Topic 14. Pathophysiology of water-salt metabolism.

1. It is characteristically for cholera to lose large quantity of water and sodium ions from the organism. The basis of biochemical action of cholera toxin is:

A. Oxidation of aldosterone in the cortex of adrenal glands

B. Activation of adenilat cyclase in enterocytes of small intestine

C. Intensification of renin secretion by the cells of juxtaglomerular apparatus

D. Decrease of synthesis of antidiuretic hormone in hypothalamus

E. Activation of synthesis of atrial natriuretic hormone

2. Wasp has stung a woman. Oedema and hyperemia develop at woman’s left cheek (site of the bite). What mechanism of oedema development is primary in this case?

A. Decrease of osmotic pressure of blood

B. Impediment for lymphatic drainage

C. Increase of oncotic pressure of tissue fluid

D. Increase of capillary permeability

E. Increase of hydrostatic pressure of blood in capillaries

3. In worker of fusing workshop thirst develops due to enhanced sweating. He drinks a lot of water without salt. What kind of water-salt balance disturbance the most possibly develops in this case?

A. Hyperosmolar hyperhydration

B. Hyperosmolar hypohydration

C. Hypoosmolar hyperhydration

D. Hypoosmolar hypohydration

E. Isoosmolar hypohydration

4. A boy, aged 9, with oedemas was admitted to the hospital. What proteins content in blood is decreased in this case?

A. Albumins

B. Protamines

C. Globulins

D. Hemoglobin

E. Hystons

5. Worker of fusing workshop, man of 23 years old and of 60 kg weight, was admitted to the emergency department. Examination of water-salt exchange in this patient displays: content of general water is 33 liters (55% of body weight), extracellular sector constitutes 28.6% of body weight (17.2 liters), intravascular fluid constitutes 4% of body weight (2.4 liters), and intracellular sector constitutes 26.3% of body weight (15.8 liters). Osmotic pressure of patient’s blood is 340 mosm/l; content of sodium in it - 160 mmol/l. Patient’s urination is 0.4 liters per 24 hours. Determine the type of dyshydration.

A. Hyperosmolar hyperhydration

B. Hyperosmolar hypohydration

C. There is no dyshydration

D. Isoosmolar hyperhydration

E. Hypoosmolar hypohydration

6. A patient with severe nephropathy accompanied by severe oedema syndrome that develops as complication of bronchiectasis. Laboratory examination of this patient displays abundant proteinuria, cylinderuria, distinct decrease of protein content in blood serum, hyperlipidemia, hypokalemia, and other pathological changes. What is the most important link in development of oedemas in this patient?

A. Decrease of oncotic pressure of blood

B. Increase of osmotic pressure of interstitial fluid

C. Increase of hydrostatic pressure of blood

D. Blockade of lymphatic drainage

E. Increase of microvessel permeability

7. A patient has increased osmolarity of urine and decreased urination due to intensive sweating and dehydration. What hormone secretion changes provide compensatory retention of water at first?

A. Antidiuretic hormone

B. Aldosterone

C. Corticosterone

D. Thyroxin

E. Insulin

8. Content of sodium in patient’s blood serum is 100 mmol/l. What does this condition may manifest in?

A. Edemas

B. Arrhythmias

C. Dehydration

D. Heart arrest

E. Tachycardia

9. In a patient, aged 44, thirst develops after burns. What receptors generate impulses that underlie thirst development in this case?

A. Osmoreceptors

B. Pain receptors

C. Thermal receptors

D. Tactile receptors

E. Chemoreceptors

10. Isoosmolar hypohydration has been formed in a patient due to severe diarrhea. What symptoms are characteristic for this disturbance of water exchange?

A. Edematous syndrome

B. Decrease of content of water inside cells

C. Hypovolemic shock

D. Polyuria

E. Arterial hypertension

11. In patient with affection of kidneys hypoosmolar hyperhydration (water poisoning) has developed. What is the main pathogenic factor of this syndrome?

A. Anuria

B. Hypoaldosteronism

C. Polyuria

D. Hypoproteinemia

E. Increase of microvessel permeability

12. Hyperosmolar hypohydration has been formed while prolonged water starvation. Which of following manifestations are typical for this condition?

A. Arterial hypertension

B. Hypoisostenuria

C. Hypothermia

D. Increased salivation

E. Cramps and hallucinations

13. In patient suffered from severe chronic glomerulonephritis retention of isoosmolar fluid in organism and distinct edematous syndrome occur. What is the major factor of edema development in case of glomerulonephritis?

A. Hyperproteinemia

B. Secondary aldoseronism

C. Hypoproteinemia

D. Hypoaldosteronism

E. Arterial hypertension

14. In patients with myeloma content of proteins in blood plasma is increased up to 200 g/l. This leads to redistribution of water between intracellular, interstitial, and intravascular spaces. What direction does water mainly move at in this case?

A. From interstitium to blood vessels

B. From cells to interstitium

C. From interstitium to cells

D. From blood vessels to interstitium

E. From lymphatic vessels to interstitium

15. A patient of 18 years old and of 60 kg weight was admitted to the hospital with signs of hemic hypoxia resulting from poisoning by nitric compounds. Examination of water exchange of this patient displays: general water – 64% of body weight, extracellular fluid – 18%, intravascular fluid – 5%, and intracellular fluid – 46%; osmotic pressure of blood plasma is 250 mosm/l; urination is 0.8 L per 24 hours. Define the type of dyshydration?

A. There is no dyshydration

B. Isoosmolar hyperhydration

C. Isoosmolar hypohydration

D. Hypoosmolar hyperhydration

E. Hypoosmolar hypohydration

16. Edemas at lower extremities occur in a patient suffered from severe heart failure. What is the leading mechanism of edema development in this case?

A. Centralization of blood circulation

B. Lowering of hydrostatic pressure

C. Secondary hyperaldosteronism

D. Orthostatic increase of venous pressure

E. Hypoproteinemia

17. What is the initial link in formation of heart edemas?

A. Increase of vascular permeability

B. Decrease of minute heart volume

C. Activation of renin-angiotensin system

D. Increase of content of aldosteron in blood

E. Increase of secretion of antidiuretic hormone

18. What is the leading factor of edema development in case of nephrotic syndrome?

A. Increase of hydrostatic pressure in capillaries

B. Increase of vascular permeability

C. Hypoalbuminemia

D. Dynamic lymphatic insufficiency

E. Increase of blood volume

19. Patient suffered from cirrhosis of liver was given with 500 ml of 5% glucose solution with medicines. What disturbances of water-salt balance may appear in this patient?

A. Hypoosmolar hyperhydration

B. Hyperosmolar hyperhydration

C. Isoosmolar hyperhydration

D. Hypoosmolar hypohydration

E. There is no dyshydrotation

20. Patient has edema of right lower part of face and pulsing pain in tooth, which intensifies when taking some hot food. Dentist has diagnosed acute pulpitis. What is the leading mechanism of edema development in this case?

A. Disorders of microcirculation in the focus of inflammation

B. Disorders of trophic function of nervous system

C. Hypoproteinemia

D. Hyperosmia

E. Lymphocytosis

21. Toxic lung edema was modeled in rat using solution of ammonium chloride. What is the leading mechanism of edema development in this case?

A. Reducing of colloid-osmotic pressure

B. Rising of venous pressure

C. Increase of vascular permeability

D. Disorders of neural and humoral regulation

E. Intensification of lymphatic drainage

22. A rat was intravenously injected by 10 ml of 40% glucose solution. In 60 min coma develops due to hyperosmolar dehydration in this rat. What is the mechanism of edema development in this case?

A. Loss of water and salts

B. Reduction of vasopessin synthesis

C. Increase of oncotic pressure of extracellular fluid

D. Increase of osmotic pressure of extracellular fluid

E. Disturbance of acid-base balance

23. Patient has extracellular edema of tissues (dimensions of soft tissues of extremities, liver, and others are enlarged). What parameter of homeostasis decrease do these changes result from?

A. Viscosity

B. pH

C. Hematocrite

D. Oncotic pressure of blood plasma

E. Osmotic pressure of blood plasma

24. At complete starvation (with taking water) generalized edemas develop. What is the leading pathogenic factor in this case?

A. Increase of oncotic pressure of interstitial fluid

B. Decrease of osmotic pressure of blood plasma

C. Decrease of oncotic pressure of blood plasma

D. Increase of osmotic pressure of interstitial fluid

E. Decrease of hydrostatic pressure of interstitial fluid

25. When treating for dehydration by means of salt-poor fluids at the background of sharply reduced excretory renal function resulted from tubular necrosis the worsening of general condition, confused consciousness, convulsive readiness, and brain edema with vomiting develop. What kind of water-salt exchange disturbances takes place in this case?

A. Hypoosmolar hyperhydration

B. Isoosmolar hyperhydration

C. Hyperoosmolar hyperohydration

D. Hypoosmolar hypohydration

E. Hyperosmolar hypohydration

26. As it is known, general amount of water in an organism depends on age, body weight, and sex. Besides, pathogenetic classification of dehydration is important. This classification includes forms of mineral salt deficiency, forms of water deficiency, and transitional forms. What reasons, according to this classification, belong to form of mineral salt deficiency?

A. Loss of electrolytes through the stomach

B. Loss of water is due to polyuria

C. Reduced intake of water

D. Loss of water with a bleeding

E. Loss water is due to hyperventilation

27. A patient has uneasiness in the chest and difficult breathing after physical exertion. Some time later cough with foamy liquid phlegm appears. Significant cyanosis develops in the patient. What is the leading mechanism for edema development in this case?

A. Hydrodynamic

B. Colloid

C. Membranogenous

D. Lymphogenic

E. Osmotic

28. In inflammation increased vascular permeability and increase of hydrostatic pressure are observed in microcirculatory vessels. The level of colloid-osmotic pressure of blood does not significantly changes. There are shift of pH towards acid state, rise of osmotic pressure, and increase in dispersion of proteins in the interstitial fluid. What kind of edema is observed in this case?

A. Mixed

B. Hydrodynamic

C. Colloid-osmotic

D. Lymphogenic

E. Membranogenous

29. A person, who has been starving for along time, has edemas. What is the main mechanism of edema development in this case?

A. Decrease of oncotic pressure of the blood

B. Increase of oncotic pressure of tissues

C. Increase of hydrostatic pressure of venous blood

D. Decrease of hydrostatic pressure of tissues

E. Decrease of blood circulating volume

30. In person, who was bitten by bees, edema of the face and the upper extremities developed. What is the main mechanism of edema development in this case?

A. Increase of vascular permeability

B. Increase of hydrostatic pressure in capillaries

C. Decrease of hydrostatic pressure of tissues

D. Increase of oncotic pressure of tissues

E. Decrease of oncotic pressure of blood

31. Pulmonary hypertension and right-ventricle heart insufficiency with ascites and edemas develop in a patient suffered from pneumosclerosis. What is the main mechanism of edema development in this case?

A. Increase of hydrostatic pressure in veins

B. Increase of oncotic pressure of tissues

C. Decrease of oncotic pressure of blood

D. Reduction of heart stroke volume

E. Increase of vascular permeability

32. Which of followings may cause the isoosmolar hypohydration?

A. Acute blood loss

B. Diarrhea

C. Vomiting

D. Perspiration

E. Hyperventilation

33. Where does fluid accumulate predominantly in case of edema?

A. Intercellular space

B. Intracellular space

C. Pleural cavity

D. Abdominal cavity

E. Intravascular space

ANSWERS:

1.-B. 2.-D. 3.-C. 4.-A. 5.-B. 6.-A. 7.-A. 8.-C. 9.-A. 10.-C. 11.-A. 12.-E. 13.-B. 14.-A. 15.-D. 16.-C. 17.-B. 18.-C. 19.-A. 20.-A. 21.-C. 22.-D. 23.-D. 24.-C. 25.-A. 26.-A. 27.-A. 28/-A. 29.-A. 30.-A. 31.-A. 32.-A. 33.-A.

Дата добавления: 2015-07-25