1. A patient was admitted to the hospital in comatose state. Accompanying people said that hi lost consciousness at training while he was finishing the Marathon distance. What sort of coma is the most possible in this patient?
A. Hyperglycemic
B. Hypoglycemic
C. Hypothyroid
D. Hepatic
E. Diabetic ketoacidosis
2. Patient has hyperglycemia, glucosuria, polydipsia, polyphagia, and polyuria. What hormone hyposecretion do these changes develop due to?
A. Antidiuretic hormone
B. Atriopeptide
C. Glucagon
D. Insulin
E. Cortisone
3. A patient, aged 80, complains of increased appetite, thirst, elevated urination, and worsening of general condition after the taking some sweet food. What disease is it?
A. Hypercortisolism
B. Hyperthyroidism
C. Hypothyroidism
D. Diabetes insipidus
E. Diabetes mellitus
4. A man, aged 38, is under the course of treatment for schizophrenia at in-patient department. Contents of glucose, ketone bodies, and urea in his blood are normal. Shock therapy with regular injections of insulin has led to development of insular coma, and after that state of patient becomes better. What is the most possible reason for insular coma?
A. Glucosuria
B. Dehydration of tissues
C. Hypoglycemia
D. Metabolic acidosis
E. Ketonemia
5. In worker at polar station, who has been working there for a long time, hemorrhage form gums occur, his teeth sway and pull out. What vitamin deficiency leads to these changes?
A. Tocopherol
B. Ergocalciferol
C. Ascorbic acid
D. Folic acid
E. Nicotinic acid
6. A patient, aged 50, complains of increased appetite, thirst, and loss of body weight, weakness. At laboratory examination rise of amount of glucose in his blood revealed. What type of cells is injured in case of this disease development?
A. Lipotropocytes
B. Thyrocytes
C. B-cells of Langerhans islets
D. A-cells of Langerhans islets
E. Pancreatocytes.
7. In 18-years-old patient, while laboratory examining presence of glucose in urine and normal concentration of glucose in blood plasma were revealed. What disorder is the most possible cause of these changes?
A. Disorders of glomerular filtration
B. Disorders of tubular secretion
C. Disorders of glucocorticoids secretion
D. Disorders of insulin secretion
E. Disorders of tubular reabsorption
8. Dyspepsia and vomiting are observed in a newborn after feeding with milk. These phenomena disappear after feeding with glucose solution. What enzyme that takes part in carbohydrate digestion is deficient in case of these changes development?
A. Amylase
B. Lactase
C. Maltase
D. Isomaltase
E. Saccharase
9. In patient painfulness along large nervous trunks and increase of pyruvate in blood are revealed. What vitamin deficiency may lead to these changes?
A. Pantothenic acid
B. Nicotinic acid (PP)
C. Biotin
D. Riboflavin (B2)
E. Thiamin (B1)
10. A newborn was admitted to the emergency department with following symptoms: vomiting, diarrhea, disorders of growth and development, cataract, and mental retardation. Galactosemia was diagnosed. What enzyme deficiency takes place in this case?
A. Glucose-1-phosphate uridiltransferase
B. Glucokinase
C. Glucose-6-phosphate dehydrogenase
D. UDP glucose pyrophosphorilase
E. UDP glucose-4-epimerase
11. Flatulence, bowel spasms, abdominal pain and diarrhea often develop in some people after taking milk. These symptoms arise in 1 - 4 hours after intake only one glass of milk. What component of milk these symptoms develop due to?
A. Galactose
B. Lactose
C. Maltose
D. Saccharose
E. Fructose
12. Newborn has been refusing food, having vomiting and diarrhea, and some time later its crystalline lens become opaque. At examination of newborn: glucose in blood – 8.5 mmol/L and in urine – 1%. What is the most possible diagnosis?
A. Galactosemia
B. Phenylketonuria
C. Tyrosinosis
D. Cystinuria
E. Alkaptonuria
13. In woman, aged 45, without symptoms of diabetes mellitus, content of glucose in blood on an empty stomach reaches 7.5 mmol/L. What test is necessary to be performed?
A. Determination of residual nitrogen in blood
B. Determination of glucose in blood on an empty stomach
C. Determination of tolerance to glucose
D. Determination of ketone bodies in urine
E. Determination of glycosylated hemoglobin
14. In man, aged 60, who is 170 cm tall and 110 kg weight, content of glucose in blood is 6.8–7.0 mmol/L. Content of insulin in his blood is normal. Tolerance to glucose is decreased, as well as number of insulin receptors, in this patient. What signs allow us to evaluate this diabetes mellitus as non-insulin dependent?
A. Decreased tolerance to carbohydrates
B. Recurrent hyperglycemia
C. Patient’s age
D. Normal content of insulin in blood
E. Obesity
15. In a patient, suffered from frequent hemorrhages from internal organs and mucous membranes, proline and lysine were found in structure of collagen fibers. What vitamin deficiency contributes disorders of these amino acids hydroxylation?
A. Vitamin C
B. Vitamin E
C. Vitamin K
D. Vitamin A
E. Vitamin B1
16. In patients who suffered from alcoholism B1 hypovitaminosis is often observed, as a consequence of nutrition disturbances. Symptoms of vitamin B1 deficiency are disorders of nervous system, psychoses, and amnesia. Why cells of nervous tissue are particularly susceptible to thiamine deficiency?
A. Aerobic decay of glucose is broken
B. Liplysis in adipose tissue is increased
C. Oxidation of fatty acids is broken
D. Glycolysis is intensified
E. Glycolysis is decreased
17. According to results of gastric juice analysis following traits were revealed: common acidity – 24 mmol/L, free hydrochloric acid – 1.5 mmol/L, content of gastric mucoprotein is decreased. What vitamin deficiency is observed in organism?
A. Cobalamin
B. Folic acid
C. Pantothenic acid
D. Nicotinamide
E. Bioflavonoids
18. A 24-years-old woman complains of dryness in mouth and loss of weight in spite of good appetite. At examination of the patient: height – 162 cm, weight – 65 kg, content of glucose in blood – 8.3 mmol/L, and presence of glucose in urine. What disease does these symptoms characteristic for?
A. Diabetes mellitus
B. Steroid diabetes
C. Diabetes insipidus
D. Alimentary glucosuria
E. Renal diabetes
19. A man, who have been suffering from diabetes mellitus for a long time, was admitted to the hospital because of rapid worsening of his condition: general malaise, polyuria, polydipsia, nausea and vomiting, confusion, sleepiness. Kussmaul respiration and scent of acetone from mouth were observed in this patient. In his urine high contents of glucose and acetone bodies were found. What is the reason for worsening of patient’s condition?
A. Diabetic ketoacidosis
B. Gas acidosis
C. Heart failure
D. Renal failure
E. Hypoglycemic coma
20. Treatment of the child for rachitis using vitamin D3 was not efficient. What is the most possible reason for ineffectiveness of treatment?
A. Disorders of hydroxylation of vitamin D3
B. Deficit of lipids in food
C. Disorders of including vitamin D3 into enzyme
D. Intensified using vitamin D3 by intestine microflora
E. Disorders of transport of vitamin D3 with blood plasma proteins
21. Content of glucose in patient’s blood is: on an empty stomach – 5.65 mmol/l, in one hour after taking sugar – 8.55 mmol/l, and in two hours after taking sugar – 4.95 mmol/l. These signs are characteristic for:
A. Healthy person
B. Person suffered from hidden diabetes mellitus
C. Person suffered from non-insulin-dependent diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
22. Patient, aged 26, who suffered from hypoglycemic coma resulted from insulin overdosage, was intravenously infused with 20% solution of glucose. After this manipulation patient’s condition improved. What process helps glucose enter the cell?
A. Osmotic transport
B. Pinocytosis
C. Active transport
D. Secretion
E. Phagocytosis
23. A 40-years-old man is suffering from diabetes mellitus. After he has endured tonsillitis, reinforcement of thirst, nausea, vomiting, abdominal pain, and sleepiness develop in him. Patient’s BP is 80/45 mmHg, pulse rate 125 bpm, and his skin is dry. Content of glucose in blood is 28 mmol/L. What complication of diabetes mellitus appears in this patient?
A. Lactic acidosis
B. Diabetic ketoacidosis
C. Hepatic coma
D. Hyperosmolar coma
E. Hypoglycemic coma
24. After the break of diet (taking the easy for assimilation carbohydrates) in a woman, who has been suffering from diabetes mellitus for a long time, general malaise and increase of blood pressure gradually develop and hallucinations and cramps appear. Woman has dry skin and distinct signs of dehydration. What is the reason for worsening of patient’s condition?
A. Hypoglycemic coma
B. Hyperosmolar hyperglycemic coma
C. Diabetic ketoacidosis
D. Heart failure
E. Respiratory failure
25. During the experiment rat was injected with 5% alloxan solution in dose 200 mg per kg of rat weight. What kind of pathology arises in this case?
A. Arterial hypertension
B. Acute renal failure
C. Diabetes insipidus
D. Diabetes mellitus
E. Hepatic failure
26 One-year infant lags in mental development from infants of the same age. The infant has vomiting, cramps, and loss of consciousness in the mornings. What enzyme deficiency these changes are connected to?
A. Phosphorylase
B. Arginase
C. Glycogen syntase
D. Saccharase
E. Lactase
27. In patient with constant hypoglycemia blood analysis does not change after injection of adrenalin. A doctor supposes hepatic disorder. What function disorder it is?
A. Cholesterol formation
B. Excretion
C. Glycolysis
D. Ketogenesis
E. Glycogen deposition
28. A woman, aged 58, was admitted to the hospital in severe condition. She has confused consciousness; dry skin, hollow eyes, cyanosis, and scent of rotten apples from her mouth. At laboratory examination of her: glucose in blood – 15.1 mmol/L, glucose in urine – 3.5%. What is the most possible reason for this condition?
A. Hypoglycemic coma
B. Hyperglycemic coma
C. Hypovolemic coma
D. Uremic coma
E. Anaphylactic shock
29. A doctor reveals in child symmetric roughness on cheeks, diarrhea, and disorders of neural activity. What nutrition factors deficit underlies this condition?
A. Methionine, lipoic acid
B. Lysine, ascorbic acid
C. Nicotinic acid, tryptophan
D. Threonine, pantothenic acid
E. Phenylalanine, pangamic acid
30. The most of participants of Magellan expedition to America died of avitaminosis. This disease displays as general malaise, subcutaneous hemorrhage, pulling teeth out, hemorrhage from gums. What is the name for this avitaminosis?
A. Scurvy
B. Pellagra
C. Addison-Birmer’s anaemia
D. Polyneuritis (beriberi)
E. Rachitis
31. In a woman, of 52 years old and of 125 kg weight, diabetes mellitus develops. It happens due to:
A. Decrease of number of insulin receptors
B. High-affinity binding insulin to synalbumin
C. Reduced cell susceptibility to insulin
D. Increase activity of insulinase
E. Broken insulin synthesis
32. Unconscious patient was admitted to the hospital. He has Kussmaul respiration, blood pressure 80/50 mmHg, and acetone scent from his mouth. What substances accumulation in organism may lead to these disturbances?
A. Complex carbohydrates
B. Carbonic acid
C. Lactic acid
D. Modified lipoproteins
E. Ketone bodies
33. In patient suffered from diabetes mellitus metabolic acidosis develops due to accumulation of ketone bodies (beta-oxybutyric acid and acetoacetic acid). At this condition pH of arterial blood is:
A. 7.40
B. 7.48
C. 7.56
D. 7.32
E. 7.66
34. A patient, 56 years old woman, who have been suffering from diabetes mellitus for 6 years, complains of compressing pain behind her sternum. What mechanism of heart affection is the most possible in this case?
A. Myocardial dystrophy
B. Microangiopathy of myocardial vessels
C. Macroangiopathy of coronary vessels
D. Myocarditis
E. Vegetative neuropathy of heart
35. Content of glucose in patient’s blood is: on an empty stomach – 4.52 mmol/l, in one hour after taking sugar – 6.23 mmol/l, and in two hours after taking sugar – 2.56 mmol/l. These signs are characteristic for:
A. Healthy person
B. Person suffered from insulinoma
C. Person suffered from hidden diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
36. What complication may develop when treating diabetic ketoacidosis with large doses of insulin?
A. Arterial hypertension
B. Leukocytosis
C. Arterial hypotension
D. Hypoglycemia
E. Hyperkalemia
37. A female patient, aged 24, complains of dryness in her mouth, loss of weight despite good appetite. Her height is 157 cm her weight is 72 kg. What analysis we have to perform at fist in this patient?
A. Urinalysis by Zemnitsky
B. Determination of glucose content in 24-hour urine quantity
C. General urinalysis
D. Determination of protein fractions in blood serum
E. Coagulogram
38. A patient D., 40-years-old woman, was admitted to the hospital with complaints of weakness, giddiness, hunger, cold sweat, and cramps. At examination of the patient: distension of pupils of the eyes, weakening of respiration, and BP is 90/50 mmHg. Biochemical analysis of her blood shows: general bilirubin is 16.0 mcmol/L, urea is 4.7 mmol/L, creatinine is 98 mcmol/L, and glucose is 2.0 mmol/L. What kind of coma may develop in this patient?
A. Hyperglycemic
B. Hepatic
C. Renal
D. Hypoglycemic
E. At adrenal glands deficiency
39. The woman B., aged 45, was admitted to the emergency department from a street. At examination of patient following symptoms was revealed: loss of consciousness, loss of reflexes, absence of reflexes from pupil of the eye and sclera, Kussmaul respiration, BP is 70/40 mmHg, and body temperature is 35oC. Biochemical analysis of patient’s blood displays: general bilirubin is 16.0 mcmol/L, urea is 3.6 mmol/L, creatinine is 108 mcmol/L, and glucose is 22 mmol/L. What kind of coma has developed in this patient?
A. Hypoglycemic
B. Hepatic
C. Renal
D. At adrenal glands deficiency
E. Hyperglycemic
40. Diabetes mellitus develops in animals after injection to them some alloxan. What is the main mechanism of this type of diabetes mellitus?
A. Selective damage of lambda-cells of pancreatic islets
B. Damage of beta- and lambda-cells of pancreatic islets
C. Formation of antibodies to insulin
D. Selective damage of beta-cells of pancreatic islets
E. Gluconeogenesis activation
41. A patient address to a doctor with complaints of constant thirst. Hyperglycemia, polyuria and increased content of 17-ketosteroids in urine were revealed. What is the most probable disease in this case?
A. Addison’s disease
B. Myxedema
C. Glycogenosis of I type
D. Insulin dependent diabetes mellitus
E. Steroid diabetes
42. In 62-years-old woman cataract (crystalline lens dimness) develops at the diabetes mellitus background. What process enhancement due to diabetes mellitus is the cause of cataract?
A. Ketogenesis
B. Lipogenesis
C. Proteolysis
D. Glycosilation of proteins
E. Gluconeogenesis
43. A 19-years-old patient has suffered from diabetes mellitus since he was 8. He took cure irregularly. He was admitted to the hospital in connection to diabetes ketoacidosis development. What kind of respiration is the most possible in this condition?
A. Kussmaul respiration
B. Biot’s respiration
C. Chane-Stocks respiration
D. Inspiratory breathlessness
E. Expiratory breathlessness
44. A patient aged 60 has been suffering from diabetes mellitus for 18 years. He complains of cold of his lower extremities and intermittent lameness during last years. What is the mechanism of indicated symptoms development?
A. Macroangiopathy of lower extremities
B. Hyperketonemia
C. Neuropathy
D. Disturbances of metabolism of muscles
E. Hyperglycemia
45. An adolescent aged 17 addressed to a physician in connection with enter a college. He has no complaints. His height is 178 cm; his weight is 96 kg without essential changes during a year. He has even distribution of subcutaneous adipose tissue. His pulse rate is 82 bpm; his BP is 115/80 mmHg. At laboratory examination of a youth: content of glucose in blood is 8.2 mmol/L; glucosuria – 4.6 g/L. What type of diabetes mellitus is the most probable in this patient?
A. Non-insulin-dependent diabetes mellitus with obesity
B. Insulin-dependent diabetes mellitus
C. Symptomatic diabetes mellitus is due to dyencephalic syndrome
D. Steroid diabetes mellitus is due to Cushing’s syndrome
E. Symptomatic diabetes mellitus is due to acromegaly
46. Signs of fatty dystrophy of liver are revealed in 38-years-old female patient who has been suffering from diabetes mellitus for a long time. What factor deficiency is leading in this state development?
A. Lipocain
B. Lecithin
C. Insulin
D. Glycogen
E. Acetyl-CoA
47. Hyperglycemia and decreased number of insulin receptors on the lipocytes are established in mice with hereditary obesity. What is the primary mechanism of lipogenesis intensification in these animals?
A. Hyperinsulinemia
B. Hypoinsulinemia
C. Hyperfunction of lipocytes
D. Decreased tolerance to glucose
E. Increased fat deposition
48. A patient with diabetes mellitus did not take the dose of insulin in time. Thus gyperglycemic coma developed (content of glucose in patient’s blood is 50 mmol/L). What is the leading factor for such coma development?
A. Hyperosmolarity of blood plasma
B. Hypokalemia
C. Hypoxia
D. Hyponatremia
E. Acidosis
49. What is the mast important mechanism of hypoglycemic coma development?
A. Carbohydrate starvation of brain
B. Reinforcement of glycogenilysis
C. Oppression of glycogenesis
D. Oppression of gluconeogenesis
E. Intensification of ketogenesis
50. What is the reason for glucosuria appearance under diabetes mellitus?
A. Hyperglycemia
B. Increase of renal threshold
C. Rise of hexokinase activity
D. Increase of glomerular membrane permeability
E. Polyuria
51. In a patient with diabetes mellitus loss of consciousness and cramps were observed after insulin injection. What is a possible result of blood test for glucose in this case?
A. 5.5 mmol/L
B. 3.3 mmol/L
C. 8.0 mmol/L
D. 10 mmol/L
E. 2.5 mmol/L
52. A patient was admitted to the hospital in connection to osteomyelitis of lower jaw. When laboratory examining of the patient glucose was found in her urine. Content of glucose in her blood is normal. What is the reason for glucosuria?
A. Insufficiency of tubular enzyme systems
B. Increase of glomerular filtration
C. Enhancement of tubular secretion
D. Decrease of renal concentration function
E. Rise of osmotic pressure in tubules
53. In a patient, who has poisoning with flodzine, glucosuria was revealed; concentration of glucose in patient’s blood is 5.6 mmol/L. What is the mechanism of glucosuria in this case?
A. Disturbances of tubular reabsorption
B. Reduction of glomerular filtration
C. Increase of glomerular filtration
D. Disorders of tubular secretion
E. Rise of oncotic pressure of blood
ANSWERS:1.- B.2.-D.3.- E.4.-C. 5.-C. 6.- C.7.- E.8.-B.9.-E 10.-A. 11.- B.12.- A.13.-C. 14.-D. 15.-A.16.-A.17.-A.18.-A.19.-A.20.-A.21.-A.22.-C.23.-D.24.-B.25.-D.26.-C.27.-E.28.-B.29.-C.30.-A.31.-A.32.-E.33.-D.34.-C.35.-B.36.-D.37.-B.38.-D.39.-E.40.-D.41.-E.42.-D.43.-A.44.-A.45.-A.46.-A.47.-A.48.-A.49.-A.50.-A.51.-E.52.-A.53.-A.
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