Internal Medicine 4th year, dental faculty Module 2. Principles of Internal Medicine (writing in and defense of training case history, diseases of urinary, endocrine system, diseases of the blood, allergy) 1. For the diabetic patient with microalbuminuria, what dietary modification should the doctor suggest? A. Decreased percentage of total calories derived from carbohydrates B. Decreased percentage of total calories derived from proteins C. Decreased percentage of total calories derived from fats D. Decreased total caloric intake E. No any answer is correct ANSWER: A 2. How does glucagon assist in maintaining blood glucose levels? A. Glucagon enhances the activity of insulin, restoring blood glucose levels to normal more quickly after a high-calorie meal. B. Glucagon is a storage form of glucose and can be broken down for energy when blood glucose levels are low. C. Glucagon converts the excess glucose into glycogen, lowering blood glucose levels in times of excess. D. Glucagon prevents hypoglycemia by promoting glucose release from liver storage sites. E. All above mentioned ANSWER: D 3. Macroangiopathy, as a symptom of diabetes mellitus, most often destroy vessels of: A. Brain B. Lung C. Kidneys D. Retina E. Intestine ANSWER: A 4. Which syndrome is not typical for chronic pyelonephritis? A. Asthenic B. Pain C. Hypertension D. Dyspeptic E. cachexia ANSWER: E 5. Three hours after surgery, the doctor note that the breath of the patient who is a type 1 diabetic has a “fruity” odor. What is the doctor’s best first action? A. Document the finding as the only action. B. Increase the IV fluid flow rat C. Test the urine for ketone bodies. D. Perform oral car E. All above mentioned ANSWER: C 6. Which examination should you prescribe for a patient if you revealed erythrocytes, protein and casts in his urine? A. Renography B. Chest X-ray C. Ultrasound examination of kidneys D. Renal scintigraphy E. Duodenal probing ANSWER: C 7. Which data of urianalyses are typical for acute glomerulonephritis? A. increased protein, erythrocytes and hyaline and wax casts B. increased protein, and hyaline casts C. leucocyturia, granular casts D. Crystals of uric acid salts in urine E. No correct answer ANSWER: A 8. What is the priority intervention for the patient having Kussmaul respirations as a result of diabetic ketoacidosis? A. Administration of oxygen by mask or nasal cannula B. Intravenous administration of 10% glucose C. Implementation of seizure precautions D. Administration of intravenous insulin E. All above mentioned ANSWER: D 9. Which action should the doctor suggest to reduce insulin needs in the patient with diabetes mellitus? A. Reducing intake of water and other liquids to no more than 2 L/day B. Eating animal organ meats high in insulin C. Taking two 1-hour naps daily D. Walking 1 mile each day E. No any answer is correct ANSWER: D 10. Which action should the doctor teach the diabetic patient as being most beneficial in delaying the onset of microvascular and macrovascular complications? A. Controlling hyperglycemia B. Preventing hypoglycemia C. Restricting fluid intake D. Preventing ketosis E. No any answer is correct ANSWER: A 11. What type of a disease is acute pyelonephritis? A. Immunoallergic B. Allergic C. Authoimmune D. Infectious E. Dysthrophic ANSWER: D 12. Select complication of chronic glomerulonephritis: A. Acute renal failure B. Chronic renal failure C. Toxic shock D. Bleeding E. All mentioned ANSWER: B 13. Select complication of chronic glomerulonephritis: A. Acute renal failure B. Chronic renal failure C. Toxic shock D. Bleeding E. Hypertonic crisis ANSWER: E 14. Sick O., 39 years old, complains of frequent urination at night. What pathology is this symptom typical for? A. acute nephritis; B. diabetes mellitus; C. chronic kidney insufficiency; D. chronic cardiac insufficiency; E. diencephalic syndrom ANSWER: C 15. What position does patient with urocolick assume? A. On affected side with legs bended hip and knee joints and by the leg pressed to the stomach from the side of affection B. Semirecumbent position with lowered legs (orthopnoe) C. Lying on a sick side D. Restless E. Sitting, bending forwar ANSWER: D 16. The most often complication of acute pyelonephritis is: A. Hypotension B. Hypertension C. Acute renal failure D. Paranephritis E. Cardiopulmonary insufficiency ANSWER: D 17. The most typical causes of acute secondary pyelonephritis: A. Stricture of a urether B. Stones of kidneys and urethers C. Prostatic gland cancer D. Pregnancy E. Iatrogenic affection of urethers ANSWER: B 18. The most typical symptoms of acute pyelonephritis: A. Bacteriuria B. Chills and hectic fever C. Leucocyturia, pain D. Hematuria and leucocyturia E. Lumbar pain, chills and hectic fever ANSWER: E 19. Which antibiotics used for treatment of glomerulonephritis are nephrotoxic? A. Hentamycin B. Penicillin C. Phthorchynolones D. Macrolides E. Cephalosporines ANSWER: A 20. Which changes of kidney concentration function are typical for chronic pyelonephritis? A. hypoisosthenuria B. isosthenuria C. hypersthenuria D. hyposthenuria E. oliguria ANSWER: A 21. Which clinical sign is not typical for the beginning of pyelonephritis? A. Febril fever B. Lumbar pain C. Dysuria D. Arterial hypertension E. chills ANSWER: D 22. Which way of infection contamination is typical for primary pyelonephritis? A. Through the urether (in bladder-urether reflux) B. Along the urether walls C. Hematogenic D. Lymphogenic E. No correct answer ANSWER: C 23. What pains are characteristic for a nephrocolic: A. dull, aching pain is in small of the back B. sharp permanent pain is in small of the back C. very sharp attack-like pain in small of the back from one side D. pain at the bottom of stomach E. permanent pain is in small of the back. ANSWER: C 24. Hemorrhages in the form of small dots are named: A. petechia B. purpura C. ecchympses D. roseola E. papula ANSWER: A 25. In collaboration with the dietician, what dietary modification should the doctor suggest for the patient with hyperthyroidism? A. Decrease calories and proteins and increase carbohydrates. B. Eliminate carbohydrates and increase proteins and fats. C. Increase calories, proteins, and carbohydrates. D. No dietary modification is neede E. All above mentioned ANSWER: C 26. Which other symptoms except of deranged appetite belong to “pica chlorotica” in irondeficiency anemia? A. Patients like such smell as benzin and others unusual strong smells B. Perching sensations in a tongue C. Bitter taste in the mouth D. Heart burn E. Foul smell from the mouth ANSWER: A 27. Which patient is most at risk for hematologic problems? A. 48-year-old man who had a myocardial infarction 5 years ago B. 62-year-old woman with diabetes mellitus on insulin therapy C. 55-year-old man with chronic alcoholism D. 27-year-old woman taking oral contraceptives E. All above mentioned ANSWER: C 28. The patient with hyperthyroid symptoms is having hormone studies done to confirm the diagnosis. Which set of values indicates non–Graves’ disease hyperthyroidism? A. Elevated T3, elevated T4, high TSH levels B. Elevated T3, normal T4, low TSH levels C. Elevated T3, low T4, low TSH levels D. Low T3, normal T4, high TSH levels E. No correct answer ANSWER: A 29. The patient with hypothyroidism as a result of Hashimoto’s thyroiditis asks the doctor how long she will have to take thyroid medication. What is the doctor’s best response? A. “You will need to take the thyroid medication until the goiter is completely gon” B. “The thyroiditis will be cured with antibiotics, and then you will no longer need the thyroid medication.” C. “You will need thyroid replacement hormone therapy for the rest of your life because the thyroid gland function will not return.” D. “When your thyroid function studies indicate a normal blood level of thyroid hormones, you will be able to discontinue the medication.” E. No correct answer ANSWER: C 30. The treatment of Grave’s disease usually include A. Antagonists of thyroid hormones B. Antidepressants C. Narcotic analgesics D. Diuretics E. Sulfonylureas ANSWER: A 31. Which medical preparation will you prescribe for a patient with chronic iron-deficiency anemia which developed as a result of stomach resection? A. Folic acid B. Ferrolec pro injections C. Tardiferon-retard D. Prednisolon E. Vit. B12 ANSWER: B 32. Which medical preparation will you prescribe for a patient with chronic hepatitis and megalocytic anemia? A. Folic acid B. Ferroplex C. Prednisolon D. Ferrum-lek E. Vit. B12 ANSWER: A 33. Which patient is at greatest risk for hyperparathyroidism? A. 28-year-old patient with pregnancy-induced hypertension B. 45-year-old patient receiving dialysis for end-stage renal disease C. 55-year-old patient with moderate congestive heart failure after myocardial infarction D. 60-year-old patient on home oxygen therapy for chronic obstructive pulmonary disease E. No correct answer ANSWER: B 34. Which clinical manifestation alerts the doctor to the possibility of Graves’ disease as the cause of hyperthyroidism? A. Weight loss B. Exophthalmos C. Menstrual irregularities D. Increased heart rate and blood pressure E. All above mentioned ANSWER: B 35. Which changes will be in biochemical blood analysis of a patient with B12 deficiency anemia? A. Increased bilirubin B. Increased amylase C. Increased kreatinine D. Increased ALT and AST E. All mentioned ANSWER: A 36. Which factor is leading in chronic posthemorrhagic anemia? A. Hemolysis B. Vit. B12-deficiency C. Intoxication D. Blood loss E. Folic acid deficiency ANSWER: D 37. A fever at pernicious anemia is caused by: A. Massive disintegration of leucocytes; B. Disintegration of red corpuscles; C. Infectious complications; D. General intoxication; E. Hyperglobulinemi ANSWER: B 38. Specify, what level of haemoglobin is normal for women. A. 150-160 B. 140-160 C. 130-150 D. 120-140 E. 100-120 ANSWER: D 39. In the complete blood count of patient was determined the level of haemoglobin – 92 gr/l . Specify degree of severity of the disease: A. Mild B. Moderate C. Severe D. Critical E. No any of them ANSWER: A 40. In the complete blood count of patient was determined the level of haemoglobin – 80 gr/l . Specify degree of severity of the disease: A. Mild B. Moderate C. Severe D. Critical E. No any of them ANSWER: B 41. In the complete blood count of patient it was determined the level of haemoglobin – 48 gr/l . Specify degree of severity of the disease: A. Mild B. Moderate C. Severe D. Critical E. No any of them ANSWER: C 42. Duration of prophylactic treatment of anemia with iron preparations: A. 7 weeks B. 4 weeks C. 5 weeks 6 weeks D. 9 weeks E. No correct answer ANSWER: B 43. Early criteria of vitamin B12-deficiency anemia treatment efficacy: A. Increased level of vit. B12 in blood serum B. Reticulocytosis C. Anysocytosis D. Increase of Hb content E. Normalisation of CI ANSWER: B 44. For what disease color index is more than 1,05? A. Iron-deficiency anemia B. Posthemorrhagic anemia C. folic acid deficiency anemia D. Hemolytic anemia E. Acute leucosis ANSWER: C 45. For which anemia such findings like anysocytosis and poikilocytosis are typical? A. Iron-deficiency B. Vitamin B12-deficiency C. Congenital hemophilic D. Acquired hemophilic E. Aplastic ANSWER: A 46. For which anemia such findings like Jollie bodies and Kebot’s rings are typical? A. Iron-deficiency B. Vitamin B12-deficiency C. Congenital hemophilic D. Acquired hemophilic E. Aplastic ANSWER: B 47. How the specific elements on skin of patient with acute leukemia are called which indicate on prolipheration of malignant cells in the skin? A. Leukaemids B. Purpura C. Ecchymoses D. Scares E. Erythema ANSWER: A 48. Which patient is at greatest risk for development of acute leukemia? A. 50-year-old being treated with cyclophosphamide (Cytoxan) for a chronic autoimmune disease B. 55-year-old with diabetes mellitus type 1 who has received insulin injections for 43 years C. 20-year-old with cystic fibrosis who has been on continuous enzyme replacement therapy since age 3 months D. 38-year-old who has used combination oral contraceptives without a break for 15 years E. All above mentioned ANSWER: A 49. How complication of acute leukemia is called when the patient develops symptoms of brain affection? A. Migrain B. Meningitis C. Encefalopathy D. Hypertension E. Neuroleukemia ANSWER: E 50. How many classes of haemopoetic cells there are? A. 6 B. 4 C. 7 D. 5 E. 3 ANSWER: A 51. In patients with leukemia there are 82% of blast cells in complete blood count. Which examination is it necessary to prescribe? A. Sternal puncture B. Trepanobiopsy C. Puncture of lumph node D. Puncture of a spleen E. Puncture of a liver ANSWER: A 52. In which disease may be found blast cells in complete blood count? A. Pernicious anemia B. Chronic myeloleucosis; C. Chroniclympholeucosis; D. Hemolytic anemia; E. Acute leucosis; ANSWER: E 53. In which disease may be found high quantity of immatured myelocytes and promyelocytes in complete blood count ? A. Pernicious anemia B. Chronic myeloleucosis; C. Chroniclympholeucosis; D. Hemolytic anemia; E. Acute leucosis; ANSWER: B 54. Enlarged liver and especially spleen, which lower border may be found even in pelvic region, is typical for: A. Tbc B. Chronic myeloleucosis C. Subleukaemic myelosis D. Lymphogranulomatosis E. Chronic lympholeucosis ANSWER: B 55. In which disease Beresovsky-Sternberg’s cells may be found in lymph node biopsy material? A. AIDS B. Lupus erythematodus C. Lymphogranulomatosis D. Tbc E. Chronic lympholeucosis ANSWER: C 56. Select typical signs of acute leucaemia: A. Skin pallor, dyspnoe B. Skin redness, paresthesia in limbs C. Necrotic pharyngitis D. Skin dryness, fragidity of nails E. Gigantic liver and spleen, jaundice ANSWER: C 57. Select typical signs of chronic lympholeycosis: A. Skin redness, paresthesia in limbs B. Necrotic pharyngitis C. Skin dryness, fragidity of nails D. Gigantic liver and spleen, jaundice E. Enlarged and solid lymph nodes of all groups ANSWER: E 58. Which from objective symptoms are typical for anemia? A. Paleness of skin and mucous membranes B. Petechias C. Cyanosis D. Edema E. Rash ANSWER: A 59. Which feature is characteristic of vitamin B12 deficiency anemia but not characteristic of folic acid deficiency anemia? A. Weight loss B. Smooth, beefy-red tongue C. Macrocytic red blood cells D. * Paresthesias of the hands and feet E. All above mentioned ANSWER: D 60. What intervention is most important to teach the patient at risk for hypercalcemia to avoid risk of kidney stones formation? A. “Avoid drinking coffee and other caffeinated beverages.” B. “Be sure to drink at least 3 liters of fluids each day.” C. to avoid overcooling and viral infections D. To use only milk products E. No any answer is correct ANSWER: B 61. Which factor is leading in anemia secondary to chronic enterocolitis? A. Hemolysis B. Vit. B12-deficiency C. Intoxication D. Blood loss E. Folic acid deficiency ANSWER: E 62. What is the purpose of Nechyporenko’s test execution? A. to reveal which part of urinary system is the source of hematuria or leukocyturia, B. estimation of kidney concentration function C. for calculation of formed elements (red cells, leukocytes, casts) in urine with the method of Kakovsky-Addis D. for determination of diuresis E. for determination of the amount of albumen in urin ANSWER: C 63. Which is main drug for treatment of acute glomerulonephritis? A. Antibiotics B. Glucocoricoids C. Immunodepressants D. Diuretics E. Calcium channel antagonists ANSWER: B 64. Which is main drug for treatment of acute pyelonephritis? A. Antibiotics B. Glucocortecoids C. Immunodepressants D. Diuretics E. Calcium channel antagonists ANSWER: A 65. Which laboratory test is useful for assessment kidney concentration function? A. Complete blood count; B. ECG; C. Nechiporenko’s test; D. Zimnicki’s test E. determination of daily proteinuri ANSWER: D 66. Which compliant is typical for “Hunter’s glossitis” in Vit.B12-deficiency anemia? A. Patients like such smell as benzin and others unusual strong smells B. Perching sensations in a tongue C. Bitter taste in the mouth D. Heart burn E. Foul smell from the mouth ANSWER: B 67. Anticoagulants are prescribed in the following course of glomerulonephritis: A. With uric syndrome B. With uric syndrome and hematuria C. In resistant hypertension D. With nephrotic syndrome E. With acute nephritic syndrome ANSWER: D 68. For patient I., 54 years old, paranephritis is diagnosed. What position does patient with paranephritis assume? A. On affected side with legs bended hip and knee joints and by the leg pressed to the stomach from the side of affection B. Semirecumbent position with lowered legs (orthopnoe) C. Lying on a sick side D. Knee-elbow position E. Sitting, bending forwar ANSWER: A 69. For the patient of 43 y.o., in the urinalysis it is found out the changed red cells. What is appearance in urine of the changed red corpuscles related to? A. acute nephritis; B. urolithiasis; C. acute cystitis; D. kidney amyloidosis; E. the cancer of urinary bladder. ANSWER: A 70. For treatment of primary acute pyelonephritis all the following drugs are used except of: A. Ampicillin B. Palin C. Biseptol D. Nevigramon E. prednisolon ANSWER: E 71. For treatment of primary acute pyelonephritis are used: A. Antibiotics, sulfa drugs, uroseptics, phitodiuretics B. sulfa drugs, spasmolythics C. Antibiotics, uroseptics, hemostatics D. Antibiotics, spasmolythics, phitodiuretics E. sulfa drugs, spasmolythics, vitamina ANSWER: A 72. For treatment of pyelonephritis it is necessary to prescribe: A. uroseptics B. Preparations which improve urine outflow C. Nonsteroid anti-inflammatory agents D. Antibiotics E. all mentioned ANSWER: E 73. For what purpose Tompson’s test is performed (tree-glass test)? A. for the exposure of department of the urinary system, which is the source of hematuria or leukocyturia, B. estimation of kidney concentration function C. for calculation of formed elements (red cells, leukocytes, casts) in urine with the method of Kakovsky-Addis D. for determination of diuresis E. for determination of the amount of albumen in urin ANSWER: A 74. How is pain called caused by kidney block with a stone? A. Urocolick B. Biliary colick C. Intestinal colick D. Spasmodic pain E. Dull boring pain ANSWER: A 75. Which clinical manifestation is common for all types of anemia regardless of cause or pathologic mechanism? A. Jaundiced sclera and roof of the mouth B. Hypertension and peripheral edema C. Skin paleness D. Increased PaCO2 E. All above mentioned ANSWER: C 76. In acute pyelonephritis in urine sediments may be found: A. Protein and erythrocytes B. Protein and uric acid salts crystals C. Leucocytes D. Leucocytes and hyaline casts E. Erythrocytes and calcium oxalatis crystals ANSWER: A 77. In pathogenesis of chronic glomerulonephritis the most important role belongs to: A. Inflammation B. Authoimmune process C. Immune disorders D. Disorders of hemostasis E. Liver disease ANSWER: B 78. In patient’s urianalyses there were found casts, leucocyturia, bacteriuria and proteinuria. Which disease is this typical for? A. Paranephritis B. Acute glomerulonephritis C. pyelonephritis D. Amyloidosis E. Kidney cancer ANSWER: C 79. In urine of the patient of 43 years old, it where found out crystals of salts. What they indicate on? A. acute nephritis; B. urolithiasis; C. acute cystitis; D. kidney amyloidosis; E. cancer of urinary bladder. ANSWER: B 80. In which age pyelonephritis usually develop in women? A. In childhood B. In young age C. In moderate age D. In declining years E. In elderly people ANSWER: C 81. Main laboratory sign of pyelonephritis: A. Large amount of casts B. Lipiduria C. Prevalence of leucocyturia against of erythrocyturia D. Prevalence of erythrocyturia against of leucocyturia E. Proteinuria more than 2 g per day ANSWER: C 82. Most often the causative agent of acute glomerulonephritis is: A. Hemolythic streptococcus group A B. Viruses C. Staphylococci and pneumococci D. Coli E. Fungi ANSWER: A 83. Most often the causative agent of acute pyelonephritis is: A. E. Coli B. Proteus C. Streptococcus D. Viruses E. Chlamidia ANSWER: A 84. Pathogenesis of arterial hypertension in kidney diseases is the following: A. increased production of renin B. transformation of angiotensinogen in angiotensin II C. decreased production of prostaglandin D. replacement of natrium ions inside cells E. increased production of renin ANSWER: A 85. Patient , 38 years old, complains of attack-like pains in lumbar area, which irradiate downward. What does can this symptom testify about? A. acute glomerulonephritis; B. urolithiasis; C. hypernephroma; D. chronic glomerulonephritis; E. heart attack. ANSWER: B 86. Provoking factors of pyelonephritis: A. severe diseases B. Focuses of infection in the organism C. Immune deficiency state D. Acute cystitis E. All mentioned ANSWER: A 87. Reberg’s test is performed with the purpose: A. to reveal which part of urinary system is the source of hematuria or leukocyturia, B. estimation of kidney concentration function C. for calculation of formed elements (red cells, leukocytes, casts) in urine with the method of Kakovsky-Addis D. for determination of diuresis E. for determination of the amount of albumen in urin ANSWER: B 88. Which clinical manifestation is common to all types of anemia regardless of cause or pathologic mechanism? A. Jaundiced sclera and roof of the mouth B. Hypertension and peripheral edema C. Tachycardia at basal activity levels D. Increased PaCO2 E. All above mentioned ANSWER: C 89. Select the method of assessment of urine outflow disorders in pyelonephritis: A. Excretory urography B. Chromocystoscopy C. Ultrasound D. Ultrasound, chromocystoscopy E. Radioisotopic renography ANSWER: D 90. The most typical provoking factor of primary pyelonephritis: A. Violation of diet B. Disorders in urine outflow C. Decreased immune resistance D. Hemodynamic disorders in kidney E. Diabetes mellitus ANSWER: C 91. The most typical symptoms of acute pyelonephritis: A. Bacteriuria B. Chills and hectic fever C. Leucocyturia, pain D. Hematuria and leucocyturia E. Lumbar pain, chills and hectic fever ANSWER: E 92. To what syndrome belong edema, high proteinuria, hypoproteinemia, dysproteinemia, hypercholesterolemia? A. To uric B. Nefritic C. Nefrotic D. To hypertension E. To hypotension ANSWER: C 93. What amount of urine is selected by kidneys for a healthy man? A. 1 liter/day; B. 2,5 liter/day; C. 3,5 liter/day; D. 5,0 liter/day; E. 7,0 liter/day ANSWER: A 94. What can not be assessed at plain X-ray examination of kidneys? A. Form of kidneys B. Size of kidneys C. Location of kidneys D. Presence of concrements E. kidney excretion function ANSWER: E 95. What edema are characteristic for kidney patients: A. edema are on lower limbs. B. edema are on the lumbar region C. edema under eyes, later - edematousness of whole the body. D. accumulation of liquid in abdominal region (hydroperitoneum) E. edema are on overhead extremities. ANSWER: C 96. What is anuria: A. absence of urination because of affection of kidney excretory function B. absence of urination because of impossibility to discharge urine from the bladder C. increase of amount of urine more than 2 liters per day D. decrease of amount of urine less than 1 liter per day E. amount of urine excreted per day is 0-30 ml per day because of affection of kidney excretory function ANSWER: E 97. What is oliguria: A. frequent urination B. increase of amount of urine more than 2 liters per day C. decrease of amount of urine less than 1 liter per day D. increase of specific gravity of urine E. lowering of specific gravity of urine ANSWER: C 98. What is pollakiuria: A. urination 3-4 times per day B. urination 4-7 times per day. C. urination 8-11 and more times per day D. absence of urination E. urination 1-2 times per day. ANSWER: C 99. What is polyuria: A. frequent urination B. increase of amount of urine more than 2 liters per day C. decrease of amount of urine less than 1 liter per day D. increase of specific gravity of urine E. lowering of specific gravity of urine ANSWER: B 100. What is the main principle of diet in acute pyelonephritis? A. Restriction of proteins (beans) and water B. Restriction of proteins (beans), spicy food C. Restriction of fats D. Restriction of products containing uric acid E. Increased caloric supplement ANSWER: B