Section XVI Functional role of kidneys in urinogenesis. Normal and pathological constituents of urine

1. In kidney diseases a decrease of glomerular filtration is observed, which leads to decrease of elimination of final metabolic products from the body. What substances are mostly retained in the body?

1. Creatinine and urea

2. Uric acid and indicane

3. Amino acids

4. Ammonia and polyamines

5. Glucose and glucosamine

2. Concentration of calcium ion in urine of healthy adult is:

А. 2,5-7,5 mmol

В. 5,5-10,5 mmol

С. 25-75 mmol

D. 55-105 mmol

Е. 0,25-0,75 mmol

3. A part of food protein is not digested in intestinal tract and is decomposed by bacterial enzymes in large intestine. This is defined as putrifaction of protein. Detection of what substance in urine may serve as indicator of the intensity of putrifaction processes?

1. Animal indican

2. Protein

3. Urea

4. Creatine and creatinine

5. Urates

4. The concentration of glucose in normal human urine is:

A. 0,00 g/l

B. 0,1 g/l

C. 30 mg%

D. 10 mMole/l

E. 2 mMole/l

5. In patients with kidneydisturbances even in normally balanced diet osteodystrophic changes are frequently observed. This may be caused by disorder in biosynthesis of:

1. 1,25-dihydroxycholecalciferole

2. 7-dehydrocholesterol

3. Cholecalciferole

4. Ergocalciferole

5. 25-hydroxycholecalciferole

6. In acidosis the excretion of ammonium ion with urine is:

A. Increased

B. Decreased

C. Without changes

D. Not detected at all

7. In 4 monthes child a “syndrome of blue clothes” is recognized, which is accomoanied by periodical feaver, enhanced exitability, growth retardation. Blood nitrogen is increased, in the urine an excess of animal indicane is detected. What amino acid absorption is impaired?

1. Tryptophan

2. Thyrosine

3. Phenylalanine

4. Lysine

5. Histidine

8. After consumption of great quantity of watermelon the urine medium (pH) became:

A. Alkaline

B. Neutral

C. Weak acidic

D. Strong acidic

E. Strong alkaline

9. Glucose is the threshold substance, the value of glucose threshold is the next:

A. 180 mg% %

B.5 mMole/l

C. 135 mg

D.20 mMole/l

E.1 g/l

10. What hormone controls water reabsorption in kidneys?

A. Vasopressin

B. Parathyroid hormone (PTH)

C. Calcitonin

D. Testosterone

E. Insulin

11. Excretion of sodium ions with urine is cotrolled by:

A. Aldosteron

B. Oxytocine

C. Adrenalin

D. PTH

E. Melatonine

12. The principal buffer system of urine is the next:

A. Phosphate

B. Bicarbonate

C. Citric acid

D. Ammonium ions

E. Proteins

13. The end product of purine metabolism,excreted with urine is:

A. Uric acid

B. Ammonium ion

C. Urea

D. Arginine

E. Creatinine

Examples of Krok 1 tests

14. 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

15. In a patient after thyroid gland surgery crumps and convulsions appeared, hyperreflexia and hyperexcitability were observed. Preliminary diagnosis is hypocalcemia, 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

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

1. Hypomagnesemia

2. Hypopotassemia

3. Hyperpotassemia

4. Hypocupremia

5. Hypercupremia

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

3. Vitamin D deficiency

4. Insulin insufficiency

5. Insulin overproduction

18. 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. Hypophosphatemia

C. Hypoproteinemia

D. Hyperkaliemia

E. Hyponatremia

19. A 35 y.o. patient who often consumes alcohol was treated with diuretics. There appeared serious muscle and heart weakness, vomiting, diarrhea, 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

20. Patient N. was admitted to clinic with complaints for pains in renal areas. The most informative biochemical indexes for evaluation of kidney functional state is determination of:

A. Creatine in blood serum and in urine

B. Creatinine in blood serum and in urine

C. Creatinine in red blood cells and in blood plasma

D. Creatine in red blood cells and in plasma

E .Creatine and creatinine in blood plasma.

21. In urine of patient B. were detected phenylpyruvic, phenyl-lactic and phenylacetic acids. What enzyme deficiency may cause this phenomenon?

1. Phenylalanine hydroxylase

2. DOPA decarboxylase

3. Thyrosine-3-monooxygenase

4. Fumaryl acetoacetate hydrolase

5. Cystathionine –β-synthase

22. Urine of a patient in reaction with iron chloride gives purple-red coloration, by exposure on air is quiqely darkening. Patient complains for pains in junctions. What substance metabolism is impaired in this case?

1. Homogentisic acid

2. Para-aminobenzoic acid

3. δ–Aminolevulinic acid

4. Pangamic acid

5. Fumarylacetoacetic acid

23. In 15 years old boy, suffering from alkaptonuria, urine after standing changes to a black color. This disease is hereditary disorder of:

1. Tyrosine metabolism

2. Alanine metabolism

3. Urea synthesis

4. Uric acid biosynthesis

5. Cysteine metabolism

24. In urine of patient M. a high content of argininosuccinate is detected. What enzyme deficiency exists in a body?

1. Argininosuccinate lyase

2. Arginase

3. Argininosuccinate synthetase

4. Carbamoyl phosphate synthetase

5. Tryptophan-5-monooxygenase

25. In a patient argininemia and argininuria is observed. Urea content in blood and in urine is decreased. What enzyme deficiency has a place?

1. Glutamate dehydrogenase

2. Arginase

3. Ornithine carbamoyl transferase

4. Argininosuccinate synthetase

5. Tryptophan-5-monooxygenase

26. 65 years old man , suffering from gout, complains for pains in kidney area. In course of ultrasound diagnostics renal stones were detected. Increased concentration of what substance is the most probable cause of stones formation in this case?

1. Bilirubin

2. Uric acid

3. Urea

4. Cystine

5. Cholesterol

27. In patient S. blood glucose level is over the renal threshold, polyuria is observed, as well as acidosis and ketonuria. What pathological state can be suggested?

1. Diabetes mellitus

2. Hypercorticism

3. Starvation

4. Addison disease

5. Hyperthyreosis

28. In 13 years old girl a hypotension and polyuria is observed. Preliminary diagnosis – diabetes insipidus. It is caused by deficiency of:

1. Vasopressine

2. Cortisol

3. Aldosterone

4. Adrenalin

5. Oxytocine

29. In diabetes mellitus and during starvation an increase of ketone bodies in blood and in urine is observed. Chose the substance from which ketone bodies are produced:

1. Acetyl-CoA

2. Citrate

3. Succinyl CoA

4. -Ketoglutarate

5. Malate

30. Excretion of ammonium cation with urine is increased in the next condition:

1. Metabolic acidosis

2. Respiratory alkalosis

3. Hyperlipidemia

4. Hypoproteinemia

5. Obesity

31. In patient T. erythropoietic porphyria was recognized (Gunter”s disease): urine and teeth are of redish shadow due to uroporphyrin accumulation.Insufficiency of what enzyme from listed below may be observed?

1. Uroporphirinogen synthase

2. Coproporphyrinogen oxidase

3. Uroporphyrinogen-decarboxylase

4. Tryptophan pyrrolase

5. Heme synthase

32. In boy P. suffering from mental underdevelopement the consumption of milk induces vomiting and diarrhea. In blood is detected glucose-1-phosphate on a background of low concentration of glucose and very high contentratyion of reducing sugars. In urine is detected galactose. Indicated symptoms are connected with deficiency of:

1. Galactose-1-phosphate uridyl transferase

2. UDP-glucose pyrophosphorylase

3. Lactase

4. UDP-glucose-4 epimerase

5. Galactokinase

33. In a patient a Konovalov-Wilson disease was recognized, at which excretion of copper with urine is observed, as well as deposition of copper in organs and tissues. What protein biosynthesis is damaged as the most probable cause of this disease?

1. Ceruloplasmin

2. Transferrine

3. Haptoglobin

4. Properdin

1. Cryoglobuline

34. Physician paid no attention to analysis, which showed a tenfold increase of diastase activity in urine. Patient has an emergency of pancreas autolysis due to activation of the following enzyme:

1. Amylase

2. Pepsin

3. Trypsin

4. Lipase

1. Nuclease

35. A patient addressed to the physician with complaints for pains in small joints as well as in temporomandibular joint. Joints are enlarged, looking as thick nodes. In blood serum and in urine an increase of urates content is detected. Metabolism of what substances is impaired?

1. Purine bases

2. Amino acids

3. Glucose

4. Pyrimidines

5. Glycerol

36. After consumption of fatty meal patient feels, after some time steatorrhea appears. Cholesterol concentration in blood is 9,2 mmoles/l, test for bile acids in urine is positive. A cause of this state may be the deficiency of:

1. Bile acids

2. Fatty acids

3. Triglycerides

4. Phospholipids

5. Chylomicrons

37. A 58 years old woman, in a heavy state, cloudy conciousness, dry skin, eyeballs are, cyanosis, an odor of spoiled apples in expired air. Blood glucose level 15,1 mmol/l , in urine – 3,5 %. This state is caused by:

1. Hyperglycemic coma

2. Uremic coma

3. Hypoglycemic coma

4. Anaphylactic shock

5. Hypovolemic coma

38. A 13 years old patient. Complains for general weakness, fatigue. Mental underdevelopement is observed. In course of investigation a high concentration of valine, isoleucine, leucine is detected in blood and in urine. Urine has specific odor. What may be the cause of that pathology?

1. Maple syrup disease

2. Basedov disease

3. Addison disease

4. Thyrosinosis

5. Histidinemia

39. In patient S. blood glucose level is over the renal threshold, polyuria is observed, as well as acidosis and ketonuria. What pathological state can be suggested?

1. Diabetes mellitus

2. Hypercorticism

3. Starvation

4. Addison disease

5. Hyperthyreosis

40. In patients with ill kidneys even in normally balanced diet osteodystrophic changes frequently are developing. It can be caused by disorder of biosynthesis of:

1. 1,25-dihydroxycholecalciferole

2. 7-dehydrocholesterol

3. Cholecalciferole

4. Ergocalciferole

5. 25-hydroxycholecalciferole

41. A patient complains for polyuria (5 liters daily) and thurst. Blood glucose level is 5,1 mmoles/l, urine specific density is equal 1,010. Glucose and ketone bodies are absent. What may be the cause of this state?

1. Diabetes insipidus

2. Mixedema

3. Steroid diabetes

4. Diabetes mellitus

5. Thyrotoxicosis

42. 47 years old woman complains for persistent feeling of thurst, rapid fatigue, loss of conciousness. Daily diuresis is 3-4 l. Blood glucose level is 4,8 mmoles/l, in urine there is no glucose.In this case it is resonable to investigate blood content of:

1. Vasopressine

2. Estrogens

3. Aldosterone

4. Cortisole

5. Thyroxine

43. In a suckling child the darkening of sclera, mucous sheets, ear bowels is observed, the urine also is developing a dark color after exposure on air. In blood and urine a homogentisic acid is detected. What pathology can be suggested?

1. Alcaptonuria

2. Porphyria

3. Albinism

4. Cystinuria

5. Hemolytic anemia