Internal Medicine-2 Step-1 PDF

Internal Medicine-2 Step- 1 Let’s beat the exam QUESTION1 What are the most recommended research methods in modern nephrology for patients with urinary tract infections? Amburger test Nechiporenko test Addis-Kakovsky sample Uncentrifuged urine Test strips and urine sediment microscopy QUESTION2...

Internal Medicine-2 Step- 1 Let’s beat the exam QUESTION1 What are the most recommended research methods in modern nephrology for patients with urinary tract infections? Amburger test Nechiporenko test Addis-Kakovsky sample Uncentrifuged urine Test strips and urine sediment microscopy QUESTION2 Which of the following pathogens is the most common cause of community-acquired urinary tract infection? E.coli Proteus Citrobacter Ps. aerouginosa Staphylococcus QUESTION3 Which of the listed pathogens is the most common causative agent of hemorrhagic cystitis? Proteus klebsiella adenovirus Escherichia coli Pseudomonas aeruginosa QUESTION4 What cause is most characteristic of nephrotic syndrome? loss of proteins in urine allergic reaction decreased protein synthesis endocrine disorders metabolic disorders QUESTION5 Which study is most mandatory during long-term clinical examination of renal patients? Cystography Zimnitsky test Excretory urography CT scan Serum creatinine and GFR calculation QUESTION6 What mechanism of development of chronic kidney disease is most likely when the number of functioning nephrons decreases? hyperfiltration obstructive uropathy vasculitis of the renal vessels immune damage to the glomeruli microbial-inflammatory kidney damage QUESTION7 What important role does hyperfiltration play in chronic kidney disease? improves kidney function does not affect kidney function universal progression mechanism has a sclerosing effect only in pyelonephritis has a sclerosing effect only in glomerulonephritis QUESTION8 What laboratory symptoms are most accurate for acute pyelonephritis? Leukocyturia completely in the field of vision, increased ESR, bacteriuria Leukocyturia 5-7 in p/z, hematuria, proteinuria 1 g/l Leukocytopenia, increased ESR, hematuria Decreased specific gravity of urine Hematuria, cylindruria, increased specific gravity of urine QUESTION9 What mechanism is the most likely cause of edema in kidney damage? Increased loss of salts Limiting salts in food Sodium retention in the body Impaired secretion of ammonium chloride Insufficient dietary protein intake QUESTION10 What symptoms are most related to nephrotic syndrome? Edema, hematuria, cylindruria, hypocholesterolemia, increased ESR Hematuria, increased blood pressure, proteinuria 1 g/day Proteinuria more than 3.5 g/day, hypoalbuminemia, hypercholesterolemia Hyperbilirubinemia, proteinuria less than 2.5 g/day, increased blood pressure Hypo-, dysproteinemia, moderate edema, hematuria, hypoalbuminemia QUESTION11 Which indicator most accurately characterizes the nitrogen excretion function of the kidneys? Creatinine Residual nitrogen Thymol test C-reactive protein Protein and protein fractions QUESTION12 Which of the following diseases is the most common cause of chronic kidney disease in adults? Kidney stones Kidney infections Glomerulonephritis Rheumatic fever Arterial hypertension QUESTION13 Which of the following diseases is the most common cause of chronic kidney disease in adults? Kidney stones Kidney infections Glomerulonephritis Rheumatic fever Diabetes mellitus QUESTION14 What drugs are the “gold standard” of nephroprotective therapy for chronic kidney disease? Vitamins Enzymes Antibiotics Glucocorticosteroids Angiotensin-converting enzyme inhibitors QUESTION15 What complication is most likely to occur in acute kidney injury? hypercholesteremia hyperoxaluria hyperkalemia hyperphosphatemia hypercalcemia QUESTION1 Patient M., 27 years old. She was admitted with complaints of dull pain in the lumbar region, more on the right, increased body temperature to 39C, with chills, and the discharge of cloudy urine. Objectively: the skin is of normal color, there is no edema, the right kidney is palpable, painful, blood pressure is 100/70 mm Hg. Blood test: leukocytes 16 x 109/l, ESR 38 mm/h. In urine analysis: specific gravity 1009-1016, protein 0.66 g/l, in the urinary sediment there are all leukocytes, 1-2 erythrocytes, single hyaline casts. Which of the following preliminary diagnoses is MOST likely? nephroptosis acute pyelonephritis urolithiasis disease acute glomerulonephritis chronic pyelonephritis QUESTION2 Patient M., 25 years old. She was admitted with complaints of dull pain in the lumbar region, more on the right, increased body temperature to 39C, with chills, and the discharge of cloudy urine. Objectively: the skin is of normal color, there is no edema, the right kidney is palpable, painful, blood pressure is 100/70 mm Hg. Blood test: leukocytes 16 x 109/l, ESR 40 mm/h. In urine analysis: specific gravity 1009-1016, protein 0.66 g/l, in the urinary sediment there are all leukocytes, 1-2 erythrocytes, single hyaline casts. Which of the following research methods is the most important? kidney biopsy cystography, ultrasound of the kidneys cystoscopy, ultrasound of the kidneys tank urine culture, kidney ultrasound excretory urography standing QUESTION3 Girl 20 years old. Frequent urination and pain when urinating have been bothering you for 3-4 days. On examination: temperature 36.6, no visible edema, the abdomen is painful in the projection of the bladder. Laboratory tests: urine tests show leukocytes up to 10-15 per p/z, erythrocytes up to 10 per p/z, bacteriuria +. Which of the following preliminary diagnoses is MOST appropriate? Cystitis Nephritic syndrome Acute pyelonephritis Tubulointerstitial nephritis Complicated urinary tract infection QUESTION4 A 30-year-old woman with edema, oliguria, dark-colored urine, blood pressure 150/90 mm beats. A blood test revealed total protein 60 g/l, albumin 34 g/l, creatinine 120 µmol/l. General Urine Analysis: protein - 1.2 g, red blood cells - in large quantities. Which of the following diagnoses is MOST likely? acute pyelonephritis acute nephritic syndrome chronic kidney disease tubulointerstitial nephritis nephrotic syndrome QUESTION5 An 18-year-old girl was brought by an ambulance with complaints of fever, weakness, and malaise. From the anamnesis: she became acutely ill, had a fever of up to 39°C for 3 days, took paracetamol and biseptol on her own without effect. At the time of examination, health was disturbed due to symptoms of intoxication, temperature 39.5°C, no edema, blood pressure 110/70 mmHg, pain in the lumbar region on the right, urination was free. Laboratory: in the GBA: HB 120 g/l, leukocytes 12 thousand, s 72%, l 20, m 8%, ESR 40 mm/h; in GUA: cloudy, protein 0.066%, leukocytes - completely, bacteria +++. What diagnosis is MOST likely? Cystitis Urethritis Osteochondrosis Acute pyelonephritis Interstitial nephritis QUESTION6 A 27-year-old woman was admitted to the emergency department with complaints of back pain and fever. From the anamnesis: according to her, she fell ill 2 days ago, when she began to have a fever and back pain. The pain began to gradually increase. Over the last 6 hours, vomiting has been observed 2 times. Temperature 39.5 ° C, pulse 120 beats per minute, blood pressure 104/68 mm Hg. Laboratory: Hb 15.3 g/dL, WCC 25.2×109/L, PLT 406x109/L, Na 134 mmol/L, K 4.1 mmol/L. Urinalysis: protein++; blood+++, bacteria++. Urine microscopy: >50 red blood cells; >50 leukocytes. X-ray of the abdominal cavity: without pathology.What diagnosis is most likely? Acute cystitis Acute pyelonephritis Urolithiasis disease Bladder tumor Acute tubulointerstitial nephritis QUESTION7 A 33-year-old man receiving regular hemodialysis has a predialysis plasma potassium level of 6.9 mmol/L (3.5–4.9). Typically his potassium was less than 5.5 mmol/L.Which food combination in the diet would be the most likely cause of high potassium? Cereals, toast, cookies Milk, ham, chicken Filter coffee, tea, boiled potatoes Milk, butter, plain yogurt Tomatoes, potato chips, banana QUESTION8 Pregnant, 25 years old, first pregnancy, 23 weeks. He makes no complaints. Blood pressure – 110/70 mmHg. OAM: protein-abs, L - 0-1 in p/zr, Er - abs. Tank. urine culture 2 times: E.coli s 10x5 micron. Which diagnosis is MOST appropriate? Asymptomatic bacteriuria Chronic pyelonephritis Acute pyelonephritis Acute cystitis No pathology QUESTION9 The patient is 28 years old. Complaints: swelling of the face, anterior abdominal wall, lower extremities. On examination: swelling to anasarca. Blood pressure 105/60 mm Hg. Blood tests: total protein 38 g/l, albumin 19 g/l, cholesterol 9.5 mmol/l. in OAM protein 3.5 g/l, Lake. and Er - 0-1 in p/z. What diagnosis is most likely? Nephritic syndrome Nephrotic syndrome Isolated urinary syndrome Tubulointerstitial nephritis Rapidly progressive glomerulonephritis QUESTION10 A 40-year-old patient is observed with CKD. Determination of which two main laboratory indicators is carried out regularly in the early stages? fluid volume and plasma osmolality level of calcium, phosphorus calculation of GFR, proteinuria hematocrit and red blood cell count vitamin D and aldosterone levels QUESTION11 What treatment tactics are the most appropriate for a patient with nephrotic syndrome and stage 3CKD as a result of diabetes mellitus? Diuretic therapy Symptomatic therapy Nephroprotective therapy Immunosuppressive therapy Intensive insulin therapy QUESTION12 A 31-year-old man consulted a nephrologist. with swelling. BP-180/100 mm Hg. Serum creatinine– 300 µmol/l. Previously he complained of weakness. Blood pressure was not measured; urinetests were examined for the first time. Proteinuria was detected at 0.9 g/day, erythrocytes andleukocytes were single. Heredity - father has hypertension. Diuresis – 600 ml/day. What research methods will allow you to MOST reliably conduct a differential diagnosis of CKD and AKI? Diuresis measurement Determination of edema Immunological studies Full biochemical study Ultrasound of the kidneys with Dopplerography of blood vessels QUESTION13 A 20-year-old woman complains of pain in the lower abdomen and often painful urination. In urineanalysis, leukocytes are 20 k/a, erythrocytes are 20-30 k/a. Which of the following diagnoses isMOST likely? acute cystitis prostate adenoma acute pyelonephritis bladder stone acute glomerulonephritis QUESTION14 A 19-year-old guy was admitted to the clinic with complaints of swelling of the face, abdomen, and limbs. From the anamnesis: these complaints occurred within a week after suffering from acute respiratory viral infection. He went to the clinic, and at the GUA the protein was 3.6 g/l. On examination: his condition and well-being are suffering. Edema to the point of anasarca, blood pressure 90/55 mmHg, diuresis reduced. Laboratory: in the GBA - Hb 110 g/l, Le 12 thousand, ESR 60 mm/hour. Biochemistry of blood: total protein 35 g/l, albumin 20 g/l, cholesterol 19.3 mmol/l, creatinine 85 µmol/l. In GUA – protein 6 g/l, Le 1-2 in p/zr, Er 0-1 in p/zr. Daily proteinuria 3.8 g/s. What diagnosis is most likely? Lupus jade Amyloidosis of the kidneys Nephritic syndrome Nephrotic syndrome Rapidly progressive nephritis QUESTION15 A 19-year-old guy was admitted to the clinic with complaints of swelling of the face, abdomen, and limbs. From the anamnesis: these complaints occurred within a week after suffering from acute respiratory viral infection. He went to the clinic, and at the GUA the protein was 3.6 g/l. On examination: his condition and well-being are suffering. Edema to the point of anasarca, blood pressure 90/55 mmHg, diuresis reduced. Laboratory: in the GBA - Hb 110 g/l, Le 12 thousand, ESR 60 mm/hour. Biochemistry of blood: total protein 35 g/l, albumin 20 g/l, cholesterol 19.3 mmol/l, creatinine 85 µmol/l. In GUA – protein 6 g/l, Le 1-2 in p/zr, Er 0-1 in p/zr. Daily proteinuria 3.8 g/s. Which study makes it possible to make the most accurate morphological diagnosis? CT skan MRI Kidney ultrasound Intravenous urography Kidney biopsy QUESTION16 A 19-year-old guy was admitted to the clinic with complaints of swelling of the face, abdomen, and limbs. From the anamnesis: these complaints occurred within a week after suffering from acute respiratory viral infection. He went to the clinic, and at the GUA the protein was 3.6 g/l. On examination: his condition and well-being are suffering. Edema to the point of anasarca, blood pressure 90/55 mmHg, diuresis reduced. Laboratory: in the GBA - Hb 110 g/l, Le 12 thousand, ESR 60 mm/hour. Biochemistry of blood: total protein 35 g/l, albumin 20 g/l, cholesterol 19.3 mmol/l, creatinine 85 µmol/l. In GUA – protein 6 g/l, Le 1-2 in p/zr, Er 0-1 in p/zr. Daily proteinuria 3.8 g/s. What is the most likely pathogenetic mechanism for the development of edema in nephrotic syndrome? Increased synthesis of catecholamines Irregular formation of antidiuretic hormone Decreased protein synthesis and hypoproteinemia Decreased serum oncotic pressure Decreased synthesis of atrial natriuretic peptide QUESTION17 Guy 18 years old. Diagnosis: chronic glomerulonephritis. There is a decrease in kidney function: GFR – 78 ml/min, protein in urine – 1.32 g/l. What gold standard of nephroprotective therapy is indicated for this patient? Diuretics B-blockers ACE inhibitor Immunosuppressants Calcium channel blockers QUESTION18 A 34-year-old patient was diagnosed with chronic kidney disease, end-stage, glomerular filtration rate 10 ml/min. This condition is associated with high blood pressure. Which treatment method is most effective in prolonging the patient`s life? diet therapy peritoneal dialysis kidney transplant antibacterial therapy immunosuppressive therapy QUESTION19 A 22-year-old woman complains of severe swelling, ascites, rare small amounts of urination, lethargy, and decreased appetite. She became acutely ill after hypothermia. Blood pressure 110/70 mm Hg. Art., urine is light. GBA: leukocytes 6x109, CP 0.9, HB 110 g/l, ESR 55 mm/hour. In blood serum: creatinine 88 µmol/l, o. protein 42 g/l, cholesterol 7.9 mmol/l. GUA: protein 6.0 g/l, leukocytes 1-2 in p/zr, erythrocyte 0-2, sp. weight – 1020. What is the most preliminary diagnosis? Acute kidney injury Nephrotic syndrome Nephritic syndrome Preeclampsia Pyelonephritis QUESTION20 A 60-year-old patient suffering from hypertension for a long time has another hypertensive crisis with an increase in blood pressure to 220/140 mm. At home, within 2 hours, I independently lowered my blood pressure to 120/80 mm. and suddenly felt severe weakness, dizziness, nausea, vomiting, and the volume of urine decreased. During hospitalization, a creatinine of 900 µmol/l was detected. On ultrasound, the dimensions of both kidneys are 11.0x4.5 cm, there is no stagnation of urine. What diagnosis is most likely? CKD, stage 5 Prerenal AKI Postrenal AKI Hypertensive crisis Acute gastroenterocolitis QUESTION21 An elderly patient after cardiac surgery.Which of the following is the earliest marker of the development of acute kidney injury? IL-1 NGAL Urea Adipokines Creatine blood QUESTION22 The patient, 26 years old, was admitted to the clinic with complaints of severe weakness, headache, and nausea. From the anamnesis: at the age of 19 she suffered from kidney disease with edema, and subsequently moderate proteinuria was detected. Upon admission: the skin is dry, pale with a yellowish tint, no swelling. The borders of the heart are expanded to the left. Blood pressure 150/90 – 160/100mmHg. In the blood: HB 80 g/l, creatinine twice – 440-430 µmol/l. The daily amount of urine is 2200 ml. Protein in urine is 0.9 g/l, spec. weight 1006-1010, in sediment: red blood cells - single. GFR 25 ml/min. Which diagnosis is likely to determine treatment tactics? Polycystic kidney disease Chronic pyelonephritis Chronic glomerulonephritis Chronic kidney disease, stage 4 Chronic kidney disease, stage 5 QUESTION23 A 21-year-old man has swelling in his legs, blood pressure is normal. Blood creatinine 80 µmol/l, total protein 40 g/l, albumin 15 g/l and proteinuria – 6 g/s, urinary sediment is normal. What research is most necessary to clarify the diagnosis? Amburger sample kidney biopsy Zimnitsky test Nechiporenko test tank. urine culture with antibiogram determination QUESTION24 A 40-year-old patient has type 1 diabetes mellitus. During the examination, protein was detected in the urine - 0.165 g/l. What diagnosis is most likely? diabetes mellitus, pyelonephritis, antibiotics diabetes mellitus, glomerulonephritis, prednisolone diabetes mellitus, AKI, transfer to the dialysis department diabetes mellitus, chronic kidney disease, transfer to the dialysis department type 1 diabetes mellitus, diabetic nephropathy, nephroprotection QUESTION25 The patient is 33 years old. She has been observed for type I diabetes mellitus for 15 years. During a control study in urine tests: proteinuria 0.066 g/l, urinary sediment without pathology. Glomerular filtration rate=56 ml/min. Which of the drugs is most preferable in this situation? diuretics cytostatics antibiotics ACE inhibitors glucocorticosteroids QUESTION26 A 56-year-old patient with arterial hypertension. During a routine examination: blood creatinine 140 ml/min. GFR=56 ml/min. In the GUA: protein 0.165 g/l, urinary sediment is normal. Which preliminary diagnosis is MOST likely? acute glomerulonephritis, nephritic syndrome hypertension, acute renal failure arterial hypertension, stage 4 chronic kidney disease hypertensive nephropathy, stage 3 chronic kidney disease chronic glomerulonephritis, chronic kidney disease stage 3 QUESTION27 Male 40 years old. Massive edema to anasarca is noted, blood pressure is 100/60 mmHg. In the tests: serum creatinine 70 µmol/l, total protein 35 g/l, cholesterol 11.3 mmol/l. In GUA: proteinuria 8 g/day, er. 2 in p/z. What diagnosis is most likely? Nephritic syndrome Nephrotic syndrome Nephro-nephritic syndrome Isolated urinary syndrome Rapidly progressive glomerulonephritis QUESTION28 Patient 30 years old. Complaints: swelling of the face, anterior abdominal wall, lower extremities. On examination: swelling to anasarca. Blood pressure 85/40 mm Hg. Blood tests: total protein 40 g/l, albumin 16 g/l, cholesterol 10.8 mmol/l. in OAM protein 6.5 g/l, Leukoc. and Er - 0-1 in p/z. What diagnosis is most likely? Berger`s disease Nephritic syndrome Nephrotic syndrome Isolated urinary syndrome Rapidly progressive glomerulonephritis QUESTION29 A 23-year-old girl took diclofenac sodium on her own due to joint pain for about 3 weeks. Within a week, he notes an increase in temperature to 37-38˚C, rashes on the body, weakness, and loss of appetite. During examination: blood pressure is 110/70 mmHg, there is no edema or gross hematuria. Laboratory: GBA HB 113 g/l, Tr 220 thousand, Le 10 thousand, s 56%, l 30%, m 3%, e 11%, ESR 30 mm/h. Biochem.analysis: total protein 62 g/l, cholesterol 5.0 mmol/l, creatinine 154 µmol/l, urea 10.6 mmol/l, potassium 4.9 mmol/l, sugar 3.7 mmol/l. GUA: 1005, protein 0.66 g/l, Le 4-6 in the field of vision, Er 8-10 in the field of vision, hyaline cylinders 2-3 in the field of view. What diagnosis is most likely? Nephrotic syndrome Isolated urinary syndrome Acute nephritic syndrome Acute tubulointerstitial nephritis Rapidly progressive glomerulonephritis QUESTION30 A 27-year-old woman complains of frequent painful urination, pain above the pubis, frequent imperative urges. These complaints occur within 2-3 days after hypothermia. When examining the GBA without changes, in the GUA – Leukocytes up to 20-30 in the p/zr, bacteria +++.What diagnosis is most likely? Cystitis Acute pyelonephritis Urolithiasis disease Asymptomatic bacteriuria Tubulointerstitial nephritis QUESTION31 A 27-year-old woman with a history of diabetes mellitus for 5 years. Which of the following symptoms is the most indication for the appointment of antibacterial therapy? Polyuria Glucosuria Hyperisostenuria Arterial hypertension Asymptomatic bacteriuria QUESTION32 A 75-year-old patient with long-term type II diabetes mellitus and hypertension was found to have proteinuria of 1.8 g/day and hypercreatinemia of 180 µmol/l. Which recommendation should most definitely be given to the patient? Hemodialysis Cytostatics Prednisolone Kidney transplantation ACE inhibitors QUESTION33 The patient is 34 years old. Complaints: swelling of the face, anterior abdominal wall, lower extremities. On examination: swelling to anasarca. Blood pressure 85/40 mmHg In blood tests: total protein 38 g / l, albumin 16 g / l, cholesterol 10.8 mmol / L. General urine analysis: protein 6.5 g / l, Leukemia. and Er - 0-1 in n/a. What is the most likely diagnosis? Berger`s disease Nephrotic syndrome Nephrotic syndrome Isolated urinary syndrome Rapidly progressive glomerulonephritis QUESTION34 Woman C, 26 years old. She was admitted to the clinic with complaints of pronounced weakness, headache, nausea. At the age of 19, she suffered from kidney disease with edema, and subsequently moderate proteinuria was detected. Upon admission: the skin is dry, pale with a yellowish tinge, there is no swelling. The boundaries of the heart are expanded to the left. Blood pressure 150/90 – 160/100mm.Hg. In the blood: Hb 50 g / l, creatinine twice - 440-500 mmol / l. Daily diuresis of 2200 ml. In urine protein 0.9 g / l, specific gravity 1006-1010, in sediment: erythrocytes – single. GFR=14 ml/min. Which of the following preliminary diagnoses is the MOST important for determining treatment tactics? Polycystic kidney disease Chronic pyelonephritis Chronic glomerulonephritis Chronic kidney disease, stage 4 Chronic kidney disease, stage 5 QUESTION35 The patient is 27 years old. Complaints: swelling of the face, lower extremities. During the inspection: Blood pressure 160/110 mm Hg In blood tests: total protein 62 g / l, albumin 38 g / l, cholesterol 5.8 mmol / L. in General urine analysis: protein 1.8 g / l, hematuria. What is the most likely diagnosis? Berger`s disease Nephrotic syndrome Nephrotic syndrome Isolated urinary syndrome Rapidly progressive glomerulonephritis QUESTION36 Patient 18 years old. He was admitted with complaints of weakness, malaise, swelling of the face, and change in the color of urine. From the anamnesis: he suffered from a sore throat, and the nasopharynx was sanitized independently. After 10 days, urine “the color of meat slop” appeared, and swelling of the eyelids appeared. On examination: dense swelling of the eyelids and legs, blood pressure 130/80 mmHg, gross hematuria. Laboratory: in the blood - ESR 42 mm/hour, o. protein 60 g/l, cholesterol 3.9 mmol/l, creatinine 112 µmol/l, urea 9.9 mmol/l, potassium 5.0 mmol/l, sugar 3.7 mmol/l; Іn general urine analysis: relative density1018, protein 1.5 g/l, red blood cells in large quantities, leukocytes 2-3 in p/z.Which clinical diagnosis is MOST appropriate? Hemolytic-uremic syndrome Post-infectious glomerulonephritis Acute tubulointerstitial nephritis Rapidly progressive glomerulonephritis Glomerulonephritis, nephrotic-nephritic syndrome QUESTION37 A 44-year-old man was admitted with complaints of headache, paroxysmal pain in the right side, lack of urine, swelling in the lower extremities. Not previously examined. During the examination: blood creatinine 300 µmol/l, urea 29 mmol/l; in the urine the protein is 0.099 g/l, leukocytes and erythrocytes are entirely subnormal, on ultrasound the kidney size is 13.5x5.4, the echogenicity of the parenchyma is increased, the pelvis is dilated.Which diagnosis is MOST appropriate? Acute appendicitis AKI postrenal Crohn`s disease Acute pyelonephritis Acute glomerulonephritis QUESTION38 The patient is 19 years old, complains of frequent, painful urination, an increase in body temperature to subfebrile figures, irritability, sleep disturbance, enuresis. The patient is on the second day, associates the disease with hypothermia. In the laboratory, in the general analysis of urine, erythrocytes 5-6 in n/a, leukocytes 10-16 in n / a, bacteria ++.What is the most likely diagnosis? Tubulointerstitial nephritis Acute pyelonephritis Glomerulonephritis Vulvitis Cystitis QUESTION39 A 26-year-old woman was admitted to the clinic with complaints of severe weakness, headache, nausea. From anamnesis: at the age of 19, she suffered from kidney disease with edema, and subsequently moderate proteinuria was detected. Upon admission: the skin is dry, pale with a yellowish tinge, there is no swelling. The boundaries of the heart are expanded to the left. Blood pressure 150/90 – 160/100mm.Hg. In the blood: Hb 50g / l, creatinine twice –440-500 mmol /l. The daily amount of urine is 2200 ml. In urine protein 0.9 g / l, specific gravity 1006-1010, in sediment: erythrocytes – single.Which method will MOST reliably establish the filtration function of the kidneys? RIFLE MDRD Schwartz CKD-EPI Cockcroft-Gault QUESTION40 The man is 37 years old. Massive edema to anasarca is noted, blood pressure is 100/60 mmHg. In tests: creatinine in the blood is 70 mmol/l, total protein is 35 g / l, cholesterol is 11.3 mmol/l. : proteinuria 4 g/day, er. 2 in n/a. Which of the listed preliminary diagnoses is the MOST likely? Pyelonephritis Nephrotic syndrome Nephrotic syndrome Isolated urinary syndrome Rapidly progressive glomerulonephritis QUESTION41 Patient S., 26 years old. She was admitted to the clinic complaining of severe weakness, headache, nausea. At the age of 19, she suffered from kidney disease with edema, and subsequently moderate proteinuria was detected. Upon admission: the skin is dry, pale with a yellowish tinge, there is no swelling. The boundaries of the heart are expanded to the left. Blood pressure 150/90 – 160/100mmHg: Hb 50 g/l, creatinine twice - 440-500 mmol/l. Daily diuresis of 2200 ml. In urine, protein 0.9g/l, specific gravity 1006-1010, in sediment: single erythrocytes. GFR=14 ml/min.Which of the following preliminary diagnoses is the most important for determining treatment tactics? Chronic kidney disease, stage 1 Chronic kidney disease stage 2 Chronic kidney disease stage 3 Chronic kidney disease, stage 4 Chronic kidney disease, stage 5 QUESTION42 Patient Zh., 25 years old. She received complaints of dull pain in the lumbar region, more on the right, an increase in body temperature to 40 C, with chills, the release of cloudy urine. Objectively: the skin is of normal color, there is no edema, the right kidney is palpable, painful, blood pressure 110/70 mmHg. In the blood test: leukocytes 16 x 109 / l, ESR 48 mm / h. In the analysis of urine: specific gravity 1016, protein 0.66 g / l, leukocytes in the urinary sediment – entirely, erythrocytes 5-6 in p / w, hyaline cylinders – single. Which of the listed preliminary diagnoses is the MOST likely? Nephroptosis Acute pyelonephritis Urolithiasis Acute glomerulonephritis Chronic pyelonephritis QUESTION43 The man is 55 years old. After cardiac surgery, there is a deterioration in the condition in the form of a decrease in diuresis, an increase in symptoms of intoxication. Laboratory: UAC – Hb 110 g/l, Le 10 thousand, ESR 28 mm/h, creatinine 189 mmol/l, urea 20mmol/L, potassium 5.9 mmol/L, sodium 140 mmol/L. Іn the general analysis of urine: Le 3-4 in n/a, Er 6-8 in n/a, bel-0.033. What is the most likely diagnosis? Chronic kidney disease Prerenal form of AKI Acute pyelonephritis Acute glomerulonephritis Postrenal form of AKI QUESTION44 An 18-year-old patient developed diarrhea within 4 days, and oliguria after vomiting. Azotemia and acidosis were found in the blood. What is the most likely diagnosis? Developmental anomaly Acute pyelonephritis Acute kidney injury Acute nephrotic syndrome Chronic kidney disease QUESTION45 A 59-year-old patient was admitted to the cardiac surgery department for surgical treatment. In the postoperative period, a deterioration in the condition was revealed in the form of a decrease in diuresis, an increase in symptoms of intoxication. In the analyses: there was an increase in creatinine on day 3 from 57 to 170 mmol/l, urea from 4.7 to 15 mmol/l, sodium 142 mmol/l, potassium 6.0 mmol/l, chlorine 120 mmol/l; pH-7.22, pCO2-19 mmHg, HCO3- 13 mmol/L. To which stage of AKI, according to the RIFLE classification, do these indicators most correspond? R I F L E QUESTION1 Idiopathic pulmonary fibrosis is MOST characterized by Acute attack of shortness of breath Shortness of breath with a tendency to increase Severe night sweating Bilateral joint damage Night attacks of suffocation QUESTION2 Which of the following is the MOST probable cause of acute bronchitis? Viral infection Nosocomial infection Fungal infection Bacterial infection Oropharynx`s pathogenic flora of the (with aspiration) QUESTION3 MOST likely risk factor for acute bronchitis Hormonal disorders Malnutrition Sedentary lifestyle Seasonality (winter-autumn period) Obesity QUESTION4 Which of the following is the MOST characteristic in the pathogenesis of acute bronchitis? Development of obstructive syndrome Violation of mucociliary transport Hyperreactivity of the bronchi iolation of the mechanisms of natural defense Immunological disorders QUESTION5 The MOST specific clinical sign of chronic bronchitis is Cough for 3 months a year for 2 consecutive years Cough worse at night, asthma attacks Chest pain associated with breathing, frequent and shallow breathing Hemoptysis, sweating, weight loss, low-grade fever Stunning chills, fever, severe intoxication symptoms QUESTION6 Which of the following complications of chronic bronchitis is the MOST frequent? Pneumothorax Pneumonia Lung gangrene Lung cancer Dry pleurisy QUESTION7 Which of the following is the MOST probable cause of the community-acquired pneumonia? Bronchoscopy Postoperative period Alcoholism Diabetes Hypothermia QUESTION8 Which of the following is the MOST probable cause of aspiration pneumonia? Hormone therapy Postoperative period Alcoholism Diabetes Hypothermia QUESTION9 The MOST common causative agent of pneumonia is... Pneumococcus Mycobacterium tuberculosis Cytomegalovirus Anaerobic staphylococci E. coli QUESTION10 A 30 years old male. Complaints about shortness of breath, cough with white viscous sputum. He works as an operator at a poultry farm. Objectively: height - 170 cm, weight - 80 kg, BMI - 27.7 kg \ m2. The skin is of normal color. By auscultation of the lungs, dry wheezing is heard, more in the upper and middle sections.Which of the following is the MOST likely cause of shortness of breath? Age and gender Stress Profession Smoking Obesity QUESTION11 A 30 years old male. Complaints about shortness of breath, cough with white viscous sputum. Works as an operator on television. Objectively: height - 170 cm, weight - 110 kg, BMI - 38 kg \ m2. The skin is of normal color. By auscultation of the lungs, dry wheezing is heard more in the upper and middle sections. Preliminary diagnosis: Bronchial asthma.Which of the following is the MOST characteristic in the pathogenesis of the disease? Emphysema Bronchospasm Laryngospasm Pneumosclerosis Mucostasis QUESTION12 Which of the following is the MOST characteristic pathogenetic mechanism in bronchial asthma? Bronchial hyperreactivity The presence of exudate in the alveoli Inflammatory reaction of the lungs to gas Pulmonary hypertension Destruction of the alveolar walls QUESTION13 A 35 years old male. Complaints of an attack of shortness of breath at night, of a recurring nature, up to 3 times a week, cough with white viscous sputum. Objectively: height - 170 cm, weight - 110 kg, BMI - 38 kg \ m2. The skin is of normal color. By auscultation of the lungs, dry wheezing is heard more in the upper and middle sections. Preliminary diagnosis: Bronchial asthma.Which of the following is the MOST characteristic in the pathogenesis of the disease? Emphysema Bronchospasm Laryngospasm Pneumosclerosis Mucostasis QUESTION14 A 60-year-old woman with a diagnosis of Chronic obstructive pulmonary disease. She worked as a cook for many years.Which of the following is the MOST likely cause of the disease? Α1-antitrypsin deficiency Bad habits Age and gender of the patient Occupational hazard Duration of lung disease QUESTION15 A 58 years old female, a doctor. Complains of cough with mucous sputum, shortness of breath during physical exertion. Suffers from chronic obstructive pulmonary disease for 10 years. Does not smoke. Sister revealed pulmonary emphysema.Which of the following is the MOST likely cause of the disease? Age and gender of the patient Occupational hazards Air pollution Duration of the disease An α1- antitrypsin insufficiency QUESTION16 THE MOST probable research method for detecting a violation of bronchial obstruction in acute bronchitis Spirometry X-ray Bronchoscopy Pulse oximetry Electrocardiography QUESTION17 Which of the following diagnoses is MOST characteristic for the infiltrative changes with fuzzy contours on X-ray? Pneumonia Chronical bronchitis Bronchial asthma Lung cancer Bronchiectatic disease QUESTION18 The MOST characteristic changes in the lungs on X-ray examination of a patient with pneumonia is? Focal and infiltrative changes Destruction cavities Increased airiness of lung tissue Thickening of the walls of the bronchi Basal pneumosclerosis QUESTION19 A 30 years old male is diagnosed with bronchial asthma. Spirometry with bronchodilator test was performed.By how many percent is the MOST expected increase in FEV1 with the positive test? 2 4 5 8 12 QUESTION20 What are the most likely changes in skin color for respiratory failure? "Cold" cyanosis "Warm" cyanosis Acrocyanosis Pallor of the skin "Blush" on the cheeks QUESTION21 The MOST specific sign of respiratory failure is: General weakness Chest pain Dyspnea Swelling on the face Headaches QUESTION22 For respiratory failure of the III degree the MOST characteristic is: Shortness of breath with significant physical exertion Shortness of breath at the slightest exertion Dyspnea at rest Bradycardia during exercise Tachycardia with significant physical exertion QUESTION23 Choose the most likely definition that characterizes bronchiectatic lung disease: Destruction of the walls of the alveoli Bronchial hyperreactivity Local suppurative process The presence of reversible bronchial changes The presence of intraalveolar exudation QUESTION24 In bronchiectasis, the following develops: Acute inflammation Chronic suppurative process Diffuse process Reversible process Destruction of lung tissue QUESTION25 The MOST likely risk factors for bronchiectasis may include: Physical inactivity Haemostasis disorder Occupational hazards Pneumonia in early life Age, gender, weight QUESTION1 The student turned to the clinic complaining of a dry, painful cough, pain behind the sternum. By auscultation - dry, scattered rales. He took mucaltin on his own for 5 days without effect.The appointment of which of the following groups of drugs is MOST appropriate? Anticholinergics Antileukotriene preparation Mukalitiki b-2 short-acting agonists Antihistamines QUESTION2 A 19-year-old student diagnosed with «Acute bronchitis» received outpatient treatment for 7 days. There are no complaints at the repeated reception, the condition is satisfactory. By auscultation is vesicular breathing, no wheezing.What is the most appropriate tactic for managing a patient with acute bronchitis? Administration of long-acting b-2 agonists Prescribing antibiotics of another series Nebulizer therapy with corticosteroid Spa treatment Administration of short-acting b-2 agonists QUESTION3 A 19-years-old student after an acute respiratory illness has developed a dry, painful cough, pain behind his sternum. During auscultation in the lungs, hard breathing, single dry rales are heard. In the blood test: white blood cells 5.0 x 10#9/l, ESR 10 mm / hour. Diagnosed acute bronchitis obstruction.Which of the following non-drug therapy methods is MOST appropriate? Administration of long-acting b-2 agonists Prescribing antibiotics of another series Nebulizer therapy with corticosteroid Administration of short-acting b-2 agonists Spa treatmen QUESTION4 A 30 years-old woman is diagnosed with «SARS. Acute bronchitis, obstructive syndrome».What is the most appropriate medication must be prescribed? Azithromycin Bromhexine Ambroxol Pulmicort Salbutamol QUESTION5 A 20 years-old student with a diagnosis of «Acute bronchitis» obstruction. received outputient treatment for 7 days. There are no complaints at the repeated reception, the condition is satisfactory. By auscultation - vesicular breathing, no wheezing.What is the most appropriate tactic for managing a patient with acute bronchitis? Physical therapy, physical therapy Breathing exercises Halotherapy Seasonal flu vaccination Vibration massage QUESTION6 A 48-year-old male complains of a cough with mucopurulent sputum for a long time, an increase in body temperature up to 37.8 ° C, weakness, malaise that appeared after hypothermia. Objectively: cyanosis of the nasolabial triangle. By auscultation - there is hard breathing. Preliminary diagnosis: Chronic bronchitis, exacerbation.Which of the following groups of drugs is MOST appropriate? Bronchodilators Antibiotics Antispasmodics Anti-aggregates Corticosteroids QUESTION7 A 40-year-old female complains of a cough with mucopurulent sputum for a long time, an increase in body temperature up to 37.5 ° C, weakness, and malaise. From the anamnesis smokes for 12 years. Allergic rhinitis last 5 years. Objectively: pallor of the skin. Auscultation - hard breathing with moist rales that disappear after coughing. Diagnosed with chronic bronchitis, exacerbation.What drugs are most appropriate to prescribe? Bronchodilators Vitamins Antispasmodics Antibiotics Corticosteroids QUESTION8 A 45-year-old man complains of a cough with mucopurulent sputum, an increase in body temperature up to 37.8 ° C, weakness, and malaise. By auscultation there is hard breathing with dry rales. Preliminary diagnosis: Chronic bronchitis, exacerbation.What drugs are most appropriate? b-2 long-acting agonists Antibacterial drugs Inhaled corticosteroids Mucolitics b-2 short-acting agonists QUESTION9 A 38-year-old woman complains of coughing with mucopurulent sputum for a long time, shortness of breath, weakness, and malaise. From the anamnesis smokes for 12 years. Objectively: pallor of the skin. By auscultation there is hard breathing, dry wheezing during forced expiration.Which drug is MOST advisable to appoint for bronchodilator? Mukaltin Salbutamol Ambroxol Amoxicillin Fluoroquinolones QUESTION10 A 44-year-old man was diagnosed with Chronic bronchitis, exacerbation. He receives outpatient treatment with antibiotics and mucolytics for 5 days. The condition is closer to satisfactory, body temperature up to 36.70С. By auscultation there is hard breathing with single dry rales.What is the most appropriate medication? Azithromycin Cepepime Ambroxol Pulmicort Salbutamol QUESTION11 A 35-year-old woman complains of a cough with mucopurulent sputum, an increase in body temperature to 37.8 ° C, weakness, and malaise. By auscultation there is hard breathing.Preliminary diagnosis: Chronic bronchitis, exacerbation.What drugs are most appropriate? b-2 long-acting agonists Antibacterial drugs Inhaled corticosteroids Mukolytics b-2 short-acting agonists QUESTION12 A 45-year-old man is diagnosed with community-acquired pneumonia.What drugs are most appropriate to prescribe? Bronchodilators Vitamins Antispasmodics Antibiotics Corticosteroids QUESTION13 A 30 years old female has been diagnosed with Community-acquired pneumonia of the lower lobe of the right lung. Which drug is the MOST appropriate to prescribe? Bronchodilators Vitamins Antispasmodics Antibiotics Corticosteroids QUESTION14 The third day you observe a 35-year-old patient with a diagnosis of Community-acquired pneumonia. He receives antibiotic therapy (penicillin series). Despite this patient`s condition of health does not improve, body temperature has not returned to normal.What is the most appropriate patient`s management tactic? Change to cephalosporin antibiotics Increase the dose of the resulting antibiotic Add to the treatment of bronchodilators Continue treatment with the selected antibiotic Prescribe inhaled corticosteroids QUESTION15 A 23-year-old woman was diagnosed with community-acquired pneumonia of the upper lobe of the left lung. Which of the following patient management tactics is MOST appropriate? Treatment with non-specific drugs After non-specific treatment, then consultation with a phthisiologist After non-specific treatment, consultation with a cardiologist Consultation with a phthisiologist, followed by non-specific treatment Treatment with broad-spectrum antibacterial drugs QUESTION16 A 32 years old man. He went to the hospital with complaints of an asthma attack, shortness of breath. From the anamnesis: similar attacks have been observed before, but stopped on their own. This attack developed suddenly during the repair of the apartment. Smokes 1 pack per day. Objectively: the skin is moist, moderate cyanosis of the lips. By auscultation of the lungs, breathing is weakened, dry wheezing.Which of the following is the MOST acceptable for this situation? Short-acting bronchodilators Long-acting bronchodilators Antibacterial drugs expectorant drugs Inhaled glucocorticosteroids QUESTION17 A 25-year-old woman was admitted to the admission department with complaints of severe shortness of breath with difficulty exhaling, reaching suffocation, poorly stopped by taking salbutamol. From the anamnesis of the disease: complains are for about 2 years, when she began to notice the appearance of shortness of breath with difficulty exhaling during walks, especially in the spring. She went to the clinic and was diagnosed with bronchial asthma. Which of the following groups of drugs is MOST acceptable for basic therapy? Antibacterial therapy Inhaled glucocorticosteroids Short-acting bronchodilators detoxification therapy Long-acting bronchodilators QUESTION18 A 32 years old man. He went to the admission department with complaints of an asthma attack, shortness of breath. From the anamnesis: similar attacks have been observed before, but stopped on their own. This attack developed suddenly during the repair of the apartment. Smokes 1 pack per day. Objectively: the skin is moist, moderate cyanosis of the lips. By auscultation of the lungs, breathing is weakened, dry wheezing.Which of the following methods of drug administration is the MOST acceptable? Inhalation Sublingual Intramuscular infusion Oral QUESTION19 A 45-year-old man is diagnosed with «Chronic Obstructive Pulmonary Disease, А, GOLD1, remission».The appointment of which of the following groups of drugs is MOST appropriate? Bronchodilators Vitamins Antispasmodics Anti-aggregates Antibiotics QUESTION20 A 40 years old man, smokes 1 pack per day. Complaints of cough with mucous sputum in the morning. During spirometry: FEV1-80%, Tiffno index-69%. Diagnosed with COPD, А.What is the most appropriate patient`s management tactic? Avoid smoking β2 - short-acting agonists β2 - long-acting agonists M-anticholinergics Inhaled corticosteroids QUESTION21 A 45 years old man, smokes from the age of 17 for 1-1.5 packs a day. The smoker`s index is 28. The diagnosis is: Chronic obstructive pulmonary disease, bronchitic type, Category B, DN0-1, incomplete remission.What is the most appropriate basic patient management tactic? Avoid smoking Antibacterial therapy Surgical treatment Therapeutic exercise Oxygen therapy QUESTION22 A 40-year-old man smokes 1 pack a day for 10 years. Complaints of cough with mucous sputum in the morning. During spirometry: FEV1-30%, Tiffno index-59%. Diagnosed with COPD С, The appointment of which group of drugs, according to the clinical protocol of the Ministry of Health of the Republic of Kazakhstan from 2019, is MOST appropriate? Antibiotics β2 - short-acting agonists β2 - long-acting agonists M-anticholinergics long-acting agonists Inhaled corticosteroids QUESTION23 A 67-year-old man is registered for COPD. He complained of a cough with mucopurulent sputum, increased shortness of breath during physical exertion, an increase in body temperature to 38 ° C. Patient associates his condition with hypothermia. During auscultation against the background of weakened breathing with an extended expiration, scattered dry rales from two sides are heard.Which of the following is the most appropriate? Salbutamol Аzithromycin prednisone Theof Illin Amikacin QUESTION24 Which of the following methods of non-drug treatment of respiratory failure is the MOST effective? Mustard plasters on the back Hot foot baths Acupuncture Oxygen therapy Herbal medicine QUESTION25 A 25-year-old man with a diagnosis of «Community-acquired pneumonia of the lower lobe of the right lung» received outpatient treatment. On the 7th day there are no complaints, the condition is satisfactory, with auscultation vesicular breathing, no wheezing.What further management tactics of the patient is MOST appropriate? Continue antibiotic therapy Prescribe antibiotics of a different row Proceed to work Control X-ray of chest on the 1-month Prescribe inhaled corticosteroids QUESTION26 A 50 years old woman. Complaints of severe pain in the right side of the chest, aggravated by inhalation, fever, severe weakness, dry cough. Complains appeared after hypothermia. Objectively: the chest is of the usual form, in the lower lobe of the right lung a dull percussion sound. With auscultation in the lower parts of the right lung, breathing is sharply weakened.Which of the following diagnoses is MOST characteristic for this chest X- ray? Community-acquired lower-lobe pneumonia Aspiration pneumonia on the right Dry pleurisy on the right Exudative pleurisy on the right Nosocomial upper lobar pneumonia QUESTION27 A 40-year-old man with complaints of chest pain with a deep breath, shortness of breath, fever, severe weakness, dry cough. Objectively: the chest is of the usual form, in the lower lobe of the left lung a dull percussion sound. With auscultation in the lower parts of the left lung, breathing is sharply weakened.Which of the following diagnoses is MOST characteristic for this chest radiograph? Community-acquired lower-lobe pneumonia Aspiration pneumonia on the right Dry pleurisy on the right Exudative pleurisy on the left Nosocomial upper lobar pneumonia QUESTION28 Analysis of pleural fluid: specific gravity - 1020, color - cloudy, protein - 30g / l, Rivalt reaction +; microscopy: white blood cells are in sight, atypical cells are not, mycobacterium tuberculosis is not.Which of the following diagnoses is MOST probable by the result of pleural fluid analysis? Dry pleurisy Exudative pleurisy Tuberculous pleurisy Pleurisy with heart failure Tumor pleurisy QUESTION29 A 55 years old woman, cooker. Complaints of cough with mucous sputum in the morning, shortness of breath during physical exertion. Spirometry indices: FEV1-65%, Tiffno index-60%. Diagnosed with COPD, moderate.What is the most appropriate medication? short–acting β2 agonists long–acting β2-agonists a short-acting cholinergic drug long-acting cholinergic drug Inhaled corticosteroids QUESTION30 The 19 years old student after acute respiratory disease on the 3rd day, a cough appeared with a mucopurulent spurum.Which of the following non-drug therapy methods is MOST aimed at facilitating sputum production? Vibration massage Physical education Remediation of foci of infection Physiotherapy Hardening the body QUESTION31 A 49-year-old man is worried about severe expiratory dyspnea, a paroxysmal cough with sputum. Smokes for 20 years. On examination: a barrel-shaped chest, percussion - box sound, auscultation - weakened vesicular breathing, shortened exhalation, rare dry rales.Which of the following drugs is most appropriate? Ipratropium bromide Sodium cromoglycate Amoxicillin / clavulanate Budesonide Beclomethasone QUESTION32 A 49-year-old man complains of shortness of breath that occurs during physical exertion, paroxysmal cough with sputum. Smoked for about 20 years. Objectively: the skin is dry, moderate “gray” cyanosis, the nails are changed according to the type of “watch glasses”, the chest is swollen with emphysema. X-ray: decreased transparency of the lungs, depleted pulmonary pattern. FEV1 =65%.What is the most appropriate treatment tactic? Ipratropium bromide Sodium cromoglycate Beclomethasone Spiramycin Budesonide QUESTION33 A 50-year-old man is concerned about an increase in body temperature to 38C, a cough with hard-to-separate green sputum. Objectively: breath rate - 24 per min. In the lungs, scattered buzzing rales are heard, decreasing after coughing. In the analysis of sputum – 85% of neutrophils.Which of the following drugs is most appropriate? Ampicillin Paracetamol Rovamycin Diflucan Biseptol QUESTION34 A 35-year-old man with community-acquired pneumonia, while taking amoxicillin 3.0 g / day, has an increase in body temperature up to 380 ° C, increased cough with mucopurulent sputum.What further antibacterial tactics are MOST appropriate? Add gentamicin Increase the dose of amoxicillin Replace amoxicillin with extensillin Replace amoxicillin with azithromycin Biseptol QUESTION35 The 47-year-old patient has been experiencing shortness of breath in the last few months. Anamnesis without features. Objectively: acrocyanosis, fingers in the form of drumsticks. In the lungs, against the background of weakened breathing, there are not sonorous wheezes resembling crepitation. There is an accent of the 2nd tone on the pulmonary artery. Radiologically, the reticulation of the pulmonary pattern, mainly in the lower parts, the size of the heart is not changed, the cone of the pulmonary artery bulges out. Еlectrocardiography shows signs of hypertrophy of the right ventricle. What is the MOST reasonable diagnosis? Mitral stenosis Idiopathic pulmonary fibrosis COPD. Pneumonia. Hematogenically disseminated pulmonary tuberculosis QUESTION1 An 18-year-old young man presented with complaints of excessive thirst, drinking up to 10 liters of water, weakness, weight loss, and frequent urination. Complete blood count shows Hb-130 g/L, WBC-5.4 x10^9, RBC-4.8 x10^12, and CI-0.9. Glucose level 4.8 mmol/L. Urinalysis shows specific gravity-1002, leukocytes-0-2-3 in the field of view.What would be the MOST appropriate treatment strategy? Desmopressin Bromocriptine Dostinex Insulin Furosemide QUESTION2 A 17-year-old girl has noted weight gain, visual disturbances, and menstrual irregularities over the past year. Wide purplish striae are observed on the thighs, abdomen, and breasts. BP 140/90 mmHg. The blood cortisol level at 8 am.- 1060 ng/L (normal range: 260-720 ng/L). MRI of the pituitary gland showed an intrasellar mass measuring 0.8x1.2 cm.What would be the most appropriate further tactics of action? Outpatient follow-up with an endocrinologist, neurosurgeon Transsphenoidal adenomectomy Long-term treatment with dopamine agonists Transcranial adenomectomy Growth hormone receptor inhibitors QUESTION3 A 28-year-old man presented complaints of headaches, weakness, visual impairment, sweating, chest pains, and joint pains. These complaints have been bothering him for a year. On examination: enlargement of the brow ridges and nose. The tongue was enlarged, with tooth imprints, a hoarse voice. BP 160/90 mmHg. GH level- 10.0 ng/mL (normal range 0 - 6.5 ng/mL). MRI of the pituitary gland revealed a 1.0 x 1.8 cm formation.What treatment strategy would be most appropriate? Transnasal adenomectomy Radiation therapy Selective dopamine agonists Non-selective dopamine agonists Growth hormone receptor inhibitors QUESTION4 A 22-year-old female patient complains of the absence of menstrual cycles and nipple discharge. Revealed increased prolactin level in the blood up to 2500 mIU/mL and an intrasellar pituitary adenoma of 0.7 cm were identified. Vision is not impaired.What treatment strategy would be most appropriate? Transcranial adenomectomy Transnasal adenomectomy Radiation therapy Long-term dopamine agonist treatment Long-term treatment with lyophilizate QUESTION5 A 36-year-old woman presented complaints of hair loss, edema, constipation, and a sensation of shortness of breath. On examination: skin is clean and dry, with dense edema on her legs that did not remain an indentation after pressure was applied. The thyroid gland is enlarged, firm, and mobile on palpation. Thyroid ultrasound- diffuse changes in the thyroid gland. Hormonal test results: TSH - 16.5 mIU/L; Free T4 - 8.0 pmol/L. What is the MOST appropriate medication to prescribe? thyroxine thiamazole iodomarin prednisolone furosemide QUESTION6 A 38-year-old woman was hospitalized with complaints of facial and leg swelling, fatigue, weakness, constipation, and chest pain. Her pulse rate is 54 beats per minute, and BP 150/90 mmHg. She has dry skin and non-pitting edema on her face and legs. The thyroid gland is firm and mobile on palpation. TSH level 25 mIU/L.What is the MOST appropriate treatment strategy? Iodine supplement Cardiac glycosides Diuretics Thyroid medications Hypotensive drugs QUESTION7 A 44-year-old man presented with complaints of hair loss. On examination, clean and dry skin, with hyperkeratosis on the elbows. There is a loss of eyebrows from the lateral edge and areas of alopecia on the scalp. Test results showed a glucose level 5.6 mmol/L, total cholesterol- 7.4 mmol/L, and TSH 28 mIU/L. Thyroid ultrasound: a total volume- 5 cm3.What is the MOST APPROPRIATE therapy? Thyreostatics Antifungals Iodine supplement Thyroid drugs Statins QUESTION8 A 25-year-old woman complains of general weakness, irritability, increased appetite, palpitations, and a sudden weight loss of 8 kg in 2 months. She has been ill for about 2 months after being dismissed from work. On examination, the patient was restless and tearful. Shiny eyes, infrequent blinking, moist and warm skin. The neck is enlarged. Heart sounds are loud, pulse rate 125 beats per minute, blood pressure 140/60 mmHg.What is the MOST APPROPRIATE therapy? Sedative Thyreostatics Glucocorticoids Symptomatic Thyroid medication QUESTION9 A 32-year-old woman complains of a feeling of pressure in the neck, sweating, weight loss, and palpitations persisting for about a year. She irregularly took thiamazole and methimazole due to allergic reactions causing itching and skin redness. Thyroid ultrasound revealed a volume of 64 cm3. Free thyroxine (FT4) level - 41 pmol/L, TSH - 0.05 mIU/mL.What is the MOST appropriate treatment strategy? Thyreostatics Thyroidectomy Glucocorticoids Radioactive iodine β-adrenoblockers QUESTION10 A 42-year-old man presented with complaints of palpitations and a weight loss of 9 kg over 3 months. On examination, skin was moist and hot. Thyroid gland enlarged (grade II goiter). Heart sounds loud, pulse-125 per minute, BP-140/60 mmHg. Free thyroxine level (FT4) - 45 pmol/L, TSH 0.001 mU/L. The doctor prescribed long-term treatment with 40 mg of thyrozole daily with subsequent reduction to maintenance dose for at least 1.5 years.To monitor potential side effects of medication, what is the MOST appropriate test? Urinalysis Complete blood count Blood electrolyte levels Determination of thyroid hormones Determination of TSH receptor antibodies QUESTION11 Patient, 42 years old. Considers herself ill since August 2018 when she first noticed an increase in blood pressure up to 190/100 mmHg, accompanied by headaches and muscle weakness. Hypertension had a crisis course; she took antihypertensive medications (does not remember exactly which ones). Hypokalemia was detected several times, which was considered as a result of treatment with diuretics. Blood test: Na-135 mmol/L, K-2.5 mmol/L, aldosterone-renin ratio 170 pg/mL (normal range for women: 14-140 pg/mL). Abdominal CT scan showed adrenal hyperplasia.What group of medications would be MOST appropriate for preoperative preparation? aldosterone antagonists Mineralocorticoids ACE inhibitors steroidogenesis inhibitors loop diuretics QUESTION12 A 32-year-old man visited a doctor complaining of general weakness, worsening with physical physical activity, weight loss, depression, decreased appetite, and nausea. From the medical history: initially, he was concerned about evening fatigue, which he connected with his work. Over the past six months, he has lost 12 kg. Blood pressure is 90/55 mmHg. Skin is clear, areola of the nipples and palmar creases are brown. Complete blood count: HB - 111 g/L, erythrocytes- 3.6x10^12/L. Blood glucose level is 3.9 mmol/L. Cortisol level in the blood is decreased.What is the MOST appropriate treatment strategy? Glucocorticoids, mineralocorticoids. Dopamine agonists Somatostatin analogs Thyroid drugs, vitamin therapy Vitamin therapy, iron supplements QUESTION13 A 49-year-old woman complains of episodes of elevated blood pressure accompanied by flushing of the face, a sense of fear, and palpitations, lasting from several minutes to an hour. After the episode, she experiences improvement with weakness, sweating, and increased urination. In the CBC: leukocytes-11.0#10^9/l. Blood glucose level 7.0 mmol/l. The level of metanephrines in the urine is 7 times higher than normal.Which group of medications would be MOST appropriate to prescribe for preoperative preparation? diuretics ACE inhibitors alpha-adrenoblockers calcium channel blockers angiotensin receptor blockers QUESTION14 A 30-year-old woman complains of headaches, weight gain, appearance of red stretch marks on the skin, thirst, and frequent urination. Symptoms appeared within 6 months after a medical abortion. On examination, the patient has a moon-shaped face, obesity with fat accumulation in the abdominal and chest area, and purplish stretch marks on the abdomen and thighs. Blood pressure 170/100 mmHg, pulse rate 85 beats/min. Cardiac borders are enlarged to the left. Results of the high-dose dexamethasone suppression test: before the test, cortisol-1200 nmol/L, after the test-1250 nmol/L.What treatment strategy would be MOST appropriate? Adrenalectomy Radiation therapy Selective dopamine receptor agonists Non-selective dopamine receptor agonists Growth hormone receptor inhibitors QUESTION15 A 66-year-old man complained of swelling in the left foot and numbness. He incidentally discovered an ulcer on the plantar surface of the 1st toe a day ago. He has had diabetes for 10 years and regularly takes 4 mg of Amaryl and 2000 mg of Metformin. On examination: an ulcerative defect measuring 1.0#1.0 cm with scant discharge on the sole of the first toe of the left foot. Fasting glucose level -7.2 mmol/L, ranging from 9.0 to 10.2 mmol/L during the day.What solution would be MOST appropriate for treating the ulcerative defect? Brilliant green Potassium permanganate Hydrogen peroxide Chlorhexidine Alcohol QUESTION16 A 56-year-old woman presented with complaints of reduced vision, headaches, and dizziness. She has had diabetes for 15 years and regularly takes Dapagliflozin 25 mg. Test results show a fasting glucose level 6 mmol/L and from 8 to 10 mmol/L throughout the day. Fundoscopic examination: multiple retinal hemorrhages and tortuosity of blood vessels. Blood pressure is 130/80 mmHg.What is the most appropriate treatment tactic? laser photocoagulation vitrectomy hypotensive angioprotectors neuroprotectants QUESTION17 A 50-year-old man complains of fatigue, excess weight, and moderate skin dryness. On examination: an apple-shaped body`s fat distribution. The skin is dry, the liver is not enlarged. Blood pressure-135/85 mmHg, height- 179 cm, weight-135 kg, waist circumference-113 cm. Fasting blood glucose-8 mmol/L. HbA1c-7%.Which drug is most appropriate to prescribe? Insulin Acarbose Gliclazide Metformin Glibenclamide QUESTION18 The patient, 40 years old, during screening for the first time showed elevated blood glucose of 7.5 mmol/L. On examination (BMI 40 kg/m2).Which drug is most appropriate to prescribe? Glimepiride Gliclazide Liraglutide Glibenclamide Glinides QUESTION19 A 22-year-old man presented with complaints of thirst and excessive urination. These symptoms appeared after he had a respiratory viral infection two weeks ago. Examination: dry, pale skin, and tachycardia. Heart rate is 100 beats/min. The abdomen is soft, with tenderness on palpation. Blood sugar level is 27 mmol/l. Urinalysis shows positive ketones.What is the MOST appropriate treatment strategy? Insulin therapy Metformin Canagliflozin Liraglutide Glimepiride QUESTION20 A 45-year-old woman has a 10-year history of type 1 diabetes mellitus. Over the past two years, she has experienced increases in blood pressure up to 150/90 mmHg. During examination, the test for microalbuminuria was positive twice.Which group of medication would be MOST appropriate to prescribe? β-blockers ACE inhibitors Calcium antagonists Potassium-sparing diuretics Calcium channel blockers QUESTION21 A 28-year-old woman was admitted to the hospital complaining of dry mouth, thirst, and frequent urination. She has been ill for about 2 months and has lost 4 kg of weight. Her blood glucose levels 18-22 mmol/l. Complete blood count: Нв-120 g/l, leukocytes-9.4#10^9/l, ESR- 12 mm/h. Urinalysis: glucose 30 mmol/l, leukocytes 3-6 in the field of view.What is the most appropriate therapy? Metformin Insulin therapy Glitazones DPP4 inhibitors Sulfonylurea drug QUESTION22 A 23-year-old woman was admitted to the surgical department with complaints of severe abdominal pain, a temperature of 38.8°C, nausea, and vomiting. She has had diabetes mellitus for 6 years. She receives long-acting insulin (Lantus) 18 units and rapid-acting insulin (Humalog) 8 units before meals. She fell ill with an acute respiratory viral infection a week ago. Her blood sugar level on admission was 32 mmol/l. In the complete blood count: leukocytes-16#10^9/l, ESR - 18 mm/h. In urine analysis ketones +++. The most appropriate initial infusion therapy to start would be? isotonic sodium chloride solution 5% glucose solution hypotonic sodium chloride solution disol 10% glucose solution QUESTION23 An 18-year-old young man visited the doctor complaining of weight loss, weakness, nausea, poor appetite, thirst, and frequent urination. Examination: the patient is undernutrition, skin is dry, palms and soles with yellowish tint. His heart tones are clear, rhythm is normal, pulse rate is 92beats/min., BP 115/70 mm Hg. The tongue is dry and covered with white plaque, abdomen is soft, and the liver is enlarged, protruding 1 cm below the costal margin. There is smell of acetone in the exhaled air. Glucose level- 15.8 mmol/l, in urineanalysis: glucose 3.5 mmol/l, acetone (++). What is the most appropriate drug to prescribe? insulin acarbose exenatide metformin liraglutide QUESTION24 A 28-year-old man suddenly lost consciousness. According to others, he has a diagnosis of type 1 diabetes mellitus and receives insulin therapy. Objective: skin is moist. Muscle tone is elevated. Pupils are dilated and unresponsive to light. The tongue is moist, pink. BP - 110/70 mm Hg. Pulse - 110 beats/min.What is the most appropriate treatment tactic? Insulin Aspart intravenously Isotonic sodium chloride solution Hypotonic sodium chloride solution 40 ml of 40% glucose intravenously Ringer`s lactate solution intravenously QUESTION25 A 30-year-old male complains of feeling hungry, shaking, and sweating, occurring two hours after exercising. Registered with a diagnosis of type 1 DM and receives insulin therapy. Objectively: conscious, skin is moist. The tongue is moist, pink. BP - 110/70 mm Hg. Pulse - 90 beats/min.What is the most appropriate treatment tactic? Prednisolone intravenously Glucagon intramuscularly Non-carbonated water 40 ml of 40% glucose intravenously Sweet drink 200.0 ml per os QUESTION1 Which hormone deficiency is MOST likely associated with the diabetes insipidus clinic? thyroxine cortisol oxytocin vasopressin aldosterone QUESTION2 Which of the following hormones is MOST likely to suppress the secretion of somatotropic hormone? glucagon estrogens serotonin somatostatin somatomedines QUESTION3 Which pathology is MOST likely to exclude the negative result of a large sample with dexamethasone? Cushing`s disease pheochromocytoma Conn`s syndrome diabetes insipidus corticosteroma QUESTION4 Which factor is most likely to have an effect on prolactin secretion? reduced aldosterone levels elevated cortisol levels rhythm of FSH secretion secretion of LH levels the effect of dopamine QUESTION5 In the pathogenesis of Graves` disease, the formation of antibodies to ? thyrophosphotase thyroglobulin TSH receptors thyroperoxidase ATP-ase QUESTION6 What is the MOST appropriate way to take thyroxine medications? 1 time in the morning on an empty stomach 30 minutes before meals 3 times a day after meals 1 time a day in the evening after meals 1 time a day before going to bed every other day, 1 time before meals at any time QUESTION7 The MOST likely risk factor for developing type 2 diabetes is? frequent exposure to viral infections a history of bad habits lack of weight improper nutrition genetic predisposition QUESTION8 What level of glycosylated hemoglobin is MOST likely to confirm the diagnosis of diabetes mellitus? 6.0% 7.0% 5,0% 6,5% 7,5% QUESTION9 What changes are most likely characterized by primary chronic insufficiency of the adrenal cortex? local depigmentation of the skin diffuse hyperpigmentation of the skin and mucous membranes hypertensive crises constantly high blood pressure weight gain QUESTION10 The main one in the pathogenesis of type 1 diabetes is MOST likely? excessive secretion of glucagon by alpha cells of the pancreas excessive secretion of somatostatin by pancreatic delta cells absolute deficiency of insulin secretion by beta cells of the pancreas insufficient secretion of glucagon by alpha cells of the pancreas absolute deficiency of somatostatin secretion by pancreatic delta cells QUESTION11 Which of the following hormones are MOST likely to be produced in excess in pheochromocytoma? catecholamines cortisol insulin endorphins aldosterone QUESTION12 Which part of the endocrine system is MOST likely to be affected by Conn`s syndrome? the adrenal medulla glomerular zone of the adrenal glands the reticulated area of the adrenal glands the bundle zone of the adrenal glands anterior pituitary gland QUESTION13 At what level of glucose in the venous blood on an empty stomach is the most likely diagnosis of diabetes mellitus? ≥6.0 mmol/l ≥6.1 mmol/l ≥6.5 mmol/l ≥7.0 mmol/l ≥5.6 mmol/l QUESTION14 What is the most characteristic feature of Conn`s syndrome? hypoglycemia hyponatremia hypokalemia hypomagnesemia hypocalcemia QUESTION15 Is glycosylated hemoglobin the MOST likely indicator? fat metabolism hematological disorders protein metabolism blood coagulation system carbohydrate metabolism