Objectives questions, Study notes of Nephrology

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MINISTRY OF HEALTH OF UKRAINE ZAPOROZHYE STATE MEDICAL UNIVERSITY THE DEPARTMENT OF INTERNAL DISEASES 3

Test “KROK-2” Tasks in

NEPHROLOGY

Zaporizhzhya

UDC: 616. 61 (075.8) T-

Approved by the Central Methodical Council of ZSMU (protocol № ___ from "_" ______2021) and recommended for use in the educational process Authors : Dotsenko S.YA., Rekalov D.H., Chorna I.V., Shekhovtseva T.H., Samura B.B., Kulynych

R.L., Kravchenko V. I., Shevchenko M .V., Sklyarova N.P., Svystun S.I., Sychov R.O.,

Tyahla O.S., Yatsenko O.V.

Reviewers:

Kraydashenko O.V. - Professor, Doctor of Medical Sciences, Head of the Department of

Pharmacology, Pharmacy, Pharmacotherapy and Cosmetology of ZSMU

Svintozevsky O.O. - Associate Professor of the Department of Clinical Pharmacology,

Pharmacy, Pharmacotherapy with a course of cosmetology at Zaporizhzhya State Medical

University, Candidate of Medical Sciences,

T 41 Test "KROK-2" tasks in nephrology: a collection of test tasks in the discipline "Internal Medicine" for students of the 6th year of medical faculty, specialty "Medical business", "Pediatrics" / Dotsenko S.YA., Rekalov D.H., Chorna I.V. [et al.]. – Zaporizhzhya, 2021. – 64 p.

Збірник тестових завдань "Тестові завдання КРОК-2 з нефрології " - для підготовки до практичних занять з дисципліни “Внутрішня медицина” іноземним студентам 6-го курсу медичного факультету, які навчаються англійською мовою за спеціальністю “Лікувальна справа”.

УДК: 616.61(075.8)

1. At the 18-years-old youth in 2 weeks after a cold edema of face, moderate pain in loin appeared. At the inspection: AP 180/105, proteinuria - 2,0 g/l, microhematuria, hyaline and erythrocyte cylinders – 5-10 in eyeshot. About what disease it follows to think:

А. Acute glomerulonephritis В. Chronic glomerulonephritis С. Acute pyelonephritis D. Chronic pyelonephritis E. Urolithiasis

2. At the 46-years-old woman after supercooling great pain in loin on the right, increase of body temperature to 38С, dysuria appeared. In urine: leukocyturia, bacteriuria; in blood: Hb - 100 g/l, leukocytosis with change to the left, blood sedimentation - 40 mm/h, urea of blood - 6,0 mmol/l. The most reliable diagnosis is:

А. Acute pyelonephritis В. Chronic pyelonephritis С. Acute glomerulonephritis. D. Chronic glomerulonephritis E. Urolithiasis

3. The 28-years-old woman is ill on systemic lupus erythematosus with the damage of kidneys (nephrotic syndrome) and joints, in this connection takes prednisolone 60 mg a day during 3 weeks. What from the resulted changes is the most reliable complication of the appointed therapy:

A. Hyperglycemia В. Erythema on cheeks С. Reyno syndrome D. Thrombocytopenia E. Decline of albumin in blood

4. The 68-years-old woman is hospitalized for an inspection in connection with macrohematuria, increase of body temperature to 38С. What examination is the most substantial for determination of the diagnosis:

А. Zimnicky sample

B. Cystoscopy С. Excretory urography D. Biopsy of kidney Е. US research of kidneys and urinary bladder

5. The sick L., 25 years old, complains on headache, dizziness. In the anamnesis: quinsy 3 weeks ago. Objectively: moderate edema of face, shins, heart rate 90, AP 180/105. Analysis of urine: protein - 1,68 g/l, L - 8-10, E - 50-60 in eyeshot. What treatment it follows to appoint first:

A. Antibiotics B. Diuretics, calcium antagonists

C. Cyclophosphamide D. Prednisolone Е. Plasma intravenous

6. At the 28-years-old woman high AP is determined during 6 months, increase of body temperature to 37,5С. Objectively: noise on the left from nawel and on carotids. The most reliable diagnosis is:

А. Chronic glomerulonephritis В. Polyarteritis nodosa С. Systemic lupus erythematosus D. Unspecific aortoarteritis E. Fibro-muscular dysplasia of renal artery

7. At the 45-years-old patient, locksmith, hypertrophy of parotid glands, Dupuytren`s contracture, proteinuria (2,5 g/l), microhematuria, increase of IgA are found out. The most reliable diagnosis is:

А. Idiopathic IgA-nephropathy В. Glomerulonephritis at hemorrhagic vasculitis С. Glomerulonephritis of alcoholic etiology D. Chronic pyelonephritis Е. Lupus glomerulonephritis

8. The sick, 20 years old, with a 12 weeks pregnancy, complains on nausea, vomit, headache. She felt ill 2 weeks ago after a viral infection. At the examination: edema of shins, AP 170/105. In urine: proteinuria - 3,3 g/l, microhematuria, erythrocyte

D. Renal amyloidosis Е. Hypertonic disease

12. The patient P., 40 years old, complains on edema of face, shins. The diagnosis of rheumatoid arthritis was set four years ago. Objectively: anasarca, AP 120/70. In blood test: Нb - 115 g/l, blood sedimentation - 30 mm/h; in the general analysis of urine: protein - 4,2 g/l, L - 6-8, hyaline and granular cylinders - 5-6 in eyeshot.

А. Secondary amyloidosis with damage of kidneys В. Chronic glomerulonephritis С. Tuberculosis of kidneys D. Myelomic nephropathy E. Chronic pyelonephritis

13. At the patient, 18 years old, pain in lumbar area appeared after intensive physical loading, there was proteinuria 0,47 g/l in the analysis of urine. At the repeated research of urine in 2 days pathology was not discovered. Specify the most credible state:

А. Salt diathesis В. Physiological proteinuria С. Acute glomerulonephritis D. Acute pyelonephritis E. Nephroptosis

14. The patient, 23 years old, with the 10 weeks term of pregnancy during one week edema of face and shins determined. At the examination: AP 170/100. In the analysis of urine: proteinuria - 1,8 g/l, microhematuria, erythrocyte cylinders - 3- in eyeshot. Specify the most credible diagnosis:

А. Early pregnancy toxaemia В. Nephropathy of pregnant С. Acute pyelonephritis D. Acute glomerulonephritis

Е. Systemic lupus erythematosus with damage of kidneys

15. The 40-years-old man has chronic renal failure, as a result of chronic glomerulonephritis. At the inspection: creatinine of blood serum – 800 mcmol/l, potassium of blood - 6,2 mmol/l. In this case it follows to appoint everything, except for:

А. Loop diuretics B. Dietotherapy C. Sorbents D. Prednisolone Е. Programming hemodialysis

16. The 45-years-old sick suffers on chronic renal failure as a result of polycystosis of kidneys. At the inspection: AP - 180/120, creatinine of blood - 770 mcmol/l, speed of glomerular filtration - 5 ml/min., potassium of blood - 6,8 mmol/l. What medical tactic is indicated for this sick:

A. Sorbents B. Hemodialysis C. Hemosorption D. Plasmapheresis Е. Preparations of Ca

17. The patient F., 30 years old, suffers on chronic glomerulonephritis during 10 years. At the inspection: AP - 160/100, creatinine of blood serum - 180 mcmol/l, potassium of blood - 4,2 mmol/l. In this case it follows to appoint everything, except for:

А. Diet with diminishing of protein B. Diuretics С. Diet with diminishing of Na and K D. Programming hemodialysis Е. Antihypertensive therapy

18. At the patient, 22 years old, anasarca with accumulation of liquid in pleura and abdomen, diminishing of urine to 300 ml/day, proteinuria (8 g/day). What syndrome developed at this patient:

A. Urinary B. Nephrotic C. Nephritic D. Heart failure Е. Acute renal failure

23. At the patient, 36 years old, with chronic glomerulonephritis take place: diuresis

• 500 ml, hemoglobin - 72 g/l, creatinine of blood - 720 mcmol/l, potassium of blood
• 6,2 mmol/l. Name the possible factors of hyperkalemia:

А. Chronic renal failure В. Taking ACE inhibitors С. Taking torasemid D. Violation of diet Е. All answers are true

24. At the sick, 64 years old, on chronic obstructive pulmonary disease with bronchiectasis edema, moderate increase of liver and spleen, high proteinuria appeared. What method is the most informative for clarification of the diagnosis of kidney damage:

А. US research of kidneys

В. Еxcretory urography C. Scintigraphy D. Nephrobiopsy Е. Angiography of kidneys

25. At the youth, 16 years old, after vaccination against diphtheria clinical signs of acute glomerulonephritis as a nephritic syndrome appeared. Specify the most reliable mechanism of kidney damage:

А. Allergic reaction of immediate type В. Allergic reaction of slow type С. Toxic influence of vaccine on capillaries of renal glomeruli D. Action of specific antibodies on renal channels Е. Action of complexes antigen/antibody on basal membrane of glomeruli

26. The patient, 19 years, has clinic-laboratory signs of rapidly progressive glomerulonephritis. What method of research is needed for confirmation of the diagnosis:

А. US research of kidneys В. Еxcretory urography C. Nephrobiopsy

D. Computed tomography E. Computed tomography and nephrobiopsy

27. The patient, 20 years old, has clinical signs of acute glomerulonephritis with nephritic syndrome. What research will be the most informative in this case:

А. Biochemical blood test В. General blood test С. General analysis of urine D. Eye fundus examination Е. X – rays of the chest

28. The patient, 32 years old, has signs of chronic glomerulonephritis with nephrotic syndrome. What changes of laboratory indexes is possible to expect in this case:

A. Dyselectrolitemia B. Hypercholesterinemia C. Bacteriuria D. Hypocoagulation E. Hyperproteinemia

29. The sick G., 22 years old, complains on increase of body temperature to 38С, pain in joints, edema of face, feet, papular rash on cheeks. Laboratory researches: Hb – 96 g/l, blood sedimentation – 55 mm/h; proteinuria – 3,5 g/l, microhematuria. What can confirm the diagnosis:

А. Increase of circulating immune complexes В. Antibodies to twochain DNA

С. Decrease of maintenance of ІgМ D. Decrease of amount of B-lymphocytes Е. Increase of blood sedimentation

30. At the patient I., 23 years old, moderate proteinuria, microhematuria, high arterial pressure appeared in a week after viral infection. What research must be conducted for confirmation of the diagnosis:

А. Biopsy of kidneys В. Analysis of urine by Nechiporenco C. Urea, creatinine of blood

С. Cancer of kidneys

D. Myelomic nephropathy

Е. Renal tuberculosis

35. The patient, 38 years old, complains on thirst, nausea, polyuria. For many years takes analgetics concerning migraine. At the inspection: moderate normochromic anemia, proteinuria - 0,33 g/l, creatinine of blood – 300 mcmol/l. Name the credible disease:

А. Chronic glomerulonephritis В. Chronic tubulointerstitial nephritis С. Chronic pyelonephritis D. Renal tuberculosis Е. Myelomic nephropathy

36. The patient T., 42 years old, after significant and protracted physical loading felt pain in lumbar area, appearance of ”brown” urine. At the patient`s father – polyarthritis, nephrolytiasis. Name the credible disease:

А. Acute glomerulonephritis В. Acute pyelonephritis С. Cancer of kidneys D. Renal tuberculosis Е. Acute uricacid nephropathy

37. At the patient, 43 years old, there are relapses of arthritis of I left metatarsophalangeal joint of toe, in urine: low proteinuria, microhematuria. What laboratory research must be conducted for clarification of the diagnosis:

А. Determination of creatinine of blood В. Determination of uric acid of blood С. Determination of С-reactive protein of blood D. Determination of proteinogram of blood Е. Determination of rheumatoid factor of blood

38. The patient, 37 years old, complains on periodic pain in I right metatarsophalangeal joint of toe and left ankle joint, renal colic, which recidivate. The level of uric acid of blood is 0,68 mmol/l. What preparation is expedient to appoint:

A. Movalis B. Diclophenak C. Prednisolone D. Allopurinol E. Delagil

39. At the sick, 25 years old, with polyuria (2,5 l/day), increase of creatinine ( mcmol/l), doctor suspected development of acute tubulointerstitial nephritis after taking panadol concerning acute viral infection. What tactic of conducting of the sick:

А. Removal of the drug В. Appointment of loratidin

С. Appointment of dimedrol D. Conducting of plasmapheresis Е. Hemodialysis

40. The patient, 59 years old, for half-year marks pain in pelvic bones, hip joints. At the inspection: normochromic anemia, creatinine of blood – 450 mcmol/l, calcium of blood 2,9 mmol/l, phosphorus of blood - 2,1 mmol/l, general protein - 100 g/l, proteinuria - to 9,0 g/l. What is the reason of such state:

А. Systemic lupus erythematosus В. Chronic glomerulonephritis С. Multiple myeloma D. Gudpascher`s syndrome Е. Chronic tubulointerstitial nephritis

41. The sick, 58 years old, marks thirst, polyuria, decline of appetite. Daily takes unsteroid antiinflammatory preparations concerning osteoarthrose of knee joint. At the inspection: moderate normochromic anemia, proteinuria - 0,66 g/l, creatinine of blood - 300 mcmol/l. Name the credible disease:

А. Secondary amyloidosis of kidneys В. Chronic glomerulonephritis С. Chronic tubulointerstitial nephritis D. Chronic pyelonephritis Е. Cancer of kidneys

D. Increase of concentration of urea Е. Metabolic changes of myocardium

46. The 40-years-old patient is ill on secondary amyloidosis of kidneys with nephrotic syndrome on the background of osteomyelitis. What is the most frequent end of amyloidosis:

А. Malignant hypertension В. Chronic renal failure С. Heart failure D. Hemorrhagic stroke Е. Myocardial infarction

47. At the 75-years-old patient, who complains on weight loss, general weakness, at the inspection cancer of thick intestine is diagnosed. In blood test: hypochromic anemia, in urine - proteinuria to 3,5 g/day, microhematuria. What is the most credible reason of development of kidney pathology:

А. Chronic pyelonephritis В. Paraneoplastic nephropathy C. Urolithiasis D. Renal tuberculosis Е. Myelomic nephropathy

48. At the 42-years-old patient, who was ill on I type diabetes, severe course for 10 years, moderate proteinuria, AH were registered during last two years. Specify the most credible reason of the state:

А. Hypertonic disease В. Heart failure С. Chronic glomerulonephritis D. Diabetic glomerulosclerosis Е. Amyloidosis of kidneys

49. At the patient on the background of flu with high fever at the research of urine proteinuria - 0,066 g/l is found out. In a week in the analysis of urine pathological changes are not discovered. What is the credible reason of transient proteinuria:

А. Acute glomerulonephritis

В. Feverish proteinuria С. Acute pyelonephritis D. Acute tubulointerstitial nephritis E. Diabetic nephropathy

50. At the sick, 26 years old, with anasarca, chronic glomerulonephritis with nephrotic syndrome was diagnosed. The diagnosis was verifiied by biopsy of kidneys. Damage of what structure of kidneys is primary in this case:

A. Glomerulus B. Tubules С. Renal arteries D. Interstitial tissue Е. Calyx and pelvis

51. At the sick L., 24 years old, in 2 weeks after quinsy edema of face, shins, increase of AP - 170/100, proteinuria - 0,99 g/l, microhematuria appeared. Proteinuria in this case is:

A. Functional B. Extrarenal C. Glomerular D. Tubular Е. Proteinuria of “overflow”

52. At the patient, 23 years old, in a week after viral infection moderate edema of extremities, arterial hypertension, proteinuria (2 g/day), microhematuria, appeared. What caused this proteinuria:

А. Increase of “pore” sizes of glomerular capillaries endothelium В. Increase of permeability of glomerular basal membrane С. Loss of negative charge of basal membrane D. Correctly A, B Е. Correctly A, B, C

53. The sick N., 69 years old, complains on osalgia, decline of appetite, subfebrile body temperature. At the inspection: normochromic anemia, blood sedimentation - 65 mm/h, proteinuria - 3,3 g/l, general protein - 105 g/l. Reason of proteinuria of “overflow” is:

E. Meningococcus

57. At the patient, 35 years old, with acute renal failure as a result of protracted compression syndrome was discovered: respiration rate - 28, at the ECG -ventricular extrasystole, high waves T; central venous pressure - 159; potassium of blood - 7, mmol/l, creatinine of blood - 0,9 mmol/l. The most expedient application will be:

A. Ultrafiltration B. Hemodialysis C. Hemosorption D. Diuretics Е. Diuretics, sorbents

58. At the sick, 19 years old, who suffers on chronic glomerulonephritis and gets treatment - medrol in day's dose 48 mg, pain in pyloroduodenal area, heartburn appeared. After conducting of FGDS erosions of duodenum bulb are diagnosed. Your subsequent action:

А. Increase of prednisolone doses

В. Decrease of prednisolone doses С. Transfer on parenteral introduction of medrol with gradual abolition D. Complete abolition of medrol E. All answers are not true

59. At the 38-years-old armenin from teens episodes of stomach-ache with rise of body temperature, which passed independently in a day were marked. Last year in the analysis of urine proteinuria to 1,5 g/l appeared. Father of the patient died from kidney disease. Specify the most credible reason of the state:

А. Chronic glomerulonephritis В. Periodic disease, amyloidosis of kidneys С. Chronic pyelonephritis D. Rapidly progressive glomerulonephritis Е. That information is not enough for setting of the diagnosis

60. The patient, 24 years old, complains on presence of microspotal symmetric hemorrhagic rash in the area of lower extremities and trunk. He is ill within a week. In the analysis of urine: protein - 0,5 g/l, leukocytes – 6-8, erythrocytes – 35-40 in eyeshot. Specify the most credible reason of origin of microhematuria:

A. Acute glomerulonephritis B. Hemorrhagic vasculitis C. Thrombocytopenic purpura D. Hemophilia E. Acute pyelonephritis

61. At the patient, 29 years old, at the inspection discoidpouring out is discovered in the area of cheeks, polyarthritis of joints of brushes, bilateral pleurisy, AG. In the analysis of urine is protein - 1,2 g/l, erythrocytes – 15-20, leukocytes – 4-5 in eyeshot. Specify the most credible reason of origin of urinary syndrome:

A. Acute glomerulonephritis B. Amyloidosis of kidneys C. Acute pyelonephritis D. Renal tuberculosis E. Lupus glomerulonephritis

62. At the youth, 20 years old, there are edema of all body, general protein of blood

• 54 g/l. Albumin - 25%, globulins - 75%, cholesterol - 9,8 mmol/l. The given clinic
• laboratory research allows to assert about presence at the patient:

A. Dysproteinemia B. Hyperalbuminemia C. Hyperproteinemia D. Hypoglobulinemia E. Hypocholesterinemia

63. The sick, 39 years old, complains on headache, decline of appetite, nausea, vomit in the morning, periodic nasal bleeding. He is ill on chronic tonsillitis, from 15 years

• pathology in the analyses of urine. At the inspection: pallor of skin, traces of scratching on skin, AP - 200/140. In the analysis of urine: protein - 0,99 g/l, L - 3- 5, E - 8-10, erythrocyte cylinders - 3-4 in eyeshot. What from the biochemical indexes is the most informative for estimation of the state:

А. Creatinine of blood serum B. Sodium of blood plasma C. Uric acid of blood D. Fibrinogen of blood