Topic 23. Renal pathophysiology 1.A patient has severe nephropathy with a massive edematous syndrome, which complicated bronchiectatic diseases. Laboratory investigations show massive proteinuria, cylindruria, considerable decrease of protein content in the blood serum, hyperlipidemia, hypokalemia and other deviations. What is the main link in the pathogenesis of the patient’s edemas?
Decrease of oncotic blood pressure.*
Increase of extracellular fluid pressure.
Increase of hydrostatic blood pressure.
Blockade of lymph drainage.
Hyperpermeability of microvessels
2.A patient with renal insufficiency has a disorder of hemopoietin synthesis produced in the kidneys. What formed blood elements development is impaired?
B-lymphocytes E. T-lymphocytes
3.The narrowing of afferent glomerular renal arteriole caused the decrease of urination. The cause of this is a decrease of:
Reabsorption of glucose
Reabsorption of ions
Reabsorption of urea
Reabsorption of water
Effective filtration pressure*
4.A man aged 32 has been ill with chronic glomerulonephritis for 4 years. He was hospitalized with the signs of anasarca. BP-185/105 mm. Hg. Blood analysis shows: Hb-110gm/l; erythrocytes-2.6x1012/l; leucocytes-9.5x109/l; residual nitrogen-32 mmol/l; total protein-50 gm/l. What change points to glomerulonephritis with nephrotic syndrome? A. Anemia
5.Sharp decrease in sodium content in the blood serum was revealed in a patient with renal insufficiency. There are pale edemas of the face manifesting in the morning. What substance composing intercellular matrix comes from blood bed?
6.Edemas appeared in a patient after Streptococcus infection. The urinalysis was made and allowed to make a diagnosis of acute glomerulonephritis. What pathologic changes in urine confirm the diagnosis?
Protein with high molecular mass and lixiviated erythrocytes
Protein only with low molecular weight (up to 40000.
Increased excretion of sodium
7.After poisoning by salts of heavy metals a patient has developed nongaseous acidosis, urine pH=6.0, glucosuria without hyperglycemia, polyuria, natriuresis. Which of the structures is damaged? A. Beta-cells of pancreatic islets
Nuclei of hypothalamus
8.A patient age 48 with fibro-cavernous tuberculosis complains of general weakness decrease of diurnal urination, edemas of the trauma and extremities, increase of BP up to 180/90 mm. Hg Urinalysis shows increase of protein, hyaline and granular cylinder, erythrocytes. A month later he died from renal insufficiency. Enlargement of the heart and large “fatty kidneys” were revealed at autopsy (weight of kidneys is 240.0 gm 260.0 gm). What disease was fibro-cavernous tuberculosis of the lungs complicated by?
9.A patient with chronic glomerulonephritis has edemas, BP-210/100 mmHg, and the rate of heart beats-85 per minute. The borders of the heart are dilated. What is the leading mechanism in the development of arterial hypertension?
Activation of renin- angiotensin -aldosterone system*
Increase of circulatory blood volume
Increase of vasopressin discharge
10.The presence of glucose in the urine in its normal concentration in the blood serum was determined in a patient aged 18 on laboratory examination. The most possible cause of this is the impairment of
Secretion of the glucocorticoids
11.In a week and a half after a severe streptococcal tonsillitis a patient aged 24 developed edematous face, increased arterial pressure, hematuria, and proteinuria of 1.2 g/L .His blood analysis shows antistreptococcal antibodies and decrease of complement components. In the microvessels of what structures is the most possible localization of immune complex deposits which caused the development of nephropathy. A. Proximal tubules
12.Increased amount of proteins in the urine was revealed in a patient with acute glomerulonephritis. The impaired function of what nephron structures is the presence of protein in the urine connected to?
Basal membrane of glomerulus capillaries*
Epithelium of parietal layer of glomerulus capsule
Epithelium of thin tubules
Epithelium of distal tubules
Epithelium of Henle’s loop
13.Proteinuria (5 g/l) due to low molecular weight proteins and hematuria with lixiviated erythrocytes were revealed in patient’s urinalysis. What renal function disorder do these findings point out? A. Increase in glomerular permeability*
Increase in tubular secretion
Increase in tubular excretion
Decrease in tubular reabsorption
14.A patient with chronic glomerulonephritis has symptoms of anemia. What causes these symptoms? A. Decrease in erythropoietin synthesis*
Loss of erythrocytes in urine
Increased destruction of normal erythrocytes
Iron deficiency for hemoglobin synthesis
15.A patient with chronic renal disease is edematous, pale, and his BP is increased.
Laboratory examination shows protein and erythrocytes in patient’s urine. Protein content in the blood is the normal. What is the main link in the pathogenesis of edematous syndrome?
16.A patient with chronic renal disease is edematous, pale, and his BP is increased. Laboratory examination revealed protein and erythrocytes in his urine, hyperazotemia, and decrease in erythrocytes and hemoglobin in his blood. What is the main link in pathogenesis of arterial hypertension of this patient?
Activation of renin-angiotensin system*
Increase of circulatory blood volume
17.A patient with diabetes mellitus has developed chronic renal failure with the development of uremia and the rate of glomerular filtration of 8 ml/min. What is the mainly possible mechanism of decrease in glomerular filtration rate and the development of chronic renal failure in this patient?
Spasm of afferent glomerular arteriole
Occlusion of tubular lumen of nephron by hyaline cylinders
Increase of osmotic blood pressure
Decrease of systemic BP
Decrease of the number of working nephron*
18.Severe poisoning by mercury salts has lead to decrease and then to ceasing of patient’s urination. There are headache, nausea, and vomiting in this patient. Laboratory investigation reveals quickly increasing azotemia. The established diagnosis is the acute renal failure, stage of oliguria-anuria. What disorders of aqueous and osmotic homeostatic does this patient have at this stage of the disease?
19.A patient with chronic renal disease is edematous, pale, his BP is increased, and he has vomiting and diarrhea with ammoniac smell. Laboratory investigation reveals protein and erythrocytes in his urine, hyperazotemia, decrease of erythrocytes and hemoglobin in his blood. What is the main link pathogenesis of anemia which complicated renal disease? A. Loss of erythrocytes with urine
Toxic influence of urea on bone marrow
Deficiency of erythropoietin*
Impaired of iron absorption due to diarrhea
Impaired of regulation of erythropoiesis by endocrine glands
20.A man suffering from gout complains of pains in the area of kidneys. Ultra sound examination reveals the presence of renal calculi. What substance increased concentration causes the formation of calculi in this case?
21.What hormone increased secretion is caused by activation of renin-angiotensin system in renal hypoxia?
22.A man has decreased urination, hypernatremia, hypokalemia. What hormone hypersecretion is the cause of such changes?
Atrial natriuretic factor
Aldosterone* E. Adrenalin
23.A patient with acute renal insufficiency developed anuria (diurnal urination - 50 ml). Which of the bellow-mentioned mechanisms is the main one in its development?
Decrease of glomerular filtration*
Impairment of renal blood circulation
Increase of water reabsorption
Increase of sodium reabsorption
Difficulty of urine outflow
24.A patient with chronic glomerulonephritis has vegetation of
collagenic fibers in interstitium near tubules in which reabsorption of sodium ions decreases. What underlies these changes in reabsorption of sodium ions in tubules?
Inhibition of energy metabolism*
Activation of glycolysis
Inhibition of lipid peroxidation
Stabilization of lysosomal membranes
Increase of antioxidative activity
25.The damage of proximal portion of nephron with decrease of sodium ion reabsorption was observed in a patient after poisoning by corrosive sublimate. How much maximally may sodium ions be reabsorbed in this part of nephron?
26.The damage of proximal portion of nephron was held in a patient in 24 hours later after the poisoning by corrosive sublimate. What electrolyte reabsorption is impaired in this pathology? A. Ions of potassium
Ions of chloride
Ions of sodium*
Ions of calcium
Ions of magnesium
27.A patient aged 35 complains of pain in the lumbar area, edema under eyes, and increased fatigability in usual physical loads. Protein was revealed in patient’s urine (0.99gr/l). Patient’s BP is -160/110 mmHg. What pathology has the patient?
Nephritic syndrome *
Acute renal failure
28.What pathological process is non-selective, non-massive proteinuria is characteristic for?
Chronic renal failure
Acute renal failure
29.What origin of protein is the most possible in selective proteinuria with intensity 12 gr/day?
From urinary bladder
30.What pathological process is characterized by combination of massive proteinuria (25gr/day) with generalized edema?
Chronic renal failure
31.What pathological process may be complicated by acute renal failure?
Chronic lung abscess
32.Acute pyelonephritis was diagnosed in a patient with complains of increased temperature, pain in the lumbar area, and frequent and painful urination .Which of the infectious agents is a cause of the disease?
D. Anaerobic flora
33.A patient suddenly has developed colicky pains in the are of kidney with irradiation to grain, nausea, and vomiting; the discharge of urine for 24 hours is 90 ml. Determine mechanism of anuria
Impairment of filtration
Increase of reabsorption
Blocking of a work of a part of nephrons
Obturation of ureters
34.A man of aged 72 is ill with chronic glomerulonephritis. On examination following was determined: absence of appetite, vomiting, diarrhea, skin itching, anemia, the content of residual nitrogen in the blood is 45mm/l. The indicated signs are caused by:
Increase of glomerular membrane permeability
Disturbance of nephron function*
Autoimmune damage of nephron function
Disturbance of concentrating mechanism
35.A patient of age 32 with acute glomerulonephritis, who did not follow regime of NaCl and water limitation, suddenly has lost his consciousness and convulsions appeared in him. His BP is 220/120 mmHg, he has mydriatic pupils and bradycardia. What complication has appeared in this patient?
Acute heart failure
36.A woman aged 25 with frequent prolonged tonsillitis in her anamnesis came to а doctor with complaints of periodical headaches, undue fatigability, periorbital edemas. Clinic-laboratory investigations show moderate arterial hypertension, proteinuria, hypoproteinemia, hyperlipidemia. Bilateral disturbance with insignificant increase of echogenicity of renal parenchyma was diagnosed by ultrasound examination of kidneys. What disease is the mast possible in this case?
Acute renal failure
37.Protein, which level didn’t exceed 1g/L, was revealed in the urine of physically healthy young military men after a hard physical exertion during one day foot match (50 km). What kind of proteinuria takes place first of all?
38.After a severe trauma a patient developed shock with signs of acute renal failure.
What is the leading mechanism in the development of acute renal failure in this case?
Decrease of oncotic blood pressure
Increase of pressure in renal arteries
Increase of pressure in glomerular capsule
Damage of outflow of urine
Fall of arterial pressure.*
39.Decrease in insulin clearance down to 60 ml/min was determined in a patient with chronic renal failure. What renal function impairment is this connected with?
Reabsorption in proximal part of nephron
Reabsorption in distal part of nephron E. Reabsorption in collecting renal tubules.
40.A patient with chronic renal insufficiency has developed anorexia, dyspepsia, impairment of cardiac rhythm, skin itching. What is the main mechanism of the development of these impairments?
Disturbance of lipid metabolism
Accumulation of products of nitrogen metabolism in the blood*
Changes of carbohydrate metabolism
Disturbance of water and electrolyte metabolism.
41.A patient who has been suffering from osteomyelitis of the mandible for many years has extensive edemas; marked massive proteinuria is revealed in his urine. Which form of complications in the course of osteomyelitis has this patient?
Chronic renal failure
Renal calculi disease
42.After automobile accident a patient’s BP is 70/40 mm Hg. The patient is unconscious. His diurnal urination is about 500 ml. There are periodical convulsions,
Kussmaul’s respiration in him. What is the cause of the disorder of urination?
Considerable acute hypotension*
Increase of glomerular filtration
Decrease of tubular reabsorption
Increase of tubular reabsorption
Intoxication by metabolites of nitric exchange
43.In a man rate of glomerular filtration rises in 20% as a result of prolonged starvation. What is the most possible reason for changes of filtration under indicated conditions?
Increased permeability of renal filter
Increase in filtration coefficient
Increased systemic arterial pressure
Decreased oncotic pressure of blood plasma*
Increase in renal blood flow
44.Under experiment morphological impairment of epithelial cells of distal part of nephron was induced in rats. What functional processes in kidneys are weakened in this case? A. Filtration
Reabsorption of sodium and glucose
Reabsorption of glucose
Reabsorption of water and salts*
Reabsorption of proteins
45.Glucosuria and aminoaciduria were found out in a patient with nephritis. What mechanism of reabsorption of glucose and amino acids is impaired in this case?
Primary active transport
Secondary Na-dependent transport*
46.Following changes were observed in a patient after poisoning with salts of heavy metals: increased level of residual nitrogen, hyperphosphatemia, hypersulfatemia, hyperacidemia, and decreased alkaline reserve. What structures impairment has led to described changes? A. Glomerulus of nephron*
Islets of Langerhans
Cortex of adrenal glands
Tubules of nephron
47.A 48-year-old man was admitted to the hospital with aggravation of chronic glomerulonephritis. Examination of this patient found out a presence of chronic renal failure in him. What does azotemia in chronic renal failure results from?
Decreased glomerular filtration*
Decreased tubular reabsorption
Decreased tubular excretion
Disorders of protein metabolism
Disorders of water-salt balance
48.A patient was admitted to the hospital with complaints of absence of urination during 24 hours and pains in lumbar area. Catheterization of patient’s urinary bladder does not relief the patient. What pathology may be cause of anuria in this patient? A. Bilateral renal calculi*
49.Inhibitor of phosphorylation in cells of nephron tubules – phloridzin, was introduced to an animal in experiment. What substances reabsorption impairment may develop in this case?
Disorders of reabsorption of glucose*
Disorders of reabsorption of non-organic phosphate and calcium
Disorders of reabsorption of amino acids
Disorders of reabsorption of proteins
Disorders of reabsorption of sodium ions and water
50.What pathological changes are characteristic for glomerulonephritis?
Presence of high molecular weight proteins (70,000 D) in urine*
Presence of fresh erythrocytes in urine
Presence of low molecular weight proteins (about 40,000 D) in urine
Increased excretion of sodium and hyaline cylinders in urine