3 Уровень

11

!A man, 28 years old, has admitted to hospital with complaints against dull pains in lumbar region, more on the right, body temperature increase to 39C with chill, turbid urine excretion. Objectively: coverlets of usual color, no edemas, right kidney is palpated, painless, BP 100/70 mmHg. In blood analysis: leukocytes 16 × 10⁹/l, ESR 40 mm/h. In urine analysis: density 1016, protein 0.66 g/l, in urinary sediment leukocytes – all over, erythrocytes 1 – 2 in f/v, hyaline cylinders – single.

Into treatment program, it is MOST reasonable to include:

1. furosemid

2. claritromycine

3. prednisolone

4. cyprofloxacine

5. diclofenac

12

!A man, 20 years old, had ARVI, complicated by bacterial pharyngitis. He received no specific treatment. After one week, malaise, headache appeared. He started to notice small edemas on face, feet and shins edemas. At the examination, increased BP to 160/100 mmHg. In urine analysis, proteinuria to 1.3 g/l was detected, erythrocytes 30 – 40 in f/v, leukocytes 3 – 4 in f/v.

Prescription of which group of drugs is MOST reasonable?

1. furosemid

2. amoxycilline

3. prednisolone

4. cyprofloxacine

5. diclofenac

13

!A man, 35 years old, suddenly paleness, puffy face, massive edemas of legs, waist, ascitis occurred. Two weeks before he suffered tonsillitis. Objectively: Heart sounds are dull, rhythm tachycardia. BP 200/100 mmHg. At the examination: creatinine – 660 µmol/l, urea – 27.0 mmol/l, Hb – 75 g/l, er – 2.3 × 10/l, ESR – 46 mm/h. CUA: spec. weight – 1002, protein – 1.38 g/l, l – 2 – 3 in f/v, er – 15 – 20 in f/v, diurnal diuresis – 150 ml.

Which of listed complications MOST probably has developed in this patient?

1. acute tubular acidosis

2. acute renal failure

3. acute cardiac failure

4. hypertensic crisis

5. paroxysmal tachycardia

14

!Into the unit was admitted a woman, 32 years old, with complaints against dyspnea, cough with excretion of foam-like sputum, narrowing of vision. At the examination, paleness of coverlets, puffy face, edemas of legs, waist. Two weeks ago she suffered from ARVI. Objectively: Heart tones are dull, pulse 112 bpm. BP 210/120 mmHg. In lungs, crepitation are heard, BR 26. At the examination: creatinine – 128 µmol/l, urea – 9.6 mmol/l, Hb – 75 g/l, er – 2.3 × 10/l, ESR – 46 mm/h. CBA: spec. weight – 1002, protein – 0.38 g/l, l – 2 – 3 in f/v, er – 15 – 20 in f/v. On ECG, P wave bifurcation and amplitude enhancement in leads I, II, aVL, V5-6.

Which of listed complications MOST probably has developed in patient?

1. acute tubular acidosis

2. acute renal failure

3. acute cardiac failure

4. hypertensic crisis

5. eclampsy as a result of brain edema

15

!A man, 40 years old, from the age of 25 suffers from arterial hypertension. Heredity has burden in AH. Received irregular treatment. GFR 12 ml/min

Which of listed therapy methods is MOST radical to prolong patient's life?

1. hemodialysis

2. dietotherapy

3. kidneys transplantation

4. peritoneal dialysis

5. immunosuppressive therapy

16

!A woman, 33years old, complaints against faint, headache, nausea. From anamnesis: from the age of 17 she suffers from chronic glomerulonephritis. At the examination: dry, pale skin, no edemas. Borders of heart are extended to the left. AP 180/110 mmHg. In CBA: Hb 55 g/l, erythrocytes 2.7 × 10¹² l. In CUA, protein 0.9 g/l, specific weight – 1012, erythrocytes – 1 – 2 in f/v. Zimnitski's test: density in the limits of 1005 – 1010. GFR – 14 ml/min.

Which treatment tactics is MOST reasonable?

1. loop diuretics

2. nephroprotection

3. plasmapheresis

4. hemodialysis

5. hypotensive therapy

17

!In a patient, 28 years old, 2 weeks after acute respiratory disease, evident edemas of lower limbs, front wall of abdomen, scrotum have appeared. Urine volume decreased to 150 ml. In urine analyses, leukocytes 20 – 30 in f/v, erythrocytes 10 – 12 in f/v, protein 2.07 g/l. In blood analysis, urine 11.3 mmol/l, creatinine 112 µmol/l.

Which management tactics is MOST optimal in this case?

1. furosemide application

2. hemodialysis

3. plasma introduction

4. saline introduction

5. abdominal dialysis

18

Female of 20 years, pregnancy of 36 weeks. Complaints to the expressed hypostases, ascites, infrequent diuresis in small volume, a fatigue, a loss of appetite. Illness began acutely after overcooling. BP of 110/70 mm Hg., urine light. OAK: leukocytes – 6х109, the CI – 0,9, Hb – 110 g/l, an ESR – 55 mm/hour. In blood serum: the total protein – 48 g/l. CUA: protein – 6,8 g/l, leukocytes – 1-2 in p/zr, erythrocytes – 0, density – 1025. What of the listed complications of pregnancy is the MOST probable at this patient?

a) Preeclampsia

b) Toxicosis

c) Anasarca

d) Premature births

e) Arterial hypertension

19

Pregnant woman, pregnancy of 8 weeks. Complaints: on large face and lower extremities edemas, weakness. At examination: hypostases to an anasarca, a BP of 180/100 mm Hg. laboratory: total protein 34 g/l, albumin of 18 g/l, creatinine of 90 µmol/l, cholesterin of 9,9 mmol/l. in CUA: protein of 4 g/l, Le 2-4 in visual field, Ayr 0-2 in in visual field. What forecast is MOST probable for a fetus from below listed?

a) The favorable

b) transferency of pregnancy

c) Prematurity

d) Fetal development delay

e) Does not any impact

20

Pregnant woman of 36 weeks. Suffers from a chronic glomerulonephritis. Complaints on hypostases, urine colors of meat slops, increase in a BP. At examination: serious condition, hypostases to an anasarca, a BP of 160/100 mm Hg., macrohematuria. Laboratory: total protein 40 g/l, creatinine of 150 µmol/l, urea 10 mmol/l, cholesterin of 12 mmol/l. GFR=53 ml/min. In CUA - protein 6 g/l, Le 5-6 in vision field, Er total. In dynamics increase of hypostases, a BP to 200/120 mm Hg is noted. In analyses: a creatinine up to 280 µmol/l, urea of 20 mmol/l. Ml/min. SKF=28. What from below the listed tactics is the MOST expedient?

a) Application of diuretics

b) Application of hypotensive

c) Early delivery

d) Application of Prednisolonum with cyclophosphamide

e) Carrying out pulse therapy with Methylprednisolonum

21

Girl of 18 years. Pregnancy I, 32 weeks. Came to clinic with high t, complaints to pains in lumbar area, a headache, fatigue. At survey: there are no hypostases, a BP of 110/70 mm Hg. At inspection changes in analyses of urine are revealed: muddy, protein of 0,066%, leukocytes – entirely, a bacteriuria. In blood: leukocytosis, high ESR. What of the listed medicines is the MOST preferable?

a) Biseptolum

b) Amoxicilline

c) Ophloxacine

d) Gentamycin

e) Nitrofurantoin

22

Woman of 30 years, pregnancy of 26 weeks. Complaints to a headache, nausea, vomiting, visual impairment, pains in right to a hypochondrium. At examination the health suffers, moderate hypostases standing, hemorrhages on a abdomen wall, a BP of 170/110 mm Hg, morbidity in right hypochondrium, a liver of +1,5 cm from under edge of a costal arch. In CBA – Hb 70 g/l, platelets of 90 thousand, in shistocytes in blood. Total protein 60 g/l, ALT 2,25, AST 1,1 mmol/l. In CUA protein 1,65 g/l, Le 5-7 in v/f, Er 2-3 in v/f. What of the listed preliminary diagnoses is the MOST probable?

a) HELLP syndrome

b) Chronic hepatitis

c) Aplastic anemia

d) Werlhof's disease

e) Congestive heart failure

23

The patient of 30 years, is sick with a malaria. Against the background of using of quinine within 2 days notes the severe headache, a cold fit, pains in right hypochondrium developed. Dark brown urine. Objective: temperature 38,6C, is expressed yellowness. CBA: Нв 73 g/l. daily urine of 300 ml. urine dark brown, density 1027, protein of 0,6 g/l, microscopy: an epithelium entirely, L 0-1 in v/f, Er 0-1 in v/f, hyaline cylinders, reaction to bile pigments negative. Your preliminary diagnosis:

a) Sepsis

b) Acute glomerulonephritis at malaria

c) Hemolitic kidney

d) Acute nephritic syndrome

e) Intoxication with quinine

24

The patient has 60 years, suffering from arterial hypertension for the long time, the next hypertonic crisis with increase in a BP to 220/140mm. hg. In house conditions within 2 hours self-contained decrease BP to 120/80mm. hg and felt the fast expressed weakness, dizziness, nausea, vomiting, urine volume decreased. At hospitalization the creatinine 900 mkmol/l is found. At ultrasonography the sizes of both kidneys 11,0x4,5sm, there is no stagnation of urine. At specification of anamnestic data it became clear that the datum level of a creatinine in 3 months earlier was 200 mkmol/l. Your specified diagnosis?

a) acute renal failure at background of chronic kidney disease

b) acute renal failure at background of a gastroenterocolitis

c) Acute gastroenterocolitis, chronic kidney disease 5 stage

d) Hypertonic crisis, chronic kidney disease

e) Hypertonic nephropathy, chronic kidney disease 5 stage