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LEKEXAM / 2024 spring

Question distribution — 2024 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

Pancytopenia is defined based on:

Awhite blood cell count.
Bwhole blood cell count.
Cpercentage of CD34+ in bone marrow aspiration biopsy.
Dabsence of blasts in myelogram.
Ered blood cell count in peripheral blood.

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Question 2

A 27-year-old patient comes to the emergency department at 29 weeks of her first pregnancy complaining about a fever up to 38.3°C for the last couple of hours, 2 episodes of vomiting and back pain. Ultrasound examination reveals a normally growing living foetus, normal placenta located in the fundus and the full bladder. On palpation, the abdomen is not rigid but tender in the hypogastric area. On bimanual vaginal examination no pain during cervical motion is observed. The percussion of the lumbar area, especially on the left side, is very painful for the patient. What do you suspect?

Aacute appendicitis
Bleft-sided renal calculi.
Cacute pyelonephritis
Dacute cystitis.
Ehydronephrosis due to the pressure of the pregnant uterus on the ureter

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Question 3

Symptoms of ovarian cancer do not include:

Apain in the lower abdomen or pelvis
Boliguria
Cincrease in the abdominal circumference
Dtympanites, abdominal distention
E. urge incontinence

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Question 4

Which of the following should you suspect in a female patient complaining of cyclic regular hypogastric pain occurring for a longer time and rectal bleeding that accompanies menstruation?

AMeckel's diverticulum
Bhyperthyroidism
Cintestinal tract endometriosis
Dhaemorrhagic diathesis.
Enone of the above

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Question 5

A patient with decompensated diabetes mellitus and severe ketoacidosis complains of abdominal pain, nausea and vomiting. There are no obvious signs of peritonitis on physical examination. The first-line approach in this patient is:

Alaparotomy.
Bminimally invasive exploratory laparotomy.
Cdetailed abdomen diagnostics (CT, MRI).
Dappropriate hydration and correction of metabolic disturbances.
Enone of the above.

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Question 6

Indicate tests that should be ordered before the abdominal puncture in a patient with hepatic cirrhosis:

Aultrasound imaging, whole blood count, PET, AlAT, AspAT, Na, K, Cl.
Bwhole blood count, clotting tests, abdominal ultrasound imaging.
Cwhole blood count, abdominal CT scan, ultrasound imaging, alkaline phosphatase, ammonia.
Dabdominal CT scan, glucose, urea, bilirubin, whole blood count.
Eclotting tests, AlAT, AspAT, bilirubin, albumin.

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Question 7

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 8

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 9

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 10

In accordance with the Law on cash benefits from social insurance in case of sickness and maternity the doctor’s statement on temporary incapacity for work because of sickness or a stay in the hospital contains the information about the circumstances influencing the entitlement to the sickness allowance or its amount marked with letter codes. The incapacity for work during pregnancy is marked with:

Acode A
Bcode B
Ccode C
Dcode D
Ecode E

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Question 11

In accordance with the Law on social insurance benefits provided for in case of work accidents and occupational diseases the insured person who has suffered a permanent or long-lasting health damage due to a work accident or occupational disease is entitled to:

Awork incapacity pension.
Bsick pay
Ctraining pension.
Done-time indemnity.
Enursing allowance.

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Question 12

The QALY indicator means:

AHuman development index
BHealthy life years indicator
CQuality- adjusted life years
DRoom area indicator
ENumber of aggressive years of life

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Question 13

Activities early detecting diseases and their causes make up secondary prophylaxis. Which of the following are part of secondary prophylaxis?

1) active guidance;

2) dispanserization;

3) vaccination;

4) health checks;

5) screening;

6) epidemiological supervision over food production.

The correct answer is:

A1, 3
B2, 3
C4, 5, 6
D1, 2, 4, 5
E2, 3, 5, 6

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Question 14

The expansion of extracellular fluid volume is an inevitable consequence of diminished salt and water excretion in renal failure. Indicate the false consequence of overhydration:

Aweight gain
Boedema.
Craised jugular venous pressure.
Dhypernatermia.
Eanaemia.

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Question 15

Which of the following foetal head diameters is the smallest and most conveniently goes through the spaces of the pelvic planes during physiological childbirth?

Asuboccipitobregmatic
Boccipitofrontal
Coccipitomental
Dsubmentobregmatic
Everticomental

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Question 16

The true conjugate is defined as:

Aline connecting the lower edge of the pubic symphysis with the iliococcygeus joint.
Bline connecting the promontory with the upper edge of the pubic symphysis
Cline connecting the promontory with the most inwardly facing part of the pubic symphysis.
Dline connecting a cavity between the spinous processes of L3 and L4 with the upper edge of the pubic symphysis
Eline connecting the promontory with the lower edge of the pubic symphysis.

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Question 17

In which of the following patients is an increased risk of perioperative complications observed?
1) obese;
2) below 30 years of age;

3) with coronary artery disease;
4) with diabetes mellitus;
5) classified to ASA PS category I according to the American Society of Anesthesiologists.
The correct answer is:

A1,2,3,4.
B3,4,5.
C1,3,5.
D1,3,4.
E2,3,4.

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Question 18

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 19

The cause of hypouricemia is not:

ASIADH
Btubular acidosis type II
Cpregnancy
Drenal insufficiency
Eallopurinol administration

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Question 20

Which of the following markers should be used in the diagnosis of molar pregnancy?

ACa125
Bbeta hCG
Cestradiol.
Dinhibin A
EHE4.

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Question 21

In female adolescents (15 years old) without signs of breast development gonadotropins should be measured in order to exclude:

AHyperprolactinemia
BHypergonadotropic hypogonadism
CHyperthyroidism
DPrecocious puberty
EPolycystic ovarian syndrome

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Question 22

In women using biphasic hormonal anticonception a typical menstrual period

Ais short and light.
Bdoes not occur.
Coccurs irregularly and last for many days.
Dis heavy and long.
Eoccurs every 21 days and is light.

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Question 23

Indicate findings present in normal cardiotocographic non-stress test (NST) in pregnancy:

1) baseline fetal heart rate - 100/min;

2) baseline fetal heart rate - 150/min;

3) marked variability of the fetal heart rate;

4) absence of accelerations;

5) absence of decelerations.

The correct answer is:

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

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Question 24

Which of the following is a mood-congruent delusion observed in depression?

Anihilistic delusion.
Bpersecutory delusion.
Cdelusion of jealousy.
Ddelusions of control
Egrandiose delusions

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Question 25

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

Afluoxetine
Breboxetine
Cquetiapine.
Dtrazodone
Evenlafaxine

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Question 26

Which of the following concerning carcinoma of the ampulla of Vater is false?

Apredominant sign of carcinoma of the ampulla of Vater is painless mechanical jaundice.
Bcarcinoma of the ampulla of Vater may lead to so called Courvoisier’s sign.
Cpercentage of resection operations in carcinoma of the ampulla of Vater is significantly lower than in pancreatic head cancer.
Dlong term results of treatment are better in carcinoma of the ampulla of Vater than in pancreatic cancer.
Eits incidence in males and females is similar.

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Question 27

The most common neuroendocrine pancreatic tumor is:

Agastrinoma.
Bsomatostatinoma.
CVIPoma.
Dglucagonoma.
Einsulinoma.

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Question 28

A 27-year-old woman with severe abdominal pain was admitted to the ER. She had fainted at home. She complains of the pain of the whole abdomen, lasting for 2 hours. The pain had acute onset in the lower abdomen. She can’t remember the date of her last menstruation period, but she confirms no periods for more than a month. On palpation increase muscle tone and tenderness are observed. Other findings include pale skin, BP 80/60 mmHg, HR 120/min. Which condition should be excluded in the first place?

Aruptured ectopic pregnancy
Bovulation pain.
Cappendicitis
Dirritable bowel syndrome.
Esalpingitis.

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Question 29

In the TNM classification of colon cancer T1 denotes infiltration of:

Amucous membrane.
Bsubmucous membrane.
Cmuscle membrane.
Dserous membrane.
Eneighboring organs.

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Question 30

In the Polish law medical secrecy covers:

Aall information that the doctor has on patients and their families
Ball information associated with patients which the doctor obtained while performing medical profession
Conly information on patients’ health and their treatment which the doctor obtained while performing medical profession.
Donly information associated with patients which the doctor obtained from them or on the basis of conducted medical examinations.
Eonly information included in medical records.

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Question 31

In accordance with the law on old age and disability pensions paid from Social Insurance Fund, an insured person with the required period of insurance and holding a medical ruling on the purposefulness of occupational retraining issued by the certifying doctor is entitled to:

A. resultant disability pension.

B. training pension.
C. carer’s benefit.
D. sickness benefit.

E. disability pension resulting from incapacity for work.

Aresultant disability pension.
Btraining pension.
Ccarer’s benefit.
Dsickness benefit.
Edisability pension resulting from incapacity for work.

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Question 32

Indicate the false statement concerning gastrointestinal stromal tumors (GIST):

Agenetic disorders play an important role in their etiology.
Btheir most common localization in the gastrointestinal tract is the stomach.
Cfirst-line treatment is their surgical removal.
Dthey are of epithelial origin.
Eadjuvant treatment is chemotherapy with imatinib.

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Question 33

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 34

Which of the following does not influence (neither positively or negatively) the risk of colon cancer?

Atobacco smoking
Bage > 50 years
Caspirin
Dobesity
Eangiotensin convertase inhibitors or angiotensin receptor antagonists

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Question 35

What is the most common reason for the obstruction of the lower gastrointestinal tract?

Acolon cancer.
BCrohn’s disease.
Cintraperitoneal adhesions.
Ddiverticulosis.
Eulcerative colitis.

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Question 36

A 25-year-old woman in 12th week of her first pregnancy made a test of antibodies against Toxoplasma gondii. The results were as follows: IgG = 300 IU/mL, IgM (-). A similar test performed 2 years earlier showed: IgG = 480 IU/mL, IgM (-). The patient should be informed that:

Athere is a high risk of an infection with Toxoplasma gondii caused by the consumption of both raw meat and contaminated fruit and vegetables.
Bshe has to repeat the test of antibodies against T. gondii every 6-8 weeks during the whole pregnancy.
Cshe should undergo antiprotozoal treatment.
Dshe was infected with Toxoplasma gondii before the pregnancy (most probably it was a subclinical infection) and her child is not at risk of the infection.
Eit is necessary to perform invasive diagnostics for the infection (amniocentesis, examination of the amniotic fluid for protozoan cysts).

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Question 37

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 38

Pharmacological agents used in the treatment of shingles include:

AAcyclovir in tablets
BAcyclovir in ointments
CPainkiller tablets
Dtrue are A,B.
Etrue are A,C

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Question 39

Aterogenic dyslipidemia is characterized by:

Aincreased concentration of triglycerides
Blow concentration of HDL-cholesterol
Cmarkedly elevated concentration of LDL-cholesterol
Dtrue are A, B
Etrue are A, B, C

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Question 40

Instability found on the examination of the pelvis is the indication for:

Aoxygen therapy with the oxygen resuscitator
Binfusion of large volumes of fluids.
Cplacing the sling stabilizing the pelvis
Dapplication of therapeutic procedures against hypothermia.
Erolling the victim onto their side to assess possible back injuries.

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Question 41

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 42

The most common symptom reported by patients with vulvar cancer:

Apain.
Bfever.
Cmalaise
Dpruritus.
Edysuria.

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Question 43

Which of the following parameters is not included in the assessment of the fetal biophysical profile?

Afetal movement.
Bfetal tone.
Cumbilical artery blood flow
Damniotic fluid volume.
Efetal heart rate.

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Question 44

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 45

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 46

Which of the following should be performed in a patient who was referred to the surgical outpatient clinic because of yellowish skin?

1) laboratory exams: bilirubin, alkaline phosphatase, ALT, AST, GGT;

2) abdominal ultrasound;

3) hospitalization in order to perform endoscopic retrograde cholangiopancreatography;

4) magnetic resonance cholangiopancreatography (MRCP).

The correct answer is:

A1,2
B1,3
C1,4
D2,3
E1,2,3

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Question 47

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 48

Rehabilitation benefit is due:

Atogether with sickness benefits.
Bonly if the insured person has not been entitled to sickness benefit.
Cfor a period not longer than 6 months
DFor a period not longer than 9 months
Eto the insured person who after exhausting the sickness benefit is still unable for work but further treatment or medical rehabilitation promises recovery of the ability to work.

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Question 49

In cost benefit analysis (comparison of two interventions that have different health effects) the most commonly used measure to compare the health effects is:

AFatality
BQALY
CVOLY
DDALY
EHYE

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Question 50

According to WHO which of the following is not a criterion for recognizing the alcohol

addiction syndrome?

Aalcohol craving.
Bloss of control over alcohol consumption.
Cincrease in alcohol tolerance.
Dincreasing neglect of pleasure and interests.
Eearlier anti-social behaviour.

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Question 51

Which of the following traumas may be an indication for immediate thoracotomy at the emergency department?

ABlunt chest trauma
BBlunt abdominal trauma
CBlunt pelvic trauma
DPenetrating injury to the chest leading to cardiac arrest
EPenetrating injury to the abdomen.

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Question 52

Indicate the site of auscultation of the aortic valve:

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

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Question 53

Which of the following conditions predisposes towards recurrent acute pancreatitis?

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

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Question 54

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

Ahypercalcemia of malignancy
Bprimary hyperparathyroidism
Csecondary hyperparathyroidism
Dpseudohypoparathyroidism
Evitamin D overdose

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Question 55

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

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

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Question 56

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

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

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Question 57

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

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

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Question 58

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

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

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Question 59

Indicate the false statement concerning erysipelas:

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

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Question 60

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

Anormospermia.
Basthenozoospermia.
Ccryptozoospermia.
Doligoteratozoospermia.
Easthenoteratozoospermia.

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Question 61

Which of the statements regarding stress urinary incontinence is true?

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

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Question 62

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

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

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Question 63

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

Apharyngitis.
Bepiglottitis.
Ccroup
Dbronchitis.
Epneumonia.

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Question 64

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 65

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

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Question 66

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

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

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Question 67

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

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

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Question 68

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

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

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Question 69

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

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

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Question 70

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

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

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Question 71

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

1) splenic artery

2) proper hepatic artery

3) right gastric artery

4) splenic vein

5) proper hepatic vein

6) portal vein

7)common bile duct

The correct answer is:

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

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Question 72

Indicate the false statement concerning acute cholecystitis:

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

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Question 73

The antithrombotic prophylaxis does not involve:

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

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Question 74

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

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

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

3) dyspareunia (pain related to sexual intercourse);

4) pain during defecation or micturition;

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

The correct answer is:

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

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Question 75

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

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

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Question 76

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

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

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Question 77

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

1) ovarian cancer;

2) liver cancer;

3) endometrial cancer;

4) cervical cancer;

5) renal cancer.

The correct answer is:

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

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Question 78

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

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

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Question 79

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

Acatatonia.
Bcataplexy.
Ccatalepsy.
Dcatathymia.
Econversion.

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Question 80

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

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

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Question 81

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 82

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

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

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Question 83

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

Aincidence rate of 100/100,000.
Bmorbidity rate of 80 / 100 000.
Ccase fatality rate of 20/100,000.
Dcase fatality rate of 200/1000.
Emortality rate of 200/1000.

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Question 84

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 85

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

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

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Question 86

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

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

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Question 87

The Glasgow-Blatchford scale refers to patients with:

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

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Question 88

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 89

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 90

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 91

The Doloplus-2 scale is a method of measuring pain:

Ain geriatric patients with impaired cognitive functions.
Bin children
Cin mechanically ventilated patients.
Din every patient after injury.
Ein none of the above patient groups.

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Question 92

Which blood test should be performed first in a person with tetany attacks?

Amagnesium
Bsodium
Cpotassium
Dcalcium
Ezinc

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Question 93

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 94

Indicate the possible reason for the presence of a persistently low urine specific gravity during properly conducted dehydration tests:

Acentral diabetes insipidus
Bnephrogenic diabetes insipidus
Cpsychogenic polydipsia
DA and B are correct
EA and C are correct

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Question 95

According to the Code of Medical Ethics, the doctor's highest ethical commandment is:

Awell-being of the patient.
Bautonomy of the patient.
Ccare of the dignity of the medical profession
Drespect for the human rights.
Erespecting the rules of a particular therapeutic entity.

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Question 96

A doctor is not authorized to provide information about a health condition of an unconscious female patient (aged 54):

Ato a granddaughter of the patient.
Bto a daughter-in-law of the patient.
Cto the husband of the patient.
Dto a cousin of the patient.
Eto a domestic partner of the patient.

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Question 97

Hyperuricemia leads to recurrent attacks of acute arthritis. This disease risk factors do not include:

Adyslipidemia.
Balcohol abuse.
Cvegetarian diet.
Doccupational exposure to lead.
Egenetic predisposition.

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Question 98

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 99

Which of the following concerning hyperprolactinemia is false?

Asleep and stress are physiological conditions associated with increased secretion of prolactin.
Bhyperprolactinemia is the cause of 30% of cases of secondary amenorrhea after discontinuation of oral contraceptives.
Cdrugs used in hyperprolactinemia treatment are cabergoline and bromocriptine.
Dconsequences of hyperprolactinemia include the lack of pubic hair and a decrease in the secretion of adrenal androgens
Egalactorrhoea is found in 30-90% women with hyperprolactinemia.

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Question 100

To carry out a medical experiment, the following conditions have to be fulfilled:

1) a written consent of an examined person who is to participate in the experiment has to be obtained;

2) a consent of the director of a regional branch of the National Health Fund (NFZ) has to be obtained;

3) prior notice has to be given to an examined person about the purposes, methods and conditions of conducting the experiment, expected therapeutic and cognitive benefits, risk and a possibility of withdrawing from the experiment at any of its stages;

4) project should be approved by an independent bioethical committee;

5) project should be verified by the Regional Medical Chamber.

The correct answer is:

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

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Question 101

Indicate the true statement concerning vulvar cancer:

Amost often occurs before the age of 40.
Baccounts for 3-8% of all female genital malignancies.
Cmore than 90% of vulvar cancers are glandular cancers.
Dthe treatment of choice is a systemic treatment.
Efive-year survival for women in FIGO stage I is 31%.

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Question 102

Indicate the false statement concerning familial adenomatous polyposis (FAP):

Ait is autosomal dominantly inherited condition, the mutation concerns the APC gene.
Bthe only surgery is proctocolectomy with end ileostomy.
Ccolectomy with ileorectal anastomosis is performed in some patients.
Dthere is an increased incidence of papillary thyroid cancer.
Edesmoid tumors form in the abdominal cavity.

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Question 103

An accident resulting in a severe damage to an employee’s body, such as loss of reproductive capacity or mental illness is:

Aminor accident at work.
Bmoderate accident at work
Cserious accident at work.
Disolated accident at work.
Egroup accident at work.

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Question 104

Thrombophilia is most probable in a patient:

Awho does not respond to acenocoumarol/warfarin treatment.
Bwho had excessive bleeding after tooth extraction.
Cwho had deep vein thrombosis and pulmonary embolism without any known risk factors.
Dwho had myocardial infarction before 50 years of age.
Ewho has an abdominal aortic aneurysm with intraluminal thrombus.

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Question 105

Typical signs and symptoms of lung contusion include:

Ahemoptysis.
Bdyspnoea
Ccyanosis
Drales
Eall the above

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Question 106

The procedure consisting in cutting the esophageal muscles including the lower esophageal sphincter is performed in the patients with:

AZenker’s diverticulum.
Bupper esophageal sphincter spasm.
Cachalasia.
Ddiffuse spasm of the esophagus.
EC and D are correct.

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Question 107

The possible causes of cervical incompetence include:

1) inherited disorders;

2) traumas of the cervix;

3) state after the cervical conization;

4) multiple pregnancy.

The correct answer is:

Aonly 1.
B1,2.
Conly 4.
Dall the above.
Enone of the above.

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Question 108

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

ABMI > 32 kg/m2.
Btamoxifen therapy.
Clate menopause.
Dnulliparity.
Efamily history of ovarian cancer.

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Question 109

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 110

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

Asertraline.
Bparoxetine.
Cmianserin.
Dtrazodone.
Eescitalopram.

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Question 111

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 112

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 113

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 114

The medication that should not be used in patient with depression and epilepsy is:

Atianeptine.
Bbupropion.
Cmoclobemide.
Dmirtazapine.
Etrazodone.

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Question 115

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 116

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 117

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 118

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

Aquetiapine.
Bolanzapine.
Chaloperidol.
Dsulpiride.
Earipiprazole.

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Question 119

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

Aparoxetine.
Bvortioxetine.
Csertraline.
Dfluvoxamine.
Eescitalopram.

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Question 120

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 121

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 122

Stomach cancer is adenocarcinoma developing from gastric mucosal lesions: dysplasia and metaplasia. The risk factors of stomach cancer include:

Ametabolic syndrome, diabetes, Clostridium difficile and Helicobacter pylori infection.
Ba diet rich in fresh fruit, a high-salt diet, smoking, male gender
Cexcessive consumption of strong alcohol, Helicobacter pylori infection.
Da gastric stump, stomach polyps.
Esmoking, male gender, Helicobacter pylori infection, chronic atrophic inflammation of the gastric mucosa, a gastric resection stump, stomach polyps.

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Question 123

Sensory experiences described as localised in an inadequate space for a particular sense, in which they cannot be present, are referred to as:

Ahallucinations.
Bpareidolia.
Cpseudohallucinations.
Dillusions.
Eparahallucinations.

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Question 124

A memory trace without a sense of its secondary character is referred to as:

Aecmnesia.
Bmemory illusion.
Ccryptomnesia.
Dpseudomnesia.
Econfabulation.

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Question 125

The treatment of choice for acute bacterial otitis media in children is the use of:

Atetracycline.
Bamoxicillin.
Clincosamides.
Doral glucocorticoids.
Ephenoxymethylpenicillin.

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Question 126

The first-line drug in the chronic treatment of bronchial asthma in children over 5 years of age is:

Ainhaled corticosteroid at low doses.
Bshort-acting beta-blocker.
Ctheophylline.
Doral glucocorticoids.
Eantihistamine drugs.

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Question 127

Metabolic markers of tumour lysis syndrome do not include:

Ahyperphosphatemia.
Bhypernatremia.
Chyperkaliemia.
Dhyperuricemia.
Ehypocalcemia.

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Question 128

In haemophilia B, the deficiency relates to the factor:

AVII.
BVIII.
CIX.
DXI.
EXII.

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Question 129

Which is the drug of choice in the treatment of acute uncomplicated bronchitis?

Aamoxicillin.
Bamoxicillin with clavulanic acid.
Cclarithromycin.
Dcefuroxime axetil.
Esymptomatic treatment - without antibiotic therapy.

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Question 130

Indcate the false statement concerning melanoma:

Aa malignant neoplasm most commonly derived from cutaneous melanocytes that have undergone malignant transformation.
Ba helpful tool facilitating the clinical diagnosis of melanoma is the ABCDE scale.
Cthe prognosis depends on the stage of the disease.
Dthe risk of developing another melanoma increases about 10-25 times in a person who has previously had this type of cancer.
Ethe best diagnostic method is a fine needle biopsy of a suspicious lesion.

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Question 131

Indicate the vaccines that can be administered to pregnant women.

1) inactivated influenza vaccine.

2) hepatitis B vaccine.

3) pertussis, diphtheria and tetanus vaccine, Tdap type.

4) pertussis, diphtheria and tetanus DTPw vaccine;

5) tuberculosis vaccine.

The correct answer is:

Aonly 1.
B1,2.
C1,2,3.
D1,2,3,4.
E2,3,4,5.

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Question 132

In which bacterial infection would you use amoxicillin as the first-line treatment?

1) bacterial pharyngitis and tonsilitis.

2) bacterial sinusitis.

3) uncomplicated cystitis in women.

4) acute pyeolonephritis.

5) traveller’s diarrhoea

The correct answer is:

Aonly 1.
Bonly 2
C1,2.
D2,4.
Eall of the above.

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Question 133

The condition of a 60-year-old female patient, suffering from venous thromboembolism has suddenly deteriorated. Dyspnoea, tachycardia and tachypnoea have occurred. The patient is significantly anxious. Indicate the cause:

Aexacerbation of ischaemic heart disease.
Bintercostal nerve neuralgia.
Cpulmonary embolism.
Dexacerbation of COPD.
Epneumonia.

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Question 134

Indicate a feature that is not characteristic of COPD:

Aprogressive character.
Bvariability of symptoms during the day.
Cchronic exposure to tobacco smoke.
Dinspiratory chest position.
Eloss of body weight.

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Question 135

Incidentaloma means an unanticipated diagnosis of:

Ahypertension.
Bhypertriglyceridemia.
Cadrenal tumour.
Dthyroid tumour.
Epituitary tumour.

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Question 136

Chose clinical signs that may indicate hypothyroidism:

1) nervousness, anxiety, sleep problems.
2) slowing down, weakness, excessive drowsiness.
3) weight loss despite increased appetite.

4) moderate weight gain.
5) feeling hot and excessive perspiration.

6) dryness and roughness of the skin.

The correct answer is:

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

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Question 137

The following methods are not used to treat irritable bowel syndrome:

Aosmotic laxatives drugs.
Bhigh doses of vitamin D.
Cpsychotropic drugs that have an additional cholinolytic effect.
Drifaximin.
Eprobiotics.

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Question 138

The drugs of choice in the treatment of pertussis are:

Aamoxicillin, doxycycline, clarithromycin.
Bcefuroxime, amoxicillin, doxycycline.
Ccefuroxime, doxycycline, erythromycin.
Dazithromycin, clarithromycin, erythromycin.
Eamoxicillin, azithromycin, doxycycline.

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Question 139

Indicate the symptoms of testicular cancer:

Atumour, lump, gynaecomastia, precocious puberty.
Btumour, lump, gynaecomastia, delayed puberty.
Clump, pain, gynaecomastia, delayed puberty.
Dlump, pain, gynaecomastia, epididymal oedema.
Etumour, lump, pain, epididymal oedema.

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Question 140

The MMSE (mini mental state examination) allows you to evaluate:

Aorientation, memory, counting, concentration, attention, language functions.
Borientation, complex activities of everyday life, concentration.
Corientation, complex activities of everyday life, counting.
Dmemory, assessment of emotional state, language functions.
Ememory, concentration, assessment of emotional state.

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Question 141

Which of the following clinical situations are β-blockers used in?

Aacute left ventricular failure.
Bheart failure with bradycardia.
Ccardiogenic shock.
Dchronic systolic dysfunction of the left ventricle.
Eheart failure with an increased cardiac output.

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Question 142

An MRI scan revealed a pituitary tumour in a 55-year-old female. A high concentration of which of the following hormones would justify pharmacological treatment as the first-line treatment of a pituitary macroadenoma?

AACTH
BGH.
CLH.
Dprolactin.
ETSH.

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Question 143

Echocardiography revealed a previously undiagnosed solid lesion in the lumen of the left atrium of a hypertensive patient. Which of the following heart tumours is the most likely diagnosis in this case?

Aangiosarcoma.
Batrial myxoma.
Cfibroma.
Delastofibroma.
Elipoma.

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Question 144

Which of the following conditions is linked with ulcerative colitis?

Ablepharitis.
Bprimary sclerosing cholangitis.
Cpsoriasis.
Dpyoderma gangrenosum.
Enephrolithiasis.

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Question 145

A 22-year-old female presents with vomiting and an increased abdominal perimeter. Which diagnosis should be ruled out first?

Aascites.
Bileus.
Cconstipation.
Dobesity.
Epregnancy.

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Question 146

A 29-year-old male patient with diabetes type 1 treated with insulin and poor glycaemic control for 6 months complains of vomiting occurring around 1 hour after a meal. The most probable diagnosis is:

Ainflammation of the gastric cardia.
Bgastroparesis.
CH. pylori infection.
Ddrug-induced vomiting.
Eincreased intracranial pressure.

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Question 147

Which of the following is the most probable location of a malignant tumour caused by inhaled carcinogens found in cigarette smoke?

Athe urinary bladder.
Bthe breast.
Cthe central nervous system.
Dthe colon.
Ethe ovary.

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Question 148

All the drugs below are disease-modifying antirheumatic drugs except for:

Amethotrexate.
Bcyclophosphamide.
CNSAIDs.
Dcyclosporine A.
Esulfasalazine.

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Question 149

Which of the following tumour marker-organ pairs is/are matched incorrectly:

1) AFP - the liver;

2) CA-125 - the ovary;

3) CA-19.9 - the pancreas;

4) CEA - the testis;

5) PSA - the thyroid.

The correct answer is:

A1,4,5.
B4,5.
C3,4,5.
D2,3,5.
Eonly 5

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Question 150

The complications of diabetes include:

1) Charcot foot;

2) a neuropathic ulcer;

3) claw toes;

4) toe gangrene;

5) gastroparesis.

The correct answer is:

A1,4,5.
B2,3,4.
C2,3,4,5.
D3,4,5.
Eall the above.

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Question 151

The main substances required in the process of haematopoiesis include:

1) erythropoietin;

2) iron;

3) vitamin B12;

4) thioacetic acid;

5) vitamin C.

The correct answer is:

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

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Question 152

HPV-16 and HPV-18 are the recognised aetiological factors of:

Acervical cancer.
Bbasal cell carcinoma.
CKaposi sarcoma.
Dtesticular cancer.
Emalignant melanoma

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Question 153

In the treatment of anaphylactic shock the drug(s) of choice is/are:

Aadrenalin.
Bhydrocortisone.
Cantihistamine drugs.
Dnoradrenalin.
EB and C are correct.

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Question 154

A sedentary lifestyle of a patient with heart failure where the patient’s physical activity is limited to maximum rest corresponds with:

ANYHA I.
BNYHA II.
CNYHA III.
DNYHA IV.
ENYHA V.

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Question 155

The typical symptoms of massive pulmonary embolism include:

1) decreased PaO₂;

2) decreased PaCO₂;

3) LBBB;

4) S₁Q₃T₃;

5) sinus tachycardia.

The correct answer is:

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

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Question 156

Ethylene glycol and methanol are still the causes of life-threatening poisonings. Which of the following remains an effective treatment method?

Amultiple doses of activated carbon.
Bhaemodialysis.
Chaemoperfusion.
Durine alkalinization.
EB and D are correct.

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Question 157

Which of the following sets of hormone levels might indicate primary hypothyroidism?

ATSH - 0.0001 mIU/l, normal FT3, normal FT4.
BTSH - 0.0001 mIU/l, increased FT3, normal FT4.
CTSH - 0.0001 mIU/l, increased FT3, increased FT4.
DTSH - 40.0 mIU/l, low FT3, low FT4.
Enormal TSH, low FT3, normal FT4.

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Question 158

Superior vena cava syndrome (SVCS) is a common cancer complication. The symptoms of SVCS include all of the following except for:

Adyspnoea.
Bswelling of the head and face.
Chiccups.
Dcough.
Evenous distention in the neck.

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Question 159

Which of the following metastasises to the brain most frequently?

Alung cancer.
Bcolorectal cancer.
Cmelanoma.
Dpancreatic cancer.
Ekidney cancer.

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Question 160

Erythrocytosis (excess of red blood cells) does not result from:

Asmoking.
Bstaying at high altitudes.
Ctestosterone therapy.
Dexcessive water intake.
Ediseases of the kidney.

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Question 161

The main aetiological factor of hepatocellular carcinoma in Europe is:

Aliver cirrhosis.
Bhepatitis B.
Chepatitis C.
Dsteatotic liver disease.
Eautoimmune hepatitis.

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Question 162

The dietary factors that increase the risk of colorectal cancer include:

Asaturated fatty acids.
Bomega-3 acids.
Cthe presence of fibre in the diet.
Dthe intake of high-calcium foods.
Efolic acid.

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Question 163

The most typical symptoms of oesophageal cancer include:

Agastro-intestinal bleeding.
Bchest pain.
Choarseness.
Dodynophagia.
Epainless dysphagia.

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Question 164

Which of the following plays a key role in the pathogenesis of gastric cancer?

Asmoking.
Balcohol.
CHelicobacter pylori.
Dachlorhydria.
Enitrates in the diet.

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Question 165

Human papilloma virus infection is one of the most common viral infections. Small common warts located on the extremities may be treated with all of the following except for:

Aa 10-20% salicylic ointment.
Ba 5-10% lactic acid ointment.
Ca 1% mupirocin ointment.
Da preparation with dimethyl sulfoxide.
Ea preparation with 5-fluorouracil.

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Question 166

All of the following parameters are important in the assessment of spirometry except for:

Aforced vital capacity (FVC).
Bpeak expiratory flow (PEF).
Ctotal lung capacity (TLC).
Dresidual volume (RV).
Eminimal inspiratory flow (MIF).

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Question 167

Which of the following is true about pyloric hypertrophy (pylorostenosis)?

Ait is typically diagnosed between the first and the second year of age.
Bexcessive jaundice is one of its typical symptoms.
Cprojectile vomiting with bile-stained content.
Dstarvation stools due to chronic malnutrition are a characteristic symptom.
Ethe treatment of choice is pyloromyotomy.

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Question 168

Glycogenoses are rare metabolic diseases in which glycogen is stored in different organs. Which of the following is a glycogenosis connected with an enzymatic defect of lysosomal alpha-glucosidase and occurs in two variants - a childhood one and a juvenile one?

APompe disease (type II).
BHers’ disease (type VI).
CTarui’s disease (type VII).
DCori’s disease (type III).
EMcArdle’s disease (type V).

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Question 169

Which of the following is the most common extracranial tumour occurring in children below 5 years of age?

Aneuroblastoma.
Bmedulloblastoma.
Crhabdomyosarcoma.
Dosteosarcoma.
EEwing’s sarcoma.

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Question 170

Which of the following is true about contagious impetigo?

Ait mostly affects adolescents above 16 years of age.
Bit is caused by Herpes viruses.
Cit is characterised by the formation of blisters and spots with honey-coloured scabs.
Dmacrolides are the first line of treatment.
Eointments with azole agents facilitate the healing process.

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Question 171

Which of the following is the correct course of action in the case of anaphylactic shock in a child?

1) intramuscular adrenalin 1 mg/kg of body weight.;

2) intravenous clemastine 0.025-0.05 mg/kg of body weight;

3) oxygen therapy 5-15 l/min depending on body weight;

4) intravenous fluid therapy in accordance with the daily fluid requirements administered within 24 hours;

5) refraining from removing the foreign body, e.g. a bee’s sting, so as to identify the root cause and implement targeted treatment.

The correct answer is:

A1,2,3.
B1,3,5.
C2,3.
D2,3,4.
EAll the above

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Question 172

Which of the following diseases is associated with niacin/nicotinamide deficiency?

Apellagra.
Bberiberi.
Cscurvy.
Dnight blindness.
Eosteoporosis.

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Question 173

Which of the following is true about Lyme disease?

Aerythema migrans occurring typically 12 months following the bite is its characteristic symptom.
Bnearly 100% of cases of isolated facial nerve palsy with pleocytosis in PMR are caused by Lyme disease.
Cdoxycycline is the treatment of choice in children below 9 years of age.
Da western blot test should be the first test performed to diagnose Lyme disease.
Esuspected neuroborreliosis is a contraindication for lumbar puncture due to the risk of an increase in intracranial pressure.

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Question 174

Legionella pneumophila infection was a serious problem in Poland last year. Which of the following is false about legionellosis?

Ain small children it occurs quite often but has a mild course.
Bmacrolides are the treatment of choice.
Cthe infection spreads by warm water and is facilitated by inhaling moist aerosols.
Dpatient isolation is not necessary.
Ethe usual onset is between 1 and 10 days after exposure.

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Question 175

Which condition is not caused by bacteria from the Streptococcus group?

Aproctitis.
Bstreptococcal pharyngitis.
Clichen planus.
Derysipelas.
Escarlet fever.

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Question 176

Cyanotic congenital heart defects include:

1) Fallot’s tetralogy;

2) dextro-transposition of the great arteries;

3) Eisenmenger syndrome;

4) ventricular septal defect;

5) aortic stenosis.

The correct answer is:

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

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Question 177

The most common disease inherited in an autosomal recessive manner is:

Acystic fibrosis.
Bphenylketonuria.
CLi-Fraumeni syndrome.
DGorlin syndrome.
Eneurofibromatosis type I.

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Question 178

Iron-deficiency anaemia is characterised by:

1) increased MCV;

2) increased MCH;

3) increased ferritin;

4) increased transferrin;

5) decreased TIBC.

The correct answer is:

A1,2,3.
B1,2.
C4,5.
Donly 4.
E3,4,5.

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Question 179

Which of the following statements is true about neuroblastoma?

1) it is most commonly located in the kidneys;

2) tumour cells display an increased uptake of MIBG in scintigraphy;

3) it is the most common in schoolchildren;

4) it is the most common in infants and small children;

5) it may infiltrate the bone marrow.

The correct answer is:

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

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Question 180

A 3-year-old child has had a fever of 39.5°C for two days, which has been causing the child to wake up screaming at night and have a poor appetite. The child has had a watery runny nose for five days. Also, a purulent discharge from the right ear has been observed. What is the optimal course of action?

Adischarge culture should be performed and, once the results have been obtained, a targeted antibiotic therapy should be instituted.
Bpneumonia should be diagnosed and empirical antibiotic therapy should be instituted.
Cin all likelihood, it is an acute uncomplicated inflammation of the upper airways. Symptomatic treatment of the runny nose should be instituted.
Dacute purulent otitis media should be diagnosed and empirical antibiotic therapy should be instituted.
Eacute non-purulent otitis media should be diagnosed and no action should be taken - the child should remain under careful observation for 48 hours.

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Question 181

Which of the following statements are true about compulsory vaccinations in Poland?

1) vaccination against rotaviruses is performed with an intramuscular polysaccharide vaccine;

2) in the first day of a newborn’s life, the newborn is vaccinated against tuberculosis and receives the first dose of a vaccine against hepatitis B;

3) the recommended interval between two live vaccines containing attenuated pathogens is 4 weeks;

4) the MMR vaccine contains live-attenuated viral pathogens;

5) vaccination against tick-borne encephalitis is compulsory for all children below 8 years of age.

The correct answer is:

A1,3,5.
B2,3,4.
C2,4,5.
D2,4.
E1,3,4.

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Question 182

Growth charts should be used as a point of reference for blood pressure in children. The charts take into account:

1) the age;

2) the sex;

3) the weight;

4) the height;

5) the height centile.

The correct answer is:

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

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Question 183

A pulse of 60/min in a 3-month-old infant:

Ais normal.
Bis tachycardia.
Cis bradycardia.
Dmay be normal - depending on the weight.
Emay be normal - depending on the height.

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Question 184

According to Polish recommendations:

1) the first-line course of action in the case of pneumonia in a 3-week-old child is careful observation without antibiotic therapy;

2) a mild-course community-acquired pneumonia in children between 4 months and 5 years of age may not be treated with antibiotics as most infections are viral;

3) Listeria monocytogenes is responsible for most cases of pneumonia in children above 5 years of age;

4) viral pneumonia cannot be distinguished from bacterial pneumonia by means of a radiological examination;

5) macrolides should be used as drugs of first choice in the treatment of pneumonia in children above 5 years of age with type I hypersensitivity to penicillin.

The correct answer is:

A2,4,5.
B1,3,4.
C1,2,4.
D1,2,3.
E3,4,5.

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Question 185

Stage 1 of the Tanner scale means that:

Athe child does not display any characteristics of puberty.
Bpubertal development of the child is complete.
Cthe child’s pubic hair is similar to the pubic hair of an adult.
Dbreast buds are formed in the case of a girl, while the testes have increased their volume above 4 ml in the case of a boy.
Ea menarche has occurred in the case of a girl, while a pubertal growth spurt has occurred in the case of a boy.

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Question 186

Which of the following statements are true about meningitis in children?

1) it requires an immediate institution of empirical antibiotic therapy before its aetiology is established;

2) most cases are of viral aetiology;

3) the symptoms might include: vomiting accompanied by headaches, nape stiffness, photophobia, fever;

4) cerebrospinal fluid analysis may reveal an increase in inflammatory cells and protein, regardless of the aetiology;

5) it always leads to irreversible changes in the brain.

The correct answer is:

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

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Question 187

When diabetes type 1 is diagnosed in children, the following abnormalities may be observed in lab tests?

1) increased levels of glycated haemoglobin;

2) the presence of anti-GAD antibodies in the blood;

3) glycosuria;

4) a high insulin concentration in the blood;

5) metabolic alkalosis.

The correct answer is:

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

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Question 188

Congenital adrenal hyperplasia may be detected in a screening test of a newborn when a dried blood spot test reveals:

Aincreased ACTH.
Bionic disorders: hypernatraemia and hypokalaemia.
Chypoglycaemia.
Dincreased 17-hydroxyprogesterone.
Eincreased cortisol.

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Question 189

Which of the following statements are true about constipation in children?

1) it is the most common cause of abdominal pain in children;

2) macrogols are the drugs of choice in the treatment of children above 6 months of age;

3) it is caused by a high amount of fibre in the child’s diet;

4) Hirschsprung’s disease is a common cause;

5) the treatment of functional constipation is long-lasting and often requires at least 2 months of pharmacotherapy.

The correct answer is:

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

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Question 190

Which of the following statements is true?

Aenophthalmos is typically a symptom of an isolated orbital fracture.
Benophthalmos is a symptom of a subarachnoid bleeding.
Cin the consensual reflex the examined eye’s pupil becomes dilated.
Dan exophthalmometre is not used to assess enophthalmos.
Ean exophthalmometre measures intraocular pressure.

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Question 191

Which of the following statements is true about blunt renal trauma with bleeding?

Aangioembolisation is always contraindicated.
Ba pulsatile renal haematoma is an absolute indication for surgery.
C50 to 60% of all blunt renal injuries in females are treated surgically.
Dcreatinine concentration is of no significance before a decision about surgical treatment is made.
Eblunt renal trauma grade V is always and without exception an absolute indication for surgery.

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Question 192

Which of the following statements is true about femoral fractures?

Ain an impacted fracture necrosis of the femoral head is more frequent.
Ba subcapital adduction fracture has the poorest prognosis for spontaneous healing.
Can abduction fracture is never impacted.
Din an adduction fracture there is no limb shortening.
Ehemiarthroplasty is preferred in young, mobile patients.

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Question 193

Which of the following statements is true about acetabular fractures?

Athey are caused only by direct injuries.
Bthey are often accompanied by a retroperitoneal haematoma in the lesser pelvis.
Cthey are often treated conservatively.
Dskeletal traction in abduction is of no use in such cases.
Ea fracture occurring a week after the injury is an indication for conservative treatment.

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Question 194

The letter ‘I’ in the AT-MIST acronym refers to:

Asymptoms.
Binjuries.
Cdrug allergies.
Dtreatment.
Epast surgeries.

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Question 195

The primary trauma examination (ABCDE) according to ATLS comprises all of the following elements, except for:

Aexamination of breathing.
Bexamination of circulation.
Cneurological assessment.
Dexposure.
Eidentification of all the injuries.

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Question 196

How many levels does the Verbal Rating Scale (VRS) contain?

A3.
B5.
C7.
D10.
E11.

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Question 197

Which of the following is not recommended in patients with multiple injuries?

Apain intensity measurement every 30 minutes.
Bthe administration of an analgesic within 20 minutes after the contact with the medical team when the pain is severe.
Cthe use of simplified pain intensity scales.
Dthe use of a Numerical Rating Scale (NRS) in children below 9 years of age.
Ethe use of the Visual Analogue Scale (VAS) in people above 65 years of age.

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Question 198

The letter S in the SAMPLE acronym refers to:

Adrugs taken by the patient.
Bpregnancy.
Cdrug allergies.
Dsymptoms.
Epast surgeries.

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Question 199

A 34-year-old male without any medical history has been brought to hospital by the medical rescue team due to disorders of consciousness. The patient opens his eyes in response to pain and produces incomprehensible sounds. A decerebrate response is also observed. How many points will the patient score according to Glasgow Coma Scale?

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Question 200

The most common extranodal location of non-Hodgkin lymphoma is:

Athe mediastinum.
Bthe stomach.
Cthe lungs.
Dthe liver.
Ethe spleen.

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