Examples of Krok 1 tests

41. A child is languid, apathetic. Liver is enlarged and liver biopsy revealed a significant excess of glycogen. Glucose concentration in the blood stream is below normal. What is the cause of low glucose concentration?

A. Low (absent) activity of glycogene phosphorylase in liver

B. Low (absent) activity of hexokinase

C. High activity of glycogen synthetase

D. Low (absent) activity of glucose 6-phosphatase

E. Deficit of a gene that is responsible for synthesis of glucose 1-phosphaturidine transferase

42. In neonates after birth during 5-6 days develops jaundice. The cause of this disorder is insufficient activity of the following enzyme:

1. UDP-glucuronyl transferase

2. Porphobilinogen synthase

3. Aminolevulinate synthease

4. Heme oxygenase

5. Biliverdin reductase

43. In blood of a patient was found an increased content of total bilirubin, in urea were detected bilirubin diglucuronides, absence of stercobilin in feces (acholic stool). What vitamins deficiency can be developed i9n this special case?

1. D, K, A

2. B₁, B₂, B₆.

3. PP, C, U

4. Biothin and lipoic acid (vitamin N)

5. P, B₁₅ (pangamic acid).

44. In a patient was recognized congenital liver disease, which is accompanied with high bilirubinemia due to increase in free (nonconjugated) bilirubin. In liver biopsia was detected trace activity of glucuronyl transferase. What disease can be recognized?

1. Crigler-Najjar syndrome

2. Gilbert syndrome

3. Physiological jaundice

4. Dubin-Johnson syndrome

5. Wilson disease

45. After a serious viral infection a 3-year-old child has repeated vomiting, loss of consciousness, convulsions. Examination revealed hyperammoniemia. What may have caused changes of biochemical blood indices of this child?

A. Disorder of ammonia neutralization in ornithinic cycle

B. Activated processes of aminoacids decarboxylation

C. Disorder of biogenic amines neutralization

D. Increased purtefaction of proteins in intestines

E. Inhibited activity of transamination enzymes

46. A patient suffering from rheumatism was administered glucocorticoids therapy. What changes in carbohydrate metabolism in liver can be expected?

1. Stimulation of gluconeogenesis

2. Stimulation of glycogenesis

3. Stimulation of glycogen hydrolysis

4. Stimulation of glycogen phosphorolysis

5. Increase of glycogen phosphorylase activity

47. A patient has yellow skin colour, dark urine, dark-yellow feces. What substance will have strengthened concentration in the blood serum?

1. Unconjugated bilirubin

2. Conjugated bilirubin

3. Mesobilirubin

4. Verdoglobin

5. Biliverdin

48. A 46 year old woman suffering from chololithiasis developed jaundice. Her urine became dark-yellow and feces became colourless. Blood serum will have the highest concentration of the following substance:

1. Conjugated bilirubin

2. Unconjugated bilirubin

3. Biliverdin

4. Mesobilirubin

5. Urobilinogen

49. A 4 y.o. boy has had recently serious viral hepatitis. Now there are such clinical presentations as vomiting, loss of consciousness, convulsions. Blood analysis revealed hyperammoniemia. Disturbunce of which biochemical process caused such pathological condition of the patient?

1. Disturbed neutralization of ammonia in liver

2. Disturbed neutralization of biogenic amines

3. Increased putrefaction of proteins in bowels

4. Activation of aminoacid decarboxylation

5. Inhibition of transamination enzyms

50. A newborn child was found to have reduced intensity of sucking, frequent vomiting, hypotonia. Urine and blood exhibit increased concentration of citrulline. What metabolic process is disturbed?

A. Ornithinic cycle

B. Tricarboxylic acid cycle

C. Glycolysis

D. Cori cycle

E. Glyconeogenesis

51. In a patient with jaundice it was detected a block in transformation of bilirubin to bilirubin diglucuronide. The concentration of indirect bilirubin in blood was markedly increased. What pathology can be suggested in a patient?

1. Prehepatic jaundice

2. Hepatic jaundice

3. Posthepatic jaundice

4. Tumor of pancreas and occlusion of bile duct

5. Addison’s disease

52. In 35 years old patient a jaundice was revealed, as well as fever, bradycardia. Laboratory investigation revealed increase in direct and indirect bilirubin, appearance of direct bilirubin and bile acids in urine, missing of stercobilinogen in feces. What type of jaundice can be expected?

1. Post-hepatic

2. Hepatic

3. Jaundice of neonates type

4. Gilbert disease

53. Investigation of patient indicated on inflammatory processes in gall bladder, alteration of colloidal stability and high risk of bile stones formation. What substance from listed below favors the formation of bile stones?

1. Cholesterol

2. Urates

3. Phosphates

4. Oxalates

5. Lecithine

54. In 14 years old patient a hereditary liver pathology was expected. It was detected high content of direct bilirubin in blood, deposition of melanin in liver due to alteration of bilirubin excretion to bile by liver cells. This state is characteristic to the next disease:

1. Dubin-Johnson syndrome

2. Crigler-Najjar syndrome

3. Gilbert disease

4. Physiological jaundice

5. Wilson disease

55. A man is resting after intensive physical effort. Which from different pathways of glucose metabolism is the most active at this time?

1. Gluconeogenesis from lactate

2. Glycolysis

3. Glycogenolysis

4. Breakdown of glycogen to glucose

5. Gluconeogenesis from amino acids

56. In a patient suffering from liver cirrhosis concentration of albumin in blood plasma is 15 g/l (normal value 32-55 g/l), prothrombine test – 40 seconds (normal value – 12-20 sec.). To what functional disorder in liver indicate these changes?

1. Inhibition of protein synthesis

2. Detoxification function

3. Excretory function

4. Production of bile

5. Secretion of lipoproteins to blood

57. In a patient with toxic damage of liver was revealed low concentration of urea in blood plasma. The cause of this may be the next:

1. Alteration of ornithine cycle of urea synthesis

2. Absence of alanil aminotransgferase in liver cells

3. Deficiency in blood ammonia concentration

4. Deficiency of CO₂ and restriction of urea synthesis

5. Excess of ammonia, which inhibits enzymes of urea synthesis