Nephrology

2 Уровень

1

!A woman, 25 years old, pregnancy 22 weeks. At the examination, moderate edemas, increased temperature 38C, BP 110/70 mmHg. At the examination: CBA without pathology. In the urine analysis: color – yellow, bacteriuria, leukocytes 20 – 30 in the field of vision, protein – 0.06%.

Which of listed provisional diagnoses is MOST probable?

1. Glomerulonephritis

2. Interstitial nephritis

3. Urolithiasis

4. Asymptomatic bacteriuria

5. Urinary tract infection

2

!In a man, 30 years old, massive edemas up to anasarca are noted, rare urination with small portions. BP – 110/80 mmHg. In analyses: blood serum creatinine 100 µmol/l, total protein 43 g/l, cholesterol 8.3 mmol/l. Common urine analysis: spec. weight – 1020, protein – 4.2 g/l, er. – 2 in f/vis, cylinders: hyalinic, granular. Common blood analysis: Hb – 120 g/l, erythrocytes – 4.6 × 10/12/l, leuk. – 15.3 × 10/9/l, ESR – 40 mm/h.

Which of listed provisional diagnoses is MOST probable?

1. Pyelonephritis

2. Nephritic syndrome

3. Nephrotic syndrome

4. Isolated urinary syndrome

5. Malignant glomerulonephritis

3

!In a woman, 57 years old, after supercooling, leg edemas appeared. At the admission, satisfactory conditions. Coverlets of usual color. Edemas of shins, feet. Heart sounds are subdued, rhythmic. AP – 160/110 mmHg. Abdomen at palpation is soft, painless. Laboratory data: Hb – 130 g/l, ESR – 64 mm/h, thrombocytes – 483 × 10/9/l, total protein – 49 g/l, albumins – 22 g/l, creatinine – 120 µmol/l, diurnal proteinuria – 3.5 g.

Which of listed diagnoses is MOST probable?

1. acute cystitis

2. acute pyelonephritis

3. nephrotic syndrome

4. nephritic syndrome

5. acute glomerulonephritis

4

!A woman, 47 years old, applied with complaints against facial edemas, weakness. In anamnesis, for 15 years age is suffering from type 2 diabetes mellitus, Objectively: condition of average severity, coverlets are dry, pale, edemas on face, feet and shins, heart sounds are subdued, AP – 140/100 mmHg. CUA: spec. weight 1010, protein – 1.3 g/l, leuk. – 10 – 12 in the field of vision, Er. – 8 – 10 in the field of vision, cylinders – hyaline 4 – 5 in the field of vision, bacteria - +++. In blood: urea – 22 mmol/l, creatinine – 136.4 mmol/l. Glycemia 15.4 mmol/l.

Which examinations should be prescribed?

1. Reberg's test

2. urine inoculation on flora

3. Addis-Kakowski test

4. test with Congo-red

5. Nechiporenko's test

5

!A woman, 50 years old, complains of weakness, fatiguability, headaches. She suffered from arterial hypertension for the long time. She use hypotensive drugs irregularly: BP 180/110 mmHg. In CBA: hemoglobin 110 g/l, ESR 14 mm/h, blood glucose 5.0 mmol/l. GFR 50 ml/min/1.73m². CUA: specific density – 1013, protein 0.22 g/l, leukocytes 4 – 5 in f/v, erythrocytes 1 – 2 in f/v.

Which of listed conditions is MOST PROBABLE?

1. essential AH, chronic kidney disease, stage 1

2. chronic glomerulonephritis, chronic kidney disease, stage 4

3. chronic pyelonephritis, chronic kidney disease, stage 2

4. essential AH, chronic kidney disease, stage 3

5. diabetes mellitus, chronic kidney disease, stage 5

6

!A woman, 35 years old. Observed due to type I diabetes mellitus for 12 years. Receives insulinotherapy. Blood glucose 6.1 mmol/l, in urine analysis: protein 0.64 g/l, leukocytes 5 – 7 in the field of vision. Glomerular filtration rate – 156 ml/min.

Which diagnosis is most probable?

1. type 1 diabetes mellitus, chronic kidney disease, stage 1

2. type 1 diabetes mellitus, chronic kidney disease, stage 2

3. type 1 diabetes mellitus, chronic kidney disease, stage 3

4. type 1 diabetes mellitus, chronic kidney disease, stage 4

5. type 1 diabetes mellitus, chronic kidney disease, stage 5

7

!A woman, 44 years old. She suffers from chronic pyelonephritis for a long time. In CUA: protein – 0.33 g/l, leukocytes 4 – 6 in the field of vision, erythrocytes 2 – 3 in the field of vision. GFR – 25 ml/min. Hb – 85 g/l.

Correction of which disturbances is MOST indicated?

1. metabolic

2. hormonal

3. immunological

4. hemocoagulatory

5. anemia and proteinuria

8

!A patient, 25 years old, suffers from chronic glomerulonephritis with AH. He is registered in the nephrologic dispensary. He came for scheduled examination. In CUA, protein – 1.23 g/l, density – 1012, GFR – 78 ml/min.

Which group of drugs is MOST preferably to prescribe with nephroprotective aim?

1. diuretics

2. β-blockers

3. nonsteroid anti-inflammatory preparations

4. immunosuppressors

5. ACE inhibitor

9

!A man, 18 years old, 6 hours after swallowing antifreeze, evident weakness, dizziness with the lost of consciousness developed. After 12 hour the urine volume decreased to 200 ml, after 36 hours he stopped to urinate, edemas appeared. In blood analysis, urea 12.5 mmol/l, creatinine 147 µmol/l.

Which diagnosis is MOST probable in this case?

1. Chronic kidney disease, stage 5

2. Prerenal acute renal failure

3. Postrenal acute renal failure

4. Renal acute renal failure

5. Toxicoinfection