline.
Bfluoxetine.
Cfluvoxamine.
Dvortioxetine.
Eparoxetine.

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Question 151

Indicate the false statement concerning hypnagogia:

Afrequently refers to the situations encountered on the passing day.
Bmay transform into dream.
Coccurs during the onset of the sleep.
Dis physiological.
Eis characterized by visual hallucinations only

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Question 152

Observation for suspected mental condition of a patient staying in the psychiatric hospital according to the article 24 of the Act on the protection of mental health may last:

A10 days at most.
B10 days at least.
C14 days at most. .
D14 days at least.
Etill the cessation of statutory premises and the article 24 does not specify time limits for such an observation

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Question 153

The group of dyssomnias does not include:

Anarcolepsy.
Brestless legs syndrome.
Chypersomnia.
Dsomnambulism.
Eprimary insomnia.

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Question 154

Indicate the diagnostic criteria of anorexia nervosa:

Aloss of weight or (in children) no weight gain leading to the body weight at least 5% below normal weight or expected weight according to the age and the height, accompanied by symptoms of depression
Bloss of weight or (in children) no weight gain leading to the body weight at least 10% below normal weight or expected weight according to the age and the height, accompanied by symptoms of depression.
Closs of weight or (in children) no weight gain leading to the body weight at least 10% below normal weight or expected weight according to the age and the height; accompanying symptoms of depression are not necessary.
Dloss of weight or (in children) no weight gain leading to the body weight at least 15% below normal weight or expected weight according to the age and the height, accompanied by symptoms of depression. .
Eloss of weight or (in children) no weight gain leading to the body weight at least 15% below normal weight or expected weight according to the age and the height; accompanying symptoms of depression are not necessary

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Question 155

Which of the following medications is used in the therapy of Alzheimer’s disease?

Asertraline.
Bsulpiride.
Cdonepezil.
Dpiracetam.
Elorazepam.

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Question 156

Which of the following should be suspected if ECG shows the elongation of the PR interval >0.2 s, flat P waves, tall peaked T waves and QRS complexes widened above 0.12 s?

Ahypocalcemia.
Bhypercalcemia
Chypokalemia.
Dhyperkalemia.
Ehypernatremia

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Question 157

Assessment of the patient according to the ABCDE scheme is aimed at:

Arevealing possible injuries.
Bexcluding direct threat to life.
Cobtaining precise diagnosis.
DA,B are true.
EA,B,C are true

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Question 158

Which of the following should primarily be checked if there are no normal movements of the chest during the ventilation performed with the use of a bag valve mask?

Awhether the airways are patent.
Bwhether the oxygen supply is correct.
Cwhether the system is airtight.
Dwhether the pop-up valve is closed.
EA and C are true.

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Question 159

A 55-year-old male came by ER department because of intense, tearing pain that radiated to the back. The patient is a chain smoker and he irregularly takes hypotensive medications. The ECG showed no ST elevation. Which disorder should primarily be considered in the diagnostics?

Apeptic ulcer
Baortic dissection.
Cpericarditis.
Dpneumothorax.
Epulmonary embolism.

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Question 160

Dyspnea, tachycardia and cough suddenly appeared in the patient while the central venous catheter was being inserted to the subclavian artery. Which of the following is a probable cause of these symptoms?

Apneumothorax on the side of the insertion.
Birritation of the diaphragmatic nerve.
Cirritation of the recurrent laryngeal nerve.
Ddamage to the brachial plexus.
Epuncture of subclavian artery and a hematoma.

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Question 161

A terrified patient came to the ER department after a chemical burn to his right eye with a clogged drain opener. Which of the following is a recommend procedure in the case of such a burning of the eye?

Aprompt enucleation.
Bexamination of the eye and then conjunctiva rinsing
Crinsing of the conjunctiva before eye examination.
Dtransplantation of the corneal limbus in the urgent mode.
Enone of the above.

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Question 162

In the case of massive blood transfusion each unit of packed red blood cells should be accompanied by:

A1 unit of fresh frozen plasma in the volume of 10-15 mL/kg
B2 units of fresh frozen plasma in a volume of 10-15 ml / kg.
C3 units of fresh frozen plasma in a volume of 10-15 ml / kg.
D4 units of fresh frozen plasma in a volume of 10-15 ml / kg.
E5 units of fresh frozen plasma in a volume of 10-15 ml / kg.

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Question 163

After falling off the bed a 18-month-old child was transported to the ER with head trauma. On physical examination the child actively flexes and extends their limbs, babbles and presents normal range of eye movement. How many points should the child be given according to the Pediatric Glasgow Coma Scale?

A15
B14
C13
D12
E11

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Question 164

The recommended management of the patient with regular narrow QRS complex tachycardia does not involve:

Aatropine bolus 1 mg i.v.
Bvagus nerve stimulation.
Cadenosine bolus 6 mg iv
Dmassage of the carotid sinus artery.
EValsalva maneuvers.

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Question 165

Which of the following is a specific antidote in the intoxication with zolpidem?

Analoxone.
Batropine.
Csodium bicarbonate.
Dglucagon.
Eflumazenil.

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Question 166

The pain in severe acute pancreatitis should not be treated with:

Abuprenorphine.
Bbupivacaine..
Cmetamizol.
Dmorphine.
Etramadol.

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Question 167

Temporary cardiac pacing should be considered in the case of:

1) symptomatic bradycardia refractory to anticholinergic agents;

2) bradycardia in Wolff-Parkinson-White syndrome;

3) symptomatic second-degree atrioventricular block of type 2;

4) symptomatic second-degree atrioventricular block of type 1;

5) asystole with the P wave present on the ECG;

6) third-degree atrioventricular block.

The correct answer is:

Aall the above.
B1,3,4,6.
C1,3,5,6.
D1,2,3,6.
E3,4,5,6.

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Question 168

Intoxication with which of the following xenobiotics does not manifest itself in excessive constriction of the pupil?

Atramadol.
Bmorphine.
Catropine.
Dfentanyl.
Ecodeine.

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Question 169

A woman came to the ER department because of abdominal pain, frequent (8 daily) painful defecation of bloody stool, high fever, tachycardia and anemia. The physical examination revealed abdominal bloating and tenderness. Lab tests showed elevated C-reactive protein and ESR. The probable diagnosis is:

Ahemorrhagic gastritis.
Btoxic megacolon
Cacute pancreatitis.
Dcolon cancer.
Eectopic pregnancy.

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Question 170

One of the criteria for treating adults in regional burn centers is the 2-degree burns exceeding:

A5% of total body surface area (TBSA).
B10% of TBSA.
C15% of TBSA.
D20% of TBSA.
E40% of TBSA.

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Question 171

Which of the following scales refers to the possibility to visualize particular structures (including the glottis) in direct laryngoscopy?

AYoung.
BTile.
CCormack-Lehane.
DConwell.
EKey's

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Question 172

Administration of an antibiotic is a routine and unconditionally indicated procedure in the case of the skin wound:

Ainflicted with a knife
Bpenetrating to the joint.
Cin elderly patients
Din obese patients.
Ein diabetic patients.

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Question 173

ERC 2015 guidelines allow administration of medications during the resuscitation of a neonate right after the birth. When the heart rate remains below 60/min the administration of which one below should be considered?

Aatropine.
Badrenaline.
Cadenosine.
Damiodarone.
Eanatoxin.

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Question 174

A 40-year-old male patient has been admitted to the ER department because of severe pain located in the right hypochondrium, accompanied by high fever, chills, and jaundice. The CRP is elevated. The ultrasound imaging shows dilated extrahepatic bile ducts. The primary diagnosis should be:

Aacute pancreatitis.
Bacute cholecystitis.
Chilar cholangiocarcinoma
Dacute cholangitis.
Esepsis.

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Question 175

Urgent electrical cardioversion is performed in the following conditions, except for:

Aventricular tachycardia resistant to pharmacological treatment.
Bhaemodynamically unstable ventricular tachycardia.
Chemodynamically unstable recurrent supraventricular tachycardia.
Dpulseless ventricular tachycardia
Eatrial fibrillation/flutter with low cardiac output syndrome and hemodynamic instability.

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Question 176

Are doctors in their professional dealings allowed to consult bioenergotherapist or natural medicine specialist?

Ait is only allowable in terminal conditions
Bit is acceptable as a so-called operating in a state of higher necessity
Cyes, but only upon patient’s consent.
Dprofessional self-government issues a special permission for such consultations.
Esuch conduct would go against medical ethics’ principles which forbid cooperation with people treating patients with untested healing methods.

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Question 177

Are doctors allowed to carry out medical experiments on pregnant women?

Asuch an activity requires separate court consent.
Bdoctors are allowed to do it only upon patient’s consent and medical self-government consent.
Cthis problem is not legally resolved
Dlaw does not allow to undertake experiments on pregnant women.
Epregnant women are allowed to take part in such experiments. The law specifies in this case special doctor’s duties

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Question 178

Are doctors allowed to intervene in human genome?

Asuch interventions are considered by contemporary ethics unethical and are banned.
BPolish regulations concerning the principles of performing medical profession do not refer to such subjects
Csuch interventions can be only purely prophylactic.
Dsuch interventions can have only therapeutic goal.
Edoctors are allowed to make such interventions for preventive and therapeutic goals upon patient’s and relevant ethics committee consent

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Question 179

Which of the following state organs is to announce the Preventive Vaccination Program for a given year?

APolish law does not have such a document/program in the offing
Bsuch a document is announced by the Chief Sanitary Inspector in the Official Journal of the Minister of Health.
Csuch activities are the responsibility of the Chief Pharmaceutical Inspector
DOmbudsman for Patients’ Rights is obliged to announce such a program once a year.
Eannouncement of the Program is the responsibility of the Minister of Health.

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Question 180

According to the Act of 1st July 2005 on the collection, storage and transplantation of cells, tissues and organs in the case of donors under 18 years of age:

1) organ donation is not possible;

2) organ donation is possible only for siblings if there is a risk of loss of the future recipient’s life and obtaining the organ from the corpse is not possible;

3) bone marrow donation is not possible;

4) bone marrow or hematopoietic stem cells of peripheral blood donation is possible only for siblings if there is a direct risk of loss of the future recipient’s life;

5) bone marrow donation is possible for a straight-line relative.

The correct answer is:

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

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Question 181

According to the Act of 5 December 1996 on the profession of doctors and dentists, prescriptions are to be given to the patient or:

1) patient’s legal representative;

2) authorized person (indicated name and family name) by the patient;

3) other party with no specified identity authorized by the patient;

4) in the case of e-prescription in the form of a printout, authorized person (indicated name and family name) by the patient;

5) in the case of e-prescription in the form of a printout, other party with no specified identity authorized by the patient.

The correct answer is:

A1,2.
B1,2,3.
C1,2,4.
D1,2,4,5
Eall the above

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Question 182

The doctor is allowed to provide medical services to the minor who turned 16 years of age:

Awithout any consent.
Bafter obtaining patient’s consent but without their legal representative’ consent
Cafter obtaining patient’s legal representative’s consent but without patient’s consent.
Dwithout patient’s consent but after obtaining their parents’ consent.
Eafter obtaining both patient and their legal representative’s consent.

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Question 183

A close person in the light of the definition in the Act on Patients' Rights and the Ombudsman for Patients' Rights is not:

Apatient's spouse.
Bchild of the patient.
Cbrother or sister of the patient.
Dmother-in-law or father-in-law of the patient.
Efather or mother of the patient.

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Question 184

Providing patients with information about their health conditions:

Ais the doctor’s duty whether or not patients ask for it.
Bis the doctor’s duty only if the doctor wants to obtain patients’ consent for medical services.
Cis the doctor’s duty only with regard to adult patients
Dis the doctor’s duty only if patients ask for it.
Edoes not concern children, to whom no information is provided by the doctor

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Question 185

The actual carer of an adult unconscious patient is allowed to express their consent for:

Aexamination of the patient only
Bexamination of the patient and the following treatment which does not pose a threat to the patient.
Cstarting treatment even if it means an increased risk to the patient.
Dexamination of the patient and an operation on them.
Eexamination of the patient and blood transfusion

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Question 186

Which of the following institutions issues the decision on stating occupational disease or the decision on the lack of grounds for concluding occupational disease? ?

ASocial Insurance Institution (ZUS)
BMinistry of Health.
CState Sanitary Inspection.
DMinistry of Labor and Social Policy.
EState Fund for the Rehabilitation of the Disabled.

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Question 187

The basic benefit period in social insurance for farmers is 180 days. When an insured person after exhausting this period is still incapable for work but as a result of further treatment or rehabilitation has a chance to recover for work then the benefit period is extended up to the predicted date of recovery but no longer than:

A90 days.
B120 days.
C180 days.
D250 days.
E360 days.

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Question 188

In the case of irregularities in issuing statements on temporary incapacity for work, especially when such a statement was issued without direct examination of the insured person or without proper documentations which formed the basis for the stated incapacity for work, the Social Insurance Fund (ZUS) can, as a decision, withdraw the authorization for issuing the statements for the period not exceeding:

A3 months from the day when the decision took effect
B5 months from the day when the decision took effect.
C6 months from the day when the decision took effect.
D9 months from the day when the decision took effect.
E12 months from the day when the decision took effect

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Question 189

SIF (ZUS) certifying doctors control the correctness of issuing medical rulings on temporary incapacity for work. However, to this purpose, they are not allowed:

Ato examine the insured person
Bto refer the insured person to SIF(ZUS) consultant doctor for specific examinations.
Cto refer the insured person for hospital observations.
Dto demand from the doctor who issued the ruling relevant medical documentations, information and explanations concerning the insured person.
Eto order auxiliary examinations within the prescribed period.

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Question 190

The information in the medical ruling on temporary incapacity to work owing to disease, stay in the hospital or another treatment facility working on stationary or round-the-clock basis and stating the circumstances influencing the right to sickness benefit and its amount is given in the form of letter codes. B code means incapacity to work:

Aduring pregnancy.
Bwhich arose after the break of no more than 60 days and its cause is the same as before the break.
Cbecause of alcohol abuse
Dbecause of tuberculosis.
Ebecause of stroke.

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Question 191

Which of the following is not payable from social insurance to the insured person in the case of sickness and maternity?

Asickness benefit.
Brehabilitation benefit.
Ccompensatory allowance.
Dcare allowance
Enursing allowance.

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Question 192

Sickness benefits are payable to insured persons who became incapable to work due to illness during the period of sickness insurance. The incapacity to work due to illness is not treated equally as the incapacity to work resulted from:

Adecision issued by a relevant organ or an authorized entity based on the law on prevention and control of infectious and communicable human diseases.
Bdue to being in a stationary drug treatment facility for the treatment of alcohol dependence
Cstay in the hospital or other medical facilities providing stationary and round-the-clock health services in order to treat addictions to narcotic drugs or psychotropic substances.
Dundergoing different medical examinations predicted for candidates for donors of cells, tissues and organs.
Esanatorium treatment.

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Question 193

The register of deaths resulting from occupational diseases is kept by:

ARegistry Office.
BStatistics Poland (Central Statistical Office).
CNational Health Fund.
DProvincial Public Health Centers.
ESocial Insurance Fund (ZUS).

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Question 194

The following institutions participate in the public health information system, except from:

ACenter of Informations Systems in Health Care
BChief Sanitary Inspection.
CNational Health Fund
DNational Institute of Public Health
ESocial Insurance Fund (ZUS)

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Question 195

Which of the following takes care of occupational health protection according to the Act of 1997 on occupational medicine service?

Aentities performing medical activities in order to provide preventive health care to working people.
Bnurses performing individual nursing practice
Cprovincial occupational medicine centers.
Dorganizational units of medical universities operating in the field of occupational medicine
Eall the above

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Question 196

In a given national population the body mass of women aged 19-25 shows a normal distribution and amounts to an average of 55 kg. The standard deviation is 5.5 kg. How many women are there in this population that weigh less than 49.5 kg?

A5%
B10%
C15%
D16%
E32%

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Question 197

Factors which influence health according to Lalonde’s concept do not include:

Aenvironmental factors
Bgenetic factors.
Clifestyle.
Dmedical care.
Efinancial factors.

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Question 198

Morbidity rate reaches higher values if:

Athe disease has a short duration.
Bthe disease has a long duration.
Cthe disease is severe and causes more deaths.
Dthe number of the new cases of the disease is low.
Ethe ill are emigrating.

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Question 199

When calculating the incidence rate for a given disease the numerator of the fraction denotes:

Anumber of people suffering from this disease.
Bthe number of known cases of the disease.
Cthe number of new cases of this disease in a given period.
Dnumber of asymptomatic cases.
Ethe number of deaths for this disease in a given period.

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Question 200

The Helsinki Declaration of 1964 concerns:

Aprimary health care.
Bprotection of the rights of clinical trial participants.
Chealth promoting hospitals.
Dimproving quality in healthcare.
EMillennium Development Goals.

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