A. inherited lack of colon autonomic innervations.

B. acute pseudo-obstructive large bowel dilatation.

C. mechanical large bowel obstruction.

D. hereditary non-polyposis colon cancer.

E. ruptures of a ventral part of the oesophageal mucosa caused by vomiting.

A. increase in pain perceived by a patient while the hand of the examiner is taken away from the abdominal wall.

B. miosis caused by increased intracranial pressure.

C. clenched fist held over the chest to describe ischemic chest pain.

D. seizures occurring on neck forward flexion.

E. cyanosis of the ear flap subsiding on its massage.

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LEKEXAM / 2021 spring

Question distribution — 2021 spring session

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

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Question 1

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

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

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Question 2

According to the Code of Medical Ethics the decision to stop the resuscitation is taken by:

Amedical consultation.
Bhead of the hospital ward or their substitute
Chospital ethics committee.
Dmanager of a relevant medical facility.
Edoctor and is associated with the assessment of medicinal chances.

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Question 3

A 7-month-old boy presented with a 2-day history of fever up to 39 °C. General condition was good. Physical exam revealed pharyngitis only. On the day 3 temperature normalized and multiform macular, pink-red rush fading under pressure was observed,. What is the most probable aetiology of the presented case?

Astreptococci (group A).
Bhuman herpes virus type 6 (HHV-6).
Cvaricella zoster virus
DEbstein-Barr virus.
Emeasles virus

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Question 4

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

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

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Question 5

Indicate the true sentence:

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

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Question 6

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

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

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Question 7

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

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

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Question 8

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

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

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Question 9

The HLY indicator means:

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

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Question 10

According to the current Polish National Program of Immunizations, which of the statements below is false in case of a child with the birth weight of 1700g?

ABCG vaccination should be postponed until the body weight has reached 2000 g.
Bvaccination against hepatitis B should be postponed until the body weight has reached 2000 g.
Cas a mandatory vaccination against diphtheria, tetanus and pertussis a vaccine with an acellular pertussis component should be used.
Das a mandatory vaccination the child should receive a conjugated pneumococcal vaccine
Evaccination against measles, mumps and rubella should be given according to the chronological age

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Question 11

Taking into consideration a theoretical risk of foetus malformations caused by the vaccine, an attenuated strain of rubella virus, what is the minimal interval between the vaccination with a combined measles-mumps-rubella vaccine and the planned pregnancy according to the Polish National Program of Immunizations?

A2 weeks
B4 weeks
C2 months
D3 months
E6 months

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Question 12

In a pregnant vegetarian you should expect the insufficiency of vitamin:

1. B2

2. B12

3. D

4. C

5. E

AOnly 1
BOnly 2
COnly 3
D1, 3, 4, 5
E1, 2, 4, 5

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Question 13

When, during pregnancy, the concentration of the β-subunit of hCG in blood is the highest?

A5-6 week
B6-7 week
C9-12 week
D14- 16 week
E16-18 week

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Question 14

Indicate the true statement concerning the uterine artery:

Aoriginates from the ovarian artery.
Bgives the branch running through the round ligament.
Coriginates from the internal iliac artery
Dcrosses the ureter from the rear.
Eprovides blood to the uterus only.

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Question 15

Which of the following is not among the abnormalities of the head position during labour:

Adeep transverse arrest.
Bbrow presentation.
Cocciput posterior position.
Dleft or right posterior position.
Eocciput anterior position.

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Question 16

Which of the following ways of treatment restores the anti-reflux barrier in gastroesophageal reflux disease?

Aprokinetic drugs
Bproton pump inhibitors.
Ccardiomyotomy
Dcardioplasty
Efundoplication

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Question 17

A 30-year-old woman, weighing 60 kg, was referred to the ER with III degree burnings of the left upper extremity, left lower extremity and of the groin. What volume of fluids should be administered within 24 hours?

Aapprox. 7 litres.
Bapprox. 2 litres
Capprox. 15 litres.
Dshe needs only oral fluids.
Edescribed degree and extent of burns do not need intensive fluid therapy.

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Question 18

Ogilvie syndrome is:

Ainherited lack of colon autonomic innervations.
Bacute pseudo-obstructive large bowel dilatation.
Cmechanical large bowel obstruction.
Dhereditary non-polyposis colon cancer.
Eruptures of a ventral part of the oesophageal mucosa caused by vomiting.

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Question 19

Which of the following is not an indication for liver transplantation:

Apost-inflammatory liver cirrhosis
BBudd-Chiari syndrome.
CWilson's disease
Dprimary and secondary biliary liver cirrhosis.
Edisseminated hepatocellular carcinoma

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Question 20

The potentially reversible causes of cardiac arrest (so-called ‘four H’) do not include:

Ahypoxia
Bhypovolemia
Chypercalcemia
Dhyperkalemia
Ehypothermia

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Question 21

What is the correct frequency of chest compressions during cardiopulmonary resuscitation in an adult?

A60-70 / min
B80-90 / min
C100-120 / min
D130-140 / min
E140-150 / min

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Question 22

Naloxone is used in the case of poisoning with:

Abenzodiazepines.
Bamanita phalloides (‘death cap’)
Catropine
Dopioids
Emethyl alcohol

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Question 23

A homeless with clear symptoms of peritonitis was taken to a private hospital admission room. The hospital is able to help the patient but it does not have the contract signed with the National Health Fund (NFZ) for this type of medical services. How should the doctors proceed?

Athey should refuse help justifying the move in the medical documentation by a lack of funding for this type of medical procedures.
Bthey should refuse the medical service but it is their duty to indicate another medical facility where such a service is available.
Cthey can help but after assuring the financing from the National Health Service (NFZ) for this procedure.
Dif the patient’s life or health is in danger they should help the patient regardless of a lack of the contract with the National Health Service (NFZ).
Ethey can help but after obtaining a written agreement from the community administrator, mayor or city president that the community will cover the cost of the procedure.

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Question 24

The first-choice drug used in treatment of acute liver failure related to paracetamol (acetaminophen) overdose is:

AN-acetylcysteine
BBAL
CVitamin E (high doses)
DGlutathione.
EBarbiturate

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Question 25

Hypercalcemia does not occur in:

Aprimary hyperparathyroidism
Buntreated postoperative hypoparathyroidism
Cmilk-alkali syndrome
Dmultiple myeloma
Ehyperthyroidism

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Question 26

An infant received the second dose of DTP vaccine 20 days after the first one. What is the proper management in this case?

Asecond dose should be considered realized and the vaccination should be continued according to the schedule.
Bsecond dose should be considered not realized and it should be repeated after 4 weeks; next doses should be given according to the schedule.
Cin this case the third dose should be given 20 days after the second dose
Din this case the time span between the second and third dose should be increased to 40 days and next doses should be given according to the schedule.
EDTP vaccination should be restarted from the first dose after a 4-week break

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Question 27

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 28

The ankle-brachial pressure index (ABPI) in healthy people is at least 1. ABPI score <0.5 indicates:

Acritical limb ischaemia
Bsuperficial vein thrombosis
Cdeep vein thrombosis
Dpulmonary embolism
Eit is not possible to obtain such a result

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Question 29

Which of the following distinguish allergic rhinitis from a common cold:

1 - itchy nose

2 - watery nasal discharge

3 - sneezing

4 - cough

5 - fever

Aonly 1
B1 ,2
C2, 3
D3, 4
Eonly 5

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Question 30

Indicate the false statement:

Ain adults the lymph nodes are considered significantly enlarged in their diameter is ≥ 2 cm.
BGeneralized lymphadenopathy may indicate systemic diseases.
CHard lymph nodes suggest the presence of neoplastic metastates, lymphoma or chronic leukemia.
DLymph nodes painful on palpation may suggest neoplastic process.
ELymph nodes unmovable against the skin and deep tissues suggest chronic inflammation or neoplastic process.

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Question 31

Levine's sign is:

Aincrease in pain perceived by a patient while the hand of the examiner is taken away from the abdominal wall.
Bmiosis caused by increased intracranial pressure.
Cclenched fist held over the chest to describe ischemic chest pain.
Dseizures occurring on neck forward flexion.
Ecyanosis of the ear flap subsiding on its massage.

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Question 32

Does the Code of Medical Ethics refer to euthanasia?

Ano, that problem is not included in the document.
Bno, that issue was raised in the Act on Professions of Physician and Dentist
Cno, such regulations were included only in historical papers, especially in the Hippocratic Oath
Dyes, the Code clearly points out that the physician is not allowed to perform euthanasia and help the ill to commit suicide.
Eyes, but the Code does not use the term “euthanasia”

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Question 33

In accordance with the law on old age and disability pensions paid from SIF, an insured person who does not agree with the SIF certifying doctor’s ruling is allowed to appeal within 14 days of the date of receiving the ruling to:

ACourt of Labor and Social Security.
Bbranch manager of SIF.
Cpresident of SIF.
DSIF medical board.
EMinistry of Family, Labor and Social Policy.

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Question 34

In accordance with the law on old age and disability pensions paid from SIF, insured persons are entitled to the disability pension resulting from incapacity for work if they have the required contributory and non-contributory period and hold the medical ruling on:

Asignificant degree of disability.
Bincapacity for work which arose during the insurance period but not later than 36 months from the date of the termination of employment.
Cincapacity for work which arose during the insurance period but not later than 24 months from the date of the termination of employment.
Dslight degree of disability.
Eincapacity for work which arose during the insurance period but not later than 18 months from the date of the termination of employment.

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Question 35

Which of the following is the indication for cardioversion?

Aatrial fibrillation.
Bventricular fibrillation.
Casystole.
Dpulseless electrical activity.
Epulseless ventricular tachycardia

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Question 36

Which of the following drug combinations is not recommended in the treatment of hypertension?

Aperindopril and amlodipine
Bramipril and indapamide
Camlodipine and hydrochlorothiazide
Dlosartan and ramipril
Elosartan and indapamide

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Question 37

Indicate the medication which should not be used in the first-line treatment of hypertension:

Aamlodipine
Blosartan
Cramipril
Dclonidine
Eindapamide

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Question 38

The treatment of acute hyperkalemia includes the administration of:

1) spironolactone;

2) sodium bicarbonate;

3) furosemide;

4) potassium chloride;

5) heparin;

6) calcium chloride.

The correct answer is:

A1,5,6
B2,4,5.
C3,5,6
D2,3,6.
E1,3,6.

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Question 39

A 72-year-old man has been taken to the emergency unit because of a severe retrosternal pain lasting for 40 minutes. Anterior ST elevation myocardial infarction is recognized. What is the most preferred method of treatment in this patient?

Aoral administration of nitroglycerine
Bintravenous administration of nitroglycerine
Cfibrinolytic treatment with streptokinase
Dfibrinolytic treatment with tissue plasminogen activator
Epercutaneous coronary intervention as soon as possible

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Question 40

Wells’ scoring system used to estimate the risk of pulmonary embolism does not include:

Ablood platelet count.
Btachycardia > 100/min.
Chemoptysis.
Dmalignant tumor
Erecent surgery

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Question 41

During the treatment with acenocoumarol/warfarin a dose of the drug should be adjusted based on:

AINR (international normalized ratio).
BAPTT (activated partial thromboplastin time).
CClotting time
DBleeding time
EPlatelet count

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Question 42

In a patient with systemic lupus erythematosus with the involvement of the respiratory system in the form of lupus pneumonitis, the following treatment may be applied:

Aglucocorticosteroids in large doses orally or in i.v. pulses.
Bcyclophosphamide i.v. in pulses.
Cplasmapheresis.
Dazathioprine, especially as a maintenance therapy after cyclophosphamide induction.
Eall the above.

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Question 43

A 2-year-old boy was admitted to the hospital because of a high fever in the last 7 days and neck lymphadenopathy. On the 5th day of the fever maculopapular eruptions occurred in the area of the crotch and on the trunk. Conjunctivitis, red lips and „strawberry” tongue were also noted. Laboratory tests showed elevated markers of inflammation (CRP), thrombocytosis, anemia, ALT = 100 U/L, AST = 85 U/L, normal coagulation tests. Which of the following diagnoses is the most probable?

AHenoch-Schönlein purpura.
BKawasaki disease
CRheumatic fever
DScarlet fever
ENone of the above.

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Question 44

A 10-year-old child with diabetes diagnosed one year ago was completely vaccinated against hepatitis B in the infancy. The parents ask whether the child needs the revaccination against hepatitis B due to the diabetes. Which is the right answer?

Athe child does not need any further vaccinations against hepatitis B.
Bconcentration of anti-HBs antibodies should be measured - if the result is higher than 10 IU/L the child does not need any additional doses of HepB vaccine.
Cconcentration of anti-HBs antibodies should be measured - if the result is higher than 100 IU/L the child does not need any additional doses of HepB vaccine.
Done booster dose of HepB vaccine should be given
Ethe child should again receive the full 3-dose schedule at 0, 1 and 6 months.

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Question 45

Indicate the false statement concerning chemoprophylaxis after the contact with a patient infected with Neisseria meningitidis:

Ait is recommended for anyone who stayed in the patient’s home or slept in the same room during 7 days before the onset of the symptoms
Bvaccination should be considered in not vaccinated children.
Cit consists in acyclovir given orally at a dose of 4 x 200 mg
Dit should be applied to close contact persons preferably within 24 hours, but not later than 2 weeks after the onset of the symptoms.
Echildren should receive rifampicin or ceftriaxone

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Question 46

As a consequence of physiological processes in the circulatory system of a pregnant woman in the case of single pregnancy the volume of circulating blood can increase by up to:

A20%
B30%
C40%
D50%
Ein a single pregnancy there is no change in the volume of circulating blood of the pregnant woman

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Question 47

CURB-65 score facilitates making decision on the proper management of a patient with:

Aurinary incontinence.
Bpneumonitis
Cacute pancreatitis
Dischemic brain stroke.
Emyocarditis.

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Question 48

Which of the following risk factors are conducive to injuries and accidents (especially traffic ones)? 1) drugs; 2) alcohol abuse; 3) dangerous car driving; 4) failure to use seatbelts; 5) low physical activity. The correct answer is:

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

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Question 49

Complete blood count: WBC 4,1 G/L, LY 0,91 G/L, MO 0,18 G/L, NE 2,81 G/L, RBC 2,16 T/L, Hgb 8,6 g/dL, MCV 119,0 fl, PLT 182 G/L suggests the diagnosis of:

AIron deficiency anemia
BB12 deficiency anemia
CAplastic anemia
DPolycythemia vera
EThalassemia

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Question 50

Antinuclear antibodies specific for Scl-70 antigen are present in patients with:

ASystemic lupus erythematosus.
BSeronegative spondyloarthropathy.
CPseudogout caused by calcium pyrophosphate.
DRheumatoid arthritis.
ESystemic sclerosis.

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Question 51

Which of the following signs and symptoms is not typical of iron-deficiency anemia?

Aheadaches and dizziness
Bweakness.
Ccardiac systolic murmur.
Dangular cheilitis
Ebradycardia.

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Question 52

Indicate the true statement concerning bronchitis in children:

Ait is caused by bacteria in above 90% of cases.
Bnebulization with 3% solution of sodium chloride can be used to ease the symptoms of acute bronchitis.
Crales can be heard over the lungs on physical examination.
Dprophylaxis of bronchitis includes annual influenza vaccination of children above 1 month of age
Ediagnostics of bronchitis includes chest x-rays as standard procedure.

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Question 53

Beckwith-Wiedemann syndrome is associated with an increased risk of developing:

AWillms tumor
BHepatoblastoma
CWillms tumor and hepatoblastoma
DWilms tumor and retinoblastoma.
Eretinoblastoma.

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Question 54

Which of the following can be classified as the grade II according to Hinchey classification of complications caused by diverticulitis?

Adiverticulitis with para-colonic abscess.
Bdiverticulitis with pelvic abscess.
Cdiverticulitis with purulent peritonitis.
Ddiverticulitis with feculent peritonitis.
EHinchey classification is not related to diverticulitis.

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Question 55

Parkland formula is used for:

Aassessment of the risk of death after a sudden cardiac arrest.
Bcalculation of X-ray radiation dose per body surface area
Ccalculation of the amount of fluids to infuse in burnt patients
Dassessment of the state of consciousness
Ecalculation of the dose of methylprednisolone after the spine injury.

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Question 56

A patient was admitted to the surgical ward in duty hours. The patient needs urgent surgery but he receives chronic anticoagulant therapy with vitamin K antagonist (VKA). Which of the following should be used to reverse VKA action promptly?

Aplatelet concentrate.
Bfresh frozen plasma.
Cserum albumin.
Dvitamin K intravenously.
EA and D are correct.

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Question 57

The Mallampati classification is used to predict the difficulties in endotracheal intubation. What class according to this classification is assigned to the situation where the soft palate is not visible in a patient with their mouth open?

Afirst.
Bsecond.
Cthird.
Dfourth.
Efifth

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Question 58

Negative symptoms of schizophrenia include:

Anihilistic delusions.
Bhallucinations
Cemotional rigidity
DA and C are correct.
Edisorders of thinking.

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Question 59

Which of the following activities are characteristic of six-month- old infants?

Asupporting their body on the extended arms with partly or fully opened hands
Bbringing a toy from one hand to the other
Cdropping things on purpose
DA, B are correct
EA, B, C are correct.

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Question 60

Which of the following cannot be a preventive measure, ordered by the court, for a mentally ill patient who committed a crime?

Asurveillance with electronic monitoring.
Btreatment at the out-patient clinic.
Cconstant care provided by the patient’s family.
Dhospitalization at the psychiatric ward.
Edrug rehabilitation.

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Question 61

The most common acquired valvular heart disease in adults is:

AMitral stenosis
BAortic regurgitation
CMitral regurgitation
DTricuspid stenosis
EAortic stenosis

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Question 62

Indicate the true statement concerning the incidence of hernias:

Athe most common are indirect inguinal hernias; less common are direct inguinal hernias, and the least frequent are femoral hernias; inguinal hernias occur more frequently in females.
Bthe most common are indirect inguinal hernias; less common are direct inguinal hernias, and the least frequent are femoral hernias; inguinal hernias occur more frequently in males.
Cthe most common are indirect inguinal hernias; less common are direct inguinal hernias, and the least frequent are femoral hernias; inguinal hernias occur in females and males with similar frequencies.
Dthe most common are direct inguinal hernias; less common are indirect inguinal hernias, and the least frequent are femoral hernias; inguinal hernias occur more frequently in males.
Ethe most common are femoral hernias; less common are direct inguinal hernias, and the least frequent are indirect inguinal hernias; inguinal hernias occur more frequently in females.

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Question 63

Which of the following is characteristic of stress urinary incontinence (SUI) in women?

Ainvoluntary voiding that is preceded by strong urge to void and nycturia.
Bleakage of urine following increased abdominal pressure.
Cinvoluntary leakage of urine as the bladder is filled over.
Dcontinuous urinary leakage through the fistula.
Efeeling of incomplete voiding after emptying the bladder.

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Question 64

Which of the following is not the symptom related to uterine fibroids?

Amenorrhagia
Bprolonged menstruation
Chypogastric pains
Dpressure on the bladder or the rectum
Esecondary amenorrhea

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Question 65

Indicate the true statements concerning oxytocin test:

1) it is a stress test;

2) it is a biophysical test assessing the placental efficiency;

3) positive result is concluded on the basis of late decelerations present after at least half of the contractions;

4) it is the test of choice in pregnant woman with placenta praevia.

The correct answer is

AAll the above
B1,3,4
COnly 4
D1,2,3
EOnly 1

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Question 66

Ultrasonographic examination performed at 6 week of gestation revealed coexistence of two fetuses and a single yolk sac. That allowed for the diagnosis of:

Amonochorionic, diamniotic twin pregnancy.
Bmonochorionic, monoamniotic twin pregnancy.
Cdichorionic twin pregnancy, conjoint twins.
Ddichorionic twin pregnancy, with abnormal development of one of the fetuses.
Edichorionic, monoamniotic twin pregnancy.

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Question 67

Which of the following is the primary medication used for the long-term antihypertensive therapy in pregnancy?

AMethyldopa
BPerindopril
CEnalapril
DRamipril
ELisinopril

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Question 68

A 13-year-old girl reports to the doctor office with her grandmother. During the examination the doctor starts to suspect that the girl has been sexually abused by her stepfather. The girl confirms this suspicion but asks the doctor to keep it secret. In that situation the doctor:

Ahas the duty to inform law enforcement authorities about the crime committed.
Bhas the duty to inform their superior and seek his/her advice what to do next
Chas the duty to call up her mother to determine the course of events
Dhas the duty to call up emergency shelter.
Eshould keep the medical secret but should call up her mother

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Question 69

What kind of study is a cohort study?

AObservation
BExperimental
CIntervention
DScreening
EClinical

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Question 70

Which of the following statements concerning cold water cooling of the patient suffering from burns is true?

ACooling is more important immediately after the burn.
BCooling should last 15 minutes or until the patient starts shivering.
CNo more than 10% of the body surface should be cooled down at a given time.
DA, B are correct.
EA, B, C are correct.

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Question 71

Which of the following should be recommended for a 55-year-old female patient if her DXA examination showed a T-score = -1,5?

1. calcium- rich diet.

2. Supplementation with vitamin D3.

3. Adequate physical activity.

4. cessation of smoking.

5. Bisphosphonates.

The correct answers is:

A1,2
B1,3
C1,2,4
D1,2,3,4
EAll the above.

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Question 72

Indicate the minimal time of the presence of symptoms necessary to formulate the diagnosis of the given psychic disorder:

A4 weeks for the episode of depression
B7 days for manic syndrome
C2 months for generalized anxiety disorder
DCorrect answers A, B
ECorrect answers A, B, C

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Question 73

Parasomnia does not include:

ASomnambulism
BNightmares
CNocturnal bruxism
DNarcolepsy
Esleep terrors.

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Question 74

According to the article 23 of the act on the mental health, a person can be hospitalized at the psychiatric hospital without their consent if:

1) is mentally ill and does not take medications systematically;

2) is mentally ill and poses a threat to their own life;

3) is mentally ill and poses a threat to other people’s health or life;

4) poses a threat to the legal system;

5) is suspected of mental illness to verify the diagnosis by observation. The correct answer is:

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

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Question 75

Hypothermia is a life-threatening condition defined as:

Acooling of the body below 32°C as measured in the armpit.
Binternal body temperature decrease below 35°C.
Clowering of the body temperature below 36°C with chills present.
Dlowering of the body superficial temperature below 35°C
Elocal cooling of the body below 35°C.

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Question 76

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

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

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Question 77

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

A50.
B45.
C40.
D35.
E30.

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Question 78

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

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

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Question 79

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

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

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Question 80

Prohibited vaccinations during pregnancy include:

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

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Question 81

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

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

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Question 82

Prolonged QRS duration occurs in:

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

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Question 83

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

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

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Question 84

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

AFregoli.
BCapgras.
CCotard.
DOthello.
EGanser.

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Question 85

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

A5%
B10%
C15%
D16%
E32%

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Question 86

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 87

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 88

”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 89

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 90

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 91

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 92

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 93

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 94

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 95

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 96

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 97

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 98

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 99

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 100

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 101

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 102

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 103

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 104

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 105

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 106

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 107

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 108

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 109

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 110

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 111

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 112

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 113

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 114

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 115

What is the most common parenteral cause of mechanical obstruction of the small intestine in adults in developed countries?

Aadhesions.
Bcancer of the small intestine.
Ctrichobezoar.
Dintussusception.
Eparasitic infestation.

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Question 116

Which of the following features does not belong to Zollinger-Ellison syndrome?

Amultiple gastric and duodenal ulcers.
Berosive esophagitis.
Csteatorrhea
Dlow blood calcium levels (hypoparathyroidism).
Ehigh levels of gastrin in the blood.

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Question 117

How should vitamin B12 be supplemented in patients with pernicious anaemia (AddisonBiermer anaemia)?

Aorally on an empty stomach for the rest of their life
Borally after a meal for the rest of their life.
Cintramuscular or deep subcutaneous injection for the rest of their life
Dintramuscular or deep subcutaneous injection for 3 months
Evitamin B should not be supplemented.

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Question 118

Subclinical hypothyroidism is characterized by:

Aincrease in TSH concentrations with FT4 concentrations within the normal range
Bnormal TSH concentrations and reduction of FT4 concentrations.
Cdecrease in TSH concentrations and decrease in FT4 concentrations.
Dincrease in TSH concentrations and decrease in FT4 concentrations
Enone of the above.

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Question 119

Superior vena cava syndrome:

Amost commonly occurs in the course of lung cancer.
Bmay be associated with vessel thrombosis.
Cis a contraindication to the use of corticosteroids.
DA and B are correct.
EA, B and C are correct.

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Question 120

Jaundice, low hemoglobin levels, high reticulocyte count, elevated indirect bilirubin levels, negative direct antiglobulin test, decreased erythrocyte osmotic resistance and abnormal EMA test result point to:

Aautoimmune hemolytic anemia.
BFanconi anemia.
CBlackfan Diamond anemia.
Dmyelodysplastic syndrome.
Espherocytosis

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Question 121

A two-year-old child unvaccinated (parents’ decision) came back home after two-week’s vacation from Ukraine. After a week the child developed high fever, dry cough, nasal discharge and conjunctivitis with eyelid edema. After three days numerous grayish white papules appeared on the cheek mucosa and after another two days as the fever dropped, a rash appeared on the forehead and then it spread. The child should be diagnosed with

AKawasaki disease.
Bmeasles.
Cscarlet fever
Dinfectious mononucleosis.
Eroseola

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Question 122

What is the time criterion for the diagnosis of dysthymia in children?

A2 years
B1 year.
C6 months.
D1 month.
E2 weeks.

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Question 123

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 124

Which of the following lowers the pressure in the portal venous system in patients bleeding from esophageal varices?

Aterlipressin.
Bglucagon.
Curapidil.
Dpropranolol
Esodium nitroprusside.

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Question 125

Pelvic floor disorders are the result of the weakening of the supporting and hanging apparatus as well as an excessive action of forces causing a displacement of genital organs. The factors conducive to the decline of the reproductive organ include:

1) damage to the vulvar and pelvic nerves in the course of vaginal delivery;

2) physical work in standing position and associated with carrying;

3) respiratory diseases associated with chronic cough;

4) chronic constipation;

5) post-menopausal estrogen deficiency.

The correct answer is:

A1,2,3,4.
B1,3,4,5.
C1,2.
Donly 1
Eall the above

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Question 126

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 127

An emergency medical ambulance has been called for a 71-year-old patient who passed out. On examination: heart rate 85/min., blood pressure 100/60 mmHg, the ECG - normal, sodium: 130 mmol/L, potassium: 3 mmol/L, height 165 cm, weight 65 kg. Abnormal allopsychic orientation, normal autopsychic orientation, the patient has auditory hallucinations and is susceptible to suggestion. The emergency team should:

Atransport the patient to the psychiatric ward.
Btransport the patient to the ward for internal diseases.
Ctransport the patient to the emergency room.
Dleft the patient at home and recommend a visit to the family doctor.
Eleft the patient at home and recommend a visit to the outpatient psychiatric clinic.

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Question 128

Placing the code "B" in the electronic form of sick leave (ZLA) means incapacity for work:

Aduring pregnancy.
Bdue to alcohol abuse.
Cdue to tuberculosis.
Ddue to the same disease that caused incapacity for work before a period shorter than 60 days.
Edue to an disease whose symptoms may not be recognized until more that 14 days.

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Question 129

In the formula for calculating the specificity of the test, the following number of results is entered in the numerator of the fraction:

Atrue negative.
Bfalse negative.
Ctrue positive.
Dfalse positive.
Eall positive.

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Question 130

A 28-year-old woman who fainted again at home reported to the obstetrics and gynecology ER. On admission she presented pale, sweaty face, rapid heart rate, body temperature 36.6˚C. Despite inserting a contraceptive intrauterine device a year ago, she had her last period 8 weeks ago. Preliminary gynecological examination showed: slight vaginal bleeding, slightly enlarged uterus, painful resistance in the projection of the left uterine appendages and doughy tumor in the pouch of Douglas. These symptoms are indicative of diagnosis:

Aectopic pregnancy - tubular miscarriage.
Bcervical pregnancy
Ccorrectly located pregnancy - incomplete miscarriage.
Dacute adnexitis.
Eovarian cancer.

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Question 131

Medical history of cervical incompetence is an indication for:

Aprophylactic placement of a cervical cerclage.
Bplacement of a cervical cerclage when uterine contractions occur before 28 week of gestation.
Cplacement of a cervical cerclage when there are symptoms of vaginal infection, along with antibiotic therapy
Dfrequent monitoring of the cervical length with ultrasonography.
Ecalcium-rich diet in order to improve the consistence of the cervix.

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Question 132

If a person is under 20 and applies for the disability pension resulting from incapacity for work, then the condition of having the required contributory and non-contributory period of insurance is considered fulfilled provided that this period is at least:

A5 years
B4 years
C3 years
D2 years
E1 year

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Question 133

Which of the following is used for the prophylaxis or the treatment of bleeding in von Willebrand disease?

Adesmopressin.
Bvitamin K.
Cfactor IX concentrate
Dfrozen plasma
Eplatelets transfusion

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Question 134

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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Question 135

A 66-year-old male who has been treated only for hypertension and had no previous diagnosis of atrial fibrillation, checked into emergency dept. because he had heart palpitations for the last 3 days. The patient was haemodynamically stable. ECG showed atrial fibrillation, with ventricle rate of ca. 135/min. Under these conditions, apart from initiating the anticoagulation treatment, you should:

Astop atrial fibrillation by electrical cardioversion, regardless of arrhythmia duration, due to high HR.
Bstop atrial fibrillation by pharmacotherapy, regardless of arrhythmia duration, due to high HR, and if ineffective, perform electrical cardioversion.
Cslow down HR to the safe and well-tolerated level, without breaking arrhythmia.
Dslow down HR to the safe and well-tolerated level only after excluding the presence of thrombi in the heart chambers through transoesophageal echocardiography.
Erefer the patient to cardiology dept. for urgent ablation, in view of no previous diagnosis of atrial fibrillation and the high efficacy of ablation procedure when performed shortly after the onset of arrhythmia before it becomes persistent.

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Question 136

An absolute contraindication to fibrynolysis is:

Aischaemic stroke within the last six months.
Bpregnancy.
Cinfectious endocarditis.
Dactive peptic ulcer disease.
Eall of the above.

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Question 137

Hypercalcemia related to malignancy:

Ais most frequent in patients with chronic myeloid leukaemia.
Bmay be related to parathormone secretion.
Cshould always be treated with oral biphosphonates.
Danswers A and B are correct.
Eanswers A, B, and C are correct.

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Question 138

Lung cancer in Poland:

Ais the most common malignant disease in men.
Bis the most common cause of cancer-related deaths in men.
Cis the most common cause of cancer-related deaths in women.
Danswers B and C are correct.
Eanswers A, B, C are correct.

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Question 139

Cancer of unknown primary site:

Ais found in 30% of all cases of malignant diseases.
Bat least half of the cases have morphology of adenocarcinomas.
Cshould be diagnosed using immunochemistry.
Danswers B and C are correct.
Eanswers A, B, and C are correct.

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Question 140

Indicate which of the following characteristics of submicroscopic glomerulonephritis (minimal lesion nephropathy) are true:
1) nephrotic syndrome dominates in clinical picture;
2) light microscopy shows normal histopathology of kidney tissue;
3) in most patients, hypertension is present;
4) the clinical course is progressive, with up to 40% of patients developing renal failure within five years;
5) the first-line treatment is administration of glycocorticosteroids.
The correct answer is:

A1,2,3,5.
B1, 2, 5.
C2, 3, 4.
D1, 2, 3.
Eall of the above.

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Question 141

Neutropenic fever in cancer patients:

Ain 80% of patients is caused by Gram-negative pathogens.
Bis diagnosed in patients with neutrophil count of less than 500/µl.
Cis more frequent in solid tumours than in leukemias.
Danswers A and B are correct.
Eanswers A, B, C are correct.

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Question 142

Indicate which of the following diseases are characterised by secondary IgA nephropathy:
1) multiple sclerosis;
2) psoriasis;
3) HIV infection;
4) aristocholic acid nephropathy;
5) inflammatory spondyloarthropathies.
The correct answer is:

A2,3,5.
B1, 2, 4, 5.
C2, 5.
D2, 3, 4, 5.
E1, 2, 3.

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Question 143

When diagnosing acute kidney injury, the renal function should be assessed based on:

AGFR changes, using Cockroft and Gault equation.
BGFR changes, using MDRD equation.
CGFR changes, using CKD-EPI equation.
Ddaily changes in creatininemia and diuresis.
Eall of the above is true.

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Question 144

Chronic myeloid leukemia is characterised by:

Ahigh leukocytosis due to eosinophilia, enlarged spleen, enlarged lymph nodes.
Blymphocytosis, enlarged spleen and lymph nodes.
Cleukocytosis (increased WBC) with blasts, immature forms of neutrophils and neutrocytes (“blood smear like bone-marrow smear”), enlarged spleen.
Dpancytopenia, enlarged lymph nodes.
Epancytopenia, enlarged spleen.

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Question 145

The classification criteria for systemic lupus erythematosus do not include:

Adermal and mucosal lesions.
Brenal lesions.
Cpolyserositis.
Dneuropsychiatric symptoms.
Enormal or high concentrations of C3 and C4 components of the complement.

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Question 146

Which of the following endocrinopathies are elements of multiple endocrine neoplasia type 2A (MEN2A syndrome)?
1) primary hypoparathyroidism;
2) medullary cancer of the thyroid;
3) adrenal adenomas;
4) primary hyperparathyroidism;
5) pituitary adenomas;
6) pheochromocytoma.
The correct answer is:

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

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Question 147

A first-degree atrioventricular block could be recognized on ECG on the basis of:

Aprolongation of the PQ interval (PR interval).
Babsence of the P wave.
Cabsence of the Q wave.
Dabsence of the QRS complex after each P wave.
Ewidened QRS complex.

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Question 148

The laboratory tests ordered at the ER show a high NT-proBNP concentration in a patient with dyspnea. Which of the following is the least probable cause of dyspnea, in light of the obtained result?

Aleft ventricular heart failure.
Bpulmonary embolism with a moderate risk of death.
Chigh arterial blood pressure.
Dasthma.
Eatrial fibrillation.

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Question 149

Pleocytosis of 600 cell/µl, with high neutrophil prevalence, high protein concentration (1.5 g/l), high lactic acid concentration, and decreased glucose concentration (decreased cerebrospinal fluid-to-serum ratio) in cerebrospinal fluid analysis points to:
1) bacterial meningitis;
2) viral meningitis;
3) tuberculous meningitis;
4) a necessity for immediate antibiotic therapy;
5) a necessity for antibiotic therapy after positive cerebrospinal fluid culture is obtained.
The correct answer is:

A1,5.
B1,4.
Conly 2.
D2,5.
E3,4.

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Question 150

The treatment recommended for acute sublaryngeal infection may include:
1) intramuscular dexamethasone;
2) inhaled budesonide;
3) inhaled adrenaline;
4) oral prednisone;
5) intramuscular adrenaline.
The correct answer is:

A1,3.
B2,3.
C2,4,5.
Dall of the above.
E1, 2, 3, 4.

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Question 151

A control chest radiography may be indicated in children treated for pneumonia in the case of:
1) persistent abnormalities on auscultation (at the end of treatment);
2) presence of lung abscess in previous exam;
3) presence of atelectasis in previous exam;
4) presence of pleural exudate in previous exam;
5) severe course of pneumonia.
The correct answer is:

A1,3.
B2,3.
C2,4,5.
Dall of the above.
E1, 2, 3, 4.

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Question 152

The mother of a 4-year-old child (with uncontrolled asthma) has been diagnosed with influenza (she has been symptomatic since yesterday). The child is a household contact to the mother. Please indicate the appropriate treatment for the child:
1) start oseltamivir (neuraminidase inhibitor) at a prophylactic dose;
2) recommend seeing the doctor immediately if the symptoms of influenza develop in the child;
3) start oseltamivir at a therapeutic dose if the child has a positive diagnostic test for influenza;
4) start oseltamivir at a prophylactic dose only when the child is symptomatic or has a positive influenza test;
5) refer the child to hospital.
The correct answer is:

A1,3.
B2,3.
C2,4.
D1, 2, 3.
Eonly 5.

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Question 153

The parents checked at evening hours into emergency dept. with a 12-year-old son who suffered from nausea, vomiting, pain during micturition that radiated to the left groin area, and left lumbar pain since morning. On physical examination, tenderness in the abdominal area and positive Goldflam syndrome on the left side were noted. Laboratory test results revealed normal blood cell count and kidney function, increased CRP, and erythrocyturia in urinalysis. Abdomen ultrasound showed left-sided hydronephrosis. The left ureter was not visible. The right diagnosis is:

Aurinary system stones.
Bacute pyelonephritis.
Crapidly progressive glomerulonephritis.
Dperitonitis.
ESARS-CoV-2 infection.

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Question 154

Indicate which of the statements regarding children with confirmed COVID-19 infection are true:
1) over 80% of the children tested have mild infection (are mildly symptomatic or asymptomatic);
2) the high risk groups include, between others, newborns, children with chronic kidney disease, children with obesity;
3) infants and children under 2 years of age always need to be seen by a doctor;
4) oxygen saturation measurement is an essential part of the examination;
5) the markers that can be useful to monitor the cytokine storm include IL-6, ferritin, LDH, and D-dimers.
The correct answer is:

Aall of the above.
B1,2,3,4.
C3,4,5.
D2,3,4,5.
E1,2,4.

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Question 155

Initial ambulatory treatment for severe asthma exacerbation in children under 5 years of age consists in:

Adoubling the dose of inhaled steroids.
Badministration of inhaled short-acting β-mimetics.
Cadministration of inhaled long-acting β-mimetics.
Daddition of anti-leukotriene drugs in treatment.
Eadministration of oral long-acting theophylline.

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Question 156

Indicate false statement regarding allergic contact dermatitis:

Adermal lesions may be asymmetric and occur not only at the contact site but also at distant parts of the body.
Btype IV of immune response is involved in the development of allergic contact dermatitis.
Cthe symptoms develop within 15-30 min. after exposure to allergen.
Dglucocorticosteroids and calcineurin inhibitors are used in therapy.
Edermal lesions are accompanied by itching.

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Question 157

A frequent complication after abdominal surgery is urinary retention. The symptoms include pain within the hypogastric region and excessive filling of the bladder along with inability to initiate micturition. The appropriate treatment procedures of postoperative urinary retention should start with:

Arapid intravenous infusion of 1000 ml normal saline (0.9% NaCl) and then 40 mg oral furosemide.
Burinary tract catheterization for 2-3 days.
Cnephrostomy.
Doral tamsulosin (rec. α1 antagonist) until normal diuresis.
Ehaemodialysis, since post-operative urinary retention is always due to acute kidney failure.

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Question 158

In acute pancreatitis, the indications for initiating antibiotic therapy include:
1) any case of acute pancreatitis related to choledocholithiasis;
2) any case of alcohol-related acute pancreatitis;
3) confirmed presence of infected necrosis in the course of acute pancreatitis;
4) pancreatic pseudocysts as a complication in acute pancreatitis.
The correct answer is:

A1, 3, 4.
B2, 3, 4.
C2, 4.
D3 only.
E4 only.

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Question 159

After falling from the height of 5 m, the patient:
- opens eyes after pain stimulus;
- is confused and disoriented, cannot tell where he is or what happened;
- does not obey commands to make a movement but can localize painful stimulus;
In the GCS, the patient will score:

A15 points.
B13 points.
C12 points.
D11 points.
E10 points.

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Question 160

The indication for splenectomy can be:

Ahereditary spherocytosis.
Bidiopathic thrombocytopenia.
Cthalassemia.
Dsickle cell anaemia.
Eall of the above.

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Question 161

An 83-year-old male who was treated for arrhythmia and arterial hypertension was admitted to emergency dept. due to severe abdominal pain. The pain appeared suddenly, about an hour before admission, was at first located within the epigastric region and was paroxysmal in nature. However, at the time of examination, the pain is continuous and concerns the entire abdomen area. The abdomen is bloated, and positive peritoneal symptoms are present in all abdominal quadrants. The patient has nausea and vomits with the stomach content. Peristalsis cannot be heard. Physical examination shows large inguinal hernia on the right side, and per rectum examination, brown stool in the rectal ampulla. HR: 96/min, BP: 103/57 mmHg, RR: 18/min, WBC: 33000/mm3, Hgb: 11.2 g/dl, Hct: 31%, Amylase: 140 U/l, D-dimers 15000 µg/l, Tnl: <0.001 ng/ml. ECG: without abnormalities. Indicate what is the cause of the patient’s complaints:

Agastric ulcer perforation.
Bacute intestinal ischaemia.
Cmyocardial infarction.
Dobstruction caused by colon tumour.
Eacute pancreatitis.

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Question 162

A 53-year-old male checked into emergency dept. due to painfulness within the right hypochondriac region. The pain, which appeared the day before, is paroxysmal and accompanied by nausea and vomiting. At present, the patient has fever with chills, 39.2 degrees Celsius. He also reports dark-coloured urine. On physical examination, Chelmonski symptom is positive, and yellowing of the eye sclera can be observed. Per rectum, the stool in the rectal ampulla is discoloured. Laboratory findings: Hgb 12.5 g/dl, Hct 36%, CRP 120 mgl/l, bilirubin 80 µmol/l (4.68 mg/dl). Ultrasound examination shows a common bile duct of 11 mm in diameter and a thin-wall gallbladder with numerous deposits. Indicate the right diagnosis and procedure:

Aacute cholecystitis - laparoscopic cholecystectomy and antibiotic therapy.
Bcholangitis - oral conservative treatment with antibiotics.
Ccholangitis - endoscopic retrograde cholangiopancreatography and antibiotic therapy.
Dacute cholecystitis - oral conservative treatment with antibiotics.
Ediagnosis cannot be made based on the information provided; all diagnoses are equally probable.

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Question 163

Indicate the false statement regarding venous ulcers of lower extremities:

Athe risk factors for venous ulcerations include previous deep vein thrombosis, thrombophilia and varicose veins.
Bvenous ulcers occur on the lower legs, typically around the lateral or medial ankle area.
Cvenous ulcers are characterised by severe pain which can be relieved by unweighting the leg.
Dthe skin surrounding venous ulcers is usually atrophic, can be discoloured, and the limb is often swollen.
Eall the above statements are true.

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Question 164

The complications of diverticular disease include:

Asigmoid cancer.
Bsigmoidovesical fistula.
Culcerative colitis.
Dleft-sided renal colic.
Eleft ovarian cyst.

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Question 165

Indicate true statements regarding an abscess:
1) an essential treatment is its evacuation;
2) surgery is contraindicated; antibiotic therapy is more beneficial;
3) the complication of perirectal abscess can be an perianal fistula;
4) the complication of perirectal abscess can be an anal fissure;
5) perianal abscess is more commonly found among males.
The correct answer is:

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

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Question 166

Meckel's diverticulum consists of:

Aall layers of the intestinal wall.
Bmucous membrane only.
Cmuscular layer only.
Dserous membrane only.
Eserous membrane and muscular layer.

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Question 167

In the classification of bleeding lesions in the ulcer niche, grade I according to Forrest means:

Arecent bleeding
Bactive bleeding
Cbleeding long time ago
Dno bleeding
Eforrest's classification does not apply to gastrointestinal bleeding

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Question 168

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 169

A 36-year-old multiparous woman went to see a gynecologist because of regular but excessive and painful periods which has lasted for the last few years. This is accompanied by increasing fatigue, general weakness, and more frequent urination. The pathological findings included pale mucosa. Gynecological exam revealed a tumour the size of a 4-month pregnancy. Blood test and transvaginal ultrasound were made. What lab test results and diagnosis can you expect?

Aaneamia, uterine myomas.
Banaemia, pregnancy.
Cnormal blood count, pregnancy.
Dnormal blood count, simple ovarian cyst.
Eanaemia, simple ovarian cyst.

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Question 170

A 14-year-old girl went to see a gynecologist due to cramp pains within lower abdomen, accompanied by nausea, vomiting and general weakness. The pain started just before her menstruation and have continued for two days. A similar condition occurred during her last cycle. The girl is disturbed as she had her menarche the year before and did not have any similar symptoms. Gynecological exam did not reveal any abnormalities. Abdominal and pelvic ultrasound did not show any pathological findings. The most probable diagnosis will be:

Apremenstrual syndrome (PMS).
Bunicornate uterus.
Cprimary dysmenorrhea.
Dsecondary dysmenorrhea.
EAsherman syndrome.

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Question 171

Indicate which of the activities below is an example of primary prevention in gynecologic onology:

Acytology.
BHPV vaccination.
Ccolposcopy.
DHPV genotyping.
Ecervical conization/LLETZ.

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Question 172

Influenza vaccination in pregnancy:
1) is recommended to every woman who has no contraindications to vaccination;
2) should be performed only in the second trimester of pregnancy;
3) should be performed using inactivated quadrivalent vaccine;
4) is safe both for the mother and the child.
The correct answer is:

A1,4.
Ball of the above.
C1,3,4.
D1,2,4.
E1,2.

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Question 173

The Mayer-Rokitansky-Kustner and Hauser syndrome is characterized by:
1) primary amenorrhoea;
2) female karyotype 46,XX;
3) scarcity of axillary and pubic hair;
4) congenital absence of ovary;
5) congenital absence of vagina;
6) ametria, rudimentary uterus or rudimentary horns of uterus.
The correct answer is:

Aall of the above.
B1,2,5,6.
C2,3,4,5.
D2,3,4,6.
E1,4,5,6.

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Question 174

A patient in a 36-week pregnancy had contact with a person diagnosed with chickenpox. If the patient is non-immune to chickenpox, the correct proceeding will be:

Aimmunoglobulin given only to the newborn, just after birth.
Binforming the patient that no prophylactic treatment is necessary.
Cintramuscular immunoglobulin given to the patient, within 72-96 hours from contact.
Dintramuscular immunoglobulin given to the patient, within 72-96 hours from contact, and to the newborn, immediately after birth.
Eperforming a cesarean section within 24 hours from contact with the chickenpox-infected person, and immunoglobulin given to the newborn just after birth.

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Question 175

In the case of post-menopausal bleeding, the recommended diagnostic procedure will be:
1) ultrasound examination after 2 months;
2) endometrial aspiration biopsy;
3) hysteroscopy and targeted biopsy;
4) computed tomography (CT) of pelvis;
5) fractional curettage of the uterine cavity.
The correct answer is:

A1,2,3.
B1, 2, 5.
C1, 2, 3, 5.
D4 only.
E2, 3, 5.

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Question 176

A 28-year-old patient obtained an ASC-H cytology result. The patient was not pregnant and was not vaccinated against HPV. The recommended procedure will be:

Acolposcopy.
Bcervical conization, both for diagnostic and therapeutic purposes.
CHPV genotyping.
Dassessment of the p16/Ki67 biomarkers.
Erepeated cytology after 6 months.

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Question 177

Indicate the true statement regarding ezetimibe:

Aits hypolipidemic effect is weaker than that of statins.
Bit should be used mainly in combination with statins, in patients with severe hypercholesterolemia.
Cis the first-line treatment in the case of statin intolerance.
Danswers A and B are correct.
Eanswers A, B, C are correct.

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Question 178

Please indicate the false statement regarding typical anginal pain:

Ait occurs in the retrosternal area.
Bit radiates to the neck, mandible, left shoulder and left arm.
Cit subsides within a few minutes at rest.
Dit subsides within 5-10 min. from taking sublingual nitroglycerin.
Eit can be evoked by physical effort or emotional stress.

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Question 179

The initiation of treatment to manage arterial hypertension with a single hypotensive agent (monotherapy) is justified in the case of:

Aelderly patients with the frailty syndrome.
Bpatients with stage 2. hypertension and intermediate overall cardiovascular risk.
Cpatients with stage 1. hypertension, regardless of the overall cardiovascular risk.
Danswers A, C are correct.
Eanswers A, B, C are correct.

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Question 180

To manage mild forms of or compliment the treatment of gastro-oesophageal reflux disease (GERD), the family doctor may administer:
1) H2-blockers;
2) sucralfate;
3) itopride;
4) cisapride;
5) metoclopramide.
The correct answer is:

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

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Question 181

Five pregnant women were tested for gestational diabetes using a 75 g glucose OGTT. Indicate normal results:

A0 h - 97 mg/dl (5.3 mmol/l); 2 h - 129 mg/dl (7.1 mmol/l).
B0h - 104 mg/dl (5,7 mmol/l); 2h - 161 mg/dl (8,9 mmol/l);.
C0h - 90 mg/dl (5,0 mmol/l); 2h - 156 mg/dl (8,6 mmol/l);.
D0h - 128 mg/dl (7,0 mmol/l); 2h - 201 mg/dl (11,1 mmol/l);.
E0h - 87 mg/dl (4,8 mmol/l); 2h - 150 mg/dl (8,3 mmol/l).

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Question 182

In type 2 diabetes, the first-line treatment in slim patients is:

Ametformin.
Bsulphonylurea derivative.
Cgliptin.
Dglitazone.
Eflosine.

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Question 183

According to FDA, the highest teratogenic risk during pregnancy is associated with using:

Asertraline.
Bparoxetine.
Cmianserin.
Dtrazodone.
Eescitalopram.

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Question 184

The drug that can be administered as a long-acting injection to treat schizophrenia is:

Achlorprothixene.
Btiapride.
Chaloperidol.
Dclozapine.
Eamisulpride.

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Question 185

The state of memory distortion, expressed as treating past events stored in memory as the presently occurring events, is known as:

Amemory illusion.
Bcryptomnesia.
Cconfabulation.
Decmnesia.
Eeidetic memory.

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Question 186

In schizophrenia treatment, the highest risk for developing the metabolic syndrome is associated with using:

Aolanzapine.
Baripiprazole.
Cziprasidone.
Dlurasidone.
Ecariprazine.

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Question 187

A 28-year-old male patient visits a psychiatrist office and reports that since high school, the dominant forms of his behavior have been: excessive doubtfulness and cautiousness, perfectionism that hinders normal task performance, pedantry, excessive conformity to social norms and conventions, inflexibility and stubbornness. The patient is most likely to have the dominant traits of:

Aavoidant personality disorder.
Bdependent personality disorder.
Chistrionic personality disorder.
Danankastic personality disorder.
Eemotionally unstable personality disorder.

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Question 188

Indicate body organs that are ranked from the shortest to longest time of tolerance to hypoxia:

Acerebral cortex, brain stem, bones, skin, muscles.
Bcardiac muscle, brain stem, kidneys, liver.
Ccerebral cortex, brain stem, cardiac muscle, kidneys, liver.
Dskin, muscles, bones, kidneys, liver.
Ebones, skin, cardiac muscle, brain stem.

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Question 189

Indicate current guidelines on pharmacotherapy for sudden cardiac arrest:

Aduring resuscitation, drugs must not be administered intramuscularly or subcutaneously.
Badministration of drugs into the femoral vein is not recommended.
Cintracardiac drugs must not be administered due to the risk of damage to the heart muscle, cardiac tamponade, pneumothorax, and the need to interrupt the rescue operation for the duration of the puncture.
Dthe endotracheal route according to the guidelines of the European Resuscitation Council is not recommended.
Eall of the above.

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Question 190

Indicate the false poison - antidote pair:

Abenzodiazepines - flumazenil.
Bopioids and opiates - naloxone.
Cmethyl alcohol - ethyl alcohol.
Dethylene glycol - methyl alcohol.
Ebeta blockers - glucagon.

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Question 191

Indicate the fracture sites ranked from the lowest to highest volume of blood loss during fracture:

Asingle vertebra, single rib, forearm bones, lower leg bones, pelvis.
Bsingle rib, shoulder and humeral bone, pelvis, femoral bone.
Cshoulder and humeral bone, forearm bones, lower leg bones, femoral bone.
Dpelvis, femoral bone, shoulder and humeral bone, single rib.
Efemoral bone, single vertebra, forearm bones, single rib.

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Question 192

In cardiac tamponade, characteristic symptoms, known as the Beck’s triad, develop. These include:

Achest pain, progressive dyspnoea, tachycardia/paradoxical pulse.
Bcold, pale skin, loss of consciousness, cardiac arrest.
Chypotension, muffled heart sounds, jugular veins distension.
Dprogressive dyspnoea, chest pain, muffled heart sounds.
Echest pain, progressive dyspnoea, cold, pale skin.

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Question 193

In which particular cases can the skull X-ray be recommended for assessment of the clinical condition, even though CT is available:

Apenetrating trauma (from a gunshot).
Bsuspected depressed skull fracture.
Csuspected basilar skull fracture.
Din patients with previous craniotomy or external ventricular drainage.
Eall of the above are true.

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Question 194

One of the major obligations of the physician is to keep any patient’s data and medical documentation in strict confidentiality. There was a case that after the patient had died in hospital, her adult sister showed up and asked the doctor for the patient’s hospital record to be made available to her. Under these circumstances, the doctor:

Ashould refuse the sister access to the record, referring to the principle of medical confidentiality and the legal and ethical obligations to comply.
Bshould make it possible for the sister to execute her right of access to the documentation only in terms of review its content.
Cshould interview the close members of family of the deceased patient and give access to the record to the person who seems to be most closely related to the patient.
Dshould make the patient’s hospital record available to any family member who would request this, provided that the patient had not objected to the above during her lifetime.
Eshould not give the sister access to the record but may provide oral information about the cause of the patient’s death.

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Question 195

When referring to the conscience clause, the physician is obliged to:

Aobtain a consent from his supervisor to apply this form of refusing provision of certain medical services to the patient.
Bmake a written statement regarding the clause in the patient’s medical record.
Cprovide the patient with information on where, specifically, he/she can refer to for the medical procedure requested.
Dconsult his/her decision with another physician specialised in the same field.
Enotify the patient in writing about his decision to refuse provision of medical service.

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Question 196

Please indicate the condition under which an oncologist can limit the scope of information provided to the patient with regard to his/her health status and prognosis:

Awhen the state of epidemic emergency is declared.
Bon demand of a family member, if the patient is adult, conscious and capable of perceiving the meaning of the information, but it is the will of the family member.
Con demand of the Ombudsman for Doctors Rights, affiliated with a given District Medical Chamber.
Dwhen the patient is a participant of a clinical trial.
Ewhen the prognosis is poor, and in the doctor’s opinion, doing so may be beneficial to the patient’s well-being.

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Question 197

The social benefits covered by the social insurance system that are granted in the case of sickness and maternity, referred to as “sickness insurance”, do not include:

Asickness allowance.
Brehabilitation benefit.
Ccompensatory benefit.
Dmaternity allowance.
Edisability pension.

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Question 198

In Poland, the sickness allowance is granted to:

Aall Polish citizens, irrespective of their social insurance.
Bonly those Polish citizens who are covered by social insurance.
Call Polish citizens who are unable to work.
Dall persons resident in Poland who are unable to work.
Ean insured person who has become unable to work due to a sickness that occurred within the period covered by the “sickness insurance”.

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Question 199

For a dataset, the median is the value which:

Asplits dataset in half (with one half being below and the other one above this value).
Bis the most frequent.
Cis statistically closest to all of the values in the distribution.
Dis a measure of statistical dispersion.
Esplits data set into five sub-groups.

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Question 200

The information stating that “in Poland, in week 45 of the year 2020, the total number of deaths among the persons infected with SARS-CoV-2 was 2262” applies to:

Aforensic epidemiology.
Bclinical epidemiology.
Cexperimental epidemiology.
Ddescriptive epidemiology.
Eanalytic epidemiology.

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