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LEKEXAM / 2019 autumn

Question distribution — 2019 autumn session

Share of each category in the latest available session.

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

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Question 1

Which of the following drugs is used to alleviate an acute gout attack?

Aindapamide
Bfurosemide
Callopurinol
Dspironolactone
Ecolchicine

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Question 2

Which of the following tests is used to confirm the diagnosis of acute pancreatitis?

Aserum amylase
Bserum bilirubin
Cserum alanine aminotransferase
Dserum aspartate aminotransferase
Eserum gamma-glutamyl transpeptidase

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Question 3

Which of the following tests is used to diagnose COPD:

Aspirometry
Bchest x-ray
Cchest CT with contrast
Dconcentration of C-reactive protein
Ecomplete blood count

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Question 4

An 81-year-old patient was admitted to the hospital because of dyspnoea and swelling of the legs. His blood pressure is 120/70 mm Hg, serum creatinine level is in a normal range and serum sodium is 130 mmol/L. Which is the first step of the treatment?

Aintravenous infusion of furosemide.
Bintravenous infusion of 0.9% sodium chloride.
Cintravenous infusion of 5% glucose solution.
Dintravenous infusion of 20% glucose solution.
Eintravenous infusion of 0.45% sodium chloride.

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Question 5

Charcot’s triad is a set of signs typical of:

Ableeding from a duodenal ulcer
Bchronic pancreatitis
Chepatic steatosis
Dcolon cancer
Echolangitis

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Question 6

Which type of esophageal cancer is a consequence of achalasia:

Acarcinoid
Bsquamous cell carcinoma
Clymphoma
Dadenocarcinoma
Esarcoma

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Question 7

The characteristic features of Crohn disease include: 1) presence of serum antibodies against Saccharomyces cerevisiae (ASCA); 2) toxic megacolon; 3) presence of fistulas; 4) presence of pseudopolyps; 5) perianal lesions. The correct answer is:

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

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Question 8

The SCORE Risk Chart, used in Poland for the assessment of a 10-year risk of cardiovascular death, includes the influence of:

1) triglyceride concentration;

2) HDL-cholesterol concentration;

3) glucose concentration;

4) total cholesterol concentration;

5) LDL-cholesterol concentration.

The correct answer is:

A4, 5
B1, 2, 4
C3, 4, 5
Donly 4
Eonly 5

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Question 9

The indications for the creation of transjugular intrahepatic portosystemic shunt (TIPS) in the course of liver cirrhosis do not include:
1) hepatic encephalopathy;
2) recurrent bleeding from esophageal varices or the gastric fundus;

3) recurrent ascites;
4) type 2 hepatorenal syndrome with refractory ascites;

5) type 1 hepatorenal syndrome.

A1, 2
B2, 3
C1, 5
D3, 4
Eonly 1

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Question 10

A 67-year-old patient came to the doctor complaining of an unspecific chest pain. Clinical examination found the following abnormalities: waist circumference 104 cm; BMI 29.5 kg/m . Available laboratory tests: glucose 108 mg/dL; total cholesterol 223 mg/dL; triglycerides 138 mg/dL, ALT 91 U/L. Indicate the true statement:

Aavailable data allow to diagnose metabolic syndrome
Bpatient presents absolute contraindications to statins
Cpatient can be diagnosed with impaired glucose tolerance
DBMI value allows to diagnose obesity in the patient
Ethere is an increased cardio-vascular risk related to the waist circumference

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Question 11

Which of the following is characteristic of the inflammatory low back pain occurring in the axial spondyloarthropathy?

Apain appears after 40
Bsudden onset
Cpain decreases after physical exercise
Dpain does not occur at night
Epain subsides while restin

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Question 12

The most common diverticula in the colon are:

Aacquired diverticula located in the sigmoid
Bhereditary diverticula located in the cecum
Chereditary diverticula located in the sigmoid
Dhereditary diverticula located in the transverse colon
Eacquired diverticula located in the cecum

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Question 13

The CHA DS -VASc scale is related to assessment of:

Arisk of ischemic stroke in patients with nonvalvular atrial fibrillation
Brisk of death in patients with the history of myocardial infarction
Crisk of all cardiovascular incidents in patients with atrial fibrillation
Drisk of bleeding in patients with atrial fibrillation
Eclinical probability of deep venous thrombosis

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Question 14

A 54-year-old woman treated with atorvastatin (40 mg daily) for hyperlipidemia for several years came for a control examination. She takes ramipril 10 mg because of arterial hypertension. She is not diabetic, her history is positive for TIA (transient ischemic attack). The examination shows: BMI 27.8 kg/m , RR 138/76 mmHg. Lab tests: total cholesterol 6.62 mmol/L (255 mg%), LDL-cholesterol 4.34 mmol/L (166 mg%), HDL-cholesterol 0.9 mmol/L (35 mg%), triglycerides 1.8 mmol/L (160 mg%), ALT in the normal range. Indicate the optimal management of her lipid disorders:

Aaddition of fibrates
Baddition of ezetimibe
Caddition of ion-exchange resins
Daddition of nicotinic acid
Econtinuation of the pharmacological treatment, dietary counseling, body mass reduction

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Question 15

Which of the following groups of medications should be preferred for the therapy of hypertension in a patient with co-occurring albuminuria?

Abeta-blockers
Bsartans (ARBs)
Cdiuretics
Dcalcium channel blockers
Ealpha-blockers

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Question 16

A 76-year-old smoker with arterial hypertension and type 2 diabetes came to the Emergency Department because of exercise intolerance, severe dyspnea and lower limb edema that have been aggravating for 3 weeks. The patient reports that the symptoms occurred after the episode of acute strong chest pain. The physical examination reveals bibasilar crackles and pitting peripheral edema. The most probable cause of the above disorders is:

Aintercostal neuralgia
Bpulmonary embolism
Caggravation of chronic obstructive pulmonary disease (COPD)
Daggravation of asthma
Eaggravation of heart failure, probably as a result of myocardial infarction

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Question 17

In what situation should the electric cardioversion of atrial fibrillation be performed immediately in a patient with Wolff-Parkinson-White syndrome?

Acoexisting hypokalemia
Bfibrillation with rapid ventricular rate
Cthere are documented numerous additional electrical conduction pathways
Din every case
Enone of the above-mentioned case

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Question 18

The determination of creatinine clearance with the MDRD formula requires

1) patient's weight

2) patient's gender

3) patient's age

4) serum creatinine concentration

5) urine creatinine concentration

6) urine 24 hour volume

The correct answer is:

A1, 2, 3, 4
B2, 3, 4
C2, 3, 4, 5
D1, 3, 4, 5
E3, 4, 5, 6

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Question 19

A 18-year-old patient without a medical history was self-referred to a family doctor due to progressive weakness, pitting edema of both lower limbs appearing in the evening, and hematuria. He had an episode of erysipelas about 3 weeks before. In the physical examination: high blood pressure and swelling of the ankles. Urinalysis revealed albuminuria 0.8 g/L and numerous erythrocytes. The symptoms most likely suggest:

Arecurrent erysipelas
Bnephritic syndrome in the course of acute glomerulonephritis
Crenal cell cancer
Dnephrotic syndrome in the course of amyloidosis
Enephrotic syndrome in the course of chronic glomerulonephritis

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Question 20

”Easy dosage, causing neither hypoglycemia (when used in monotherapy) nor weight gain; there are proofs of reducing the cardiovascular and death risks, as well as delaying diabetic nephropathy” - is a description of the advantages of:

Along-acting insulin analogues
Bmetformin
Cincretin mimetics
Dsulfonylureas
Esodium-glucose co-transporter 2 inhibitors, so-called gliflozins

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Question 21

Detemir is a hypoglycemic agent that that is one of:

Ashort-acting insulin analogues.
Bshort-acting insulins.
Cglucagon-like peptide 1 (GLP-1) receptor agonists.
Dlong-acting insulin analogues.
Egliflozins.

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Question 22

A 84-year-old patient was referred to a hospital emergency department by a medical emergency team because of the sudden deterioration of his general condition, hypotension, delirium and a subsequent loss of contact (unconsciousness). A resident of the nursing care unit, he was suffering from dementia and was persistently catheterized because of benign prostate hyperplasia. There was visible cloudy urine in the bag. The workup for the diagnosis of urosepsis includes bacteriological examination of the following samples:

Ablood and urine obtained directly from the catheter
Burine obtained from the bag after its replacement
Cblood and urine taken after catheter rinsing with physiological saline solution.
Durine obtained through bladder puncture.
Eblood and urine after re-catheterization

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Question 23

The clinical symptoms of chronic (end-stage) renal failure indicating the necessity to start renal replacement therapy (dialysis) do not include

Alack of appetite, nausea and possible development of malnutrition.
Bsignificant fluid retention with dyspnoea and crepitations at the bases of both lungs despite loop diuretics being used chronically in high dose.
Csystolic blood pressure > 200 mmHg despite high doses of antihypertensive drugs from 5 groups (beta-blocker, alpha-blocker, calcium channel blocker, loop diuretic and clonidine).
Dgout
Epruritis that does not respond to the use of hydroxyzine

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Question 24

In which of the following types of glomerulonephritis the deposition of immunologic complexes in the glomeruli is found?

1) membranous nephropathy;

2) IgA nephropathy;

3) focal segmental glomerulosclerosis (FSGS);

4) minimal change disease;

5) acute post-infectious glomerulonephritis.

The correct answer is:

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

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Question 25

Which of the following is not included in diagnostic criteria for adult-onset Still’s disease?

Afever >39°C lasting > 1 week
Bjoint pain lasting >2 weeks
Ctypical rash
Dleukocytosis >10,000/m³, neutrophils >80%
Epresence of mononuclear cells in the blood smear

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Question 26

Indicate clinical conditions presenting with ‘sterile pyuria’:

1) tuberculosis of the urinary tract;

2) drug-induced acute tubulointerstitial nephritis;

3) Chlamydia trachomatis infection;

4) lupus nephropathy;

5) Sjӧgren syndrome.

The correct answer is:

A1, 2, 3, 4
B1, 4, 5
C1, 2, 3, 5
D3, 4, 5
Eall of the above

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Question 27

A 27-year-old woman, nicely tanned, came to the doctor in February complaining of fatigue, nausea, lightheadedness and scotoma, especially upon standing up. She lost about 4 kg. She’s going to get married in May and she’s planning pregnancy. On clinical examination: blood pressure 105/60 mmHg, pulse about 90/minute, TSH concentration 7.85 µIU/mL (normal range 0.27-4.2). Indicate the correct management:

Abecause of the planned pregnancy, levothyroxine should be given in a dose of at least 50 µg/daily
Bbecause of the fact that free concentrations of thyroid hormones fall only at TSH concentration >10 µIU/mL the determination of TSH, fT4 and anti-thyroid peroxidase antibodies (anti-TPO) should be repeated in 3-4 months
Ccortisol concentration in the morning, electrolytes and anti-TPO antibodies should be urgently determined
Dultrasound scan of the thyroid should be performed and levothyroxine in a dose of 25-50 µg daily should be immediately introduced if a hypoechoic and heterogeneous echotexture of the thyroid resembles the image typical of chronic thyroiditis
Ebecause of the elevated TSH concentration and tachycardia the treatment with Thiamazole and a beta-blocker should be provided.

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Question 28

Indicate the true statements concerning rapidly progressive glomerulonephritis mediated by anti-glomerular basement membrane antibodies (anti-GBM):

1) the peak incidence occurs in the elderly> 60 years of age;

2) autoantibodies against the alpha-3 chain of type IV collagen are found in patients’ serum;

3) induction treatment includes pulses of glucocorticosteroids and cyclophosphamide;

4) clinical course is characterized by frequent relapses;

5) renal lesions may be accompanied by pulmonary complications in the form of alveolar hemorrhage.

The correct answer is:

A2, 3, 4
B1, 3, 4
C1, 2, 4
D2, 3, 5
E3, 4, 5

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Question 29

Indicate the false statement concerning syndrome of inappropriate antidiuretic hormone secretion - SIADH:

Adiagnosis of SIADH is not possible without the exclusion of adrenal insufficiency.
Brisk of central pontine myelinolysis increases with too a rapid correction of hyponatremia.
Curine sodium determination is diagnostically significant only if the patient does not take diuretics.
Dcorrection of hyponatremia requires the administration of a concentrated (3%) saline solution in the majority of patients.
Eserum osmolarity is lower than 280 mOsm/kg, while urine osmolarity should be above 100 mOsm/kg.

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Question 30

Typical signs of gout do not include:

Aredness of the skin above the affected joint;.
Bjoint pain lasting > 14 days;.
Cbreaking through the skin or chalky tophi;.
Dhigh serum concentration of uric acid;.
Edestruction of joints induced by uric acid crystals.

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Question 31

Autoimmune pancreatitis may present with the increased concentration of:

AIgG1
BIgG2
CIgG3
DIgG4
EIgG5

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Question 32

Extra-articular symptoms of rheumatoid arthritis include:

1) lymphadenopathy

2) rheumatoid nodules

3) pulmonary fibrosis

4) keratoconjunctivitis, scleritis and episcleritis

5) pericarditis

The correct answer is:

Aall of the above
Bonly 2
C3, 5
D1, 2, 3, 5
E2, 3, 5

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Question 33

IIn a patient with acute kidney injury features of thrombotic microangiopathy were found in the biopsy. It can occur in the course of:

1) granulomatosis with polyangiitis (GPA);

2) malignant-phase hypertension;

3) atypical hemolytic-uremic syndrome;

4) pulmonary-renal syndrome;

5) antiphospholipid syndrome.

The correct answer is:

A1, 3, 5
B2, 3, 5
C1, 2, 3, 5
D2, 4, 5
E2, 3, 4

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Question 34

Which of the following medications is not recommended in the first-line empiric therapy of uncomplicated urinary tract infections in non-pregnant women?

Acotrimoxazole
Btrimethoprim
Cciprofloxacin
Dfurazidine
Efosfomycin

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Question 35

Which of the following scales is used to evaluate a severity of symptoms in patients with atrial fibrillation?

AEHRA
BHAS-BLED
CCCS
DCHA2DS2-VASc
EEuroSCORE

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Question 36

Indicate the false statement concerning right bundle branch block (RBBB):

Awidth of QRS complex is > 120 ms.
BQRS complex displays rsR’ pattern in leads V1-V2.
CRBBB is accompanied by a splitting of the first heart sound.
Dit may accompany ischemic heart disease.
Eis an absolute indication for pacemaker implantation

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Question 37

The most common locations of a gastrinoma tumor include: 1) stomach; 2) duodenum; 3) gallbladder; 4) pancreas; 5) appendix. The correct answer is:

A1, 3
B1, 4
C2, 4
D2, 5
E4, 5

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Question 38

Which of the following is not typical of subacute thyroiditis of the deQuervain type?

Atransient decrease in TSH concentration.
Bgood response to treatment with antibiotics.
Cpresence of giant multinuclear cells in cytological smear.
Dhigh CRP concentration.
Emarked pain in the neck.

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Question 39

The diagnosis of iron deficiency anemia in an otherwise asymptomatic 75-year-old male should suggest the need to exclude:

Agastrointestinal cancer.
Blung cancer.
Cprostate cancer.
Dthyroid cancer
Ebladder cancer

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Question 40

Which of the following is not recommended for the feeding in the treatment of cow’s milk protein allergy?

1) soy protein-based formula;

2) breast-feeding by a mother on the elimination diet;

3) amino acid-based formula;

4) extensively hydrolyzed formula;

5) partially hydrolyzed formula.

The correct answer is:

A1, 5
B2, 3
C2, 4
Donly 2
Eonly 4

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Question 41

Which of the following foreign bodies should be immediately removed endoscopically from the gastrointestinal tract?

1) coins;

2) buttons;

3) batteries;

4) foreign bodies stuck in the esophagus, not passing to the stomach;

5) needles.

The correct answer is:

A1, 2
B3, 4
C1, 5
D2, 5
E2, 3

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Question 42

Indicate the true statements concerning the severe combined immunodeficiency (SCID):

1) it is a genetic disorder consisting in the absence or dysfunction of lymphocytes T that may be accompanied by the absence of lymphocytes B, NK or other cells of the hematologic system;

2) it is the most common type of primary immunodeficiency in children;

3) if left untreated it usually leads to death in the first year of life;

4) hematopoietic cell transplantation may result in permanent cure;

5) it may be radically treated by regular administration of immunoglobulins.

The correct answer is:

A1, 2, 4
B1, 3, 4
C2, 3, 4
D2, 3, 5
E3, 4, 5

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Question 43

The well-child visit schedule up to 12 months of life should include:

Asix visits: the patronage visit, the examination at the age of 6-9 weeks, 3-4 months, 6 months, 9 months and 12 months.
Bfive visits: the patronage visit, the examination at the age of 3-4 months, 6 months, 9 months and 12 months.
Cthree visits: following the schedule of mandatory vaccinations.
Dfour visits: the patronage visit and then following the schedule of mandatory vaccinations.
Ethere are no strict recommendations on the schedule of well-child examinations and the individualized decision on the schedule should be made by the general practitioner or pediatrician.

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Question 44

The alarming symptoms of GERD in children include:

1) swallowing disturbances

2) diarrhea

3) night attacks of coughing and shortness of breath

4) constipation

5) weight loss

The correct answer is:

A1, 2, 3
B2, 3, 5
C1, 3, 5
Donly 2
E1, 4, 5

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Question 45

The mother of a 2-year-old boy is concerned with her child’s diet. He doesn’t want to eat vegetables or meat and demands milk desserts or sweet drinks only. His height and weight are at the level of a 50th centile. The boy doesn’t present any signs of infection but he was treated with oral antibiotics twice in his life, for pharyngitis and bronchitis. There are no alarming symptoms. On the complete blood count: leucocytes - 8,400/mm , hemoglobin - 9.1 g/dL, MCV - 62 fL, platelets - 330 000/mm . Fasting glucose - 88 mg%. Indicate the correct decision and its justification:

Areferring the child to a psychologist, as the lab tests are normal.
Bperforming oral glucose test because the symptoms may be caused by diabetes.
Ctherapy with steroids because the symptoms and lab tests suggest hemolytic anemia.
Dtreatment with parenteral iron preparations and vitamins because the symptoms and lab tests suggest iron deficiency anemia.
Etreatment with oral iron preparations and vitamins because the symptoms and lab tests suggest iron deficiency anemia

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Question 46

Which of the following is not an indication for the histopathological examination of an enlarged lymph node in a child?

Aan ultrasound result suggesting proliferative nature of the lesion
Badenopathy of supra- and subclavicular lymph nodes.
Cadenopathy accompanied by general symptoms: weight loss, fever without infection, pruritus
Dneck lymph node enlargement lasting for a week, accompanying pharyngitis.
Epainless lymph node, growing for several weeks without symptoms of infection.

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Question 47

Parents present to a pediatrician their 7-year-old child born abroad and never vaccinated against Haemophilus influenzae type b for deciding about the completion of the vaccination. Indicate the correct decision of the doctor:

Amissing vaccination with 1 dose of vaccine must be completed immediately
Bmissing vaccination must be completed immediately with 3 doses of vaccine using a schedule 0, 1 and 6 months.
Cmissing vaccination should be completed at the age of 10 years together with the next scheduled vaccines.
Dmissing vaccination should be completed at the age of 14 years together with the next scheduled vaccines.
Ethere is no indication to vaccinate a 7-year old child against Haemophilus influenzae type b.

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Question 48

Which of the following should be performed in a male neonate in whom prolonged bleeding from the heel occurs after taking blood drop for screening tests and a hematoma develops after intramuscular administration of vitamin K?

1) examination of the clotting system in order to exclude coagulopathy, e.g. hemophilia;

2) intravenous administration of vitamin K;

3) administration of fresh frozen plasma;

4) taking family history in relation to hemophilia or other coagulopathies occurring in family members;

5) there is no need for further diagnostics.

The correct answer is:

A1, 2, 3
B1, 4
C2, 4
D3, 4
Eonly 5

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Question 49

Which of the following vaccines may be given to a woman at the 30th week of gestation?

1) against influenza (inactivated vaccine);

2) against chickenpox;

3) against tuberculosis;

4) against diphtheria, tetanus and pertussis (dTpa - an adult type of vaccine);

5) against measles, mumps and rubella.

The correct answer is:

Aonly 1
B1, 2, 3
C1, 4
D1, 4, 5
E4, 5

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Question 50

Which of the following are characteristic of Wilson disease in children?

1) excessive storage of copper in the liver accompanied by the increased serum activity of aminotransferases;

2) frequent neurological disorders, especially dysarthria;

3) frequent presence of Kayser-Fleischer ring of the cornea;

4) increased serum ceruloplasmin concentration;

5) increased urinary copper excretion.

The correct answer is:

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

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Question 51

In which of the following diseases may the postexposure prophylaxis be used?

1) mumps;

2) measles;

3) pertussis;

4) varicella;

5) Neisseria meningitis infection.

The correct answer is:

A1, 2
B1, 3, 4
C2, 3, 4
D2, 3, 4, 5
E2, 4, 5

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Question 52

A foreign body in the bronchi can cause the following, except:

Arecurrence of pneumonia in the same localization.
Bpneumonia resistant to routine treatment
Catelectasis
Dpain that increases with neck movements
Easymmetry of vesicular murmur

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Question 53

Hypercalcemia may be caused by any of the following, except for:

Aoverdosage of vitamin D
Bnecrosis of subcutaneous adipose tissue.
Cimmobilization
Dneuroblastoma
Ehypoparathyroidism.

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Question 54

A mother comes with her obese 5-year-old son to the doctor office. As an infant he had difficulty in eating, was consulted due to reduced muscle tone. During his stay in the office the child presents skin-picking behaviour. The most probable diagnosis is:

APrader-Willi syndrome
BKlinefelter syndrome.
CAlström syndrome
Dmetabolic syndrome
ECarpenter syndrome

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Question 55

The most probable diagnosis in a patient with recurrent infections, thrombocytopenic purpura (the onset in the first six months of live) and eczema (atopic dermatitis-type) is:

ANijmegen syndrome
BHyper-IgE syndrome
CBloom syndrome.
DNetherton syndrome.
EWiskott-Aldrich syndrome.

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Question 56

Which of the following infectious diseases is characterized by the incubation period between 11 to 21 days?

Awhooping cough.
Bscarlet fever
Cvaricella.
Dinfectious mononucleosis
Ediphtheria

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Question 57

Cholestasis is a set of clinical and laboratory signs typical of increased serum conjugated bilirubin concentrations. According to the definition of cholestasis, it may be diagnosed in a patient with total bilirubin concentration exceeding 5 mg/dL (85 µmol/L) if conjugated bilirubin concentration is above:

A5% of total bilirubin concentration
B10% of total bilirubin concentration
C15% of total bilirubin concentration
D20% of total bilirubin concentration
E25% of total bilirubin concentration

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Question 58

The Streptococcus pyogenes infection may cause various complications in children, mainly related to autoimmune reactions. These complications include:

1) haemolytic-uraemic syndrome (HUS);

2) rheumatic fever;

3) obsessive-compulsive disorder syndrome (PANDAS);

4) acute glomerulonephritis;

5) periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome (PFAPA). T

he correct answer is:

Aall the above
B1, 2, 3, 4
C2, 3, 4
D2, 4
Eonly 2

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Question 59

A palpable tumor visible on the neonate’s head over the left parietal bone is most probably caused by:

Alymphatic edema
Bcephalohematoma
Ccaput succedaneum
Dskull hernia.
Einfantile hemangioma

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Question 60

The most common type of juvenile idiopathic arthritis in children is:

Aoligoarticular juvenile idiopathic arthritis.
Bpolyarticular juvenile idiopathic arthritis.
Csystemic-onset juvenile idiopathic arthritis.
Dpsoriatic arthritis
Eenthesitis-related arthritis.

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Question 61

Which of the following diagnoses should be considered the most probable in a boy over 2 years of age with increased levels of transaminases and phosphocreatine kinase if the mother reports that her son is clumsy?

Alabyrinthine disorders accompanying viral infection.
Bbenign joint hypermobility syndrome.
CEpstein-Barr virus (EBV) infection
Dparasitic infection
Emuscular dystrophy

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Question 62

Which of the following is more common among teenagers than pre-school children?

Amalignant bone tumors
Bnon-Hodgkin lymphoma
Cneuroblastoma
Dretinoblastoma
EWilms tumor

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Question 63

In children fever and small itchy blisters that form crusts within 7 days are the symptoms of:

Aerythema infectiosum
Bimpetigo
CHSV infection
Dchickenpox
Emeasles

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Question 64

Skin lesions that occur in children, especially those in immunosuppression, in a form of small dome-shaped and pearly papules with a dimpled center are related to:

Aviral warts
Bscabies lesion
Ccutaneous mycosis
Dpsoriasis
Emolluscum contagiosum

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Question 65

Which of the following is recommended in a 2-year old child diagnosed with acute pyelonephritis?

Astart antibiotic therapy after receiving the result of urinary culture
Bavoid antibiotics, because it is usually viral infection.
Cstart antibacterial treatment after cystography.
Dstart antibiotic therapy as soon as possible.
Estart antibiotic therapy only when the child is diagnosed with congenital hydronephrosis.

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Question 66

What are the typical features of pseudohypoparathyroidism?

Aincreased phosphate and cAMP urinary excretion after PTH infusion.
Blow serum calcium and high serum phosphate concentrations.
Clow serum calcium and low serum phosphate concentrations.
Dlow serum PTH concentration.
Eshortened 2 and 3 metacarpal bones.

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Question 67

Which of the following cannot be related to hyperthyroidism?

Aarrhythmias
Bincreased serum glucose
Cdecreased muscle strength
Dincreased cholesterol level
Emenstrual disorders

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Question 68

A patient weighing 100 kg was admitted to the surgical ward because of the 3rd degree thermal burns of the anterior chest wall, abdomen and scrotum. Calculate the percentage of the burned body surface according to the rule of nines and the volume of fluids that should be transfused in the first 24h according to the Parkland formula:

Aburned body surface is 19% and the volume of fluids to be transfused within the first 24h is 7600 mL.
Bburned body surface is 19% and the volume of fluids to be transfused within the first 24h is 760 mL.
Cburned body surface is 10% and the volume of fluids to be transfused within the first 24h is 4000 mL.
Dburned body surface is 10% and the volume of fluids to be transfused within the first 24h is 400 mL.
Eburned body surface is 10% and the Parkland formula should not be used in patients with burns of the 3rd degree.

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Question 69

In the case of acute abdominal symptoms in a cachectic patient in a serious condition - large intestine perforation due to diverticulitis of the sigmoid colon - the operation of choice is:

Asigmoid resection with end-to-side anastomosis
BHartmann’s procedure of the resection of the sigmoid colon.
Cpercutaneous drainage of the abdominal cavity
Dsigmoid resection with end-to-end anastomosis.
Eabdominoperineal resection of the rectum.

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Question 70

Which of the following organs is the most common site of metastases from other organs?

Abrain
Blungs
Cliver
Dbones
Eskin

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Question 71

Kwashiorkor is a form of malnutrition caused by a lack of:

Asaturated fats
Bunsaturated fats
Ccarbohydrates
Dproteins
Ewater

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Question 72

Which of the following is not characteristic of Buerger’s disease?

Aonset of illness above 50 years of age
Bheavy smoking
Coccurrence of changes in all extremities
Dpresence of typical changes in angiographic examination
Emigrating thrombophlebitis

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Question 73

The type IV of Takayasu disease is characterized by inflammatory lesions located in:

Aarch of the aorta and its branches.
Bwhole aorta and its branches.
Cdescending aorta and its branches.
Dabdominal aorta and its branches.
Epulmonary artery.

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Question 74

A 57-year-old man was admitted to the hospital with symptoms of acute pancreatitis. He has never been diagnosed with cholecystolithiasis, but he did abuse alcohol the nigh before. On admission Hct 46%, WBC 16,300/mm , glucose 189 mg/dL, LDH 279 U/L, AST 193 U/L, serum Ca2+ 1.95 mtmo/L, urea 1.50 mmol/L, PaO2 67 mmHg. On the third day at the hospital: Hct 40%, WBC 13,500/mm , glucose 163 mg/dL, LDH 183 U/L, AST 170 U/L, serum Ca2+ 1.85 mmol/L, urea 1.73 mmol/L, PaO2 57 mmHg. According to the Ranson criteria in this patient:

Asevere pancreatitis is unlikely on admission and on the third day of hospitalization.
Bsevere pancreatitis is unlikely on admission but it is probable on the third day of hospitalization.
Csevere pancreatitis is probable on admission and on the third day of hospitalization.
Dsevere pancreatitis is probable on admission but it is unlikely on the third day of hospitalization.
Eprovided data are not sufficient to assess the risk of severe pancreatitis.

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Question 75

Indicate the true statement concerning gastric cancer:

Afemales are affected twice as often as males.
Bintestinal metaplasia does not increase the risk of the disease.
Cearly gastric cancer does not spread to lymph nodes according to its definition.
Dtreatment is mostly confined to chemo- and radiotherapy.
EHelicobacter pylori infection 5-fold increases the risk of the disease.

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Question 76

Which of the following is not the name for inguinal hernia repair operation technique?

ABassini
BHalsted
CLittre
DRutkow
EShouldice

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Question 77

A 25-year-old woman found a lump of 2 cm x 1 cm in size in the upper lateral quadrant while self-examining her right breast. The biopsy result was ductal carcinoma. Considering the lymphatic drainage through the Roth path, the lymph node metastases may be expected in:

Afirst level of axillary lymph nodes.
Bsecond level of axillary lymph nodes.
Cthird level of axillary lymph nodes.
Dfirst and second level of axillary lymph nodes.
Esecond and third level of axillary lymph nodes.

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Question 78

A female patient was urgently operated due hemorrhage of parenchymal disruption in the liver and the Pringle maneuver was performed during this procedure. It involves compressing:

1) splenic artery

2) proper hepatic artery

3) right gastric artery

4) splenic vein

5) proper hepatic vein

6) portal vein

7)common bile duct

The correct answer is:

A1, 2, 3
B1, 4
C2, 5, 6, 7
D2, 5, 7
E2, 6, 7

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Question 79

Indicate the false statement concerning diverticulosis of the gastrointestinal tract:

AMeckel’s diverticulum is the remnant of the fetal umbilical gastrointestinal duct and may contain ectopic foci of gastric or pancreatic tissue.
Bacquired diverticula are created by bulging the mucus membrane through the muscular layer of the intestine.
CMeckel’s diverticulum is a congenital and true diverticulum of the ileum located on the mesenteric edge of the intestine and its length can measure up to 15 cm.
Dcolon diverticula appear usually in the 4th decade of life, they are often localized in the sigmoid colon and do not occur in the rectum.
Ecomplications of diverticular disease include inflammation, abscess, perforation, bleeding and mechanical obstruction.

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Question 80

Which of the following signs is not typical of acute appendicitis?

ADunphy’s sign.
BBlumberg sign
Cpsoas sign.
Dlack of appetite.
ECullen’s sign

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Question 81

Indicate the false statement concerning acute cholecystitis:

Ait’s usually related to cholelithiasis.
Bexamination of choice is computed tomography.
Cdifferential diagnostics should include right-side pneumonia and pleurisy among others.
Dits complications include an empyema of the gallbladder and emphysematous cholecystitis.
Eacute acalculous cholecystitis may be caused by several infectious agents including Cytomegalovirus, Pneumocystis jiroveci and Isospora belli.

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Question 82

Secondary peritonitis does not include:

Aperitonitis related to chronic peritoneal dialysis.
Bnecrosis of the intestinal wall.
Cperitonitis related to the leakage of an intestinal anastomosis.
Dgranulomatous peritonitis.
Efungal peritonitis.

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Question 83

The absolute indications for the surgical treatment of acute pancreatitis do not include:

Alack of improvement after conservative treatment.
Binfected pancreatic necrosis.
Cbleeding to the abdominal cavity.
Dgastrointestinal perforation.
Eabdominal compartment syndrome.

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Question 84

Which of the following is the most common cause of upper gastrointestinal bleeding?

Ahemorrhagic gastritis.
Besophagitis.
Cpeptic ulcer.
Dgastric cancer.
EMallory-Weiss syndrome.

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Question 85

The abdominal compartment syndrome does not lead to the decrease in:

Aintracranial pressure.
Bblood flow into the liver and its ischemia.
Cvenous return to the heart.
Dblood flow through the intestinal wall.
Etidal volume.

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Question 86

Identify the true statement about colorectal cancer:

Aits diagnosis is based on endoscopic biopsy followed by histopathological examination.
Bit rarely spreads to the liver and is the most common cause of a bowel obstruction
Cit usually develops from polyp lesions.
DA and C are true
EA,B,C are true.

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Question 87

The antithrombotic prophylaxis does not involve:

Ause of low molecular weight heparin.
Bearly mobilization of the patient.
Cuse of compression stockings.
Dadministration of acetylsalicylic acid.
Elimitation of fluid supply.

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Question 88

Percutaneous endoscopic gastrostomy (PEG) is not performed in:

Aa pyloric tumor obstructing the lumen of the gastrointestinal tract
Ban esophageal tumor obstructing the lumen of the digestive tract
Ca tumor at the cardia obstructing the gastrointestinal tract lumen
Da laryngeal tumor obstructing the lumen of the gastrointestinal tract cancer
EPEG can be performed in each of these situations

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Question 89

Indicate the false statement regarding the Whipple triad:

Aneurological disturbances due to fasting
Bthe patient is usually lean
Chypoglycemia below 2.22 mmol/l (40 mg/dl) occurs
Dsymptoms subside after intravenous glucose administration.
Eit is related to a pancreatic neuroendocrine tumor.

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Question 90

Which of the following is the rarest reason for mechanical gastrointestinal obstruction:

Aa strangulated hernia
Bpresence of adhesions
Ca malignant tumor
Da gallstone
Eperitonitis

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Question 91

Classic signs and symptoms of acute cholangitis that form the Charcot’s triad include:

AChelmonski’s sign, Bloomberg’s sign, jaundice.
Bepigastric pain, nausea and vomiting without relief, fever
Cpain in the upper right quadrant of the abdomen, jaundice and fever with chills
Dright upper quadrant abdominal pain, signs of shock, jaundice.
Eepigastric pain, nausea and vomiting without relief, jaundice

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Question 92

Mallory-Weiss syndrome means:

Aspastic esophageal spasm.
Bhepatic vein thrombosis
Cirritable bowel syndrome
Dhaemorrhage from the ruptured mucosa in the area of the cardia.
Ethrombocythemia after splenectomy

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Question 93

Complete or partial removal of the spleen (splenectomy) is recommended for:
1) splenic artery aneurysm
2) traumatic isolated splenic rupture in a 25-year-old patient who required 2 transfusion units of red blood cell concentrate
3) spontaneous splenic rupture as a complication of hematological disease
4) Gaucher disease
5) Felty's syndrome
The correct answer is:

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

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Question 94

The type I according to Bormann’s morphological classification of advanced gastric cancer denotes:

Aa polypoid ulcerated tumor
Ban ulcerated tumor with raised margins
Ca tumor with ulceration, whose margins are hardly visible
Ddiffuse cancer (linitis plastica)
EBormann classification concerns early gastric cancer

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Question 95

A single-handed maneuver performed during palpation of the pregnant woman’s abdomen that allows to determine the leading part of the fetus and its location in relation to the inlet is called:

Afirst Leopold’s maneuver.
Bsecond Leopold’s maneuver.
Cthird Leopold’s maneuver.
Dforth Leopold’s maneuver.
Enone of the above.

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Question 96

Bacterial vaginosis :

1) is asymptomatic in most women, and in symptomatic cases manifests with a grey or white vaginal discharge;

2) is related to dysuria and dyspareunia;

3) is diagnosed on the basis of reported-by-the-patient fishy smell that aggravates after the intercourse;

4) is related to the increase in the number of Lactobacilli;

5) is characterized by the presence of clue cells in the smear. The correct answer is:

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

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Question 97

Which of the following surgical approaches is characterized by invisible scare, better healing in obese women but the limited field of view?

Aabdominal approach - the incision in the midline.
Babdominal approach - the incision in the paramedian line.
Cabdominal approach - the Pfannenstiel incision.
Dvaginal approach.
Elaparoscopic approach.

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Question 98

An absolute contraindication to laparoscopic surgery in gynecology is not:

Apatient’s lack of consent.
Bcondition after extensive oncological surgery of the stomach and intestines.
Cdiffuse peritonitis.
Dobesity.
Epulmonary hypertension.

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Question 99

Choriocarcinoma is one of the rarest but most aggressive malignant tumors in women. Its diagnosis is based on:

Amagnetic resonance imaging of the abdominal cavity and pelvis
Bhistopathological result from biopsy or curettage of the uterine cavity.
Chistopathological result obtained during hysterectomy.
Dhigh levels of hCG in blood serum.
Epregnancy induced hypertension before the 20th week of pregnancy.

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Question 100

The factors that increase the risk of endometrial cancer include:

1) smoking cigarettes;

2) metabolic syndrome (obesity, diabetes);

3) multiparity;

4) polycystic ovary syndrome;

5) long-term estrogen therapy not balanced with progesterone administration.

The correct answer is:

A1, 3, 5
B3, 4, 5
C2, 3, 4
D2, 4
E2, 4, 5

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Question 101

The absolute contraindications to the use of two-component hormonal contraceptives include:

1) smoking tobacco at the age over 35 years;

2) pregnancy or not excluded possibility of pregnancy;

3) migraine headaches;

4) mitral valve prolapse;

5) estrogen-dependent neoplasms.

The correct answer is:

A1, 2, 3, 4
B3, 4, 5
C1, 2, 3
D1, 2, 5
Eall the above

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Question 102

Fetal bradycardia is defined as a decrease of the basic fetal heart rate:

Abelow 100 beats/min. lasting at least 15 minutes.
Bbelow 110 beats/min. lasting at least 10 minutes.
Cbelow 110 beats/min. lasting at least 15 minutes.
Dbelow 120 beats/min. lasting at least 10 minutes.
Ebelow 120 beats/min. lasting at least 15 minutes.

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Question 103

The diagnosis of endometriosis should be considered in a patient with the following symptoms:

1) periodic pain, beginning just before the menstrual period lasting throughout the whole time of menstruation;

2) the temperature during the menstrual period > 39°C;

3) dyspareunia (pain related to sexual intercourse);

4) pain during defecation or micturition;

5) a stinking discharge from the vagina, occurring cyclically after menstruation.

The correct answer is:

A2, 3, 4
B1, 3, 4
C1, 3, 4, 5
D2, 5
Eall the above

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Question 104

Indicate the clinical features of germinal neoplasms of the ovary:

1) occur mainly in young women;

2) occur mainly in post-menopausal women;

3) may be diagnosed on the basis of increased blood levels of CA-125, CEA, CA 15-3;

4) may be diagnosed on the basis of increased blood levels of LDH, AFP, hCG;

5) respond well to chemotherapy;

6) are treated only surgically;

7) are always malignant tumours.

The correct answer is:

A1, 4, 7
B3, 4, 6
C2, 4, 6, 7
D1, 4, 5
E2, 3, 7

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Question 105

Which of the following medications is certified for the treatment of stress urinary incontinence?

Aparoxetine
Bduloxetine
Cvenlafaxine
Ddapoxetine
Efluoxetine

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Question 106

The phase of voiding the urinary bladder, initiated by the brain cortex is characterized by the relaxation of sphincter muscles surrounding the urethra and the increased tone of the detrusor muscle. These phenomena are caused by:

Ainhibition of the sympathetic activity and the increased pulsation in theparasympathetic system.
Binhibition of the parasympathetic activity and the increased pulsation in the sympathetic system.
Cincreased pulsation in the somatic system innervating muscles of the pelvic floor.
Dinhibition of the sympathetic activity only
Einhibition of the parasympathetic activity only

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Question 107

A 42-year-old patient came to the gynecologist to get anticonception advice. She smokes 5 cigarettes daily and is treated for arterial hypertension. Periodic bleeding are abundant and last up to 7 days. Which of the following methods should be advised?

Aprogestogen-only "mini pill".
Bsubcutaneous implant releasing etonogestrel.
Cintrauterine device with copper, Cu-IUD
Dintrauterine device releasing levonorgestrel.
Esterilization

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Question 108

A 35-year-old patient came to the gynecological outpatient clinic because of vaginal bleeding occurring between periods for about a year. The bleeding with dark brown blood occurs on 11 -12 day of the cycle and lasts 2-3 days. The periods occur every 30 days. The patient underwent a caesarian section two years earlier. Which of the following is the most probable cause of the bleedings?

Aundiagnosed disorder of the clotting system.
Bcorpus luteum insufficiency.
Cpelvic inflammatory disease.
Dperiovulatory LH surge.
Escar defect of the myometrium after the cesarean section.

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Question 109

The following factor does not predispose to fetal breech presentation:

Aoligohydramnios.
Bpolyhydramnios.
Clocalization of the placenta on the posterior wall of the uterus.
Dhydrocephalus.
Eplacenta praevia.

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Question 110

The multiple pregnancy is related to the increased risk of numerous obstetrical complications compared with the singleton pregnancy. Which of the following complications are not observed in multiple pregnancies more often than in singleton pregnancies?

1) shoulder dystocia;

2) gestational hypertension;

3) necessity for the cesarean section;

4) postterm pregnancy;

5) perinatal death;

6) placenta praevia;

7) congenital defects.

The correct answer is:

A1, 4
B2, 6
C2, 7
D3, 5
E4, 6

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Question 111

A patient with twin monochorionic pregnancy has been informed about the risk of twinto-twin transfusion syndrome (TTTS). The syndrome is characterized by an unbalanced blood flow between the twins through active interconnecting blood vessels. One of the complications of TTTS that occurs in the recipient is:

Afetal hypertrophy.
Bgrowth retardation.
Canemia.
Doligohydramnios.
Ehypovolemia.

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Question 112

Marsupialization is a surgical method of:

Aprimary treatment of stress urinary incontinence.
Btreatment of recurrent stress urinary incontinence.
Ctreatment of a recurrent Bartholin gland abscess.
Dtreatment of impaired statics of the reproductive organ.
Ecreation of the vagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

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Question 113

A 58-year-old patient complains of vaginal dryness and postcoital bleedings. The gynecological examination reveals atrophic lesions in the vagina and normal uterus and uterine appendages. The cytological smear of the cervix is normal. The local vaginal estrogen therapy has been recommended and thus the patient should:

Areceive simultaneous gestagen therapy in order to prevent the overgrowth of endometrium and the development of endometrial cancer.
Breceive simultaneous gestagen therapy in order to prevent the development of breast cancer.
Creceive simultaneous gestagen therapy in order to prevent the development of cervical cancer.
Dreceive simultaneous gestagen therapy in order to decrease the risk of a stroke.
Ethere is no indication for gestagen therapy in this patient.

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Question 114

Premature thelarche in contrast to precocious puberty is characterized by the isolated:

Adevelopment of axillary hair.
Bdevelopment of pubic hair.
Cbreast development.
Doccurrence of ovulation.
Eoccurrence of voice change.

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Question 115

The treatment of arterial hypertension in pregnant women includes the use of:

Aangiotensin-converting-enzyme inhibitors, methyldopa, labetalol.
Bangiotensin-converting-enzyme inhibitors, methyldopa, angiotensin II receptor antagonists.
Clabetalol, nifedipine, methyldopa.
Ddiuretics, angiotensin II receptor antagonists, labetalol.
Elabetalol, methyldopa, amiodarone.

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Question 116

A 32-year-old childless patient has a history of 4 miscarriages in the first trimester. The evaluation of the possible causes of miscarriages in this patient should include:

1) diagnostics of Toxoplasma gondii infection;

2) diagnostics of Human Papilloma Virus infection;

3) determination of anti-cardiolipin antibodies;

4) diagnostics of Cytomegalovirus infection;

5) determination of lupus anticoagulant.

The correct answer is:

A1, 2
B2, 3
C3, 5
D2, 4, 5
E1, 4, 5

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Question 117

Which of the following should be done in the case of a patient without risk factors for diabetes if her fasting glucose level is 110 mg/dL in the 9 week of gestation?

Aoral glucose tolerance test with 75g of glucose between 24 and 28 week of gestation.
Brepeated fasting glucose examination.
Crecommend diabetes diet.
Dassessment of the 24-hour blood glucose profile.
Eoral glucose tolerance test with 75g of glucose immediately.

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Question 118

Teratozoospermia according to WHO criteria of 2010 denotes:

Apercentage of sperm with normal morphology below 4%.
Bpercentage of sperm showing normal mobility below 4%.
Cno sperm in the ejaculate.
Dover 250 million sperm in 1 mL of the ejaculate.
Epercentage of sperm with normal morphology below 40%.

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Question 119

Oral hormonal anticonception is a well-documented protective factor against:

1) ovarian cancer;

2) liver cancer;

3) endometrial cancer;

4) cervical cancer;

5) renal cancer.

The correct answer is:

A2, 3, 4
B1, 5
C1, 3, 4
D1, 3
E2, 4, 5

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Question 120

Which of the following changes in blood morphology occurs in the second trimester of normal pregnancy?

Aincrease in hematocrit levels
Bdecrease hemoglobin concentration
Cincrease in hemoglobin concentration
Dincreased platelet count
Eincreased leucocyte count

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Question 121

Jaundice in breast-fed neonates is regarded as late if it appears in the end of:

A2-3. days of life and subsides spontaneously during 2-3. week of life.
B4-5. days of life and subsides spontaneously during 3-4. week of life.
C6-7. days of life and subsides spontaneously during 2-3. week of life.
D8-10. days of life and subsides spontaneously during 2-3. week of life.
E1 week of life and lasts up to 4-12 weeks.

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Question 122

Which of he following is a contraindication to vaccination in neonates?

Amedical condition after intraventricular hemorrhage
Bbronchopulmonary dysplasia.
Csevere immunodeficiency
Diron deficiency anemia.
Eadministration of palivizumab (Synagis) in the past

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Question 123

A bi- phasic fever, conjunctivitis, photophobia, runny nose, macropapular rash first occurring on the head and then spreading to the feet are characteristic of the infectious disease preventable with vaccination, called:

Achickenpox.
Brubella.
Cmeasles.
Derythema infectiosum.
Escarlet fever.

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Question 124

Which of the following is not a proven risk factors for cervical cancer?

AHPV infection.
Bcigarette smoking.
Cvaginal coinfection/ infection.
Dhyperglycemia.
Eimmunosuppression.

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Question 125

Which of the following is an etiological factor for infectious mononucleosis?

AHSV.
BCoxackie virus.
CEBV.
Dgroup A streptococci.
Eadenoviruses.

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Question 126

In 2005 a new vaccination was introduced into the mandatory vaccination schedule that significantly reduced the number of cases of epiglottitis. The vaccination was directed against:

Apneumococcuci.
Bmeasles, mumps and rubella.
CHaemophilus influenzae.
Dchickenpox.
Emeningococci.

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Question 127

A female patient reports to her family doctor that her father had colon cancer while her mother and aunt had breast cancer. Indicate the most appropriate management:

Aobservation of the patient, there is no need to refer her to any specialists - she does not present any alarming symproms.
Btelling the patient about the risk and providing an observation in the settings of a family doctor service.
Creferring the patient to the outpatient clinic for genetic counseling, there is no need for other consultations.
Dreferring the patient to the cancer prevention center ant the outpatient clinic for genetic counseling.
Ereferring the patient to the emergency department in order to carry out quick cancer diagnostics.

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Question 128

The signs and symptoms of Conn's syndrome (primary hyperaldosteronism) do not include:

Adecreased thirst.
Bdecreased muscle strength
Carterial hypertension refractory to pharmacological treatment
Dpolyuria.
Etetany.

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Question 129

A pale, mucous vaginal discharge occurring in a neonate that subsides within several days is a symptom of:

Aimpact of mother's estrogens.
Bimpact of mother's oxytocin.
Cfungal infection.
Dtrichomoniasis.
Ebacterial infection.

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Question 130

A 29-year-old patient after gynecological surgical operation complains of calf pain lasting 2 days and accompanied by edema that appeared 24 hours later. The physical examination reveals no redness nor pain over the veins but the Homan's sign is positive (the pain increasing on a forced dorsiflexion of the foot). The most probable diagnosis is:

Asuperficial thrombophlebitis
Bdeep venous thrombosis
Cthromboangiitis
Darteriosclerosis obliterans
Ethromboangiitis obliterans

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Question 131

After the removal of the tick the patient should be instructed to observe the place of the bite for possible appearance of erythema migrans for:

A7 days.
B14 days.
C30 days.
D60 days.
E90 days.

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Question 132

Indicate the amount of glucose to be given and the scheme for blood sampling in a 60-year-old male while performing the oral glucose tolerance test:

A50g; at fasting, the first and second hour of the test.
B75g; at fasting, the first and second hour of the test.
C50g; at fasting and the second hour of the test.
D75g; at fasting and the second hour of the test.
E100g; at fasting,the first and second hour of the test.

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Question 133

A retrosternal pain that radiates to the neck and left shoulder should raise a suspicion of:

1) angina pectoris;

2) myocardial infraction;

3) pericarditis;

4) aortic dissection;

5) pneumothorax.

The correct answer is:

Aonly 1.
B1,2,3.
C2,3,4.
D2,5.
Eall the above.

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Question 134

Indicate the limit for normal arterial oxygen saturation as determined by the pulse oximeter in a person under 70:

A≥ 85%.
B≥ 89%.
C≥ 92%.
D≥ 95%.
E≥ 97%.

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Question 135

A patient on constant acenocoumarol therapy came to the family doctor with the result of INR = 5.8 without any sign of bleeding. Which of the following should be recommended?

Areduce the weekly dose of acenocoumarol by 10% without any break in the treatment.
Bwithdraw acenocoumarol for 1-2 days till obtaining INR values: 2.0-3.0.
Cgive immediately ½ tablet of vitamin K and decrease the dose of acenocoumarol for that day.
Dgive immediately ½ tablet of vitamin K withdraw acenocoumarol for 1-2 days.
Erefer the patient to the hospital in order to administer vitamin K intravenously.

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Question 136

Anemia of chronic disease differs from iron deficiency anemia in:

Aincreased serum ferritin concentration.
Bdecreased total iron binding capacity (TIBC).
Cdecreased MCV values.
Danswers A and B are correct.
Ethe correct answers are A, B, C.

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Question 137

The efficacy of minimal smoking cessation (the 5xP rule), defined as the total smoking cessation for a year, is about:

A1-3%.
B3-5%.
C5-10%.
D10-15%.
E15-20%.

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Question 138

When analyzing measurements of body temperature performed by a patient the family doctor should consider the location where the measurements was performed. Which of the following statements is true?

Ameasurements under the armpit or in the ear is the least reliable
Btemperature measured orally is about 0.5 ° C higher than the basic temperature.
Ctemperature measured rectally is about 0.5 ° C lower than the basic temperature.
DA,B are true
EA,B,C are true.

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Question 139

Paracetamol is the first choice anti- fever medication. Its maximum daily dose in adults amounts to:

A2 grams.
B3 grams.
C4 grams,
D5 grams.
E6 grams.

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Question 140

Which of the following tests is not obligatory in every patient with newly diagnosed arterial hypertension?

Aoral glucose tolerance test.
BNa +, K + concentration.
Ccreatinine concentration with GFR assessment
Dcomplete blood count
Elipid profile

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Question 141

A sudden loss of muscle tone that leads to a fall without a loss of consciousness is called:

Acatatonia.
Bcataplexy.
Ccatalepsy.
Dcatathymia.
Econversion.

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Question 142

Beck’s cognitive triad includes the following elements of a person's belief system present in depression:

1) ‘I didn’t achieve anything in my life’;

2) ‘the world is a danger to me’;

3) ‘I am too sensitive’;

4) ‘I have constant memory problems’;

5) ‘things can only get worse’.

The correct answer is:

A1,2,3,4.
B1,3,4.
C2,3,4.
D1,2,5.
E3,4,5.

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Question 143

Negative symptoms in schizophrenia include:

Anihilistic delusions.
Bhallucinations.
Cpoverty of speech.
Dpseudohallucinations.
Eformal thought disorders.

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Question 144

The rescue team has been called to a 16-year-old female patient because of fainting. On examination: the pulse 45/min., arterial pressure 90/50 mmHg, ventricular arrhythmia on the ECG, sodium 135 mmol/L, potassium 3 mmol/L; height 165 cm, weight 35 kg. The rescue team should:

Atransport the patient to the psychiatric ward.
Btransport the patient to a pediatric ward.
Ctransport the patient to a hospital emergency department.
Dleave the patient at home and recommend a consultation with the general practitioner.
Eleave the patient at home and recommend a visit to the doctor in the outpatient psychiatric clinic.

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Question 145

Which of the following types of dementia is characterized by the shortest life expectancy?

Adementia in Alzheimer's disease.
Bvascular dementia.
Cdementia with Lewy bodies.
Dfronto-temporal dementia.
Edementia in Parkinson's disease.

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Question 146

Hebephilia is a subtype of:

Afetishism.
Bexhibitionism.
Cpedophilia.
Dsadomasochism.
Etransvestitism.

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Question 147

Which of the following medications is not used for premature ejaculation treatment?

Aclomipramine.
Bsertraline.
Cfluoxetine
Ddapoxetine.
Eall of the above are applicable.

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Question 148

Amenorrhea occurred in a 25-year-old patient with schizophrenia when the pharmacotherapy was started. She was most probably treated with:

Aolanzapine.
Bquetiapine.
Czyprasidon.
Drisperidon.
Earypiprazole.

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Question 149

Which of the following should be monitored during the therapy with lithium?

Athyroid and kidney function
Bparathyroid gland function
CECG
Dtriglyceride concentration
EComplete blood count

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Question 150

A patient with the diagnosis of bipolar II disorder may present with each of the following states, except for:

Ahypomania.
Bsevere depression.
Csubdepression.
Dpsychotic mania.
Eeuthymia.

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Question 151

In psychiatry the term ”mania” denotes:

Asynonym for suspiciousness, distrust, “conspiracy theories” (“paranoid mania”).
Bsense of superiority (“grandiose mania”).
Csynonym for psychiatric disorder, paranoia.
Dset of psychopathological symptoms characterized by increased drive and mood, occurring among others in the course of affective disorders.
Esynonym for compulsive actions (e.g. obsessive hand washing).

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Question 152

Which of the peripartum disorders usually does not need to be treated?

Apostpartum depression.
Bantepartum depression.
C„baby blues”.
DOCD.
Egeneral anxiety disorder.

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Question 153

A 49-year-old woman came to the pharmacy and asks for a prescription drug that may help her fall asleep at night and soothe her nerves affected by a ‘difficult family situation’. She promises to bring the prescription in several days as soon as her doctor comes back from vacation. She negates the overuse of sedatives or tranquilizers. When her request is declined she reacts with indignation, cry and more intense demand for the medication, asking for at least a few pills of diazepam. It is highly probably that the woman suffers from:

Ageneral anxiety disorder.
Bsleep disorder not due to medical condition.
Csedative use disorder.
Dmoderate depressive episode.
Ebipolar disorder.

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Question 154

A 20-year-old woman in the 34 week of pregnancy complains of headache, visual disturbances, nausea and edema. On physical examination: respiratory rate - 32/min, crepitation audible over the lungs, heart rate - 120/min, on the ECG a regular rhythm with narrow QRS complexes, blood pressure - 190/110 mmHg. During the examination seizures occurred. Which medication and dose should be administered?

Aadenosine 6mg iv
Bfurosemide 5mg i.v.
Cmorphine 3-5mg iv
Ddiazepam 40mg iv
Emagnesium sulfate 4g iv

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Question 155

A 44-year-old male complains of severe abdominal pain and hematemesis. On examination: respiratory rate - 24/min, normal respiratory sounds over the lungs, SpO - weak signal, heart rate - 130/min, no pulse on the distal arteries, blood pressure - 75/50 mmHg, the skin is pale and sweaty, on the ECG - a regular rhythm with narrow QRS complexes. Which of the following should be performed?

Acardioversion.
Bvagal maneuver.
Cadenosine 6mg iv rapid bolus.
Dfluid therapy.
Eamiodarone 300mg iv within 20-60 minutes.

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Question 156

The treatment of hyperosmolar nonketotic hyperglycemic state includes:

Aadministration of glucagon at a dose of 1.0g.
Baggressive insulin therapy.
Cadministration of intravenous fluids (10 L)
Dthyroid hormone replacement therapy.
Eadministration of 250 mg of hydrocortisone.

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Question 157

Information on the use of which of the following medications does not explain hyperkalemia observed in a patient:

Aramipril.
Bketoprofen.
Cpropranolol.
Dtrimethoprim.
Etorasemide.

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Question 158

Indicate the location where a rescuer’s hands should be placed on an adult patient while performing CPR:

Ain the middle of the chest.
Bin the lower half of the sternum.
Con the intranipple line.
DA,B are true.
EA,B,C are true.

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Question 159

According to the European Resuscitation Council Guidelines 2015 the breaks for ventilation during CPR should not be longer than:

A5 seconds.
B10 seconds.
C15 seconds.
D20 seconds.
E30 seconds.

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Question 160

According to the European Resuscitation Council Guidelines 2015 when the first aid is provided to a person with seizures it should be initiated with:

Acontrol of breathing and exclusion of cardiac arrest.
Bprotection of the head from secondary injuries
Cplacing an available object between the teeth in order to prevent tongue bites.
Dplacing the patient in the recovery position.
Erefraining from taking any rescue actions until seizure cessation.

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Question 161

The European Resuscitation Council Guidelines 2015 underline the role of diagnosis of reversible causes of cardiac arrest with the use of:

Amagnetic resonance imaging.
Bultrasound imaging.
Cquick point-of-care testing (blood spot tests).
Dcomputer tomography.
Escintigraphy.

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Question 162

According to the European Resuscitation Council Guidelines 2015 the time of immersion during drowning that is related to the bad prognosis is longer than:

A3 minutes.
B5 minutes.
C7 minutes.
D10 minutes.
E15 minutes.

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Question 163

Which of the following medications is not used in order to lower the potassium concentration in the blood?

A1 mg/kg m.c. furosemide i.v
B15mg salbutamol in nebulization.
C10 j. of short-acting insulin and 25 g of glucose i.v. within 15-30 min
D10ml 10% CaCl2 i.v.
Esodium bicarbonate 1 mmol/kg of b.w. i.v.

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Question 164

The maintenance fluid requirement in a child weighing 35 kg amounts to:

A1000 ml.
B1300 ml.
C1500 ml.
D1800ml.
E2100ml.

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Question 165

Indicate the true statement concerning capnography (ETCO2) used during chest compressions in the course of CPR:

Avalues of ETCO2 < 10 mmHg after 20 minutes of CPR suggest good outcome of the treatment
Bvalues of ETCO2 are prognostically irrelevant during CPR.
Cvalues of ETCO2 are independent of the depth of chest compressions.
Dit helps to monitor the frequency of chest compressions.
Eit may allow to diagnose the return of spontaneous circulation (ROSC) during CPR

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Question 166

The use of positive end-expiratory pressure (PEEP):

Ais contraindicated in severe chest and pulmonary injuries.
Bis not indicated in patients rescued from the drowning.
Cdecreases venous return - thus it is contraindicated in hypovolemic shock.
Dis contraindicated in severe pulmonary edema.
Eis not possible during the ventilation with a bag valve mask.

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Question 167

Indicate the true statement concerning defibrillation performed in a patient in hypothermia (core temperature 27 ºC) with a sudden cardiac arrest due to ventricular fibrillation:

Ait is not recommended to perform defibrillation until the core temperature is ≥ 30 ºC
Bit is recommended to perform single defibrillation before reaching core temperature ≥ 30 ºC
Cit is not recommended to perform defibrillation until the core temperature is ≥ 32 ºC.
Dit is recommended to perform triple defibrillation before reaching core temperature ≥ 30 ºC
Eit is recommended to repeat defibrillation till the effect according to the general algorithm for ventricular fibrillation.

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Question 168

A 45-year-old woman was admitted to the Emergency Department deeply unconscious, breathing shallowly at the rate of 10/min, with pinpoint pupils, heart rate 60/min, blood pressure 110/60 mmHg, glucose concentration 115 mg/dL. Her medical history includes back pain treated with meloxicam 15 mg daily and 10 mg oxycodone on demand. Indicate the diagnosis and the treatment that should be initiated:

Aopiate intoxication, 0.5 mg of flumazenil i.v
Bhypoglycemic coma, 10 mL of 40% glucose i.v
Copiate intoxication, 0.4 mg of naloxone i.v.
Dneurogenic shock, 200 mg of hydrocortisone i.v.
Eanaphylactic shock, 1 mg of epinephrine i.m.

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Question 169

Acute intoxication with which of the following is not an indication for hemodialysis?

Amethyl alcohol.
Bethylene glycol.
Csalicylates.
Ddiazepam.
Elithium.

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Question 170

Indicate the recommended rate of chest pressures to rescue breaths during CPR:

A5: 1 in newborns.
B3: 1 in newborns.
C2:15 in neonates.
D2:15 in children under 8 years old.
E2:30 in adults.

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Question 171

Hyperthermia is a characteristic symptom of:

Aacute ethyl alcohol intoxication.
Bacute intoxication with clonazepam.
Copioid toxidrome
Dneuroleptic malignant syndrome.
Esedative/hypnotic toxidrome.

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Question 172

Which of the following sets of signs and symptoms does not allow to diagnose the systemic inflammatory response syndrome (SIRS)?

Abody temperature over 38 °C, leukocyte count in the peripheral blood above 12 000/mL, heart rate above 90/minute.
Bbody temperature under 36 °C, respiratory rate over 20/minute, pCO under 32 mmHg.
Cbody temperature under 38 °C, heart rate under 80/minute, leukocyte count in the peripheral blood under 2000/mL, respiratory rate under 20/minute
Dbody temperature over 40 °C, heart rate over 110/minute, respiratory rate over 30/minute.
Ebody temperature under 35 °C, heart rate over 90/minute, pCO under 32 mmHg.

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Question 173

A patient who has been exposed to cold is brought to the Emergency Department. He presents with chills, increased respiratory rate to 25/minute, core temperature 34°C, increased heart rate to 95/minute, he is agitated and completely conscious. The above clinical image suggests:

Asevere hypothermia
Bmoderate hypothermia
Cmild hypothermia
Dfrostbite.
Echillblains.

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Question 174

Is the doctor obliged to report to the police an attempt to kill a man if they obtained this information during medical examination?

Adoctor never has such an obligation
Breporting a patient is a matter of choice not duty.
Cdoctor in this kind of situation is obliged to inform the Medical Chamber
Dlaw does not address such issues
Edoctor is obliged to do so because the matter concerns an activity that is forbidden by Art. 240 § 1 of the Penal Code

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Question 175

Should the attending doctor planning a diagnostic procedure carrying increased risk obtain his patient’s consent for it?

Ayes, oral consent prior to the test
Byes, written consent after the test.
Cyes, written consent prior to the test.
Dyes, oral consent after the test.
Eno, such consent is not required in the diagnostic process.

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Question 176

A medical experiment involving humans is allowed to be carried out:

Aunder the supervision of a medical law specialist.
Bonly under the supervision of a doctor with appropriate high qualifications.
Conly under the supervision of a doctor who is a medical university employee.
Dunder the supervision of a bioethicist.
Eunder the supervision of an anthropologist

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Question 177

Does the Code of Medical Ethics contain regulations on doctor’s duties concerning preventive vaccinations?

Athere is no such regulations in the Code.
Byes, the doctor has the duty to carry on preventive vaccinations for the benefit of the society even against patient’s will
Cthere is an indirect regulation which states that the call of the doctor includes also disease prevention
Dyes, the doctor following their call to prevent diseases can vaccinate a child even against their parents’ will.
EB and D are correct.

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Question 178

According to the Code of Medical Ethics which criteria should the doctor take into consideration while deciding on the patient order for special therapy forms if they cannot be applied to all the patients simultaneously?

Amedical.
Bsocial.
Ceconomic.
DA and B are correct.
Ethe correct answers are A and C.

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Question 179

Which of the following concerning the principle of double effect is true?

Ain bioethics the principle of double effect is used for evaluating morally dual actions - those of good and bad outcomes.
Baccording to the principle of double effect some procedures in medicine are allowed on condition that their nature is good, they are carried on to achieve a good result and the proportion in results between good and bad is balanced.ed.
Caccording to that principle it is allowed to use palliative sedation
Daccording to that principle it is allowed to use euthanasia.
EA, B and C are correct.

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Question 180

A 67-year-old female patient was diagnosed with malignant jawbone cancer. The patient was offered an extensive surgical procedure involving the removal of half of the jawbone along with the teeth and hard palate, which would result in speech impairment, impediment to food intake, and changes in external appearance (scar and facial asymmetry). The patient categorically opposed the operation, arguing that she did not want to be visibly disfigured. Despite this objection, the doctor did not offer her any alternative treatment and continued to persuade the patient, also in the presence of her children, to give consent to the operation although the patient decided only on palliative treatment. After repeated persuasions of the doctor and her children, the patient gave in and agreed to the treatment proposed by the doctor. Was the doctor's behavior (persuading the patient, not offering alternative treatment and involving her children in the process of decision making) justified by ethics?

Ayes, the doctor acted for the benefit of the patient
Bno, by persuading the patient and taking advantage of the family pressure, the doctor ignored the patient's autonomous decision - he forced her to accept the operation.
Cyes, the proposed surgical procedure was consistent with the current state of medical knowledge.
Dyes, the doctor took into account the wishes of patient's loved ones, who acted in the name of the patient's welfare.
Eno, the doctor had the right to limit the autonomy of the patient, recognizing that the good of the patient required it, but he did not have the right to involve the family in the patient's decision making.

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Question 181

A pregnant woman had previously given birth to a child with hypochondroplasia, a genetic disease manifesting itself in dwarfism combined with joint and bone deformities. Fearing that this disease will occur in another child, she was referred by a gynecologist to a consultation clinic for women with high-risk pregnancies where she asked the physician for a referral to prenatal testing. The physician refused. Was that decision justified?

Ayes, because the physician assumed that once this genetic disease is confirmed, the woman would terminate the pregnancy.
Byes, because the physician acknowledged that in order to exercise their professional freedom they were entitled to refuse to do so.
Cno, because physician's refusal to refer the patient violated the patient's right to information and medical services.
Dno, because prenatal testing is compulsory for pregnant women.
Eyes, because patient's wish is not a sufficient reason to refer her to prenatal testing.

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Question 182

According to the Declaration of Helsinki (Ethical Principles for Medical Research Involving Human Subjects) the primary purpose of medical research is to generate new knowledge. Such medical research:

Acan never take precedence over the rights and interests of individual research subjects
Bcan, in exceptional clinical cases, take precedence over the exclusive interests of individual research subjects.
Ccan limit rights of individual research subjects only in the name of their interests.
Dcan take precedence over individual research subjects' rights upon their consent.
Ecan take precedence over individual research subjects' interests only upon the consent of the bioethical committee allowing the medical experiment to be carried out.

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Question 183

Is the doctor allowed to perform a surgical procedure or use increased risk treatment without the consent of the minor patient’s legal guardian (e.g. their parent) or the consent of the guardianship court?

Asuch actions are only possible with the consent of the guardianship court.
Bsuch action are possible after the doctor’s obtaining the consent from their superior
Csuch actions are against the law
Ddoctor is allowed to take such actions if any delay caused by obtaining the consent could result in patient’s death, grievous bodily harm or severe health disorder.
Esuch actions are possible but the consent of the legal guardian is in those situations indispensable.

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Question 184

Which of the following are paid to a person who had an accident at work or suffers from occupational disease?

Asickness benefit and rehabilitation benefit at 80% of the base as well as one-time compensation.
Bsickness benefit and rehabilitation benefit at 100% of the base as well as one-time compensation but only in the case of permanent or long-term damage to health.
Csickness benefit and rehabilitation benefit at 100% of the base paid also in the case when the person retains the right to remuneration, salary or scholarship.
Dsickness benefit and rehabilitation benefit at 60% of the base.
Esickness benefit and rehabilitation benefit at 80% of the base as well as one-time compensation paid only to the person’s family if the person deceased due to an accident at work or occupational disease.

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Question 185

The sickness benefit due to tuberculosis is paid throughout the period of temporary incapacity to work but not longer than:

A128 days
B182 days
C228 days
D240 days
E270 days

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Question 186

Which of the following concerning SIF (ZUS) medical committee is false?

Ait consists of three members who deliver a ruling.
Bit decides in the form of a ruling
Cits member can also be a SIF (ZUS) certifying doctor
Dit works at the SIF (ZUS) branch.
Eit does not deal with objections lodged after the deadline.

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Question 187

In the event of irregularities in the issue of medical certificates, ZUS may withdraw the authorization to issue medical certificates for a period not exceeding:

A12 months from the date on which the decision became final.
B10 months. from the day the decision became final.
C10 months. from the date of the decision.
D6. months. from the day the decision became final.
E6. months. from the date of the decision.

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Question 188

To control the decision on temporary incapacity to work a SIF (ZUS) certifying doctor cannot:

Acarry out examinations of the insured person at the designated place.
Bcarry out examinations of the insured person at their place of residence.
Crefer the insured person to any doctor for specialist examinations
Ddemand from the doctor who issued the decision the medical documentation on grounds of which the decision was taken.
Eorder to carry out further examinations at a specified time.

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Question 189

The period in which the occurrence of documented disease symptoms entitles to diagnose occupational disease despite a prior termination of the job inducing exposure to occupational disease is:

A10 days in the cases of acute poisoning.
B6 months in the case of acute radiation sickness with lesions of inflammatory or inflammatory-necrotic nature affecting the skin and subcutaneous tissue.
C1 year in the case of bronchial asthma.
D5 years in the case of chronic diseases of the vocal organs caused by excessive voice exploitation lasting at least 15 years
E10 years in the case of decompression sickness, caused by working in the conditions of elevated atmospheric pressure.

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Question 190

There are three levels of disability - severe, moderate and mild. One of the criteria qualifying for mild disability is:

Anecessity to provide help including social functioning, i.e. dependence of the disable on their environment.
Btemporary help in social functioning - necessity to provide indispensable help (i.e. caring help that supports everyday activities, curing process and rehabilitation) in health-dependent periods of time
Cinability to work or ability to work only under protected work conditions or in conditions requiring temporal or partial help from other persons
Dincapacity to work, i.e. total incapacity to work for money due to physical, psychiatric or mental impairment of the body’s fitness.
Edecreased ability to work (whether for money or not) due to impairment of the body’s fitness essentially lowering work efficiency at workplace compared with a healthy person of similar qualifications.

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Question 191

Indicate the screening tests that will be performed according to the guidelines of the National Cancer Control Program 2016-2024:

1) colonoscopy in people aged 50-65, at intervals of once every 15 years;

2) colonoscopy in people aged 50-69, at intervals of once every 5 years;

3) colonoscopy in people aged 55-64, at intervals of once every 10 years;

4) pap smear in women aged 25-59, every 3 years;

5) mammography in women aged 50-69, every 3 years;

The correct answer is:

A1,4.
B1,5.
C2,5.
D3,4.
E3.5.

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Question 192

A population-based screening of breast cancer was performed using mammography. The sensitivity of the diagnostic tool was 90%, and its specificity was 95%. As a result it can be estimated that in the examined population:

A5% of the screening participants have a false positive result.
B10% of the screening participants have a true positive result.
C10% of the screening participants have a true negative result.
D95% of the screening participants have a true positive result.
E90% of the screening participants have a true negative result.

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Question 193

A biomarker of exposure used in environmental epidemiology to assess the effect of environmental exposure on the examined health outcome is defined as:

Amarker of individual susceptibility to the exposure to a harmful environmental factor.
Bmarker of early (subclinical) health effects of the exposure to a harmful environmental factor.
Cmarker of the exposure to a harmful environmental factor obtained using dosimetry techniques that measure the individual exposure.
Dmarker of the exposure to a harmful environmental factor calculated as the average concentration of the xenobiotic provided by analyses of various environmental media in the microenvironment of the exposed individual.
Emarker of the exposure to a harmful environmental factor provided by the direct measurement of the concentration of a xenobiotic or its metabolite in a biological material obtained from the individual who is exposed to the factor in question.

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Question 194

In one calendar year mortality due to malignant diseases was compared between the population of Town A (mortality: 420 / 100 000) and the population of Town B (mortality: 458 / 100 000). Indicate the correct interpretation of the obtained data:

Atwo populations (A and B) differ statistically significantly in terms of mortality because the difference is greater than 5%.
Bincidence of malignant diseases is larger in Town B than in Town A.
Ccase fatality in malignant diseases is larger in Town B than in Town A providing that the observed difference in mortality is statistically significant.
Dreliable assessment of the difference in between-town mortality due to malignant diseases is not possible without age standardization.
Eduration of observation (one calendar year) is too short to implement populationbased comparisons of two mortalities due to malignant diseases.

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Question 195

A potential relationship between a given disease and a given exposure, expressed by odds ratio, is possible to assess using an analysis of data provided by epidemiological study performed according to the scheme of:

Across-sectional study.
Bcase-control study.
Cecological study.
Dcorrelation study.
Edescriptive study.

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Question 196

In Poland, reports on suspected or diagnosed infectious diseases that are subject to compulsory notification are to be submitted to:

ANational Health Fund.
BMinistry of Health.
CState Sanitary Inspectorate.
DCentral Statistical Office.
EDepartment of Health in a region-specific Voivodship Office.

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Question 197

Which of the following is not a proven risk factor for hospital-onset pneumonia?

Arecent history of multiple episodes of treatment with wide spectrum antibiotics.
Bdiagnosis of chronic obstructive pulmonary disease.
Cswallowing disorders.
Dpolytrauma (multiple traumatic injuries), which is the cause of the patient’s hospitalization.
Eviral infection of the upper respiratory tract in the last 4 weeks preceding the patient’s hospitalization.

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Question 198

In a population of 1.000.000 inhabitants 1.000 persons suffer from pancreatic cancer and in this population there were 200 deaths from that disease in one calendar year. Which of the following is the best overall measure of the described epidemiological situation with regard to pancreatic cancer?