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Lekarski Egzamin Weryfikacyjny (LEW)

Practice Questions

Lekarsko-Dentystyczny Egzamin Końcowy (LDEK)

Practice Questions
Exam Review

Key Facts: LEK Exam

200

Official Exam Questions

Ustawa o zawodach lekarza i lekarza dentysty, art. 14d

56%

Passing Threshold

Ustawa o zawodach lekarza i lekarza dentysty, art. 14e

240 min

Exam Duration (4 hours)

MZ Regulation of 12 August 2025, §10

250 PLN

Fee for Later Polish-Language Applications

MZ Regulation of 12 August 2025, §17

70%

Questions Drawn from CEM's Public Question Base

Ustawa o zawodach lekarza i lekarza dentysty, art. 14c

2 sessions

February and September Each Year

MZ Regulation of 12 August 2025, §7

The Lekarski Egzamin Końcowy (LEK) is Poland's 200-question final medical examination, run by Centrum Egzaminów Medycznych (CEM) in February and September sessions. It lasts 4 hours, needs 56% to pass, and can be taken in Polish or, by those who studied medicine in English in Poland, in English. OpenExamPrep offers an independent English-language MCQ study bank with four-option questions; it is not an official CEM translation or a simulation of the five-option test.

Sample LEK Practice Questions

Try these sample questions to review concepts for the LEK exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old male with long-standing hypertension presents with crushing retrosternal chest pain radiating to his left shoulder and jaw for 90 minutes. ECG shows 3 mm ST-segment elevations in leads II, III, and aVF with reciprocal depressions in leads I and aVL. The nearest primary percutaneous coronary intervention (PCI) center is 35 minutes away. What is the most appropriate immediate reperfusion strategy according to European and Polish Cardiac Society guidelines?
A.Immediate transfer for primary PCI, as diagnosis-to-wire-crossing can stay under 120 minutes
B.Immediate administration of IV alteplase followed by transfer for elective angiography in 48 hours
C.Admission to the local intensive coronary care unit for IV unfractionated heparin and observation
D.Administration of oral clopidogrel monotherapy with transfer only if cardiac troponin levels rise above the 99th percentile
Explanation: Primary PCI is the preferred reperfusion strategy in STEMI when the anticipated time from STEMI diagnosis to wire crossing is under 120 minutes. Here the PCI centre is only 35 minutes away, comfortably inside that window, so the patient should be transferred immediately without giving fibrinolysis first. Fibrinolysis is reserved for situations where primary PCI cannot be delivered within 120 minutes of diagnosis.
2A 54-year-old female presents with persistent fatigue, cold intolerance, constipation, and a 6 kg weight gain over 4 months. Physical examination reveals periorbital puffiness, dry skin, and delayed relaxation of deep tendon reflexes. Laboratory investigations show TSH 18.4 mIU/L (reference: 0.4–4.0) and free thyroxine (FT4) 7.1 pmol/L (reference: 11.5–21.0). What is the first-line pharmacological treatment?
A.Combined liothyronine (T3) and levothyroxine (T4) therapy in a fixed 1:4 ratio
B.Levothyroxine once daily on an empty stomach, 30–60 minutes before breakfast
C.Methimazole 10 mg daily with beta-blocker therapy for symptom control
D.Desiccated thyroid extract administered twice daily with meals
Explanation: The clinical picture and laboratory findings (elevated TSH and low FT4) confirm primary hypothyroidism. Levothyroxine (L-T4) monotherapy is the undisputed first-line treatment. It should be taken once daily in the morning on an empty stomach, at least 30 to 60 minutes before breakfast, with a glass of water to ensure consistent gastrointestinal absorption. Combination T3/T4 or thyroid extracts are not recommended for initial therapy.
3A 68-year-old male with a 45 pack-year smoking history has progressive exertional dyspnea (mMRC grade 2, CAT score 18) and a chronic productive morning cough. Post-bronchodilator spirometry shows FEV1/FVC 0.58 and FEV1 62% of predicted. He has had no moderate or severe exacerbations in the past year. According to the GOLD report, what is the recommended initial maintenance inhaler therapy?
A.Short-acting beta-2 agonist (SABA) alone, used as needed
B.High-dose inhaled corticosteroid (ICS) monotherapy
C.Dual long-acting bronchodilator therapy (LABA plus LAMA)
D.Triple therapy with ICS, LABA, and LAMA
Explanation: A post-bronchodilator FEV1/FVC below 0.70 confirms COPD. With no exacerbations in the past year but a high symptom burden (mMRC 2 or more, CAT 10 or more), he belongs to GOLD group B. The GOLD 2026 report recommends starting group B patients on a LABA plus LAMA combination, which outperforms a single long-acting bronchodilator for symptoms and lung function. ICS monotherapy is never used in COPD.
4A 45-year-old female presents with epigastric pain that improves immediately after meals but returns 2 to 3 hours later and occasionally awakens her at night. Upper endoscopy reveals a 1.2 cm punched-out ulcer in the duodenal bulb. Rapid urease testing on antral biopsy is positive. What is the recommended first-line eradication therapy in Poland, given high regional clarithromycin resistance (>15%)?
A.Standard triple therapy with PPI, amoxicillin, and clarithromycin for 7 days
B.High-dose amoxicillin dual therapy for 5 days
C.Levofloxacin triple therapy (PPI, amoxicillin, and levofloxacin) for 10 days as first line
D.Bismuth quadruple therapy (PPI, bismuth, metronidazole, tetracycline) for 14 days
Explanation: According to the Maastricht VI / Florence consensus and Polish Gastroenterology Society guidelines, in regions where Helicobacter pylori clarithromycin resistance exceeds 15% (which includes Poland, where clarithromycin resistance exceeds 25%), standard clarithromycin triple therapy should not be used empirically. The first-line regimen of choice is bismuth quadruple therapy (a proton pump inhibitor, bismuth salt, metronidazole, and tetracycline) administered for 14 days.
5A 71-year-old male with a history of permanent atrial fibrillation is admitted with sudden-onset right hemiparesis and expressive aphasia. Blood pressure is 155/90 mmHg. Non-contrast head CT rules out intracerebral hemorrhage and early ischemic changes. His last known well time was 110 minutes ago. He takes no anticoagulants. What is the immediate treatment of choice?
A.Intravenous thrombolysis with recombinant tissue plasminogen activator (alteplase 0.9 mg/kg)
B.Oral aspirin 300 mg and immediate initiation of therapeutic unfractionated heparin
C.Urgent carotid endarterectomy within 6 hours
D.Intravenous dexamethasone and mannitol for cerebral edema prevention
Explanation: In acute ischemic stroke without hemorrhage on CT and within 4.5 hours of symptom onset, intravenous thrombolysis with alteplase (0.9 mg/kg, max 90 mg; 10% bolus, 90% over 60 min) is the standard of care to restore perfusion and reduce disability. Aspirin should be deferred for 24 hours post-thrombolysis. Heparin is not indicated acutely due to bleeding risk, and corticosteroids have no role in ischemic stroke management.
6A 35-year-old male is evaluated for recurrent nephrolithiasis. Serum chemistry reveals calcium 2.85 mmol/L (reference: 2.15–2.55), phosphate 0.72 mmol/L (reference: 0.81–1.45), and intact parathyroid hormone (iPTH) 112 pg/mL (reference: 15–65). 24-hour urinary calcium excretion is elevated at 9.2 mmol/24h. What is the most likely diagnosis?
A.Secondary hyperparathyroidism due to chronic kidney disease
B.Primary hyperparathyroidism
C.Familial hypocalciuric hypercalcemia (FHH)
D.Malignancy-associated hypercalcemia mediated by PTHrP
Explanation: The triad of hypercalcemia, hypophosphatemia, and inappropriately elevated intact PTH in the presence of hypercalciuria is diagnostic of primary hyperparathyroidism, most commonly caused by a solitary parathyroid adenoma (85% of cases). In FHH, urinary calcium excretion is low (calcium-to-creatinine clearance ratio < 0.01). In secondary hyperparathyroidism, calcium is low or normal with high phosphate. In PTHrP-mediated malignancy, intact PTH is suppressed.
7A 28-year-old woman presents with symmetrical polyarthritis of the small joints of both hands and wrists for 8 weeks, accompanied by morning stiffness lasting 90 minutes. Physical examination reveals swelling and tenderness of the second and third MCP and PIP joints bilaterally. Which laboratory test has the highest specificity for confirming rheumatoid arthritis?
A.Erythrocyte sedimentation rate (ESR)
B.Rheumatoid factor (RF) IgM
C.Anti-cyclic citrullinated peptide (anti-CCP / ACPA) antibodies
D.Antinuclear antibodies (ANA) by immunofluorescence
Explanation: Anti-cyclic citrullinated peptide (anti-CCP / ACPA) antibodies have a specificity exceeding 95–98% for rheumatoid arthritis, significantly higher than rheumatoid factor (RF), which has a specificity of only 70–80% and can appear in other autoimmune conditions, chronic infections (hepatitis C, endocarditis), and healthy elderly individuals. ESR and CRP indicate inflammation non-specifically.
8A 66-year-old female with long-standing type 2 diabetes mellitus and hypertension has a serum creatinine of 145 mcmol/L (eGFR 38 mL/min/1.73 m2) and a urine albumin-to-creatinine ratio (uACR) of 420 mg/g on two repeat morning samples. Blood pressure is 142/86 mmHg. Which class of antihypertensive medication is the cornerstone first-line choice to slow the progression of diabetic kidney disease?
A.Dihydropyridine calcium channel blockers such as amlodipine
B.Direct vasodilators like hydralazine
C.Loop diuretics
D.ACE inhibitors or angiotensin receptor blockers (ARBs)
Explanation: Renin-angiotensin-aldosterone system (RAAS) inhibitors—either an ACE inhibitor or an ARB (but never both combined)—are the first-line antihypertensive agents in diabetic kidney disease with significant albuminuria (uACR >= 300 mg/g). They preferentially dilate the efferent renal arteriole, lowering intraglomerular pressure, reducing albuminuria, and retarding the progression of chronic kidney disease.
9A 23-year-old male presents with generalized malaise, sore throat, and low-grade fever. Physical examination reveals posterior cervical lymphadenopathy, pharyngeal erythema with tonsillar exudates, and mild splenomegaly. Administration of amoxicillin 2 days ago resulted in a widespread maculopapular rash. Heterophile antibody test is positive. What is the most appropriate management plan?
A.Supportive care, stop amoxicillin, and no contact sports for 3–4 weeks
B.Switch amoxicillin to oral azithromycin for 5 days
C.Immediate intravenous acyclovir plus broad-spectrum antibiotics for 10 days
D.Emergency splenectomy due to high risk of spontaneous rupture
Explanation: The clinical presentation (fever, pharyngitis, posterior cervical adenopathy, splenomegaly, positive heterophile test) and characteristic amoxicillin-induced rash are classic for Epstein-Barr virus (EBV) infectious mononucleosis. Management is supportive (rest, hydration, antipyretics). Contact sports and heavy lifting must be avoided for at least 3 to 4 weeks from symptom onset to prevent splenic rupture. Antibiotics and antivirals have no therapeutic benefit.
10A 58-year-old male with chronic hepatitis B cirrhosis presents with increasing abdominal distension and fever (38.4°C). Examination shows tense ascites with diffuse abdominal tenderness without rigidity. Diagnostic paracentesis yields cloudy ascitic fluid with a neutrophil count of 380/mcL. What is the definitive initial treatment for spontaneous bacterial peritonitis (SBP)?
A.Oral ciprofloxacin 500 mg twice daily for 3 days
B.IV third-generation cephalosporin (cefotaxime or ceftriaxone) plus IV albumin
C.Urgent exploratory laparotomy to identify bowel perforation
D.Discontinuation of diuretics and therapeutic paracentesis without antibiotics
Explanation: An ascitic fluid polymorphonuclear (PMN) neutrophil count >= 250/mcL confirms spontaneous bacterial peritonitis (SBP). The standard empirical treatment is an intravenous third-generation cephalosporin (such as cefotaxime 2 g q8h or ceftriaxone 2 g q24h) for 5–7 days. Concurrent IV albumin (1.5 g/kg on day 1, 1.0 g/kg on day 3) significantly reduces the incidence of hepatorenal syndrome and in-hospital mortality.

About the LEK Exam

Independent LEK practice by OpenExamPrep for Poland's Lekarski Egzamin Końcowy, run by Centrum Egzaminów Medycznych (CEM). Features 100 English-language, four-option study questions with explanations across the official LEK subjects: internal medicine, pediatrics, surgery, obstetrics and gynecology, family medicine, emergency care, psychiatry, bioethics and medical law, public health and medical certification.

Exam sponsor: Centrum Egzaminów Medycznych (CEM). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

200 questions

Time Limit

4 hours

Passing Score

56%

Exam / Certification Fees

Free first attempt; 250 PLN later attempts (400 PLN in a foreign language)

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

39 of 200 questions (19.5%)

Internal Medicine (Choroby wewnętrzne)

Including cardiovascular diseases; also pulmonology, gastroenterology, nephrology, endocrinology, hematology and oncology

29 of 200 questions (14.5%)

Pediatrics (Pediatria)

Including neonatology; development, infections and pediatric emergencies

27 of 200 questions (13.5%)

Surgery (Chirurgia)

Including trauma surgery; acute abdomen, vascular surgery and surgical oncology

26 of 200 questions (13%)

Obstetrics and Gynecology (Położnictwo i ginekologia)

Pregnancy and labour, obstetric emergencies, gynecologic oncology and reproductive endocrinology

20 of 200 questions (10%)

Family Medicine (Medycyna rodzinna)

Primary care diagnosis, prevention, screening and chronic disease management

20 of 200 questions (10%)

Emergency Medicine & Intensive Care (Medycyna ratunkowa i intensywna terapia)

Resuscitation algorithms, shock, acute organ failure and toxicological emergencies

14 of 200 questions (7%)

Psychiatry (Psychiatria)

Mood and psychotic disorders, substance use and psychopharmacology

10 of 200 questions (5%)

Bioethics and Medical Law (Bioetyka i prawo medyczne)

Medical ethics (KEL), informed consent, confidentiality, patient rights and physicians' statutory duties

8 of 200 questions (4%)

Public Health (Zdrowie publiczne)

Epidemiological measures, screening and immunization programmes, and the Polish health system

7 of 200 questions (3.5%)

Medical Certification (Orzecznictwo lekarskie)

ZUS sick-leave certification, sickness and rehabilitation benefits, and incapacity for work

Preparing for the LEK Exam

What You Need to Know

  • Passing score: 56%
  • Exam length: 200 questions
  • Time limit: 4 hours
  • Exam / certification fees: Free first attempt; 250 PLN later attempts (400 PLN in a foreign language) Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

LEK: Suggested Study Strategy

1Internal medicine, pediatrics, surgery, and obstetrics and gynecology supply 121 of the 200 questions (60.5%), so build your plan around them.
2Expect at least 30 oncology questions spread across the clinical subjects, as required by the 2025 LEK regulation.
3Bioethics and medical law, public health and medical certification add 25 questions (12.5%); learn Polish law on consent, confidentiality, patient rights and ZUS sick leave.
4Practise pacing at about 72 seconds per question to finish 200 questions in the 4-hour exam.

Frequently Asked Questions

What is the Lekarski Egzamin Końcowy (LEK)?

The LEK is Poland's national final medical examination, organized twice a year (in February and September) by Centrum Egzaminów Medycznych (CEM) in Łódź under articles 14a–14f of the Act on the Professions of Physician and Dentist. A positive result, together with the postgraduate internship (staż podyplomowy) and the other statutory conditions, is required for a full right to practise as a physician (prawo wykonywania zawodu lekarza) in Poland.

What is the format and passing score of the LEK?

The LEK is a written test of 200 questions, each with five answer options and one correct answer. Each correct answer scores one point and there is no negative marking. The exam lasts 4 hours, and a pass requires at least 56% of the maximum score (112 of 200 points if no question is annulled).

In what languages can the LEK be taken?

Under article 5(4) of the Act, the LEK counts towards the right to practise when it is taken in Polish, or in the language in which the candidate studied medicine at a Polish university (in practice, English). The foreign-language test is a translation of the Polish paper. OpenExamPrep's bank is an independent English-language MCQ study adaptation with four-option questions, not an official CEM translation or a simulation of the exam format.

What topics are tested on the LEK?

The Minister of Health regulation of 12 August 2025 (Dz.U. 2025 poz. 1132) sets the split: internal medicine 39 questions, pediatrics 29, surgery 27, obstetrics and gynecology 26, family medicine 20, emergency medicine and intensive care 20, psychiatry 14, bioethics and medical law 10, public health 8 and medical certification 7. At least 30 of the questions in internal medicine, pediatrics, surgery, obstetrics and gynecology and family medicine must concern oncology.

What does the LEK cost?

The first application is free, and a second free application is possible only after failing or missing the first attempt. Other Polish-language applications cost 250 PLN, and every foreign-language application costs 400 PLN. The fee is paid to the individual account generated in the SMK system no later than 5 days after the application deadline.

How do I register for the LEK?

Applications are submitted only through the SMK system (System Monitorowania Kształcenia Pracowników Medycznych): by 15 July for a September session and by 30 November of the previous year for a February session. Late applications are not accepted.

Are LEK questions public, and is that changing?

Under the current Act, each LEK test contains 70% questions from CEM's public question base and 30% new questions, and used questions are published within 7 days. A Ministry of Health draft act published in June 2026 (UD384) proposes tests made entirely of new, non-public questions and paid repeat applications; it was a proposal, not law, when this page was reviewed in October 2026, so check CEM for the rules that apply to your session.