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LEKEXAM / 2020 spring

Question distribution — 2020 spring session

Share of each category in the latest available session.

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

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Question 1

Pulse palpation in clinical settings is possible on the following arteries, except for:

Aulnar artery
Bdorsalis pedis artery.
Cposterior tibial artery.
Dcommon iliac artery.
Epulse can be examined on all the above arteries.

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Question 2

Which of the following tests should be preferred in the case of a low probability of pulmonary embolism to verify the diagnosis?

ACT angiogram of the thorax.
BD-dimer concentration.
Ctransthoracic echocardiogram
Dnatriuretic peptide concentration.
Etransesophageal echocardiogram.

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Question 3

A 78-year-old patient was admitted to the hospital for the treatment of communityacquired pneumonia. Which is the most appropriate medication in this case?

Avancomycin
Bmetronidazole
Cfosfomycin
Damoxycilllin/clavulanic acid
Egentamicin

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Question 4

Maneuvers that increase the tone of the vagal nerve (e.g. Valsalva maneuver) are frequently effective in the emergency treatment of:

Aatrial fibrillation
Bbradycardia.
Cventricular tachycardia with narrow QRS complexes.
Dventricular tachycardia with wide QRS complexes.
Enone of the above.

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Question 5

Which of the following changes cannot be observed in the electrocardiogram of a patient suspected of acute coronary syndrome, with the regular heart rate of 72/min, who had normal previous ECG?

AST depression.
BT-wave pseudonormalization.
CQ wave in the lead III.
Dleft bundle branch block (LBBB).
EST segment elevation.

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Question 6

The most common form of mesangial glomerulonephritis is:

ASubmicroscopic glomerulonephritis
BIgA nephropathy
CMembraneous glomerulonephritis
DFocal segmental glomerulosclerosis.
EMembranoprolipherative GN

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Question 7

Which of the following is characteristic of acute glomerulonephritis?

Aincreased concentration of anti-glomerular basement membrane antibodies (antiGBM).
Bincreased concentration of anti-neutrophil cytoplasmic antibodies (ANCA).
Cincreased concentration of anti-streptolysin O (ASO).
Dincreased concentration of anti-double stranded DNA antibodies (dsDNA).
E. B and C are true.

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Question 8

A glomerulopathy that manifests itself as a nephritic syndrome and is characterized by the presence of so-called crescents in over 50% of glomeruli in the light microscopy histopathological image is:

Aminimal change disease
BIgA nephropathy
Cmembranous glomerulonephritis
Dfocal segmental glomerulosclerosis
Erapidly progressive glomerulonephritis

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Question 9

Which of the following signs and symptoms, occurring with variable intensity, may suggest acute tubulo-interstitial nephritis?

1) dull lumbar pain;

2) oliguria;

3) maculopapular rash;

4) hematuria;

5) fever.

The correct answer is:

Aall the above
B1,2,4
Conly 1.
D3,4,5
E2,3.

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Question 10

When should asymptomatic bacteriuria be treated? 1) in patients with permanent urinary catheterization; 2) in patients with a neurogenic bladder; 3) in pregnant women; 4) before urologic procedures related to a rupture of the urothelium; 5) in the recipients of a kidney transplant for the whole post-transplant period. The correct answer is:

A2,3,4.
B1,3,4.
C1,2,4.
D3,4.
E3,4,5.

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Question 11

The first-choice medication in the treatment of skin itching caused by cholestasis is:

Acholestyramine
Brifampicin
Cnaltrexone
Drifaximin
Eursodeoxycholic acid

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Question 12

In a 25-year-old female patient a laboratory test performed during the hospitalization showed TSH concentration 0.1 mIU/L. Indicate the correct interpretation of this result:

Aprimary hyperthyroidism.
Bpituitary insufficiency.
Coverdosage of levothyroxine.
Dglucocorticosteroid treatment.
Ethe result should not be interpreted without the information on clinical data and FT4 concentration.

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Question 13

A 25-year-old woman comes to her doctor because of palpitations occurring for 6 weeks. TSH concentration is below the normal range and FT4 concentration is over the normal limit. Which of the following diagnoses is the most probable?

Aeuthyreosis
Bprimary hyperthyroidism
Cprimary hypothyroidism.
Dsecondary hyperthyroidism
Esecondary hypothyroidism.

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Question 14

The most common cause of signs and symptoms of Cushing’s syndrome is:

ACushing's disease.
Badrenal cancer.
Cchronic administration of glucocorticoids.
Dcongenital adrenal hyperplasia.
Epheochromocytoma.

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Question 15

Which of the following is the most characteristic abnormality in patients with multiple myeloma?

Ageneralized lymphadenopathy
Bhepatomegaly
Csplenomegaly
Dosteolytic bone lesions
Eplasmacytic infiltration in the kidneys

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Question 16

The disorders observed in the course of AIDS do not include:

Amycosis
Bperiodontal lesions.
Chairy leukoplakia
DKaposi’s sarcoma.
EHodgkin lymphoma.

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Question 17

A positive direct Coombs test in a patient diagnosed with haemolysis suggests:

1) ABO haemolytic disease of the newborn;

2) Rh D haemolytic disease of the newborn;

3) hemoglobinopathy;

4) atypical haemolytic-uremic syndrome;

5) spherocytosis.

The correct answer is:

A1,2
B3,4,5
C1,2,4
D4,5
Eall the above

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Question 18

The classical set of skin and mucosal signs of reactive arthritis following sexual exposure includes:

1) psoriasis-like lesions on the soles of the feet and the palms of the hands;

2) erythema nodosum;

3) aphtous stomatitis;

4) finger skin reddening ("sausage digit");

5) erythema migrans

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

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Question 19

The diagnosis of osteoarthritis is based on clinical signs and symptoms. In the case of a non-characteristic clinical picture the imaging examinations are recommended, of which the examination of choice is:

1) magnetic resonance scan, as it allows the imaging of all joint structures, including the marrow;

2) ultrasonography of knee joints, as it allows the imaging of soft tissues of the joints;

3) computed tomography of the affected joint, as it allows the precise imaging of bone structures;

4) classical X-ray of the affected joint;

5) bony scintigraphy that allows the evaluation of blood flow related to inflammation in all the joints.

The correct answer is:

Aall the above.
Bonly 1.
C1,2,3.
Donly 4.
Eonly 5.

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Question 20

"Nun's knee", a condition characterized by edema and marked pain in the anterior part of the knee joint, is a consequence of:

ABaker’s cyst.
BAchilles tendinitis.
Cde Quervain’s syndrome.
Dfibromyalgia.
Eprepatellar bursitis

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Question 21

Indicate factors predisposing for contrast nephropathy:

1) chronic kidney disease, eGFR< 60 mL/min/1.73 m;

2) dehydration;

3) multiple myeloma;

4) use of proton-pump inhibitors;

5) use of non-steroidal anti-inflammatory drugs.

The correct answer is:

A1,2,3,5.
B1,2,4,5.
C1,2,3.
D2,3,5.
Eall the above

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Question 22

The aldosterone-to-renin ratio is used as a screening test in the diagnostics of:

Arenal artery stenosis
BConn syndrome
Cpheochromocytoma
Deffectiveness of aldosterone antagonist therapy
EA and D are true

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Question 23

The typical rheumatological signs of inflammatory bowel disease do not include

Ainflammation of large joints, especially of the lower limbs.
Bnon-symmetrical metacarpophalangeal arthritis
Cerythema nodosum
Dsacroiliitis, usually non-symmetrical.
Eperichondritis of the pinna and the nose.

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Question 24

A 45-year-old man was transported to the hospital because of a strong chest pain not responding to nitrates. The pain radiates to the lumbar region. The patient has a history of poorly controlled arterial hypertension. Which of the following murmurs should be expected in this patient on auscultation?

Adiastolic murmur over the second intercostal space at the left sternal border
Bsystolic murmur over the second intercostal space at the left sternal border
Cdiastolic murmur over the second intercostal space at the right sternal border
Dsystolic murmur over the second intercostal space at the right sternal border
Ediastolic murmur over the cardiac apex

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Question 25

A hypercalcaemic crisis may occur in the course of:

Aradioactive iodine therapy
Bacute pancreatitis
Cmultiple blood transfusions
DHodgkin lymphoma
Echronic kidney disease

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Question 26

A 82-year-old man was brought to the ER by his son because of the swollen and painful left leg. The patient was diagnosed with pulmonary cancer 2 months ago. Which is the most probable cause of the swelling and the pain in the leg?

Adeep vein thrombosis
Bperipheral arterial disease
Cgout
DCongestive heart failure
EHypoalbuminemia

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Question 27

A 28-year-old man comes to the doctor complaining of an epigastric pain that radiates to his back. Serum amylase concentration is 10-fold higher than the normal limit. What is the most probable diagnosis?

Aacute pancreatitis
Baortic dissection.
Cpeptic ulcer.
Dacute myocardial infarction.
Eceliac disease.

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Question 28

A densitometric examination of a 78-year-old woman showed T-score equal to -2,8 and her calcium concentration was 13.0 mg/mL (normal range 8.5-10.5). The patient should be further diagnosed for:

Aprimary hyperparathyroidism
Bsecondary hyperparathyroidism
Cneoplastic lesions located in the bones
DA and C are true
EB and C are true

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Question 29

A 75-year-old patient comes to the cardiology outpatient clinic because of the aggravation of the right ventricular failure. He has an ischemic cardiomyopathy and had a biventricular cardioverter defibrillator implanted 5 years ago. The patient complains of recurrent fever and lower respiratory tract infections for the last 6 months. Indicate the correct management:

Aat present the patient needs no further cardiac diagnostics, a pulmonologist consultation is urgently needed.
Bafter excluding a vegetation with the transthoracic echocardiogram the treatment of the heart failure should be intensified, and the patient needs no further cardiac diagnostics.
Ctransthoracic and transesophageal echocardiograms should be performed as the infectious endocarditis is suspected.
Dabsence of pacemaker pocket infection signs excludes electrode lead endocarditis so the only needed interventions are the pacemaker checkup and the intensification of heart failure treatment.
Eantibiotic prophylaxis of electrode lead endocarditis should be started and the treatment of the heart failure should be intensified.

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Question 30

In a 54-year-old man abusing alcohol, the computer tomography revealed an irregularity of the liver contour, splenomegaly and a focal lesion in the right liver lobe of 3.5 cm in the diameter. The lesion enhancement was higher than in the surrounding liver tissues in the arterial phase and a contrast washout was visible in the venous phase. The radiologist suggested the diagnosis of hepatic adenoma. The alpha-fetoprotein concentration is 14 ng/mL (normal values < 5 ng/mL).
Indicate the next step:

Aguided-biopsy with histopathological examination.
Bdiagnosis of hepatic hemangioma - no further tests are needed.
Cthe patient should be referred to the surgeon for the right liver lobe resection.
Drepeated CT or MRI scan after 3 months.
Ediagnosis of hepatocellular carcinoma and a selection of appropriate treatment.

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Question 31

Dopamine D2 receptor agonists (bromocriptine, quinagolide, cabergoline) are used for:

Astimulation of lactation when the amount of milk produced in the postpartum period is too low
Btreatment of pituitary tumors producing prolactin.
Cdiagnostics of functional hyperprolactinemia.
Dcontrolled ovarian hyperstimulation.
Econtraception

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Question 32

A family doctor visitina a 75-year-old patient at her home, who was diagnosed with ischemic heart disease and type 2 diabetes, found that the patient is disoriented about time, place and people, and she complains of dyspnea. The physical examination revealed fine crackles in the left subscapular area, the blood pressure was 90/60 mmHg. Which of the following scales would be useful for making a decision on the indications for hospitalization of the patient?

AWells score.
BCURB-65
CCHADS -VASc.
DCentor criteria.
ESCORE

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Question 33

Which set of symptoms is characteristic of acute glomerulonephritis in children?

Ahaematuria, oedema, hypertension.
Bproteinuria, glycosuria, oedema.
Cphosphaturia, proteinuria, hypertension.
Dhaematuria, leukocyturia, hypertension.
Ecalciuria, glycosuria, hypertension.

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Question 34

Indicate the true statement concerning the clinical features of measles:

Arash is preceded by a high fever up to 40°C.
BKoplik's spots are pathognomonic for the disease.
Crash is af maculopapular type
DA,C are true
EA,B,C are true

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Question 35

In accordance with the Act of 5 December 2008 on preventing and combating infections and infectious diseases in humans, a Canadian citizen while in Poland is exempted from the obligation to undergo protective vaccinations (except post-exposure vaccinations) if their length of stay is not longer than:

A1 month
B2 months
C3 months
D4 months
E6 months

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Question 36

A 3-year-old girl came to the clinic because of malaise, abdominal pain, and oedema localized mainly in the lower limbs. The urinalysis revealed: the SG - 1.030, pH - 6.0, erythrocytes - 0-1 in the field of vision, leukocytes - 0-1 in the field of vision, protein - 1170 mg/dL, nitrites - absent. Which of the following is the most likely diagnosis?

Anephrotic syndrome
BAlport syndrome.
Cnephritic syndrome.
DSchönlein-Henoch syndrome.
Eurinary tract infection

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Question 37

In a 7-year-old child, suffering from asthma treated with inhaled glucocorticoids, after a trip to the woods the aggravation of the disease occurred in the form of increasing dyspnea, cough and wheezing. The parents administered an additional dose of shortacting β -mimetic. The next step in this situation should be:

Aaddition of a leukotriene receptor antagonist.
Bwithdrawal of inhaled glucocorticoids and the introduction of long-acting β-mimetics.
Caddition of oral preparations of long-acting theophylline.
Ddoubling the basic dose of inhaled glucocorticoids
Econtinuation of inhaled glucocorticoids at the same dose combined with formoterol, all in a single inhaler.

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Question 38

The cerebrospinal fluid test performed in a 15-year-old child showed: cell count 420 /µL, 86% lymphocytes, erythrocytes 3/µL, glucose concentration 61 mg/dL, protein concentration 46 mg/dL, chloride ion concentration 122 mmol/L. The result is characteristic of:

Ahealthy child.
Bsuppurative meningitis.
Cviral meningitis.
Dtuberculous meningitis.
Esubarachnoid hemorrhage.

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Question 39

Celiac disease differs from the non-celiac gluten sensitivity in:

Apresence of gastrointestinal symptoms.
Brelation between the symptoms and the introduction of gluten into the diet.
Cpresence of emotional disorders.
Dabnormalities in the eeg.
Edetection of partial or complete villous atrophy in the biopsy of the duodenum

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Question 40

Indicate the true statement concerning newly diagnosed immune thrombocytopenia:

Ais an indication for an immediate start of immunosuppressive treatment.
Btreatment of choice is splenectomy.
Cit can be diagnosed only if the platelet count in the peripheral blood is < 100 x 10 /µL and disorders are excluded that might suggest other reason for thrombocytopenia (e.g.lymphadenopathy, hepatomegaly, anemia, abnormal WBC).
Dwhen the platelet count is < 50 x 10 /µL there are indications for platelet concentrate transfusion.
Ein order to confirm the immune background it is necessary to perform tests for the presence of anti-platelet antibodies in the blood.

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Question 41

Indicate the feature characteristic of chronic lymphocytic leukemia:

Aincreased lymphocytosis in the peripheral blood
Bpresence of lymphoblasts in the peripheral blood
Costeolytic bone lesions
Dmegaloblastic anemia
Ethrombocytosis

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Question 42

Which of the following are the attenuated vaccines given obligatorily to all children?

1) BCG vaccine against tuberculosis;

2) IPV polio vaccine;

3) influenza vaccine;

4) diphtheria, pertussis and tetanus vaccine;

5) measles, mumps and rubella vaccine;

6) varicella vaccine.

The correct answer is

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

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Question 43

Indicate the true statement concerning diffuse large B-cell lymphoma:

Ait is a potentially curable neoplasm
Bthe treatment of choice is monotherapy with a cytostatic agent, independently on the staging of the disease
Cthe progression is always slow
Dallotransplantation of hematopoietic stem cells is a preferred method in the first-line treatment
Eit is one the least common lymphomas

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Question 44

Indicate the false statement concerning vaccines:

Apneumococcal polysaccharide vaccine (PPV23) is used for vaccination of neonates and children under 2 years of life.
Bvaccination against influenza is recommended in children over 6 months of life.
CBCG vaccine is a viable, attenuated vaccine and that is why it is contraindicated in children suspected of or diagnosed with severe immune deficiency.
Dpneumococcal vaccine PCV10 or 13 is an example of conjugated vaccine in which polysaccharide antigens are connected to a protein carrier
EDPT vaccine is an example of inactivated, conjugated vaccine with whole cell pertussis bacteria.

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Question 45

Enteroviral infections in children do not cause:

Ameningitis.
Bmyocarditis and pericarditis.
Chand, foot and mouth disease.
Dherpangina.
Einfluenza.

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Question 46

Indicate the true statement concerning Ewing’s sarcoma:

Ait is more common in girls than in boys.
Bprimary lesion causes laminated periosteal reaction.
Cis a highly differentiated sarcoma.
Dit is usually located in an upper limb.
Ethe most common location of metastases is the liver.

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Question 47

Which neoplastic tumors may develop in the abdominal cavity of a child?

1) Wilms’ tumor;

2) neuroblastoma;

3) non-Hodgkin lymphoma;

4) medulloblastoma;

5) dysgerminoma.

The correct answer is:

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

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Question 48

A seven-year-old girl visited her friend suffering from measles. The boy had had a rash for 6 days. What post-exposure prophylaxis should be performed in the girl?

Ameasles vaccination should be given within 72 hours since the contact.
Bspecific immunoglobulin should be given within 72 hours since the contact.
Cunspecific immunoglobulin should be given within 96 hours since the contact.
Dacyclovir should be given within 6 days since the contact.
Enone, there is no need for a post-exposure prophylaxis.

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Question 49

Indicate the correct statements concerning acute epiglottitis:

1. it is usually caused by viruses (RS, influenza, parainfluenza, adenovirus)

2. it is caused by bacteria (H. influenzae, S.pneumoniae, S. pyogenes)

3. it develops within several days

4. it develops within several hours

5. it leads to respiratory distress

6. it has a mild course and is treated symptomatically

The correct answer is:

A1,4,6
B2,3,6
C2,4,5.
D1,3,5
E1,3,6

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Question 50

Which of the following genetic disorders is not related to the increased risk of malignancy in children?

ADown syndrome
BBeckwith-Wiedemann syndrome.
CNijmegen breakage syndrome.
Dneurofibromatosis type I.
Efamilial Mediterranean fever

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Question 51

Which of the following is not used to diagnose obesity in children?

Alocation on the BMI centile chart
Bwaist-to-hip ratio (WHR)
Cabdominal circumference chart.
DCole’s index
Ecrown-rump length (CRL)

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Question 52

Cafe-au-lait spots are typical of:

ANoonan syndrome.
BMarfan syndrome.
Cneurofibromatosis type 1.
Dosteogenesis imperfecta.
ECrouzon syndrome.

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Question 53

The complications of ketoacidosis include:

1) cerebral edema;

2) anuria;

3) acute pancreatitis;

4) gastrointestinal bleeding;

5) hypovolemic shock.

The correct answer is:

A1,2
B2,3
C1,2,3,4
D1,2,4,5
Eall the above

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Question 54

A 15-month-old child who was vaccinated according to the current immunization schedule should be immune to tuberculosis, diphtheria, tetanus, pertussis and:

Ahepatitis A and B, poliomyelitis, Haemophilus influenzae type B, pneumococci, measles, mumps, rubella, meningococci.
Bhepatitis A and B, pneumococci.
Chepatitis B, Haemophilus influenzae type B, pneumococci, rotaviruses, poliomyelitis, measles, mumps, rubella.
Dhepatitis B, poliomyelitis, Haemophilus influenzae type B, pneumococci, measles, mumps, rubella.
Ehepatitis B, poliomyelitis, Haemophilus influenzae type B, measles, mumps, rubella, influenza.

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Question 55

An 18-year-old patient with a sore throat and body temperature 37.4 ºC presents puslike exudate tonsils, enlarged cervical lymph nodes, spleen enlargement, and a maculopapular rash after amoxicillin administration. The most probable diagnosis is:

Astreptococcal pharyngitis.
Binfectious mononucleosis
Cdiphtheria.
Dscarlet fever
Eherpangina.

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Question 56

Can a child be diagnosed with diabetes using oral glucose tolerance test?

Ayes, 50 g of glucose are administered
Byes, you give 75 g of glucose
Cyes, the calculated dose of glucose 1.75 g / kg bw, maximum 50 g is administered.
Dyes, the calculated dose of glucose 1.75 g / kg bw, maximum 75 g is administered
Eno, an oral glucose load test is not performed in children.

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Question 57

Congenital metabolic disorders should be considered when there is an episode of:

Anon-immune fetal hydrops
Bsigns suggestive of Reye’s syndrome
Cconvulsions and/or apnea in a child without signs of an infection
DB + C
EA + B + C

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Question 58

Which of following diseases does not lead to height restriction?

Aceliac disease
Bhypothyroidism.
Cadrenal insufficiency.
DCushing’s syndrome.
Echronic kidney disease.

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Question 59

A 12-year-old girl was admitted to the ward because of an acute paroxysmal abdominal pain located in the epigastrium and the right subcostal region, radiating to the right side, that appeared the previous morning. The laboratory test showed: ALT 278 U/L, AST 47 U/L, GGTP 178 IU/L, lipase 167 IU/L, amylase 248 mg%, direct bilirubin 2.06 mg%, indirect bilirubin 1.02 mg%. The most probable diagnosis is:

Ahemolytic-uremic syndrome.
Bgallstones
Chepatitis type A
DWilson’s disease
EShwachman-Diamond syndrome.

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Question 60

A woman came to the GP with her one-year-old son because of a trivial viral infection of the upper respiratory tract. The doctor noticed paleness of the child. The boy had been fed non-modified cow milk since 6 months of age. He is unwilling to eat anything else than porridge with cow milk. The complete blood count shows: RBC 4 x 10 /µL, Hgb 9.0 g/dL, MCV 60 fL, RDW 18%, PLT 480 x 10 /µL, WBC 9 x 10 /µL. The child had never taken any medications. Indicate the correct management:

Athe boy should be immediately referred to a hospital because of anemia and infection.
Biron-deficiency anemia should be diagnosed and an oral iron preparation should be prescribed as well as diet modification should be advised.
Canemia related to the acute infection should be diagnosed; the infection should be cured and the full blood count should be repeated in 2 weeks.
Dthe child is well adapted to the anemia and no treatment is needed, only diet modification.
Emegaloblastic anemia should be diagnosed, as a consequence of malnutrition; and oral preparations of folic acid and vitamin B should be prescribed.

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Question 61

A 54-year-old woman came to the ER because of bloody stool. On physical examination: good verbal communication, apathy, tachycardia 120/min, blood pressure 90/60 mmHg, pale skin, abdominal walls at the level of costal margins, the abdomen soft on palpation with no peritoneal signs, hyperactive bowel sounds, fresh blood visible on per rectum examination. On lab tests: WBC 17 000/mm , RBC 2.9x10 /mm , HGB 8.7 g/dL, PLT 60x10 /mm , APTT 40 s, INR 1.9. Additionally there is hepatitis B infection several years earlier in the medical history. Indicate the true statements:

1) the first step should be fluids infusion and blood transfusion in order to manage hypovolemic shock;

2) colonoscopy should be performed because the most probable place of the bleeding is located in the lower gastrointestinal tract;

3) blood tests should be repeated in short time to confirm active bleeding;

4) urgent gastroscopy is indicated;

5) gastric tube should be placed in the stomach to evaluate its contents which would allow formulation of the correct diagnosis and proper treatment.

The correct answer is:

A1,2,3.
B2,3,5.
C1,4.
Dall the above.
Eonly 4.

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Question 62

Which of the following may be a cause of ileus?

Adiabetes.
Bporphyria.
Cbiliary colic.
Drenal colic.
Eeach of the above.

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Question 63

Type I in the Bismuth classification of the bile duct injury denotes an injury of:

Acommon hepatic duct < 2 cm from the hepatic duct confluence.
Bcommon hepatic duct > 2 cm from the hepatic duct confluence.
Ccommon bile duct only.
Dright or left hepatic duct.
Eat the level of the hepatic duct confluence.

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Question 64

The patient in discharge papers has the annotation: "Condition after Hartmann surgery". It means that:

Ahe underwent total colectomy with the creation of the intestinal reservoir (pouch) and protective ileostomy.
Bhe has temporary, end-colostomy.
Che has temporary, end-ileostomy.
Dhe has permanent, end-colostomy.
Ehe underwent a submucosal resection of haemorrhoids.

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Question 65

Ointments containing nitroglycerine are used in proctology. In which of the following diseases?

Aanal fistula.
Bperianal abscess.
Chaemorrhoidal disease.
Dpilonidal disease.
Eanal fissure.

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Question 66

A young man came to the clinic. He noticed a periodic leaking of purulent content in the upper part of the gluteal cleft. There is a periodic pain in that area. The examination reveals several openings in the skin in the area, without any leakage. The most probably diagnosis is:

Aperianal fistula.
Bperianal abscess (in the phase without inflammation).
Canal fissure.
Dcutaneous form of ulcerative colitis.
Epilonidal cyst.

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Question 67

The patient in poor general condition was transported to the hospital admission room. He reports a retrosternal pain and high fever. On the physical examination the crackling of the skin was palpable around the neck. The patient had been diagnosed with advanced oesophageal cancer. The chest CT showed the presence of air in the mediastinum, contrast leakage in the thoracic section of the esophagus and fluid effusion in the right pleural cavity. Indicate the optimal surgical procedures in this case:

Aa gastric probe, a ban on oral nutrition, antibiotic therapy.
Bstitching the oesophagus with an access via right-sided thoracotomy.
Cexclusion of the oesophagus by emergent esophagostomy at the neck, mediastinal drainage, closure of the gastric cardia, further feeding by nutritional gastrostomy.
Doesophageal resection with gastroesophageal anastomosis in the cage chest.
Eimplantation of a self-expandable coated stent with possible drainage of the right pleural cavity.

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Question 68

A patient complains of a dull, disturbing, diffuse, deep abdominal pain, which precise location he is unable to determine, but the pain is the strongest at the midline. The patient reports the pain resembles a pain that was accompanying the first symptoms of acute appendicitis 20 years ago. Such a pain is called:

Aphantom pain.
Bcluster pain.
Csomatic pain
Dneuralgic pain.
Evisceral pain.

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Question 69

A Richter’s hernia is defined as:

Aevery linea alba hernia.
Bevery inguinal hernia in a woman.
Ca hernia that contains the Meckel’s diverticulum.
Da hernia that contains the antimesenteric wall of the intestine.
Ea hiatal hernia.

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Question 70

This disease usually affects young smoking men. It manifests itself with pain in the feet and toes, aggravating while moving. Superficial thrombophlebitis may co-occur. Arteriography shows occlusions and stenosis of small caliber arteries. Limb necrosis may occur in the course of the disease. The disease is not related to atherosclerosis. The above is a description of:

ARaynaud’s disease
BBuerger’s disease.
Cjuvenile arthritis
DLeriche syndrome.
EHorton’s disease.

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Question 71

Which of the following does not indicate the necessity of the surgical treatment of an umbilical hernia?

Ahernia persists at the age of 4 years.
Bcomplications occur.
Chernia is enlarging.
Dhernia’s diameter is 3.5 cm
Ehernia enlarges while the child is crying.

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Question 72

In the case of a pancreatic cyst, the surgery should be considered:

1) if it is a pseudocyst;

2) when a cyst connection to the duct of Wirsung has been visualized in MRI (magnetic resonance imaging) and endoscopic retrograde cholangiopancreatography (ERCP);

3) if there are complications (infection, bleeding);

4) when the diameter of the cyst is greater than 6 cm.

The correct answer is:

Aonly 1.
B1,3.
C3,4.
Donly 4.
E1,2,4.

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Question 73

Kehr's drain is used in:

Athyroid surgery.
Bbariatric surgery.
Cthoracic surgery.
Dbiliary surgery.
Eneurosurgery

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Question 74

A surgeon, after consultation, stated that the patient had Courvoisier syndrome. It means:

Athere is no dullness over the liver during percussion (probable perforation of the digestive tract).
Bsignificant distention of the sigmoid colon - suspicion of a torsion.
Cabdominal guarding in the left lower abdomen (probable diverticulitis).
Ddistended, painless gallbladder with accompanying jaundice.
Epelvic resistance during rectal examination (outside the rectum).

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Question 75

Which three of the listed elements constitute the so-called Virchow's triad (factors affecting blood clotting)?

1) slowed-down blood flow;

2) changes in blood composition (e.g., elevated hematocrit);

3) damage to the vessel wall (i.e. endothelium);

4) increase in the blood pressure;

5) increase in serum potassium level.

A1,2,3
B3,4,5
C2,3,4
D1,3,5
E2,4,5

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Question 76

A 56-year-old patient was subjected to total thyroidectomy because of Grave’s disease. Immediately after the removal of the tracheal tube the symptoms of acute respiratory failure occurred including stridor and dyspnea. The most probable reason for such symptoms is:

Ainjury of the trachea during the intubation.
Bbilateral vocal fold paralysis with narrow glottis gap.
Cbilateral vocal fold paralysis with wide glottis gap.
Dpostoperative bleeding at the site of the excised gland.
Eoverdose of general anesthetics.

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Question 77

During the surgery of the metastatic tumor of the liver, the surgeon performed, as he explained to the students, the Pringle maneuver. It consists in:

Atemporal pressure of the inferior vena cava
Bintroducing Kehr's drain into the right hepatic duct.
Cbreaking with the fingers the liver parenchyma to visualize the blood vessels and bile ducts, which facilitates their ligation.
Dcutting off all the ligaments fixing the liver to ensure a free access to the rear hepatic segments.
Etemporal clamping of the hepatic duodenal ligament to limit the inflow of blood to the liver.

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Question 78

The treatment of tracheo-esophageal fistulas, which are a pathological connection between tracheal and esophageal lumena through an epithelium-covered canal, is very difficult and marked by numerous failures. Indicate the methods used for the treatment of tracheo-esophageal fistulas:

1) placing a tube into the stomach or intestine and conducting enteral nutrition;

2) placing a permanent self-expanding esophageal stent;

3) placing a temporary self-expanding stent in the trachea and esophagus;

4) attempts to close the fistula canal by means of repetitive ablation, biological glues and obliteration;

5) excision of the fistula with a segmental resection of the trachea and a primary esophageal sewage strengthened with a pedunculated tissue flap taken from the neighbourhood.

The correct answer is:

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

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Question 79

Damage to the middle meningeal artery causes:

Asubdural hematoma
Bepidural hematoma
Cintracerebral hematoma
DA + B
Eall the above

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Question 80

The classical side-effects of non-steroidal anti-inflammatory drugs include:

1) mucosal ulcerations and gastrointestinal bleeding;

2) cardio-vascular complications;

3) photophobia;

4) kidney injury;

5) elevation of hepatic enzyme activity;

The correct answer is:

Aall the above
B1, 2, 5
C1, 2, 4, 5
D2, 3, 4
E2, 3, 5

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Question 81

Splenectomy resulting from a traumatic spleen rupture in a healthy adult:

Amay cause a transfer of extramedullary hematopoiesis to the liver.
Bmay lead to thrombocytosis
Cmay lead to bacterial infections
Dhas no effect on the health of the operated person.
EB and C are correct

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Question 82

A 40-year-old patient came by the ER because of a strong chest pain on the left side, aggravating on inspiration, accompanied by dyspnea. On physical examination: tachypnoe, no respiratory sounds and hyperresonance on percussion in the left supraspinous region. The chest X-ray revealed a lack of bronchovascular markings in the upper area of the left lung. The above clinical data suggest the diagnosis of:

Aatelectasis
Blobar pneumonia.
Cbronchopneumonia
Dpneumothorax
Epleural effusion.

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Question 83

The Glasgow-Blatchford scale refers to patients with:

Aacute pancreatitis.
Bhead trauma
Ccommunity-acquired pneumonia.
Dgastrointestinal bleeding
Eseptic shock.

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Question 84

In TNM classification of colon cancer the T4 denotes the infiltration of:

Amucous membrane.
Bsubmucous membrane.
Cmuscle membrane.
Dserous membrane.
Esurrounding organs.

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Question 85

Mark the incorrect statement about erysipelas:

Athere are no general symptoms
Binfection site may be a small invisible wound
Ccan lead to complications within deeper tissues (e.g. phlegmon)
Dstreptococci are the etiological factor
Eis an infection of the skin and subcutaneous tissue

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Question 86

Which of the following is characteristic of the vaginal discharge in a woman with bacterial vaginosis?

ApH < 4.5, yellow-greenish foamy discharge with clue cells present
BpH < 4.5, grey or milky homogenous discharge with clue cells present.
CpH > 4.5, grey or milky homogenous discharge with clue cells present.
DpH > 4.5, white, clotty, serous discharge with clue cells present.
EpH < 4.5, white, clotty, serous discharge without any cells present

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Question 87

Clue cells are characteristic of:

Abacterial vaginosis
Bvaginal mycosis
Cchlamydiosis
Dtrichomoniasis
EHPV infection

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Question 88

Which stage of endometriosis according to the classification of the American Society for Reproductive Medicine should be diagnosed in a patient with an endometrial cyst of the left ovary of 4 cm in diameter, partial obliteration of the recto-uterine pouch and superficial lesions of the peritoneal membrane of the diameter < 1 cm?

AI
BII
CIII
DIV
EV

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Question 89

Which of the following is not related to the polycystic ovary syndrome?

Aoverweight and obesity.
Binsulin resistance and increased risk of type 2 diabetes
Cincreased risk of cardiovascular diseases.
Dincreased risk of breast cancer and rectal cancer
Eincreased risk of endometrial cancer.

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Question 90

Which of the following is not a germ cell tumor of the ovary?

Agerminoma.
Bteratoma.
Cembryonal carcinoma.
Dgranulosa cell tumor.
Echoriocarcinoma.

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Question 91

Which of the following ovarian tumors is a virilizing tumor?

ASertoli-Leydig cell tumor.
Bendometrioid tumor
CWolffian duct cell tumor.
Dcorpus luteum cyst.
Efibroblast tumor.

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Question 92

The secondary prophylaxis of cervical cancer consists in:

Apro-healthy style of life to avoid HPV infection.
Bcytological screening.
Ccervical conization in the case of CIN2+ cytological outcome.
Dradical hysterectomy with lymphadenectomy in the case of invasive cancer.
Ebrachytherapy in the case of metastatic cancer.

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Question 93

Treatment of preinvasive cervical cancer involves:

Atopical removal of the lesion
Bsimple hysterectomy
Cradical hysterectomy
Dobservation and control every six months
Ecervical conization

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Question 94

In which of the following neoplasms brachytherapy is not used as an auxiliary method?

Aovarian cancer
Bendometrial cancer.
Ccervical cancer
Dvulvar cancer
Ein the all of the above cancers brachytherapy is used as an auxiliary method

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Question 95

The indications for insemination include:

1) decreased parameters of the semen;

2) ejaculation disorders;

3) PCOS;

4) III grade endometriosis;

5) idiopathic infertility.

The correct answer is:

A1,2,3
B1,2,3,4.
C1,2,4,5
D1,2,5
E3,4,5

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Question 96

Pregnancy in a woman with Swyer’s syndrome may be possible:

Aafter stimulation of ovulation with gonadotropins.
Bafter performing patient’s oocyte retrieval by the aspiration of ovarian follicles.
Cwhen a donor oocyte is used.
Dafter surgical recreation of the vagina.
Eafter the uterus transplantation.

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Question 97

Absolute contraindications to the use of oral hormonal contraception include:

1. history of gestational diabetes

2. active venous thromboembolism

3. age >35 years and smoking

4. coronary heart disease

5. hypertension

The correct answer is:

A1,2,3
B2,3,4,5
C2,4
D2,3,4
Eall the above

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Question 98

Venous or arterial thrombosis, recurrent miscarriage, the presence of anti-cardiolipin antibodies allow to suspect:

Asystemic lupus erythematosus
Bsystemic scleroderma.
Cantiphospholipid syndrome
DSjögren’s syndrome
EWilliams' syndrome

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Question 99

Which of the following is not a risk factor for urinary incontinence?

Apatient’s age
Bobesity
Cprevious gynecological procedures
Dnulliparity
Echronic constipation

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Question 100

The complications of fetal diabetes include:

Amacrosomia
Bpreterm birth, respiratory distress syndrome
Chypoglycemia, polycythemia, hypokalemia
Dall the above
Enone of the above.

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Question 101

A normal fetal heart rate is in the range of:

A160-180 beats/minute
B110-160 beats/minute
C100-120 beats/minute
D80-100 beats/minute.
E60-80 beats/minute.

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Question 102

Which of the following does not affect the result of the triple test?

Abody weight of the pregnant woman.
Btobacco smoking.
Cnumber of pregnancies.
Drace
Etype I diabetes.

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Question 103

A 33-year-old pregnant woman in 37th week of her second pregnancy came by the obstetric out-patient clinic because of the weakening of fetal movements. The course of the previous pregnancy was uncomplicated. The cardiotocography showed normal reactive FHR. Ultrasound examination of biophysical profile of the fetus revealed normal volume of amniotic fluid, one episode of breathing movements lasting 60 seconds, three movements of the trunk and twice hand closing and opening. The result of biophysical profile is:

A2/10 points
B4/10 points
C6/10 points
D8/10 points
E10/10 points

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Question 104

The prevention of Rh disease during pregnancy consists in the administration to each pregnant woman:

Awho is Rh-D negative, of 300 µg anti-RhD immunoglobulin at 28 -32 week of gestation.
Birrespectively of her Rh-D status, of 300 µg anti-RhD immunoglobulin at 28 -32 week of gestation.
Cwho is Rh-D negative, of 300 µg anti-RhD immunoglobulin at 28t -32t week of gestation, but only if Rh-D status of the father is provided
Dwho is Rh-D negative, of 150 µg anti-RhD immunoglobulin at 28 -32 week of gestation.
Ewho is Rh-D negative, of 300 µg anti-RhD immunoglobulin after 34 week of gestation.

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Question 105

The pregnancy in a patient with chronic hypertension is a high-risk pregnancy and may be complicated with the following disorders except for:

Apreterm birth related to the cervical incompetence.
Bintrauterine growth retardation.
Csuperimposed preeclampsia.
Dabruption of normally located placenta.
Eoligohydramnios.

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Question 106

A 25-year-old woman reported at 20th week of her pregnancy for a prenatal examination. Her arterial pressure was measured to be 170/100 mmHg. Which of the following medications should be advised?

Acaptopril
Blosartan.
Catenolol.
Dclonidine
Emethyldopa.

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Question 107

Which of the following is not characteristic of thrombotic thrombocytopenic purpura in a pregnant woman?

Amicroangiopathic hemolytic anemia.
Bdisseminated intravascular coagulation.
Cthrombocytopenia
Dkinley failure
Efever

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Question 108

Which of the following are assessed by the Bishop score?

Arelation between the cervix and the vaginal axis, dilation, cervical effacement, fetal station
Bgestational age, fetal position, cervical dilation and effacement.
Ccervical consistency, fetal lie, dilation, cervical effacement, fetal presentation.
Drelations between the uterine axis and vaginal axis, dilation, cervical effacement, fetal position.
Erelations between the long fetal axis and the vaginal axis, dilation, cervical effacement, strength of uterine muscle contractions.

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Question 109

The relation of the long fetal axis to the long axis of the uterus and reproductive canal is called:

Afetal lie
Bposition.
Cfetal location.
Dengagement
Epresentation.

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Question 110

Indicate the true statements concerning labor induction:

1) in the case of cholestasis of pregnancy when fatty acid concentration is 45 nmol/L the labor induction should be considered after 34 weeks of gestation;

2) in the case of gestational diabetes the labor induction should be considered after 39 weeks of gestation;

3) rupture of membranes is an absolute contraindication to labor preinduction with the use of prostaglandins;

4) in the case of pregestational diabetes the labor induction should be considered after 39 weeks of gestation;

5) in the pregnancy complicated by diabetes the labor induction is indicated when the difference between the fetal abdomen diameter and the biparietal diameter is over 4 cm.

The correct answer is:

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

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Question 111

Hemorrhage, strong hypogastric pain, no palpable fundus of the uterus above the pubic symphysis and rapid deterioration of the patient’s general condition during the third stage of delivery are the symptoms and signs of:

Auterine inversion
Buterine rupture.
Crupture of the vaginal fornix
Dafterbirth retained in the uterine cavity
Eincarcerated placenta

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Question 112

Persistent pain is one of the symptoms accompanying depression that can significantly worsen its course. Which of the following antidepressants should be considered in such a clinical setting?

1) duloxetine;

2) trazodone

3) agomelatine

4) venlafaxine;

5) milnacipran.

The correct answer is:

Aonly 2
Bonly 4.
C3,5.
D1,2,4.
E1,4,5.

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Question 113

Bipolar disorder was diagnosed in a 27-year-old man. Physical examination: BP 135/85 mm Hg, HR 86 / min, WHR 99 cm, BMI 30.5 kg / m2. Lab tests: triglycerides 180 mg / dl, HDL-C 36 mg / dl, glucose 105 mg / dl (fasting). Pharmacotherapy of BD should begin with:

Aarypiprazole
Brisperidone
Cclozapine
Dolanzapine
Equetiapine

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Question 114

A 30-year-old patient diagnosed with bipolar disorder was advised to take one of the medications preventing the relapse of the disease. After several days of the treatment polyuria and an upper limb tremor occurred. These effects suggest that the medication is:

Acarbamazepine.
Bvalproic acid.
Clamotrigine.
Doxcarbamazepine.
Elithium salts

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Question 115

A patient feels fear of public speaking - is predominantly afraid of being judged by other people. The most probable diagnosis is:

Asocial phobia
Bpanic disorder
Cgeneralized anxiety disorder
Dagoraphobia
Epanic disorder with agoraphobia

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Question 116

The only disorder of sexual preference (paraphilia) which incidence in females and males is similar is:

Afetishism.
Bmasochism.
Csadism
Dexhibitionism.
Evoyeurism.

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Question 117

Selective serotonin uptake inhibitors (SSRIs) include the following antidepressants, except:

Acitalopram
Bfluoxetine
Cparoxetine
Dfluvoxamine
Eamitriptyline

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Question 118

A 25-year-old man was referred for a psychiatric examination after an abuse of drugs and alcohol. The examination revealed that his behavior is characterized by: emotional instability, feeling of inner desolation, tendency towards self-destructive actions, unstable emotional relations. These features correspond with the diagnostic criteria for:

Aborderline personality disorder
Bdissociative personality disorder.
Chistrionic personality disorder.
Dnarcissistic personality disorder.
Edependent personality disorder

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Question 119

For several years a 35-year-old woman has been treated by her GP for numerous gastroesophageal symptoms (flatulence, nausea, occasionally abdominal pain), frequent urination, recurrent dyspnea not related to physical exercise. The symptoms occur in various constellations with variable intensity and are not related to her life events. She does not suspect any particular disease, but she is doing worse and worse. The patient was consulted by the gastroenterologist and cardiologist who did not find any diseases after performing necessary tests. She used various OTC pain-killers and muscle relaxants without a noticeable effect. The above picture corresponds to the diagnostic criteria of:

Ahypochondriasis (illness anxiety disorder).
Bsomatization disorder (somatic symptom disorder).
Cpsychogenic pain.
Dneurastenia
Emixed conversion disorder.

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Question 120

Bulimia is the least commonly accompanied by:

Amajor depressive disorder
Banankastic personality disorder
Cborderline personality disorder.
Daddictions.
Eanxiety disorders.

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Question 121

The most common side-effects of the SSRI include:

Acognitive disturbances.
Bangina symptoms
Cvertigo
Dnausea, diarrhea, insomnia
Esuicidal thoughts

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Question 122

Which of the following should be monitored in patients treated with clozapine for schizophrenia?

Acreatinine concentration.
Bthyroid hormone concentration.
Celectrolytes (Na and K).
Dgamma-glutamyltransferase (GGT).
Ecomplete blood count

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Question 123

Which drug is not a normothymic?

Ahaloperidol
Blithium carbonate
Clamotrigine
Dcarbamazepine
Evalproic acid

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Question 124

The signs and symptoms of serotonin syndrome do not include:

Ahyperthermia.
Bdecreased muscle tone.
Cconfusion.
Dnausea and vomiting.
Eincreased sweating

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Question 125

The primary structure of the psyche that is identified as instinctual drives generating strong needs and emotions, which seeks immediate gratification is:

Athe id.
Bthe superego.
Cthe conscious.
Dthe preconscious.
Ethe ego.

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Question 126

The spread of bacterial rhinosinusitis is an indication for antibiotic therapy. The medication of choice in an adult patient in such cases is:

Aamoxicillin in a dose of 1.5-2 g saily, given every 12 hours for 10- 14 days
Bamoxicillin and clavulanic acid in a dose of 1g (875 mg+125 mg) every 12 hours for 7 days.
Camoxicillin in a dose of 3 g daily, given every 8 hours for 7-10 days.
Damoxicillin and clavulanic acid in a dose of 625 mg (500 mg+ 125 mg) every 12 hours for 7-10 days
Eazithromycin in a dose of 500 mg daily for 6 subsequent days.

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Question 127

A woman comes to the GP with her 4-year-old daughter, who has had a fever up to 39.5 ºC since the morning. The child complains of strong sore throat too. The physical examination reveals enlarged tonsils covered with white exudate and pus plugs. Anterior cervical lymph nodes are also enlarged. The clinical image allows the diagnosis of:

Aacute pharyngitis, 2 points on the Centor/McIsaac score, no indications for antibiotic therapy.
Binfectious mononucleosis, there is no indications for antibiotic therapy
Cacute streptococcal pharyngitis and tonsillitis, 4 points on the Centor/McIsaac score; antibiotic therapy is indicated without need for the rapid strep test.
Dacute streptococcal pharyngitis and tonsillitis, but the decision on antibiotic therapy should be based on the rapid strep test result.
Escarlet fever, the antibiotic therapy is necessary

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Question 128

A 45-year-old professionally active woman was diagnosed with arterial hypertension. The blood pressure measured at home was 160/100 mmHg. The pharmacological therapy should be started with:

Aangiotensin-converting-enzyme inhibitor.
Bthiazide or thiazide-like diuretic
Ccalcium channel blocker.
Dcombined preparation - converting enzyme inhibitor with thiazide diuretic
Eangiotensin II receptor blocker.

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Question 129

An increase in the mean corpuscular volume (MCV) may be caused by:

Avitamin B12 insufficiency
Bfolic acid insufficiency
Ciron insufficiency
DA and B are true
EA and C are true.

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Question 130

Which of the following is the recommended management of acute bronchitis in adults?

Alevofloxacin
Bamoxycillin
Camoxicillin/clavulanic acid
Dcefuroxime axetil
Erefraining from antibiotic therapy in most cases.

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Question 131

A patient of Polish nationality born in 1973 and suffering from high fever, dry cough, runny nose, conjunctivitis and photophobia reports to the doctor office. The doctor finds Koplik’s spots on the buccal mucosa and individual spots and papules on the hairline behind the ears. According to the Act of 5 December 2008 on preventing and combating infections and infectious diseases in humans the doctor is obliged to:

Areport suspected infectious disease within 48 hours to the state county sanitary inspector relevant for the place of suspicion.
Breport suspected infectious disease within 24 hours to the state county sanitary inspector relevant for the place of suspicion.
Crefer the patient to the periodontist for consultation.
Dask the patient if he has travelled abroad lately or had contact with measles.
Eask the patient if he suffered from measles in his childhood.

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Question 132

A decreased serum iron concentration can be found in:

Amegaloblastic anemia
Bsideroblastic anemia
Cchronic disease anemia.
Dhealthy persons aged 16-20 years.
Ehealthy persons aged over 65 years.

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Question 133

A doctor, after recognizing or suspecting the occurrence of vaccine adverse event, is obliged to report this fact to the state country sanitary inspector not later than within:

A24 hours
B48 hours
C4 days
D1 week
E2 weeks

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Question 134

Which of the following is not characteristic of chronic obstructive pulmonary disease (COPD)?

Achronic cough
Bchronic coughing up of sputum
Cdyspnea, usually every day
Dlarge daily and interdaily variation in symptom intensity
Ehistory of exposure to the risk factors of COPD, especially the tobacco smoke

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Question 135

The alarming signs and symptoms in the course of gastroesophageal reflux disease, which are an indication for prompt endoscopic diagnostics, include:

1. weight loss

2. swallowing disturbances;

3. cough

4. upper gastrointestinal bleeding

5. hoarseness, aphonia

6. chest pain with non-cardiac etiology

The correct answer is:

A1,3,4
B2,4,6
C2,4,5
D1,3,6
E1,2,4

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Question 136

A urinalysis in a 45-year-old man revealed proteinuria, erythrocyturia and red blood cell casts. The most probable cause is:

Aurinary tract infection.
Burolithiasis
Cidiopathic arterial hypertension.
Dchronic pyelonephritis.
Eglomerulonephritis

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Question 137

A 58- year-old woman came by the family doctor office and complains od constant fatigue, weakness, sleepiness, feeling cold and constipation. The symptoms last for about 3 months. She gained 6 kg in 2 months in spite of a stable diet. The pysical examination revealed dry, rough skin and swollen lower eyelids. The blood pressure was 110/60 mmHg, the heart rate was regular, 58/min, with quiet normal heart sounds. The respitaroty sounds were normal bilaterally. No other abnormalities were noted. The most probable diagnosis is:

Adepressive disorder
Bglomerulonephritis
Chypothyroidism
Dirritable bowel syndrome.
Eiron deficiency anemia.

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Question 138

The defined components of the metabolic syndrome do not include the criterion of:

Aserum/ plasma triglyceride concentration >150 mg / dl
Bserum/plasma total cholesterol concentration > 250 mg/dL.
Cserum/plasma fasting glucose concentration > 100 mg/dL or the treatment of hyperglycemia.
Dwaist circumference> 94 cm in males, > 80 cm in females.
Esystolic and/or diastolic blood pressure > 130/85 mmHg or the current treatment of hypertension

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Question 139

In all patients with chronic coronary syndrome, irrelatively of a cardiovascular risk, comorbidities and the presence of symptoms of ischemia, in order to improve prognosis it is recommended to administer:

Aliraglutide
BACEI
Cbeta-adrenergic receptor antagonist.
Dlong-acting nitrate
Estatin

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Question 140

A 68-year-old patient came by the doctor office because of cough lasting for 2 months. He smokes one pack of cigarettes daily for 50 years. The physical examination shows no abnormalities. What should be the next diagnostic step?

Anone, the patient needs no further diagnostics.
Bspirometry
Cbronchoscopy
Dchest MR
Echest x-ray

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Question 141

A 40-year-old patient with newly diagnosed arterial hypertension, treated for two months with amlodipine and indapamid, came for a control visit. Her blood pressure is 120/80 mmHg. She complains of weakness and is anxious because she defecates only once a week. Which of the following should be advised first:

Afiber-rich diet and calming the patient down.
Bpotassium concentration test.
Cfecal occult blood test.
Dcolonoscopy.
Eabdominal ultrasound.

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Question 142

The class 3 obesity is a condition of patient whose BMI is:

A20-25,9
B26-29,9
C30-40
Dover 40
EBMI is not an index of the obesity but only a ratio of the body weight to the height squared (m²).

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Question 143

Which of the following is not a cause of obesity in children?

Aleptin deficiency
Bleprechaunism
Covereating
Dhypercortisolemia
EPrader-Willi syndrome

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Question 144

Referred (secondary) otalgia may be caused by:

1. tooth disorders;

2. temporomandibular joint inflammation

3.cervical spondylosis

4. trigeminal neuralgia

5. pharyngitis

The correct answer is:

Aonly 1
B1,2
C1,3
D2,3,4
Eall the above

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Question 145

The most common etiology of infectious conjunctivitis is:

Aallergy (a sign of allergy to plant pollen)
Bbacterial (Staphylococcus aureus, Streptococcus pneumoniae).
Catopy in patients with atopic dermatitis.
Dviral (adenoviruses, herpesviruses)
Eunknown factor

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Question 146

In the event of a major incident, a patient who is alive but unlikely to survive will be marked with the following color:

Agreen
Byellow
Cred
Dblack
Enone of the above

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Question 147

The patient after injury, without verbal contact, does not open his eyes, extension to painful stimuli. How many points will I get on the GCS scale?

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Question 148

The most sensitive and specific confirmation of the correct placement of an endotracheal tube can be achieved by the monitoring of:

Apulse oximetry
Bcapnography.
Ccapillary refill time
Dpattern of breathing.
Eblood oxygen saturation

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Question 149

The maximal daily dose of diazepam used in the treatment of status epilepticus in adults amounts to:

A1 mg
B10 mg
C25 mg
D50 mg
E100 mg

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Question 150

Which of the following is not administered during CPR before the restoration of spontaneous circulation?

Amagnesium sulphate
Bdopamine.
Cepinephrine
Dlidocaine.
Eamiodarone.

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Question 151

When used during the CPR amiodaron is administered in:

Abolus dose of 300 mg.
Bbolus dose of 200 mg.
Cbolus dose of 150 mg
Dbolus dose of 150 mg that can be repeated if needed.
Edose of 300 mg, given slowly over 10-20 minutes.

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Question 152

An ambulance team was called for an unconscious man found in the city park on a December morning. The paramedics should check for signs of life in this patient not longer than:

A10 seconds
B20 seconds.
C30 seconds.
D60 seconds.
E120 seconds

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Question 153

The supply of activated charcoal is contraindicated in the event of poisoning with:

Aalkalis
Bacids
Cheavy metals
Dhydrocarbons
Eall of the above

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Question 154

A 70-year-old man was admitted to the ER because of an aggravating dyspnoe lasting 2 hours. The patient is chronically treated for diabetes and arterial hypertension. The physical examination showed normal respiratory sounds with bibasal fine crackles. The heart rate was 90/min, blood pressure 190/80 mmHg. The first-choice medication in such a situation is:

Athiamazole.
Burapidil.
Cfurosemide.
Dmetoprolol.
Eamiodarone.

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Question 155

The polymorphic ventricular tachycardia occurred in a patient intoxicated with tricyclic antidepressants. The treatment should include the administration of:

Amagnesium sulphate.
Bβ-blocker.
Cdigoxin.
Damiodarone.
Everapamil.

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Question 156

Which of the following is an antidote to cyanide intoxication?

Ahydroxocobalamin.
Batropine.
Cglucagon
Dpyridoxine
Enaloxone

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Question 157

The following signs and symptoms:

1) headaches and vertigo;

2) blurred vision or vision loss;

3) severe metabolic acidosis;

are characteristic of the intoxication with:

Acorrosive substances.
Bparacetamol.
Ctricyclic antidepressants
Dmethanol.
Eorganophosphates.

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Question 158

The classic triad of signs present in shock consists of:

Ahypotonia, bradycardia, oliguria
Bhypotension, bradycardia, oliguria
Chypotonia, tachycardia, pale skin
Dhypotension, tachycardia, oliguria
Ehypotension, tachycardia, pale skin

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Question 159

A 24-year-old man has been transported to the ER because of a coma. The physical examination shows low blood pressure and tachycardia and the results of lab tests are as follows: plasma glucose 432 mg/dL, pH 7.1, HCO 9 mmol/L, Na 141 mmol/L, K 6.1 mmol/L, serum creatinine 106 µmol/L (1.2 mg/dL). What is the most probable diagnosis?

Aacute kidney damage
Bchronic kidney disease
Cketoacidosis
Dcirrhosis of the liver
Epotassium poisoning.

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Question 160

The signs of neurogenic shock include:

1) decreased blood pressure;

2) tachycardia;

3) bradycardia;

4) pale, cold skin;

5) warm skin with a good blood supply.

The correct answer is:

A1,2,4
B1,3,4.
C1,2,5.
D1,3,5.
E3,5.

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Question 161

A 70-year-old patient was admitted to the ER with the electrocardiogram shown below. The pulse was palpable on the carotid artery, and the paramedics reported that the ambulance had been called by patient’s wife who had found her husband fainted in the bathroom. Indicate the most appropriate treatment:

A200 J defibrillation.
B100 J defibrillation
Celectric cardioversion
Dtranscutaneous pacing.
Eadministration of catecholamines.

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Question 162

A 35-year-old motorcyclist was admitted to the Emergency Department after a traffic accident. The patient is unconscious. The examination revealed: rigid abdomen, HR 140 / min, BP 60/40 mmHg, GCS 3, no auscultation noise above the left pleural cavity. At FAST, fluid in the peritoneal cavity. In blood gas, the estimated Hb concentration is about 6.5 g / dL. What should be the order of the proceedings?

AWhole body CT scan - laparotomy - drainage of the left pleural cavity.
BChest X-ray - drainage of the left pleural cavity - laparotomy.
Cdrainage of the left pleural cavity - laparotomy - CT of the whole body after stabilization general.
Dadmission to ICU - massive blood transfusion - laparotomy after stabilization of patient’s general condition.
Elaparotomy - drainage of the left pleural cavity - CT of the whole body after stabilization general.

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Question 163

The term ”death triad” denotes:

Ahyperthermia, acidosis, coagulation disorders.
Bhypothermia, acidosis, coagulation disorders
Chypothermia, alkalosis, coagulation disorders.
Dhypothermia, alkalosis, water-electrolyte imbalance.
Ehyperthermia, alkalosis, coagulation disorders

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Question 164

The intubation of a patient is indicated when their Glasgow Coma Scale score is:

A≤ 10points.
B≤ 9 points
C≤ 8 points
D≤ 7 points
E≤ 6 points.

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Question 165

A 50-year-old man comes to the ER because of vomiting for the last 24 hours. The first and immediate step should be the intravenous transfusion of:

A5% glucose solution
B10% glucose solution
C20% glucose solution
D0,9% sodium chloride solution
E3% sodium chloride solution

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Question 166

The right of the patient to be informed includes:

Agiving them only the information on their health.
Bgiving them the easily understandable information on their health, diagnosis, suggested and possible diagnostics, treatment and its possible results coming from either applying or abandoning it, prognosis.
Cgiving them the easily understandable information on their health, diagnosis, suggested and possible diagnostics, treatment and all results coming from either applying or abandoning it, prognosis.
Dgiving the information to a person close to the patient even against the patient’s will.
Egiving the patient only the general information about the surgery.

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Question 167

The doctor providing the patient with medical services is allowed to refuse the patient the right to have their life partner present if:

Apatient requires professional nursing care.
Bpatient stays in the clinical hospital and their examination is of demonstrative nature in which students take part.
Cfor organizational reasons there are a number of patients being examined at the same time in a room with no private spaces.
Dthere is a probability of epidemic threats or patient’s health is in danger.
Ethey cannot guarantee the partner health security with regards to medical services provided.

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Question 168

A fully capable to express informed consent participant of a non-commercial clinical test carried on by the medical school:

Ahas to be acquainted with the purposes, risks and inconveniences associated with the test and the conditions in which the test is going to be carried out and they can withdraw at any time.
Bhas to be acquainted with the purposes of the test and the conditions in which the test is going to be carried out and can withdraw at any time.
Chas to be acquainted with the risks associated with the test and cannot withdraw from it if they expressed a written consent to take part in it
Dhas to be acquainted with the risks associated with the test and can withdraw on condition that they cover all the costs incurred by the medical school and its researcher.
Ehas to be acquainted with the purposes associated with the test and can withdraw on condition that they cover all the costs incurred by the medical school and its researcher.

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Question 169

A victim of a traffic accident was brought to the hospital. Despite several days of efforts of the doctors, the patient did not regain consciousness, and breathing is maintained with the help of a respirator. The commission declared brain death. To obtain organs for transplant, in accordance with applicable law, it is necessary:

Ato ensure that the deceased did not object in his lifetime
Bto make sure that the deceased declared consent in life
Cto obtain the consent of the deceased's family
Dto obtain the consent of the guardianship court
Eto obtain the consent of the prosecutor

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Question 170

To which sources of proceedings does the Code of Medical Ethics refer doctors in matters not regulated by it?

Aprofessional tradition.
Bprofessional tradition and religious associations which doctors identified themselves with.
Cmedical legislation.
DConstitution of the Republic of Poland.
Eprinciples expressed in the resolutions of the medical self-government authorities, in medical court case law and in good manners accepted by the medical community.

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Question 171

Is the doctor allowed to take part in activities aiming to trigger hereditary genetic changes in humans?

Athere are no regulations in this field.
Bno, this is a prohibition under the Criminal Code.
Cno, although this is the co-called imperfect ban - it results from the European Bioethical Convention, which is not binding in Poland.
Ddoctor is not allowed to do so - the ban is expressed directly in the Act on the profession of doctors and dentists.
Edoctor is not allowed to do so - the ban is expressed directly in the Code of Medical Ethics.

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Question 172

The duty of the Regional Chamber of Physicians does not include:

Arelease information to interested doctors concerning the general rules of the profession, medical ethics and healthcare regulations
Bkeeping records of individual medical practices in the Register of Entities Performing Medical Activities.
Crunning self-help institutions and other forms of material support for doctors and their families.
Dkeeping records of group medical practices in the Register of Entities Performing Medical Activities.
Ekeeping records of processing personal data in relation to medical activities performed by the members.

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Question 173

Who can issue a patient’s death certificate?

Aany doctor
Bany doctor with at least five years of service.
Cdoctor employed in a specific entity dealing with forensic medicine.
Dhospital representative on approval of the prosecutor.
Eany employee performing a medical profession who is previously authorized by director of the hospital

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Question 174

If the doctor does not give the patient who is qualified for further treatment the information on the suggested and possible diagnostics and treatment:

Adoctor is not lawfully liable - there is no obligation to provide such information.
Bdoctor is exposed to civil liability - the patient can demand monetary compensation and also the doctor is professionally liable.
Cdoctor is exposed to criminal liability - not passing the information is an offense subject to private prosecution
Ddoctor assumes no civil liability and can only be held responsible before a medical court.
Edoctor is exposed to civil liability - the patient can demand monetary compensation which amount is set by a commission operating at the competent voivode.

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Question 175

A certificate of temporary unfitness for work due to illness or hospital stay can be sent to the e-mail inbox of the Social Insurance Institution in a form of an electronic document by:

Aonly a certifying doctor of the Social Insurance Institution.
Bonly a medical specialist.
Conly a medical specialist authorised by the Social Insurance Institution to issue medical certificates on temporary unfitness for work.
Dany doctor authorised by the Social Insurance Institution to issue medical certificates on temporary unfitness for work.
Eany doctor who completed a suitable training in issuing medical certificates in the form of an electronic document.

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Question 176

According to the Law the accident at work is defined as a sudden event brought about by an external cause resulting in injury or death and which occurred during/while:

1) performing an activity for the employer without their order;

2) business trip;

3) population self-defense training;

4) performing tasks commissioned by professional organizations at the employer’s.

The correct answer is:

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

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Question 177

The circumstances qualifying the insured for receiving a rehabilitation allowance (unfitness for work after exhaustion of sickness benefit, with the prognosis that the further treatment or physiotherapy will restore the ability to work) are defined by:

Acertifying doctor of the Social Insurance Institution.
BMedical Committee of the Social Insurance Institution.
Cgeneral practitioner
Doccupational medicine specialist.
Ephysician issuing a sick leave for the insured.

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Question 178

A person partially unfit for work is a person who:

Alost the ability to perform any kind of paid work.
Bwas never able to perform any paid work.
Crequires help from third parties in performing simple daily activities.
Dlost the ability to perform any work consistent with his/her qualifications to a significant extent.
Edoesn’t have any professional qualifications.

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Question 179

The employer employing employees in conditions of exposure to carcinogens and fibrotic pollen is obliged to provide them with additional periodic examinations:

Aabsolutely once every 12 months
Bafter termination of employment if a person concerned submit an application for them; the costs are covered by the person concerned.
Cabsolutely after termination of employment.
Dafter cessation of the exposure; the costs are covered by the employer.
Eemployer is not obliged to provide such employees with additional periodic examination.

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Question 180

On the same level as temporary incapacity to work due to illness is treated inability to work resulting from:

1) stay at a stationary addiction treatment institution for the cure of alcohol dependence, addiction to narcotic drugs or psychotropic substances;

2) honorary blood donor’s set deadline for blood donation;

3) stay at a vocational rehabilitation institution;

4) decision issued by a relevant entity based on the regulations on preventing and combating infections and infectious diseases in humans.

The correct answer is:

Aall the above.
Bonly 1.
C1,4.
D1,3.
Eonly 4.

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Question 181

The supervision over the compliance of the Social Insurance Institution (ZUS) with applicable regulations is exercised by:

AMinister of Health.
BMinister competent in social security.
CPrime Minister.
DSupervisory Board of the Social Insurance Institution.
EPresident of the Social Insurance Institution.

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Question 182

In what situation does the employer order tests for an employee exposed to harmful factors and who bears the costs?

Abefore starting work, at the employee's expense
Bbefore starting work and during employment, at the expense of the employee
Cbefore starting work and during employment, at the employer's expense
Donly during employment, at the employer's expense
Eafter work, at the expense of the employee

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Question 183

One of the family doctor's duties is to keep medical records. The individual documentation of the patient consists of the internal documentation, kept for the purposes of the entity providing care, and the external documentation. The internal individual documentation includes:

1. health and disease history

2. patronage visit card

3. referral for diagnostic test

4. referral to the hospital

5. hospital treatment information card

The correct answer is:

Aonly 1
B1,2
C1,2,3
D1,3
Eall the above

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Question 184

In a given calendar year there were 100 cases of X disease in a city of 500,000 inhabitants. Half of the patients died. All the cases occurred in the same city district. Given the circumstances, what else do we have to know to calculate the incidence rate in this district and year?

Aage structure of the city’s population.
Bcase fatality rate in this district.
Cthat district population in the middle of this year.
Dduration of the prodromal period of X disease.
Eno further data is needed to calculate the incidence rate.

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Question 185

In the years 2016 - 2018 African Swine Fever occurred in Asia and Africa (only in domestic pigs) as well as in Europe (in wild boars and domestic pigs). In 2018 ASF outbreaks in domestic pigs occurred in six EU countries (Romania, Poland, Lithuania, Latvia, Italy, Bulgaria). The occurrence of ASF bears the hallmark of:

Aepidemic
Bendemic.
Cepizootic.
Denzootic.
Eepidemic outbreak

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Question 186

The recommendation 179/2014 of 28 July 2014 issued by the President of Agency for Health Technology Assessment qualifying the medical service “treatment of coronary vessels with a drug-releasing balloon” as a guaranteed benefit is an example of the use of:

Ahealth technology assessment
Btechnology security analysis.
Ctechnology clinical effectiveness analysis.
Deconomic analysis (technology cost effectiveness).
Eanalysis of alternative solutions for technology.

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Question 187

The data on the number of the cases of X disease obtained in surveys carried out during health festivities is of little value as far as epidemiology and the disease spreading are concerned because:

Adata on comorbidities is not collected.
Bself-selection of the respondents means that the sample is not representative.
Cfalse negative results are common.
Dthere is no further diagnostic system.
Emost diseases are rare in the population.

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Question 188

A person with an infectious disease capable of spreading to other healthy people is:

Aderatization
Bdisinfection
Cepidemic outbreak
Ddisinsection
Esterilization

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Question 189

According to NHS Scotland data in the last decade the participation in cytological screening has dropped from 80% to 70% in women aged 25 -34 with low education. Indicate health effects of this situation:

Aincrease in public spending on medical services.
Bincrease in inequalities in health.
Cblaming women for not being responsible for their health.
Dintensification of information campaigns.
Egreater involvement of gynecologists.

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Question 190

Which antipyretic may be given to a 2-month-old child?

A0.6 mL of ibuprofen suspension (200 mg/5 mL), i.e. 5 mg/kg/dose.
B1.25 mL of ibuprofen suspension (200 mg/5 mL), i.e. 10 mg/kg/dose.
C2.5 mL of ibuprofen suspension (200 mg/5 mL), i.e. 20 mg/kg/dose.
D0.75 mL of paracetamol suspension (100 mg/1 mL), i.e. 15 mg/kg/dose.
Enone, only physical methods can be used.

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Question 191

Life-threatening anemia should be diagnosed when hemoglobin concentration drops below:

A7,5 g/dl
B7g/dl
C6,5g/dl
D6g/dl
E5,5 g/dl

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Question 192

A Sengstaken-Blakemore tube is used to:

Ameasure of pulmonary wedge pressure.
Bremove varices in the lower limbs.
Cperform colonoscopy.
Dtemporally stop the bleeding from esophageal varices.
Eremove gallstones during ERCP.

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Question 193

A 44-year-old woman comes to the doctor because of the stiffness of her hands occurring in mornings for several months. The stiffness usually subsides after more than one hour. What is the most probable cause of these symptoms?

Aosteoarthritis.
Brheumatoid arthritis.
Cgout.
Dpsoriasis.
Eankylosing spondylitis

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Question 194

A 35-year-old patient was admitted to the surgical ward with the diagnosis of acute pancreatitis in the course of alcohol use disorder. The patient complains of epigastric pain and vomiting. In the imaging studies cholelithiasis has been excluded, and acute edematous pancreatitis has been confirmed without any pathological cysts in the pancreatic area. There are no signs of cholangitis and inflammatory markers are low. Indicate the correct management:

Aurgent laparotomy and a drainage of the peritoneal cavity.
Bdischarge after 24 hour observation.
Cconservative treatment until the normalization of laboratory test results and the relief of symptoms.
Dlaparoscopic cholecystectomy.
EERCP or MRCP.

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Question 195

Indicate the true statement concerning the risk factors for ovarian cancer:

ABRCA2 mutation is more common than BRCA1 mutation in Poland.
Brisk of the disease is higher in the bearers of BRCA1 mutation than in the bearers of BRCA2 mutation.
Crisk of the disease is similar in the bearers of BRCA1 mutation and the bearers of BRCA2 mutation.
Dfamily history of breast cancer does not increase the risk of the disease.
Elong-term use of hormonal contraceptives increases the risk of the disease.

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Question 196

An adult man who has fallen from the third floor is unconscious: he does not open eyes in response to pain, does not produce any sound, tenses up extensor muscles of the limbs, he extends and rotates internally his arms - he holds his limbs in an extended position. What should his GCS score be?

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Question 197

An increased aminotransferase activity does not occur in:

Anon-alcoholic fatty liver disease.
BKawasaki disease.
CDuchenne muscular dystrophy.
Diron-deficiency anemia.
Eacute hepatitis.

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Question 198

The sign and symptoms of hyperparathyroidism do not include:

Aosteoporosis.
Brecurrent peptic ulcer.
Ccirrhosis of the liver.
Drecurrent pancreatitis with lithiasis.
Epolyuria and a tendency towards urinary tract infections.

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Question 199

Indicate the true statement concerning acute pancreatitis (AP):

Amain causes of AP are gallstones and drug abuse.
Bin 50% of patients the AP has the form of severe necrotic pancreatitis.
Cin the course of AP the increase in serum lipase activity lasts longer than the increase in amylase activity.
Dendoscopic retrograde cholangiopancreatography should be performer in all patients with the diagnosis of AP.
Ewhen severe necrotic pancreatitis is diagnosed, the treatment of choice is surgery

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Question 200

A 68-year-old woman came in the evening to the ER because of colic abdominal pain, fecal vomiting, intermittent diarrhea and constipation for 7 days, and the presence of fresh blood in the stool. She reports she had lost 12 kg for the last 3 months without any specific diet. On physical examination the abdomen is distended, without muscle guarding, with audible resonant peristaltic sounds. On per rectum examination - the rectal ampulla is empty. Indicate the correct management:

Aadmission to the internal medicine ward for the hospital observation.
Babdominal ultrasound imaging and the observation in the out-patient settings
Curgent out-patient colonoscopy.
Dadmission to the general surgery ward and qualification to the surgical treatment of the ileus.
Edischarging the patient to home and referral for the control visit in the surgery outpatient clinic on the next day

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