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LEKEXAM / 2026 autumn

Question distribution — 2026 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

The treatment of pre-invasive cervical cancer consists in:

Aexcision of the affected part of the cervix.
Bstrict cytologic and colposcopic examination once a month.
Csimple hysterectomy.
Dradical hysterectomy.
Ebrachytherapy.

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Question 2

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

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

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Question 3

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 4

In a patient with the symptoms of acute urticaria with no allergy in anamnesis, it is necessary to order :

Awhole blood count with blood smear, CRP
Bskin prick tests
Cphysical tests
Dall the above.
Enone of the above.

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Question 5

The proliferative phase of the uterine cycle is dependent on:

AProgesterone produced by the corpus luteum.
BProgesterone produced by granulous cells.
CEstrogen produced by the corpus luteum.
DEstrogen produced by granulous cells.
EEstradiol produced by the dominant follicle.

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Question 6

Neuroborreliosis can manifest itself as:

1. lymphocytic meningitis,

2. encephalitis,

3. spinal cord inflammation;

4. cranial nerve palsy,

5. chronic encephalopathy,

6. impaired concentration;

7. increased nerve excitability

The correct answer is:

A1, 2, 3
B2, 3, 4
C5, 6, 7
Dall the above
Enone of the above

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Question 7

Fever, lymphadenopathy, inflammation of the upper respiratory tract, conjunctivitis and red, maculopapular rash, are symptoms characteristic of:

Ameasles
Bvaricella
Croseola
Dhand, foot and mouth disease
Enone of the above

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Question 8

Food allergy may manifest itself as:

AUrticaria (hives)
Brhinitis
Cconjunctivitis
DA, B are true
EA, B, C are true.

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Question 9

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 10

The HLY indicator means:

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

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Question 11

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 12

Sheehan’s syndrome - postpartum pituitary gland necrosis - is characterized by

Ahypogonadotropic hypergonadism
Bhypogonadotropic hypogonadism.
Chypergonadotropic hypergonadism.
Dhypergonadotropic hypogonadism.
Eprimary amenorrhoea

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Question 13

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

ASmoking tobacco
BObesity
CDiabetes
DExogenous estradiol
ELate menopause

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Question 14

Treatment of an episode of depression in the course of bipolar disorder should be initiated with the administration of:

Afluoxetine
Bhaloperidol
Cdoxepin
Dvalproic acid
Elamotrigine

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Question 15

The most frequent side effect of clozapine is:

Ametabolic syndrome
BParkinson-like syndrome.
Ccardiac arythmia.
Dleukopenia
Ehyperprolactinemia

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Question 16

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 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 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 19

A contract of employment in the hospital has been offered to a doctor. The employment is based on the co-called equivalent work time. This means that:

1) standard daily working time can be increased up to 12 hours;

2) standard daily working time can be increased up to 18 hours;

3) standard weekly working time is increased to 48 hours;

4) basically the time calculation period is shortened to 1 month;

5) basically the time calculation period is prolonged to 6 months.

The correct answer is:

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

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Question 20

A doctor is going to do some experiment on animals. Before launching it they should obtain the approval of:

Abioethical committee at the Medical University.
BDepartment of Science and Higher Education in the Ministry of Health.
CChief Veterinarian.
Dlocally appropriate district veterinarian.
Elocally appropriate local ethical committee.

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Question 21

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 22

Neoplastic ovarian tumours which produce steroid hormones include: 1) thecoma; 2) mature teratoma; 3) endometrioid carcinoma; 4) granulosa cell tumour. The correct answer is:

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

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Question 23

The most common neuroendocrine pancreatic tumor is:

Agastrinoma.
Bsomatostatinoma.
CVIPoma.
Dglucagonoma.
Einsulinoma.

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Question 24

In accordance with the Act on Patients’ Rights and the Ombudsman for Patients’ Rights the doctor providing the patient with medical services is allowed to object to the presence of patient’s beloved one while performing those services:

Ain any case without having to give reasons
Bonly in the case when performing a medical service requires the patient to take their clothes off.
Conly in the case when the presence of the beloved one may pose a threat to the patient’s health.
Donly in the case when the patient suffers from terminal infectious disease.
Eonly if there is a risk of epidemic or if the patient’s health safety is at stake.

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Question 25

In accordance with the law on old age and disability pensions paid from Social Insurance Fund, who is entitled to submit an application for the disability pension resulting from incapacity for work to SIF?

Aoccupational medicine physician.
Bmedical specialist.
Cfamily doctor.
Demployer.
Einsured person.

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Question 26

Which denominator number is used for calculating the mortality rate of the disease?

Anumber of all incidence of the disease.
Bnumber of new incidence of the disease in the given time.
Cnumber of deaths of the disease.
Daverage number of people in the population in the given period of time.
Enumber of people in the population suffering from the disease.

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Question 27

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

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

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Question 28

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 29

"The first- step treatment od this disease consists in non- pharmacological methods, including quantitatively and qualitatively adjusted diet, refain from smoking and drinking alcohol and withdrawal of ulcerogenic drugs." The above description refers to:

Agastroesophageal reflux disease
Bcoeliac disease
Cirritable bowel syndrome
Dulcerative colitis
ECrohn's disease

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Question 30

The procurement of tissues, organs and cells for transplantation from corpses can be carried out after:

1) identifying the permanent irreversible cessation of brain activities (brain death);

2) declaring death due to irreversible cardiac arrest;

3) declaring death due to irreversible respiratory arrest;

4) declaring death due to irreversible cessation of brainstem activities;

5) donor’s next of kin in the meaning of the Act on Patients’ Rights and the Ombudsman for Patients’ Rights do not object to the explantation.

The correct answer is:

A1, 2
B2, 3
C3, 4
D1, 2, 5
E4, 5

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Question 31

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 32

Emergency indications for surgery in a patient with Crohn disease:

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

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Question 33

Which of the following is the most common cause of the mechanical ileus in the lower

gastrointestinal tract?

Adiverticulosis of the colon.
Bperitoneal adhesions.
CMeckel's diverticulum
Dneoplastic tumors.
Ebezoars.

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Question 34

Which of the following operations can be performed in the case of adenocarcinoma

localized in the sigmoid colon?

Alaparoscopic sigmoid resection.
BHartmann’s procedure by means of laparotomy.
Csigmoid resection by means of laparotomy.
Dlaparoscopic Hartmann operation.
Eall the above.

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Question 35

Negative symptoms of schizophrenia include:

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

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Question 36

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

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

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Question 37

A woman whose only chance to survive is bone marrow transplant comes to the hospital. Searching for the donor failed, but the test results of tissue compatibility antigens indicate that her minor son could be the donor. Taking bone marrow from the minor in order to transplant it to his mother:

Ais not possible.
Bis possible only from minors over 16 years of age.
Cis possible only when facing imminent danger of mother’s death and another donor has not been found
Dis possible after obtaining written consent from the minor and the consent from the Ethics Committee of the National Transplant Council.
Eis possible after obtaining consent from the minor, in pen, from the court and from the Ethics Committee of the National Transplant Council.

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Question 38

Epidemiology as a science deals with the assessment of:

Aoccurrence of health phenomena.
Bconditioning of health phenomena.
Ceffectiveness of interventions.
DA and B are correct.
EA, B and C are correct.

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Question 39

Craniotabes (softening and thinning of occipital and parietal bones) may be observed in the following disorders, except for:

AExcess of phosphates in the diet
BOsteopenia in prematurity
Costeogenesis imperfecta
DEhlers-Danlos syndrome
EDown syndrome

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Question 40

Directly after the third stage of the delivery massive hemorrhage occurred leading to hypovolemic shock. The condition of the patient improved significantly over several days, but she is suspected of Sheehan’s syndrome. Which of the following justifies this suspicion?

Aher child receiving 7 in the Apgar score.
Bchange in respiratory rate.
Cworsening of the general condition and depressive thoughts.
Dno lactation.
Eoccurrence of diarrhea

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Question 41

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

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

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Question 42

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 43

Specific diabetic complications do not include:

ANephropathy
BRetinopathy
CPolyneuropathy
Dcoronary artery disease
EDiabetic foot

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Question 44

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 45

The risk factors for gastroesophageal reflux disease do not include:

AFemale gender
Belderly age
CPregnancy
DOverweight or obesity
ETabacco smoking

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Question 46

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

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

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

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

4) poses a threat to the legal system;

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

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

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Question 47

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 48

The most common solid malignant tumor in children is:

Aleukemia
Bprimary bone tumors.
Cbrain tumors.
Dliver neoplasm.
Esoft tissue sarcomas.

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Question 49

A feature common for the Mayer-Rokitansky-Küster-Hauser syndrome and complete androgen insensitivity syndrome is:

AXY karyotype.
BXX karyotype.
Clack of the uterus and vagina.
Ddefect of the androgen receptor gene.
Epresence of testicles in the abdominal cavity.

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Question 50

Endocrine hypertension occurs in the course of:

ACushing syndrome.
Bprimary hyperaldosteronism.
Chyperparathyroidism.
Dpheochromocytoma.
Eall the above

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Question 51

A 67-year-old woman lives alone in a small apartment. She has been conflicted with her neighbors for 2 years. She threatens them and keeps tapping the pipes and the ceiling. She believes the neighbors let a poisonous gas into her flat. She frequently calls the police asking for an intervention. She complains of the neighbors, ineffectiveness of the police and building authority. She was never treated psychiatrically before. Which of the following is the most probable diagnosis?

Aschizophrenia.
Bschizotypal disorders.
Cpersistent delusional disorders.
Dacute transient psychiatric disorders.
Eschizoaffective disorder.

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Question 52

Mantism is:

Atotal block of the train of thought that has been already slowed down.
Bno verbal response from the patient despite direct commands and encouraging.
Cburdensome feeling of the excess of spontaneously occurring trains of thought or topics, usually disturbing and expressed in the form of limited fluency, clarity and content of speech.
Dpersistent repetition of a single action.
Erepetition of words or consonants that do not form a meaningful entity, but are connected only by a similarity of sounds

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Question 53

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 54

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

A5%
B10%
C15%
D16%
E32%

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Question 55

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 56

The most probable diagnosis in a patient with recurrent infections, thrombocytopenic purpura (the onset in the first six months of live) and eczema (atopic dermatitis-type) is:

ANijmegen syndrome
BHyper-IgE syndrome
CBloom syndrome.
DNetherton syndrome.
EWiskott-Aldrich syndrome.

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Question 57

Which of the following is more common among teenagers than pre-school children?

Amalignant bone tumors
Bnon-Hodgkin lymphoma
Cneuroblastoma
Dretinoblastoma
EWilms tumor

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Question 58

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 59

A patient weighing 100 kg was admitted to the surgical ward because of the 3rd degree thermal burns of the anterior chest wall, abdomen and scrotum. Calculate the percentage of the burned body surface according to the rule of nines and the volume of fluids that should be transfused in the first 24h according to the Parkland formula:

Aburned body surface is 19% and the volume of fluids to be transfused within the first 24h is 7600 mL.
Bburned body surface is 19% and the volume of fluids to be transfused within the first 24h is 760 mL.
Cburned body surface is 10% and the volume of fluids to be transfused within the first 24h is 4000 mL.
Dburned body surface is 10% and the volume of fluids to be transfused within the first 24h is 400 mL.
Eburned body surface is 10% and the Parkland formula should not be used in patients with burns of the 3rd degree.

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Question 60

Indicate the true statement concerning gastric cancer:

Afemales are affected twice as often as males.
Bintestinal metaplasia does not increase the risk of the disease.
Cearly gastric cancer does not spread to lymph nodes according to its definition.
Dtreatment is mostly confined to chemo- and radiotherapy.
EHelicobacter pylori infection 5-fold increases the risk of the disease.

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Question 61

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

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

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Question 62

Indicate the clinical features of germinal neoplasms of the ovary:

1) occur mainly in young women;

2) occur mainly in post-menopausal women;

3) may be diagnosed on the basis of increased blood levels of CA-125, CEA, CA 15-3;

4) may be diagnosed on the basis of increased blood levels of LDH, AFP, hCG;

5) respond well to chemotherapy;

6) are treated only surgically;

7) are always malignant tumours.

The correct answer is:

A1, 4, 7
B3, 4, 6
C2, 4, 6, 7
D1, 4, 5
E2, 3, 7

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Question 63

The multiple pregnancy is related to the increased risk of numerous obstetrical complications compared with the singleton pregnancy. Which of the following complications are not observed in multiple pregnancies more often than in singleton pregnancies?

1) shoulder dystocia;

2) gestational hypertension;

3) necessity for the cesarean section;

4) postterm pregnancy;

5) perinatal death;

6) placenta praevia;

7) congenital defects.

The correct answer is:

A1, 4
B2, 6
C2, 7
D3, 5
E4, 6

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Question 64

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

1) Wilms’ tumor;

2) neuroblastoma;

3) non-Hodgkin lymphoma;

4) medulloblastoma;

5) dysgerminoma.

The correct answer is:

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

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Question 65

Cafe-au-lait spots are typical of:

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

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Question 66

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

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

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Question 67

Which of the following ovarian tumors is a virilizing tumor?

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

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Question 68

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

Afetal lie
Bposition.
Cfetal location.
Dengagement
Epresentation.

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Question 69

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

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

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Question 70

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 71

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

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

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Question 72

Work accident insurance is obligatory for:

Aemployees.
Bunemployed person on unemployment benefits
Cunemployed person taking integration benefits.
DMembers of the European Parliament.
EMembers of the Council of Europe.

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Question 73

Which of the following are characteristic of a granulosa cell tumor?

1) most often occurs on both sides;

2) it is a germ cell tumor;

3) it is secreting estrogens and inhibin;

4) it is often accompanied by ascites;

5) most often occurs before puberty.

The correct answer is:

A1,2,4
B2,4,5
Conly 3
D1,3,5
E2,3,5

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Question 74

hip joints ultrasound should be performed in all newborn babies up to:

A4 weeks of age
B6 weeks of age
C8 weeks of age
D10 weeks of age
E12 weeks of age

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Question 75

The causes of hyperamylasemia include:

1) acute pancreatitis;

2) peptic ulcer perforation;

3) distal radius fracture;

4) ectopic pregnancy miscarriage;

5) renal failure;

6) cystitis;

7) acute appendicitis;

8) right foot toe paronychia.

The correct answer is:

A1,2,4,5,6.
B2,4,5,6,7.
C1,2,4,5,7.
D1,3,4,7,8.
E3,5,6,7,8.

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Question 76

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 77

Which of the following concerning pancreatic cancer is true?

1) laparoscopy is contraindicated in surgical treatment;

2) jaundice may be one of the first symptoms and may indicate compression of the bile ducts;

3) head of the pancreas is the most common location;

4) curability is estimated at 50%;

5) women fall ill more often.

The correct answer is:

A1,3.
B2,3.
C2,4,5.
Dtylko 1.
Etylko 3.

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Question 78

The treatment of aggravated symptoms of alcohol withdrawal syndrome includes:

1) hydration of the patient;

2) correction of electrolyte and vitamin deficiencies;

3) use of benzodiazepines;

4) use of SSRI agents.

The correct answer is:

A1,2.
B1,2,3.
Call the above.
D3,4.
Eonly 1.

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Question 79

Identifying sources of infection, routs of its transmission and people susceptible to infection are action taken in the case of:

Adisinfection.
Bsterilization.
Cdisinfestation.
Dderatization.
Eepidemic outbreak.

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Question 80

Endometriosis should be taken into account in the case of:

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

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Question 81

Which of the following findings on cardiotocography (CTG) is a good prognostic factor?

Adecelerations.
Bsinusoidal pattern.
Ctachycardia.
Daccelerations.
Ebradycardia.

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Question 82

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

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

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Question 83

For a dataset, the median is the value which:

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

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Question 84

Which of these medical conditions should be considered in the differentiation of acute cholecystitis?
1) gastric or duodenal ulcer perforation;
2) sigmoid diverticulitis;
3) cholangitis;
4) acute pancreatitis;
5) mechanical obstruction.
The correct answer is:

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

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Question 85

Increased end-tidal CO2 concentration (EtCO2), measured with capnometry, does not occur during:

Ahypoventilation.
Bmalignant hyperthermia.
Chypothermia.
Dskeletal muscle activity.
Ethyroid storm.

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Question 86

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

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

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Question 87

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

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

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Question 88

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

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

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Question 89

What are the clinical symptoms of Wilms’ tumour (nephroblastoma)?

1) abdominal tumour;

2) haematuria;

3) abdominal pain;

4) anorexia;

5) hypertension.

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

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Question 90

A 75-year-old female patient with persistent atrial fibrillation suddenly experienced right-sided paresis with aphasia. The patient has not been treated with anticoagulants. What should you do first?

Atake a head CT scan with contrast.
Btake a non-contrast head CT scan.
Cdetermine the glucose concentration.
Dadminister tissue plasminogen activator.
Eadminister heparin.

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Question 91

In the case of restoration of cardiovascular activity during CPR (cardiopulmonary resuscitation) in a patient with cardiac arrest, the end-tidal carbon dioxide (ETCO2) level:

Awill increase.
Bwill fall.
Cwill not change.
Dwill fall to zero.
Ewill reach 200 mmHg.

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Question 92

A 40-year-old male patient has lost consciousness.The patient is unconscious at the time of arrival of an RRT (Rapid Response Team), takes 6 breaths per minute, and occasionally falls into apnea, pulse 120/min, saturation 78%, the pupils are constricted. What do you need to do first?

Astart to ventilate the patient with oxygen, intubate the patient, administer naloxone.
Badminister atropine to dilate the pupils.
Cpump the stomach.
Dadminister naloxone, do not ventilate the patient.
Eadminister 500 ml of BMES intravenously.

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Question 93

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 94

Erythema nodosum (EN) might be a symptom of all the diseases listed below except:

Asarcoidosis.
Bchronic inflammatory bowel disease.
Cdegenerative arthritis.
Dsystemic diseases of connective tissue.
Emalignant tumours.

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Question 95

What are the most common pathogens that cause of meningitis in newborns?

Aviruses.
Bviruses and Neisseria meningitidis.
CNeisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae.
DE. coli, Streptococcus agalactiae, Listeria monocytogenes, Klebsiella pneumoniae.
EStreptococcus pyogenes.

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Question 96

The first international treaty on evidence-based public health, accepted by over 170 United Nations countries is:

APolitical Declaration on Non-Communicable Diseases (UN NCD).
BWorld Health Organization Framework Convention on Tobacco Control (WHO FCTC).
CWorld Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (GlobAlcRed WHO).
DConvention for the Protection of Human Rights and Fundamental Freedoms.
EAlma Ata Declaration.

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Question 97

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 98

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 99

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 100

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 101

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 102

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 103

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 104

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 105

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 106

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 107

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 108

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 109

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 110

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

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

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Question 111

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 112

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 113

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

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

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Question 114

Select the correct treatment option for a patient with Mallory-Weiss syndrome:

Aoesophagectomy including the source of bleeding.
Bendoscopic sclerotherapy of the source of bleeding.
Csuturing of oesophageal perforation.
Dendoscopic banding of the source of bleeding.
EH. pylori eradication.

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Question 115

A 65-year-old man had an ischemic stroke with hemiparesis and speech disturbances. At discharge for outpatient treatment, the physician entered into the medical history report that the patient has been classified as Cerebral Performance Category (CPC) category 3, which refers to:

Alack of neurologic deficits.
Bminimal neurologic deficits.
Cmoderate neurologic deficits.
Dsevere neurologic impairment.
Evegetative state.

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Question 116

The Injury Severity Score (ISS) defines 6 body regions. How many body regions are used to calculate the final ISS score?

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Question 117

Which of the following is a false statement regarding trauma centres (CU) and the format for collecting medical data by the emergency medical team (ZRM) for a trauma centre according to the AT-MIST scheme:

Atrauma team is always led by an anaesthesiologist.
Btrauma team can be led by a surgeon.
CAT-MIST scheme includes a pre-hospital trauma assessment.
DAT-MIST scheme includes a description of the mechanism of injury.
EAT-MIST scheme includes a description of the patient’s symptoms and signs.

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Question 118

A 63-year-old conscious man with tachycardia, GCS=15 and hemodynamic instability requires:

Adefibrillation under sedation.
Bdefibrillation under general anaesthesia.
Cpharmacologic defibrillation.
Dcardioversion under general anaesthesia.
Ecardioversion under local anaesthesia.

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Question 119

In case of bradycardia, adult patients with a heart transplant should:

Areceive atropine.
Breceive aminophylline.
Creceive adrenaline.
Dundergo cardioversion.
Eundergo defibrillation.

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Question 120

A 39-year-old man with obesity (BMI=44 kg/m<sup>2</sup>) was transported by the emergency medical services (ZRM) to the emergency department. The cardiac monitor shows asystole with P waves. In this case the ERC guidelines recommend:

Apharmacological cardioversion.
Belectrical cardioversion.
Cdefibrillation.
Dcardiac pacing.
Enone of the above.

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Question 121

Select the correct diagnosis in a patient with massive swelling of the lower limbs and groin, daily proteinuria of 8 g/24 h, hypoalbuminemia, dyslipidaemia and negative anti-PLA2R antibody:

Acardio-renal syndrome.
Bantiphospholipid syndrome.
Cnephritic syndrome.
Dnephrotic syndrome.
EAddis triad.

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Question 122

In a 56-year-old patient with heart failure, left ventricular ejection fraction (LVEF) of 55%, diabetes mellitus type 2 treated with metformin and proteinuria of 0.9 g/L detected on urinalysis it is recommended to add:

Apioglitazone.
Bsaxagliptin.
Csemaglutide.
Dexenatide.
Eempagliflozin.

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Question 123

Select the correct statements about Sjögren syndrome:

1) Homans test result of 7 mm favours the diagnosis;

2) it is recommended to monitor the patient for the development of lymphoma;

3) approximately 80% of patients develop hypergammaglobulinaemia;

4) Congo red is used for the corneal evaluation.

The correct answer is:

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

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Question 124

Select the suspected diagnosis in a 34-year-old female patient with human immunodeficiency virus infection detected in 2012 who for the past 3-4 weeks has had a dry cough, frequent sensation of cold and chills:

AKlebsiella pneumoniae infection.
Bpneumocystosis.
Cchronic bronchitis.
DStaphylococcus aureus infection.
EPseudomonas aeruginosa infection.

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Question 125

Select the suspected diagnosis in a 65-year-old male patient with a history of severe right-sided chest pain, chronic dry cough, progressive fatigue and clinical evaluation findings of dull percussion with asymmetric chest expansion:

Aherpes zoster.
Bpericarditis.
Cmesothelioma.
Ddiscopathy with root compression of nerves T5-T11.
Etuberculosis.

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Question 126

Monitoring of persistent thyroid cancer involves measurements of the titres/levels of:

Athyroid-stimulating hormone.
Bthyroglobulin and antibodies to thyroid-stimulating hormone receptor.
Cthyroid peroxidase antibodies.
Dantibodies to thyroid-stimulating hormone receptor.
Ethyroglobulin and antibodies to thyroglobulin.

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Question 127

Select the correct statement about carcinoma of the renal pelvis and ureter:

Aaccounts for the majority of diagnosed renal tumours.
Boriginates in the urothelium.
Crenal colic is the dominant symptom.
Durine cytology is the gold standard for screening.
Efrank haematuria is a rare complication.

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Question 128

Select the most likely suspected diagnosis in a 72-year-old male patient with fatigue, weight loss, severe bone pain and proteinuria with hypercalcaemia detected on laboratory tests:

Arenal cancer.
Bplasma cell myeloma (multiple myeloma).
Csarcoidosis.
Drheumatoid arthritis.
Eprostate cancer.

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Question 129

Select the first-line treatment in a patient with gastric adenocarcinoma without submucosal infiltration and at minimal risk for metastases:

Agastric sleeve surgery.
Btumour cryoablation.
CH. pylori eradication with endoscopic follow-up in 6 months.
Dsubmucosal dissection of the tumour.
ENissen surgery.

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Question 130

Secondary arterial hypertension is suspected in the following situations:

1) sudden-onset hypertension in an individual <40 years of age;

2) coexisting hyperlipidaemia;

3) vascular murmur heard on abdominal examination;

4) family history of arterial hypertension.

The correct answer is:

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

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Question 131

Select the correct statement about dabigatran:

Adabigatran treatment requires APTT monitoring.
Bit is safe for pregnant patients.
Cdabigatran solution is used to fill the lumen and maintain the patency of dialysis catheters.
Ddabigatran dosage has to be reduced in patients >80 years of age.
Eno specific antidote for dabigatran exists.

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Question 132

Amotivational syndrome develops as a result of injury to:

Aconvexity surface of the frontal lobes.
Bdorsolateral aspect of the frontal lobes.
Cmedial frontal lobes.
Dsuperior temporal gyrus.
Efusiform gyrus.

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Question 133

Which of the agents used for relapse prevention in bipolar affective disorder have solely antimanic effects?

1) valproic acid;

2) lamotrigine;

3) aripiprazole;

4) lithium carbonate;

5) quetiapine.

The correct answer is:

A1, 3.
Bonly 1.
C3, 5.
Donly 4.
Eonly 2.

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Question 134

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 135

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 136

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 137

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 138

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 139

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 140

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 141

In a type 2 diabetic patient, the following factors accelerate the progression of diabetic kidney disease:

1) female gender;

2) hypocalcemia;

3) high-protein diet;

4) proteinuria;

5) urinary tract infections.

The correct answer is:

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

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Question 142

Allergic rhinitis ought to be differentiated from the common cold. A symptom, which speaks in favor of allergic rhinitis is:

Awatery nasal discharge.
Bnasal itching.
Ccough.
Dnasal pain.
Enasal congestion.

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Question 143

In a patient who has undergone eradication of Helicobacter pylori, follow-up tests to assess the treatment outcome should be performed after:

A1 week.
B2 weeks.
C4 weeks.
D8 weeks.
E10 weeks.

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Question 144

In paracetamol poisoning, the treatment includes:

1) N-acetylcysteine;

2) patiromer;

3) gastric lavage;

4) hemodialysis.

The correct answer is:

A1,2.
B1,2,3.
C2,4.
D1,3.
E1,3,4.

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Question 145

In a patient with hyperthyroidism, a basic eye examination was performed. The appearance of a rim of sclera above the iris when the patient directs his/her eyeballs downward was observed. This indicates a positive:

AStellwag’s sign.
BJellinek’s sign.
CMöbius sign.
DGraefe’s sign.
EKocher’s sign.

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Question 146

A 70-year-old male was brought to the Emergency Department due to weakness, reluctance to eat and drink, and abdominal pain. On physical examination of the abdomen, a hard, non-movable mass was palpated in the lower abdomen, reaching up to 2 cm below the umbilicus. Laboratory tests showed creatinine level of 9.36 mg/dL (N 0.52-1.02 mg/dL), urea level of 231 mg/dL (N 15-40 mg/dL) and CRP level of 12.3 mg/l (N <5.0 mg/L). The most likely diagnosis is:

Aacute appendicitis.
Bsigmoid diverticulitis.
Cintestinal obstruction.
Dobstructive uropathy.
Ecolorectal cancer.

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Question 147

A 62-year-old male with history of arterial hypertension and persistent pruritus, presented himself with persistent facial redness, gradually increasing waist circumference accompanied with dilation of abdominal wall vessels, and exacerbation of hemorrhoids for last several weeks. Laboratory abnormalities included polycythemia with hemoglobin level of 18.9 g/dL (N 13.0-18.0 g/dL). In this case we should first suspect:

Afamilial hypercholesterolemia.
Bpancreatic head cancer.
Cpolycythemia vera.
Dpolycystic kidney and liver disease.
Echolelithiasis.

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Question 148

A 40-year-old male with history ulcerative colitis, despite low activity of the disease, complains of increased fatigue, skin pruritus and fluctuating pain in the right subcostal area appearing for last 2-3 months. Imaging studies revealed numerous segmental biliary strictures. In this case we should suspect:

Ahepatitis B.
Bchronic pancreatitis.
Ccholelithiasis.
Dprimary sclerosing cholangitis.
Eacute cholangitis.

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Question 149

Before initiating treatment with a statin, the activity of the following should be measured:

Aalanine aminotransferase and aspartate aminotransferase.
Balanine aminotransferase and creatine kinase.
Calanine aminotransferase and alkaline phosphatase.
Daspartate aminotransferase and creatine kinase.
Ecreatine kinase and alkaline phosphatase.

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Question 150

A parent brings an 18-month-old child to the Emergency Department (ED) after a convulsive seizure associated with fever up to 39.4°C. According to the parents, the child had another episode involving limb shaking later the same day, and after one of the seizures, movement of the right upper limb was decreased for a dozen or so minutes. After resolution of the seizure, the child is drowsy but hemodynamically and respiratory stable. Which of the following features are characteristic of complex febrile seizure?

1) they account for the majority of febrile seizures;

2) they are generalized in nature;

3) they recur within 24 hours;

4) they last longer than 15 minutes or have a focal nature;

5) neurological signs may occur after the seizure, e.g. Todd’s paresis.

The correct answer is:

A1,2,3.
B1,2,4.
C2,3,4.
D3,4,5.
E1,4,5.

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Question 151

A mother presents to the Pediatric Emergency Department with her 5-year-old son due to recurrent abdominal pain for the last 4 days. The pain is mainly periumbilical, occurs intermittently, and has no clear relation to meals. There are no vomiting, diarrhea, or fever. The boy is reluctant to drink, but remains in a good general status. Which of the following is the most common cause of abdominal pain in children and adolescents?

Aconstipation.
Bgastrointestinal infection.
Cacute appendicitis.
Dacute pancreatitis.
Esmall bowel intussusception.

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Question 152

A child admitted to hospital because of electrolyte abnormalities; marked hyperphosphatemia was found, which may result in hypocalcemia, tetany, cardiac arrhythmias, and calcium phosphate accumulation in tissues. Which of the following conditions or situations may lead to hyperphosphatemia in children?

1) vitamin D overdose;

2) frequent use of rectal laxatives (e.g. enemas);

3) renal failure;

4) increased cellular breakdown in the course of tumor lysis syndrome (TLS);

5) excessive calcium intake.

The correct answer is:

A1,2,3.
B1,2,3,4.
C2,3,4,5.
D1,3,4,5.
E1,2,5.

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Question 153

A mother presents to the Pediatric Emergency Department with her 8-year-old son, who stepped on a rusty nail while playing outdoors. This resulted in a deep puncture wound of the foot contaminated with soil. The wound was managed surgically. According to the vaccination records, the child received all primary immunizations according to the national schedule in infancy, but did not receive the booster dose at 6 years of age due to parental refusal. The child is in good general status, with no signs of systemic infection. What is the most appropriate tetanus prophylaxis management in this case?

Ano tetanus prophylaxis is required, as the child completed primary immunization.
Badminister a booster dose of tetanus/diphtheria/pertussis vaccine only.
Cadminister tetanus immunoglobulin (TIG) only.
Dadminister both tetanus/diphtheria/pertussis vaccine and tetanus immunoglobulin (TIG).
Edefer prophylaxis and monitor the wound for 24-48 hours.

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Question 154

According to the current National Immunization Programme, BCG vaccination against tuberculosis is included as mandatory vaccination. Indicate the true statement concerning qualification for vaccination:

Ain infants born to mothers treated with biologic agents within 3 months before delivery, BCG vaccination is absolutely recommended.
Bin children with a family history suggestive of immune disorders, BCG vaccination should be given as soon as possible after birth.
Cin preterm infants, BCG vaccination should be given after achieving a stable body weight of more than 2000 g.
Dif there is uncertainty regarding BCG vaccination status, BCG vaccination should not be administered.
EBCG vaccination should always be administered simultaneously with hepatitis B vaccination.

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Question 155

A mother brings her 8-month-old infant to the pediatric clinic. The child has been healthy so far and has not received influenza vaccination to date. It is currently influenza season. The infant has no chronic medical conditions. Which of the following seasonal influenza vaccination schedules is the most appropriate in this situation?

Aa single dose of influenza vaccine administered at any time during the influenza season.
Btwo doses of influenza vaccine administered at an interval of at least 4 weeks.
Cthree doses of influenza vaccine administered at intervals of at least 6 weeks.
Dfour doses of influenza vaccine administered at intervals of at least 4 weeks.
Einfluenza vaccination is contraindicated before the age of 2 years.

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Question 156

A mother presents to the Emergency Department with her 4-year-old son weighing 20 kg, who experienced a generalized tonic-clonic seizure lasting approximately 4 minutes, which resolved spontaneously before the arrival of the emergency medical team. The child has a history of epilepsy and had similar seizures in the past. His status after the seizure is stable, with no signs of central nervous system infection and there are no indication for hospitalization. As part of the discharge recommendations, the doctor plans to prescribe a rescue medication for rectal administration to be used in the event of a prolonged epileptic seizure. What dose of diazepam in the form of a rectal enema should be recommended for this child?

A10 mg.
B7.5 mg.
C5 mg.
D2.5 mg.
E1 mg.

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Question 157

A 6-day-old neonate develops progressive lethargy, vomiting, tachypnea, and worsening responsiveness. Laboratory testing reveals severe hyperammonemia with ammonia level of 480 µmol/L. An inborn urea cycle disorder is suspected. Which of the following is the most appropriate management in the acute treatment phase?

Aimmediately stop all protein intake for 5-7 days and provide nutrition with glucose alone.
Bimmediately stop protein intake, initiate high-dose intravenous glucose with insulin, consider urgent dialysis, and administer nitrogen-scavenging agents.
Crestrict fluids intake, start a loop diuretic, and observe, because ammonia level <500 µmol/L does not require renal replacement therapy.
Dstart intravenous L-carnitine alone, because it is the first-line treatment for all causes of hyperammonemia.
Econtinue oral protein intake in small amounts to prevent catabolism and start oral lactulose.

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Question 158

In respiratory function test, total lung capacity (TLC) is defined as the total volume of air contained in the lungs after a maximal inspiration. Which of the following combinations correctly constitutes TLC?

Atidal volume (TV) + inspiratory reserve volume (IRV) + expiratory reserve volume (ERV).
Bfunctional residual capacity (FRC) + expiratory reserve volume (ERV).
Cinspiratory capacity (IC) + tidal volume (TV) + residual volume (RV).
Dvital capacity (VC) + residual volume (RV).
Evital capacity (VC) + expiratory reserve volume (ERV).

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Question 159

In the pediatric population in Europe, solid tumors constitute an important group of neoplasms. Which of the following sequences correctly represents the most common solid tumors in children (from the most to least common)?

Aleukemias → CNS tumors → neuroblastoma.
BCNS tumors → leukemias → neuroblastoma.
CCNS tumors → leukemias → bone tumors.
DCNS tumors → neuroblastoma → bone tumors.
ECNS tumors → neuroblastoma → leukemias.

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Question 160

For which of the following surgical procedures is the surgical wound classified as a clean-contaminated wound (according to the four-grade surgical wound classification)?

Acholecystectomy.
Bright hemicolectomy.
Csurgery due to gastrointestinal perforation.
Dthyroid gland removal.
Einguinal hernia repair.

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Question 161

Natural healing mechanisms support the proper closure of a postoperative wound. Wound healing consists of several phases, each dominated by specific types of cells. Which cells predominate during the granulation phase?

Aplatelets.
Bneutrophils.
Cmacrophages.
Dfibroblasts.
Ekeratinocytes.

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Question 162

A 67-year-old patient presents himself to outpatient clinic with a rectal adenocarcinoma diagnosed on colonoscopy and confirmed in histopathological examination. Which of the following tests should be ordered to properly expand the oncologic diagnostics for this patient?

ACA 19-9.
BChest X-ray.
CAbdominal ultrasound.
DMRI of pelvis minor.
EAbdominal PET scan.

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Question 163

Patient malnutrition is one of the major factors increasing postoperative risk. Which of the following features is a criterion for diagnosing malnutrition in a patient?

ABMI < 20.
Balbumin level < 6 g/dL.
Creduced food intake for 2 weeks.
Dweight loss > 5% over 6 months.
Enone of the above.

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Question 164

Somatic pain is characterized by:

Aincreasing intensity at rest.
Bsudden onset.
Cdifficult-to-pinpoint location.
Dassociated nausea and vomiting.
Ecyclical pattern (variable intensity).

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Question 165

Metastatic lymph nodes in left supraclavicular region are a characteristic sign of advanced cancer of the:

Aesophagus.
Blung.
Clarynx.
Dcolon.
Estomach.

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Question 166

A patient treated for ulcerative colitis for 5 years developed a sudden deterioration of his general status. Abdominal X-ray shows colonic distension. The patient develops clinical signs of septic shock. The surgical management of choice in this case is:

Aloop ileostomy.
BHartmann’s sigmoidectomy.
Crestorative proctocolectomy.
Dabdominoperineal resection of the rectum.
Ecolectomy with end ileostomy.

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Question 167

In a 58-year-old female patient, mammography (MMG) was performed, and the radiologist described the findings as BI-RADS category 3. What recommendations should be given to the patient?

Aprophylactic (screening) examinations on periodic basis.
Bfollow-up MMG in 6 months.
Cfollow-up MMG in 12 months.
Dcore-needle biopsy is required.
Ebreast-conserving surgery is required.

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Question 168

Indicate true statement concerning mucinous cystic neoplasm (MCN) of the pancreas:

Aoccurs more frequently in men.
Bis located mostly in the head of the pancreas.
Cusually requires surgical treatment.
Dhas a mean age at diagnosis > 70 years.
Ecommunicates with the pancreatic ducts.

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Question 169

The term “microcarcinoma” of the thyroid is reserved only for carcinoma of the:

Apapillary type.
Bfollicular type.
Concocytic (Hürthle cell) type.
Dsquamous cell type.
Eadenocarcinoma.

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Question 170

A 69-year-old female patient has squamous cell carcinoma of the anal canal infiltrating the anal sphincters, diagnosed by endoscopy and confirmed in histopathology examination. Which treatment would provide her with the greatest benefit?

Achemoradiotherapy.
Bradiotherapy.
Cchemotherapy.
Dabdominoperineal resection of the rectum.
Elocal resection of the tumor.

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Question 171

The rights of pregnant women are regulated in many legal acts. The basic source obliging the state authorities to take special care of this social group is:

AResolution of the Supreme Medical Chamber.
BRegulation of the Minister of Health.
CRegulation of the Minister of Labour and Social Policy.
DThe Constitution of the Republic of Poland.
EDecision of the Civil Rights Ombudsman.

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Question 172

In the case of a pregnant woman with HIV infection, in order to provide her and the newborn with appropriate medical care:

Ashe may give birth in a hospital of any referral level.
Bshe may give birth in a secondary referral hospital, and the newborn must be transferred to a tertiary referral center.
Cshe may give birth at home if she is treated effectively.
Dit is reasonable to refer her to a tertiary referral perinatal and neonatal center.
Eshe should have a caesarean section delivery in a hospital of any referral level.

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Question 173

On the basis of Article 176 of the Labour Code, a categorical ban has been introduced relating to the performance of burdensome, dangerous or harmful work by pregnant women. A detailed specification of the above activities is provided in the Regulation of the Council of Ministers of 3 April 2017 on the list of works that are burdensome, dangerous, or harmful to the health of pregnant and breastfeeding women. The above-mentioned ban is general and absolute in nature. Indicate the correct elements of this implementing act:

1) the aforementioned implementing act primarily lists activities that involve excessive physical effort (manual transport of loads), as well as those performed in hot, cold or variable microclimate;

2) an employer must not require a pregnant woman to perform work in conditions that expose her to noise or vibrations;

3) an employer may require a pregnant woman to work in conditions where she is exposed to electromagnetic fields of intensity exceeding the values set for the safe zone;

4) the universality of this ban in this case means that it should apply to all women;

5) the absolute nature of this ban is manifested primarily in the fact that the ban applies even in a situation in which a woman agrees to perform a specific job.

The correct answer is:

A1,2,3.
B1,2,5.
C2,3.
D1,3.
E4,5.

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Question 174

Article 176 of the Labour Code is the legal basis for an employer to require a woman who participates in a recruitment process for a position at their workplace to provide information covered by personal confidentiality, i.e., data relating to whether she is pregnant and status of the pregnancy, among other things. Indicate the correct interpretation of this provision, in line with the interpretation of the Supreme Court:

Athis applies to all jobs for which a woman is employed.
Bthis applies only to women aged 20-40 years.
Can employer is entitled to collect the above information from a woman only if they intend to employ her in a position that requires work in conditions that are burdensome and dangerous for pregnancy.
Da woman can always refuse to provide such information.
Ea woman can always withhold such information.

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Question 175

Embryogenesis is the process of embryonic development that occurs in the first 8 weeks after fertilization. Indicate the true statements concerning this period of embryonic life:

1) implantation bleeding may occur on day 16;

2) on day 12 the blastocyst is completely embedded in the uterine endometrium;

3) the first heartbeat occurs (which can be visible in a transvaginal ultrasound as early as the 4th week of embryonic life);

4) end of organogenesis occurs at the end of week 12;

5) if a pregnant woman unvaccinated against rubella becomes infected with the rubella virus at this stage, the fetus can be expected to have complex anomalies of particular organs, as the developing embryo is particularly susceptible to damage during this period of pregnancy.

The correct answer is:

A1,2,4.
B2,3,5.
C1,3,5.
D3,4,5.
E2,3,4.

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Question 176

Indicate the false statement concerning the structure of the umbilical cord:

Ait is most commonly attached centrally to the chorionic plate of the placenta.
Bumbilical cord development begins around the third week of embryonic development.
Cat the end of pregnancy, the umbilical cord is about 50-70 cm long.
Da fully developed umbilical cord is surrounded by the amnion and contains fetal vessels: two umbilical veins and one umbilical artery, embedded in gelatinous connective tissue.
Ethe umbilical vein delivers oxygenated, nutrient-rich blood from the placenta to the fetus and connects to the inferior vena cava through the venous duct (ductus venosus).

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Question 177

Human papillomavirus is an essential, although not the only, etiological factor of cervical squamous cell and glandular carcinoma. Factors predisposing to the cancer do not include:

Ahigh economic status.
Bmultiparity.
Ctobacco smoking.
Dhormonal contraception.
Esexually transmitted infections.

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Question 178

Factors that predispose to cervical cancer facilitate infection and increase the chances of the persistence of HPV (human papillomavirus) infection. Indicate the true statement regarding this virus in terms of cervical cancer risk:

1) HPV genotypes 16, 18, 31, 33, 35 are considered highly oncogenic (high-risk) ones;

2) HPV causes only cervical, vaginal and vulvar cancers;

3) HPV infection is most common in women under 35 years of age; later, its occurrence is less common and reaches a plateau in middle-aged women. The next peak in occurrence occurs after the age of 60 years;

4) the risk of HPV infection during a woman's lifetime is 80%, but the risk of developing cervical cancer in infected women does not exceed 0.6%;

5) lesions of the LSIL nature (CIN 1) resolve spontaneously and indicates only the presence of HPV infection rather than the lesions caused by it.

The correct answer is:

A1,2,3.
B2,3,4.
C1,4,5.
D2,3,5.
E3,4,5.

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Question 179

Endometrial cancer, also known as uterine body cancer, is the fourth most common cancer in women and the most common malignant tumor of female genital organs in economically developed countries. Indicate the main risk factor for this cancer:

Amultiparity.
Bobesity.
Cfrequent changes of partners.
Dhigh economic status.
Ehypoestrogenism.

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Question 180

Common causes of hemoptysis do not include:

Alung cancer.
Btuberculosis.
Cbronchitis.
Dbacterial pneumonia.
Ebleeding diathesis.

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Question 181

Constipation does not occur due to:

Ahyperthyroidism.
Bhypothyroidism.
Cmultiple sclerosis (MS).
Dcolorectal cancer.
Eexcessive use of laxatives.

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Question 182

Symptoms of esophageal cancer include:

Aretrosternal pain.
Bdysphagia, odynophagia.
Ccough, hoarseness.
Dcorrect answers are A and B.
Ecorrect answers are A, B and C.

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Question 183

The main risk factor of esophageal adenocarcinoma is:

Agastro-esophageal reflux.
Bdrinking alcohol.
Ctobacco smoking.
Dprevious mediastinal radiotherapy.
Eprevious X-ray esophagus examination with contrast.

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Question 184

The cause of renal colic in a patient with renal pelvis cancer is:

Aobstruction of urine flow by the tumor.
Bobstruction of urine flow by a clot.
Conly a deposit in the urinary tract.
Dcorrect answers are A and B.
Enone of the above.

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Question 185

Loss of taste, burning tongue, hand and foot paresthesia and numbness of the limbs are symptom indicating:

Avitamin B12 deficiency anemia.
Biron deficiency anemia.
Cfolic acid deficiency anemia.
Dhemolytic anemia.
Ecorrect answers are A, B and C.

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Question 186

The cause of reactive (secondary) thrombocytosis is:

Alung tumor.
Bpancreatic solid tumor.
Cacute blood loss.
Dcorrect answers are A and B.
Ecorrect answers are A, B and C.

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Question 187

Separation of the nail, nail plate pitting and hyperkeratosis are typical for:

ANail fungal infection.
BPsoriasis.
CVitamin B group deficiency.
DIron deficiency.
ESystemic lupus erythematosus (SLE).

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Question 188

Indicate chronically used medications that may contribute to the development of osteoporosis:

Aglucocorticosteroids.
Bproton pump inhibitors.
Csodium-glucose co-transporter 2 inhibitors (SGLT2) - flozins.
Dvitamin K antagonists.
Eall of the above.

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Question 189

Indicate the false statement regarding the treatment of Lyme disease:

Ain the case of erythema migrans, amoxicillin should be used for 14-21 days.
Bin the case of neuroborreliosis with cranial nerve paralysis, doxycycline should be used for 14-28 days.
Cif specific antibodies are present in the patient blood, despite the lack of clinical manifestation, it is necessary to use doxycycline or amoxicillin for 28 days.
Din the case of chronic arthritis, symptoms may persist despite treatment.
Ein the case of Lyme carditis, oral antibiotic therapy (doxycycline or amoxicillin) may be used for 14-21 days.

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Question 190

A 46-year-old female patient with recurrent depressive disorder has sustained partial response to treatment; she is currently taking paroxetine. Because of concomitant neuropathic spinal pain, her doctor is considering adding an antidepressant with analgesic properties. Which of the following combinations carries the highest risk of a significant pharmacokinetic interaction resulting from CYP2D6 inhibition, potentially leading to increased level of the added drug and increased adverse reactions?

Aparoxetine + mianserin.
Bparoxetine + trazodone.
Cparoxetine + venlafaxine.
Dparoxetine + agomelatine.
Eparoxetine + reboxetine.

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Question 191

A 31-year-old patient with schizophrenia is being treated with clozapine, with good clinical efficacy. He is admitted to an internal medicine ward because of pneumonia, stops smoking cigarettes, and simultaneously starts treatment with a macrolide antibiotic. Which of the following mechanisms explains best why, in this situation, a rapid increase in clozapine level and toxicity symptoms may occur?

Ainduction of CYP3A4 by the macrolide and increased clozapine clearance.
Binhibition of CYP1A2 related to infection and smoking cessation, with a possible additional effect of enzymatic inhibitor.
Cincreased binding of clozapine to plasma proteins caused by the macrolide.
Daccelerated renal elimination of clozapine in the course of infection.
Ereduced absorption of clozapine due to the effect of the macrolide on the gastrointestinal tract.

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Question 192

If severe hyperkalemia (≥6.5 mmol/L) is detected without ECG changes, do not use in the emergency management:

Aglucose infusion with insulin.
Bsalbutamol at the dose of 30-40 mg.
Csodium zirconium cyclosilicate.
Dpatiromer.
Edialysis.

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Question 193

The purpose of titrating the oxygen concentration in the respiratory mixture after return of spontaneous circulation (ROSC) is not:

Aarterial oxygen saturation in the range of 94-98%.
Barterial oxygen partial pressure (PaO2) between 10 and 13 kPa.
Cavoiding hypoxemia (<50 mmHg).
Davoiding hyperoxemia.
Earterial oxygen partial pressure 75-100 mmHg.

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Question 194

Risk factors for pulmonary embolism do not include:

Ahistory of cancer.
Bhistory of pulmonary embolism or deep vein thrombosis.
Csurgery or immobilization within the last 4 weeks.
Doral contraception or hormone replacement therapy.
Elong-haul flights.

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Question 195

The treatment for symptomatic bradycardia in adults includes:

A300 μg of atropine intravenously and, if necessary, repeat this dose every 3-5 minutes up to a total dose of 3 mg.
B300 μg of atropine intravenously and, if necessary, repeat this dose every 3-5 minutes up to a total dose of 5 mg.
C500 μg of atropine intravenously and, if necessary, repeat this dose every 3-5 minutes up to a total dose of 3 mg.
D500 μg of atropine intravenously and, if necessary, repeat this dose every 3-5 minutes up to a total dose of 5 mg.
Enone of the above.

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Question 196

In adult patients with cardiac arrest in VF/pVT rhythms, the following should be done:

Aadminister 150 mg of amiodarone IV (IO) after three shocks.
Badminister 150 mg of amiodarone IV (IO) after three shocks, then another dose of 150 mg of amiodarone IV after five shocks.
Cadminister 300 mg of amiodarone IV (IO) after five shocks.
Dadminister 300 mg of amiodarone IV (IO) after three shocks, then another dose of 300 mg of amiodarone IV after five shocks.
Eadminister 300 mg of amiodarone IV (IO) after three shocks, then another dose of 150 mg of amiodarone IV after five shocks.

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Question 197

The following person is entitled to nursing allowance:

1) person aged 70 years or more, irrespective of his/her health status and degree of body function impairment;

2) person entitled to retirement pension determined completely incapable to work, who is unable to live independently and requires assistance of other persons;

3) person entitled to disability pension due to his/her complete incapacity to work, who is unable to live independently and requires assistance of other persons;

4) disabled child up to the age of 16 years.;

5) person aged 75 years or more, irrespective of his/her health status and degree of body function impairment.

Correct answer is:

A1,2,3.
B2,3,4.
C2,3,5.
D3,4,5.
E1,2,4.

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Question 198

During a calendar year, insured person is entitled to care allowance for a period of leave from work due do the need for personal care of a child aged above 14 years or other sick family member for the period not longer than:

A14 days.
B21 days.
C28 days.
D30 days.
E60 days.

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Question 199

Sickness allowance is granted:

Afor a period of first 5 days of temporary incapacity to work due to alcohol abuse.
Bto an insured person that became temporarily incapable to work after the termination of health insurance, if the temporary incapacity to work lasted continuously for at least 30 days and occurred not later than within 30 days from the termination of health insurance in the case of contagious disease.
Cto an insured person that became temporarily incapable to work after the termination of health insurance, if the temporary incapacity to work lasted continuously for at least 30 days and occurred not later than within 14 days from the termination of health insurance.
Dto persons entitled to unemployment benefit.
Eto persons entitled to pre-retirement benefit.

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Question 200

Insured man aged 23 years applied for disability pension due to his incapacity to work. He completed vocational school as car mechanic at the age of 18 years, and then worked up to the age of 21 years. Three months before his 22<sup>nd</sup> birthday he noticed enlargement of his right testis, and then was diagnosed with right testicular cancer. He underwent right orchiectomy and currently is receiving chemotherapy. Medical adjudicator determined complete incapacity of the insured to work from the first day of the sickness allowance granted due to testicular cancer. The prerequisite for the payment of the disability pension is documented contributory and non-contributory periods of total duration amounting to at least:

A1 year.
B2 years.
C3 years.
D4 years.
E5 years.

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