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Lekarski Egzamin Końcowy (LEK)

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Lekarsko-Dentystyczny Egzamin Końcowy (LDEK)

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Exam Review

Key Facts: LEW Exam

200

Official Exam Questions

Ustawa o zawodach lekarza i lekarza dentysty, art. 6f

60%

Passing Threshold

Ustawa o zawodach lekarza i lekarza dentysty, art. 6g

240 min

Exam Duration (4 hours)

MZ Regulation of 22 February 2021, §9

700 PLN

Examination Fee

MZ Regulation of 22 February 2021, §16

2 sessions

Spring and Autumn Each Year

Ustawa o zawodach lekarza i lekarza dentysty, art. 6c

Polish only

Official Exam Language

Centrum Egzaminów Medycznych (CEM)

The Lekarski Egzamin Weryfikacyjny (LEW) is the 200-question verification exam that Centrum Egzaminów Medycznych (CEM) uses to recognize physicians' qualifications obtained outside the European Union. It is taken only in Polish, lasts 4 hours, costs 700 PLN and requires 60% to pass. OpenExamPrep offers an independent English-language MCQ study adaptation with four-option questions; it is not an official CEM translation and does not reproduce the Polish-language exam.

Sample LEW Practice Questions

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

1A 58-year-old man in a small district hospital has 2 hours of crushing chest pain, and the ECG shows anterior ST-segment elevation. The nearest PCI centre cannot achieve wire crossing within 120 minutes of diagnosis (the expected delay is about 3 hours). He has no contraindications to fibrinolysis. According to ESC guidelines, what is the appropriate reperfusion strategy?
A.Fibrinolysis within 10 minutes of diagnosis, then immediate transfer to a PCI centre
B.Transfer for primary PCI without lysis, accepting the 3-hour delay to wire crossing
C.Aspirin and heparin only, with elective coronary angiography after 72 hours
D.Fibrinolysis, then local care with angiography only if chest pain recurs
Explanation: When primary PCI cannot be delivered within 120 minutes of STEMI diagnosis, ESC guidelines recommend fibrinolysis, ideally within 10 minutes of diagnosis, for patients presenting within 12 hours of symptom onset without contraindications, followed by immediate transfer to a PCI-capable centre. Angiography follows 2–24 hours after successful lysis, or emergently (rescue PCI) if lysis fails or the patient becomes unstable.
2A 64-year-old man with heart failure with reduced ejection fraction (LVEF 30%) remains in NYHA class II despite enalapril, bisoprolol, spironolactone and dapagliflozin. His cardiologist decides to replace enalapril with sacubitril/valsartan. What is the key safety rule when making this switch?
A.Give the first sacubitril/valsartan dose with the last enalapril dose to avoid a gap
B.Stop enalapril at least 36 hours before the first sacubitril/valsartan dose
C.Stop spironolactone permanently before any sacubitril/valsartan is started
D.Add valsartan to enalapril for 2 weeks before introducing sacubitril
Explanation: Combining a neprilysin inhibitor with an ACE inhibitor sharply increases the risk of angioedema, because both raise bradykinin levels. Sacubitril/valsartan must therefore not be started until at least 36 hours after the last ACE-inhibitor dose. ESC heart failure guidelines support replacing an ACE inhibitor with sacubitril/valsartan in ambulatory HFrEF patients who remain symptomatic, while continuing the beta-blocker, MRA and SGLT2 inhibitor.
3A 54-year-old male with a prosthetic mechanical aortic valve presents with persistent low-grade fever (38.4°C), night sweats, weight loss, and fatigue over the past 3 weeks. On physical examination, a new early diastolic murmur of aortic regurgitation is noted, along with splinter hemorrhages under his fingernails. Three separate sets of blood cultures drawn 12 hours apart grow Enterococcus faecalis. Transesophageal echocardiography reveals an 11-mm oscillating mass attached to the prosthetic sewing ring. According to the modified Duke criteria, what is the definitive diagnosis?
A.Possible infective endocarditis because only one blood culture organism was isolated
B.Rheumatic heart disease with secondary valve degeneration
C.Definite infective endocarditis based on two major Duke criteria fulfilled
D.Non-bacterial thrombotic endocarditis (marantic endocarditis)
Explanation: Under the modified Duke criteria, a diagnosis of 'definite infective endocarditis' requires 2 major criteria, 1 major and 3 minor criteria, or 5 minor criteria. The two major criteria fulfilled in this patient are: (1) positive blood cultures with a typical microorganism (Enterococcus faecalis) isolated from separate blood cultures, and (2) evidence of endocardial involvement on echocardiography (oscillating mass/vegetation on the prosthetic valve).
4A 55-year-old man returns from a week in a hotel with a large spa pool. Three days later he develops high fever (39.8°C), dry cough, diarrhea and confusion. Chest radiograph shows right lower-lobe consolidation, serum sodium is 128 mmol/L and ALT is 95 U/L. Which test gives the most rapid specific confirmation of the suspected pathogen?
A.Sputum Gram stain looking for gram-positive diplococci
B.Cold agglutinin titre
C.Serum procalcitonin to decide whether bacteria are involved
D.Legionella urinary antigen test
Explanation: Exposure to hotel water systems, high fever, gastrointestinal symptoms, confusion, hyponatremia and abnormal liver tests suggest Legionnaires' disease. The Legionella urinary antigen test gives a rapid result and detects Legionella pneumophila serogroup 1, which causes most cases; PCR or culture of respiratory samples can detect other serogroups. Treatment uses a respiratory fluoroquinolone or a macrolide, because beta-lactams are ineffective against this intracellular organism.
5A 66-year-old male with severe chronic obstructive pulmonary disease (COPD, GOLD stage 3) presents to the emergency department with acute worsening of dyspnea, increased sputum purulence, and drowsiness. Physical examination shows respiratory rate 28/min, widespread wheezing, and use of accessory respiratory muscles. Arterial blood gas (ABG) analysis on room air reveals: pH 7.28, PaCO2 62 mmHg, PaO2 54 mmHg, and HCO3- 29 mmol/L. Controlled low-flow oxygen therapy is initiated via a Venturi mask, targeting SpO2 88-92%. What is the most appropriate next step in ventilatory management?
A.Initiate non-invasive positive pressure ventilation (NIPV / BiPAP)
B.Immediate endotracheal intubation and invasive mechanical ventilation without an NIPV trial
C.Increase oxygen delivery to 100% via a non-rebreather mask
D.Administer high-dose intravenous sedative hypnotics to reduce respiratory drive and muscle fatigue
Explanation: Non-invasive positive pressure ventilation (NIPV/BiPAP) is the first-line ventilatory intervention in acute hypercapnic respiratory failure secondary to COPD exacerbation in patients who remain acidotic (pH 7.25-7.35, PaCO2 >45 mmHg) despite optimized medical therapy. NIPV reduces the need for invasive intubation, shortens hospital length of stay, and significantly decreases in-hospital mortality.
6A 45-year-old female presents with acute-onset right-sided pleuritic chest pain and shortness of breath 10 days following an uncomplicated elective laparoscopic cholecystectomy. Her vital signs are: heart rate 108 bpm, blood pressure 125/80 mmHg, respiratory rate 22/min, and SpO2 94% on room air. She has no signs of deep vein thrombosis, no history of venous thromboembolism, and no hemoptysis. Her calculated two-level Wells score for pulmonary embolism is 4.5 points (intermediate / 'PE likely' clinical probability). According to ESC guidelines, what is the most appropriate next diagnostic investigation?
A.Transthoracic echocardiography to rule out right ventricular strain before imaging
B.Computed tomography pulmonary angiography (CTPA)
C.High-sensitivity D-dimer testing as the definitive stand-alone test to rule in PE
D.Immediate invasive catheter pulmonary angiography
Explanation: According to ESC guidelines on acute pulmonary embolism, when clinical probability is assessed as 'PE likely' (Wells score >4), computed tomography pulmonary angiography (CTPA) is the first-line imaging test of choice. D-dimer testing is reserved for low or 'PE unlikely' probability cases to rule out PE; a negative D-dimer cannot safely rule out PE when clinical pretest probability is elevated.
7A 58-year-old male with a history of alcohol-related liver cirrhosis and portal hypertension presents to the emergency department with hematemesis of approximately 400 mL fresh red blood and melena. On examination, blood pressure is 95/60 mmHg, heart rate is 115 bpm, and he exhibits jaundice and spider nevi. Two large-bore peripheral IV lines are established, fluid resuscitation is initiated, and blood is drawn for typing and crossmatching. Which pharmacological agent should be initiated immediately before endoscopy to reduce portal pressure and splanchnic blood flow?
A.Intravenous tranexamic acid bolus followed by infusion
B.Intravenous vasopressin monotherapy without nitroglycerin
C.Intravenous terlipressin (or somatostatin/octreotide)
D.Oral propranolol 40 mg via nasogastric tube
Explanation: In acute variceal upper gastrointestinal hemorrhage, vasoactive agents (terlipressin, somatostatin, or octreotide) should be initiated as soon as variceal bleeding is suspected, even before diagnostic endoscopy. Terlipressin induces splanchnic vasoconstriction, reduces portal inflow and portal venous pressure, facilitates endoscopic therapy, and improves survival. Non-selective beta-blockers (propranolol) are contraindicated in acute hemorrhage and are used only for secondary prophylaxis once stabilized.
8A 42-year-old female presents with severe, unrelenting epigastric pain that radiates to her back, accompanied by persistent nausea and non-bilious vomiting following a heavy meal. Physical examination reveals epigastric tenderness with guarding, absent bowel sounds, and a temperature of 37.9°C. Laboratory workup reveals: serum lipase 1,480 U/L (reference <60 U/L), serum amylase 620 U/L, ALT 240 U/L, AST 180 U/L, total bilirubin 2.4 mg/dL, and alkaline phosphatase 210 U/L. What is the most likely underlying etiology of this patient's acute pancreatitis?
A.Autoimmune IgG4-related pancreatitis
B.Severe familial hypertriglyceridemia (type V)
C.Chronic alcohol misuse and binge drinking
D.Biliary lithiasis (gallstone pancreatitis)
Explanation: Gallstones (biliary pancreatitis) and alcohol are the two most common causes of acute pancreatitis. An ALT level >150 U/L in the setting of acute pancreatitis has a positive predictive value of >90-95% for a biliary etiology (gallstone migration into or transient obstruction of the ampulla of Vater). The elevation in alkaline phosphatase, total bilirubin, and aminotransferases strongly confirms biliary pancreatitis.
9Which of the following clinical, endoscopic, and histological features is characteristic of ulcerative colitis rather than Crohn's disease?
A.Continuous mucosal inflammation from the rectum proximally, without skip lesions
B.Transmural inflammation leading to deep fissuring ulcers, strictures, and fistulae
C.Discontinuous 'skip' lesions involving any segment of the gastrointestinal tract from mouth to anus
D.Presence of non-caseating granulomas on histological examination of intestinal biopsies
Explanation: Ulcerative colitis (UC) is characterized by diffuse, continuous, superficial mucosal inflammation that invariably begins in the rectum and extends proximally into the colon without skip areas. In contrast, Crohn's disease features transmural inflammation, skip lesions anywhere along the GI tract (frequently terminal ileum), stricturing/fistulizing disease, and non-caseating epithelial granulomas.
10According to the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline, which of the following criteria defines Stage 1 Acute Kidney Injury (AKI)?
A.An increase in serum creatinine of >=0.1 mg/dL (8.8 umol/L) within 12 hours
B.Creatinine rise ≥0.3 mg/dL within 48 h, or to 1.5–1.9 × baseline within 7 days
C.A reduction in urine output to <0.1 mL/kg/h for more than 24 hours
D.An increase in serum creatinine to >=4.0 mg/dL (>=353.6 umol/L) with initiation of renal replacement therapy
Explanation: The KDIGO criteria define Stage 1 AKI as: an absolute increase in serum creatinine by >=0.3 mg/dL (>=26.5 umol/L) within 48 hours, OR an increase in serum creatinine to 1.5 to 1.9 times baseline within the prior 7 days, OR urine volume <0.5 mL/kg/h for 6 to 12 hours.

About the LEW Exam

Independent LEW practice by OpenExamPrep for Poland's Lekarski Egzamin Weryfikacyjny, the CEM verification exam for physicians with non-EU diplomas. Features 100 English-language, four-option study questions with explanations across the six official LEW areas: internal medicine with family medicine, pediatrics with neonatology, general and trauma surgery, obstetrics and gynecology, emergency medicine and intensive care, and psychiatry.

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

60%

Exam / Certification Fees

700 PLN

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.

34 of 100 practice questions

Internal Medicine with Family Medicine (Choroby wewnętrzne z medycyną rodzinną)

Cardiology, pulmonology, gastroenterology, nephrology, endocrinology, hematology, rheumatology, infections and prevention

16 of 100 practice questions

Pediatrics with Neonatology (Pediatria z neonatologią)

Newborn resuscitation and jaundice, childhood infections, pediatric surgery-related conditions and prevention

16 of 100 practice questions

General Surgery with Trauma Surgery (Chirurgia ogólna z chirurgią urazową)

Acute abdomen, biliary disease, trauma, vascular emergencies, burns and perioperative care

15 of 100 practice questions

Obstetrics and Gynecology (Położnictwo i ginekologia)

Prenatal screening, obstetric hemorrhage and hypertension, labour monitoring and gynecologic oncology

10 of 100 practice questions

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

ALS, septic shock, anaphylaxis, poisoning, electrolyte emergencies and acute respiratory failure

9 of 100 practice questions

Psychiatry (Psychiatria)

Depression, mania, schizophrenia, anxiety disorders, delirium, alcohol withdrawal and psychopharmacology

Preparing for the LEW Exam

What You Need to Know

  • Passing score: 60%
  • Exam length: 200 questions
  • Time limit: 4 hours
  • Exam / certification fees: 700 PLN 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

LEW: Suggested Study Strategy

1Remember the 60% pass mark (120 of 200 points if no question is annulled), which is higher than the LEK's 56%.
2Internal medicine with family medicine is the broadest LEW area, so cover cardiology, endocrinology, nephrology and infectious disease thoroughly.
3Study current European guidelines (ESC, ERC, Surviving Sepsis Campaign) and Polish programmes such as screening and vaccination schedules, which shape correct answers.
4Because the exam is only in Polish, learn Polish medical terminology alongside the clinical content you practise here in English.

Frequently Asked Questions

What is the Lekarski Egzamin Weryfikacyjny (LEW)?

The LEW is the verification exam set out in articles 6c–6h of the Act on the Professions of Physician and Dentist and the Minister of Health regulation of 22 February 2021 (Dz.U. 2021 poz. 341). Centrum Egzaminów Medycznych (CEM) runs it for physicians whose diploma was obtained outside the European Union, and a positive result is the basis for the CEM director's recognition of their qualifications. The right to practise is then granted separately by a medical council under further statutory conditions.

What is the format and pass mark of the LEW?

The LEW is a written test of 200 questions, each with five answer options and one correct answer, lasting 4 hours. Each correct answer scores one point, and a pass requires at least 60% of the maximum score, which is higher than the 56% threshold of the LEK.

What language is the LEW taken in?

CEM states that the LEW is taken only in Polish. OpenExamPrep's bank is an independent English-language MCQ study adaptation with four-option questions to help international graduates review the tested medicine; it is not an official CEM translation and does not replace preparing for a Polish-language exam.

What topics does the LEW cover?

Questions cover the content of the Polish uniform master's programme in medicine within six areas set by the 2021 regulation: internal diseases with family medicine, pediatrics with neonatology, general surgery with trauma surgery, obstetrics and gynecology, emergency medicine and intensive care, and psychiatry. The regulation does not set a number of questions per area.

What does the LEW cost and how do I apply?

The fee is 700 PLN per application. The application is generated on the CEM portal (portalcem.ezdrowie.gov.pl) by 28 February for the spring session or 31 July for the autumn session; the signed paper application and the legalized or apostilled diploma with a sworn Polish translation must reach CEM by 5 March or 5 August respectively.

When is the LEW held, and are past questions published?

The LEW is held twice a year, in a spring window (15 May to 15 June) and an autumn window (15 October to 15 November). Unlike the LEK, LEW questions are not published: an examinee may view a used test only at CEM on request, and used questions become available under the public-information law only 5 years after the exam.