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1.A patient has severe nephropathy with a massive edematous syndrome, which complicated bronchiectatic diseases. Laboratory investigations show massive proteinuria, cylindruria, considerable decrease of protein content in the blood serum, hyperlipidemia, hypokalemia and other deviations. What is the main link in the pathogenesis of the patient’s edemas?
A. Decrease of oncotic blood pressure.
B. Increase of extracellular fluid pressure.
C. Increase of hydrostatic blood pressure.
D. Blockade of lymph drainage.
E. Hyperpermeability of microvessels
2.A patient with renal insufficiency has a disorder of hemopoietin synthesis produced in the kidneys. What formed blood elements development is impaired?
A. Erythrocytes
B. Granulocytes
C. Thrombocytes
D. B-lymphocytes
E. T-lymphocytes
3.The narrowing of afferent glomerular renal arteriole caused the decrease of urination. The cause of this is a decrease of:
A. Reabsorption of glucose
B. Reabsorption of ions
C. Reabsorption of urea
D. Reabsorption of water
E. Effective filtration pressure
4.A man aged 32 has been ill with chronic glomerulonephritis for 4 years. He was hospitalized with the signs of anasarca. AP-185/105 mm. Hg. Blood analysis shows: Hb-110gm/l; erythrocytes-2.6x1012/l; leucocytes-9.5x109/l; residual nitrogen-32 mmol/l; total protein-50 gm/l. What change points to glomerulonephritis with nephrotic syndrome?
A. Anemia
B. Arterial hupertension
C. Hyperzotemia
D. Hypoproteinemia
E. Leukocytosis
5.Sharp decrease in sodium content in the blood serum was revealed in a patient with renal insufficiency. There are pale crumby edemas of the face manifesting in the morning. What substance composing intercellular matrix comes from blood bed?
A. Collagen
B. Elastin
C. Procollegen
D. Hyaluronic acid
E. Fibronectin
6.Edemas appeared in a patient after Streptococcus infection. The urinalysis was made and allowed to make a diagnosis of acute glomerulonephritis. What pathologic changes in urine confirm the diagnosis?
A. Fresh erythrocytes
B. Protein with high molecular mass and lixiviated erythrocytes
C. Protein only with low molecular weight (up to 40000.
D. Increased excretion of sodium
E. Leukocyturia
7.After poisoning by salts of heavy metals a patient has developed nongaseous acidosis, urine pH=6.0, glucosuria without hyperglycemia, polyuria, natriuresis. Which of the structures is damaged?
A. B-cells of Lanhergans islets
B. Nephron glomeruli
C. Nephron tubules
D. Nuclei of hypothalamus
E. Adrenal cortex
8.A patient age 48 with fibro-cavernous tuberculosis complains of general weakness decrease of diurnal urination, edemas of the trauma and extremities, increase of AP up to 180/90 mm. Hg Urinalysis shows increase of protein, hyaline and granular cylinder, erythrocytes. A month later he died from renal insufficiency. Enlargement of the heart and large “fatty kidneys” were revealed at autopsy (weight of kidneys is 240.0 gm -260.0 gm). What disease was fibro-cavernous tuberculosis of the lungs complicated by?
A. Glomerulonephritis
B. Nephrotic syndrome
C. Amyloidosis
D. Pyelonephritis
E. Nephrosclerosis
9.A patient with chronic glomerulonephritis has edemas, AP-210/100 mmHg, and the rate of heart beats-85 per minute. The borders of the heart are dilated. What is the leading mechanism in the development of arterial hypertension?
A. Increase of sympathetic-adrenal system activity
B. Hyperfunction of the heart
C. Activation of renin- angiotensin -aldosteron system
D. Increase of circulatory blood volume
E. Increase of vasopresin discharge
10.The presence of glucose in the urine in its normal concentration in the blood serum was determined in a patient aged 18 on laboratory examination. The most possible cause of this is the impairment of
A. Tubular reabsorption
B. Glomerular filtration
C. Tubular secretion
D. Secretion of the glucocorticoids
E. Insulin secretion
11.In a week and a half after a severe streptococcal tonsillitis a patient aged 24 developed edematous face, increased arterial pressure, hematuria, and proteinuria of 1.2 g/L.His blood analysis shows antistreptococcal antibodies and decrease of complement components. In the microvessels of what structures is the most possible localization of immune complex deposits which caused the development of nephropathy.
A. Proximal tubules
B. Gomeruli
C. Descendent tubules
D. Henle’s loop
E. Pyramids
12.Increased amount of proteins in the urine was revealed in a patient with acute glomerulonephritis. The impaired function of what nephron structures is the presence of protein in the urine connected to?
A. Basal membrane of glomerulus capillaries
B. Epithelium of parietal layer of glomerulus capsule
C. Epithelium of thin tubules
D. Epithelium of distal tubules
E. Epithelium of Henle”s loop
13.Proteinuria (5 g/l) due to low molecular weight proteins and hematuria with lixiviated erythrocytes were revealed in patient’s urinalysis. What renal function disorder do these findings point out?
A. Increase in glomerular permeability
B. Increase in tubular secretion
C. Increase in tubular excretion
D. Decrease in tubular reabsorption
E. Extrarenal disorders
14.A patient with chronic glomerulonephritis has symptoms of anemia. What causes these symptoms?
A. Decrease in erythropoietin synthesis
B. Loss of erythrocytes in urine
C. Increased destruction of normal erythrocytes
D. Erythrocytes hemolysis
E. Iron deficiency for hemoglobin synthesis
15.A patient with chronic renal disease is edematous, pale, and his BP is increased. Laboratory examination shows protein and erythrocytes in patient’s urine. Protein content in the blood is the normal. What is the main link in the pathogenesis of edematous syndrome?
A. Arterial hypertension
B. Hyperazotomia
C. Secondary aldosteronism
D. Hematuria
E. Poteinemia
16.A patient with chronic renal disease is edematous, pale, and his BP is increased. Laboratory examination revealed protein and erythrocytes in his urine, hyperazotemia, and decrease in erythrocytes and hemoglobin in his blood. What is the main link in pathogenesis of arterial hypertension of this patient?
A. Activation of renin-angiotensin system
B. Anemia
C. Hyperazotemia
D. Increase of circulatory blood volume
E. Proteinuria
17.A patient with diabetes mellitus has developed chronic renal failure with the development of uremia and the rate of glomerular filtration of 8 ml/min. What is the mainly possible mechanism of decrease in glomerular filtration rate and the development of chronic renal failure in this patient?
A. Spasm of afferent glomerular arteriole
B. Occlusion of tubular lumen of nephron by hyaline cylinders
C. Increase of osmotic blood pressure
D. Decrease of systemic BP
E. Decrease of the number of working nephron
18.Severe poisoning by mercury salts has lead to decrease and then to ceasing of patient’s urination. There are headache, nausea, and vomiting in this patient. Laboratory investigation reveals quickly increasing azotemia. The established diagnosis is the acute renal failure, stage of oligouria-anuria. What disorders of aqueous and osmotic homeostatic does this patient have at this stage of the disease?
A. Hypoosmolar hypohydration
B. Hyperosmolar hypohydration
C. Isoosmolar hypohydration
D. Hypoosmolar hyperhydration
E. Hyperosmolar hyperhydration
19.A patient with chronic renal disease is edematous, pale, his AP is increased, and he has vomiting and diarrhea with ammoniac smell. Laboratory investigation reveals protein and erythrocytes in his urine, hyperazotemia, decrease of erythrocytes and hemoglobin in his blood. What is the main link pathogenesis of anemia which complicated renal disease?
A. Loss of erythrocytes with urine
B. Toxic influence of urea on bone marrow
C. Deficiency of erythropoietin
D. Impaired of iron absorption due to diarrhea
E. Impaired of regulation of erythropoiesis by endocrine glands
20.A man suffering from gout complains of pains in the area of kidneys. Ultra sound examination reveals the presence of renal calculi. What substance increased concentration causes the formation of calculi in this case?
A. Bilirubin
B. Uric acid
C. Urea
D. Cystine
E. Cholesterol
21.What hormone increased secretion is caused by activation of renin-angiotensin system in renal hypoxia?
A. Hydrocortisone
B. Thyroxin
C. Aldosteron
D. Insulin
E. Parathormone
22.A man has decreased urination, hypernatremia, hypokalemia. What hormone hypersecretion is the cause of such changes?
A. Vasopressin
B. Atrial natriuuretic factor
C. Parathormone
D. Aldosterone
E. Adrenalin
23.A patient with acute renal insufficiency developed anuria (diurnal urination - 50 ml). Which of the bellow-mentioned mechanisms is the main one in its development?
A. Decrease of glomerular filtration
B. Impairment of renal blood circulation
C. Increase of water reabsorption
D. Increase of sodium reabsorption
E. Difficulty of urine outflow
24.A patient with chronic glomerulonephritis has vegetation of collagenic fibers in interstitium near tubules in which reabsorption of sodium ions decreases. What underlies these changes in reabsorption of sodium ions in tubules?
A. Inhibition of energy metabolism
B. Activation of glycolysis
C. Inhibition of lipid peroxidation
D. Stabilization of lysosomal membranes
E. Increase of antioxidative activity
25.The damage of proximal portion of nephron with decrease of sodium ion reabsorption was observed in a patient after poisoning by corrosive sublimate. How much maximally may sodium ions be reabsorbed in this part of nephron?
A. 65 %
B. 80 %
C. 50 %
D. 35 %
E. 20 %
26.The damage of proximal portion of nephron was held in a patient in 24 hours later after the poisoning by corrosive sublimate. What electrolyte reabsorption is impaired in this pathology?
A. Ions of potassium
B. Ions of chloride
C. Ions of sodium
D. Ions of calcium
E. Ions of magnesium
27.A patient aged 35 complains of pain in the lumbar area, edema under eyes, and increased fatigability in usual physical loads. Protein was revealed in patient’s urine (0.99gr/l). Patient’s BP is -160/110 mmHg. What pathology has the patient?
A. Pyelitis
B. Nephritic syndrome
C. Cystitis
D. Acute renal failure
E. Nephrotic syndrome
28.What pathological process is non-selective, non-massive proteinuria is characteristic for?
A. Nephritic syndrome
B. Urethritis
C. Chronic renal failure
D. Acute renal failure
E. Nephrotic syndrome
29.What origin of protein is the most possible in selective proteinuria with intensity 12 gr/day?
A. Suprarenal
B. Tubular
C. Glomurular
D. Urethra
E. From urinary bladder
30.What pathological process is characterized by combination of massive proteinuria (25gr/day) with generalized edema?
A. Urethritis
B. Chronic renal failure
C. Nephrotic syndrome
D. Cystitis
E. Nephritic syndrome
31.What pathological process may be complicated by acute renal failure?
A. Chronic lung abscess
B. Viral hepatitis
C. Polycystitic kidneys
D. Extensive burn
E. Hypertensive disease
32.Acute pylonephritis was diagnosed in a patient with complains of increased temperature, pain in the lumbar area, and frequent and painful urination.Which of the infectious agents is a cause of the disease?
A. Staphylococci
B. Streptococci
C. Escherichia coli
D. Brucella
D. Anaerobic flora
33.A patient suddenly has developed colicky pains in the are of kidney with irradiation to grain, nausea, and vomiting; the discharge of urine for 24 hours is 90 ml. Determine mechanism of anuria
A. Impairment of filtration
B. Increase of reabsorption
C. Blocking of a work of a part of nephrons
D. Reflex anuria
E. Obturation of ureters
34.A man of aged 72 is ill with chronic glomerulonephritis. On examination following was determined: absence of appetite, vomiting, diarrhea, skin itching, anemia, the content of residual nitrogen in the blood is 45mm/l. The indicated signs are caused by:
A. Increase of glomerular membrane permeability
B. Disturbance of nephron function
C. Autoimmune damage of nephrone function
D. Renal ischemia
E. Disturbance of concentrating mechanism
35.A patient of age 32 with acute glomerulonephritis, who did not follow regime of NaCl and water limitation, suddenly has lost his consciousness and convulsions appeared in him. His BP is 220/120 mmHg, he has mydriatic pupils and bradycardia. What complication has appeared in this patient?
A. Acute heart failure
B. Hypertensive crisis
C. Renal coma
D. Epilepsy
E. Eclampsy
36.A woman aged 25 with frequent prolonged tonsillitis in her anamnesis came to а doctor with complaints of periodical headaches, undue fatigability, periorbital edemas. Clinic-laboratory investigations show moderate arterial hypertension, proteinuria, hypoproteinemia, hyperlipidemia. Bilateral disturbance with insignificant increase of echogenity of renal parenchyma was diagnosed by ultrasound examination of kidneys. What disease is the mast possible in this case?
A. Chronic pyelonephritis
B. Acute glomerulonephritis
C. Lipoid nephrosis
D. Chronic glomerulonephritis
E. Acute renal failure
37.Protein, which level didn’t exceed 1g/L, was revealed in the urine of physically healthy young military men after a hard physical exertion during one day foot match (50 km). What kind of proteinuria takes place first of all?
A. False proteinuria
B. Organic proteinuria
C. Alimentary proteinuria
D. Dehydrated proteinuria
E. Cyclic proteinuria
38.After a severe trauma a patient developed shock with signs of acute renal failure. What is the leading mechanism in the development of acute renal failure in this case?
A. Decrease of oncotic blood pressure
B. Increase of pressure in renal arteries
C. Increase of pressure in glomerular capsule
D. Damage of outflow of urine
E. Fall of arterial pressure.
39.Decrease in insulin clearance down to 60 ml/min was determined in a patient with chronic renal failure. What renal function impairment is this connected with?
A. Glomerular filtration
B. Tubular secretion
C. Reabsorption in proximal part of nephron
D. Reabsorption in distal part of nephron
E. Reabsorption in collecting renal tubules.
40.A patient with chronic renal insufficiency has developed anorexia, dyspepsia, impairment of cardiac rhythm, skin itching. What is the main mechanism of the development of these impairments?
A. Disturbance of lipid metabolism
B. Accumulation of products of nitrogen metabolism in the blood
C. Changes of carbohydrate metabolism
D. Renal acidosis
E. Disturbance of water and electrolyte metabolism.
41.A patient who has been suffering from osteomyelitis of the mandible for many years has extensive edemas; marked massive proteinuria is revealed in his urine. Which form of complications in the course of osteomyelitis has this patient?
A. Pyelitis
B. Nephrotic syndrome
C. Nephritic syndrome
D. Chronic renal failure
E. Renal calculi disease
42.After automobile accident a patient’s BP is 70/40 mm Hg. The patient is unconscious. His diurnal urination is about 500 ml. There are periodical convulsions, Kussmaul’s respiration in him. What is the cause of the disorder of urination?
A. Considerable acute hypotension
B. Increase of glomerular filtration
C. Decrease of tubular reabsorption
D. Increase of tubular reabsorption
E. Intoxication by metabolites of nitric exchange
43.In a man rate of glomerular filtration rises in 20% as a result of prolonged starvation. What is the most possible reason for changes of filtration under indicated conditions?
A. Increased permeability of renal filter
B. Increase in filtration coefficient
C. Increased systemic arterial pressure
D. Decreased oncotic pressure of blood plasma
E. Increase in renal blood flow
44.Under experiment morphological impairment of epithelial cells of distal part of nephron was induced in rats. What functional processes in kidneys are weakened in this case?
A. Filtration
B. Reabsorption of sodium and glucose
C. Reabsorption of glucose
D. Reabsorption of water and salts
E. Reabsorption of proteins
45.Glucosuria and aminoaciduria were found out in a patient with nephritis. What mechanism of reabsorption of glucose and amino acids is impaired in this case?
A. Pinocytosis
B. Primary active transport
C. Simple diffusion
D. Secondary Na-dependent transport
E. Phagocytosis
46.Following changes were observed in a patient after poisoning with salts of heavy metals: increased level of residual nitrogen, hyperphosphatemia, hypersulfatemia, hyperacidemia, and decreased alkaline reserve. What structures impairment has led to described changes?
A. Glomerulus of nephron
B. Langerhgans’ islets
C. Hepatocytes
D. Cortex of adrenal glands
E. Tubules of nephron
47.A 48-year-old man was admitted to the hospital with aggravation of chronic glomerulonephritis. Examination of this patient found out a presence of chronic renal failure in him. What does azotemia in chronic renal failure results from?
A. Decreased glomerular filtration
B. Decreased tubular reabsorption
C. Decreased tubular excretion
D. Disorders of protein metabolism
E. Disorders of water-salt balance
48.A patient was admitted to the hospital with complaints of absence of urination during 24 hours and pains in lumbar area. Catheterization of patient’s urinary bladder does not relief the patient. What pathology may be cause of anuria in this patient?
A. Bilateral renal calculi
B. Heart failure
C. Bleeding
D. Vomiting
E. Severe intoxication
49.Inhibitor of phosphorilation in cells of nephron tubules – floridzine, was introduced to an animal in experiment. What substances reabsorption impairment may develop in this case?
A. Disorders of reabsorption of glucose
B. Disorders of reabsorption of non-organic phosphate and calcium
C. Disorders of reabsorption of amino acids
D. Disorders of reabsorption of proteins
E. Disorders of reabsorption of sodium ions and water
50.What pathological changes are characteristic for glomerulonephritis?
A. Presence of high molecular weight proteins (70,000 D) in urine
B. Presence of fresh erythrocytes in urine
C. Presence of low molecular weight proteins (about 40,000 D) in urine
D. Increased excretion of sodium and hyaline cylinders in urine
E. Leukocyturia without hematuria
ANSWERS:
1.-A.2.-A.3.-E.4.-D.5.-D.6.-A.7.-C.8.-C.9.-C.10.-A.11.-B.12.-A.13.-A.14.-A.15.-C.16.-A.17.-E.18.-D.19.-C.20.-B.21.-C.22.-D.23.-A.24.-A.25.-B.26.-C.27.-B.28.-A.29.-B.30.-C.31.-D.32.-C.33.-D.34.-B.35.-E.36.-D.37.-E.38.-E.39.-A.40.-B.41.-B.42.-A.43.-D.44.-D. 45.-D. 46.-A. 47.-A. 48.-A. 49.-A. 50.-A.
Topic24.Pathophysiology of the nervous system
1. A 38-year-old man is going undertreatment in a hospital for schizophrenia. Blood contents of glucose, ketone bodies, and urea in him are norm. Shock therapy with regular injections of insulin was led to the development of insulin coma, after that the patient’s condition improved. What was the most possible reason for development of insulin coma?
2. Smell of apples is felt from the patient in comatose state. The content of glucose is 18 mmol/L. Which coma is more possible in this case?
3. A patient is drowsy, with cloudiness of consciousness, his reaction to the strong stimuli is slow. His skin is pale and dry. He has edemas, muscular fibrillar tremor, midriasis, Cheyne-Stokes respiration with ammonium smell. Pericardial rub was revealed during auscultation. Which type of coma has been developed in this patient?
4. Increase of blood pressure and rapid pulse are noticed in a sportsman at the start before competitions. Influence of which part of the CNS can above-mentioned changes be explained?
5. The close clinical examination of the patient, admitted to the reanimation department in unconscious condition allowed to make a conclusion that the patient was in uremic comatose state. Which symptom is more characteristic for this type of coma?
6. The close clinical examination of the patient, admitted to the reanimation department in unconscious condition allowed to make a conclusion that the patient was in state of diabetic coma. Which symptom is more characteristic for this type of coma?
7. Ptyalism, bradycardia (heart rate 45 beats per minute), miosis are observed in a man. What is the most possible reason for such changes?
8. The reactions, typical for stimulation of parasympathetic nerves, appeared after irritation of throphogenic zone of hypothalamus, including preoptic nucleas and anterior hypothalamic area. What appears in this case?
9. After amputating the upper extremity a patient had a bad pain in it. Which mechanism of the pain feeling formation is more possible in this case?
10. A patient had hemiplegia after insult. What disorder is observed in this case?
ANSWERS:
1.-C. 2.-D. 3.-B. 4.-A. 5.-D. 6.-A. 7.-B. 8.-D. 9.-A. 10.-C.
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