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LEKEXAM / 2022 spring

Question distribution — 2022 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

The most common cause of idiopathic nephrotic syndrome in children is:

Aminimal change glomerulopathy
Bmesangial proliferative glomerulonephritis
Cfocal segmental glomerulosclerosis
DIgA nephropathy
Eacute post-streptococcal nephritis.

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Question 2

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 3

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

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

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Question 4

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

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

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Question 5

Carcinoembryonic antigen level assessment is of most value in:

ABreast cancer
BLung cancer
CColorectal cancer
DPancreatic cancer
EStomach cancer

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Question 6

Haemolytic-uraemic syndrome is:

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

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Question 7

Live, attenuated vaccines include:

1) BCG

2) DTP

3) MMR

4) OPV

5) IPV

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

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Question 8

In obstetrics, the term position (positio) means:

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

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Question 9

The management of febrile convulsions in children includes:

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

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Question 10

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 11

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

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

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

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

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

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

The correct answer is:

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

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Question 12

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

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

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Question 13

Indicate the true information on Alport’s syndrome of sex-linked inheritance:

1) it is caused by inherited defect in alpha 5 collagen IV chain synthesis and leads to end-stage renal disease;

2) women (heterozygotes) are healthy gene carriers or they have only mild symptoms;

3) haematuria and proteinuria occur in men at around 10 years of age;

4) therapy with cyclosporine inhibits the development of the disease;

5) angiotensin converting enzyme inhibitors are used to decrease proteinuria.

The correct answer is:

A1 ,3, 5.
B1, 3, 4.
C1, 4, 5.
D1, 2, 5.
E2, 4 ,5.

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Question 14

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 15

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 16

Which of the following are not classified as internal abdominal hernias:

Adiaphragmatic hernias.
Bhernias of the paraduodenal recess.
Cpericaecal hernias.
Dhernias of the omental bursa.
Elumbar hernias.

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Question 17

Which of the following accesses to the digestive tract can be used in nutritional therapy?

Anaso-gastric tube, gastrostomy, jejunostomy.
Bnaso-gastric tube, gastrostomy, ileostomy.
Cesophagostomy, gastrostomy, jejunostomy.
Dgastrostomy, jejunostomy, ileostomy
Ejejunostomy, ileostomy, colostomy

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Question 18

The following symptoms, such as rapid and irregular breathing, extension of the limbs in reaction to external stimuli, bilateral Babinski sign, impaired pupil reaction to light, increased blood pressure, pulse acceleration and increased sweating indicate the contusion of:

Abrain stem.
Bcerebellar hemisphere.
Cfrontal lobes.
Doccipital lobe.
Etemporal lobe.

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Question 19

A skin disease of non-bacterial etiology is:

Aimpetigo contagiosa
Btinea versicolor
Cerythrasma
Derysipelas
Eecthyma

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Question 20

A 35-year-old man was admitted to the Emergency Unit because of black stools occurring for a few hours. He is also suffering from haemophilia A. The primary treatment should include:

Ablood group determination and a transfusion of two units of red blood cell concentrate.
Bprotonic pump inhibitor administration.
Cfactor VIII immediate administration.
Dimmediate gastroscopy.
Edetermination of factor VIII concentration.

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Question 21

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 22

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 23

Which of the following is not considered in the assessment of the thromboembolic complication risk in patients with non-valvular atrial fibrillation, according to CHA2DS2 VASc scale:

Acongestive heart failure
Bage > 75 years
Cdiabetes mellitus
Dischemic stroke in the history
Ehyperlipidemia with LDL concentration > 150 mg%

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Question 24

Which of the following medications can cause hypercalcemia?

1) calcimimetics;

2) thiazides;

3) lithium;

4) calcium receptor antagonists;

5) vitamin D.

The correct answer is:

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

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Question 25

A simultaneous increase in prothrombin time (PT) and in activated partial thromboplastin time (APTT) is characteristic of:

Afactor VIII deficiency
Bfactor XIII deficiency.
Cdefect of the so-called common clotting pathway - (factor X, V, II, fibrinogen).
Dhemophilia A.
Efactor VII deficiency.

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Question 26

Indicate the false statement on vaccinations against influenza:

Apregnancy is a contraindication to the vaccination
Bpatients older than 50 should be vaccinated
Cpatients with coronary heart disease should be vaccinated.
Dmedical staff should be vaccinated
Eallergy to chicken egg white is not an absolute contraindication to the vaccination

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Question 27

Patient with the following set of viral markers: HBsAg plus, HBeAg plus, anti-HBc IgM minus, anti-HCV minus should be regarded as:

Ahepatitis B carrier with features suggesting exposition to HCV
Binfected with HBV, with probable high replication of HBV, without features suggesting exposition to HCV
Ccarrier of HCV, without immunity after vaccination against hepatitis B
Drecoverer from hepatitis B, with features of acquired immunity against HBV and HCV
Enone of the above

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Question 28

The cause of hypouricemia is not:

ASIADH
Btubular acidosis type II
Cpregnancy
Drenal insufficiency
Eallopurinol administration

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Question 29

Which of the following disorders are causes of secondary arterial hypertension: 1) primary hyperaldosteronism; 2) renal artery stenosis; 3) obstructive sleep apnea; 4) hypo- or hyperthyroidism; 5) acromegaly; 6) coarctation of the aorta. The correct answer is:

A1,2,4
B1,2,6
C1,2,4,5
D1,2,4,5,6
Eall the above.

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Question 30

An example of serotonin norepinephrine reuptake inhibitor (SNRI) is:

Afluoxetine
Breboxetine
Cquetiapine.
Dtrazodone
Evenlafaxine

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Question 31

According to the rule of nines, a burning of both lower limbs and the scrotum in adult patients affects:

A19% of the body surface.
B36% of the body surface.
C37% of the body surface.
D45% of the body surface
Erule of nines is not related to burned body surfaces.

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Question 32

Which of the following should be given to a patient with hyperkalemia at the level of 7 mmol/l, if the ECG shows toxic influence of potassium on the heart muscle?

A30 ml of 10% calcium gluconate iv.
B30 ml of 10% calcium chlorate iv.
C6 mg of adenosine iv.
D500 ml of isotonic electrolyte solution iv.
E2 g of magnesium sulfate.

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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

A 44-year-old women with lupus nephritis diagnosed 20 years earlier comes to the emergency room because of a head injury, without any other symptoms. She is treated with prednisone 10 mg/d and azathioprine 50 mg/d. The urinalysis revealed proteinuria - 0.1 mg/dL, 50-100 white cells and a lot of bacteria in the field of view. Which of the following should be ordered?:

AUrine culture
Bquinolone for 3 days.
Cfluorochinolon for 7 days.
Dnitrofurantoin for 7 days.
Enone, as the patient does not require any diagnostic tests and any antibacterial treatment.

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Question 35

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 36

Meningeal irritation symptoms observed in children include:

1) Flatau’s sign;

2) Brudzinski’s symphyseal sign;

3) Lasègue’s sign;

4) Amoss’ sign;

5) Kernig’s sign.

The correct answer is:

Aall the above
B1,2,5
C1,2,4,5
D1,2,3,5
E1,2,3,4

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Question 37

Subacute sclerosing panencephalitis (SSPE) occurs with higher rate in children suffering in the early childhood (under 2 years of age) from:

Ameasles
Bmumps
Crubella
Dvaricella
Ecytomegalovirus infection.

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Question 38

I-metaiodobenzylguanidine (MIBG) scintigraphy is a method used in children for the diagnosis of:

Ahepatoblastoma.
Bneuroblastoma.
Cmedulloblastoma.
DHodkin's lymphoma.
Eosteosarcoma.

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Question 39

Indicate the true statement concerning ovarian cancer surgery:

Ait strives for tumour sample obtaining and fast radical chemotherapy application.
Bcytoreduction is performed to the highest possible extent.
Conly and always the affected ovary is removed.
Dfollowing uterectomy the region of the lesser pelvis may be irradiated.
Eneoadjuvant chemotherapy is always used in order to decrease a tumour mass.

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Question 40

When should the next cytological examination be ordered in a 35-year-old multipara with normal results of the last three cytological examinations and without any risk factors?

Ain 3 months
Bin 6 months
Cin a year
Din three years
Eonly if some symptoms occur, such as increased vaginal discharge, or contact bleeding.

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Question 41

A patient with hypothyroidism should be instructed to take levothyroxine:

Aon empty stomach, 30-60 minutes before breakfast
Bon an empty stomach, directly before breakfast
Cduring breakfast
Dhalf an hour after breakfast
Etwo hours after breakfast

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Question 42

A patient with her husband come to the gynaecologist’s office. The husband wants to be present at the examination. What should the doctor do?
1) they should allow the husband to be present at the examination because husband as a close person has the right to be present at the provision of health services;
2) if the patient does not give her clear consent to her husband’s presence, they should ask him to leave;
3) they may not allow the husband to be present at the provision of health services to his wife if they decide that the patient’s health safety is at stake;
4) they should let the husband assist because her silence should be interpreted as implicit consent;
5) regardless of circumstances and the patient’s will they should ask the husband to leave because the examination may violate the patient’s right to intimacy.
The correct answer is:

Aonly 1.
B2,3
C1,4
Donly 5
Eonly 4

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Question 43

The doctor while giving medical services to his patient finds out that they suffer from infectious, sexually transmitted disease. What should he do?

1) he should immediately pass on the information to the appropriate voivode, who can take a decision to isolate the patient;

2) he should force the patient to stay in place and immediately call the sanitary services;

3) he should inform the patient about the means that prevent the disease from spreading;

4) he has the duty to inform the patient of the necessity that their sexual partner consult a doctor;

5) he must immediately let all the people closely associated with the patient know and warn them about the threat.

The correct answer is:

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

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Question 44

Epidemiological surveillance of hospital-related infections in healthcare includes all the following except for:

Aepidemiological description of infections and pathogens.
Bmonitoring the microbiological flora, antibiotic susceptibility, trends in drug resistance of pathogens causing nosocomial infections.
Cevaluation of problem level, i.e. incidence, mortality, drug resistance, etc.
Dvaccination of healthcare professionals.
Ecomparative analysis of the situation of nosocomial infections in different healthcare facilities.

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Question 45

Inferior wall ST segment elevation myocardial infarction (STEMI) in a 48-year-old male can be recognized in the case of a typical chest pain and persistent ST-segment elevation in J point of ≥ 0.1 mV in leads:

AV1-V3
BV3-V5
CIII, aVF
DI, aVL
EVr3-Vr4

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Question 46

Alfa-fetoprotein is a laboratory indicator of:

Agastrointestinal stromal tumor (GIST)
Bfetal renal cancer
Cgastric sarcoma
Dhepatocellular carcinoma
Epancreatic islet tumor

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Question 47

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 48

Because of suspected hypothyroidism the physician ordered the measurement of TSH and fT4 levels. TSH was elevated and fT4 was within limits. What diagnosis should be formulated considering there laboratory findings?

Aeuthyroidism
Bsubclinical hypothyroidism
Cprimary hypothyroidism
Dsecondary hypothyroidism
Etertiary hypothyroidism

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Question 49

Extranodal lymphoma is most commonly localized in:

Astomach.
Bduodenum.
Csmall intestine.
Dcolon.
Erectum.

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Question 50

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 51

Emergency indications for surgery in a patient with Crohn disease:

Aenterocutaneous fistula.
Bappearance of neoplasms (colon adenocarcinoma, intestinal lymphoma).
Cchronic subileus.
Dperianal fistula.
Eanorectal abscess.

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Question 52

A young female patient gave birth to her child about a year ago through the vaginal delivery, after which curettage was necessary because of fragments of the placenta did not separate from the uterus. She stopped breastfeeding 4 months ago, but the periods have not reoccurred yet. Her medical history may suggest:

AKallmann syndrome.
BSheehan’s syndrome.
CAsherman’s syndrome.
DMayer-Rokitansky-Küster-Hauser syndrome.
ECouvelaire syndrome.

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Question 53

The total dose of N-acetylcysteine used intravenously in paracetamol intoxication amounts to:

A100 mg/kg m.c.
B150 mg/kg m.c.
C200 mg/kg m.c.
D250 mg / kg m.c.
E300 mg/kg m.c.

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Question 54

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 55

The 3rd class in ASA (American Society of Anesthesiologists) physical status classification system denotes:

Ahealthy patient, without any comorbidities.
Bpatient with a mild systemic disease.
Cpatient with a severe but controlled systemic disease.
Dpatient with a severe systemic disease posing a threat to their life.
Epatient who will probably not survive next 24 hours regardless the surgery.

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Question 56

Which of the following medications are used to treat dementia in Alzheimer’s disease?

1) mianserin;
2) mirtazapine;
3) memantine;
4) rivastigmine;
5) duloxetine.
The correct answer is:

A1,2,3.
B1,4,5.
C3,4.
D4,5.
Eall the above.

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Question 57

MMSE (Mini Mental State Examination) and clock-drawing test are recommended for the screening for:

Aintellectual disability
Bspecific learning disorders.
Cpersonality disorders.
Dautism
Edementia.

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Question 58

Indicate the false statement concerning the management of streptococcal pharyngitis;

Athere is no need to determine the susceptibility of Streptococcus pyogenes to antibiotics.
Bprobability of Streptococcus pyogenes infection can be assessed with the use of Centor criteria.
Cphenoxymethylpenicillin is the drug of choice in the treatment of streptococcal pharyngitis.
Ddoxycycline should be used in patients with hypersensitivity type I to penicillin
Ewhen in doubts whether the patient will take orally phenoxymethylpenicillin, benzathine benzylpenicillin should be administered in a single dose intramuscularly.

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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

A 5-year-old child presents with his mother to obtain a vaccination against flue. The medical documentation shows that child underwent 10-day antibiotic therapy because of streptococcal pharyngitis which was withdrawn two weeks ago. Which of the following should be recommended?

Ato vaccinate on the same visit
Bto vaccinate on a visit in 7 days
Cto vaccinate 4 weeks after the withdrawal of antibiotic therapy
Dto postpone the vaccination for 2 months
Eto discourage the vaccination

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Question 61

According to the Act on the Professions of Physician and Dentist, the right to perform the profession of doctor and the right to perform the profession of dentist (in other words, the medical license) is granted by:

APolish Chamber of Physicians and Dentists
BSupreme Medical Council
CRector of the Medical University.
Dcompetent Regional Medical Council.
Ecompetent Regional Chamber of Physicians and Dentists.

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Question 62

Indicate the false statement concerning the use of loop diuretics in patients with arterial hypertension and chronic kidney disease:

ALoop diuretics are effective even in patients with glomerular filtration eGRF <15 ml / min / 1.73 m2
BUse of high doses of loop diuretics may cause dehydration and reduce GFR
Cloop diuretics should not be used in patients without hyperkalemia.
DUse of diuretics in combination with angiotensin receptor blockers reduces albuminuria
EUse of high doses of loop diuretics may cause hearing damage

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Question 63

Gastroesophageal reflux in physiological conditions is a short-term phenomenon. But if it lasts long or the episodes of reflux are frequent it could be the cause of gastroesophageal reflux disease (GERD). Alarming signs of GERD do not include:

Aweight loss.
Bcoughing attacks at night with dyspnoea.
CHeartburn
DSwallowing disorders
EAnemia

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Question 64

Which of the following is introduced into the peritoneal cavity in order to produce pneumoperitoneum during the laparoscopic procedure?

ASaline solution
BCarbon dioxide
COxygen
DNitrogen
ECompressed air

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Question 65

Which of the following blood vessels is used in the non-invasive ultrasound evaluation of foetal anaemia?

Auterine artery
Bductus venosus
Cumbilical artery
Dmiddle cerebral artery
Eumbilical vein

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Question 66

Which of the following is not a typical complication of gestational diabetes?

APolyhydramnios
BFetal macrosomia
CIntrauterine growth retardation
DObstetric cholestasis
ETraumatic delivery

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Question 67

Which of the following fetal head circumferences is the smallest?

AOccipito-frontal
BSuboccipito-bregmatic
COccipito-mental
DSuboccipito-hyoid
EGenio-hyoid

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Question 68

What kind of study is a cohort study?

AObservation
BExperimental
CIntervention
DScreening
EClinical

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Question 69

Coughing up of more than 100 ml of blood in a short time suggests massive hemoptysis and is an indication for:

Atreatment at the family doctor clinic
Bplanned specialist consultation
Curgent specialist consultation
DHospitalization
EFurther observation and hospitalization in the case of worsening

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Question 70

Systematic, internally coherent and logical system of delusions may occur in:

Ahallucinosis
BParanoid syndrome
CGanser syndrome
DEkbom syndrome
ENone of the above

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Question 71

A 32-year-old male was transported to the emergency department with the signs of progressive hypovolemic shock. The patient demands quick fluid replacement. Which access and which cannula should be chosen?

Acentral access, 22 G cannula of 30 cm in length.
Bcentral access, 20 G cannula of 21 cm in length.
Cperipheral access, 18 G cannula of 5.0 cm in length
Dperipheral access, 16 G cannula of 5.0 cm in length.
Eintraosseous access, 20 G cannula of 8.0 cm in length.

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Question 72

A patient with an implanted pacemaker fainted in the street. The arriving emergency team diagnosed cardiac arrest and the ECG monitor showed ventricular fibrillation. Should the rescuers perform defibrillation in this patient?

Ano, the pacemaker should be disconnected first.
Byes, but it is recommended to place the electrodes in the ‘front-back’ position.
Cno, defibrillation may destroy the pacemaker
Dyes, the presence of the pacemaker is irrelevant.
Eyes, but shock energy should be lowered.

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Question 73

Which of the following characterizes pulsus bisferiens?

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

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Question 74

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

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

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Question 75

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

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

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Question 76

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

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

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Question 77

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

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

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Question 78

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

- anisocoria L>R

- opening the eyes only to a strong pain stimulus

- the patient makes incomprehensible sounds

- when establishing venous access, the patient withdraws his hand

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

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

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Question 79

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

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

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Question 80

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

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

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Question 81

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

Asynthymia.
Bcatathymia.
Chypothymia.
Dathymia.
Ehyperthymia.

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Question 82

Temporary cardiac pacing should be considered in the case of:

1) symptomatic bradycardia refractory to anticholinergic agents;

2) bradycardia in Wolff-Parkinson-White syndrome;

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

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

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

6) third-degree atrioventricular block.

The correct answer is:

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

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Question 83

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

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

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Question 84

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

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

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Question 85

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

1) against influenza (inactivated vaccine);

2) against chickenpox;

3) against tuberculosis;

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

5) against measles, mumps and rubella.

The correct answer is:

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

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Question 86

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

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

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Question 87

Indicate the false statement concerning diverticulosis of the gastrointestinal tract:

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

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Question 88

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

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

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Question 89

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

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

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Question 90

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

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

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Question 91

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

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

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Question 92

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

1) diagnostics of Toxoplasma gondii infection;

2) diagnostics of Human Papilloma Virus infection;

3) determination of anti-cardiolipin antibodies;

4) diagnostics of Cytomegalovirus infection;

5) determination of lupus anticoagulant.

The correct answer is:

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

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Question 93

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

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

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Question 94

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

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

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Question 95

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

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

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Question 96

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

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

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Question 97

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 98

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

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

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Question 99

Indicate the minimal period of symptom appearance that is the criterion for cyclothymia diagnosis in adults:

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

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Question 100

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 101

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 102

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 103

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 104

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 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

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 107

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 108

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 109

The follow- up visit in patients with diagnosed hypertension who has been treated pharmacologically should be scheduled after approx:

A2 days
B1 week
C3 weeks
D6 weeks
E2 months

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Question 110

Which of the following are used in the treatment of von Willebrand disease?

1) factor VIII concentrate with von Willebrand factor;

2) factor IX concentrate;

3) intravenous immunoglobulins;

4) dexamethasone;

5) desmopressin.

The correct answer is:

Aall the above
B1,5.
C1,2,4
D1,3,4.
E2,4.

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Question 111

A 75-year-old patient who has undergone hip arthroplasty in the last month has dyspnoea, cough, chest pain, tachycardia and fever. These symptoms indicate:

Apneumonia
Bpulmonary edema.
Cpulmonary embolism.
Dpneumothorax.
Emyocardial infarction

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Question 112

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 113

Ulcerative colitis is treated surgically. The gold standard in elective treatment is:

AHartmann’s colectomy.
Bcolectomy with ileorectal anastomosis.
Crestorative proctocolectomy.
Drestorative proctocolectomy with loop ileostomy.
Esegmental colon resection.

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Question 114

A doctor speaking critically about another doctor's actions should:

Abe extremely careful in formulating an opinion about this doctor's professional activity, in particular he should not publicly discredit him in any way.
Bmake clear and distinct claims against that doctor by presenting his opinion in the media.
Ccomment on perceived errors in the conduct of another doctor primarily to the competent authorities of the medical chamber.
Densure that the patient is consulted by another doctor.
Efirst and foremost inform the patient concerned of his objections to that doctor.

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Question 115

Quicktrach is used for:

Adecompression of pneumothorax.
Bdiagnostic puncture of the pericardial sac.
Cexecution of emergency needle cricothyrotomy.
Dperforming tracheostomy.
Enone of the above.

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Question 116

In the event of a planned surgery in people with diabetes, the surgery should be postponed (if possible) if the HbA1C level exceeds:

A7,5%
B8,0%
C8,5%
D9,0%
E9,5%

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Question 117

Which of the following has the smallest application in the treatment of small-cell lung cancer?

Achemotherapy
Bradiotherapy
Cradiochemotherapy
Dsurgery
EB and D are correct.

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Question 118

In many countries, the key method of fighting the COVID-19 pandemic in 2019-2020 was the so-called flattening the epidemic curve that serves to:

1) reduce the overall number of cases;

2) spread the number of cases over time;

3) slow down the rate of spread of SARS-CoV-2 infection;

4) counteract the paralysis of treatment under the pressure of new cases;

5) gain time to develop treatment procedures and vaccines.

The correct answer is:

A1
B1,2,3.
C1,2,3,4.
Dall the above
E2,3,4,5.

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Question 119

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 120

A person whose previous behavior suggests psychical disturbances that pose a direct threat to their life or the life or health of other people and there are doubts whether they are mentally ill may be admitted to the psychiatric hospital without their consent in order to clarify these doubts. How long may such an observation last?

A10 days maximum.
B10 days minimum.
C14 days maximum.
D14 days minimum.
Euntil all the diagnostic doubts are clarified.

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Question 121

During the operation consisting in the resection of the right liver lobe, because of the wrong cut the hepatic flexure of the colon was injured which led to its perforation and the intestinal contents entered the peritoneal cavity. What is the correct classification of such a wound?

Aclean-contaminated.
Bdirty.
Ccontaminated.
Dclean.
Esecondary.

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Question 122

All patients with coronary artery disease (in absence of contraindications) should be chronically treated with:

Aacetylsalicylic acid.
Bstatin.
CACEI or ARB.
DA,B are correct.
EA,B,C are correct.

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Question 123

In February 2019 the Supreme Administrative Court dismissed A.D.’s (plaintiff’s initials) cassation appeal from the verdict of the Provincial Administrative Court in Warsaw which in 2016 supported the Health Minister’s decision who in turn upheld the provincial governor’s decision to impose a fine of 420 PLN on A.D. for avoiding subjecting his minor daughter to preventive vaccinations. The SAC’s verdict is an example of the following law function in the field of public health:

Aban on actions and behaviors harmful to the health of individuals and the community.
Bregulation of the rights of individuals and groups to health care.
Cregulation of health care resources.
Dregulation of healthcare financing.
Eregulation of requirements in the field of healthcare quality.

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Question 124

The decision stating an occupational disease after carrying out explanatory proceedings is issued by:

Aoccupational doctor
BInstitute of Occupational Medicine.
CCentral Institute of Labour Protection.
DState Sanitary Inspection organ.
ESocial Insurance Fund.

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Question 125

Endometriosis should be taken into account in the case of:

Aendometrial hyperplasia on ultrasound, the presence of symptoms of hirsutism.
Babnormal postmenopausal bleeding from the uterine cavity
Creduced fertility, pelvic pain syndrome, dysmenorrhea
Drare menstruation with the image of polycystic ovaries on ultrasound.
Epresence of endometrial polyps in the uterine cavity

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Question 126

In the case of erythema migrans diagnosed in a 4-year-old boy the following antibiotics can be used:

1) amoxicillin;

2) doxycycline;

3) cefuroxime axetil;

4) azithromycin;

5) clarithromycin. The correct answer is:

A1,2,3.
B1,2,3,4
Call the above
D1,2,4,5
E1,3,4,5.

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Question 127

A previously healthy 14-year-old girl comes to the physician because of a low-grade fever and a non-productive cough lasted for 7 days. Her temperature is 37.7°C. A few scattered inspiratory crackles are audible. An x-ray of the chest shows interstitial infiltrates and enlarged hilar lymph nodes. Which of the following is the most appropriate initial pharmacotherapy?

Aamoxicillin.
Bmetronidazole.
Cciprofloxacin
Dtrimethoprim-sulfamethoxazole.
Eclarithromycin or azithromycin.

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Question 128

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 129

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 130

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 131

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 132

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 133

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 134

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 135

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 136

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 137

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 138

Indicate true statements regarding complications associated with using chemotherapy in cancer treatment:
1) the most frequent haematological complication is neutropenia (found in 60-88% of the patients treated);
2) neutropenic fever is found in ca. 10-50% of patients treated for solid tumours and in over 80% of patients treated for haematological malignancies;
3) the G-CSF prophylaxis is recommended only in radical and palliative treatment.
The correct answer is:

A1,2.
Ball of the above.
C1,3.
D2 only.
E3 only.

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Question 139

Indicate which of the cancers below is the most radiosensitive one:

Aglioma.
BHodgkin’s lymphoma.
Cliposarcoma.
Dmelanoma.
Eadenocarcinoma.

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Question 140

When visiting the primary care unit, a 55-year-old woman told her general practitioner that she could feel some palpable lumpy abnormality, of ca. 3 cm in size, in her right breast. The appropriate management in this case should be:

Aphysical examination and ordering a screening mammography (patient aged over 50 years).
Bphysical examination and ordering tumour biopsy.
Cissue the DiLO card (cancer diagnostics and treatment card) referring the patient to an outpatient cancer clinic.
Dordering breast ultrasound.
Eordering urgent breast MRI (magnetic resonance).

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Question 141

Indicate which of the cancers are treated with hormone therapy:

Amelanoma and kidney cancer.
Bbreast cancer and colorectal cancer.
Clung cancer and thyroid cancer.
Dprostate cancer and carcinoma of uterine body.
Esquamous cell cervical cancer and liver cancer.

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Question 142

Anuria is not caused by:

Abladder tumour.
Bpost-radiation bilateral ureteral obstruction.
Caortic dissection involving renal arteries.
Dsevere hypoperfusion in the course of the hepatorenal syndrome.
Eright-sided ureterolithiasis.

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Question 143

The risk factors for urinary tract infection include:
1) prostatic hypertrophy;
2) diabetic neuropathy;
3) permanent urinary catheterisation;
4) urolithiasis;
5) urethral stenosis.
The correct answer is:

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

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Question 144

Indicate which factors should be considered when assessing the need for hospitalization in a patient diagnosed with pneumonia:
1) patient’s age;
2) breath rate;
3) arterial blood pressure;
4) body temperature;
5) type of cough.
The correct answer is:

A2,3,5.
B1,2,3.
C2,3.
D1,5.
Eall of the above.

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Question 145

Hypokalaemia may be caused by:
1) severe vomiting;
2) laxative-induced diarrhoea;
3) loop diuretics;
4) alkalosis;
5) acidosis.
The correct answer is:

A1,2,3,4.
B1,2,3,5.
C3 only.
D1,2,3.
Eall of the above.

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Question 146

The 24-h Holter ECG monitoring in a patient revealed R-on-T premature ventricular complexes. Which grade is it according to the Lown grading system?

AI.
BII.
CIII.
DIV.
EV.

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Question 147

Identify the true causes of left ventricular myocardial diastolic dysfunction:
1) arterial hypertension;
2) dilated cardiomyopathy;
3) hypertrophic cardiomyopathy;
4) constrictive pericarditis;
5) diabetes.
The correct answer is:

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

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Question 148

Which of the factors listed below does not increase the risk of community-acquired pneumonia?

Aold age.
Btobacco smoking.
Ctreatment with systemic glucocorticoids or other immunosuppressants.
Dworking outdoors.
Eperiodontal diseases.

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Question 149

A 60-year-old man with a long history of arterial hypertension with comorbid type 2 diabetes mellitus was admitted to Emergency Dept. because of massive oedema, dyspnoea, malaise, weakness, nausea and vomiting. Laboratory tests showed creatinine 8 mg/dl, urea 220 mg/dl, gasometry: pH 7.2, pCO2 30 mmHg, pO2 80 mmHg, HCO3 16 mmol/l, abdominal ultrasound revealed both kidneys with a longitudinal axis of 6 cm, with decreased corticomedullary differentiation. Indicate appropriate measures to be taken:

Aintravenous Solu-Medrol pulse dosing.
Binsertion of dialysis catheter and permanent dialysis.
Cinsertion of dialysis catheter and management of acute renal failure.
Dkidney biopsy and taking relevant measures according to biopsy findings.
Eintravenous fluid therapy.

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Question 150

Haematological abnormalities are a common symptom of acute lymphoblastic leukaemia in children. Blood morphology test shows:
1) anaemia;
2) thrombocytopenia;
3) low white blood cell count;
4) normal white blood cell count;
5) high white blood cell count.
The correct answer is:

Aall of the above.
B1,2,3.
C1,2,4.
D1,2,5.
E1,5.

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Question 151

Indicate true statements regarding mycoplasmatic pneumonia:

Arapid onset of symptoms and high fever are typical characteristics.
Bin the course of disease, upper respiratory symptoms and mild fever develop gradually.
Ccharacteristic rash and diarrhoea occur.
Dthe disease is asymptomatic, with diagnosis based on laboratory test results.
Eall of the above.

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Question 152

Although the assessment of cytogenetic and molecular traits is not required in the diagnosis of acute lymphoblastic leukaemia (ALL), they are among the basic classification criteria of ALL. Indicate false statements regarding ALL:

Ain ALL, B lymphoblasts are almost always positive for B CD19 markers.
Bin ALL, B lymphoblasts must be negative for CD3 (T cell antigen).
Cin ALL, B lymphoblasts must be negative for myeloperoxidase (MPO).
DB-ALL diagnosis should be avoided when the number of lymphoblasts is <20%.
EB-ALL is always diagnosed when the number of lymphoblasts > 5%.

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Question 153

A 15-year-old boy came to the primary care unit because of fever (>38.0 C), fatigue, lack of appetite, profuse night sweats and losing weight. Physical examination confirmed weight loss (> 10% over last six months), painless cervical and supraclavicular lymphadenopathy. Indicate the most probable diagnosis:

Aacute lymphoblastic leukaemia.
Bacute myeloid leukaemia.
CBurkitt’s lymphoma.
DHodgkin’s lymphoma.
Echronic myeloid leukaemia.

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Question 154

Hodgkin’s lymphoma can be diagnosed based on the findings of all measures listed below, except for:

Aexcision biopsy of enlarged lymph node.
Bdetecting Hodgkin/Reed-Sternberg cells in histopathology (HRS).
Cfine-needle aspiration biopsy of lymph node.
Dbone marrow biopsy in patients in an advanced stage of the disease.
Ediagnostic imaging, including positron emission tomography (PET).

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Question 155

The leading cause of viral meningitis in children is:

Aenteroviruses (EV).
Bparechoviruses.
Cherpesviruses.
Dlymphocytic choriomeningitis virus (LCMV).
Einfluenza virus.

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Question 156

Early treatment of pertussis in infants (within the first seven days since the onset of symptoms) can reduce the symptoms of the disease. To effectively eradicate pertussis from the nasopharynx, you should administer:

Amacrolides.
Bampicillin.
Cpenicillin.
Dsecond-generation cephalosporins.
Eaminoglycoside.

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Question 157

The diagnosis of neonatal chickenpox is not based on:

Acharacteristic appearance of the newborn, with generalised vesicular skin lesions at different stages of development and healing.
Bhistory of maternal exposure to chickenpox virus.
Cestablishing by history that the mother had clinical signs of chickenpox before delivery.
Ddetection of chickenpox virus by polymerase chain reaction (PCR) from vesicle swabs.
Ecataracts/ congenital glaucoma.

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Question 158

A 56-year-old male patient diagnosed with adenocarcinoma of the body of the stomach, confirmed by histopathological findings, came to see a doctor at an outpatient clinic. Which examination will you order for the local staging assessment of the cancer:

Aabdominal ultrasound.
Bdiagnostic laparoscopy.
Cparacentesis.
Dabdominal CT.
EPET.

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Question 159

A 70-year-old female patient with a history of rectal cancer surgery three years before, came in to an outpatient clinic. She provided the findings of the last two CEA blood tests. The first one showed 8.45 ng/ml, and the other one, performed three months afterwards, 19.39 ng/ml (normal range <5.0 ng/ml). The dual-phase abdominal and thoracic CT scan and colonoscopy findings did not show any abnormalities. Indicate which examination should be ordered for the patient:

Atransrectal ultrasound.
Bpelvic magnetic resonance imaging (MRI).
CPET-CT.
Ddiagnostic laparoscopy.
ECEA test in three months’ time.

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Question 160

A 34-year-old female patient who has been treated for paroxysmal hypertension for three years came to see a doctor at an outpatient clinic. She complains of polydipsia, profuse sweating and heart palpitations. Laboratory tests showed considerably increased blood catecholamines, and double-phase abdominal CT scan showed a 3 cm tumour in the left adrenal gland. Indicate appropriate treatment:

Aresection of adrenal gland with the tumour.
Bfine-needle aspiration biopsy of the tumour.
Cabdominal magnetic resonance (MRI).
Dtumour resection with adrenal gland preservation.
Ebilateral adrenalectomy.

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Question 161

The factors that increase the risk for pancreatic cancer do not include:

Aobesity.
Binsulin-dependent diabetes mellitus.
Cchronic exposure to aluminum.
Dtobacco smoking.
Eacute pancreatitis.

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Question 162

A pre-operative local staging assessment of rectal adenocarcinoma, considered to be a gold standard examination, is performed using:

Atransrectal ultrasound.
Bdouble-phase abdominal and pelvic CT.
Cpelvic magnetic resonance (MRI).
Dproctosigmoidoscopy.
Eabdominal and pelvic PET-CT.

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Question 163

Indicate true statement(s) regarding pancreatic adenocarcinoma:
1) it usually derives from acinic cell of the pancreas;
2) Whipple surgery is the method of choice for resection of the head of the pancreas;
3) migrating phlebohtrombosis may develop in the course of the disease;
4) it can stem from the intraductal papillary mucinous neoplasm of the pancreas (IPMN);
5) the Courvoisier symptom is characteristic of cancer of the body of the pancreas.
The correct answer is:

A1,2,4.
B2,5.
C2,3,4.
D1,3,4,5.
E2 only.

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Question 164

In a young woman of reproductive age, the histopathological findings from fine-needle aspiration biopsy of the abdominal wall revealed a desmoid tumour. Indicate the best treatment option:

Atumour resection along with a broad margin of healthy tissue.
Bobservation and re-examination.
Cresection confined to the tumour.
Dtaking a tissue specimen during open incisional biopsy.
Etumour resection along with a narrow margin of healthy tissue.

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Question 165

In young women of reproductive age, a fibrous tumour of the abdominal wall, which is comorbid with the Gardner’s syndrome, will most probably be:

Afibrosarcoma.
Bperitoneal mesothelioma.
Cold fibrotic haematoma.
Dirreducible hernia.
Edesmoid.

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Question 166

An elderly male patient with obturative lung disease was diagnosed with hernia. It was protruding from the abdominal cavity through the transverse fascia which forms the posterior wall of the inguinal canal, at the site bordering the conjoint tendon at the top, the inguinal ligament at the bottom, and laterally, through inferior epigastric vessels. The hernia in such location is known as:

Aoblique inguinal hernia.
Bscrotal hernia.
Cdirect inguinal hernia.
Dfemoral hernia.
Espigelian hernia.

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Question 167

Indicate true statements regarding epidemiology of cervical cancer:

Athe incidence of cervical cancer is correlated with the rate of human papilloma virus.
Bthe relative risk of cervical cancer decreases with age.
Ccervical cancer is more prevalent among obese women.
Dcervical cancer is not found among sexually inactive women.
Ethe relative risk of cervical cancer decreases with the number of childbirths.

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Question 168

The most frequent type of vulvar cancer (65-90% of cases) is:

Aadenocarcinoma.
Bsquamous cell carcinoma.
Cclear cell carcinoma.
DPaget’s disease.
EBowen’s disease.

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Question 169

A female genital neoplasm which gives a positive pregnancy test result, and is often manifested by the development of bilateral ovarian cysts during its course, is termed as:

Adysgeminoma.
Bfolliculoma.
Csertolioma.
Dchoriocarcinoma.
Eluteoma.

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Question 170

In gynaecology, an example of primary prevention of cervical cancer is:

ADNA genotyping of highly oncogenic HPVs.
Bcytology.
Ca so-called ‘co-testing’ i.e. cytology combined with HVP genotyping.
Dvaccination against HPV.
Ecolonoscopy.

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Question 171

The basic examination for detecting ovarian cancer is:

Aroutine gynaecological examination.
Bcytological assessment of the peritoneal fluid obtained in abdominal paracentesis.
Cdetermination of Ca125 marker.
DROMA test (Ca125 and HE-4 markers).
Etransvaginal ultrasound of pelvic organs.

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Question 172

In ovarian cancer diagnostics, the family history of this cancer is of high significance. Which genes should be considered in gene mutation testing that could help assess an increased risk of ovarian cancer among family members?

AP 53.
BBcl-2.
CBRCA1 and BRCA2.
DACE 2.
EHE4.

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Question 173

Indicate which of the factors below contribute to decreasing the risk of ovarian cancer and are thought to play a protective role:
1) multiparity;
2) combined hormonal contraceptive;
3) hormonal stimulation of ovulation;
4) ovarian puncture in the in vitro fertilization procedure.
The correct answer is:

A2 only.
B1,2.
C1,2,3.
Dall of the above.
Enone of the above.

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Question 174

Indicate hormonal drugs used in the complementary therapy of cancer of the body uterus:

Aestrogens.
Bselective oestrogen receptor modulators.
Cprogestagens.
Dselective progesterone receptor modulators.
Eandrogens.

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Question 175

A female patient, 65 years of age, came to see her family doctor because of severe abdominal pain which has become more intense for the last few days. Over the last few months she has had alternating constipation and diarrhoea. Presently, she has had no bowel movement for a few days. Medical history revealed iron-deficiency anaemia diagnosed a few months before and arterial hypertension which has been poorly controlled as the patient is not fond of going to the doctor and she did not have any health complaints. On physical examination, the abdomen was distended and painful to touch, and increased intestinal peristalsis could be heard. Deep palpation was not possible due to abdominal tension. Indicate appropriate measures to be taken:

Aurgently refer the patient to hospital because of suspected intestinal obstruction.
Brefer the patient to hospital for elective abdominal diagnostics.
Crefer the patient to an outpatient clinic for abdominal X-ray in a standing position, to exclude intestinal obstruction.
Drefer the patient for laboratory blood tests for diagnostics of anaemia.
Easking the patient to take simethicone preparation and come for a control visit after the bloating recedes.

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Question 176

A male patient, 70 years of age, came to see his family doctor to discuss the results of laboratory tests he made to check whether he may have osteoporosis because he had had a radial bone fracture after a slight fall a few months before. Apart from that, he reports occasional lumbar pain and weakness which he thinks can be attributed to ageing. Laboratory tests showed blood calcium concentration 4 mmol/l (normal range: 2.1-2.6 mmol/l), creatinine 2.1 mg/dl (normal range: 0.6-1.3 mg/dl), and slight normocytic anaemia, with no other abnormalities. What is the most probable diagnosis?

Aprimary hyperparathyroidism.
Bmultiple myeloma.
Cvitamin D deficiency.
Diron deficiency.
Eprimary osteoporosis.

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Question 177

A mother with her 5-year-old daughter came to see their family doctor. The daughter has been complaining of headache and she has occasionally vomited for some time. The symptoms usually occur in the morning hours. The doctor suspects a tumour of the central nervous system. However, the physical examination, including full neurological exam, did not reveal any abnormalities. The same refers to laboratory testing. What further measures should be taken?

Aparacetamol administration to control headache, at a dose based on kg body weight.
Brecommendation to avoid eating late, in order to prevent morning vomiting.
Crefer the patient to cancer centre for imagining diagnostics of the head.
Drefer the patient to gastro ward for imaging diagnostics of the abdomen.
Erefer the patient to psychology clinic, as most probably the child simulates the symptoms, which may be associated with impaired family relationships.

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Question 178

During a complex medical check-up for children at 3rd grade of primary school, the mother asks the doctor for a medical waiver to exempt her child from the physical education course. She claims that owing to obesity, the child has difficulty performing physical exercises and does not get such good grades as other children do. Which group of the physical education course should the doctor classify the child into?

Agroup C, for a non-defined period of time, and ask the child to show up for regular control check-ups at the clinic.
Bgroup C, for a month’s time, and then make a re-assessment.
Cgroup C1, as obesity is a serious disease which requires supplementary rehabilitation out of school.
Dgroup B, considering the reason for the limitation and, possibly, providing guidelines to the teacher.
Egroup A, as the child should perform the same exercises as other pupils do, which will be beneficial to his/her health.

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Question 179

Indicate the true criteria for positive bronchodilator response in asthma diagnostics in adults and children over 6 years of age:
1) FEV1 increase > 12% and >200 ml from baseline, in adults;
2) FEV1 increase > 12% or >200 ml from baseline, in adults;
3) FEV1 increase > 12% of baseline, in adults;
4) FEV1 increase > 12% and >200 ml from baseline, in children;
5) FEV1 increase > 12% or >200 ml from baseline, in children;
6) FEV1 increase >12% from baseline, in children.
The correct answer is:

A1,4.
B1,5.
C2,5.
D3,5.
E1,6.

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Question 180

Which symptoms are typical for the carpal tunnel syndrome?
1) Tinel-Hoffman sign
2) Phalen’s sign;
3) Hashizume sign;
4) Rumpel-Leede sign;
5) Thompson sign.
The correct answer is:

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

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Question 181

The positive symptoms of schizophrenia include:
1) hallucinations
2) depressed mood
3) anhedonia
4) ambivalence
5) delusions
The correct answer is:

A1,2.
Ball of the above.
C1,5.
D2,5.
E3,4.

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Question 182

Indicate the true time-based criterion for the occurrence of depressive episode, according to ICD-10 classification:

Atwo weeks.
Bone month.
Cthree months.
Dsix months.
Enone of the above.

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Question 183

Among mental health disorders, the highest mortality risk is associated with:

Adepressive episode.
Bschizophrenia.
Cbipolar mood disorder.
Danorexia.
Edementia in Alzheimer’s disease.

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Question 184

Indicate the drug whose administration is associated with the lowest metabolic risk:

Aquetiapine.
Bolanzapine.
Chaloperidol.
Dsulpiride.
Earipiprazole.

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Question 185

The selective serotonin reuptake inhibitors (SSRI) do not include:

Aparoxetine.
Bvortioxetine.
Csertraline.
Dfluvoxamine.
Eescitalopram.

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Question 186

During a physical examination, you have to determine the cause of headache. The facial pain can be caused by:

Athe condition of teeth and gums.
Btrigeminal neuralgia.
Cglossopharyngeal neuralgia.
Danswers A,B,C are correct.
Eanswers B and C are correct.

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Question 187

Indicate false statements regarding carbon monoxide (CO) characteristics:

Acarbon monoxide is a colourless, odourless and tasteless gas.
BCO has a 200-times greater affinity for haemoglobin than oxygen.
CCO particles cannot pass through the drywall.
Dcarboxyhaemoglobin (COHb) is a carbon monoxide carrier in the organism.
ECO particles are small enough to pass through the drywall and induce intoxication of people staying in adjacent rooms.

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Question 188

In CT scan of the head, the early radiological symptoms of ischaemic stroke do not include:

Asmoothing of cerebral sulci.
Bloss of the insular ribbon sign.
Creduced contrast of the basal ganglia.
Dhyperdense middle cerebral artery sign.
Ehypodense middle cerebral artery sign.

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Question 189

Indicate false statements regarding acute limb ischaemia:

Asudden onset of symptoms.
Bpain subsiding after relaxation.
Cthe most common pathway is embolism or thrombosis.
Doccurs after physical effort.
Edoes not subside after relaxation.

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Question 190

Indicate false statements regarding general principles of seizure control:

Ayou should not put any material objects into the patient’s mouth/between his teeth.
Byou should not try to revive the patient.
Cyou should not pour water over the patient’s face.
Dyou should wake up the patient after the seizure.
Eyou should put something soft under the patient’s head when the seizure starts.

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Question 191

Most of the deaths of haemodynamically unstable patients who have gastrointestinal bleeding can result from:

Arenal failure.
Bcerebral ischaemia.
Cmyocardial ischaemia.
Dliver ischaemia (in patients with limited hepatic functional reserve).
Eall of the above are true.

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Question 192

Having reviewed the results of the ordered laboratory tests, the physician informs the patient about the diagnosis which is unfavourable for him/her. The patient interrupts the physician and asks him to stop as he does not want to hear about his diagnosis any more. Under these circumstances, the physician should:

Arefrain from informing the patient, because he is legally exempt from this duty if the patient requests so.
Bcontinue with his duty of informing the patient, as it is the condition for the patient’s granting or denying his informed consent to treatment procedures.
Cpersuade the patient to continue listening about the diagnosis, as the doctor is obliged to provide him/her with all the available information about his/her health condition.
Dpass the information about the patient’s condition to the person authorised by the patient.
Ecall a medical council composed of three physicians, including at least two specialists in the field which the diagnosis concerns, and pass health information to the patient in a broader circle.

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Question 193

Who may represent the complainant during the proceedings before the Regional Medical Chamber?

Apublic prosecutor.
Bpresident of the medical malpractice office.
Cprofessional indemnity ombudsman.
DPatient Rights Ombudsman.
Ephysician, advocate or legal counsel.

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Question 194

A patient diagnosed with a massive cerebrovascular accident is admitted to the Emergency Dept. The communication with the patient is impossible due to severely impaired speech and perception. The physician decides that the patient needs immediate medical assistance. Can he undertake treatment and start the procedures without the patient’s consent?

ANo, because both the law and the Code of Medical Ethics forbid any kind of medical intervention be undertaken without the patient’s consent.
BYes, because the medical profession act for physicians and dentists permits, by way of exception, that medical intervention be undertaken without the patient’s consent if he needs immediate medical assistance and is unable to make the said consent because of his health condition.
CYes, but only on condition that a judicial approval by the guardianship court has been granted before any procedures are undertaken.
DYes, but he can order only examinations and laboratory tests, and is not allowed to undertake any treatment.
ENo, because when making such a decision, he risks being accused of unlawfulness.

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Question 195

The decision regarding disability issued by district disability assessment committee can be appealed to:

Amedical committee of the Social Insurance Institution.
Bmedical committee of the National Health Fund.
Cmedical committee of the district medical chamber.
Dvoivodeship committee for disability assessment.
Enational committee for disability assessment.

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Question 196

Monthly sickness allowance for hospital stay amounts to:

A65% of the benefit calculation basis.
B70% of the benefit calculation basis.
C80% of the benefit calculation basis.
D90% of the benefit calculation basis.
E100% of the benefit calculation basis.

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Question 197

Mounting scientific evidence supports the hypothesis that the postal code is a better health predicting factor than the genetic code. This hypothesis refers to:

Ahealth inequality.
Bprevention paradox.
Creverse healthcare.
Dthe Pareto principle.
Eoverdiagnosis of diseases.

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Question 198

The use of variolisation in the past was associated with the spreading of:

Aplague.
Bcholera.
Cspotted typhus.
Dsmallpox.
Eyellow fever.

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Question 199

Which of the following medications does not increase the risk of type 2 diabetes?

Ahydrochlorothiazide.
Bmetformin.
Catorvastatin.
Dbisoprolol.
Eprednisone.

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Question 200

Which of the following scales is used to assess the maturation of a neonate?

ATanner.
BGlasgow.
CNYHA.
DBallard.
EApgar.

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