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LEKEXAM / 2025 autumn

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Question distribution — 2025 autumn session

Share of each category in the latest available session.

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

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Question 1

A 12-year-old boy presents in GP's office after cleaning and dressing a wound on his leg. The patient seeks the recommendation concerning tetanus prophylaxis. The boy received the full basic vaccination against tetanus, and the last booster dosis was given 6 years ago. In the opinion of the GP a risk of tetanus in this case is low. Choose the proper recommendation:

Athere is no need to give a booster dose of diphtheria-tetanus vaccine.
Bone dose of diphtheria-tetanus vaccine (Td) or tetanus toxoid should be given
Ctwo doses of diphtheria-tetanus vaccine or tetanus toxoid should be given 4 weeks apart.
Dthree doses of diphtheria-tetanus vaccine or tetanus toxoid should be given according to the schedule 0;1;6 months
Eone dose of diphtheria-tetanus vaccine or tetanus toxoid should be given simultaneously with an antitoxin (specific immunoglobulin).

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Question 2

A 40-year-old man with type 1 diabetes comes to the office because of more frequent incidents of hypoglycaemia. He decreased the dose of insulin. What might be the cause of hypoglycaemia in this patient?

Aincreased alcohol consumption
Bincreased physical activity
Cdecreased calorie intake.
Dimpaired renal function.
Eall the above

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Question 3

A 30-year-old male complains of colic pain in the left lumbar region with macroscopic hematuria, chills and fever 40 Celsius. Indicate the most probable diagnosis:

Akidney stones
Bkidney stones with accompanying urinary tract infection
Cacute pyelonephritis
DIgA nephropathy
Erenal papillary necrosis

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Question 4

What drug is used for the treatment of juvenile idiopathic arthritis?

Aacetylsalicylic acid
Bsecond generation cephalosporin.
Cphenoxymethylpenicillin
Dmethotrexate
Enone of the above

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Question 5

The most common cause of food allergy in infants is:

Awheat
Bsoybeans
Ccow's milk protein
Degg white
Ecarrot

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Question 6

The symptoms of cystic fibrosis include:

Arecurrent obstructive bronchitis and pneumonia.
Bsteatorrhoea
Cchronic cough.
DPoor weight gain
EAll of the above

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Question 7

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

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

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Question 8

A 72-year-old woman in the 4th stage of chronic kidney disease and with severe back pain was admitted to the department of nephrology with the suspicion of monoclonal immunoglobulin deposition disease in the course of multiple myeloma. Indicate the examinations that allow to confirm the diagnosis:

1) presence of plasmocytes in the bone marrow > 10%;

2) nephrotic proteinuria;

3) presence of monoclonal immunoglobulins in the serum and in the urine;

4) haematuria;

5) deposits of light or heavy immunoglobulin chains in the kidney glomeruli.

The correct answer is:

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

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Question 9

Oral anticoagulant drugs are all of the following, except for:

Aapixaban
Bwarfarin
Cdabigatran
Deptifibatide
Erivaroxaban

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Question 10

A child at preschool age is presented in GP’s office. According to the parents the child has been suffering from fever for 10 days and 2 days ago they observed a facial rash intensely red and a symmetric, macular, lace-like rash on the trunk, buttocks and arms. The general condition of the child is good. Which diagnosis is the most probable?

Arubella.
Bmeasles.
Cscarlet fever.
Derythema infectiosum.
Eerythema multiforme.

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Question 11

A mother comes with a 3-week-old newborn and she is concerned about regurgitations that occur after each feeding. A child, born at term is fed with modified milk, drinks greedily; it has gained 400 g of weight since the birth. A proper approach to this newborn is:

Aorder metoclopramide
Bsuggest thickening of the milk with ice gruel
Ccalming the mother, instructions on the appropriate positioning of the child during feeding.
Dorder urgent surgical consultation
EA and C are true

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Question 12

Which of the following is not typical of cervical cancer?

Aurinary urgency
Bbloody vaginal discharge with unpleasant smell
Cintermenstrual bleeding
Dabdominal pain.
Econtact bleeding.

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Question 13

Indicate the true statement concerning the uterine artery:

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

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Question 14

The most characteristic disorders of thought content in paranoid syndrome are:

Athought broadcasting.
Bpoisoning
Cjealousy
Dhypochondrical.
Eideas of reference

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Question 15

The main symptom of alcohol hallucinations is:

Adelusional jealousy
Bvisual hallucinations
Cauditory hallucinations
Dauditory pseudohallucinations
Epersecutory delusions

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Question 16

Contraindications to laparoscopic surgery include:

1) surgery in anamnesis;

2) peptic ulcer of the stomach rupture;

3) cardio-respiratory failure;

4) surgery because of cancer disease;

5) clotting disorders;

6) lack of patient’s consent to this surgery.

The correct answer is:

A1,3,6.
B2,4,6.
C3,5,6
Donly 6.
E4,3,6.

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Question 17

Indicate the true statement concerning Charcot’s triad:

Arefers to cholecystitis.
Brefers to colon diverticulitis.
Cis characterized by epigastric pain, jaundice, recurrent fever and chills.
Dis characterized by left side hypogastric pain, diarrhoea, recurrent fever and chills.
Eis an indication for cholecystectomy.

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Question 18

A skin disease of non-bacterial etiology is:

Aimpetigo contagiosa
Btinea versicolor
Cerythrasma
Derysipelas
Eecthyma

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Question 19

The differential diagnostics of a sudden and strong epigastric pain, accompanied by sweating, occurring for the first time in lifetime in a 50-year-old tobacco smoker should include:

1) myocardial infarction;

2) ulcer perforation;

3) biliary colic;

4) incarcerated inguinal hernia

5) bleeding in the digestive tract.

The correct answer is:

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

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Question 20

Naloxone is used in the case of poisoning with:

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

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Question 21

A patient in need of dialysis has been taken to the hospital. He is not able to give effective consent for the surgery because of his health condition. In such a case the doctor is allowed to carry out the surgery:

1) after obtaining consent from their superior;

2) after obtaining consent from the patient’s spouse or his close person;

3) after releasing the ruling by the domestic Court of Protection stated incapacitation of the patient;

4) after obtaining judicial authorization;

5) in the situation in which a delay could cause death or grievous bodily harm, without anyone’s permission - but they should possibly consult another doctor if possible of the same specialty.

The correct answer is:

A1,4.
B4,5.
C1,3.
D2,4.
E1,5.

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Question 22

Social pension is due to a person of age who suffered damage to health in the periods specified in the Act on social pension and who holds a ruling on:

Apartially incapable of work
Bslight degree of disability.
Cconsiderable degree of disability
Dtotal incapacity for work.
Etotal incapacity for service.

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Question 23

The normal age of menarche in Poland is defined as:

A8-9 years
B9-16 years
C16-17 years
D>18 years
Eno norm exists

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Question 24

Internal hernias do not include:

Adiaphragmatic hernia
Bparastomal hernia
Cparacecal hernia
Dparaduodenal hernia
Eforamen of Winslow hernia.

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Question 25

Positive Chvostek, Trousseau and Erb’s signs suggest:

Aacute cholecystitis.
Bacute pancreatitis.
Chyperthyroidism.
Dadrenocortical hyperfunction.
Ehypoparathyroidism.

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Question 26

Spurious hyponatremia occurs secondary to:

ACNS disease
BAddison disease
Crenal tubular acidosis.
Dhyperglycemia.
Ehypopituitarism.

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Question 27

A 25-year-old man with normal male phenotype is examined because of infertility. Apart from a decreased sperm count in the semen analysis, gynecomastia was found and laboratory tests showed decreased follicle-stimulating hormone levels and increased testosterone levels. The most probable cause of the above abnormalities is:

Achemotherapy in the past
Bradiotherapy in the past.
Cuse of anabolic steroids.
DKallmann syndrome.
ESertoli cell-only syndrome.

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Question 28

Which of the following drugs is preferred to start the treatment of asymptomatic type 2 diabetes, when all of its potential contraindications have been excluded?

AMetformin
BGlibenclamide
CGliclazide
DInsulin
EPhenformin

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Question 29

Chronic obstructive pulmonary disease can be diagnosed based on the symptoms and spirometry results. Which component of spirometry is used to diagnose chronic obstructive pulmonary disease?

Aforced expiratory volume in one second (FEV1) and forced expiratory volume vital capacity (FVC)
Binspiratory capacity (IC)
Ctidal volume (TV).
Dexhalation reserve volume (ERV)
Einspiratory reserve volume (IRV).

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Question 30

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 31

Indicate the false statement concerning HPV infection:

Aso-called oncogenic HPV may cause cancers of the anus, the perineum, the penis and the oral cavity.
Buse of condoms fully eliminates the risk of HPV infection.
Ccytological result of LSIL suggests HPV infection
Dvaccination against HPV is recommended for young girls who have not started sexual activity.
EHPV infection does not lead to stable acquired immunity against subsequent infections with HP viruses.

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Question 32

Which of the following statements concerning hydatidiform mole is false?

Acomplete hydatidiform mole is diploid and all the genetic material is of paternal origin.
Bincomplete hydatidiform mole is usually triploid.
Cprincipal diagnostic tool for hydatidiform mole is ultrasound imaging.
Dfirst symptom of hydatidiform mole is usually uterine bleeding.
Emost common symptoms of hydatidiform mole are excessive vomiting and the symptoms of hypothyroidism.

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Question 33

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 34

Sexual preference disorders should not include:

Apedophilia.
Bsadism and masochism.
Ctransvestic fetishism.
Ddual-role transvestism.
Eexhibitionism.

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Question 35

Which of the following shows significant preventive activity against suicidal tendencies?

Aolanzapine
Bquetiapine
Cvalproate.
Dlamotrigine
Elithium

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Question 36

Indicate the true statement concerning dementia:

Amemantine is registered for the treatment of mild and moderate dementia in Alzheimer disease.
Bbecause of the hypersensitivity to cholinesterase inhibitors it is recommended to use memantine in dementia with Lewy bodies.
Cneurological symptoms are typical of frontotemporal dementia, as opposed to Alzheimer disease.
Din dementia with Lewy bodies the longest timespan between the onset of parkinsonism and the onset of dementia symptoms is 6 months.
Ehaloperidol is the first-line medication for the treatment of dementia with Lewy bodies and visual hallucinations.

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Question 37

According to the Act on the profession of the doctor and dentist, medical secrecy after the patient’s death:

Amay be divulged to any person because the patient’s death frees the doctor from having to obey it.
Bis absolutely protected and none entity may free the doctor from obeying it.
Cmay be divulged with the consent of the locally appropriate regional medical council.
Dmay be divulged if after the patient’s death a person close to the patient within the meaning of the Act on Patients’ Rights and the Ombudsman for Patients’ Rights expresses their consent.
Emay be divulged if the doctor decides that it does not harm the good of the patient and confirms that decision in the consultation with another doctor.

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Question 38

In accordance with the Act on Therapeutic Activities autopsy in principle is carried out after at least:

A6 hours after the declaration of death.
B12 hours after the declaration of death.
C24 hours after the declaration of death.
D12 hours after issuing the death act.
E24 hours after issuing the death certificate

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Question 39

Which of the following measures are necessary in order to reduce morbidity and
premature mortality due to cardiovascular diseases?
1) improving nutrition;
2) reducing incidence of diabetes;
3) increasing physical activity;
4) reducing smoking and alcohol consumption;
5) fighting hypertension and atrial fibrillation.
The correct answer is:

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

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Question 40

Which of the following is the most common localization of bacterial infections in patients with decompensated liver cirrhosis?

ASubcutaneous tissue
BRespiratory system
CUrinary system
DAscitic fluid and peritoneal membrane
EGallbladder

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Question 41

Which of the following is not an indication for liver biopsy?

Aevaluation of the transplanted liver condition or the condition of the donor’s liver before the planned transplantation
Bmonitoring of drug hepatotoxicity or treatment effectiveness in some liver diseases.
Cabdominal pain located in the right upper quadrant with a fever and a suspicion of cholangitis.
Ddiagnostics of biochemical features of liver damage that has not been successfully assessed with other examinations.
Ediagnosis, the evaluation of the activity and stage of chronic liver diseases.

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Question 42

Which of the following is not characteristic of typical angina?

Apain feels like pressure, heaviness, or tightness.
Bpain is usually retrosternal.
Cpain is provoked by exercise and relieves at rest.
Dpain relieves after nitroglycerin is taken sublingually.
Epain is triggered by a change in body position or by putting pressure on.

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Question 43

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

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

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Question 44

Indicate the false statement concerning impetigo:

Aimpetigo is the most common bacterial infection in children.
Bin many cases it is caused by beta-hemolytic streptococcal infection.
Cerythema, followed by blisters and honey and yellow crusts occur
Dglomerulonephritis may be a complication of impetigo.
ELisch nodules are found in more than 90% of patients with impetigo

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Question 45

Parkland formula is used for:

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

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Question 46

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 47

Which of the following laboratory test is the first critical parameter determined in unconscious patient’s blood at the emergency department?

Aglucose concentration
Barterial blood gas test.
Ccarboxyhemoglobin concentration
Dhemoglobin concentration
Epotassium concentration

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Question 48

Which of the following test should be performed in order to qualify the patient to the nephrectomy due to hydronephrosis without recurrent infections but accompanied by treatment-resistant hypertension?

Aabdominal ultrasonography with kidney size assessment.
BDoppler ultrasonography with the assessment of the blood flow in the renal arteries.
Ccomputed tomography of the abdomen.
Durography.
Erenoscintigraphy

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Question 49

Which of the following abnormalities in laboratory tests should be expected in a patient with clinical symptoms of hyperthyroidism?

Adecreased TSH concentration, increased FT4 and FT3 concentrations, anemia, hypercholesterolemia
Bdecreased TSH concentration, increased FT4 and FT3 concentrations, hypocholesterolemia, hypercalcemia.
Cdecreased TSH concentration, decreased FT4 and FT3 concentrations, hypocholesterolemia, hypocalcemia.
Dincreased TSH concentration, increased FT4 and FT3 concentrations, polycythemia, hypercalcemia.
Eincreased TSH concentration, decreased FT4 and FT3 concentrations, anemia, increase ALT activity, hypertriglyceridemia.

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Question 50

Which of the following are important for selection of chemotherapy in pulmonary cancer?

1) general condition of the patient;

2) stage of the disease;

3) organ damages;

4) histological type of the cancer;

5) familial history of cancer.

The correct answer is:

A1,2,5
BOnly 2
C1,2,3,4
DOnly 3
Eall the above.

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Question 51

A 65-year-old male complains of knee joint pains, particularly on physical exercise. The pain subsides upon the rest. The anteroposterior radiograph of his knee joints is shown below: Indicate the cause of the observed symptoms:

AGout
BAlkaptonuria
CPseudogout
DOsteoarthritis
ERheumatoid arthritis

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Question 52

Which of the following factor increase the risk of urolithiasis?

1) increased fluid intake;

2) familial history of urolithiasis;

3) warm climate;

4) infection caused by Proteus mirabilis.

The correct answer is:

A1,2,3
B1,2,4
C1,3,4
D2,3,4
EAll the above

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Question 53

A 3-year-old boy fits to 39 °C, is apathetic. During the examination, the doctor found on the skin of the right thigh three skin lesions. What characteristics of the skin lesions can point to meningococcal sepsis?

Athey appeared suddenly, do not disappear under pressure, have a dark red color
Bappeared a few days before the fever, they are itchy.
Cthey have the character of vivid lumps
Dthey are vesicles located on the erythematous area.
Ethey are vesicles filled with purulent content.

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Question 54

The causes of hypertonic dehydration do not include:

Ainsufficient water supply.
Bhyperventilation.
Chypoventilation.
Dwatery diarrhea.
Esweating.

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Question 55

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

AMethyldopa
BPerindopril
CEnalapril
DRamipril
ELisinopril

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Question 56

An insured person is entitled to the training pension from the Social Insurance Fund if they hold both the required insurance period and the ruling on:

Apartial inability to work
Bpurposefulness of professional retraining due to total inability to work.
Ctemporary inability to work
Dpurposefulness of professional retraining due to inability to work in previous profession.
Etotal inability to service and ability to work.

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Question 57

What kind of study is a cohort study?

AObservation
BExperimental
CIntervention
DScreening
EClinical

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Question 58

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 59

The depressive episode in the course of the bipolar disorder is characterized, more frequently than the one in the course of recurrent depressive disorder, by:

Ahypersomnia.
Bfirst episode occurring at young age.
Cpresence of symptoms of psychosis.
Dresistance to the treatment with antidepressant medications.
Eall the above

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Question 60

Numerous interactions between vitamin K antagonists (VKA) and other medications or food must be considered in patients chronically treated with VKA. Which of the following intensify the action of VKA?

1. carbamazepine;

2. ciprofloxacin;

3. amiodarone;

4. spinach;

5. grapefruit juice;

6. mesalazine.

The correct answer is:

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

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Question 61

Which of the following is classified as a disease-modifying antirheumatic drug?

Aindomethacin
Bmetotrexate
Ccelecoxib
Detanercept
Erituximab

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Question 62

A 78-year-old patient was transported to the Emergency Department because of general fatigue, peripheral pitting edema of lower limbs and dyspnea increasing for the last month. The patient has a several year history of well-controlled arterial hypertension and rheumatoid arthritis with a sustained moderate disease activity despite the use of non-steroidal anti-inflammatory drugs. Because of the increasing edemas his family doctor gave him furosemide, twice daily, 10 days earlier. The treatment did not alleviate edemas. Which of the following should be first ordered to find the cause of increasing fluid retention?

Ablood testing to determine CRP concentration and ESR to assess the activity of rheumatoid arthritis.
Bblood testing to determine troponin and NT-proBNP concentrations
Ckidney biopsy.
Dcollecting urine for culture.
Eurinalysis and blood testing to determine creatinine concentration.

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Question 63

A 3-year-old child suffers from significant pruritus aggravating at night. There are excoriations visible on the foot skin and in the intergluteal area. The probable diagnosis is:

Ascabies.
Bpediculosis.
Cskin allergy.
Dfood allergy to protein.
EBoston exanthem disease

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Question 64

Which of the following is the most common cause of blindness in children in Poland?

Acataract.
Bdiabetic retinopathy.
Cretinopathy of prematurity
Dtumors of the organ of sight (including haemangioma, sarcoma, retinoblastoma)
Euveitis (e.g. in the course of prenatal infection).

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Question 65

Which of the following cannot be a consequence of intrauterine infection?

ADown syndrome.
Bhydrocephalus.
Cfetal tachycardia.
Dpreterm labor.
Eprelabor rupture of membranes.

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Question 66

The second-line medication in the outpatient treatment for community-acquired pneumonia is:

Aamoxicillin
Bmacrolide
Ccefuroxime
Dfluoroquinolone
Ebenzylpenicillin

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Question 67

The causes of the infantile colic include:

Aincreased intestinal gas formation
Blactose intolerance.
Cimmaturity of the central nervous system.
Dbad diet of breastfeeding mother.
Eall the above.

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Question 68

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 69

Sickness benefits are payable to insured persons who became incapable to work due to illness during the period of sickness insurance. The incapacity to work due to illness is not treated equally as the incapacity to work resulted from:

Adecision issued by a relevant organ or an authorized entity based on the law on prevention and control of infectious and communicable human diseases.
Bdue to being in a stationary drug treatment facility for the treatment of alcohol dependence
Cstay in the hospital or other medical facilities providing stationary and round-the-clock health services in order to treat addictions to narcotic drugs or psychotropic substances.
Dundergoing different medical examinations predicted for candidates for donors of cells, tissues and organs.
Esanatorium treatment.

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Question 70

Morbidity rate reaches higher values if:

Athe disease has a short duration.
Bthe disease has a long duration.
Cthe disease is severe and causes more deaths.
Dthe number of the new cases of the disease is low.
Ethe ill are emigrating.

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Question 71

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

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

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Question 72

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

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

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Question 73

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

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

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Question 74

Indicate clinical conditions presenting with ‘sterile pyuria’:

1) tuberculosis of the urinary tract;

2) drug-induced acute tubulointerstitial nephritis;

3) Chlamydia trachomatis infection;

4) lupus nephropathy;

5) Sjӧgren syndrome.

The correct answer is:

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

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Question 75

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

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

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Question 76

The alarming symptoms of GERD in children include:

1) swallowing disturbances

2) diarrhea

3) night attacks of coughing and shortness of breath

4) constipation

5) weight loss

The correct answer is:

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

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Question 77

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

Aerythema infectiosum
Bimpetigo
CHSV infection
Dchickenpox
Emeasles

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Question 78

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 79

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 80

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 81

Hebephilia is a subtype of:

Afetishism.
Bexhibitionism.
Cpedophilia.
Dsadomasochism.
Etransvestitism.

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Question 82

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

Aolanzapine.
Bquetiapine.
Czyprasidon.
Drisperidon.
Earypiprazole.

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Question 83

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

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

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Question 84

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

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

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Question 85

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

1) slowed-down blood flow;

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

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

4) increase in the blood pressure;

5) increase in serum potassium level.

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

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Question 86

The Glasgow-Blatchford scale refers to patients with:

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

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Question 87

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

Afetishism.
Bmasochism.
Csadism
Dexhibitionism.
Evoyeurism.

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Question 88

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

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

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Question 89

Which of the following is an antidote to cyanide intoxication?

Ahydroxocobalamin.
Batropine.
Cglucagon
Dpyridoxine
Enaloxone

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Question 90

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

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

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Question 91

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

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

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Question 92

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 93

Which of the following are recommended as the first-line treatment for maintenance therapy after achieving remission in mesangial proliferative lupus nephritis?

1) mycophenolate mofetil + prednisone;

2) cyclosporine + prednisone;

3) oral cyclophosphamide + prednisone;

4) azathioprine + prednisone;

5) methotrexate + prednisone.

The correct answer is:

A1,2.
B4,5.
C1,5
D1,4.
E3,4.

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Question 94

A 66-year-old male patient with an attack of atrial fibrillation has TSH 0.1 mlU/L (N 0.27 - 4.2) and FT4 1.98 ng/dL (N 0.7-1.7). The patient has been taking 100 µg of thyroxine once a day because he was diagnosed with hypothyroidism three years ago. Indicate the optimal treatment of thyroid disease:

Areduce the dose of thyroxine to 75 µg/day and check TSH in 4-6 weeks.
Btotally stop thyroxine and check TSH in three days.
Ctotally stop thyroxine and check TSH in three months.
Dstart to implement thyrostatic treatment.
Erefer the patient to radioiodine treatment.

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Question 95

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

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

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Question 96

In a 25-year-old female patient suffering from schizophrenia, akathisia occurred as a result of pharmacotherapy. The patient probably takes:

Aolanzapine.
Bquetiapine
Cclozapine.
Damisulpride
Earipiprazole.

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Question 97

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 98

Acute pharyngitis in children 3-4 years of age:

Ais most often caused by streptococci and requires antibiotic treatment
Bis always an indication for basic tests: peripheral blood counts and CRP in order to differentiate a bacterial infection from a viral infection
Cis most often caused by viruses and does not require antibiotic therapy
Dis an indication for throat swab culture.
EC and D are correct

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Question 99

Which of the following determinations is used to diagnose hyperandrogenism in a 25- year-old woman?

Aratio of LH to FSH.
Bfree testosterone or index of free androgens.
Cdihydrotestosterone.
DSHBG
ESHBG and dihydrotestosterone.

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Question 100

Which of the following clinical problems may indicate primary immunodeficiency?

1) six acute otitis media during a year in a child 4 years of age;

2) seven mild episodes of pharyngitis during a year in a 3-year-old child attending kindergarten;

3) purulent inflammation of the hip joint caused by Staphylococcus aureus in a 5-yearold child and extensive liver abscess of the same etiology at 9 years of age;

4) childhood tuberculosis in a mother, BCGitis in her son;

5) a 7-year-old unvaccinated against pneumococci boy underwent invasive pneumococcal disease; the boy had no problematic disease before and doesn’t have any other health problems;

6) occurrence of three episodes of pneumonia in a 12-year-old healthy girl including last episode complicated with lung abscess and pleural empyema; she had to be hospitalized for all episodes.

The correct answer is:

A1,3,4,6.
B1,3,4,5,6.
C3,4,5,6.
D2,3,4,5.
E1,3,5,6.

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Question 101

The chief executive of a hospital decided to conduct a study on the experiences of patients, i.e. the feelings of patients and their families or caregivers that arise from the medical care at the hospital. Quantitative studies suitable for measuring patient experiences are:

Apolls.
Bfocus group interviews.
Cindividual in-depth interviews.
Dcase study.
Eobservation.

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Question 102

According to the Cochran review of January 2019, GP health reviews for people under 65 (medical history, physical examinations, screening for several diseases at once, behavioral interventions) have little or no impact on the reduction in mortality from cancer and cardiovascular diseases. Such reviews are an example of:

Aanalysis of alternative solutions for technology.
Btechnology cost-effectiveness analysis.
Ctechnology safety analysis.
Dhealth technology assessment.
Ehealth needs analysis.

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Question 103

A basis for discharging a patient from hospital is not:

Arefusal of a patient to undergo one of therapeutic methods proposed by the doctor.
Bdemand for the doctor to discharge a minor made by their parents, a demand which is not objected to in a decision issued by the family court notified to this effect.
Coccurrence of circumstances that indicate that the patient’s health condition does not require any further health services at this healthcare center.
Ddemand of an adult patient to be discharged from the hospital.
Egross violation of the order and the progress of therapeutic services by a patient, where there is no concern that a refusal or discontinuation to provide healthcare services may cause direct hazard to their life or other people’s life or health.

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Question 104

Acquired hemophilia A can occur in:

Awoman two months after childbirth.
Bsystemic lupus erythematosus.
Celderly for no apparent reason, the so-called idiopathic form.
Dprostate cancer.
Eall the above.

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Question 105

Indicate the result of an arterial blood gas test which shows decompensated respiratory acidosis:

ApH - 7,30, pCO - 55 mmHg, HCO - 24 mmol/l.
BpH - 7,40, pCO - 40 mmHg, HCO - 25 mmol/l.
CpH - 7,50, pCO - 30 mmHg, HCO - 23 mmol/l.
DpH - 7,30, pCO - 50 mmHg, HCO - 19 mmol/l.
EpH - 7,48, pCO - 28 mmHg, HCO - 31 mmol/l.

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Question 106

Typical signs and symptoms of lung contusion include:

Ahemoptysis.
Bdyspnoea
Ccyanosis
Drales
Eall the above

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Question 107

The most common cause of intestinal fistulas is:

Aradiation-induced damage.
Bperitoneal adhesions.
CCrohn’s disease.
Dmalignant neoplasm.
Esurgical complication.

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Question 108

The anterior wall of the inguinal canal is formed by:

Aaponeurosis of the abdominal external oblique muscle.
Babdominal external oblique muscle.
Ctransverse abdominal muscle.
Dabdominal external oblique muscle with the transverse abdominal muscle.
Etransverse fascia.

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Question 109

The family doctor has a patient, a 54-year-old male with 2nd degree obesity, type 2 diabetes and arterial hypertension, and with a family history of heart disease from his father's side. The doctor decided to use a transtheoretical model for the slimming therapy of this patient. When starting therapy, the doctor should check:

Apatient’s awareness of the relationship between obesity and health.
Bpatient's perception of his susceptibility to heart disease.
Cpatient's perception of the severity of heart diseases.
Dpatient’s perception of social norms and influences.
Epatient’s self-efficacy in weight loss..

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Question 110

Medical history of cervical incompetence is an indication for:

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

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Question 111

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

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

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Question 112

Uterine leiomyomas are the most frequent benign neoplasms of the uterus. Indicate the false statement concerning their symptoms:

Athey include prolonged heavy periods and intermenstrual bleedings.
Bthey include pain in the hypogastrium, and pressure on the bladder or the rectum.
Csmall leiomyomas may be asymptomatic.
Dhot flushes are typical symptoms.
Eleiomyomas may be the cause of infertility.

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Question 113

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 114

A physician who coordinates a medical experiment is carrying out a procedure for obtaining informed consent from the study participants. The participants are minors who have attained the age of 13 years but have not attained the age of 16 years. The physician has an obligation to obtain informed consent:

Aonly from the statutory representative of the minor age participants.
Bonly from the minor age participants who have acquired full legal capacity on their completing the age of 13 years.
Cboth from the statutory representatives and the minor age participants.
Dfrom the guardianship court as the only body that has capability to make an objective assessment of the risk related to the minor’s participation in the trial and to protect his/her welfare.
Efrom the statutory representative of the minor as well as from his primary care physician who knows best his/her health condition and is able to evaluate the risk versus benefits related to participation.

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Question 115

In the medical certificate of temporary incapacity for work, the letter code A denotes:

Aincapacity for work after a period of absence from work that does not exceed 60 days, resulting from the same sickness that caused incapacity for work before the absence.
Bincapacity for work during the period of pregnancy or breastfeeding.
Cincapacity for work resulting from alcohol or drug abuse.
Dincapacity for work resulting from tuberculosis.
Enone of the above.

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Question 116

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 117

According to the Act of Old-Age and Disability Pensions from the Social Insurance Fund, a certificate of incapacity for work is issued:

Afor a maximum of 10 years, unless current medical knowledge excludes the possibility of regaining capacity for work within this period (in this case for 15 years).
Bfor a maximum of 8 years, unless current medical knowledge excludes the possibility of regaining capacity for work within this period (in this case for 10 years).
Cfor a maximum of 5 years, unless current medical knowledge excludes the possibility of regaining capacity for work within this period (in this case for a period longer than 5 years).
Dfor a period of 10 years each time.
Efor a period of 15 years each time.

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Question 118

Indicate the form of practicing the profession of a physician, which allows limitation of civil liability in the event of damage, that was not caused by an intentional mistake or due to gross negligence:

AIndividual medical practice.
BIndividual medical practice only in a medical facility on the basis of a contract with the medical entity running that facility.
CEmployment contract.
DCivil law contract concluded with the hospital.
EMandate contract

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Question 119

Polyuria with hypostenuria is typical of:

Aurinary tract infections.
Bfebrile diseases.
Curinary tract defects.
Ddiabetes insipidus.
Eintravenous administration of albumin.

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Question 120

Which karyotype is found in a patient with Morris syndrome?

A46 XX.
B45 XO.
C47 XXX.
D46 XY.
E48 XXXY.

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Question 121

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 122

In a 75-year-old woman in a check-up a serum sodium of 132 mmol/l has been found. The woman does not complain about any symptoms and does not take any drugs. Indicate the proper way of treatment:

Aintravenous infusion of 10% NaCl.
Bintravenous infusion of 3% NaCl.
Cintravenous infusion of 0.9% NaCl.
Doral NaCl administration.
Erecommend only a healthy and balanced diet.

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Question 123

The most frequently occurring malignant tumor in Polish women is:

Abreast cancer.
Bendometrial cancer.
Ccervical cancer.
Dovarian cancer.
Elung cancer.

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Question 124

You are performing a segregation of patients in the mass event. You use START system. You reach the victim who cannot walk, is breathing (15 breaths per minute), his/her radial artery pulse is palpable, is not responding to commands. You qualify him/her to the group:

Ablue.
Bgreen.
Cyellow.
Dred.
Eblack.

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Question 125

Hypothermia is a life-threatening condition defined as:

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

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Question 126

A 54-year-old patient reported to a GP due to presence of fresh RBCs in urine, detected incidentally during a pre-employment screening test. Which cancer marker should the patient be tested for first?

ACEA.
BCA 125.
CPSA.
DCA 19-9.
Ealfa-fetoproteiny (AFP).

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Question 127

A typical, benign kidney cyst on an ultrasound scan is:

Aanechoic and thin-walled.
Bisoechoic.
Chyperechoic.
Dthick-walled with septa.
Ean area of mixed echogenicity.

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Question 128

Indicate the true statement regarding esophageal adenocarcinoma (EAC):

AEAC more often affects pre-menopausal women.
BThe main risk factor for EAC is alcohol consumption.
CEAC is not associated with tobacco use.
DThe risk of EAC is nearly 30 times greater in people with achalasia.
EIntestinal metaplasia of the lower esophagus is a precancerous condition.

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Question 129

The clinical presentation of hypercalcemic syndrome includes:

1) polyuria;

2) diarrhea;

3) vomiting;

4) nephrolithiasis;

5) oliguria.

The correct answer is:

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

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Question 130

A 55-year-old female patient reported to a GP with her abdominal ultrasound scan results. The scan, which she had had due to suspected nephrolithiasis, revealed a polypous lesion of size 11 mm, adhering to the gall bladder wall. What should you do next?

Arefer the patient for cholecystectomy.
Brefer the patient for ultrasound-guided biopsy of the lesion.
Crefer the patient for a follow-up ultrasound scan in 12 months.
Drefer the patient for a PET-CT scan.
Einitiate ursodeoxycholic acid treatment.

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Question 131

Screening tests for colorectal cancer should be started at the age of 50. As a method alternative to colonoscopy every 10 years, occult blood stool tests can be used and they should be performed:

Aonce every 6 months.
Bonce every 12 months.
Conce every 2 years.
Donce every 5 years.
Eonce every 10 years.

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Question 132

A very rapid growth of a thyroid nodule, which is detectable on a physical examination and associated with an extensive infiltration of the surrounding structures, is indicative of:

Aanaplastic thyroid cancer.
Bpapillary thyroid cancer.
Cmedullary thyroid cancer.
Dfollicular thyroid cancer.
Eoncocytic thyroid cancer.

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Question 133

For patients on dialysis, the target parathyroid hormone level is 2-9 times the upper limit of the reference range. The persistence of lower levels may cause:

Anodular calcification of the skin.
Bvascular calciphylaxis.
Ccalcification of the aortic valve.
Dadynamic bone disease.
Esarcoidosis.

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Question 134

Indicate the true statements regarding renal cell carcinoma:

1) it is more often observed in men;

2) it affects men as often as women;

3) hematuria is the typical symptom;

4) the treatment of choice is surgical treatment;

5) the treatment of choice is traditional chemotherapy.

The correct answer is:

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

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Question 135

Treatment based on the use of a statin drug is contraindicated in:

Achronic hepatitis B.
Bacute coronary syndrome.
Cchronic kidney disease in patients receiving conservative treatment.
Dfatty liver.
Edecompensated liver cirrhosis.

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Question 136

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

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

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Question 137

Which of the following are characteristic of ECG in hypokalemia?

1) elongation of PR interval;

2) flattening of P wave;

3) widening of QRS complexes;

4) depression of ST segments;

5) increased amplitude and width of U waves.

The correct answer is:

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

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Question 138

Indicate the false statement regarding the clinical staging of Hodgkin lymphoma:

Aall stages are subdivided into stages A and B.
Bthe general symptoms used for the classification into stages A and B in the course of the clinical staging of Hodgkin lymphoma include body weight loss of >10% over the last 6 months, unexplained fever of >38°C, night sweat.
Cthe classification into stage A is based on the absence of general symptoms.
Dstage IV refers to a diffuse or disseminated involvement of one or more extralymphatic organs, with or without involvement of the lymph nodes.
Estage V refers to the spread to the central nervous system and cerebrospinal fluid, involvement of the lymph nodes on both sides of the diaphragm, and malignant pleural or peritoneal effusion without any other extralymphatic lesions.

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Question 139

Indicate the false statement regarding acute renal failure in children:

Aviral infections, such as viral hepatitis, can be the renal cause of acute renal failure.
Bthe use of sulfonamides is the most common pre-renal cause of acute renal failure.
Cdehydration and an insufficient fluid intake is the pre-renal cause of acute renal failure.
Dthe most common causes of acute renal failure are pre-renal causes (about 70%).
Econgenital urinary abnormalities, such as structural anomalies of the urinary tract, predispose to extrarenal acute renal failure.

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Question 140

Indicate the true statements regarding bone tumors in children:

1) osteosarcoma is the second most common bone tumor in children;

2) the characteristic feature of osteosarcoma is that it metastasizes to the lungs;

3) the first-choice diagnostic test for bone lesions is an MIBG (3-iodobenzylguanidine) scintigraphic scan;

4) methotrexate is not used in the course of treatment for osteosarcoma;

5) Ewing sarcoma can also occur in the soft tissues;

6) if distant metastases is detected (Stage IV), Ewing sarcoma is associated with a 5-year survival in 15-20% of cases.

The correct answer is:

Aall the above.
B1, 2, 3.
C3, 4, 6.
D2, 5, 6.
E2, 6.

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Question 141

A 4-year-old child with an abdominal lump on an ultrasound scan is admitted into the Pediatric Emergency Department. The lump is localized in the plan view of the right kidney, size: 8x7x7 cm. It is not encapsulated and infiltrates the adjacent structures. There are metastases to the local lymph nodes. A physical examination has revealed edema of the temporozygomatic region with bilaterally visible periorbital hematomas. Indicate the true statement(s) regarding the above clinical scenario (diagnosis and prognosis):

1) one of the steps to ensure proper diagnostic workup is to order a 24-hour urine collection to carry out tests e.g. for metanephrines and vanillylmandelic acid;

2) a biopsy of the lump is contraindicated due to worsening of the prognosis;

3) the presence of the N-MYC amplification in the tumor tissues improves the prognosis;

4) the disease stage as described above is referred to as IVS;

5) the patient’s prognosis is good (a 5-year survival in >70% of cases).

The correct answer is:

Aonly 1.
B1,2.
C1,2,3.
Dtylko 2.
Eall the above.

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Question 142

A 5-month-old infant is admitted to the Pediatric Emergency Department, presenting with symptoms of a respiratory infection which started a few days earlier, following a cold and cough for several days. The child had a fever of up to 39°C, rapid breathing rate (50/min) and difficulty breathing, with clearly detectable intercostal retractions. A physical examination revealed audible crackles in both lungs and tachycardia. A radiological study of the chest showed shadowing in the lungs, suggestive of an inflammation. Laboratory test results showed an elevated CRP level (132 mg/l) and elevated WBC count (17,000/µl). Indicate the false statement:

Agiven the age of the child, a confirmed pneumonia is an indication for hospital treatment.
Bfluoroquinolones and 3rd generation cephalosporins, including ceftriaxone, are first-line drugs for children of <1 year of age.
Cmacrolides are rarely used due to the significant resistance of Streptococcus pneumoniae.
Dblood culture tests should be carried out in patients with severe pneumonia.
Ebacterial causes of pneumonia in infants include, e.g., pneumococci, Haemophilus influenzae, and staphylococci.

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Question 143

A type of monogenic diabetes characterized by autosomal dominant inheritance and constantly elevated fasting glycemia which generally does not require pharmacological treatment is:

AWolfram syndrome.
BDEND syndrome.
CMODY2 diabetes.
DMODY3 diabetes.
EMODY5 diabetes.

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Question 144

When, after streptococcal infection, do the symptoms of rheumatic fever appear?

Aduring the infection.
Bimmediately after the infection is over.
C3-4 weeks after the infection is over.
D2-3 months after the infection is over.
Ehalf a year after the infection is over.

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Question 145

The symptoms of asthma in children are:

Awheezing.
Bcough.
Cexpiratory dyspnea.
Dtightness in the chest.
Eall of the above.

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Question 146

Which procedure is necessary for the diagnosis of Wilms’ tumour?

Aopened biopsy of the tumour.
Bfine needle biopsy of the tumour.
Cabdominal ultrasound and/or computed tomography.
Dalpha-fetoprotein (AFP) concentration in plasma.
Erenal scintigraphy.

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Question 147

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 148

A 44-year-old patient who 3 months earlier underwent endoscopic retrograde cholangiopancreatography with removal of choledocholithiasis and implantantion of a prosthesis into the bile ducts, and gall bladder resection, was admitted as an emergency case into the Surgery Department due to pain in the right subcostal area without peritoneal symptoms. Body temperature 39°C, heart rate 95/min, breathing rate 20/min, elevated WBC count 18,000/µl, CRP 180 mg/l. Even prior to imaging tests, it should be suspected that the patient has:

Agastrointestinal perforation due to migration of the bile duct prosthesis.
Biatrogenic interruption of the bile ducts which occurred during cholecystectomy.
Cdecompensated chronic liver disease in the form of biliary cirrhosis.
Dcholangitis associated with an onset of sepsis.
Eblockage of the common bile duct because it was clipped intraoperatively during the gall bladder removal procedure.

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Question 149

Proper treatment of a patient in shock involves all the procedures described below, except:

Arestore the normal intravascular blood volume.
Beliminate or treat the underlying cause of shock.
Cuse vasoconstrictors without the need for fluid transfusion.
Dtreat oliguria and anuria.
Etreat respiratory disturbances through appropriate oxygenation.

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Question 150

A 75-year-old patient has reported to a surgical clinic. He noticed skin yellowing and weight body loss but otherwise he has no complaints. He underwent a laparoscopic cholecystectomy 10 years earlier. The proper approach in this case will be:

Ato diagnose Gilbert syndrome and calm the patient.
Bto diagnose damage to the bile ducts and refer the patient to an Emergency Surgical Department.
Cto diagnosed advanced liver cirrhosis and refer the patient for further liver treatment.
Dto suspect a tumor in the head of pancreas and order abdominal imaging tests.
Eto diagnose hemolytic jaundice and refer the patient to a hematology clinic.

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Question 151

A 60-year-old patient has reported to a surgical clinic with ascending colon cancer confirmed by a histopathological examination of specimens collected during colonoscopy. Which of the following examinations should be ordered first prior to operation in order to determine the stage of the cancer?

Aa bone scan.
Ba contrast CT scan.
Ca PET scan.
Dan exploratory laparoscopy.
Ean endoscopic ultrasound scan.

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Question 152

Which of the following patients is not eligible for gastric sleeve resection?

Aa 78-year-old male patient with BMI at 45 kg/m2 and arterial hypertension.
Ba 35-year-old male patient with BMI at 37 kg/m2 and obstructive sleep apnea.
Ca 64-year-old female patient with BMI at 36 kg/m2 and type 2 diabetes.
Da 25-year-old male patient with BMI at 34 kg/m2 and a tumor in the pancreas.
Ea 60-year-old female patient with BMI at 45 kg/m2.

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Question 153

Procedures used for treating cancer patients are often only targeted at improving their quality of life. Palliative procedures do not include:

Aplacement of a prosthesis in the bile ducts.
Bsigmoidostomy in patients with gastrointestinal obstruction due to non-resectable rectal cancer.
Cliver resection associated with an isolated colorectal cancer metastasis.
Dpercutaneous endoscopic gastrostomy.
Eceliac plexus neurolysis.

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Question 154

All the following conditions can be considered an indication for an above-knee amputation of the lower limb, except:

Astage 3 (Breslow’s depth) melanoma on the lower leg.
Bnecrosis secondary to critical lower limb ischemia.
Ccolliquative necrosis associated with diabetic foot.
Dcrushing injury of the lower limb.
Eemphysematous gangrene of the lower limb.

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Question 155

Preoperative patient-related risk factors for a postoperative wound infection do not include:

Aage above 65, smoking, alcohol addiction.
Bobesity, anemia, neoplastic disease.
Cdiabetes, post chemotherapy status and immunosuppression.
Dsteroid therapy, a history of urgent operations.
Eshort-term catheterization of the urinary bladder and hospital treatment lasting less than 2 days.

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Question 156

To minimize the risk of ischemic esophageal necrosis, balloons on the Sengstaken-Blakemore tube should be kept filled for no longer than:

A6h.
B12h.
C24h.
D56h.
E72h.

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Question 157

A female patient, status-post removal of the thyroid gland due to cancer, who has been for 4 hours in the postoperative room, was observed to have breathlessness, stridor and increasing neck circumference. In this case you should:

Ainitiate administration of vitamin D and calcium products, suspecting tetany.
Bschedule an urgent consultation an ENT specialist, suspecting unilateral paralysis of the recurrent laryngeal nerve.
Cschedule an elective consultation with an ENT specialist, suspecting bilateral paralysis of the recurrent laryngeal nerves.
Dintubate the patient and refer her for an urgent operation, suspecting postoperative hemorrhage.
Ethe patient requires only observation and administration of analgesics as per the analgesic ladder.

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Question 158

Which of the following is not/are not a contraindication(s) for percutaneous endoscopic gastrostomy:

Aesophageal obstruction.
Bpost stroke status.
Ccoagulation abnormalities.
Dpost gastrectomy status.
Eascites.

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Question 159

A syndrome involving vegetative symptoms, which occurs when large amounts of food move too quickly into the subsequent parts of the intestine in patients who have had a gastric resection and presents with drowsiness, nausea, weakness and perspiration, is termed:

Agastropexy.
Bhematemesis.
Cdumping syndrome.
DHoman’s sign.
ECourvoisier’s sign.

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Question 160

A 40-year-old patient with atrial fibrillation, transferred into the admission room of a university hospital, was found to have pain in the right lower limb and altered sensations, white skin, weakened muscle power and absence of palpable pulse in the dorsal artery of the right foot. In this case, you should suspect:

Avenous deep thrombosis in the lower limb.
Bdissecting aneurysm of the aorta.
Csuperficial vein thrombosis in the lower limb.
Darterial embolism in the lower limb.
ERaynaud’s disease.

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Question 161

Which of the following refers to partial gastric resection?

AHalsted surgery.
BTraverso-Longmire procedure.
CShouldice method.
DBillroth’s operation (Billrotha I).
EHartmann’s procedure.

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Question 162

When restoring the continuity of the gastrointestinal tract after removal of the esophagus due to cancer, all of the following are used, except:

Astomach.
Bsmall intestine.
Cascending colon.
Dtransverse colon.
Eduodenum.

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Question 163

A 75-year-old patient, a retired auto repair worker, was found to have dysphagia which has progressed over the several past months and was associated with body weight loss. In this case you should suspect:

Acancer of the gastric cardia.
Besophageal perforation.
Cgastroesophageal reflux disease.
DGIST in the small bowel.
Echronic pancreatitis.

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Question 164

A 72-year-old patient reports pain in the region of the left iliac fossa, which has been present for the last 3 days, associated with fever of up to 39°C, tachycardia at 90 bpm, highly elevated inflammation parameters (WBC and CRP) and an identified fluid collection in the lower abdomen on the left side. In this case you should diagnose:

Aacute pyelonephritis in the left kidney.
Bintra-abdominal abscess associated with appendicitis.
Cabscess secondary to sigmoid diverticulitis.
Dinfected ascites associated with liver cirrhosis.
Eperitoneal carcinomatosis associated with colorectal cancer.

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Question 165

The most common direct cause of peritonitis is:

Astrangulation of the small intestine.
Bintussusception of the small intestine into the large intestine.
Cdigestive tract perforation.
Dsepsis.
Elarge bowel obstruction.

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Question 166

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

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

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Question 167

Surgical treatment of an ovarian functional cyst is recommended if:

Athe cyst is the cause of secondary amenorrhea.
Bthe cyst is the cause of excessive menstruation.
Cthe cyst persists during 2 consecutive menstruation cycles.
Dthe cyst size is greater than 3 cm.
Ethe cyst size is greater than 6 cm and the cyst causes pain.

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Question 168

Secondary prevention of cervical cancer includes:

Avaccination against HPV.
Bcervical screening tests.
Ctests for BRCA gene mutations.
Dencouraging health-promoting behaviours aimed at avoiding HPV infections.
Eall the above.

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Question 169

The gold standard for treating ovarian torsion is:

Aconservative treatment (hormonal contraception, non-steroid anti-inflammatory drugs, antiobiotic treatment).
Bsurgical treatment, such as laparoscopy or laparotomy, intended to preserve the ovarian functions (restoring ovarian mobility and normal blood supply).
Csurgical treatment based on laparoscopy or laparotomy which should always involve adnexectomy due to high risk of recurrence.
Dsurgical treatment using laparoscopy or laparotomy associated with the removal of the reproductive organ (bilateral andexectomy and supravaginal uterine amputation).
Etransvaginal attempt aimed at untwisting the ovary (to restore mobility of the ovary and normal blood supply).

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Question 170

Possible complications of genetic amniocentesis include all the following risks, except:

Avaginal spotting.
Bpremature leakage of amniotic fluid.
Cintrauterine infection.
Dmiscarriage.
Eopen neural tube defect.

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Question 171

Missed miscarriage is defined as:

Avaginal bleeding associated with uterine contractions, which leads to total expulsion of the fertilized ovum components.
Bvaginal bleeding associated with uterine contractions, which leads to partial expulsion of the fertilized ovum components.
C‘biochemical’ pregnancy, i.e. an increased level of b-hCG subunit in the absence of a gestational sac, vitelline sac or embryo echo on ultrasound.
Dthree consecutive miscarriages.
Eintrauterine fetal death associated with total preservation of the fertilized ovum components.

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Question 172

Doppler ultrasound blood flow assessment for the diagnosis of hemolytic disease of the fetus involves measuring peak systolic velocity in:

Aumbilical artery.
Bvenous duct.
Cmiddle cerebral artery of the fetus.
Danterior cerebral artery of the fetus.
Euterine arteries of the mother.

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Question 173

The gold standard for establishing the final diagnosis of pulmonary embolism in a pregnant woman with a negative result from a lower extremity venous assessment using a Doppler ultrasound scan for blood flow assessment in the lower extremity veins is:

Achest X-ray with an abdominal shield.
Bangio-CT with an abdominal shield.
Cmonitoring of D-dimer levels.
DECG.
Echest MRI.

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Question 174

Conservative treatment of endometriosis uses the following drug groups, except:

Aprogestational hormones.
Bgonadoliberin analogs.
Ccontraceptives.
Dchronic steroid therapy.
Enon-steroid anti-inflammatory drugs (NSAIDs).

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Question 175

Metrorrhagia juvenilis refers to abnormal vaginal bleeding in young females due to:

Aanatomic causes related to congenital uterine anomaly.
Bfunctional causes attributable to hyperthyrodoism.
Corganic causes related to the presence of a foreign body in the vagina.
Dfunctional causes attributable to hypocorticoidism.
Efunctional causes attributable to anovulation or luteal phase defect.

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Question 176

Tertiary prevention of preterm labor in patients at risk, who have had preterm contractions should not include:

Astrict bed rest.
Bearly diagnosis.
Ctransfer into a tertiary referral medical center.
Dtocolytic therapy.
Eprenatal steroid therapy.

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Question 177

RSV vaccination is recommended for:

Aadults aged 60 and older.
Badults aged 50-59 due to the greater risk of RSV-induced diseases.
Cpregnant women at any stage of pregnancy.
Danswers A and B are correct.
Eanswers A, B and C are correct.

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Question 178

A 32-year-old male patient has reported to a GP because he is going on a business trip and would like to know if he needs to take a routine booster dose of hepatitis B vaccine. The patient receive all the three vaccine doses as a child. He has had no chronic diseases and takes no medications on a regular basis. What should you do next?

Aadminister 1 booster dosis.
Badminister the primary dose and booster doses at 0-1-6 month intervals.
Ctest the patient for anti-HBs and if the result is <10 mIU/ml, administer 1-3 doses of hepatitis B vaccine.
Dtest the patient for anti-HBs and if the result is <100 mIU/ml, administer 1-3 doses of hepatitis B vaccine.
Ethere is no need for the patient to take booster doses.

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Question 179

Indicate the true statement regarding preventive vaccinations:

Aearlier administration of measles vaccine is not a contraindication against administration of the 3-valent combined MMR (measles, mumps and rubella) vaccine.
Badministration of tuberculosis vaccine is contraindicated in children of mothers who received immunosuppressive treatment, including biological treatment within 3 months prior to childbirth.
Cfor post-exposure prevention of tetanus, a patient with an uncertain history of vaccinations against tetanus and at low risk of tetanus should be given all the required (primary and booster) vaccine doses, i.e. 3 doses at 0-1-6-month intervals.
Danswers A and B are correct.
Eanswers A, B and C are correct.

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Question 180

Vaccination against HPV reduces the risk of:

Acervical cancer.
Banal cancer.
Cpenile cancer.
Danswers A and B are correct.
Eanswers A, B and C are correct.

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Question 181

Medications for the management of cancer pain up to Step 2 of the pain ladder include all the following, except:

Asmall doses of morphine.
Btramadol.
Ctapentadol.
Dhydromorphone.
Eall the above are Step 2 analgesics.

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Question 182

Indicate the false statement regarding hepatocellular carcinoma (HCC):

AHCC originates from hepatocytes.
BHCC is known to be caused by HCV and HBV infections.
Ca screening test for AFP is recommended due to high sensitivity and specificity.
DHCC should be differentiated against adenocarcinoma, metastatic tumors and intrahepatic cholangiocarcinoma.
Eat a very early stage, HCC is treated using ablation or liver resection.

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Question 183

Indicate the false statement regarding adrenal cancer:

Aradiotherapy is a standard treatment option for adrenal cancer.
Babout 20% of patients survives the next 5 years from the diagnosis.
Cclinical presentation of the disease varies according to whether the tumor is hormonally functional.
Da hormonally non-functional adrenal cancer is most often manifested late.
Eit is possible to use mitotane for treating adrenal cancer patients.

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Question 184

Causes for exacerbation of chronic heart failure include:

1) poor arterial pressure control;

2) atrial fibrillation;

3) worsening renal function;

4) increased intake of sodium and fluids.

The correct answer is:

Aall the above.
Bonly 2.
C1,3.
D1,2,4.
E1,3,4.

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Question 185

Indicate the recommended protein intake for adult patients with chronic kidney disease (stage G2-G5) associated with diabetes, who do not receive dialysis therapy:

A0.55-0.6 g/kg bw/d.
B0.6-0.8 g/kg bw/d.
C0.8-1 g/kg bw/d.
D1.0-1.2 g/kg bw/d.
E>1.5 g/kg bw/d.

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Question 186

In which of the following cases pre-diabetes should be diagnosed?

Afasting glycemia: 123 mg/dl.
Bfasting glycemia: 136 mg/dl.
C2-hr glycemia (OGTT): 132 mg/dl.
D2-hr glycemia (OGTT): 203 mg/dl.
Eall the above.

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Question 187

Hirschberg test is a screening test for:

Astrabismus in children.
Bvisual acuity in children.
Clower limb ischemia in adults.
Dhip displasia in children.
Esexual development assessment in children.

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Question 188

Mother reports to a GP and says that her 4-year-old child has had fever, rhinitis symptoms associated with dry cough and conjunctivitis for 5 days now. The mother has also noted white spots/pimples (on the buccal mucosa) near the molar teeth. The day before the appointment bright red maculopapular rash appeared behind the ears and spreading downwards. The child’s medical history shows no preventive vaccinations. Which diagnosis is most likely in the case described?

Apertussis.
Bdiphtheria.
Cmeasles.
Drubella.
ECOVID-19.

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Question 189

Which screening tool is not used as a cognitive assessment tool?

AMontreal Cognitive Assessment.
BMini-Mental State Examination.
CRaven’s Progressive Matrices.
DFrontal Assessment Battery.
EClock Draw Test.

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Question 190

Indicate the false statement regarding perinatal mood disorders:

Apost-partum depression affects about 1-2% of women.
Bpost-partum blues affects about 50-80% of women.
Cthe risk of post-partum depression is greater in teenage mothers.
Dpost-partum blues symptoms resolve spontaneously without the use of medications.
Epost-partum blues may last up to 2 weeks or sometimes up to a month after childbirth.

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Question 191

A 23-year-old male reports that he has been hearing the “voice in his head, which comments what the man is doing and tells him to commit suicide”. Which syndrome is this symptom the most characteristic of?

Adepressive.
Bparanoid.
Cparanoic.
Dalcohol dependence.
Ecatatonic.

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Question 192

Indicate the true statement regarding cervical spine injuries:

Athe use of the HALO orthosis is the most stable and effective method for stabilizing the cervical spine.
Bthe Minerva brace (cervico-thoracic orthosis) does not limit the axial rotation of the head.
Csoft cervical collars are not useful for an ad-hoc short-term treatment of a minor cervical muscle tear.
DKirschner bows are not useful for immobilizing the spine in the recovery position.
Eit is usually recommended to apply up to 5 kg to load the Kirschner bow, regardless of the severity of the cervical spine injury.

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Question 193

Indicate the true statement regarding anisocoria:

Aanisocoria is diagnosed when the difference in the pupil size is more than 1 mm.
Banisocoria must be associated with abnormal accommodation.
Canisocoria must be associated with diplopia.
Dpost-injury anisocoria is most often an isolated symptom.
Eprogressive anisocoria in an unconscious patient is not suggestive of the increasing severity of intracranial hypertension.

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Question 194

Indicate the true statement regarding quaternary blast injuries:

Athey are caused by the impact of the blast wave.
Bthey are caused by the impact of blast debris.
Cthey are the result of the transposition of the victim’s body on the ground due to the impact of the blast wind.
Dthese are burns of the respiratory tract due to inhalation of toxic gases.
Enone of the above.

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Question 195

In which of the following cardiac arrests CPR starts with 5 rescue breaths?

Acaused by drowning.
Bin the pregnant.
Ccaused by myocardial infarction.
Din children.
EA, D are true.

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Question 196

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

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

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Question 197

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

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

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Question 198

Which of the following concerning positive features of screening tests, which justifying their application, is false?

Amethods used in screening usually carry no risk for examined patients.
Bthere is a possibility to verify diagnoses obtained through these tests.
Cmethods used in screening do not have to be accepted by examined patients.
Ddiagnostic tests used in screening are generally fast and easy.
Ecosts of screening tests and possible further treatment are economically justified.

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Question 199

Risk factors for laryngeal cancer include:

Asmoking.
Balcohol consumption.
Can HPV-6,-11,-18 infection.
Danswers A and B are correct.
Eanswers A, B and C are correct.

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Question 200

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

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

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