Examples of Krok 1 tests

33. After prolong vomiting and diarrhea in a patient is observed tachycardia, skin dryness, muscular hypotonia and apathia. Such state can be caused by:

1. Hypomagnesemia

2. Hypopotassemia

3. Hyperpotassemia

4. Hypocupremia

5. Hypercupremia

34. What disorders of water and mineral metabolism can be expected in a worker, having a job in hot conditions?

1. Hypoosmolar dehydration

2. Hyperosmolar dehydration

3. Cellular hyperhydration

4. Extracellular hyperhydration

5. Isotonic hyperhydration

35. In a patient after thyroid gland surgery cramps and convulsions appeared, hyperreflexia and hyperexcitability were observed. Preliminary diagnosis is hypocalcaemia, which may be caused by:

1. Hypoparathyreosis, induced by extirpation of parathyroid glands

2. Hyperparathyreosis due to tumor developement from cells of parathyroid gland

3. Overdose of vitamin E

4. Overdose of vitamin D

5. Insulin insufficiency

36. In a patient a development of calcium deposits in soft tissues, stones in urinary ducts are observed. Preliminary diagnosis is hypercalcemia, which may be caused by:

1. Hyperparathyreosis due to tumor development from cells of parathyroid glands

2. Vitamin D deficiency

3. Hypoparathyreosis, induced by injury of parathyroid glands during thyroid gland surgery

4. Insulin insufficiency

5. Insulin overproduction

37. Dietary intake of a 30 year old nursing woman contains 1000 mg of calcium, 1300 mg of phosphorus and 20 mg of iron per day. It is necessary to change content of these mineral substances in the following way:

A To increase phosphorus content

B. To increase calcium content

C. To reduce fluorine content

D. To increase iron content

E. To reduce iron content

38. A 35 y.o. patient who often consumes alcohol was treated with diuretics. There appeared serious muscle and heart weakness, vomiting, AP- 100/60 mm Hg, depression. This condition is caused by intensified excretion with urine of:

A. Potassium

B. Sodium

C. Chlorine

D. Calcium

E. Phosphates

39. A 50-year-old patient complains about general weakness, appetite loss and cardiac arrhythmia. The patient presents with muscle hypotonia, flaccid paralyses, weakened peristaltic activity of the bowels. Such condition might be caused by:

A. Hypokaliemia

B. Hypoproteinemia

C. Hyperkaliemia

D. Hypophosphatemia

E. Hyponatremia

Clinical cases and Situational tasks

40. The elderly people (over 60 yr.) of both sexes are at risk for osteoporosis. However, it more predominantly occurs in the post-menopausal women. Explain why.

Answer: The ability to produce calcitriol from vitamin D is decreased with age, particularly in the postmenopausal women. lmmobilized or sedentary individuals tend to decrease bone mass while those on regular exercise tend to increase bone mass. Deficiency of sex hormones (in women) has been implicated in the development of osteoporosis.

41. A patient with the symptoms of irritability, muscular weakness, tachycardia, cardiomegaly and cardiac arrest was delivered to the hospital. What disorders of mineral metabolism can be expected?

Answer: Such symptoms are observed in hypokalemia. Decrease in the concentration of serum potassium is observed due to overactivity of adrenal cortex (Cushing's syndrome), prolonged cortisone therapy, intravenous administration of K⁺-free fluids, treatment of diabetic coma with insulin, prolonged diarrhea and vomiting.

42. Iron deficiency anemia is the most prevalent nutritional disorder worldover, including the well developed countries (e.g. USA). Several factors may contribute to iron deficiency anemia. These include inadequate intake or defective absorption of iron, chronic blood loss, repeated pregnancies and hookworm infections. Explain why strict vegetarians are more prone for iron deficiency anemia.

Answer: This is due to the presence of inhibitors of iron absorption in the vegetarian foods, besides the relatively low content of iron.

43. Wilson's disease (hepatolenticular degeneration) is a rare disorder of abnormal copper metabolism. Characterize the main manifestations of this disorder.

Answer: Copper is deposited in abnormal amounts in liver and lenticular nucleus of brain. This may lead to hepatic cirrhosis and brain necrosis. Low levels of copper and ceruloplasmin in plasma with increased excretion of copper in urine. Copper deposition in kidney causes renal damage. This leads to increased excretion of amino acids, glucose, peptides and hemoglobin in urine.