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E. * Prolymphocytic.
6. Albumin contents of normal plasma is:
A. 55-75 g/l
B. 45-85 g/l
C. * 35-50 g/l
D. 55-95 g/l
E. 15-25 g/l
7. ALL is more common in:
A. * Children
B. Adults
C. Neonates
D. Adults above 60
E. None of the above
8. All of the following are true of erythrocytes except
A. When mature, they have no nucleus or other organelles
B. Their plasma membrane contains many antigens (molecules projecting
from the surface)
C. They normally contain practically all of the hemoglobin that is present
in blood
D. They transport oxygen from the lungs to body tissues
E. * They have a finite life span averaging about 60 days
9. All of the following cause Microcytic Hypochromic anemia except:
A. * Lead poisoning
B. Thalassemia
C. Iron deficiency anemia
D. Fanconi's anemia
E. Nothing is correct
10. An excessive number of white blood cells is called:
A. Lymphoma
B. Leukopenia
C. * Leukocytosis
D. All of the above
E. None of the above
A. Phagocytosis
B. * Antibody production
C. Release of histamine
D. Cell to cell killing of viral infected cells
E. The production of erythropoietin
17. B12-deficiency anemia developed in a patient after the total resection of
stomach. What type of cells are present in blood?
A. Anulocytes
B. Microcytes
C. Ovalocytes
D. Spherocytes
E. * Megalocytes
18. Because of local intravessels of blood coagulation arises
A. Slage-syndrome
B. Embolism
C. DIC-syndrome
D. Arterial hyperemia
E. * Thrombosis
19. Bence Jones protein is a Paraprotein and it is characteristics of the following:
A. * Multiple myeloma
B. Sidoroblastic anemia
C. Aplastic anemia
D. Iron deficiency
E. Leukemia
20. Biochemical investigations can be performed on types of blood specimens:
A. 2
B. * 4
C. 6
D. 8
E. 10
21. Blood perform such functions:
A. Gas transport
C. 0 1 %
D. * 1 6 %
E. 45 72 %
27. Choose the indexes of normal basophilic granulocytes:
A. 19 37 %
B. 3 11 %
C. * 0 1 %
D. 0,5 5 %
E. 45 72 %
28. Choose the indexes of normal concentrations of RBC in male:
A. 3-4,1? 1012/L
B. 2,1-5,1? 1012/L
C. * 4-5,1? 1012/L
D. 12-15 ? 1012/L
E. 5-10? 1012/L
29. Choose the indexes of normal concentrations of RBC in female:
A. * 3,7-4,7? 1012/L
B. 2,1-5,1? 1012/L
C. 4-5,1? 1012/L
D. 12-15 ? 1012/L
E. 5-10? 1012/L
30. Choose the indexes of normal eosinophilic granulocytes:
A. 19 37 %
B. 3 11 %
C. 0 1 %
D. * 0,5 5 %
E. 45 72 %
31. Choose the indexes of normal hematocrit in female:
A. 3,7-4,7 %
B. 2,1-5,1 %
C. * 36- 42 %
D. 12-15 %
E. 50-60 %
32. Choose the indexes of normal hematocrit in male:
A. 3,7-4,7 %
B. 2,1-5,1 %
C. * 40- 48 %
D. 12-15 %
E. 50-60 %
33. Choose the indexes of normal lymphocytes:
A. * 19 37 %
B. 3 11 %
C. 0 1 %
D. 0,5 5 %
E. 45 72 %
34. Choose the indexes of normal maintenance of hemoglobin in women:
A. 140-160 g/l
B. * 120-140 g/l
C. 125-160 g/l
D. 50-80 g/l
E. 70-100 g/l
35. Choose the indexes of normal maintenance of hemoglobin in men:
A. 80-100 g/l
B. * 130-160 g/l
C. 115-145 g/l
D. 70-90 g/l
E. 100-120 g/l
36. Choose the indexes of normal monocytes:
A. 19 37 %
B. * 3 11 %
C. 0 1 %
D. 0,5 5 %
E. 45 72 %
37. Choose the indexes of normal neutrophilic segmented granulocytes:
A. 19 37 %
B. 3 11 %
C. 0 1 %
D. 0,5 5 %
E. * 45 72 %
38. Choose the indexes of normal plateletes CBC:
A. 100-220 ? 109/L
B. 100-120 ? 109/L
C. 80-120 ? 109/L
D. * 180-320 ? 109/L
E. 10-32 ? 109/L
39. Choose the indexes of normal reticulocytes CBC:
A. 3,7-4,7 %
B. 2,1-5,1 %
C. 36- 42 %
D. * 0,5-1 %
E. 50-60 %
40. Choose the indexes of normal total leukocytes CBC:
A. 10-20 ? 109/L
B. 1-2 ? 109/L
C. 8-12 ? 109/L
D. * 4-9 ? 109/L
E. 10-32 ? 109/L
41. Circulating mature RBCs lack:
A. Ribosomes
B. * Mitochondria
C. Nuclei
D. All of the above
E. None of the above
42. Classes of immunoglobulin produced by multiple myeloma:
A. IgM
B. IgD
C. * IgG
D. IgE
E. IgA
43. Classification of leukemia:
A. * Acute and chronic
B. Mild and Grievous
C. Hemorrhagic and post Hemorrhagic
D. Microcytic and Macrocytic.
E. Hyperchromic and Hypochromic
44. Combination of haemoglobin with oxygen named:
A. Carboxyhemoglobin
B. Methemoglobin
C. Carbylaminhemoglobin
D. Carbhemoglobin
E. * Oxyhemoglobin
45. Combination, that transported CO2 from tissues to lung named:
A. Methemoglobin
B. * Carbhemoglobin
C. Oxyhemoglobin
D. Carbylaminhemoglobin
E. Carboxyhemoglobin
46. Complete blood count in patients with vitamin B12 deficiency anaemia shows
all changes except of the following:
A. Decreased amount of erythrocytes and haemoglobin
B. Macrocytosis
C. Increased colour index more than 1,1
D. * Decreased colour index below 0.8
E. Zhollis bodies and Kebots rings in erythrocites
47. Coomb's Positive Hemolytic Anaemia is seen in except:
A. * Alcoholic cirrhosis
B. Chronic active hepatitis
C. Primary biliary cirrhosis
B. Monocytes
C. Thrombocytes
D. Lymphocytes
E. * Erythrocytes
64. Examples of tests used in case-finding programmes in neonates:
A. Plasma cholinesterase activity
B. * Serum [TSH] and/or [thyroxine]
C. Drug screen
D. Maternal serum [a-fetoprotein]
E. Nothing is correct
65. Examples of tests used in case-finding programmes in neonates:
A. Plasma [albumin] and/or [pre-albumin]
B. * Serum [phenylalanine]
C. Plasma and urine [glucose]
D. Maternal serum [a-fetoprotein]
E. Everything is correct
66. Examples of tests used in case-finding programmes in pregnancy:
A. Plasma [albumin] and/or [pre-albumin]
B. Serum [phenylalanine]
C. Drug screen
D. * Maternal serum [a-fetoprotein]
E. Everything is correct
67. Fibrinogen contents of normal plasma is:
A. 5-7 g/l
B. 5-8 g/l
C. * 2-4 g/l
D. 5-9 g/l
E. 1-2 g/l
68. Fluoride is also anticoagulant. It should not be used for:
A. Blood urea
B. Blood albumin
C. * Enzyme assays
D. Blood bilirubin
E. Blood creatinine
69. Globulins contents of normal plasma is:
A. 5-75 g/l
B. 45-85 g/l
C. * 25-35 g/l
D. 55-95 g/l
E. 15-25 g/l
70. Haemoglobin A of erythrocytes in the adult include:
A. 22 and 1 polypeptide chains
B. 11 and 2 polypeptide chains
C. 4 4 - polypeptide chains
D. 4 - polypeptide chains
E. * 2 and 2 - polypeptide chains
71. Haemoglobin A of erythrocytes in the adult include:
A. 22 and 1 polypeptide chains
B. 11 and 2 polypeptide chains
C. 4 4 - polypeptide chains
D. 4 - polypeptide chains
E. * 2 and 2 - polypeptide chains
72. Hemoglobine of erythrocytes include:
A. * Hem and globin
B. Histones and hem
C. Protamines and hem
D. Globin and NAD
E. Iron, copper and protein
73. Hemoglobine of erythrocytes include:
A. * Hem and globin
B. Histones and hem
C. Protamines and hem
D. Globin and NAD
E. Iron, copper and protein
A. * Leukocytes
B. Trombocytes
C. Erythrocytes
D. Hemoglobin
E. Bilirubin
80. In eight years old child in general blood test is revealed: erythrocytes
1.2*1012/1, hemoglobin 34 g/l, color index 0.9 , thrombocytes 50*109/1,
leukocytes 2.3*109/1, blasts 30%, neutrophyls 22%, lymphocytes 43%,
monocytes 5%, ESR 62 mm/hour. Characterize these changes.
A. Hemophilia
B. Thrombocytopenic purpura
C. Henoch's disease
D. Anemia
E. * Leukosis
81. In general, biochemical tests can be broadly divided into groups:
A. * 2
B. 4
C. 6
D. 8
E. 10
82. In microscopy of a peripheral blood smear, auer rods where seen. Which of
the following diseases is it seen in?
A. CML
B. * AML
C. CLL
D. ALL
E. None of the above.
83. In Polycythemia vera, all the following are seen except:
A. * Thrombocytopenia
B. Increased GI bleed
C. Thrombosis
D. Transient visual loss
E. Nothing is correct
84. In ten years old boy in general blood count is revealed: erythrocytes
1.2*1012/1, hemoglobin 34 g/l, color index 0.9 , thrombocytes 50*109/1,
leukocytes 12.3*109/1, blasts 45 %, neutrophyls 22%, lymphocytes 28%,
monocytes 5%, ESR 52 mm/hour. Characterize these changes.
A. Hemophilia
B. Thrombocytopenic purpura
C. Henoch's disease
D. Anemia
E. * Leukosis
85. In the sickle cell anemia is synthesized anomalous HbS as a result of gene
mutation, in which in place of glutamic acid present
A. Alanin
B. Cystine
C. Leucin
D. Tyrosine
E. * Valin
86. In which of the following types of white blood cells do the cytoplasmic
granules stain preferentially with red-staining dyes?
A. Neutrophils
B. Basophils
C. * Eosinophils
D. Lymphocytes
E. Monocytes
87. Increase related to O2 in the perinatal period of child has:
A. HbS
B. * HbF
C. HbA
D. HbE
E. HbC
88. It is known that in pathological condition erythroblastic type of blood
formation in bone marrow may change on megaloblastic. It is characterized
for:
A. Cancer of duodenum
B. Tuberculous intoxication
C. Sickle
E. B and C
94. Most of the circulating leukocytes are:
A. Basophils
B. Eosinophils
C. Leukocytes
D. Monocytes
E. * Neutrophils
95. Multiple myeloma can be diagnosed with which of the following?
A. Serum protein electrophoresis
B. Bone marrow examination
C. Urine protein electrophoresis
D. X-ray of the the involved bones
E. * All of the above
96. Multiple myeloma is also known as
A. * Kahlers disease
B. Hodgkins disease
C. Reed- Stenberg disease
D. Arthurs syndrome.
E. All of the above.
97. Multiple myeloma is also known as:
A. Lymphogranulomatosis.
B. * Plasma cell myeloma
C. Myelomatosis.
D. Hodgkins disease.
E. Granulomatosis
98. Myeloma is diagnosed with:
A. Blood tests
B. Bone marrow examination
C. X-rays of commonly involved bones
D. Urine protein electrophoresis
E. * All of the following
99. Normal anisocytosis is :
A. * 11-14 %
B. 24-33 %
C. 15-35 %
D. 50-100 %
E. 1-10 %
100.
101.
102.
103.
104.
105.
I.
50-100 fl
J.
1-10 fl
Normal RDW is:
A. * 11-14 %
B. 24-33 %
C. 15-35 %
D. 50-100 %
E. 1-10 %
106.
107.
108.
Normal value of MCHC (mean corpuscular hemoglobin concentration)
in blood:
A. 44 45 %
B. 45 47 %
C. * 33 37 %
D. 36 47 %
E. 57 60 %
109.
110.
?Phenylketonuria of newborn was diagnosed after a reaction of urine
with:
A. CuSO4
B. NaCl
C. Fe+
D. Na3PO4
E. * FeCI3
111.
112.
113.
Sideroblastic anemia often arises at treatment by some
antituberculousis drugs (isoniasid), because in the process of treatment
appears a deficit of vitamin
A. C
B. 12
C. A
D. K
E. * 6
114.
115.
116.
117.
Specialized tests:
A. Hormones
B. DNA analyses
C. Trace elements
D. * Everything is correct
E. Drugs
118.
119.
121.
The biological fluids employed in the clinical biochemistry laboratory
include:
A. Blood
B. Urine
C. Saliva
D. * Everything is correct
E. Tissue and cells
122.
The biological fluids employed in the clinical biochemistry laboratory
include:
A. Cerebrospinal fluid
B. Peritoneal fluide
C. Saliva
D. * Everything is correct
E. Stones
123.
125.
126.
127.
128.
129.
130.
The oxyphylic normocytes were appeared in the blood of a patient after
acute blood loss. 25 % of reticulocytes were found with a supravital dye.
Name the type of this anemia according to the bone marrow capacity to
regeneration?
A. Aregenerative
B. Hyperegenerative
C. Hyporegenerative
D. Disregenerative
E. * Regenerative
131.
132.
133.
134.
135.
The white blood cell that is most like the mast cell is the:
A. * Basophil
B. Lymphocyte
C. Neutrophil
D. Eosinophil
E. Monocyte
136.
To measure or differentiate anemia of mixed causes and forms such as
anisocytosis, which of the following is most appropriate to use?
A. Red cell distribution width
B. MCHC
C. * MCV
D. Non of above
E. MCH
137.
To the boy of 8 months that is cured because of pneumonia and rickets
moderate severity anemia was diagnosed. What indicators of hemoglobin in
the blood are characteristic for this degree of anemia?
A. * 70-89 g / l
B. 90 - 110 g / l
C. 80 - 100 g / l
D. 69 g / l and less
E. 100 - 120 g / l
138.
To the girl of 12 months that is cured because of pneumonia and rickets
mild severity anemia was diagnosed. What indicators of hemoglobin in the
blood are characteristic for this degree of anemia?
A. 70-89 g / l
B. * 90 - 110 g / l
C. 80 - 100 g / l
D. 69 g / l and less
E. 100 - 120 g / l
139.
140.
Urine preservatives:
A. Formalin
B. Thymol
C. * Everything is correct
D. Chloroform
E. Concentrated HCl
141.
142.
143.
What are the main laboratory findings in patient with chronic lymphatic
leukemia?
A. Thrombocytosis
B. * Anemia and thrombocytopenia
C. Thrombocytosis and lymphocytosis
D. No findings,
E. Philadelphia chromosome in abnormal cells
144.
What does mean of erythrocytosis in a sick with heart congenital
defect?
A. Independent disease
B. Complication
C. Terminal state
D. Index of convalescence
E. * Compencatory reaction
145.
146.
147.
148.
149.
150.
J.
B. Vit. B12
C. * Paraprotein
D. Iron
E. All of the Above.
152.
153.
Which formed elements are most directly associated with the immune
responses that defend the body against pathogens?
A. Erythrocytes
B. * Leucocytes
C. Platelets
D. None of the above (the immune response is strictly a function of
plasma)
E. All of the above
154.
Which formed elements are most directly associated with the immune
responses that defend the body against pathogens?
A. Erythrocytes
B. * Leucocytes
C. Platelets
D. None of the above (the immune response is strictly a function of
plasma)
E. All of the above
155.
Which indexes are responsible for the normal volume of blood in adult?
A. 15 L
B. 25 L
C. * 5 L
D. 50 L
E. 2 L
156.
B. Monocytes
C. Lymphocytes
D. Eosinophils
E. Basophils
157.
158.
159.
Which of the following cells play a crucial role in the pathogenesis of
alveolar-capillary damage in adult respiratory distress syndrome (ARDS)?
A. CD4-positive lymphocytes
B. CD8-positive lymphocytes
C. Eosinophils
D. Mast cells
E. * Neutrophils
160.
161.
C. Monocyte
D. * All of the above
E. None of the above
162.
Which of the following is NOT a type of granular white blood cell? ____
A. Monocytes
B. Neutrophils
C. * Eosinophils
D. Basophils
E. None of the above
163.
164.
Which of the following medical investigation is used for patients with
vitamin B12 deficiency:
A. Tzanck test
B. Wood lamp test
C. * Schillings test
D. Elisa test
E. Wassermans test
165.
166.
D. G6PD deficiency
E. * Iron deficiency
167.
____ is a hormone produced by the ____ when tissue levels of oxygen
are low.
A. Bilirubin stomach
B. Bilirubin; bone marrow
C. * Erythropoietin; kidneys
D. Erythropoietin; bone marrow
E. Hemoglobin; liver
168.
169.
170.
171.
E. * Prolymphocytic.
172.
173.
174.
175.
176.
Anemia is hereditary enzymepathy on the base of glucose-6-phosphat
dehydrogenase insufficiency. Type of hereditance it is:
A. Autosome-recessive
B. Linked X-chromosome, recessive
C. Autosome-dominant
D. Intermediate
178.
179.
180.
181.
B12-deficiency anemia developed in a patient after the total resection
of stomach. What type of cells are present in blood?
A. Anulocytes
B. Microcytes
C. Ovalocytes
D. Spherocytes
E. * Megalocytes
182.
183.
Bence Jones protein is a Paraprotein and it is characteristics of the
following:
A. * Multiple myeloma
B. Sidoroblastic anemia
C. Aplastic anemia
D. Iron deficiency
E. Leukemia
184.
185.
186.
By the genetic marker of myeloleucosis is philadelphian chromosome.
What chromosomal aberration it formed as a result of?
A. Inversion of short shoulder of 21-th chromosome
B. Deletion of short shoulder of 22-th chromosome
C. Translocation of short shoulder of 22-th chromosome on 21-th
D. Duplication of long shoulder of 22-th chromosome
E. * Translocation of long shoulder of 22-th chromosome on 9-th
187.
A. 19 37 %
B. 3 11 %
C. 0 1 %
D. * 1 6 %
E. 45 72 %
188.
189.
190.
191.
192.
C. * 36- 42 %
D. 12-15 %
E. 50-60 %
193.
194.
195.
196.
197.
E. 45 72 %
198.
199.
200.
201.
202.
203.
A. IgM
B. IgD
C. * IgG
D. IgE
E. IgA
204.
Classification of leukemia:
A. * Acute and chronic
B. Mild and Grievous
C. Hemorrhagic and post Hemorrhagic
D. Microcytic and Macrocytic.
E. Hyperchromic and Hypochromic
205.
206.
207.
Complete blood count in patients with vitamin B12 deficiency anaemia
shows all changes except of the following:
A. Decreased amount of erythrocytes and haemoglobin
B. Macrocytosis
C. Increased colour index more than 1,1
D. * Decreased colour index below 0.8
E. Zhollis bodies and Kebots rings in erythrocites
208.
210.
Deficit of what vitamin in the liver leads to decrease in coagulation
factors II, V, VIII?
A. B6
B. C
C. PP
D. B1
E. * K
211.
212.
213.
C. Lymphatic nodes
D. Intracellular liquid
E. * Blood vessels
214.
215.
216.
217.
218.
Erythropoietin:
A. * Stimulates red blood cell synthesis
B. Stimulates white blood cell synthesis
C. Is released in response to a decrease in blood flow to the bone marrow
D. A and C
E. B and C
219.
Erytropoietin synthesis is disordered in chronic kidney insufficiency.
Development of what blood elements will be decreased?
A. Neutrophils
B. Monocytes
C. Thrombocytes
D. Lymphocytes
E. * Erythrocytes
220.
221.
222.
223.
226.
How is anaemia named, in base which lie decrease of enzymes
activition which take part in the hem synthesis?
A. Metaplastic
B. Sickle cell
C. Toxic-hemolytic
D. Irondeficiency
E. * Sideroblastic
227.
228.
229.
230.
In eight years old child in general blood test is revealed: erythrocytes
1.2*1012/1, hemoglobin 34 g/l, color index 0.9 , thrombocytes 50*109/1,
leukocytes 2.3*109/1, blasts 30%, neutrophyls 22%, lymphocytes 43%,
monocytes 5%, ESR 62 mm/hour. Characterize these changes.
A. Hemophilia
B. Thrombocytopenic purpura
C. Henoch's disease
D. Anemia
E. * Leukosis
231.
In microscopy of a peripheral blood smear, auer rods where seen.
Which of the following diseases is it seen in?
A. CML
B. * AML
C. CLL
D. ALL
E. None of the above.
232.
233.
In ten years old boy in general blood count is revealed: erythrocytes
1.2*1012/1, hemoglobin 34 g/l, color index 0.9 , thrombocytes 50*109/1,
leukocytes 12.3*109/1, blasts 45 %, neutrophyls 22%, lymphocytes 28%,
monocytes 5%, ESR 52 mm/hour. Characterize these changes.
A. Hemophilia
B. Thrombocytopenic purpura
C. Henoch's disease
D. Anemia
E. * Leukosis
234.
In the sickle cell anemia is synthesized anomalous HbS as a result of
gene mutation, in which in place of glutamic acid present
A. Alanin
B. Cystine
C. Leucin
D. Tyrosine
E. * Valin
235.
In which of the following types of white blood cells do the cytoplasmic
granules stain preferentially with red-staining dyes?
A. Neutrophils
B. Basophils
C. * Eosinophils
D. Lymphocytes
E. Monocytes
236.
237.
It is known that in pathological condition erythroblastic type of blood
formation in bone marrow may change on megaloblastic. It is characterized
for:
A. Cancer of duodenum
B. Tuberculous intoxication
C. Sickle
D. Cronical blood loss
E. * B12-deficiency anemia
238.
Leukocytes are divided into two classes based on the presence or
absence of microscopically visible structures called
A. Nuclei
B. * Granules
C. C. Ribosomes
D. Mitochondria
E. Golgi complexes
239.
Leukocytes are divided into two classes based on the presence or
absence of microscopically visible structures called
A. Nuclei
B. * Granules
C. C. Ribosomes
D. Mitochondria
E. Golgi complexes
240.
241.
242.
243.
D. Monocytes
E. * Neutrophils
244.
245.
246.
247.
248.
249.
250.
251.
252.
253.
G. 80-100 fl
H. 15-35 fl
254.
I.
50-100 fl
J.
1-10 fl
Normal RDW is:
A. * 11-14 %
B. 24-33 %
C. 15-35 %
D. 50-100 %
E. 1-10 %
255.
256.
Normal value of MCHC (mean corpuscular hemoglobin concentration)
in blood:
A. 44 45 %
B. 45 47 %
C. * 33 37 %
D. 36 47 %
E. 57 60 %
257.
258.
Sideroblastic anemia often arises at treatment by some
antituberculousis drugs (isoniasid), because in the process of treatment
appears a deficit of vitamin
A. C
B. 12
C. A
D. K
E. * 6
259.
260.
261.
262.
263.
265.
266.
267.
268.
C. Monocyte
D. Eosinophil
E. B lymphocyte
269.
270.
The oxyphylic normocytes were appeared in the blood of a patient after
acute blood loss. 25 % of reticulocytes were found with a supravital dye.
Name the type of this anemia according to the bone marrow capacity to
regeneration?
A. Aregenerative
B. Hyperegenerative
C. Hyporegenerative
D. Disregenerative
E. * Regenerative
271.
272.
273.
The white blood cell that is most like the mast cell is the:
A. * Basophil
B. Lymphocyte
C. Neutrophil
D. Eosinophil
E. Monocyte
275.
To measure or differentiate anemia of mixed causes and forms such as
anisocytosis, which of the following is most appropriate to use?
A. Red cell distribution width
B. MCHC
C. * MCV
D. Non of above
E. MCH
276.
?To the boy of 8 months that is cured because of pneumonia and
rickets moderate severity anemia was diagnosed. What indicators of
hemoglobin in the blood are characteristic for this degree of anemia?
A. * 70-89 g / l
B. 90 - 110 g / l
C. 80 - 100 g / l
D. 69 g / l and less
E. 100 - 120 g / l
277.
To the girl of 12 months that is cured because of pneumonia and rickets
mild severity anemia was diagnosed. What indicators of hemoglobin in the
blood are characteristic for this degree of anemia?
A. 70-89 g / l
B. * 90 - 110 g / l
C. 80 - 100 g / l
D. 69 g / l and less
E. 100 - 120 g / l
278.
B. Iron deficiency
C. Malaria
D. Jaundice
E. * Hodgkins lymphoma
279.
280.
What are the main laboratory findings in patient with chronic lymphatic
leukemia?
A. Thrombocytosis
B. * Anemia and thrombocytopenia
C. Thrombocytosis and lymphocytosis
D. No findings,
E. Philadelphia chromosome in abnormal cells
281.
What does mean of erythrocytosis in a sick with heart congenital
defect?
A. Independent disease
B. Complication
C. Terminal state
D. Index of convalescence
E. * Compencatory reaction
282.
283.
C. Decreased IgA
D. Hypouricemia
E. Nothing is correct
What is not seen in multiple myeloma?
284.
285.
286.
287.
J.
290.
Which formed elements are most directly associated with the immune
responses that defend the body against pathogens?
A. Erythrocytes
B. * Leucocytes
C. Platelets
Which indexes are responsible for the normal volume of blood in adult?
A. 15 L
B. 25 L
C. * 5 L
D. 50 L
E. 2 L
293.
294.
295.
Which of the following cells play a crucial role in the pathogenesis of
alveolar-capillary damage in adult respiratory distress syndrome (ARDS)?
A. CD4-positive lymphocytes
B. CD8-positive lymphocytes
C. Eosinophils
D. Mast cells
E. * Neutrophils
296.
297.
Which of the following is NOT a type of granular white blood cell? ____
A. Monocytes
B. Neutrophils
C. * Eosinophils
D. Basophils
E. None of the above
298.
299.
Which of the following medical investigation is used for patients with
vitamin B12 deficiency:
A. Tzanck test
B. Wood lamp test
C. * Schillings test
D. Elisa test
E. Wassermans test
300.
E. erythroblast.
301.
302.
What part of tooth (in 100g of tissues) containes: 30 40 g of water, 40
g of organic compounds 20 -30 g of inorganic compounds, Ca 30 g, 17
g?
A. Dentine
B. * Pulp
C. Enamel
D. Cementum
E. None of the above
303.
304.
A carbonate apatite is soluble in an acidic environment. What diet is
most promotes formation of organic acids?
A. Protein
B. * Carbohydrate
C. Lipid
D. Vitamin
E. Diet isnt important
305.
A collagen is synthesized from procollagen ripening of which includes
a few stages, except:
A. * Partial hydrolysis of polypeptide chains
B. Posttranslative modification with participation of hydroxylases and
glycosyltransferases
C. Transmembrane transfer into intracellular space from fibroblasts
310.
C. * D
D.
E. K
311.
312.
After strenuous muscle activity, lactate produced from anaerobic
glycolysis is recycled in the liver by being ____________________ in a reaction
catalyzed by lactate dehydrogenase.
A. oxidized by NADH to form oxaloacetate
B. reduced by NADH to form oxaloacetate
C. * oxidized by NAD+ to form pyruvate
D. reduced by NAD+ to form pyruvate
E. none of above
313.
314.
Amino acid remnants wich the most often are met in collagen are:
A. tryptophane, oxilysine, cysteine, valine
B. tryptophane, cysteine, glycine, methionine
C. lysine, arginine, cysteine, tryptophane
D. * oxiproline, oxilysine, glycine, proline
E. aminosuccinamic, glutamine, lysine
315.
Anemia, hemorrhage, and chronic obstructive pulmonary disease can
all cause metabolic acidosis. The best explanation is that the lack of oxygen
causes
317.
318.
319.
At a hyperparathyroidism (Recklinghausen disease) mineralization of
the bony system and tooth tissues is violated as a result of:
A. * Hypercalciemia, phosphateuria, osteoporosis
B. Violation of Ca absorption in an intestine
C. Violation of hydroxylation of calciferol
D. Violation of posttranslational modification of collagen
E. At this disease there are no any changes of the bony system and teeth
tissues
320.
At wound's healing scars appear. What matter is the main component
of scar's connective tissue?
A. keratan sulfate
B. elastin
C. hyaluronic acid
D. chondroitin sulfate
E. * collagen
321.
Beginning of caries is characterized by enamel demineralization as
result of such changes as:
A. Maintenance of Ca, , F decrease in the area of caries,
B. A form, size and configuration of crystals of hydroxyapatite are
changed
C. A soluble proteins are washed in the area of caries from an enamel and
dentine
D. Activity of alkaline Phosphatase decreases
E. * All of the above
322.
323.
324.
327.
328.
329.
D. Surgery
E. * Problems with heart
330.
331.
Day's requirement of adults in F (with a meal and water) is 2,7-5 mg. It
excess causes a risk of fluorosis. The toxity of F increases such factor as:
A. Lack of vitamin of
B. Excess of carbohydrates in a meal
C. * Lack of Ca
D. Increase of amylase activity
E. All of the above
332.
333.
Demineralization (resorption) of bony tissues takes place at all below
mentioned states, except:
A. Hypervitaminosis D
B. Hyperparathyroidism
C. Icenko-Kushing disease
D. Hypervitaminosis A
E. * Acromegalia
334.
Demineralization is a process of dissolving of tooth tissues. The
mechanisms of this process are all of the following, except:
A. * An increase of activity of alkaline phosphatase in saliva.
B. Increase of activity ? glycosidases and acidic phosphatase in saliva.
C. Splitting of connections of inorganic ions with the molecules of organic
substance.
336.
337.
338.
Disorders of tooth tissues calcification is a consequence of calcium
homoeostasis violation, caused:
A. By the deficiency of vitamin D
B. By a hyperparathyroidism
C. By a hypoparathyroidism
D. By the deficiency of calcitonin
E. * By the all of the above factors
339.
Dissolving of teeth surface because of damaging action of some factors
is named:
A. Diastheme
B. Threme
C. * Erosion
D. Absorption
E. Extraction
340.
During muscle contraction, calcium is released from the endoplasmic
reticulum. An increase in glycogenolysis is initiated when calcium binds to
A. * Calmodulin
B. Troponin I
C. Protein kinase A
D. Zymogen
E. Protein phosphatase
341.
Dysgeusia is:
A. Changes in tooth structure
B. Changes in the structure of mucous
C. Changes in saliva compounds
D. * Changes in taste
E. Changes in salivary glands
342.
Dysphagia is:
A. Difficulty in speaking
B. Difficulty in moving of the jaws
C. * Difficulty in swallowing
D. Difficulty in touching
E. Difficulty in biting
343.
Excess of F in an organism, particular in children, causes a fluorosis
and such pathology of teeth as:
A. Hypoplasia
B. * Hyperplasia
C. Loose of teeth
D. Caries
E. Excess of F is not dangerous for teeth
344.
For Drooling are liable people with all the listed diseases, except:
A. Parkinsons
B. Cerebral vascular accidents
C. Dementia
D. Amyotropic lateral sclerosis
E. * Xerostomia
345.
For Drooling are liable people with all the listed diseases, except:
A. Parkinsons
B. Cerebral vascular accidents
C. * Hyposalivation
D. Amyotropic lateral sclerosis
E. Dementia
346.
For Drooling are liable people with all the listed diseases, except:
A. Parkinsons
B. Cerebral vascular accidents
C. Dementia
D. Amyotropic lateral sclerosis
E. * Dry mouth syndrome
347.
Formation of collagen in the organism needs hydroxylating of proline
which takes place with participation of proline hydroxalase. Which vitamin
activates this process?
A. NAD
B. Biotin
C. * Ascorbic acid
D. FAD
E. Pyridoxine phosphate
348.
349.
How many ascorbic acid in normal condition is excreted per day with
urine:
A. * 20-30 mg
B. 113,5-170,5 mg
C. 10-28 g
D. 80-100 mg
E. 18-33 g
350.
Hyaluronidase splits hyaluronic acid, intercellular permeability rises as
a result. Which vitamin does inhibit activity of hyaluronidase, assist in
strengthening of walls of vessels?
A. * Vitamin P
B. Vitamin A
C. Vitamin B1
D. Vitamin B2
E. Vitamin D
351.
Hypercalciemia, hyperphosphatemia and decreased excretion of
phosphorus with urine were observed. It can be caused by:
A. Increased production of the parathormone
B. Decreased production of the parathormone
C. * Decreased production of calcitonin
D. Increased production of calcitonin
E. Increased production of glucocorticoids
352.
Hypercalciemia, hypophosphatemia and the intensive excretion of
phosphorus with urine were found. It can be caused by:
A. * Increased production of parathormone
B. Decreased production of parathormone
C. Decreased production of calcitonin
D. Increased production of calcitonin
E. Increased production of glucocorticoids
353.
Hypocalciemia, hyperphosphatemia and decreased excretion of
phosphorus with urine were found. It can be caused by:
A. Increased production of parathormone
B. * Decreased production of parathormone
C. Decreased production of calcitonin
D. Increased production of calcitonin
E. Increased production of glucocorticoids
354.
Hypocalciemia, hypophosphatemia and the intensive excretion of
phosphorus with urine were observed in a patient. It can be caused by:
A. Increased production of the parathormone
359.
In the process of organism's ageing is decreased bonding of water by
connective tissue. This is tied with the decrease of concentration of:
A. * glycosaminoglycans
B. collagen
C. phospholipids
D. hyaluronic acid
E. chondroitin sulphuric acid
360.
In the synthesis of 1,25-dihydroxycholecalciferol from 7dehydroxycholesterol
A. The steroid ring structure remains intact
B. Cholesterol is an intermediate
C. * Ultraviolet light is required
D. Three hydroxylation occur
E. Calcitonine is required
361.
Increase of strontium maintenance in food products or effect of radioactive strontium is dangerous for an organism. A multiple increase in a diet of
such component as _____ can prevent including of strontium on 50% :
A. Fluorine
B. * Calcium
C. Sodium
D. Phosphorus
E. Iodine
362.
363.
Insufficiency of ascorbic acid results in development of scurvy.
Synthesis of which protein is diminished:
A. * Collagen
B. Protrombin
C. Fibrinogen
D. Albumin
E. Ceruloplasmin
364.
365.
It is known that the excessive entering of fluorine in an organism
causes development of fluorosis spots of enamel. It develops in a 100% of
population at a hit in an organism of F in an amount which exceeds:
A. * 5 mg
B. 0,5 mg
C. 100 mg
D. 1 mg
E. 1g
366.
It was established disorders of hydroxylation of proline and lysine in
composition of a collagen of a patient with scurvy. Inhibition of which
biochemical process does result in this disorders?
A. * Microsomal oxidation
B. Peroxidation of lipids
C. Tissue respiration
D. Peroxidase oxidation
E. Phosphorylation
367.
368.
E. * Masticatory disorders
369.
370.
371.
372.
Lipid soluble vitamins execute numerous functions in an organism
except:
A. * They are components of enzymes
B. Modulators of cell membranes
C. Antioxidants
D. They have provitamins
E. . Cause hypervitaminosis
373.
374.
375.
Mineralization of tooth is promoted by glycoproteins and
proteoglycans, which are synthesized at participation of vitamin A by:
A. * Formation of covalent bonds of carbohydrate fragments with residues
of serine and threonine of proteins
B. Formation of hydrogen bonds between protein and carbohydrate
components
C. Formation of ionic bonds between protein and carbohydrate
components
D. Apoprotein and carbohydrate components form micelles
E. All of the above
376.
Mineralization of tooth tissues - is a formation of organic matrix and it
saturation by mineral elements. This proces includes the row of
transformations, except:
A. Synthesis of pulps cells and releasing into intercellular space of
collagen, GAG
B. Forming of organic matrix of mineralization
C. Ionization of GAG
D. * Splitting of intermolecular connections in the molecules of organic
substance
E. Insertion of apatites into a matrix
377.
378.
C. * Carotenoids
D. Hesperedin
E. Dehydroascorbic acid
379.
One of main factors of caries development is decrease of in an oral
cavity due to the presence of organic acids at the excessive use of
carbohydrates. Such situation is caused by activation of:
A. Gluconeogenesis
B. Hydrolysis of starch
C. Hydrolysis of glycogen
D. * Fermentation
E. Breaking up of GAG
380.
381.
D:
382.
Permeability of enamel is increased by all of the following factors
except:
A. Calcitonin
B. Calcitriol
C. * Parathormone
D. Hyaluronidase, acidic environment
E. Ions of Fe, carotin
383.
Plastic, trophic, sensory - are the functions of the following tooth tissue:
A. Enamel
B. * Pulp
C. Cementum
D. Dentine
E. Periodontal ligaments
384.
385.
386.
387.
388.
Proline and lysine was founded in composition of collagen fibres of a
patient with the frequent bleeding of internal organs and mucous
membranes. Lack of which vitamin caused disorders of hydroxylation?
A. Vitamin E
B. Vitamin K
C. Vitamin A
D. Thiamin
E. * Vitamin C
389.
Proper tooth tissues mineralization, prevention of defects, caries are
provided by vitamins:
A. D and B1
B. K and B5
C. and F
D. * D and
E. A and
390.
Pulp is a tooth tissue with high content of such soluble proteins,
enzymes, except of:
A. Enzymes of glycolisis, TCA
B. Enzymes of PPP, respiratory chain
C. Enzymes of proteins and nucleic acids biosynthesis
D. * Enzymes of fatty acids biosynthesis
E. Alkaline and acidic phosphatase
391.
392.
393.
E. Mucous
394.
395.
396.
Salivary glands which are lying in tile submucosa of hard and soft
palates are:
A. * Palatine
B. Buccal
C. Labial
D. Submandibular
E. Sublingual
397.
Salivary glands which are lying on the inner surface of the lips are:
A. Sublingual
B. Submandibular
C. * Labial
D. Buccal
E. Parotid
398.
399.
Synthesis of protein of glycoproteins and proteoglycans, which take
part at tooth mineralization stimulates:
A. Vitamin of D
B. Somatotropin
C. * Vitamin A
D. Vitamin
E. Glucocortikoids
400.
The active form of vitamin D (1,25-dihydrocholecalciferol) maintain in
an organism a constant level of:
A. Potassium and phosphorus
B. * Calcium and phosphorus
C. S. Iron and calcium
D. Iron and magnesium
E. . Magnesium and manganese
401.
The affection of collagen fibers structure by the lack of vitamin C in the
organism is caused by enzymes activity malfunction:
A. glycosyltransferase
B. lysine hydroxylase and lysine oxidase
C. * lysine hydroxylase and proline hydroxylase
D. procolagenpeptidase
E. collagenase
402.
403.
404.
405.
The amount of fluid translocated each day through salivary glands is:
A. 500 ml
B. 950 ml
C. * 750 ml
D. 380 ml
E. 280 ml
406.
407.
408.
409.
B. 3 L
C. * 1,5 L
D. 1,2 L
E. 5 L
410.
411.
412.
413.
414.
The amount of sialic acids in patient's blood is 1060 mg/l. From the
probable diagnosis should be removed the following:
A. * atherosclerosis
B. tuberculosis
C. malignant growth
D. rheumatitis
E. cardiac infarction
415.
416.
417.
The bolus is :
A. * The ball of food
B. Parotid gland
C. Ulcer of oral cavity
D. Inflammation of the tongue
E. Part of digestive system
418.
The carbohydrate components of organic matrix of tooth are the
following compounds, except:
A. Glucose, mannose
B. Galactose, maltose
C. * Cellulose, dextrane
D. Glucuronic acid, sialic acids
E. Chondroitin-4 and 6-sulphates, glycogen
419.
D. Yellow
E. Pink
420.
The damage of the immune system reduces resisting of human
organism to the infections. Immune status of organism depends on the
followings structures, except:
A. Bony marrow
B. Thymus
C. Tissue macrophages
D. Lymphatic nodes
E. * Hypophysis
421.
422.
The duct of this salivary gland opens into the floor of the mouth on
either side of tongue:
A. Sublingual
B. Parotid
C. Lingual
D. Buccal
E. * Submandibular
423.
The duct of this salivary gland opens into the mouth opposite side of
second molar on both sides:
A. Sublingual
B. * Parotid
C. Lingual
D. Buccal
E. Submandibular
424.
D. Steinberg duct
E. Romanovskyy duct
425.
426.
The following acute phase protein increase dramatically in
concentration during inflammation :
A. ceruloplasmin
B. haptoglobulin
C. C-reactive protein
D. fibrinogen
E. C3
427.
The greatest concentration of antibodies is found in the fraction of the
serum.
A. * Gamma globulin
B. Albumin
C. Beta globulin
D. Alpha globulin
E. Prealbumin
428.
The labial minor salivary gland is the most frequently sampled site in
evaluation of :
A. * Sjogrens syndrome
B. Downs syndrome
C. Arthurs syndrome
D. Xerostomia
E. Xerophthalmia
429.
The lack of vitamin D in the organism of children causes a rickets. All
below mentioned are reasons of this disease except:
A. Disorders of Ca and metabolism
B. Disorders of mineralisation
C. * Lower activity of alkaline phosphatase
D. Lack of vitamin of D in diet
E. . Lack of ultraviolet
430.
431.
432.
The most important marker of transition of demineralization as a
physiology process into pathological one is a decline of the index Ca/P in
enamel below than:
A. 1,6
B. * 1,3
C. 1,5
D. 0,9
E. 1,9
433.
434.
The patient has vessel penetration malfunction. Name the connective
tissue protein, which synthesis is affected:
A. tropomyosin
B. myoglobine
C. albumin
D. * collagen
E. ceruloplasmin
435.
436.
The remnants of desmosine and isodesmosine in elastin are formed
from aminoacid radicals of the following amino acids:
A. * lysine
B. glycine
C. proline
D. ornithine
E. hydrooxilysine
437.
The salivary gland that is situated just under the back of the tongue is:
A. Parotid
B. Buccal
C. * Sublingual
D. Submandibular
E. Lingual
438.
The second stage of mineralization is inseretion of apatites on an
organic matrix, in crystallization points. The ions of Ca and contact with the
followings components, except:
A. OH groups of serine, threonine, tyrosine
B. OH groups of hydroxy-proline, oxylysine
C. * CH3 groups of alanine and valine
D. COOH groups of glutamate, aspartate
E. With osteocalcin
439.
B. Sympathetic
C. Parasympathetic
D. Sensory division of CNS
E. Peripheral nervous system
440.
The such organic components of tooth, as soluble proteins, execute the
following functions, except:
A. Catalytic
B. Protective
C. Transport
D. Mineralizing
E. * Immune
441.
The toxity of F at it excessive entering in an organism may be
decreased by:
A. Sufficient maintenance of vitamin of
B. Normal salivation
C. Normal activity of amylase
D. * Excess of Ca
E. Sufficient maintenance of vitamin D
442.
The toxity of fluorine develops at it hit in an organism in an amount
which exceeds 5 mg due to it:
A. Changes of oral cavity
B. * Forms CaF2 which leaves tooth tissues
C. Reduces salivation
D. Promotes fermentation in an oral cavity
E. Prevents the synthesis of -bounding proteins of tooth
443.
The typical symptoms of hyperfunction of adrenal cortex are
osteoporosis and negative balance of calcium and phosphates. Disorders of
synthesis and disintegration of which substance is a result of these
symptoms:
A. * Collagen
B. Parathormone
C. Calcitonine
D. Corticotropine
E. Somatotropine
444.
This hormone promotes the transition of calcium from bones to blood,
inhibits reabsorption of phosphorus in kidneys and stimulates absorption of
calcium in intestine. Which hormone is it?
A. Calcitonin
B. Thyroxine
C. Triiodthyronine
D. * Parathormone
E. Thyrotropin
445.
This hormone stimulates the formation of 1,25dihydroxycholecalciferol in kidneys. What hormone is it?
A. Calcitonin
B. Thyroxine
C. Triiodthyronine
D. * Parathormone
E. Thyrotropin
446.
This salivary gland that is situated on either side of the head in front of
ears:
A. Sublingual
B. Parotid
C. Buccal
D. Lingual
E. Submandibular
447.
448.
449.
Tooth mineralization includes 2 stages- formation of organic matrix and
calcification. In the first stage the most important role belongs to:
A. Enamel
B. Dentine
C. Cement
D. * Pulp
E. Periodontal tissues
450.
451.
Viscoelastic features of major matter of connective tissue are
conditioned mainly by:
A. * glycosaminoglycans
B. elastin
C. ATP
D. collagen
E. keratin
452.
Vitamin A play a general role in the folowing biochemical processes,
except:
A. * The transport of Ca2+ across certain membranes
B. Processes of growth and cell differentiation
C. Inhibits the oxidation of hemoglobin
D. Processes of glycoproteins formation
E. Reduces the disulfide bonds to sulfhydril bonds
453.
Vitamin A provides the synthesis of proteoglycans, formation of PAPS
as source for the synthesis of chondroitinsulfates, that why hypovitaminosis A
has all below mentioned consequences, except:
A. Decrease of activity of odontoblasts and fibroblasts
B. Disorders of calcification of enamel and dentine
C. * Decrease of salivation
D. Problems with teeth eruption
457.
458.
D. * Cementum
E. Enamel
463.
464.
Which of the following do you expect to see in a patient with metabolic
acidosis with no respiratory compensation?
A. Decrease of [H+] in blood
B. * Decrease of [HCO3-] in blood
C. Decrease of [H2CO3] in blood
D. Decrease of pCO2 in blood
E. Decrease of dissolved CO2 in blood
465.
466.
467.
Xerostomia is:
A. * Dry mouth syndrome
B. Lack of one tooth
C. Lack of two teeth
468.
A boy with congenital stenosis of pulmonary artery the dyspnea
increase during a walk, the cyanosis appears and he lost consciousness.
What is the basic mechanism development of this state?
A. * Acute brain hypoxia
B. Dilatation of peripheral vessels
C. Decrease of arterial pressure
D. Disorders of pulmonary ventilation
E. Disorders of gases diffusion in the lungs
469.
A human has an active expiration at the rest. What is the cause of this?
A. * Narrowing of respiratory tracts
B. Irritation of respiratory ways
C. Decrease of lung stretch
D. Negative intrapleural pressure
E. Irritation of intercostal muscles
470.
A miner has diagnosis pneumoconiosis. What non-respiratory
function of lungs is changed?
A. * Protective
B. Filtration
C. Excrection
D. Absorption
E. tabolic
471.
A patient has the atelectasis of lung with collapse of alveoli. What
factor is the most impotant in the pathogenesis of this disease?
A. * Defficiency of surfactant
B. Hyperventilation
C. Spasm of pulmonary vessels
D. Arterial hypertension
E. Respiratory acidosis
472.
A patient was poisoned by carbon monooxide. In how many times the
affinity for hemoglobin is higher than for oxygen?
A. * 300
B. 20
C. 15
D. 10
E. 5
473.
A patient with bronchial asthma has an acute respiratory insufficiency.
What type of breathing disorders is typical in this case?
A. * Obstructive disorders of alveolar ventilation
B. Restrictive disorders of alveolar ventilation
C. Perfusion
D. Diffusive
E. Disregulative disorders of alveolar ventilation
474.
A patient with the diagnosis of pneumoconiosis was hospitalized to
the clinic of professional diseases. The disorders of what component of the
external breathing is present in this patient?
A. * Depression diffusions of gases
B. Disorders ventilation of lungs
C. Disorders perfusion of lungs
D. Disorders the neural reguation of the external breathing
E. Disorders humoral regualtion of the external breathing
475.
A patiet with the penetrating wound of pectoral wall was hospitalized
to a clinic. What form disorders of the external breathing may develop in this
patient?
A. * Ventilative-restrictive
B. Obstructive
C. Primary-diskinetic
D. Difusion-restrictive
E. Difusion-pneumonosis
476.
A student executed intensive arbitrary hyperventilation. What changes
will be observed in his organism?
A. * Respiratory alcalosis
B. Respiratory acidosis
C. Hypoxemia
D. Hypercapnia
E. Hypoxemia and hypercapnia
477.
A woman has a bronchial asthma. What type of respiratory
insufficiency does she have?
A. * Obstructive
B. Restrictive
C. Pectoral
D. Abdominal
E. Mixed
478.
A woman has the attack of bronchial asthma with the bronchial spasm.
Activity what nerves nucleus is higter in this case?
A. * Vagus
B. Sympatethic
C. Gloso-faringeus
D. Trigeminus
E. Facialis
479.
A woman who inherits a pair of BRCA1 gene alleles has what chance for
developing breast cancer during her lifetime?
A. 0% chance
B. Approximately 50% chance
C. Approximately 100% chance
D. * Chance is the same as for the general population
480.
481.
An acute atelectasis of lungs developed in the newborn baby. What was
the most possible primary cause of this diseases?
A. * Absence of alveolar surfactant
B. Under-development of central nervous system
C. Increased aerodynamic resistance
D. Increased elastic resistance
E. Under-development respiratory muscles
482.
A. * Diminishes
B. Does not change
C. Rises
D. Grows
E. Become even
483.
484.
485.
486.
487.
C. Hypoxic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
488.
At anaemia is developed:
A. * Hemic hypoxia
B. Mixed hypoxia
C. Hypoxic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
489.
490.
491.
492.
At injection of sodium nitrite to the experimental frog colour of blood
will be:
A. * Dark red
B. Bright red
C. Green
D. Dark blue
E. Ordinary
493.
At injection to the experiment frog cyanic potassium the colour of
venous blood will be:
A. * Bright red
B. Dark red
C. Green
D. Dark blue
E. Ordinary
494.
At pneumonia is developed:
A. * Hypoxic hypoxia
B. Mixed hypoxia
C. Hemic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
495.
496.
497.
E. Formation carbhemoglobin
498.
499.
500.
501.
502.
Based on research findings, what preoperative factor is most likely to
result in increased postoperative pain?
A. Older age
B. * High anxiety
C. Smoking history
D. Presence of chronic pain
503.
Bradypnea it is:
505.
506.
507.
A patient with congenital stenosis of pulmonary artery the dyspnea
increase during a walk, the cyanosis appears and he lost consciousness.
What is the basic mechanism development of this state?
A. * Acute brain hypoxia
B. Dilatation of peripheral vessels
C. Decrease of arterial pressure
D. Disorders of pulmonary ventilation
E. Disorders of gases diffusion in the lungs
508.
B. Methemoglobin
C. Oxyhemoglobin
D. Carboxyhemoglobin
E. Carbhemoglobin
509.
510.
511.
512.
Deep and infrequent breathing, that is arose at stenosis of upper
respiratory ways is named:
A. * Stenotic
B. Bradypnea
C. Hypoxic
D. Apnea
E. Hyperpnea
513.
C. A ligament
D. * Skull bone
E. Lung
514.
515.
During auscultation of lungs wheeze are listened. What type of external
breathing disorders may be suspected in that patient?
A. * Obstructive
B. Primary-diskinetic
C. Ventilation-restrictivE)
D. Difusion-restrictive
E. Difusion-pneumonosis
516.
During climbing up to the mountains without oxygen bulbs in the
alpinists can develop:
A. * Hypoxic hypoxia
B. Mixed hypoxia
C. Hemic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
517.
During dehermetization of airplane at height 9000m in the passengers
will develop:
A. * Hypoxic hypoxia
B. Mixed hypoxia
C. Hemic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
518.
During the preoperative assessment, the client tells the nurse that he
has been taking NSAIDs for years. What question should the nurse ask the
client?
A. * When was the last time you took your NSAIDs?
B. Have you ever vomited blood?
C. Have you told the anesthesiologist that you are taking NSAIDs?
D. What is the dosage or how many tablets do you take every day?
519.
520.
521.
522.
523.
525.
For the improvement of the common status a patient with bronchial
asthma must breathe out:
A. * Slowly
B. Fast
C. Usually
D. Speed-up
E. Throug nose
526.
For what type of cancer should the nurse be prepared to administer
chemotherapy by the intrathecal route?
A. Lung tumor
B. * Brain tumor
C. Ovarian tumor
D. Prostate tumor
527.
How does residual volume change at the obstructive type of respiratory
insufficiency?
A. * Increase
B. Does not change
C. Decrease
D. Does not change or increase
E. Does not change
528.
529.
How does the vital capacity of lungs at the obstructive type of
pulmonary insufficiency change?
A. * Does not change or decrease
B. Increase
C. Decrease
D. Does not change or increase
E. Does not change
530.
How does the vital capacity of lungs at the restrictive type of
pulmonary insufficiency change?
A. * Decrease
B. Does not change or decrease
C. Increase
D. Does not change or increase
E. Does not change
531.
Hypercapnia it is:
A. * Increase of 2
B. Decrease of 2
C. Decrease of 2
D. Increase of 2
E. Increase of 2 and 2
532.
533.
Hyperpnea it is:
535.
Hypocapnia it is:
A. * Decrease of 2
B. Increase of 2
C. Decrease of 2
D. Increase of 2
E. Increase of 2 and 2
536.
Hypoxemia it is decrease :
A. * Contents of oxygen in a blood
B. Contents of oxygen in tissue
C. Alveolar ventilation
D. Contents of 2 in tissue
E. Contents of 2 in a blood
537.
538.
In a child is deficit of surfactant. What pathological changes in
pulmonary tissue as a result of absence this substance?
A. * Atelectasis
B. Emphysema
C. Bronchoconstriction
D. Edema
E. Limfostasis
539.
In a child with bronchial asthma an acute respiratory failure developed
due to asthmatic attack. The cause of this complication is disorders of:
A. * Alveolar ventilation
B. Alveolar blood circulation
C. Oxygen capacity of blood
D. Dissociation of oxyhemoglobin
E. Utilization of oxygen
540.
In a patient decrease activity of lung surfactant. What changes can be
expected in this patient?
A. * Tendency alveolus to collapse
B. Change elasticity of lung
C. Decrease tracheobronchial secret
D. Change diffusion of gases
E. Violation perfusion of lungs
541.
In a patient was diagnosed emphysema of lungs. What is the main
cause of this condition?
A. * The decrease elastic properties of lungs
B. Decrease alveolar ventilation
C. Decease extensibility of lungs
D. Decrease blood stream in lungs
E. Disorders ventilation-perfusion ratio
542.
In a patient with emphysema the functional status of the respiratory
system was examined The most typical changes characterized for this
disease?
A. * Increase remaining volume of lungs
B. Increase vital capacity of lungs
C. Increase reserve volume of inhalation
D. Decrease general capacity of lungs
E. Decrease reserve volume of inhalation
543.
A. * Hypoxic hypoxia
B. Mixed hypoxia
C. Hemic hypoxia
D. Circulatory hypoxia
E. Histotoxic hypoxia
544.
545.
In how many times the ability of 2 for diffusion through an alveolarcapillary membrane is higher, than that ability of oxygen?
A. * 25
B. 20
C. 15
D. 10
E. 5
546.
In premature new-born the syndrome of respiratory failure is often
developed What is the most possible reason of this disease?
A. * Insufficient quantity of surfactant
B. Prenatal asphyxia
C. Prenatal hypoxia
D. Swallowing of parafetus waters
E. Prenatal hypercapnia
547.
In which of the enumerated pathological processes you can determine
the obstructive form of external breathing disorders?
A. * Bronchial asthma
B. Opened pneumatothorax
C. Pneumonia
D. Pleurisy
E. Lung edema
548.
A. * Hypokinetic
B. Hypoxic
C. Hemic
D. Circulatory
E. Histotoxic
549.
550.
551.
Pathological process which develops as a result of low supply to tissues
of oxygen or violation of the use it by tissues is named:
A. * Hypoxia
B. Hypercapnia
C. Bradypnea
D. Tachypnea
E. Polypnea
552.
553.
A boys has poisoning of nitrites. What is a main mechanism in
pathogenesis of this disorders?
A. * Insufficiency of met-b-reductase
B. Insufficiency of superoxyddesmutase
C. Blocade of cytochromoxydase
D. Insufficiency of glutationperoxydase
E. Insufficiency of katalase
554.
555.
Retropharyngeal abscess was diagnosed in a patient H. What form of
respiratory insufficiency is present in this patient?
A. * Obstructive
B. Central
C. Periferal
D. Restrictive
E. Thoracic-diaphragmatic
556.
557.
State of organism, that is characterized by the decrease of
maintenance oxygen and increase of carbonic acid in blood and tissues is
named:
A. * Asphyxia
B. Hypercapnia
C. Hypoxia
D. Apnea
E. Hyperpnea
558.
Tachypnea it is:
560.
Temporal decrease of the maintenance 2 in blood and reflex
disorder of breathing will result in development:
A. * Apnea
B. Bradypnea
C. Hypoxia
D. Stenosis
E. Hyperpnea
561.
562.
is:
563.
A. Bacterial endocarditis
B. * Primary malignancy
C. Metastatic lung malignancy
D. Tuberculosis infection
E. No correct answer
564.
565.
566.
567.
568.
C. Mucin-containing vacuoles
D. Increased N:C ratio
E. No correct answer
569.
All of the following are normal cells seen in pleural fluid except:
A. Mesothelial cells
B. Neutrophils
C. Lymphocytes
D. * Mesothelioma cells
E. No correct answer
570.
An additional test performed on pleural fluid to classify the fluid as a
transudate or exudate is the:
A. WBC count
B. RBC count
C. * Fluid-to-cholesterol ratio
D. Fluid-toserum protein gradient
E. No correct answer
571.
572.
573.
D. Cirrhosis
E. No correct answer
574.
Chemical tests primarily performed on peritoneal fluid include all of the
following except:
A. * Lactose dehydrogenase
B. Glucose
C. Alkaline phosphatase
D. Amylase
E. No correct answer
575.
576.
577.
578.
Define, what pathologic state is characterized by the increasing of
creatine kinase activity in 2-3 hours from disease beginning , in 13-20 hours
exceeds a norm in 5 -10 times, normalizes on 2 - 3 days?
A. Lung infarction
B. * Myocardial infarction
C. Chronic heart failure
During normal production of serous fluid, the slight excess of fluid is:
A. * Absorbed by the lymphatic system
B. Absorbed through the visceral capillaries
C. Stored in the mesothelial cells
D. Metabolized by the mesothelial cells
E. No correct answer
581.
582.
Fluid-toserum protein and lactic dehydrogenase ratios are performed
on serous fluids:
A. When malignancy is suspected
B. * To classify transudates and exudates
C. To determine the type of serous fluid
D. When a traumatic tap has occurred
E. No correct answer
583.
E. Bronchial asthma
584.
In a patient with chronic bronchitis what consistency of sputum will be
found?
A. Viscous
B. Sticky
C. * Liquid
D. Gelatinous
E. Hard
585.
In case of patient with pulmonary hemorrhage, edema of the lungs.
What will be the consistency of the sputum?
A. * Liquid
B. Gelatinous
C. Sticky
D. Viscous
E. Hard
586.
587.
588.
Patient was admitted to the hospital with lobar pneumonia, what kind
of mucous will be found?
A. * Viscous
B. Liquid
C. Gelatinous
D. Sticky
E. Hard
589.
Patient was diagnosed with bronchial asthma, what kind of sputum will
be found?
A. Purulent
B. * Mucous
C. Bloody
D. Serous
E. Mucous-purulent
590.
591.
592.
593.
Serous fluids:
A. Are derived from serum
B. Provide lubrication and protection
C. Fill the potential space
D. * All of the above
E. A and B only
594.
Some of the tests performed on the pleural fluid to classify the fluid as
transudate or exhudate is:
A. WBC count
B. RBC count
C. Platelet count
D. * Fluid-to-cholesterol ratio
E. No correct answer
595.
596.
597.
598.
599.
The recommended test for determining if peritoneal fluid is a
transudate or an exudate is the:
A. Fluid-toserum albumin ratio
B. * Serum ascites albumin gradient
C. Fluid-toserum lactic dehydrogenase ratio
D. Absolute neutrophil count
E. No correct answer
600.
601.
602.
What is sputum?
A. A pathological substance secreted from the GIT
B. * A pathological secretion formed in case of respiratory diseases
C. Mucous secretion from the colon
D. Chemical substance which becomes mucous
E. An enzyme
603.
What is the amount of sputum secreted in case of acute bronchitis and
bronchial asthma?
A. 2 to 3 ml
B. * 200 to 300 ml
C. 300 to 500 ml
D. 50 to 100 ml
E. 10 to 25 ml
604.
A. At night
B. * Early morning before eating
C. After meal
D. Before meal
E. In the afternoon
605.
What is the character of the sputum in a patient with pulmonary
tuberculosis?
A. Mucous sputum
B. * Purulent sputum
C. Bloody sputum
D. Serous sputum
E. Purulent-mucous sputum
606.
607.
608.
609.
B. * Liquid
C. Gelatinous
D. Sticky
E. Hard
610.
611.
612.
613.
614.
D. Mucous sputum
E. Purulent-mucous sputum
615.
616.
617.
Which of the following appears in macroscopic examination of sputum
in case of bronchial asthma?
A. * Kurshmans spirals
B. Rice-like bodies
C. Koch lenses
D. Crystals of cholesterol
E. Ehrlich tetrads
618.
Which of the following appears in macroscopic examination of sputum
in case of pulmonary tuberculosis?
A. Kurshmans spirals
B. * Koch lenses
C. Elrich tetrasd
D. Mucous purulent bloody
E. Visceral membranes
619.
Which of the following appears in microscopic examination of sputum
in the case chronic bronchitis?
A. * Alveolar macrophages and leukocytes
B. Eosinophils
C. Charcot-leyden crystals
621.
622.
623.
624.
____________ is hydrolytically cleaved to directly yield urea in the urea
cycle.
A. ornithine
B. glutamate
C. * arginine
D. carbamoyl phosphate
E. None of the above
625.
626.
627.
A hyperketonemic coma developed in a patient with diabetes mellitus.
What type violation of acid-basic balance he has?
A. * Metabolic acidosis
B. Exogenous acidosis
C. Respiratory acidosis
D. Respiratory alkalosis
E. Not respiratory alkalosis
628.
629.
A man has chronic glomerulonephritis. In the examination in him
absence of appetite, vomiting, diarrhea, itch of skin, anemia. Contents of
residual nitrogen of blood - 43 mmol/l. The indicated signs are caused:
A. * Disorder of secretory function of nephron
B. Increase of permeability of glomerular filter
C. Ischemia of kidneys
D. Disorder of resorption of bicarbonates
E. Disorder of concentrating mechanism
630.
A man with a chronic pyelonephritis has arterial hypertension. What did
cause this phenomenon?
A. * Activation of renin-angiotensin system
B. Activation of central cholinergic mechanism
C. Decrease of partial pressure of oxygen in kidney
D. Activation of angiotensinase synthesis in kidney
E. Activation of acidogenesis and ammoniagenesis in kidneys
631.
A patient complaints of permanent thirst, polyuria (to 10 l per day).He
carried a cranio-cerebral trauma earlier. Relative density of urine -1008,
pathological components are not present. The secretion of what hormone is
disordered in this case?
A. * Deficient of antidiuretic hormone synthesis
B. Increase of antidiuretic hormone production
C. Deficient of insulin synthesis
D. Hyperproduction of aldosterone
E. Deficient of aldosterone synthesis
632.
A patient entered to the department of resuscitation. Arterial pressure
90/60 mm Hg, in a blood high maintenance of creatinine and urea, day's
diuresis 80 ml. In him:
A. * Anuria
B. Olyguria
C. Polyuria
D. Pollakiuria
E. Nycturia
633.
A patient had anuria. The arterial pressure - 55/20 mm Hg. Disorder of
what process of uropoiesis became the cause of acute decrease of urine
passage?
A. * Glomerular filtrations
B. Obligate resorption
C. Facultative resorption
D. Tubular secretion
E. All enumerated processes
634.
A patient has a bleeding gastric ulcer. Arterial pressure 80/60 mm Hg
He excretes 60-80 ml urine on days. The amount of residual nitrogen and
urea is increased in plasma of blood. What main mechanism of falling of day's
diuresis?
A. * Decrease hydrostatic pressure in the nephron capillaries
B. Increase of urine osmotic pressure
C. High level of nitrogen in blood
D. Increase of colloid-osmotic pressure in blood
E. Increase of renal pressure
635.
A patient has chronic glomerulonephritis, glomerular filtration rate is
reduced to 20% from normal. What is the principal cause of the decline of
glomerular filtration in this case?
A. * Decrease amounts of functioning nephrons
B. Tubulopathy
C. Obstruction of urinary tract
D. Ischemia of kidneys
E. Thrombosis of kidney arteries
636.
A patient has complaints of great pains in a lumbar area, increase of
temperature to 39 C. At examination was observed: positive symptom
Pastepnatsky. There is leukocytosis , ESR is raised. In urine: albumen 0,039
, leucocytes 250-300 in field of view, red corpuscles 8-10 in field of view,
mucus +++, bacterias +++. What does disease in the patient ?
A. * Acute pyelonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Nephrolithiasis
E. Chronic kidney insufficiency
637.
A patient has diabetic nephropathy with development of
uremia.Glomerular filtration rate - 9 ml/min. What main mechanism of
decreasing of glomerular filtration rate?
A. * Decrease of functioning nephrons amount
B. Decrease of systemic arterial pressure
C. Occlusion of tubules
D. Development of acidosis in tissues
E. Spasm of afferent glomerular arteriole
638.
A patient has lumbodynia, increase of temperature to 39C. Positive
Pasternatskys symptom on the other side, Hb - 115 g/l, leukocyturia. What is
disease in this patient?
A. * Acute pyelonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Nephrolithiasis
E. Chronic kidney insufficiency
639.
A patient who had frequent protracted quinsy in anamnesis complained
of periodic headache, rapid tiredness, periorbital edema. Clinicodiagnostic
researches was revealed arterial hypertension, proteinuria , hypoproteinemia,
hyperlipidemia. What disease is most likely in this case?
A. * Chronic glomerulonephritis
B. Acute pyelonephritis
C. Chronic pyelonephritis
D. Lipoid nephrosis
E. Acute kidney insufficiency
640.
A patient with arterial hypertension used furosemyd. In the next time in
him arose general weakness, loss of appetite, palpitation, lower of blood
pressure and intestine peristaltic . The cause of such change can be
A. * Hypokalemia
B. Hyponatremia
C. Hyperuricemia
D. Hypercalcemia
E. Hyperkalemia
641.
A patient with chronic glomerulonephritis has edemas. What is cause of
their development?
A. * Proteinuria
B. Disorder of liver functions
C. Hyperosmolarity of plasma
D. Hyperaldosteronism
E. Hyperproduction of vasopressin
642.
A patient with chronic kidney insufficiency has the dyspepsia,
irrepressible itch of skin, general weakness, smell of ammonia and greyearthy tint of skin. These symptoms are characterized for
A. * Decrease of excretion products of nitrogenous metabolism
B. Disorder of water-electrolyte metabolism
C. Disorder acid-basic balance
645.
646.
647.
649.
650.
651.
652.
653.
655.
656.
657.
As a result of starvation ascites developed in a child. What mechanism
of it development?
A. * Decrease of oncotic pressure
B. Membranogenic
C. Disregulatory
D. Lymphogenic
E. Hyperosmolar
658.
As a result of the frequent vomiting the pregnant lost the gastric juice.
What disorder of acid-basic balance can be in her?
A. * Metabolic alkalosis
B. Respiratory acidosis
C. Not respiratory acidosis
D. Respiratory alkalosis
E. Metabolic acidosis
659.
At a biochemical inspection of a patient were found a hyperglycemia,
glucosuria, high urines density, in blood found - enhanceable amount of
glucocorticoids. At the same time in blood and urine found excess of 17
ketosteroids. What type of diabetes developed:
A. * Steroid diabetes
B. Diabetes Mellitus, the I type
C. Diabetes Mellitus , the II type
D. Kidney diabetes
E. Hepatic diabetes
660.
661.
At the top of mountain respiratory alkalosis developed in the alpinists.
What level of the tension 2 is possible in his arterial blood?
A. * 30 mm Hg
B. 40 mm Hg
C. 50 mm Hg
D. 60 mm Hg
E. 70 mm Hg
662.
663.
A. Pyelonephritis
B. Diabetes mellitus
C. * Hemolytic anemia
D. Acute nephritis
E. Diabetes insipidus
664.
665.
666.
667.
668.
Benedicts test is less likely to give weakly positive results with
concentrated urine due to the action of
A. Urea
B. * Uric acid
C. Ammonium salts
D. Phosphates
E. All of these
669.
Benzoic acid in the organism is transformed to hypuric acid (Quick's
test). Name the compound it connects with:
A. * glycine
B. glycocol
C. valine
D. alanine
E. threonine
670.
By what method is conducted quantitative determination of glucose in
urine?
A. Felling
B. Roberts - Stolnikov
C. Gmelin and Rosenbakh
D. * Altgauzen
E. Salkovskiy
671.
By what test is conducted quantitative determination of proteins in
urine?
A. Altgauzen
B. * Roberts Stolnikov
C. Gmelin and Rosenbakh
D. Felling
E. Salkovskiy
672.
Cardiogenic shock in a patient was complicated by metabolic acidosis.
What compensatory mechanism it?
A. * Alveolar hyperventilation
B. Alveolar hypoventilation
C. Decrease ammoniagenesis in kidneys
D. Decrease of resorption of hydrogen carbonate in kidneys
E. Decrease acidogenesis in kidneys
673.
B. 1015 - 1012
C. 1011 - 1013
D. 1004 - 1010
E. 1010 - 1016
674.
675.
676.
Chronic insufficiency of kidneys developed in a patient with chronic
diffuse glomerulonephritis. In the terminal stage of chronic kidney
insufficiency olygo- and anuria developed. What is cause of disorders:
A. * Decrease of functioning nephron amount
B. Ischemia of kidney cortex
C. Decrease of filtration pressure
D. Increase of resorption of water in tubule
E. Spasm of afferent glomerular arteriole
677.
678.
C. 50-100
D. 1-10
E. 2-6
679.
680.
681.
682.
683.
E. 20 35 g
684.
685.
686.
Determination of which products in urine is important for the
estimation of adrenal cortex function?
A. * 17-ketosteroids
B. Cholesterol
C. Cyclopentanoperhydrophenantren
D. Ketone bodies
E. Lanosterol
687.
Development of nephrotic syndrome is conditioned by immune
mechanisms. Antibodies that appear in reply to exogenous and endogenous
antigens belong to the class:
A. * Ig M or Ig G
B. Ig A or Ig M
C. Ig G or Ig A
D. Ig E or Ig G
E. Ig D or Ig E
688.
E. Respiratory chain
689.
690.
For a patient was found the increase of maintenance of urea and
creatinine in blood and diminishing in urine. What are possible reasons of
such state?
A. Main reason of such state it is disorder of detoxification, transport and
excretion of ammonia with urine
B. Main reason is a disease of liver
C. Such state appears at the disease of muscles
D. * Diseases which result in insufficiency of kidneys
E. Such state appears as a result of disorder of acid-base balance in an
organism
691.
For diagnostic of acute inflammatory process in kidneys was conducted
a specific test - determination of such substance in urine:
A. Content of lactose
B. Activity of creatinkinase
C. Concentrations of creatin
D. Activity of pepsin
E. * Activity of alanine amino peptidase
692.
For the patient in the preceding question, what is the most appropriate
treatment?
A. Magnesium oxide supplementation
B. * Potassium phosphate supplementation
C. Reduction of levothyroxine dose
D. Daily use of a tranquilizer
693.
For the patient in the preceding question, what is the most appropriate
treatment?
A. Magnesium oxide supplementation
B. * Potassium phosphate supplementation
C. Reduction of levothyroxine dose
696.
697.
For what disease is the most proper urine with low density?
A. Itchenko - Cushing
B. Addison disease
C. * Diabetes insipidus
D. Diabetes mellitus
E. Chronic pyelonephritis
698.
For what disease is the most proper urine with low density?
A. Itchenko - Cushing
B. Addison disease
C. * Diabetes insipidus
D. Diabetes mellitus
E. Chronic pyelonephritis
699.
Fresh erythrocytes are found in urine of a patient. What pathology it is
most characterized for?
A. * Nephrolithiasis
B. Acute diffuse glomerulonephritis
C. Chronic diffuse glomerulonephritis
D. Nephrotoxic syndrome
E. Acute kidney insufficiency
700.
Glomerular filtrate it is a:
A. Whole blood
B. Blood plasma with a proteins
C. * Blood plasma without any proteins
D. Blood plasma without glucose
E. Blood plasma without glucose and proteins
701.
702.
703.
704.
A. Acute glomerulonephritis
B. Cancer of urinary tract
C. Stone in urinary tract
D. * Mismatched blood transfusion
E. Both C and D
705.
706.
707.
708.
709.
C. Anuria
D. Nicturia
E. Polyuria
710.
711.
712.
713.
714.
E. * Poliuria
715.
How long do kidneys need for proceeding of imbalanced acid-base
state?
A. 30 sec. 1 minutes
B. 1 3 minutes
C. * 10 - 20 hours
D. 5 10 minutes
E. 1 - 2 hours
716.
How many ascorbic acid in normal condition is excreted per day with
urine:
A. * 20-30 mg
B. 113,5-170,5 mg
C. 10-28 g
D. 80-100 mg
E. 18-33 g
717.
How many ascorbic acid in normal condition is excreted per day with
urine:
A. * 20-30 mg
B. 113,5-170,5 mg
C. 10-28 g
D. 80-100 mg
E. 18-33 g
718.
How many grammes of potassium are contained in daily urine of
healthy adult?
A. * 2 5 g
B. 0,5 1,5 g
C. 2 3 g
D. 1,5 3,5 g
E. 0,1 0,5 g
719.
How many grammes of proteins can lose with urine patients with a
glomerulonephritis daily?
A. 100
B. 50
C. 60 -70
D. * 20 - 40
E. 120 - 150
720.
721.
How much time do kidneys need for proceeding of imbalanced acidbase state?
A. 30 sec. 1 minutes
B. 1 3 minutes
C. * 10 - 20 hours
D. 5 10 minutes
E. 1 - 2 hours
722.
In a addict as a result of oppression respiratory center due to
overdosing of drugs appeared disorder acid-basic balance, namely:
A. * Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
E. Mixed acidosis
723.
In a child a weakness, hypodynamia appeared as a result of protracted
diarrhea. What form of disorder of acid-basic balance will be in this case?
A. * Metabolic acidosis
B. Excretory acidosis
C. Metabolic alkalosis
D. Exogenous anrespiratory acidosis
E. Respiratory alkalosis
724.
In a child for 2 weeks after the carried tonsillitis developed acute
diffuse glomerulonephritis, which was characterized by oliguria, proteinuria,
hematuria, hyperazotemia, edema. What function of kidneys is desordered?
A. * Glomerular filtration
B. Tubular resorption
C. Tubular secretion
D. Depressive function
E. Incretory function
725.
In a child the foreign body of larynges. What disorders of acid-basic
balance can be observed in this case?
A. * Respiratory acidosis
B. Metabolic acidosis with the raised anionic difference
C. Metabolic alkalosis
D. Respiratory alkalosis
E. Metabolic acidosis with normal anionic difference
726.
In a man during starvation the edema on lower extremities, ascites
developed. What factor is main in pathogeny of edema in this case?
A. * Decrease of blood oncotic pressures
B. Increase of blood hydrostatic pressure
C. Increase of oncotic pressures of intercellular liquid
D. Increase of permeability of vascular wall
E. Disorder of lymphokinesis
727.
In a neonate with pylorostenosis there is the frequent vomiting. What
form of disorder of acid-basic balance will be in the child ?
A. * Not respiratory alkalosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
E. Excretory acidosis
728.
729.
In a patient acute glomerulonephritis the defeat basic membrane of
kidney nephrons on the allergy mechanism
A. * Immune complex type
B. Stimulating type
C. T-lymphocytic type
D. B-lymphocytic type
E. Delayed-type hypersensitivity
730.
In a patient acute kidney insufficiency with the anuria, uremia and
necrosis of renal cortical lobule kidneys developed as a result of the
pathogenic effect of unknown substance. What substance could be cause
such defeat of kidneys?
A. * Mercuric chloride
B. Ethanol
C. Vicasol
D. Penicillin
E. Casein
731.
732.
In a patient anuria developed with acute kidney insufficiency (day's
diuresis - 30 ml). What the basis mechanism of development in this case?
A. * Decrease glomerular filtration
B. Increase resorption of sodium
C. Violation of urine passage
D. Violation of kidney blood circulation
E. Increase resorption of water
733.
In a patient as a result of considerable blood loss (35 % volume) anuria
occur. What leading mechanism of its development in this case?
A. * Decrease of hydrostatical pressure on the wall of capillaries
B. Increase of oncotic pressures of blood
C. Increase of renal pressure
D. Decrease of functioning nephrons
E. Decrease of renal pressure
734.
In a patient diagnosed acute glomerulonephritis. What is basic
mechanism of anemia developmentat this disease
743.
In a patient is chronic kidney insufficiency. What mass of functioning
nephron likely in these kidneys
A. * 10-30 %
B. 5-10 %
C. 30-50 %
D. 50-70 %
E. 70-90 %
744.
In a patient is determined in urine sugar. The table of glucose contents
in a blood corresponds to the norm. What is mechanism of glucosuria in this
case?
A. * Disorder of glucose resorption in nephron tubule
B. Insulin insufficiency
C. Hyperfunction of adrenals
D. Hyperfunction of thyroid gland
E. Hyperfunction of adrenal cortex
745.
In a patient is edema, at the examination proteinuria, arterial
hypertensionis, hypoproteinemia, hyperlipemia occur. How this syndrome is
named?
A. * Nephrotic
B. Anemic
C. Hypertensive
D. Thyrotoxic
E. Hypothyroid
746.
In a patient is general weakness, pain in the area of kidneys, edema of
face. In research of urine expressed proteinuria, hematuria, cylindruria was
revealed. What from enumerated is the leading pathogenetic mechanism of
edema development?
A. * Decrease of blood oncotic pressures
B. Increase of vascular permeability
C. Increase of hydrodynamic pressure of blood
D. Disorder of hormonal balance
E. Disorder of lymphokinesis
747.
In a patient is substantial decrease of kidney ability to osmotic
concentration of urine. How this disorder is named?
A. * Isohyposthenuria
B. Proteinuria
C. Hematuria
D. Cylinderuria
E. Leukocyturia
748.
In a patient occur disorders of sodium ions , glucose, amino acid,
hydrogen carbonate, phosphates resorption. For the damage of what part of
nephron it is characterized?
A. * Proximal tubule
B. Distal tubule
C. Henles loop
D. Collecting tubule
E. Connective segment
749.
In a patient pain in a lumbar part , sickly and frequent urination,
increased temperature of body to 39 C. In laboratory research of blood leukocytosis and ESR acceleration occur, at research of urine leukocyturia,
proteinuria, bakteriauria. What disease the most likely in this case?
A. * Pyelonephritis
B. Adnexitis
C. Urolithiasis
D. Glomerulonephritis
E. Radiculitis
750.
In a patient proteinuria (4,5 g/l), hematuria with the lixiviated
erythrocytes occur. What function of kidneys is disordered?
A. * Disorder of nephron permeability
B. Extrarenal disorders
C. Disorder of tubular resorption
D. Disorder of nephron secretion
E. Disorder of tubular secretion
751.
In a patient the edema of face appeared after a streptococcus
tonsillitis, arterial pressure increased. In the analysis of urine - hematuria and
proteinuria. Antistreptococcus antibodies and decrease of blood complement
components occur in blood. What part of kidney the most likely localization of
immune complexes in?
A. * Glomerules
B. Henles loop
C. Proximal part of tubule
D. Pyramids
D. Pollakiuria
E. Hematuria
766.
In a patient with complaints of increased temperature, pain in area of
kidneys, frequent and sickly urination, acute pyelonephritis is diagnosed.
What factor is cause of illness?
A. * Colon bacillus
B. Staphylococcus
C. Streptococci
D. Brucelus
E. Anaerobic flora
767.
In a patient with diabetes mellitus as a result of accumulation ?oxybutteric and acetoacetic acids there was disordered of acid-basic balance
which is named
A. * Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Mixed acidosis
E. Not respiratory alkalosis
768.
as
769.
In the urine of a patient with liver disease is absent urobilinogen. It is
connected with the affection of:
A. stercobilin formation
B. * direct bilirubin formation
C. kidneys function
D. transformation of bilirubin in the intestine
E. bile passage to the intestine
770.
772.
Ketoacidosis refers to the metabolic acidosis caused by the
overproduction of ketoacids. The classic form of ketoacidosis is uncontrolled
diabetes mellitus. All of the following would occur in a patient suffering from
a diabetes-induced metabolic acidosis (diabetic ketoacidosis) EXCEPT:
A. Deep, rapid breathing causes a decrease in the partial pressure of
carbon dioxide (PaCO2) in the blood.
B. The removal of carbon dioxide through deep, rapid breathing results in
a rise in the blood pH
C. When endogenous acid production rises sharply, net acid excretion
cannot keep pace and the bicarbonate lost in buffering is not replaced
causing plasma HCO3- levels to fall
D. * Serum bicarbonate levels will decrease after the administration of an
insulin injection
E. The fall in insulin causes fat cells to liberate fatty acids, which flood the
hepatocytes
773.
Laboratory test of a patients urine with intestines dysbacteriosis
established the increase of indican. It testifies:
A. kidney disease
B. * normal neutralization liver function
C. increased fat hydrolysis
D. liver malfunction
E. vitamins F hypovitaminosis
774.
776.
777.
778.
779.
Postoperatively, the preceding patient develops a fever, and pyuria is
noted. Laboratory studies show a leukocyte count of 12,000/?L, a blood urea
nitrogen level of 24 mg/dL, and a serum creatinine concentration of 1.4
mg/dL. The urine culture grows Escherichia coli, and treatment with
trimethoprim-sulfamethoxazole is started. Three days later, the pyuria and
fever have resolved. The leukocyte count is 10,000/?L, blood urea nitrogen
level is 24, serum creatinine is 1.8 mg/dL. Urinalysis shows no leukocytes in
high-power fields. What is the most likely explanation for the elevated serum
creatinine concentration?
A. Acute interstitial nephritis
B. Acute pyelonephritis
C. Obstructive uropathy
D. * Reduced creatinine excretion
E. Acute tubular necrosis
780.
Postoperatively, the preceding patient develops a fever, and pyuria is
noted. Laboratory studies show a leukocyte count of 12,000/?L, a blood urea
nitrogen level of 24 mg/dL, and a serum creatinine concentration of 1.4
mg/dL. The urine culture grows Escherichia coli, and treatment with
trimethoprim-sulfamethoxazole is started. Three days later, the pyuria and
fever have resolved. The leukocyte count is 10,000/?L, blood urea nitrogen
level is 24, serum creatinine is 1.8 mg/dL. Urinalysis shows no leukocytes in
high-power fields. What is the most likely explanation for the elevated serum
creatinine concentration?
A. Acute interstitial nephritis
B. Acute pyelonephritis
C. Obstructive uropathy
D. * Reduced creatinine excretion
E. Acute tubular necrosis
781.
Postoperatively, the preceding patient develops a fever, and pyuria is
noted. Laboratory studies show a leukocyte count of 12,000/?L, a blood urea
nitrogen level of 24 mg/dL, and a serum creatinine concentration of 1.4
mg/dL. The urine culture grows Escherichia coli, and treatment with
trimethoprim-sulfamethoxazole is started. Three days later, the pyuria and
fever have resolved. The leukocyte count is 10,000/?L, blood urea nitrogen
level is 24, serum creatinine is 1.8 mg/dL. Urinalysis shows no leukocytes in
high-power fields. What is the most likely explanation for the elevated serum
creatinine concentration?
A. Acute interstitial nephritis
B. Acute pyelonephritis
C. Obstructive uropathy
D. * Reduced creatinine excretion
E. Acute tubular necrosis
782.
Resorption of sodium ions in kidney tubule occur in the use of salt
water. What compensatory changes of hormones secretion will arise in that?
A. * Decrease of aldosterone excretion
B. Decrease of vasopressin excretion
784.
785.
Sinus tachycardia and extrasystole in a patient was caused by
diuretics. What from enumerateded is the most likely cause of this
complication?
A. * Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hyponatremia
E. Hypovolemia
786.
Syndrome of Lesch-Nyhan hard hyperuricemia is the genetic
deficiency of such enzyme:
A. Xantine oxidase
B. Adenosine deaminase
C. Hypoxanthine oxidase
D. Phosphorylase
E. * Hypoxanthine guanine phosphoribosyltransferase
787.
The active form of vitamin D (1,25-dihydrocholecalciferol) maintain in
an organism a constant level of:
A. Potassium and phosphorus
B. * Calcium and phosphorus
The amino acid which detoxicated benzoic acid to form hippuric acid is
A. * Glycine
B. Alanine
C. Serine
D. Glutamic acid
E. Tyrosine
789.
The amount of urea in patient's urine is normal. Which of the listed
indexes are true in this case?
A. 10-15 g
B. 20-40 g
C. 10-35 g
D. * 25-30 g
E. 50-60 g
790.
The changes in kidneys at the glomerulonephritis as a result of damage
basic membrane
A. * Antibodies and immune complexes
B. Bacterium
C. Bacterial toxins
D. Biological active substance
E. Products of nitrogen metabolism
791.
The concentration of what substance does increase in the blood at
disorders of excretory function of kidneys?
A. Uric acid and creatinine
B. * Creatinine and urea
C. Creatinine and creatin
D. Creatinine and indican
E. Uric acid and indican
792.
C. Melatonin
D. * Gomogentisic acid
E. Erythropoietin
793.
794.
The excretion of chlorides with urine decreases at all of the followings
states, except:
A. Vomiting
B. Diabetes insipidus
C. Diarrhea
D. * Addison disease
E. Icenko Cushing disease
795.
The hyperthermia causes the considerable increase of breathing rate.
What type of water-electrolyte balance disorder arose in that case?
A. * Dehydration hyperosmolar
B. Dehydration hypoosmolar
C. Dehydration isoosmolar
D. Hyperhydration isoosmolar
E. Hyperhydration hyperosmolar
796.
The indexes of acid-basic balance in plasma of a patient blood are: pH
7,33, concentration 3 15 mmol/l (norm 21-25 mmol/l); 2 49
mm Hg (norm 35-45 mm Hg). He has
A. * Mixed acidosis
B. Decompensated metabolic acidosis
C. Decompensated respiratory acidosis
D. Compensated metabolic acidosis
E. Metabolic and respiratory y alkalosis
797.
The insufficient production of mineralocorticoids (Addison diseases,
bronze diseases) is accompanied with muscle weakness. This is explained by
the excretion with urine increased amount of ions of:
A. * Na+
B. K+
C. H+
D. Ca2+
E. Mg2+
798.
799.
800.
801.
The lixiviated erythrocytes are found in day's urine of patient. For what
pathology of kidneys the most characterized this symptom?
A. * Diffuse glomerulonephritis
B. Urethritis
C. Nephrolithiasis
D. Acute pyelonephritis
E. Chronic pyelonephritis
802.
804.
805.
The massive crush of soft tissues caused appearance in the patient of
oliguria, hyposthenuria, proteinuria, myoglobinuria, hyperkalemia,
hyponatremia. What main mechanism of kidney function disorder in this
case?
A. * Development of toxemia
B. Painful stimulation
C. Stimulation of sympathetic nervous system
D. Catecholamine release
E. Protein loss
806.
The most dangerous for life such effect of acute kidney insufficiency:
A. Overhydratation
B. Hypokaliemia
C. Hypermagniyemia
D. * Hyperkaliemia
E. Hyperkal'ciemia
807.
The nephrotoxic serum of guinea-pig was entered to the rabbit. What
disease of man was designed in this experience?
A. * Diffuse glomerulonephritis
B. Nephrotoxic syndrome
C. Acute pyelonephritis
D. Chronic kidney insufficiency
E. Chronic pyelonephritis
808.
The normal organic components of urine are all of the followings,
except:
A. Urea
B. Hyaluronic acid
C. * Glucose
D. Uric acid
E. Creatinine
809.
810.
The polysaccharide used in assessing the glomerular fittration rate
(GFR) is
A. Glycogen
B. Agar
C. * Inulin
D. Hyaluronic acid
E. All of these
811.
812.
The preceding patient is given intravenous infusion of 0.9% normal
saline at 200 mLIh. Two days later, his flank pain worsens dramatically, but
nausea and vomiting have resolved. Blood pressure and pulse rate are
unchanged. Laboratory studies: Blood urea nitrogen 8 mg/dL Serum
creatinine 0.9 mg/dL Serum potassium 4.0 meq/L Serum chloride 105 meq/L
Serum bicarbonate 22 meq/L Arterial blood gases pH 7.48, PCO2 30 mm Hg
What is the best therapy to resolve the alkalemia?
A. Increase infusion of 0.9% normal saline to 300 mL/h
B. * Control the flank pain
C. Start treatment with acetazolamide, 125mg twice daily
D. Administer lactated Ringers solution at 200 mL/h
813.
The protracted starvation of experimental animals results in
development of edema. What possible mechanism of this process?
A. * Decrease of oncotic pressures plasma of blood
B. Decrease of sodium resorption in kidneys
C. Increase of filtration pressure in the capillaries of tissues
D. Increase of renin secretion
E. Decrease of albumen resorption in tubule
814.
815.
There is disorder of excretory kidneys function - oligo-anuria in the
stage of acute kidney insufficiency. Specify the main characterized index of
this phenomenon?
A. * Azotemia
B. Decrease of hematocrit
C. Decrease of arterial pressure
D. Hypokalemia
E. Hyponatremia
816.
There is proteinuria as a result of kidney illness. What the most likely
mechanism of this phenomenon?
A. * Damage of glomerular membranes
B. Increase of renin secretion
C. Increase of muscles tone
D. Increase of protein synthesis in a liver
C. Allergic edema
D. Cachectic edema
E. Kidney edema
822.
Weight of the patient - 56 kg, hematocrit - 0,55 , concentration of
sodium in the blood - 152 mmol/l (norm 135-145 mmol/l), potassium - 5,9
mmol/l, hemoglobin - 100 g/l. What from the resulted indexes testifies of
hyperosmolar dehydration?
A. * Concentration of sodium
B. Hematocrit
C. Concentration of potassium
D. Weight of body
E. Level of hemoglobin
823.
Weight of the patient - 69 kg, hematocrit - 0,59 , concentration of
sodium in the blood -142 mmol/l (norm 135-145 mmol/l), to potassium - 5,0
mmol/l. What type of water-salt balance disorder in the man?
A. * Isoosmolar dehydration
B. Hypoosmolar dehydration
C. Hypoosmolar hyperhydration
D. Hyperosmolar hyperhydration
E. Hyperosmolar dehydration
824.
Weight of the patient -56 kg, hematocrit - 0,55 , concentration of
sodium in the blood -142 mmol/l, potassium - 3,9 mmol/l, hemoglobin - 100
g/l. What from the resulted indexes suggests an idea about dehydration?
A. * Hematocrit
B. Concentration of sodium
C. Concentration of potassium
D. Weight of body
E. Hemoglobin
825.
Weight of the patient -65 kg, hematocrit - 0,59 , concentration of
sodium in blood -150 mmol/l (norm 135-145 mmol/l), potassium - 6,0 mmol/l.
What type of water-salt balance disorder in a man?
A. * Hyperosmolar dehydration
B. Hypoosmolar dehydration
C. Hypoosmolar hyperhydration
D. Hyperosmolar hyperhydration
E. Isoosmolar dehydration
826.
Weight of the patient -75 kg, hematocrit - 0,58 , concentration of
sodium in the blood -130 mmol/l (norm 135-145 mmol/l), potassium - 3,0
mmol/l. What type of water-salt balance disorder in a man?
A. * Hypoosmolar dehydration
B. Hyperosmolar dehydration
C. Hypoosmolar hyperhydration
D. Hyperosmolar hyperhydration
E. Isoosmolar dehydration
827.
What disorder of water-electrolyte metabolism the most probably
arises at burn disease?
A. * Isoosmolar dehydration
B. Hypoosmolar dehydration
C. Hyperosmolar dehydration
D. Hyperosmolar hyperhydration
E. Hypoosmolar hypohydration
828.
What form disorder of acid-basic balance develops in a patient with
kidney insufficiency?
A. * Renal azotemic acidosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosis
E. Respiratory alkalosis
829.
What from disorders of water-salt balance in a human will develop in
use of salt water?
A. * Hyperosmolar hyperhydration
B. Isoosmolar hyperhydration
C. Hyposmolar hyperhydration
D. Hyperosmolar dehydration
E. Hypoosmolar dehydration
830.
What from pathogenetic factors is main in the mechanism of edema
development at a nephrotic syndrome?
A. * Decrease of oncotic pressures blood plasma
B. Increase of capillar permeability
C. Increase of hydrostatic pressure in capillaries
833.
834.
835.
What is the most appropriate initial treatment for a patient with a
nonobstructing radiolucent stone in the right renal pelvis?
A. Hydrochlorothiazide
B. * Low-sodium diet
C. Allopurinol
D. Oral sodium bicarbonate or potassium citrate
840.
E. * Intravenous acyclovir
841.
What is the most important next step in confirming the diagnosis of the
decreased renal function in the preceding patient?
A. * Serum and urine protein immunoelectrophoresis
B. Measurement of circulating 25-hydroxycholecalciferol level
C. Measurement of angiotensin-converting enzyme level
D. Measurement of N-terminal parathyroid hormone level
E. Urine toxicology screen
842.
What is the most important next step in confirming the diagnosis of the
decreased renal function in the preceding patient?
A. * Serum and urine protein immunoelectrophoresis
B. Measurement of circulating 25-hydroxycholecalciferol level
C. Measurement of angiotensin-converting enzyme level
D. Measurement of N-terminal parathyroid hormone level
E. Urine toxicology screen
843.
844.
845.
846.
847.
848.
849.
850.
What method of research is characterized concentration property of
kidneys?
A. Creatinine of blood
B. * Zimnitskiys test
C. Glomerular filtration
D. Electrolytes of blood
E. All of the above
851.
What origin albumen,the most likely at selective proteinuria of intensity
11 g/day?
A. * Tubular
B. Suprarenal
C. Glomerular
D. Urethral
E. From an urinary bladder
852.
?What pathology is developed in the absence of phenylalanine 4monooxygenase?
A. * Phenylketonuria.
B. Alkaptonuria
C. Galactosemia.
D. Hyperglycemia.
E. Achilia
853.
854.
855.
What type disorder of general blood volume will develop in a patient at
the decrease of kidney excretory function?
A. * Oligocythemic hypervolemia
B. Polycythemic hypovolemia
C. Oligocythemic hypovolemia
D. Polycythemic hypervolemia
E. Simple hypervolemia
856.
What type of edema can develop at the starvation in the stage of
disintegration and utilization of own albumens?
A. * Cachectic
B. Inflammatory
C. Allergic
D. Toxic
E. Lymphogenous
857.
What type of water-mineral metabolism disorder will develop in a
patient with the hypophysial form of diabetes mellitus?
A. * Dehydration hyperosmolar
B. Dehydration hypoosmolar
C. Dehydration isoosmolar
D. Hyperhydration hypoosmolar
E. Hyperhydration hyperosmolar
858.
Which hormone increases sodium and water reabsorption by renal
tubule cells:
A. A.Oxytocine
B. Aldosterone
C. Vasopressin
D. Prolactin
E. Cortisol
859.
860.
861.
B. insulin
C. foliculin
D. * aldosterone
E. vasopressin
862.
863.
864.
865.
866.
868.
You see the preceding patient again in your office 4 months later. He
read in the newspaper about a medicine that prevents diabetic kidney
disease and stroke. Urinalysis by dipstick is negative for protein. What is the
best test to evaluate the patients risk for diabetic nephropathy and
cardiovascular disease?
A. * Microalbumin-to-creatinine ratio
B. Serum protein electrophoresis
C. Urine amino acid levels
D. 24-hour urine total protein
E. Annual urine dipstick analysis
Situation task
1.
54-year-old man status prostaortic value replacement complains of
fatigue, palpitations, tachypnea on exertion, insomnia. On examination,
jaundice is present. Which type of anemia is in this patient?
A. Iron deficiency anemia
B. Megaloblastic anemia
C. Hemolytic anemia
D. Folic acid deficiency anemia
E. * B12 vitamin deficiency anemia
2.
A 46 years old woman complains of weakness, malaise, anorexia,
fever, dental bleeding. Spleen, liver, and lymphatic nodes are enlarged,
petechiae on a skin. Laboratory findings: the platelet count is 90,000/?L, the
white count 100,000/?L
A. * Acute leukemia
B. Megaloblastic anemia
C. Hemolytic anemia
D. Thrombocytopenia
E. Chronic leukemia
3.
A man of 55 years old has a complaints for abdominal discomfort, gum
bleeding, large ecchymoses after trauma, weakness, sternal tenderness,
fever, skin nodules.Laboratory Findings: the white cell count 540,000/?L,
basophils, eosinophils and platelets are increased; and a few normoblasts are
seen; Er 3,1 1012/l, blast 40 %. What is the most probable diagnosis?
A. * Acute leukemia
B. Megaloblastic anemia
C. Hemolytic anemia
D. Thrombocytopenia
E. Chronic leukemia
4.
A 15-year-old girl complains of fatigue, palpitations, tachypnea on
exertion, insomnia, she likes eat coal. Examinations reveals pallor of skin and
mucous membranes, nail cracking ,tachycardia, soft systolic murmur on the
apex. Peripheral blood: Erythrocytes-3,0 1012/l, - 80 g/l, CI -0,8,
erythrocytes sedimantation rate (ESR) - 9 mm/hour, leucocytes - 4,5 109/l,
anisocytosis. Which investigations will you do?
A. * Serum Iron and Total Iron-Binding Capacity
B. Ultrasound examination
C. Urine analysis
D. Stool test
E. Bilirubin test
5.
A 17-year-old girl complains of fatigue, palpitations, tachypnea on
exertion, insomnia, she likes eat coal. Examinations reveals pallor of skin and
mucous membranes, nail cracking, tachycardia, soft systolic murmur on the
apex. Peripheral blood: Erythrocytes-3,0 1012/l, - 80 g/l, CI -0,8,
erythrocytes sedimantation rate (ESR) - 9 mm/hour, leucocytes - 4,5 109/l,
anisocytosis. What is your initial diagnosis?
A. * Iron deficiency anemia
B. Megaloblastic anemia
C. Anemia of myxedema
D. Folic acid deficiency anemia,
E. B12 vitamin deficiency anemia
6.
A 18-yr-old Asian girl presents with anaemia. She remembers her
brother died at the age of 5 after an illness since birth, which required
repeated transfusions. What is the nesessary test?
A. * Hb electrophoresis
B. Coombs' test
C. Serum B12
D. Urine for Bence-Jones proteins
E. Thrombin time, fibrin degradation products
7.
A 20 -yrs adult presents with severe hypoplastic anemia. What is most
effective treatment:
A. -interferon
B. IL-2
C. ATG therapy
D. * Bone marrow transplantation
E. Everything is correct
8.
A 21-year-old man complains of fatigue, palpitations, tachypnea on
exertion, insomnia, weakness, abdominal pain. He was treated previously in
gastroenterology 2 months ago (it was peptic ulcer). Examination reveals
pallor of skin and mucous membranes, nail cracking ,tachycardia, soft
systolic murmur on the apex. Peripheral blood: Erythrocytes-3,0 1012/l, 80 g/l, CI -0,8, erythrocytes sedimantation rate (ESR) - 9 mm/hour, leucocytes
- 4,5 109/l, anisocytosis. What is your initial diagnosis?
A. *Iron deficiency anemia
B. Megaloblastic anemia
C. Anemia of myxedema
D. Folic acid deficiency anemia
E. B12 vitamin deficiency anemia
9.
A 25-year-old woman complains of bone pain, fever, fatique, weakness,
weight loss. Physical and laboratory examinations find out tender bones,
normocytic and normochromic anemia, granulocytopenia and
thrombocytopenia. Bone x-ray examination shows lytic bone lesions. What is
the possible diagnosis?
A. *Multiple myeloma.
B. Polycytemia rubra vera
C. AML
D. CML
E. CLL
10.
A 29 year old woman was found to have hemoglobin of 7.8 g/dl with a
reticulocyte count 0.8%. The peripherial blood smear showed microcytic
hypochromic anemia. The serum iron and the total iron binding capacity were
E. * Absolute erythrocytosis
14.
A 54-year-old woman complains of increasing fatigue and easy bruising
of 3 weeks duration. Physical findings included pale, scattered ecchymoses
and petechiae and mild hepatosplenomegaly. CBC: RBC 2.550.000/mcL; Hb
73 g/L; HCT 20 %; PLT 23.000 mcL; and WBC 162.000/mcL with 82\%
blasts, that contained Auric rods; peroxidase stain was positive; What is the
most probable diagnosis?
a. * Acute leukemia
b. Megaloblastic anemia
c. Hemolytic anemia
d. Thrombocytopenia
e. Chronic leukemia
15.
A 65-yr-old woman presents with anaemia. She is noted to have
koilonychias and atrophic glossitis. Her blood smear reveals microcytic,
hypochromic blood cells. What is the diagnosis?
A. Megaloblastic anaemia
B. * Iron deficiency anaemia
C. Aplastic anemia
D. Hemolytic anemia
E. Sickle cell anaemia
16.
A 70-yr-old man presents with bone pain, anaemia and renal failure. His
bone marrow reveals abundance of malignant plasma cells. What is the
diagnosis?
A. * Multiple myeloma
B. Myeloid metaplasia
C. AML
D. CLL
E. Megaloblastic anaemia
17.
A decrease in hemoglobin level, increase in colour index were revealed
during examination of patient. There are megalocytes and megaloblasts in
the peripheral blood smear. What kind of anemia has the patient?
A. Hypoplastic
B. Posthemorrhagic
C. Irondeficiency
D. Hemolytic
E. * B12-deficiency
18.
A group of polar explorers 8 month worked in Antarctic Continent at
height of 3000 metes above level of seA) In the process of adaptation in the
appeared changes in blood, namely:
A. * Activation of erythropoiesis
B. Activation of leukopoiesis
C. Activation of immune system
D. Activation of phagocytes
E. Decrease of thrombocytopoiesis
19.
A man 25-year-old lost 1L of blood. At the expense of what substance
will be stimulate renewal of erythrocytes maintenance?
A. * Erythropoietin
B. Renin
C. Interferone
D. Interleukin -1
E. Serotonin
20.
A man was admitted in a clinic with complaints of dispnea, heart
acceleration, pain and burning in area of tongue, feeling of numbness of
extremities. In the past carried the resection of stomach stipulated ulcerous
illness. In blood test: Hb 80 g/l, erythrocytes 2,01012/l, leucocytes
3,5109/l, colour index 1,3. What type of anemia in the patient?
A. * B12-(folate)deficiency anemia
B. Hemolytic anemia
C. Posthemorrhagic anemia
D. Aplastic anemia
E. Proteindeficiency anemia
21.
A man, 35 years old, complains of weakness, palpitation, flickering
before eyes, dizziness. Data of anamnesis: peptic gastric ulcer, repeated
bleeding. Data of objective examination\: skin is pale, in the lungs vesicular
breathing is heard. Systolic murmur is heard at the apex, pulse rate is 100
per min, blood pressure - 100/70 mm of Hg. Mild pain is present at palpation
of epigastric region. Data of complete blood count: Red blood cells 3,2*1012/l, haemoglobin content - 75 g/l, colour index is 0,7. What kind of
anaemia is present in this case?
A. * Iron deficiency anaemia
B. Postgaemorrhagic anaemia
C. Vitamin B12-deficiency anaemia
D. Haemolitic anaemia
E. Hypoplastic anaemia
22.
A patient 2 year ago carried the operation of stomach resection for
cause tumor. At the moment of examination complains of ageneral weakness,
appearance of dark circles before eyes, dyspneA) In a blood test\: Hb 60g/l,
red corpuscles 2,81012/l, colour index 1,4. What forms of red corpuscles
are characterized for this state?
A. * Megalocytes
B. Macrocytes
C. Ovalocytes
D. Microcytes
E. Schistocytes
23.
A patient 25 year-old, palestinian, complains of weakness, dispneA. In
anamnesis there is anemia which is periodically intensified. In blood: Hb 60
g/l, erythrocytes 2,51012/l, reticulocytes 35 %. There are anisocytes and
poikilocytes, polychromatophils, much target erythrocytes. Name the type of
anemia in the patient.
A. * Thalassemia
B. Sickle cell
C. Minkovsky-Shoffars illness
D. Toxico-hemolytic anemia
E. Glucose-6-phosphat dehydrogenase anemia
24.
A patient applied to the doctor with complaints of hypodermic
hemorrhage at insignificant mechanical traumas. What from enumerated
below can be by reason of such phenomenon?
A. * Thrombocytopenia
B. Leukopenia
C. Decrease of hemoglobin content
D. Erythropenia
E. Lymphocytosis
25.
A patient complains of dyspnea for the rapid walking. A skin is pale,
cold. Results of analysis\: erythrocytes 3,21012/l, hemoglobin 90 g/l,
colour index 0,6, contents of proteins 72 g/l. In the smear of blood much
anulocytes and microcytes, there are reticulocytes, single oxiphilic
normocytes:
A. * Deficit of iron
B. Blood loss
C. Hemolysis of erythrocytes
D. Deficit of cyanocobolamin
E. Lack of protein
26.
A patient complains of general weakness, dispnae. Shortly before it she
accepted levomycetin for the prophylaxis of intestinal infection. In blood:
erythrocytes - 1,91012/l, - 58 g/l, colour index - 0,9, leucocytes - 2,2
109/l. Which anemia has the patient?
A. Metaplastic
B. Irondeficiency
C. Hemolytic
D. Aplastic
E. * Hypoplastic
27.
A patient presents with subleukemic leukemia, what changes in
peripheral blood smear will be seen?
A. Increased WBC due to blasts
B. * Blasts without increased WBC
C. None of the above
D. All of the above
E. Decreased WBC with no blasts
28.
A patient suffers from periodic attacks of fever, which caused by
malaria agent. Blood test revealed: amount of erythrocytes - 3,21012/l,
hemoglobin level - 115 g/l, colour index - 0,85. Which anemia has the
patient?
A. Pernicious
B. Posthemorrhagic
C. Proteindeficiecy
D. Iron-deficiency
E. * Hemolytic
29.
A patient suffers with periodic attacks of fever, was caused malaria
agent. On examination of blood was revealed: amount of erythrocytes
3,21012/l, content of hemoglobin 115 g/l, colour index 0,5. What anemia
does the patient suffers by?
A. * Hemolytic
B. Posthemorrhagic
C. Proteindeficiecy
D. Irondeficiency
E. Pernicious
30.
A patient was admitted at the hospital with continuous bleeding after
tooth extraction, what changes will be found in complete blood count?
A. Leukocytosis
B. Erythrocytopenia
C. * Thrombocytopenia
D. Lymphocytosis
E. None of the above
31.
A woman 24 years old, complains of general weakness, shortness of
breath, brittleness of hair and nails. Here menstruations started when she
was 10 years old. Duration of menses is for 7 days, first 4-5 days she loses a
lot of blood with menses. She had not deliveries and abortions. Data of
examination: sklera are of blue tint, pallor of skin is present. What changes
should you expect in here blood count?
A. * Decreased level of serum iron
B. Increased level of serum iron
C. High colour index
D. Increased level of free bilirubin
E. Decreased amount of thrombocites
32.
A woman 52-year-old suffers with thyrotoxicosis. Examination of blood
was revealed\: amount of erythrocytes 5,91012 /l, content of hemoglobin
171 g/l, colour index 0,9, amount of leucocytes 4,9109/l. How are named
these changes of blood ?
A. * Absolute erythrocytosis
B. Hypoplastic anemia
C. Absolute leucocytosis
D. Leukemoid reaction
E. Relative leucopenia
33.
An 8-yr-old boy presents with painful swelling of hands and feet,
jaundice and anaemia. He is noted to have splenomegaly. His blood film has
target cells. What is your diagnosis?
A. Iron-deficiency anemia.
B. * Sickle cell anaemia
C. B12-deficiency anemia
D. Hemolytic anemia.
E. Aplastic anemia.
34.
B12-deficiency anemia was appeared in a patient after resection of
stomach. Which colour index characterize this illness?
A. 1,0
B. 1,15
C. 0,85
D. 0,70
E. * 1,30
35.
Blood examination of the patient with anacidic gastritis reveals the
following results: RBC - 2,51012/l, Hb- 50 g/l, colour index - 0,6, microcytes.
Which anemia is characterized by such indexes?
A. B12-deficiency
B. Proteindeficiency
C. Aplastic
D. Hypoplastic
E. * Irondeficiency
36.
In a 52-year-old man with a history of surgery to remove the stomach
erythrocytes amout in blood is 2,01012/l, Hb- 85 g/l, colour index - 1,27.
Lack of what vitamin causes such changes?
A. A
B. C
C. B6
D. D
E. * B12
37.
In a patient was determined such changes in general blood acount:
RBC - 81012/l, hemoglobin - 179 g/l, hematocrit - 0,55 l/l. It is characterized
for:
A. Dehydration
B. Infusion of erythrocytic mass
C. Infusion of blood
D. B12-deficiency anemia
E. * Policytemia
38.
Jaundice, splenomegaly, pain in the left hypochondrium, pigment
gallstones were found in the patient during his examination. MinkowskiChauffard's disease was diagnosed. The peripheral blood smear in this case is
characterized by
A. Reticulocytosis
B. Agranulocytosis
C. Macrocytosis
D. Ovalocytosis
E. * Microspherocytosis
39.
Patient 30 years present at the hospital with fatigue, weight loss, bone
pain with tenderness. The diagnosis is chronic myelocytic leukemia, which of
these confirms the diagnosis?
A. Lymphocytic infiltrates
B. * Myeloid hyperplasia of bone marrow
C. Smudge cells
D. None of the above
E. A and E
40.
Patient 55 yrs was admitted at the hematological department with the
following laboratory result: GBC reveals lymphocytosis, smudge cells,
anemia, thrombocytopenia and bone marrow biopsy shows lymphocytic
infiltrates: What is clinical diagnosis?
A. * Chronic lymphocytic leukemia
B. Chronic myelocytic leukemia
C. Multiple myeloma
D. B and C
E. None of the above
41.
Patient D, was diagnosed with acute leukemia, peripheral blood reveals
blasts 35 % without increased WBC, what type of acute leukemia is present in
this patient?
A. * Subleukemic
B. Aleukemic
C. Leukemic
D. None of the above
E. All of the above
42.
Patient E was admitted at the hospital in the hematological
department, CBC revealed RBC- 4.0?1012/l , WBC- 6?109/l, Hb -130g/l,
platelets- 60 ?109/l, lymphocytes- 45 %, reticulocytes- 1 %, define abnormal
parameters.
A. Erythrocytosis and lymphocytosis
B. Lymphocytosis and leucocytopenia
C. * Thrombocytopenia and lymphocytosis
D. Lymphocytopenia and thrombocytosis
E. Erythrocytosis and reticulocytopenia
43.
Patient G, was admitted to the hospital with symptoms of leukemia,
how can chronic myelocytic be differentiated from chronic lymphocytic from
bone marrow biopsy?
A. Myeloid hyperplasia
B. High myeloid: Erythroid ratio
C. Hypercellular bone marrow
D. Increased basophils and eosinophils
E. * All of the above
44.
Patient I., 40 years old, was undergone resection of stomach because
of peptic ulcer 5 years ago. The patient develop general weakness and
dyspnea last time. Data of his complete blood count are the following:
erythrocytes count is 3,1*1012/l, haemoglobin content is 60 gr/l, colour index
is 0,6, leucocytes count is 4,5*109/l, stub neutrophyls - 2%, eosynophils - 3%,
segmented neutrophyls - 5%, lymphocytes - 32%, monocytes - 8%, ESR - 5
mm/hour, serum iron content is 6 mkmol/l. What pathological condition
developed in the patient?
A. * Chronic iron deficiency anaemia
B. Haemolytic anaemia
C. Aplastic anaemia
D. Acute posthemorrhagic anaemia
E. Folic acid deficiency anaemia
45.
Patient is diagnosed with Hodgkins lymphoma, during examination
painless lymphadenopathy, hepatosplenomegaly is observed. What other
name is Hodgkins lymphoma called?
A. CML
B. AML
C. ALL
D. Multiple myeloma
E. * Lymphogranulomatosis
46.
Patient is diagnosed with Kaylers disease, presence of Bence Jones
protein in urine was discovered. What other name can this disease be called?
A. CML
B. ALL
C. * Multiple myleloma
D. Hodgkins lymphoma
E. None of the above
47.
Patient K, arrived at the hospital with painless lymphanedopathy,
lymph node biopsy reveals Reed - Sternberg cells. Give clinical diagnosis.
A. Chronic lymphocytic leukemia
B. Multiple myeloma
C. * Hodgkins disease
D. None of the above
E. All of the above
48.
Patient L, was admitted to the hospital with symptoms of acute
leukemia, peripheral blood smear reveals decreased WBC with no blasts.
What form is diagnosed?
A. C and D
B. Leukemic
C. Subleukemic
D. * Aleukemic
E. None of the above
49.
Patient M, was admitted to the hospital with symptoms of kaylers
disease, presence of bence jones protein in urine was discovered. What is
Kaylers disease?
A. Malignant tumor of lymphoid tissue
B. Cancer of WBC
C. * Cancer of plasma cells
D. None of the above
E. All of the above
50.
Patient P, arrived at the hospital with recurrent infections, GBC
revealed plasma cells, what other means of examination will be done to
confirm diagnosis?
A. Biochemical blood profile
B. General urine analysis
C. Bone marrow biopsy
D. * Serum protein electrophoresis
E. A and B
51.
Patient present to the hospital with itchy skin, night sweats and
unexplained weight loss. Diagnosis is hodgkins lymphoma. What laboratory
examination will you to do confirm diagnosis?
A. Complete blood count
B. * Lymph node biopsy
C. Urine analysis
D. B and C
E. All of the above
52.
Patient S, was admitted and diagnosed with acute leukemia. What
changes will you find in complete blood count?
A. * Anemia, thrombocytopenia and leukocytosis
B. Anemia, thrombocytosis and leukocytopenia
C. Thrombocytosis and presence of blasts
D. Anemia and presence of blasts
E. All of the above
53.
Patient was admitted to the hospital and diagnosed with multiple
myeloma, what other diseases can it be differentiated with?
A. Peptic ulcer disease
B. COPD
C. None of the above
D. * Hodgkins lymphoma
E. All of the above
54.
Patient X, presents at the hospital with fatigue, sweat and weight loss.
During examination, hepatosplenomegaly, lymphadenopathy was revealed.
Bone marrow biopsy reveals presence of blast 35 %, promyelocytes and
promonocytes. Give clinical diagnosis.
A. Chronic lymphocytic leukemia
B. Chronic myelocytic leukemia
C. All of the above
D. * Acute leukemia
E. None of the above
55.
Patient Z, was admitted to the hospital with suspicion of leukemia, how
can you differentiate acute leukemia from chronic leukemia.
A. Clinical presentation
B. Onset of disease
C. All of the above
D. None of the above
E. * Morphology of cells
56.
Patient, 60 yrs, is diagnosed with Hodgkins disease at the hospital.
What specific cells can confirm diagnosis?
A. Sickle cells
B. Cabot ring
C. Target cells
D. Burr cells
E. * Reed Sternberg cells
57.
Posthemorrhagic anemia was developed in a patient who suffers from
the periodic bleeding due to fibromyoma of uterus. What is its type?
A. , hyporegeneratory
58.
?Thalasemia with hemolysis of erythrocytes was determined in a
patient which arrived from Tunis. Illness was diagnosed on the basis of
presence in blood:
B. Grainy erythrocytes
C. Polychromatic erythrocytes
D. Sickle-cell erythrocytes
E. Reticulocytes
F. * Taget erythrocytes
59.
The amount of reticulocytes was increased in the peripheral blood of a
patient with an stomach ulcer at 5 days after acute bleeding. What may this
symptom testify about?
A. Presence of allergy
B. Presence of inflammation in stomach
C. Increase of proteins synthesis
D. Presence of hypoxia
E. * Activation of hemopoiesis
60.
The atrophy-inflammatory processes in the cavities of mouth, disorder
of deep sensitiveness were revealed in a woman. Addison-Birmers anemia
was diagnosed. This anemia is
A. Normochromic
B. Erythroblastic
C. Hemolytic
D. Irondeficiency
E. * Megaloblastic
61.
The excessive entering into blood of estrogenes because of persistence
of follicle often indicate by reason of the uterine bleeding. What anemia can
develop in this case?
A. Metaplastic
B. Sideroblastic
C. Sickle sel
D. Hypoplastic
E. * Iron-defficiency
62.
The resection of stomach was made in a man 5 years ago.
Megaloblastic anemia was revealed. What is direct cause of origin and
development of megaloblastic aaemia in the patient?
A. Alimentary lack of vitamin B12
B. Alimentary lack of folic acid
C. Deficit of iron
D. Deficit of vitamin A
E. * Intrinsic factor deficiency
63.
There are hypochromic erythrocytes, micro- and anisocytes,
poikilocytes in the smear of patient blood. These signs are common for irondeficiency and iron-refractory anemias. What investigations will allow
differentiate these anemias?
A. Determination of erythrocytes amount
B. Analysis of bone marrow smear
C. Determination of haemoglobin content
D. Determination of colour index
E. * Determination of serum iron
64.
65.
4-month old child suffers from severe rickets. Disorders of digestion
were not found. A child is exposed to sunlight foe enough time every day. For
two months a child obtained the vitamin D3, however the symptoms of
rickets were not diminished. Disorders of the synthesis of which compound
can explain the development of rickets in this child?
A. Calcitonin
B. * Calcitriol (1,25- dihydroxycholecalciferol)
C. Thyroxine
D. Parathormone
E. Insulin
66.
A patient complains about a general weakness and bleeding of gums.
Insufficiency of which vitamin can be reason of such state?
A. * Vitamin C
B. Vitamin E
C. Vitamin A
D. Vitamin H
E. Vitamin D
67.
A patient complains about loss of weight, general weakness, pain in the
area of heart, petehial hemorrhages, bleeding of gums, loss of teeth. The lack
of which vitamin caused such symptoms?
A. Vitamin K
B. Vitamin PP
C. Vitamin B1
D. * Vitamin C
E. Vitamin B2
68.
For the patient with decreased immunity and frequent cold diseases
was recommend to use ascorutin as more effective preparation than ascorbic
acid. Which component in this preparation strengthen the action of vitamin of
C?
A. * Vitamin P
B. Vitamin A
C. Glucose
D. Lactose
E. Vitamin D
69.
Patient complains for dry lips, cracks and crusts in the mouth
corners, bright red tongue, dermatitis of nasolabial folds, photophobia and
conjunctivitis. To the lack of which vitamin is it related?
A. * Riboflavin
B. Cholecalciferol
C. Pyridoxin
D. Coballamin
E. Ascorbic acid
70.
Patient complains for pain in joints. By sight can be seen edemas and
reddening in the joints area. What enzyme activity have be investigated to
draw out a diagnosis?
A. hyaluronidase
B. creatine kinase
C. alkaline phosphatase
D. acidic phosphatase
E. urease
71.
Patient of 62 years has diabetes mellitus. Glomerulosclerosis has
evolved. The most possible reason for this complication is the affection in
renal glomerulus of:
A. calcium excretion
B. formation of primary urine
C. gluconeogenesis process
D. glucose reabsorption
E. * collagen structure
72.
Patient of 63 years suffers from rheumatitis. The concentration of
oxyprolin in blood and in urine is increased. What is the main reason of
hyperoxyprolinemia?
A. hyaluroprotein degradation
B. * collagen degradation
C. kidney malfunction
D. cathepsin activation
E. prolyl hydroxylase activation
73.
A 30 year old patient was admitted to the hospital, she excretes small
amount of mucous, viscous sputum, but later the amount of sputum she
excretes increased. It became mucous purulent during microscopic studies a
lot of cylindrical, epithelium, leucocytes and at times red blood cells. Which
diagnosis is typical for such symptoms?
A. Bronchial Asthma
B. * Acute Bronchitis
C. Lobar Pneumonia
D. Bronchiectasis
E. Lung Abcess
74.
A cloudy pleural fluid has a glucose level of 30 mg/dL (serum glucose
level is 100 mg/dL) and a pH of 6.8.
A. * Pneumonia
B. Bronchitis
C. Pleuritis
D. Myocardial infarction
E. Non is correct
75.
A patient expectorates up to 600 ml of sputum a day, she went to the
hospital and microscopic examination was conducted microscopically, there
was presence of white blood cells, elastic fibers, scraps of lung tissue,
crystals of fatty acids and cholesterol and different flora. What is the
diagnosis of these patient?
A. Lobar Pneumonia
B. Lung Cancer
C. Tuberculosis of lungs
D. * Lung Abcess
E. Bronchial Asthma
76.
Doctor consults a patient with complaints of frequent cough, high
temperature, coupious amount of sputum (>200 ml/day), which has foul odor.
What disease can be suspected?
A. Acute Pneumonia
B. Acute bronchitis
C. Bronchial asthma
D. Tuberculosis
E. * Lung abscess, gangrene, bronchiectasis
77.
Doctor consults a patient with complaints of sleeplessness, night
sweats, frequent cough. There is small amount of sputum with traces of blood
in it. What disease can be suspected?
A. Acute Pneumonia
B. Acute bronchitis
C. Bronchial asthma
D. * Tuberculosis
E. Lung abscess
78.
Fluid from a patient with congestive heart failure is collected by
thoracentesis and sent to the laboratory for testing. It appears clear and pale
yellow and has a WBC count of 450/mL, fluid:serum protein ratio of 0.35, and
fluid:serum LD ratio of 0.46. What type of fluid was collected?
A. * Pleural fluid
B. Peritoneal fluid
C. Serum
D. Plasma
E. Non is correct
79.
Fluid from a patient with congestive heart failure is collected by
thoracentesis and sent to the laboratory for testing. It appears clear and pale
yellow and has a WBC count of 450/mL, fluid:serum protein ratio of 0.35, and
fluid:serum LD ratio of 0.46. Based on the laboratory results, would this fluid
be considered a transudate or an exudate?
A. * Transudate
B. Exudate
C. Serum
D. Plasma
E. Non is correct
80.
Patient K. was diagnosed of lung cancer, what type of sputum does he
expectorate:
A. Mucous purulent
B. Viscous rusty
C. * Mucous purulent with RBC
D. Gelatinous
E. Purulent
81.
Patient K. was diagnosed of lung cancer. Which type of cell can be
found in microscopic examination of sputum in this case?
A. * Atypical cells
B. Chief cells
C. Parietal cell
D. Typical cell
E. Satellite cell
82.
The following results were obtained on a peritoneal fluid: serum
albumin, 2.8 g/dL; fluid albumin, 1.2 g/dL. Calculate the SAAG.
A. 1,2
B. * 1,6
C. 2,5
D. 5,5
E. Non is correct
83.
What type of sputum is excreted by patient, which was admitted to the
hospital with lobar pneumonia?
A. Serous purulent
B. Glassy
C. * Viscous rusty sputum
D. Serous
E. Bloody sputum
84.
A man who ascented at height 4,5 km lost consciousness suddenly. The
cause is a hypocapnia due to
A. * Hyperventilation
B. Decrease of metabolism rate
C. Binding of carbonic acids by proteins
D. Neutralization of carbonic acid by bicarbonates
E. Absorption of carbonic acids by red blood cells
85.
A man with the barbiturate poisoning was hospitalized to emergency
department. He has hypopnea due to oppression of respiratory center. What
type insufficiency of breathing does he have?
A. * Disregulative
B. Obstructive
C. Restrictive
D. Perfusive
E. Diffusion
86.
A nurse has been asked to create a cancer risk reduction pamphlet for
the clients who come to a clinic that serves a large African American
population. Therefore, prevention and early detection tips for which cancer
types would be most important to include in this pamphlet?
A. * Lung and prostate
B. Bone and leukemia
C. Skin and lymphoma
D. Stomach and esophageal
87.
A patient 28 years old has a pneumonia The most typical symptom of
this disease is:
A. * Rapid and shallow breathing
B. Rapid and deep breathing
C. Slow and deep breathing
D. Chein-Stocks breathing
E. Kussmaul`s breathing
88.
A patient has an acute decrease of surfactant activity in the lungs.
What changes can be expected in this patient?
A. * Inclination alveoles to spasm and impossibility of their rapid
spread
B. Change elastic properties of lungs
93.
A patient, 64 years old, was hospitalized with complaints of a cough
with sputum, expressed dyspnea . During examiation the next signs were
revealed: position is forced, breath rate 32/min, the intercostales muscles
take part in the breathing. During X-ray examination the increased
transparency of lungs were determined. What is the most important in the
pathogenesis of respiratory failure in this patient?
A. * Decrease of elastic properties of lungs
B. Accumulation of sputum in the bronchial tubes
C. Thinning of mucus shell of bronchial tubes
D. Insufficiency of the surfactant system of lungs
E. Fibrosis of lungs
94.
for:
95.
96.
An young man with the signs of morphin poisoning was hospitalized to
the emergency department. His breathing is shallow and slow as a result of
oppression of respiratory center. What type of breathing disorders is present
in this patient?
A. * Disregulative disorders of alveolar ventilation
B. Perfusive
C. Ventilation restrictive
D. Diffusive
E. Ventilative obstructive
97.
At the height 7 km alpinist feeled dizziness and severe weakness. He
lost consciousness, his breathing stoppeD) These disorders was a result of
A. * Surplus discharge of 2 from his organism
B. Obstructive
C. Pectoral
D. Abdominal
E. Mixed
103. The patient was asked to breath deep during auscultation. After 10
respiratory movements she felt dizziness. What is the cause of this disorder?
A. * Respiratory alcalosis
B. Decrease concentrations of hemoglobin
C. Disorder of diffusions of gases in lungs
D. Respiratory acidosis
E. Decrease quantity of erythrocytes
104. What type of breathing in patient A. is typical for a child with
diphtheria of larynges?
A. * Dispnea (shortness of breath)
B. Gasping breathing
C. Apneustic breathing
D. Kussmaul`s breathing
E. Biot's breathing
105. What type of hypoxia in patient G. is conditioned by violation of
exchange gases in lungs:
A. * Respiratory
B. Exogenous
C. Hemic
D. Tissue
E. Circulatory
106. A 23-year-old woman with type 1 diabetes mellitus presents to the
emergency department because of a 2-day history of dysuria and urinary
frequency. She has no gross hematuria, fever, or chills. She states that 3
years ago, she had cystitis twice in 6 months; in both occasions, she was
treated with antibiotics. She uses insulin to control diabetes and takes 1 or 2
ibuprofen tablets daily for headaches. On physical examination, the patient is
alert and in no distress. Blood pressure is 115/80 mm Hg, pulse rate 80/min,
and temperature 37.4 C (99.3 F). Optic funduscopy reveals
microaneurysms. The neck is supple, the carotids are normal, and the lungs
are clear. Cardiac examination reveals regular sinus rhythm and no murmur
or rub. Abdominal examination is normal. No lower extremity edema or ulcers
are present. Neurologic examination demonstrates diminished sensitivity to
pinprick and light touch in the lower extremities. Laboratory studies:
Leukocyte count 8400/?L Polymorphonuclear cells 70% Lymphocytes 20%
Hematocrit 40% Hemoglobin 13.8 g/dL Serum creatinine 1.8 mg/dL (was 1.6
mg/dL 1 month ago) Serum sodium 140 meq/L Serum chloride 106 meq/L
Serum potassium 6.2 meq/L Serum bicarbonate 23 meq/L Urinalysis Specific
gravity 1.020; 2+ glucosuria, 1 + hematuria, 3+ proteinuria, no ketonuria ,
3+ leukocyturia; 25 to 50 leukocytes/hpf, 10 to 20 erythrocytes/hpf, broad
casts On renal ultrasonography, the right kidney is 11.0 cm and the left
kidney is 10.9 cm. No hydronephrosis or stones are present. What is the most
likely cause of this patients hyperkalemia?
A. Diabetic ketoacidosis
B. * Hyporeninemic hypoaldosteronism
C. Acute renal failure
D. High potassium diet
E. No correct answer
107. A 26-year-old woman with type 1 diabetes mellitus presents to the
emergency department because of abdominal pain for the past 24 hours. Her
temperature is 38C (101 F). Laboratory studies: Blood urea nitrogen 20
mg/dL Serum creatinine 1.2 mg/dL Serum sodium 133 meq/L Serum
potassium 3.9 meq/L Serum chloride 97 meq/L Serum bicarbonate 10 meq/L
Serum glucose 450 mg/dL Arterial blood gases pH 7.2, PCO2 23 mm Hg Blood
cultures Negative Whole-blood lactate 0.6 mmol/L What condition best
explains the patients acid-base status?
A. Diabetic ketoacidosis alone
B. * Diabetic ketoacidosis complicated by a proximal renal tubular
acidosis
C. Diabetic ketoacidosis complicated by sepsis
D. Diabetic ketoacidosis complicated by respiratory acidosis
E. No correct answer
108. A 28-year-old woman presents for evaluation of recurrent kidney stones
that she says contain calcium. She estimates that she has passed four
stones during the past 4 years. She currently has no symptoms of renal colic.
For several years, she has had dry eyes and dry mouth. She also describes
symptoms of Raynauds phenomenon. Crohns disease was diagnosed 10
years ago; the patient is currently asymptomatic and passes one formed stool
daily. She takes no medications. There is no family history of renal stone
disease. On examination, the patient is alert and healthy. Blood pressure is
115/74 mm Hg, pulse rate is 72/min, and temperature is 37 C (98.6 F). The
skin is clear, and the joints are normal. The lungs are clear. Cardiac
examination shows regular sinus rhythm and no murmur. The liver and spleen
are not palpable, and the abdomen is not tender. Plain abdominal
radiography shows multiple calcifications overlying both renal
shadows.Laboratory studies: Hemoglobin 13.2 g/dL Hematocrit 39%
Leukocyte count 7400/?L Blood urea nitrogen 18 mg/dL Serum creatinine 0.9
mg/dL Serum sodium 138 meq/L Serum potassium 2.8 meq/L Serum chloride
109 meq/L Serum bicarbonate 19 meq/L Serum calcium 9.1 mg/dL Serum
phosphorus 3.2 mg/dL Urinalysis pH 6.0; specific gravity 1.020; trace
hematuria, no proteinuria Arterial blood pH 7.29 What is the most likely
etiology of this patients renal stone disease?
A. Idiopathic hypercalciuria
B. Primary hyperthyroidism
C. * Distal renal tubular acidosis
D. Enteric hyperoxaluria
E. No correct answer
109. A 32-year-old white woman with slowly progressive chronic kidney
disease secondary to post-streptococcal glomerulonephritis is seen for
routine follow-up. Her medical regimen includes dietary phosphorus
restriction; oral calcium acetate, 667 mg three times daily with meals as a
phosphorus binder; and ramipril, 10 mg/d. The estimated glomerular filtration
rate is stable, at 22 mL/min. Laboratory studies: Serum creatinine 3.2 mg/dL
Serum calcium 8.4 mg/dL Serum phosphorus 4.9 mgldL Serum albumin 4.0
g/L Serum parathyroid hormone 256 pg/mL What is the most appropriate
management plan?
A. Add 1,25-dihydroxyvitamin D (calcitriol), to increase the serum
calcium level to 9.5 to 10.5 mg/dL
B. Add calcium carbonate, 2 tablets with each meal
C. Add 1 ,25-dihydroxyvitamin D (calcitriol), to suppress parathyroid
hormone to normal levels or below
D. Increase calcium acetate binder from two to three tablets three
times daily with meals
E. * Add 1 ,25-dihydroxyvitamin D (calcitriol), to suppress parathyroid
hormone to two to three times the upper limit of normal
110. A 34-year-old pregnant woman with a 5-year history of biopsydiagnosed hypertensive nephropathy has been followed in obstetric clinic for
3 months after her last menstrual period. One year ago, her serum creatinine
concentration was 1 .6 mg/dL. Her pregnancy has been uneventful. Her blood
pressure has been well controlled on a combination of methyldopa and
hydralazine and is currently 130/85 mm Hg. She has trace edema. Laboratory
studies: Hematocrit 37% Leukocyte count Normal Platelet count Normal
Peripheral smear No schistocytes Blood urea nitrogen 14 mg/dL Serum
creatinine 1.8 mg/dL Serum uric acid 4.9 mg/dL Urinalysis Specific gravity,
1.010; urinary protein 4+ by dipstick; no glucosuria, hematuria, or ketonuria
Microscopic urine examination shows rare broad casts. Liver function tests
are normal. Which one of the following statements about the patients course
is true?
A. She has developed preeclampsia.
B. * The course is most consistent with progression of her chronic
renal disease.
C. She has developed microangiopathic hemolytic anemia.
D. She has developed prerenal azotemia.
E. Her blood pressure is likely to improve during the course of her
pregnancy.
quadrant pain radiating to the right lower quadrant and into the right testicle.
He vomits once shortly after arrival. He does not have fever or chills but has
mild dysuria. On examination, the patient is restless because of pain. Blood
pressure is 145/89 mm Hg, pulse rate is 92/min, and temperature is 37 C
(98.6 F). Abdominal examination reveals mild right costovertebral angle
tenderness, but no abdominal guarding. Genitalia are normal. The serum
creatinine concentration is 0.9 mg/dL. Urinalysis shows a specific gravity of
1.025, 3+ hematuria, no proteinuria. Urine microscopy reveals more than 50
erythrocytes/hpf, 3 to 5 leukocytes/hpf, and occasional calcium oxalate
crystals. You suspect that a renal stone is causing the colicky pain and
hematuria. What radiologic procedure is best to confirm the diagnosis?
A. Plain radiography of the abdomen
B. Intravenous pyelography
C. Renal ultrasonography
D. * Noncontrast spiral computed tomography
E. No correct answer
116. A 39-year-old male carpenter presents to the emergency department
with a 4-hour history of gradually worsening right flank and right upper
quadrant pain radiating to the right lower quadrant and into the right testicle.
He vomits once shortly after arrival. He does not have fever or chills but has
mild dysuria. On examination, the patient is restless because of pain. Blood
pressure is 145/89 mm Hg, pulse rate is 92/min, and temperature is 37 C
(98.6 F). Abdominal examination reveals mild right costovertebral angle
tenderness, but no abdominal guarding. Genitalia are normal. The serum
creatinine concentration is 0.9 mg/dL. Urinalysis shows a specific gravity of
1.025, 3+ hematuria, no proteinuria. Urine microscopy reveals more than 50
erythrocytes/hpf, 3 to 5 leukocytes/hpf, and occasional calcium oxalate
crystals. You suspect that a renal stone is causing the colicky pain and
hematuria. What radiologic procedure is best to confirm the diagnosis?
A. Plain radiography of the abdomen
B. Intravenous pyelography
C. Renal ultrasonography
D. * Noncontrast spiral computed tomography
E. No correct answer
117. A 39-year-old nurse has recurrent calcium nephrolithiasis due to
idiopathic hypercalciuria (24-hour urinary calcium excretion of 350 mg and
sodium excretion of 250 meq). You prescribe a low-sodium (100 meq/d), lowoxalate, normal-calcium diet and start therapy with hydrochlorothiazide, 50
mg/d. Two months later, you obtain the following laboratory studies: Serum
sodium 138 meq/L Serum potassium 2.9 meq/L Serum chloride 110 meq/L
Serum bicarbonate 33 meq/L Arterial blood pH 7.43 24-Hour urine studies:
Creatinine 900 mg Calcium 290 mg Oxalate 45 mg Uric acid 540 mg Citrate
356 mg Potassium 45 meq Sodium 225 meq pH 4 What is the most likely
cause of the persistent hypercalciuria?
A. Distal renal tubular acidosis
B. Hyperoxaluria
C. Noncompliance with the normal-calcium diet
D. Surreptitious laxative use
E. * Noncompliance with the low-sodium diet
118. A 39-year-old nurse has recurrent calcium nephrolithiasis due to
idiopathic hypercalciuria (24-hour urinary calcium excretion of 350 mg and
sodium excretion of 250 meq). You prescribe a low-sodium (100 meq/d), lowoxalate, normal-calcium diet and start therapy with hydrochlorothiazide, 50
mg/d. Two months later, you obtain the following laboratory studies: Serum
sodium 138 meq/L Serum potassium 2.9 meq/L Serum chloride 110 meq/L
Serum bicarbonate 33 meq/L Arterial blood pH 7.43 24-Hour urine studies:
Creatinine 900 mg Calcium 290 mg Oxalate 45 mg Uric acid 540 mg Citrate
356 mg Potassium 45 meq Sodium 225 meq pH 4 What is the most likely
cause of the persistent hypercalciuria?
A. Distal renal tubular acidosis
B. Hyperoxaluria
C. Noncompliance with the normal-calcium diet
D. Surreptitious laxative use
E. * Noncompliance with the low-sodium diet
119. A 39-year-old salesman is admitted for elective right inguinal hernia
repair. He previously underwent left inguinal hernia repair. He has bipolar
disorder, for which he takes lithium carbonate. He also takes a multivitamin
daily. In preparation for surgery, he has received nothing by mouth for the
previous 12 hours. He feels well but is thirsty. On examination, the patient is
alert and in no distress. Blood pressure is 135/85 mm Hg seated and
standing, pulse rate 70/min, respiratory rate 12/min, temperature 36.9 C
(98.4 F). No neck vein distention is present. The lungs are clear. Cardiac
examination shows regular sinus rhythm and no murmur. Abdominal
examination is normal. Right inguinal hernia is present. There is no lower
extremity edema and no evidence of volume depletion. Laboratory studies:
Leukocyte count 7800/?L Hemoglobin 16.5 g/dL Hematocrit 45% Blood urea
nitrogen 18 mg/dL Serum creatinine 1.1 mg/dL Serum sodium 150 meq/L
Serum potassium 4.5 meq/L Serum chloride 112 meq/L Serum bicarbonate 26
meq/L Serum glucose 85 mg/dL Urinalysis Specific gravity 1.006; no
proteinuria, hematuria, or cyturia What is the cause of the elevated serum
sodium level?
A. Syndrome of inappropriate antidiuretic hormone secretion
B. * Renal concentrating defect
C. High dietary sodium intake
D. Fluid restriction
E. No correct answer
120. A 40-year-old man has recurrent nephrolithiasis due to idiopathic
hypercalciuria. He has had more than 40 calcium oxalate stones in the past 5
years. He is started on hydrochlorothiazide therapy and a low-sodium diet.
meq/L). Taking the hypokalemia into account, what therapy should the
patient receive for hypercalciuric stone disease?
A. High-potassium diet plus hydrochlorothiazide
B. Acetazolamide plus hydrochlorothiazide
C. Magnesium oxide plus hydrochlorothiazide
D. * Amiloride plus hydrochlorothiazide
E. No correct answer
124. A 43-year-old woman presents with back pain and is evaluated for renal
insufficiency. Infection with HIV was diagnosed 2 years ago, and the patient
began taking highly active antiretroviral therapy with zidovudine, lamivudine,
and indinavir 1 year later because of a decreasing CD4 count and
development of oral candidiasis. Six months ago, she developed fasting
hyperglycemia and hypercholesterolemia and was treated with rosiglitazone
and atorvastatin. Physical examination reveals a blood pressure of 130/85
mm Hg and a pulse rate of 88/rn in that is regular, with no orthostatic
changes. The respiratory rate is 18/min, and ternperature is 37.8 C (100 F).
There is no neck vein distention or hepatojugular reflux. The cardiac,
pulmonary, and abdominal exarninations are normal, but 2+ lower extremity
ederna is present. Laboratory studies: Blood urea nitrogen 22 mg/dL Serum
sodium 141 rneq/L Serum potassium 6.0 meq/L Serum chloride 101 meq/L
Serum bicarbonate 19 meq/L Serum creatinine 3.2 mg/dL Serum calcium 7.2
mg/dL Serum phosphate 8.3 mg/dL Serum uric acid 9.0 mg/dL Serum total
cholesterol 177 mg/dL Fasting blood glucose and glycosylated hemoglobin
concentrations are elevated. Hematocrit is 31%, with an elevated mean
corpuscular volume. Leukocyte count is 3300/?L, but platelet count is normal.
Urinalysis reveals specific gravity 1.010, trace proteinuria, 2+ hematuria, and
no ketonuria or glycosuria. Microscopic examination shows muddy brown
casts and tubular epithelial cells, but no erythrocytes or crystalluria. What is
the most probable diagnosis?
A. * Rhabdomyolysis caused by atorvastatin therapy
B. Indinavir nephrolithiasis
C. Indinavir tubulointerstitial renal disease and atrophy
D. HIV-associated nephropathy
E. Diabetic nephropathy
125. A 46-year-old man with chronic kidney disease secondary to biopsyproven focal and segmental glomerulosclerosis returns for routine follow-up.
The hematocrit is 28%, and potentially correctable causes of anemia have
been excluded. Therapy with recombinant human erythropoietin is
recommended. In patients with chronic kidney disease and pre-end-stage
renal disease, what is a benefit of therapy with erythropoietin to effectively
treat anemia?
A. Reduced mortality
B. Decreased cardiovascular event rates
C. Normalization of hypertension
D. * Regression of left ventricular hypertrophy
E. No correct answer
126. A 47-year-old man calls Monday morning seeking help with the worst
headache ever Friday night and Saturday. The headache was associated with
severe lethargy and intermittent confusion. He recovered and has felt well for
the past 24 hours. He states that he does not have fever or neurologic or
cardiovascular symptoms. His medical history is significant for hypertension
and recurrent urinary tract infections related to his known autosomal
dominant polycystic kidney disease. He is concerned because his father died
of a stroke during dialysis. The serum creatinine concentration is 2.6 mg/dL.
What do you recommend for this patient?
A. Make an office appointment for him to see you this week
B. Arrange a consultation with the neurology/headache clinic
C. Order computed tomography of the head without contrast
D. * Arrange urgent magnetic resonance angiography of the head
E. No correct answer
127. A 47-year-old man calls Monday morning seeking help with the worst
headache ever Friday night and Saturday. The headache was associated with
severe lethargy and intermittent confusion. He recovered and has felt well for
the past 24 hours. He states that he does not have fever or neurologic or
cardiovascular symptoms. His medical history is significant for hypertension
and recurrent urinary tract infections related to his known autosomal
dominant polycystic kidney disease. He is concerned because his father died
of a stroke during dialysis. The serum creatinine concentration is 2.6 mg/dL.
What do you recommend for this patient?
A. Make an office appointment for him to see you this week
B. Arrange a consultation with the neurology/headache clinic
C. Order computed tomography of the head without contrast
D. * Arrange urgent magnetic resonance angiography of the head
E. No correct answer
128. A 47-year-old man with autosomal dominant polycystic kidney disease
presents with a recurrent urinary tract infection despite therapy with
ampicillin forEscherichia coli infection 3 weeks earlier, which was sensitive to
all antibiotics tested. During that urinary tract infection, there was concern
about an infected cyst, since the patient had right flank discomfort. The
serum creatinine concentration was 1.0 mg/dL, and renal ultrasonography did
not identify obstruction, stones, or abscess. Currently, the patient describes a
3-to 4-day history of dysuria without fever or pain. He is taking no
medications and is allergic to ciprofloxacin. On examination, the patient
appears well and is afebrile. Physical examination is normal, without
tenderness over either polycystic kidney. Urine culture grew E. ccli sensitive
to ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and
ceftriaxone. What would you recommend for this patients urinary tract
infection?
A. Discontinue valsartan
B. Discontinue ibuprofen
C. Obtain renal ultrasonography
D. Administer normal saline
E. * Administer acetylcysteine
133. A 52-year-old man is referred by his primary care physician for
hypertension and hypokalemia over the past 6 months. Blood pressure and
routine chemistries were normal last year at the time of an executive
physical. He has no history of cardiovascular disease, stroke, or renal disease.
Family history is negative for hypertension. He uses alcohol socially and does
not smoke but chews tobacco. He takes no medications regularly. On
examination, the patientweighs 77kg (168 Ib). Blood pressure is 164/102mm
Hg seated and standing. Except for trace pedal edema, the remainder of
examination is normal. The primary care physician provides the following
laboratory values: Blood urea nitrogen 21 mg/dL Serum creatinine 0.9 mg/dL
Serum sodium 141 meq/L Serum potassium 3.1 meq/L Serum chloride 100
meq/L Serum bicarbonate 28 meq/L A 24-hour urine test during salt loading
reveals the following values: Creatinine 1.1 g Sodium 252 meq Potassium 128
meq The daily aldosterone excretion rate is 6 mg (normal, 5 to 15 mg),
plasma renin activity is 1 ?g/L/h, and plasma aldosterone level is 9 ng/dL.
Which diagnostic test would you order next?
A. Computed tomography of the adrenal glands
B. * Serum cortisol and urinary free cortisol measurement
C. Magnetic resonance angiography with gadolinium
D. Adrenocorticotropin hormone stimulation test
E. No correct answer
134. A 54-year-old man is admitted with jaundice and edema. He has been
healthy but has a 13-year history of habitual heavy alcohol use and
intermittent binge drinking. He felt well until yesterday, when he experienced
difficulty urinating and dysuria. On physical examination, the blood pressure
is 122/72 mm Hg, without orthostatic changes; heart rate 98/min; respiratory
rate 22/min; and temperature 38.8 C (101 .8 F). Scleral icterus is present,
but there is no neck vein distention or hepatojugular reflux. The cardiac and
chest examinations are normal. The abdomen is distended, but there is no
rigidity or rebound. Bilateral lower extremity edema is present. There is no
asterixis. Laboratory studies: Hematocrit 32% Leukocyte count Normal
Platelet count Normal Blood urea nitrogen 24 mg/dL Serum creatinine 1.9
mg/dL Serum potassium 4.2 meq/L Serum chloride 99 meq/L Serum
bicarbonate 25 meq/L Direct bilirubin 6.5 mg/dL Serum albumin 2.1 g/dL
Urine creatinine 105 mg/dL Urine sodium 12 meq/L Urinalysis pH 6.0; specific
gravity, 1 .023; trace proteinuria; no hematuria or ketonuria Microscopic urine
examination reveals 30 to 50 leukocytes/hpf but no other formed elements,
casts, or debris. Which of the following is true regarding the diagnosis of the
decreased renal function in this patient?
A. The ratio of blood urea nitrogen to creatinine indicates chronic renal
insufficiency
C. * Hypercalcemia
D. Acute glomerulonephritis
E. Bilateral renal artery stenosis
143. A 58-year-old woman with a 4-year history of type 2 diabetes mellitus
is evaluated in the emergency department for weakness. Six months ago, her
serum creatinine concentration was 1.0 mg/dL. She now has polydipsia and
polyuria. On physical examination, blood pressure is 120/60 mm Hg and heart
rate is 98/min while supine; blood pressure is 108/50 mm Hg and heart rate
was 112/min standing. The chest is clear, and cardiac examination is normal.
The remainder of the examination is unremarkable. Laboratory studies: Blood
urea nitrogen 32 mg/dL Serum creatinine 1.6 mg/dL Serum sodium 148
meq/L Serum potassium 3.2 meq/L Serum chloride 99 meq/L Serum
bicarbonate 19 meq/L Serum glucose 405 mg/dL Urine creatinine 35 mg/dL
Urine sodium 76 meq/L Urinalysis Specific gravity, 1.009; no hematuria; trace
proteinuria; 1 + glucosuria; 1 + ketonuria Microscopic urine examination was
unremarkable. Which statement is true regarding the evaluation of this
patient with renal insufficiency?
A. The fractional excretion of sodium (FE Na) is incompatible with a
diagnosis of prerenal azotemia
B. * The FE Na is due to glycosuria
C. The history, physical examination, and laboratory evaluation are
consistent with chronic renal insufficiency secondary to diabetic
nephropathy
D. The FE Na is incompatible with a diagnosis of urinary tract
obstruction
E. The FE Na is most reliable in evaluation of acute renal failure if
oliguria is not present
144. A 59-year-old man presents to the emergency department with a 3-day
history of worsening weakness, decreased mental acuity and responsiveness,
and slurred speech. The patient had been experiencing worsening weakness
over the past 6 months. The patients medical history includes bipolar
disorder (diagnosed 10 years ago) and hypothyroidism (diagnosed 5 years
ago). His medications are lithium, 300 mg/d, and levothyrroxine, 150 ?g/d.
The patient is disoriented and lethargic, with slurred speech and periods of
agitation. A fine tremor and hyperreflexia are present. On physical
examination, supine blood pressure is 148/79 mm Hg, pulse rate 101/min,
respiratory rate 16/min, temperature 37.7 C (99.9 F). While he is standing,
his blood pressure is 142/80 mm Hg and heart rate is 108/min. The mucous
membranes are dry, and the neck veins are flat. Cardiac, pulmonary, and
abdominal examinations are normal. No lower extremity edema is noted.
Laboratory studies: Blood urea nitrogen 82 mg/dL Serum creatinine 9.2 mg/dL
Serum sodium 162 meq/L Serum potassium 6.7 meq/L Serum chloride 131
meq/L Serum bicarbonate 17.2 meq/L Serum calcium 10.7 mg/dL Serum
albumin 4.5 g/dL Serum lithium 4.5 meq/L Serum thyroid-stimulating
hormone
A. Begin intravenous infusion of normal saline for volume repletion
B. Administer 1 ampule of dextrose and 10 U of insulin intravenously
for hyperkalemia
changes; pulse rate 11 5/min; respiratory rate 22/min; and temperature 36.8
C (98.2 F). Three-fingerbreadth neck-vein distention at 45 degrees and
hepatojugular reflux are present. Cardiac examination shows an S3 gallop.
There are scattered bibasilar rales. The abdomen has a fresh surgical scar.
Bowel sounds are not heard, and there is diffuse tenderness. The patient has
2+ lower extremity edema. She is arousable but somnolent and moves all
extremities in response to commands. She complains of dyspnea. Laboratory
studies: Hematocrit 37% Leukocyte count Leukocytosis Platelet count Low
Blood urea nitrogen 75 mg/dL Serum creatinine 4.4 mg/dL Serum sodium 130
meq/L Serum potassium 6.3 meq/L Serum chloride 90 meq/L Serum
bicarbonate 16 meq/L Arterial blood gaspH 7.26, Pco2 25 mm Hg, Po2 65 mm
Hg Urinalysis pH 6.0, specific gravity 1.009, 2+ proteinuria, no hematuria or
ketonuria There are muddy brown casts on microscopic examination. The
electrocardiogram shows prominent, peaked T waves. What is the next step
in treatment of this patient with acute renal failure?
A. Administer fenoldopam
B. Start ultrafiltration
C. * Start continuous venovenous hemofiltration
D. Start peritoneal dialysis
E. Initiate plasma exchange
148. A 61-year-old woman with a previously normal serum creatinine
concentration is admitted with abdominal pain. Abdominal aortic aneurysm
was diagnosed after an intravenous contrast study, and the patient
underwent emergency aneurysmectomy. On the third hospital day, in the
intensive care unit, the patient was oliguric. She was given an intravenous
furosemide infusion but was still oliguric several hours later. On physical
examination, the blood pressure is 90/62 mm Hg, with no orthostatic
changes; pulse rate 11 5/min; respiratory rate 22/min; and temperature 36.8
C (98.2 F). Three-fingerbreadth neck-vein distention at 45 degrees and
hepatojugular reflux are present. Cardiac examination shows an S3 gallop.
There are scattered bibasilar rales. The abdomen has a fresh surgical scar.
Bowel sounds are not heard, and there is diffuse tenderness. The patient has
2+ lower extremity edema. She is arousable but somnolent and moves all
extremities in response to commands. She complains of dyspnea. Laboratory
studies: Hematocrit 37% Leukocyte count Leukocytosis Platelet count Low
Blood urea nitrogen 75 mg/dL Serum creatinine 4.4 mg/dL Serum sodium 130
meq/L Serum potassium 6.3 meq/L Serum chloride 90 meq/L Serum
bicarbonate 16 meq/L Arterial blood gaspH 7.26, Pco2 25 mm Hg, Po2 65 mm
Hg Urinalysis pH 6.0, specific gravity 1.009, 2+ proteinuria, no hematuria or
ketonuria There are muddy brown casts on microscopic examination. The
electrocardiogram shows prominent, peaked T waves. What is the next step
in treatment of this patient with acute renal failure?
A. Administer fenoldopam
B. Start ultrafiltration
C. * Start continuous venovenous hemofiltration
D. Start peritoneal dialysis
E. Initiate plasma exchange
abdomen is not tender. There is trace bilateral lower extremity edema. The
left leg is cooler than the right, and no popliteal or dorsalis pedis pulse is
detected. Blood urea nitrogen is 29 mg/dL, and serum creatinine is 1.4
mg/dL. Urinalysis shows a specific gravity of 1.018, trace protein, and no
glucose or ketones. Microscopic examination of the urine is normal. The
patient undergoes arteriography with a limited amount of iopamidole and
receives acetylcysteine and hydration. Laboratory tests are ordered for the
next day. On physical examination, her pulse rate is 98/min and regular, and
blood pressure is 142/90 mm Hg. Chest, abdominal, and cardiac
examinations are normal. The lower extremities are unchanged. Laboratory
studies: Blood urea nitrogen 43 mg/dL Serum creatinine 1.9 mg/dL Serum
sodium 141 meq/L Serum potassium 3.7 meq/L Serum chloride 100 meq/L
Serum bicarbonate 21 meq/L Urinalysis Specific gravity 1 .009; trace
proteinuria; no glucosuria, ketonuria, or hematuria Urine microscopy Tubular
epithelial cells, rare granular casts Which of the following should be done?
A. Administer dopamine
B. Administer bicarbonate
C. Administer half-normal saline and readminister acetylcysteine
D. Start dialysis to clear contrast medium
E. * Observe for complications of acute renal failure
152. A 62-year-old woman with coronary artery disease and atherosclerotic
peripheral vascular disease is hospitalized because of pain in her left leg. She
has had hypertension for 17 years and hypercholesterolemia for 13 years,
both of which are well controlled by various medications. On physical
examination, the pulse rate is 90/min and regular, and blood pressure is
148/94 mm Hg. The chest is clear. No murmurs or gallops are heard. The
abdomen is not tender. There is trace bilateral lower extremity edema. The
left leg is cooler than the right, and no popliteal or dorsalis pedis pulse is
detected. Blood urea nitrogen is 29 mg/dL, and serum creatinine is 1.4
mg/dL. Urinalysis shows a specific gravity of 1.018, trace protein, and no
glucose or ketones. Microscopic examination of the urine is normal. The
patient undergoes arteriography with a limited amount of iopamidole and
receives acetylcysteine and hydration. Laboratory tests are ordered for the
next day. On physical examination, her pulse rate is 98/min and regular, and
blood pressure is 142/90 mm Hg. Chest, abdominal, and cardiac
examinations are normal. The lower extremities are unchanged. Laboratory
studies: Blood urea nitrogen 43 mg/dL Serum creatinine 1.9 mg/dL Serum
sodium 141 meq/L Serum potassium 3.7 meq/L Serum chloride 100 meq/L
Serum bicarbonate 21 meq/L Urinalysis Specific gravity 1 .009; trace
proteinuria; no glucosuria, ketonuria, or hematuria Urine microscopy Tubular
epithelial cells, rare granular casts Which of the following should be done?
A. Administer dopamine
B. Administer bicarbonate
C. Administer half-normal saline and readminister acetylcysteine
D. Start dialysis to clear contrast medium
E. * Observe for complications of acute renal failure
D. Reset osmostat
E. Pseudohyponatremia
159. A 65-year-old man who is known to have alcoholism is transferred from
a local jail to the hospital because of generalized weakness and a witnessed
seizure 1 hour ago, shortly after he was arrested for vagrancy. In the
emergency department, he is lethargic but conversant and oriented. He
reports a several-day history of diarrhea and has muscle cramps. He has no
history of trauma or previous seizures. He is taking no medications but has
smoked 1 pack of cigarettes daily for the past 30 years. On physical
examination, blood pressure is 110/75 mm Hg, pulse rate is 100/min, and
respiratory rate is 18/min. The neck is supple, and the carotids are normal.
The lungs are clear, and cardiac examination shows regular sinus rhythm and
a G1-2/6 systolic murmur at the base. The abdomen is soft, with bowel
sounds; the edge of the liver is palpable, but the spleen is not. Cranial nerves
are normal, and the patient has 3+ reflexes. Carpal pedal spasm is noted
intermittently during examination, and Chvosteks sign is present. Laboratory
studies: Leukocyte count 9500/?L Hemoglobin 12 g/dL Hematocrit 37% Blood
urea nitrogen 35 mg/dL Serum creatinine 1.4 mg/dL Serum sodium 136
meq/L Serum potassium 2.7 meq/L Serum chloride 98 meq/L Serum
bicarbonate 23 meq/L Serum calcium 7.6 mg/dL Serum magnesium 0.5
mg/dL Serum phosphorus 3.0 mg/dL Serum total protein 7.2 g/dL Serum
albumin 3.5 g/dL Urinalysis Specific gravity 1.025; no proteinuria or
hematuria; 1-3 erythrocytes/hpf and 5-7 leukocytes/hpf What is the most
appropriate therapy for this patients electrolyte disorder?
A. Intravenous magnesium sulfate
B. * Intravenous magnesium sulfate and potassium chloride
C. Oral magnesium and potassium chloride
D. Intravenous potassium chloride
E. Intravenous calcium
160. A 66-year-old woman is hospitalized after a right hip fracture requiring
open reduction and internal fixation. She received intravenous hydration
through postoperative day 3. On presentation, her blood pressure was 160/90
mm Hg. Three years earlier, her blood pressure at a routine office visit was
128/82mm Hg. The patient is discharged on postoperative day 4 to an
inpatient extended care center. On postoperative day 10, a consultation is
obtained to help manage her persistent hypertension. Her only medication is
celecoxib. Laboratory studies: Value At presentation On postoperative day 2
On postoperative day 10 Blood pressure 160/90 mmHg 180/104 mmHg
160/95 mmHg Serum sodium 141 meq/L 142 meq/L 141 meq/L Serum
potassium 3.0 meq/L 2.4 meq/L 2.9 meq/L Serum chloride 100 meq/L 98
meq/L 99 meq/L Serum bicarbonate 31 meq/L 32 meq/L 32 meq/L Arterial
blood gas-pH 7.46, Pco2 46 mm Hg What condition best explains the patients
status?
A. Essential hypertension
B. Pheochromocytoma
C. Hypertension induced by use of nonsteroidal anti-inflammatory
drugs
D. * Primary hyperaldosteronism
E. No correct answer
161. A 67-year-old retired nurse presents because of a 6-month history of
gradual-onset dementia. Aside from loss of recent memory and confusion
about time and place, she has no symptoms or complaints. She has
hypothyroidism that is treated with levothyroxine, 100 ?/d, and hypertension
treated with amlodipine, 5 mg/d. She also takes estrogen therapy. She has
smoked 1 to 2 packs of cigarettes daily for the past 35 years, and she drinks
less than 1 ounce of alcohol weekly. On examination, the patients demeanor
is pleasant. She is in no distress, but she is disoriented to time and place.
Blood pressure is 142/88 mm Hg seated and 135/85 mm Hg, pulse rate
68/min, respiratory rate 12/min, temperature 37 C (98.6 F). There is no
neck vein distention, and the carotids are normal. The lungs are clear. Cardiac
examination reveals regular sinus rhythm, a grade 1/6 systolic murmur at the
base, and no gallop. Abdominal examination is normal. There is no edema,
and lower extremity pulses are present and normal. Neurologic examination
is normal. Laboratory studies: Complete blood count Normal Plasma glucose
84 mg/dL Blood urea nitrogen 6 mg/dL Serum creatinine 0.5 mg/dL Serum
sodium 124 meq/L Serum potassium 4.2 meq/L Serum chloride 89 meq/L
Serum bicarbonate 24 meq/L Serum thyroid-stimulating hormone 3.2 mIU/L
Serum uric acid 2.3 mg/dL Serum cholesterol 182 mg/dL Serum triglyceride
60 mg/dL Serum total protein 7.5 g/dL Serum albumin 3.8 g/dL Serum
osmolality 255 mosmol/kg H2O Urinalysis Specific gravity 1.030; no
hematuria or proteinuria What is the most likely cause of this patients
hyponatremia?
A. * Syndrome of inappropriate antidiuretic hormone secretion
B. Pseudohyponatremia
C. Surreptitious diuretic use
D. Cryptogenic cirrhosis
E. Psychogenic polydipsia
162. A 69-year-old white man is referred for worsening hypertension over
the past 2 to 3 months. He has had hypertension for the past 18 months. It
had been controlled by ?-blocker therapy, which was begun after he had an
inferior myocardial infarction. A recent blood pressure measurement was
200/120mm Hg, requiring additional therapy with amlodipine. His medical
history is significant for the myocardial infarction and a right femoral popliteal
bypass. He smokes two packs of cigarettes daily and drinks alcohol socially.
On examination, blood pressure is 178/104 mm Hg seated and standing, and
body weight is 72 kg (159 Ib). Optic funduscopy reveals background
hypertensive retinopathy. A left carotid bruit is heard. Cardiopulmonary and
neuromuscular examinations are normal. Abdominal examination showed no
organomegaly, but an epigastric bruit is present. No peripheral edema is
noted. Serum creatinine concentration is 2.3 meq/dL, and serum potassium
concentration is 3.9 mg/dL. Urinalysis shows 1 + proteinuria without
hematuria. Electrocardiography is positive for left ventricular hype rtrophy.
What is the most appropriate noninvasive screening test for possible renal
artery stenosis in this patient?
A. * Magnetic resonance angiography with gadolinium
B. Computed tomographic angiography with contrast
C. Captopril renography
D. Captopril plasma renin activity test
E. No correct answer
163. A 70-year-old woman is admitted because she has had malaise and
anorexia for 1 week. She has been previously healthy, except for
hypertension and hypercholesterolemia, treated with hydrochlorothiazide and
atorvastatin. On physical examination, the supine blood pressure is 150/95
mm Hg, pulse rate 80/min, respiratory rate 20/min, and temperature 37.4 C
(99.3 F). The blood pressure is 125/80 mm Hg and the pulse rate 96/min
while standing. There is no neck vein distention or hepatojugular reflux.
Cardiac, breast, abdominal, and pulmonary examinations are normal. No
lower extremity edema is present. Laboratory studies: Hematocrit 29%
Leukocyte count 3,200/?L Platelet count 90,000/?L Blood urea nitrogen 62
mg/dL Serum creatinine 4.6 mg/dL Serum sodium 134 meq/L Serum
potassium 5.0 meq/L Serum chloride 114 meq/L Serum bicarbonate 15 meq/L
Serum glucose 105 mg/dL Serum calcium 12.5 mg/dL Serum inorganic
phosphate 8.5 mg/dL Urine creatinine 25 mg/dL Urine sodium 50 meq/L
Urinalysis Specific gravity 1 .007; trace proteinuria; no glucosuria or ketonuria
Arterial blood gaspH 7.30, PCO2 28 mm Hg Microscopic analysis shows
scattered tubular epithelial cells. Posteroanterior and lateral films of the chest
are normal. What is the most likely diagnosis?
A. Milk-alkali syndrome
B. Sarcoidosis
C. * Multiple myeloma
D. Primary hyperparathyroidism
E. Clinical consequence of hydrochlorothiazide therapy
164. A 72-year-old white man returns for a follow-up visit subsequent to
admission to another hospital for hypertension. He was seen in the local
emergency department for severe musculoskeletal back pain, where the
treating physician noted elevated blood pressure (200/92 mm Hg) and a
serum creatinine concentration of 1.6 mg/dL. Results of other laboratory tests
were normal. The patient was admitted for evaluation and management of
back pain, and the attending physician obtained additional studies relating to
the patients hypertension. Renal ultrasonography was negative for calculus,
mass, or obstruction; kidney size was 11 cm on the right and 12 cm on the
left. Renal artery duplex ultrasonography was suggestive of right renal artery
stenosis. Renal angiography revealed a normal left renal artery and 50%
stenosis in the right renal artery. Analysis of renal vein renin activity showed
a low inferior vena cava value of 1.5 ?g/L/h, right renal vein value of 2.0 ?
g/L/h, left renal vein value of 2.0 ?g/L/h, and a high inferior vena cava value
of 2.0 ?g/L/h. The plasma renin activity is 1 .0 mg/LIh, and the plasma
aldosterone level is 8.0 ng/dL.The thyroid-stimulating hormone level is 1.0 ?
U/mL. Review of your office records confirms that the patient has a 22-year
history of hypertension controlled with a ?-blocker and diuretic therapy. The
serum creatinine concentration has been stable at 1.6 mgldL for more than 3
years, and urinalysis shows 1 + proteinuria. What is the cause of this mans
hypertension?
A. * Primary hypertension
B. Hypothyroidism
C. Primary hyperaldosteronism
D. Renovascular hypertension
E. Pheochromocytoma
165. A 73-year-old frail white woman is seen for preoperative assessment of
kidney function before aortic valve replacement. Body weight is 46 kg (101
Ib). The serum creatinine concentration is 1.6 mg/dL, and results of urinalysis
are normal. In evaluating and classifying patients with chronic kidney
disease, the National Kidney Foundation recommends estimating the
patients glomerular filtration rate. Which of the following statements is true?
A. Measurement of serum creatinine is the best predictor of
glomerular filtration rate, independent of the patients age, body
weight, and sex
B. Calculation of the timed 24-hour creatinine clearance is the clinical
gold standard for estimating glomerular filtration rate, as it is
simple and reproducible
C. Measurement of the clearance of 125I-iothalamate or inulin is the
most accurate measurement of glomerular filtration rate and should
be applied to all patients
D. * The glomerular filtration rate should be estimated by using
prediction equations (Cockcroft-Gault or Modification of Diet in
Renal Disease) that take into account serum creatinine
concentration, age, body weight, and sex
E. No correct answer
166. A 74-year-old man is hospitalized with cough and chest pain. He was
previously healthy and has not been seen by a physician in more than 14
years. At a health fair 1 year ago, he had a blood pressure check and blood
and urine tests, but he did not return for a scheduled office examination. He
came to the office at the request of his wife. On physical examination, the
blood pressure is 148/92 mm Hg, with no orthostatic changes; heart rate,
75/min; respiratory rate, 18/min; and temperature 37.8 C (100 F). There is
no neck vein distention or hepatojugular reflux. The cardiac examination is
normal. The left lower lung field shows increased fremitus, dullness to
percussion, and scattered basilar crackles. No lower extremity edema is
present. The electrocardiogram is normal. Hematocrit is 34 %, and
leukocytosis is present with a normal platelet count. The serum creatinine
concentration is 2.3 mg/dL. Urinalysis shows a pH of 6.0, 1 + proteinuria, and
no hematuria or ketonuria. No formed elements appear on microscopic
examination. What is the most important next step in determining the
diagnosis of the decreased renal function in this patient?
A. Calculate the ratio of blood urea nitrogen to creatinine
B. Obtain renal ultrasonography
C. * Obtain creatinine clerence
D. Obtain previous serum creatinine concentration and urinary protein
excretion
167. You are asked to see the patient 2 days postpartum to assist in
managing persistently elevated blood pressure. The patients only symptom is
mild frontal headache. She is alert and oriented, and she appears well. Blood
pressure is 175/95 mm Hg, with no orthostatic changes; pulse rate is 84/min;
respiratory rate is 18/min; and temperature is 38 C (100.4 F). She has no
evidence of retinopathy. There is no neck vein distention or hepatojugular
reflux. Cardiopulmonary examination is normal. No lower extremity edema is
present. You recommend increasing the dose of -blocker and adding
hydralazine. Blood pressure on day 3 postpartum is 130/75mm Hg. You find
the following laboratory studies in the chart: Postpartum day 2 Postpartum
day 3 Hemoglobin 12.8 g/dL 11.0 g/dL Platelet count 180,000/?L 120,000/?L
Serum glucose 89 mg/dL 97 mg/dL Blood urea nitrogen 24 mg/dL 36 mg/dL
Serum creatinine 1.2 mg/dL 2.9 mg/dL Serum sodium 134 meq/L 132 meq/L
Serum potassium 3.8 meq/L 4.2 meq/L Serum chloride 99 meq/L 100 meq/L
Serum bicarbonate 24 meq/L 20 meq/L You request a urine sample for
microscopy, and the patient produces only 5 mL of blood-tinged urine. She
comments that this is the first time she has urinated since last night.
Urinalysis shows specific gravity of 1.009, positive dipstick hematuria, trace
proteinuria, and small urobilinogen with no cellular casts. What is the next
appropriate step in management of this patient?
A. Aggressive intravenous saline infusion for volume repletion
B. * Emergency renal ultrasonography to rule out obstructive uropathy
C. Repeat complete blood count and inspection of blood smear.
D. Two sets of blood cultures and ticarcillin-clavulanate therapy for
empiric coverage of early sepsis.
E. Transfer to intensive care unit and start dopamine infusion