1. Patient S. 23 years old suffering from chronic pyelonephritis, for the
diagnosis of kidneys function was held excretory urography. After that,
the patient appeared complaints of general weakness, nausea. Diuresis
decreased to 100 ml/day. Objectively: skin pale and dry. Blood
pressure – 130/80 mmHg, pulse - 96/min. Cardiac tones are
attenuated. Clinical blood analysis: Hb - 126 g/l, er. - 4.9x1012/l, ESR 18 mm/h. Biochemical blood analysis: creatinine - 0,5 mmol/l, K 6, 0 mmol/l. Your diagnosis?
A. Acute renal failure *
B. Chronic renal failure
C. Acute glomerulonephritis
D. Nephrotic crisis
E. Hypertensive crisis
2. Patient M. 32 years old ambulance delivered in the emergency
department of the regional hospital complaining of a acute decrease
urine output (50 ml/day), pronounced weakness, nausea, back
pain. Fell
ill
suddenly,
a
few
hours
after
eating
mushrooms. Objectively: lethargy, yellowness of skin, pulse 100/min.,
rhythmic, BP 90/60 mmHg. Blood urea 35 mmol/l, and creatinine 300 mmol/l, the content of K - 5,8 mmol/l. Which of the following
urgent measures is a priority?
A. Hemodialysis *
B. Diuretic therapy
C. Correction of hyperkalemia
D. Introduction of an antidote
E. Correction of BP
3. Man 55 years complaining on general weakness, decreasing urine
output, heart pain of aching character. In the last 15 years suffered
from chronic pyelonephritis treated in hospitals. Objective: skin dry
with a yellowish tint. Pulse – 80/min., rhythmic, blood pressure 100/70 mmHg. Auscultation of the heart: attenuation of heart sounds,
auscultated pericardium murmur. In the study: creatinine – 1,1 mmol/l,
glomerular filtration rate of 5 ml/min. What treatment will be most
effective ?
A. Hemodialysis. *
B. Hemosorbtion.
C. Plasmapheresis
D. Intestinal dialysis
E. Conservative therapy
4. Patient M. 25 years old who addmited to the emergency department
hospital, a cardiac arrest occurred. Diagnosis: Acute renal failure.
What metabolic disturbances of blood electrolytes are most likely in
this case?
A. Calcium
5.
6.
7.
8.
B. Magnesium
C. Potassium *
D. Phosphorus
E. Sodium
Male 43 years old took about 100 ml of brake fluid. At 5-day stay in
the department of toxicology appeared nausea, headache, thirst,
bloating, itching of the skin. Diuresis <0,5 ml/kg/h. for 12 hours. What
is the most likely diagnosis in this patient?
A. Acute renal failure *
B. Acute liver failure
C. Acute hepato-renal failure
D. Acute gastritis
E. Acute cholecystitis
Patient T. 51 with developed acute renal failure. The cause of this
condition may be all of the following except:
A. Cardiogenic shock
B. Mushroom poisoning
C. Malignant hypertension
D. Urolithiasis
E. Chronic heart failure *
Man 75 years old delivered to the hospital with complains on intensive
pain, lack of urine during the day. Objectively: pale skin, tachycardia,
blood pressure 170/90 mm Hg, dullness during percussion in the
suprapubic area. 750 ml of urine received by metallic catheter. In
clinical analysis of urine there are traces of protein, leukocytes at 1012/sight, erythrocytes 3-5 in preparation. The level of urea in plasma
was 8,0 mmol/l, creatinine – 0,11 mmol/l. Specify the probable reason
for the lack of urine?
A. Acute urinary retention *
B. Acute glomerulonephritis
C. Urolithiasis
D. End stage renal disease
E. Acute renal failure
Patient 35 years called ambulance. Complaints on severe back pain that
irradiates to the right groin and scrotum, nausea, vomiting. On
examination, the patient is restless, covered with cold sweat, stomach
tense. Slight tenderness in the right iliac region on palpation. Weakly
positive Pasternatsky symptom on the right side. Disuria. Your
diagnosis?
A. Renal colic *
B. Biliary colic
C. Intestinal colic
D. Acute pancreatitis
E. Acute cholecystitis
9.
Woman 28 years old about 10 years suffering from chronic
glomerulonephritis, not systematically treated. During the last six
months there appeared weakness, loss of appetite, nausea, dry
mouth. The patient complains on headache, pain in the
joints. Examination: anemia, increased blood urea (24,5 mmol/l) and
creatinine in the blood (0,766 mmol/l), hyperphosphatemia (1,78
mmol/l), proteinuria (1,2 g/day). What complicated the course?
A. Chronic renal failure *
B. Acute renal failure
C. Nephrotic syndrome
D. Kidney amyloidosis
E. Gout nephropathy
10. A woman 50 years old, who suffers from chronic pyelonephritis,
during exacerbation was prescribed combination of antibacterial means
- gentamicin (80 mg/3 times per day) and biseptol (960 mg/2 times per
day.) What this scheme of antibiotic therapy could cause?
A. Acute interstitial nephritis *
B. Glomerulosclerosis
C. Chronic renal failure
D. The above combination of antibiotics is optimal and is quite
safe
E. Acute renal failure
11. Patient 35 years with acute renal failure is on hemodialysis in ICU. On
the 3rd day of treatment there appeared irregular heart work,
hypotension, severe weakness, shortness of breath. The ECG:
bradycardia, atrioventricular block I st., acute and high wave T. What
is the most likely reason as well above clinical picture?
A. Increased level of potassium*
B. Hyperhydration
C. Decreased level of potassium
D. Increased level of sodium
E. Increased level of calcium
12. Woman 42 years old complains on vomiting, nausea, weakness,
decrease in urine output to 450 ml/day. She suffers from chronic
glomerulonephritis 8 years. Objectively: skin pale, dry mouth - smell
of ammonia. Edamata of feet. BP 180/100 mmHg. In urine: protein
0,33 g/day, leuk. - 2-4/sight, er. - 8-10/sight, wax cylinders - 2-4 in
preparation. Nicturia, relative density of urine 1,005 – 1,011. In blood
Hb - 92 g/l, er. - 2.79x1012/l. Blood creatinine 720 mmol/l, K - 6,0
mmol/l. What is the function of the kidneys that is impaired ?
A. Nitrogen decrease *
B. Electrolyte regulation
C. Osmosis regulation
D. Volume regulation
E. Incretory function
13. Patient 29 years old with clinical signs of rapidly progressive
glomerulonephritis. Which method of research needed to verify the
diagnosis?
A. Ultrasound of the kidneys
B. Excretory urography
C. Nephrobiopsy *
D. CT imaging
E. CT imaging and nephrobiopsy
14. Patient 19 years old with clinical signs of rapidly progressive
glomerulonephritis. What research or complex of investigations in this
case, the most important and urgent decisions about treatment choices?
A. Glomerular filtration rate, calcium level in blood *
B. Ultrasound of the kidneys
C. The concentration of creatinine and potassium levels, kidney
ultrasound
D. The concentration of urea and blood potassium
E. Urine output per day
15. Patient 33 years old after day after took unknown poison in order of
suicide appeared complaints on general weakness, headache, nausea,
hemorrhage urine, oliguria. Objectively: BP - 170/100 mmHg, Ps 84/min., rhythmic. In the analysis of urine: protein – 0,73 g/l,
erythrocyte cover the entire field of view. Serum K – 6,9 mmol/l,
creatinine – 1,2 mmol/l. What is the most likely diagnosis?
A. Acute renal failure *
B. Acute glomerulonephritis
C. Toxic hepatitis
D. Toxic gastritis
E. Toxic encephalopathy
16. Patient 29 years who addmited to the hospital on the 6th day of disease
in critical condition. Drowsiness, slower, does not urine
output. Acutely ill, the body temperature is 39,5 ºC, headache, muscle
pain, especially on the calf. On the 4th day there appeared jaundice,
hemorrhagic rash, nausea, vomiting, decreased urine output. What state
has developed in a patient?
A. Acute hepato-renal failure *
B. Acute liver failure
C. Acute renal failure
D. Infectious and toxic shock
E. DIC
17. Patient in 45 years old, for 8 years suffering from chronic
glomerulonephritis. AT - 180/120 mmHg, serum creatinine - 770
mmol/l, blood urea - 28 mg/dl, glomerular filtration rate –
5,0 ml/min. What medical tactics shown in this case?
A. Hemodialysis *
B. Enterosorption
C. Hemosorbtion
D. Plasmapheresis
E. Hemofiltration
18. The patient has sopor condition, anasarca, asthma, blood pressure 200/120 mmHg. Blood: creatinine – 0,96 mmol/l, urea 38,5 mmol/l
Urinalysis: protein - 3,3 g/l, white blood cells - 5-15, erythrocytes
leached - 3-4, granular cylinders - 12-15, wax cylinders - 2-4 in
sight. The most likely diagnosis?
A. Uremic coma *
B. Hypothyroid coma
C. Diabetic coma
D. Hepatic coma
E. Cerebral coma
19. In the emergency department patient addmited the hospital, which in
the purpose of suicide took about 50 ml of vinegar essence. He
complains on a sore throat and nausea. Breathing is not broken,
hemodynamics is stable. Development of what complication should be
expected in patients in the near future?
A. Acute renal failure *
B. Acute liver failure
C. Toxic shock
D. Gastro-intestinal bleeding
E. Asphyxia
20. Patient K. 52 years old delivered by our own transport to hospital
admissions department with the attack of very severe pain in the back
and side of the abdomen, more to the right with irradiation to the
vagina, and inner thighs. The patient is excited, complaining of
nausea. Urine: minor proteinuria, microhematuria, leukocyturia,
crystalluria. Worsening of the patient within 2 hours. Your diagnosis?
A. Urolithiasis *
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Gallstone disease
E. Acute appendicitis
21. 35-year-old man admitted to hospital with a gunshot wound to the
groin area. Patient pale. Pulse - 108/min., BP - 70/35 mmHg. After
bandaging the wound in a few hours later he is diagnosed with a
further fall of blood pressure. There was discovered outside of the
peritoneum bleeding, which was stopped. A hemotransfusion was
conducted, norepinephrine infused. Laboratory data on the following
day: urea 21,5 mmol/l, creatinine 0,25 mmol/l, sodium 142,0 mmol/l,
potassium 4,2 mmol/l. What is the diagnosis?
A. Acute renal failure *
B. Chronic renal failure
C. Diabetes insipidus
D. Hyperaldosteronism
E. Hypoaldosteronism
22. Patient 25 years innacurately held transfusion of inappropriate
erythrocyte mass. The patient appeared with intense back pain, catheter
from the bladder allocated 100 ml of urine red-lacquer colors. What
complication has developed in a patient?
A. Acute renal failure *
B. Radiculitis
C. Acute glomerulonephritis
D. Renal colic
E. Osteochondrosis
23. A patient 23 years after the use of brake fluid anuria occurred, which
continues the fifth day, the creatinine level increased to 0,569 mmol/l.
What medical tactics in this case?
A. Hemodialysis *
B. Detoxification therapy
C. Antidote therapy
D. Diuretics
E. Plasmapheresis
24. A patient with severe pneumonia there appeared back pain, nausea,
severe weakness, headache. In overview: pale skin, swelling of the
lower extremities. Blood pressure 80/40 mmHg. Urine output – 100,0
ml per day. Urine relative density – 1008. There is proteinuria,
erythrocyturia, hyaline and granular cylinders. At elevated levels in
blood creatinine and urea were found. Which diagnosis in this case?
A. Acute renal failure *
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Urolithiasis
E. Nephrotic syndrome