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Gastro-intestinal tract diseas 3 pageDrop of oncotic blood pressure # A 16 year-old patient got numerous traumas in automobile accident. Now the patient is haning a shock. ÀP - 80/60 mm Hg. daily urine volume 60-80 ml. What pathogenic mechanism leads to kidneys function violation? Increased vasopressin blood concentration Increased osmotic pressure in glomerular capillaries Increased pressure in Bowman’s capsule Trauma of the urinary bladder @Decreased hydrostatic pressure in glomerular capillaries # As a result of long-term starvation the glomerular filtration of a man was accelerated by 20%. The most probable cause of filtration changes under such conditions is: Rise of systemic arterial pressure Growth of filtration coefficient Increase of renal plasma flow Increased permeability of renal filter @Fall of oncotic pressure of blood plasma # 4 A 24-years-old patient has edema of face and increasing of BP, which appeared in 1.5 weeks after severe streptococcus tonsillitis. The patient has hematuria and proteinuria of 1.2 g/L. Anti-streptococcus antibodies and decrease in content of components of compliment system were revealed in patient’s blood. Which microvessels are deposits of immune complexes localized in that case of nephropathy? @Glomerule Proximal tubules Descendent tubules Loop of Henle Pyramids # A girl of 5-years-old has admitted to nephrologic department of a municipal hospital. She complains of pain in low back, urine contains constantly raised amount of red blood cells (erythrocytes), proteins (albumins and globulins). Which from the following renal structures is destroyed? @Glomerulus of nephron Proximal convoluted tubule of nephron Distal convoluted tubule of nephron Mesangium of glomerulus Collecting tubule of nephron # A 30 year old woman has face edemat A. Examination revealed proteinuria (5,87 g/l), hypoproteinemia, dysproteinemia, hyperlipidemi A. What condition is the set of these symptoms typical for? Chronic renal failure Acute renal failure @Nephrotic syndrome Chronic pyelonephritis Nephritic syndrome # Which of the following is the most likely cause of the clinical combination of generalized edema, hypoalbuminemia, and hypercholesterolemia in an adult whose urinalysis demonstrated marked proteinuria, with fatty casts and oval fat bodies? Nephritic syndrome @Nephrotic syndrome Acute renal failure Renal tubular defect Urinary tract infection # A physical examination of a young woman revealed marked edemas and high proteinuria. A histological investigation of kidneys biopsy determined a disappearance of podocytes, a declining of heparansulfate in a basal membrane of glomerular capillaries. What is the most likely disease? @Idiopathic nephrotic syndrome Postinfectious glomerulonephritis Rapidly progressive glomerulonephritis Chronic glomerulonephritis Acute necrotic nephrosis # A 5-year-old girl with a history of an acute respiratory virus infection presented with widespread swelling, a massive proteinuria, a hypoalbuminemia, a lipidemia. A microscopic investigation of the renal biopsy revealed an absence of small podocytes processes within vascular glomerulus. What is the most probable diagnosis? @Lipoid nephrosis Postinfectious glomerulonephritis Rapidly progressive glomerulonephritis Focal segmentalglomerulosclerosis Membranous glomerulonephritis # A 28-year-old man with AIDS presents with moderate proteinuria and hypertension. Histologic sections of the kidney reveal the combination of normal-appearing glomeruli and occasional glomeruli that have deposits of hyaline material. No increased cellularity or necrosis is noted in the abnormal, glomeruli. Additionally, there is cystic dilation of the renal tubules, some of which are filled with proteinaceous material. Electron microscopy reveals focal fusion of podocytes, and immunofluorescence examination finds granular IgM/C3 deposits. Which of the following is the most likely diagnosis? Diffuse proliferative glomerulonephritis (DPGN) Focal segmental glomerulonephritis (FSGN) @Focal segmental glomerulosclerosis (FSGS) Membranous glomerulopathy (MGN) Minimal change disease (MCD) # A 2-year-old boy is being evaluated for peripheral edema that developed shortly after he recovered from an upper respiratory infection. Physical examination finds that he is afebrile, and his blood pressure is within normal limits. Laboratory examination finds decreased serum albumin, increased serum cholesterol, and normal BUN and creatinine levels. Examination of his urine finds massive proteinuria and lipiduria, but no red blood cells are seen. The loss of albumin in the urine is much greater than the loss of globulins. A histologic section from a renal biopsy examined with a routine H&E stain is unremarkable. Which of the following pathologic changes is most likely to be seen with electron microscopic examination of a renal biopsy from this child? Diffuse thinning with fragmentation of the basement membrane @Fusion of the foot processes of the podocytes Large irregular subendothelial electron-dense deposits Ribbon-like electron-dense deposits in the basement membrane Small uniform subepithelial electron-dense deposits # 12 In a 25 year-old female patient with severe edemas, hyperproteinuria, hyperlipidemia the biopsy of kidney established: well-developed thickening of the glomerular capillary wall with the presence of electron-dense immunoglobulin-containing deposits along the epithelial surface of the basement membrane. Epithelial cells lost their foot processes. Described changes are characteristic for… @Membranous glomerulonephritis Acute Poststreptococcal glomerulonephritis Crescentic glomerulonephritis Chronic glomerulonephritis Acute pyelonephritis # Marked thickening of the glomerular basement membrane, as shown in the photomicrograph below, may be seen in lipoid nephrosis @membranous glomerulonephritis Goodpasture's syndrome acute pyelonephritis chronic glomerulonephritis # All the following renal disorders are assocated with the nephrotic syndrome EXCEPT membranous glomerulonephritis lipoid nephrosis membranoproliferative glomerulonephritis @acute tubular necrosis focal segmental glomerulosclerosis # A 58-year-old patient with a history of purulent osteomyelitis died of chronic renal insufficiency. A post-mortem revealed the enlarged firm kidneys of white-yellow color with a sebaceous (waxy) cut surface. What is the most likely diagnosis? @Amyloidosis of kidneys Chronic glomerulonephritis Subacute glomerulonephritis Septic nephrite Acute necrotic nephrosis # A post-mortem of a patient with a history of chronic renal insufficiency revealed the enlarged,firm, sebaceous (waxy) kidneys with multiple retractions on their surface. Histological investigation showed many glomeruli were replaced by the Congo-Red positive masses. The same substance was found on the basal membranes of capillaries, in mesangium and also within arterial walls and kidneys stroma. What of the listed diagnoses the most likely? @Amyloidosis of kidneys Acute glomerulonephritis Chronic glomerulonephritis Subacute glomerulonephritis Lipoid nephrosis # The young man with a history of bronchiectasis disease since the early childhood died of renal insufficiency. A post-mortem revealed in lungs plural dilated bronchi and bronchial tubes, filled with a purulent exudate. Besides, the enlarged kidneys had a dense texture, their cortical layer was thickened, white color and dense. Kidney pyramids were anemic and accurate. Name process which has developed in kidneys? @Secondary amyloidosis Glomerulonephritis Chronic pyelonephritis Congenital kidney cysts Secondary nephrosclerosis # A 35-year-old woman recovering from hepatitis B develops hematuria, proteinuria, and red cell casts in the urine. Which one of the following statements best describes the expected renal changes in this patient? Plasma cell interstitial nephritis IgG linear fluorescence along the glomerular basement membrane @Granular deposits of antibodies in the glomerular basement membrane Diffuse thickening of the glomerular basement membrane by subepithelialimmune deposits Nodular hyaline glomerulosclerosis # An adult medical laboratory technician recovering from hepatitis B develops hematuria, proteinuria, and red cell casts in the urine. Which of the following would best describe the changes within the kidney in this patient? Plasma cell interstitial nephritis IgG linear fluoresence along the glomerular basement membrane @Granular deposits of antibodies in the glomerular basement membrane Diffuse thickening of the glomerular basement membrane by subepithelial immune deposits nodular hyaline glomerulosclerosis # A 54-year-old patient with a history of a diabetes mellitus died of chronic renal insufficiency. A post-mortem revealed all uremia symptoms and kidneys alterations. What are most probable microscopical renal changes in that case? @Hyalinosis and sclerosis of capillaries of glomerulus. Spasm of afferent glomerular arteriole. Hyaline cast in the lumen of renal tubules. Necrosis of renal tubular epithelium. Necrosis of renal cortex. # An 8-year-old girl, with a history of acute tonsillitis 3 weeks before the application, presented with nephrotic syndrome (proteinuria, haematuria and cylindruria). These testify the glomerular basal membrane's lesion. What is the mechanism of the basal membrane pathology? @Immune complex mechanism Granulomatous mechanism Antibody-mediated mechanism Reagin-mediated mechanism Cytotoxical mechanism # A 12-year-old boy with a history of acute tonsillitis two weeks ago presented with edematous face in the mornings, increasing of arterial pressure, urine in a kind of “meat slops” (“coca-cola” color). Immunohistochemistry of kidneys biopsy revealed immune complexs on basal membranes of capillaries and within glomerular mesangium. What disease has developed at the patient? @Acute glomerulonephritis Acute interstitial nephrite Lipoid nephrosis Acute pyelonephritis Necrotic nephrosis # 23 A 12-year-old child has developed nephritic syndrome (proteinuria, hematuria, cylindruria) after angina of 2 weeks ago. In a biopsy of kidney it was established: diffuse proliferation of endothelial and mesangial, epithelial cells in glomeruli, infiltration with leukocytes, both neutrophils and monocytes, interstitial edema. Described changes are characteristic for… @Acute poststreptococcal glomerulonephritis Membranous glomerulonephritis Chronic glomerulonephritis Acute necrotic nephrosis Crescentic glomerulonephritis # The photomicrograph below shows evidence of glomerular fibrin deposition. This histopathology is a supplemental finding in a 2-year-old child who was a history of abdominal pain and bloody diarrhea, followed by acute glomerulonephritis, Coombs'-negative severe hemolytic anemia, and renal failure. The likely diagnoses might include lupus erythematosus acute poststreptococcal glomerulonephritis lipoid nephrosis @hemolytic-uremic syndrome bacterial endocrditis # Acute poststreptococcal glomerulonephritis usually does all the following EXCEPT follow infection with group A beta-hemolytic streptococci @follow a streptococcal infection in less than 5 days have a better prognosis in children than in adults show low serum complement levels (hypocomplementemia) exhibit elevation of antistreptolysin O (ASO) titer # A 7-year-old boy presents with bilateral swelling around his eyes. His parents state that the child's eyes have become "puffy" over the past several weeks, and his urine has become cocoa-colored. Physical examination reveals bilateral periorbital edema, but peripheral edema is not found. The boy is afebrile and his blood pressure is slightly elevated. A urinary dipstick reveals mild proteinuria, while microscopic examination of the boy's urine reveals hematuria with red blood cell casts. Laboratory tests reveal increased ASO liters and decreased serum C3 levels, but C2 and C4 levels are normal. A throat swab for streptococci is negativA microscopic section from the kidney reveals increased numbers of cells within the glomeruli. An electron microscopic section of the kidney reveals large electron-dense deposits in the glomeruli that are located between the basement membrane and the podocytes. The foot processes of the podocytes are otherwise unremarkable. Which of the following is the most likely diagnosis? @Acute poststreptococcal glomerulonephritis Focal segmental glomerulonephritis Focal segmental glomerulosclerosis Membranous glomerulonephritis Minimal change disease # A 43-year-old man with a history of microscopic polyarteritis acutely develops renal failure with oliguria and hematuria. Laboratory examination reveals the presence of serum p-ANCA (antineutrophil cytoplasmic antibodies). A renal biopsy is diagnostic of type III rapidly progressive glomerulonephritis. Which of the following histologic changes is most likely to have been present in this biopsy specimen? Eosinophilic masses were seen attached to the capsule of Bowman's space Fibrinoid necrosis was present in many of the afferent arterioles Large numbers of neutrophils were seen in the intersritium and tubules @Numerous crescents were present in the glomeruli The basement membrane was seen to be split by mesangialcells # A patient died from uremia. A post- mortem revealed enlarged flaccid kidneys with wide, swallowed with red specks cortex. Medulla had a dark red coloring. Microscopic investigation showed epithelial crescents which compressed capillaries. Nephrocytes exhibited a dystrophy; a stromal edema and infiltration were also recognized. What is the most likely diagnosis? @Glomerulonephritis Pyelonephritis Nephrolithiasis Nephrotic syndrome Amyloidosis of kidneys # A patient died with uremia. The autopsy demonstrated kidneys to be enlarged, of flabby consistence, cortex was broad, edematous, with red spots; medulla was dark red in colour. Microscopic examination in the glomeruli capsule cavity revealed "semilunar formations", squeezing capillaries, nephrocytes dystrophy, edema and infiltration of stroma. What disease caused the death of the patient? Renal amyloidosis Pyelonephrosis Nephrolithiasis Nephrotic syndrome @Glomerulonephritis # An autopsy of the 58-year-old patient revealed an enlarged kidneys, which had a well defined yellow-grey with red specs cortical layer. Kidney's medulla colored in a dark red. Histological investigation revealed proliferation of capsular epithelial cells and podocytes with crescents formation, sclerosis and hyalinosis of the glomerular tufts, stromal fibrosis. What is the most likely kidneys disease? @Extracapillary productive glomerulonephritis Intracapillary productive glomerulonephritis Extracapillary exudative glomerulonephritis Intracapillary exudative glomerulonephritis Interstitial nephrite # At the section were revealed the following changes in kidneys: kidneys were enlarged in size; the cortex was wide, yellow-gray with red drops. It was separated from medulla in a good way. The medulla was of cherry color. Histological exam revealed the overgrowth of nephrothelium and podocytes in the capsule of glomeruli with the formation of crescents, the facts of sclerosis and hyalinosis of glomeruli, the fibrosis of the stroma. What disease is meant? Interstitial nephritis Intercapillary productive glomerulonephritis Extracapillary exudative glomerulonephritis Intercapillary exudative glomerulonephritis @Extracapillary productive glomerulonephritis # Histological investigation revealed proliferation of Bowman’s capsul epithelial cells, podocytes and macrophages, resulted in crescents formation, which compressed dlomeruli. Necrotic capillary loops had fibrinous thrombi within their lumens. A sclerosis and hyalinosis of some glomeruli were detected. In addition, the expressed nephrocytes dystrophy, an edema and stromal infiltration of kidneys was observed. What is the most likely kidneys pathology? @Rapidly progressive glomerulonephritis Postinfection glomerulonephritis Chronic glomerulonephritis Chronic pyelonephritis Amyloidosis of kidneys # The young man presented in hospital with a headache and giddiness. Within last year he ofthen had high arterial pressure. Medical drugs almost did not help. Kidneys biopsy investigation revealed the extra capillary epithelial proliferation with a crescent formation. For what disease described pathology is characteristic? @Rapidly progressive glomerulonephritis Acute glomerulonephritis Lupus glomerulonephritis Wegener's granulomatosis Chronic glomerulonephritis # At the microscopical exam of the kidneys was noted the proliferation of the nephrothelium in Bowman’s capsule, of the podocytes and macrophages with the formation of crescent structures that compress the glomerulus. Capillaries of glomeruli are affected with necrosis; fibrinous thrombi can be seen in the lumens of capillaries. Some of glomeruli are affected with sclerosis or hyalinosis. The dystrophy of nephrocytes, oedema and infiltration of the nephral stroma are observed, too. Name the pathology of kidneys. @High-progressive glomerulonephritis Postinjectional glomerulonephritis Chronic glomerulonephritis Chronic pyelonephritis Renal amyloidosis # A 28 year old patient had high arterial pressure, hematuria and facial edemat A. In spite of treatment renal insufficiency was progressing. 6 months later the patient died from uremia. Microscopic examination of his kidneys and their glomerules revealed proliferation of capsule nephrothelium and of podocytes with "demilune" formation, sclerosis and hyalinosis of glomerules. What disease corresponds with the described picture? @Subacute glomerulonephritis Acute pyelonephritis Chronic glomerulonephritis Nephrotic syndrome Acute glomerulonephritis # Microscopical renal examination of a 36 y.o. woman who died from renal insufficiency revealed in the glomerules proliferation of capsule nephrothelium as well as of podocytes and phagocytes accompanied by formation of "crescents", capillary loop necrosis, fibrinous thrombs in their lumens; sclerosis and hyalinosis of glomerules, atrophy of tubules and fibrosis of renal strom a. What is the most probable diagnosis? Membranous nephropathy Acute glomerulonephritis Focal segmentary sclerosis Chronic glomerulonephritis @Subacute glomerulonephritis # A 36-year-old woman died of renal insufficiency. Microscopical exam revealed the proliferation of the nephrothelium in the capsule, of the podocytes and macrophages with the formation of crescents. There was also necrosis of capillary stitches with fibrinous thrombi in their lumens, sclerosis and hyalinosis of glomeruli, atrophy of the tubules and fibrosis of the nephral stroma. What is the most possible diagnosis? Membranous nephropathy Acute glomerulonephritis Chronic glomerulonephritis Focal segmental sclerosis @Subacute glomerulonephritis # A 42-year-old man died of renal insufficiency. Microscopic investigation revealed a proliferation of Bowman's capsule epithelial cells, podocytes and macrophages, resulted in crescents formation, necrosis of capillary loops and fibrin thrombi within their lumens. In addition, the histological study showed sclerosis and hyalinosis of glomeruli, tubular atrophy and stromal fibrosis of kidneys. What of the listed diagnoses the most likely? @Subacute glomerulonephritis Acute glomerulonephritis Chronic glomerulonephritis Focal segmental sclerosis Membranous nephropathy # A 48-year-old woman died of renal insufficiency. A post- mortem revealed enlarged flaccid kidneys with wide, swallowed, dim cortical layer. A yellow-grey with red specks cortex was delimited from dark red cerebral substance. Microscopic investigation showed a proliferation of Bowman's capsule epithelial cells, podocytes and macrophages, resulted in crescents formation. For what disease described changes are characteristic? @Subacute glomerulonephritis. Acute glomerulonephritis. Chronic glomerulonephritis. Acute pyelonephritis. Amyloidosis of kidneys. # A man died of renal insufficiency. A post- mortem revealed enlarged flaccid kidneys with wide, yellow-grey with red specks cortex. Microscopic investigation showed a proliferation of Bowman's capsule epithelial cells, resulted in crescents formation. Capillary loops exhibited necrotic alterations and fibrin thrombi within their lumens. What is the most likely diagnosis? @Subacute glomerulonephritis Acute glomerulonephritis Lipoid nephrosis Chronic glomerulonephritis Amyloidosis of kidneys # Nephrobiopsy is performed to 30-year-old women. Histological investigation revealed a proliferation of mesangial cells, a swelling and proliferation of capillary endothelial cells, enlargement mesangial matrix, is diffusive a thickening of the glomerular basal membrane, mild tubular-interstitial component. Electron-microscopic research showed interposition of mesangium, a diffusive and irregular thickening of a glomerular basal membrane. What form of a glomerulonephritis has developed in that case? @Mesangiocapillary glomerulonephritis. Mesangial proliferative glomerulonephritis Membranous glomerulonephritis. Rapidly progressive glomerulonephritis. Postinfectious The elderly man, with 15 years history of a membranous -proliferative glomerulonephritis, constantly received hemodialysis therapy. The last half a year he did not receive a treatment. He presented to the hospital with extremely severe condition, without consciousness, with a smell of urea from his body and edemas. A marked pleuritis, pericarditis and peritonitis were also diagnosed. In a whole, all symptoms were regarded as a uremia. What kind of an inflammation is the most probable? @Fibrinous inflammation Purulent inflammation Catarrhal inflammation Hemorrhagic inflammation Serous inflammation # A 47-year-old man presents with increasing peripheral edema and dark, tea-colored urinLaboratory examination finds decreased serum albumin, while examination of a 24-h urine specimen reveals marked proteinuria. Microscopic examination of this patient's urine reveals numerous red cells along with rare red cell casts. Electron microscopic examination of a renal biopsy from this patient reveals dense, ribbon-like deposits in the lamina densa of the glomerular basement membrane. Which of the following is the most likely diagnosis? Acute glomerulonephritis IgA nephropathy Lipoid nephrosis @Membranoproliferative glomerulonephritis Membranous glomerulopathy # A linear pattern of immunoglobulin deposition along the glomerular basement membrane that can be demonstrated by immunofluorescence is typical of lupus nephritis diabetic glomerulopathy @Goodpasture's syndrome Goldblatt's fidney renal vein trombosis # A 28-year-old man with a history of malaise and hemoptysis presents with the acute onset of renal failure. Laboratory examination reveals increased serum creatinine and BUN, but no antineutrophil cytoplasmic antibodies (ANCA) nor antinuclear (ANA) antibodies are present. Urinalysis reveals the micrpscopic presence of red blood cells and red blood cell casts, while a renal biopsy reveals crescents within Bowman's space of many glomeruli. Immunofluorescence reveals linear deposits of IgG and C3 along the glomerular basement membrane. Which of the following is the most likely diagnosis? Alpon syndrome Diabetic glomerulopathy @Goodpasture's syndrome Henoch-Schonlein purpura Wegener's granulomaiosis # A 26-year-old woman presents with increasing fatigue and malaisShe states that recently she develops a red facial rash whenever she goes outside on a sunny day. Physical examination finds that she is afebrile, but her blood pressure is slightly increased and slight peripheral edema is founLaboratory evaluation finds slightly elevated BUN and creatinine, while dipstick examination of her urine reveals slight proteinuria with microscopic hemaiuria. Very rare granular and red cell casts are seen. Laboratory examination is also positive for serum antinuclear antibodies, one of which is anti-double-stranded DNA renal biopsy reveals changes ol diffuse proliferative glomerulonephritis, and the diagnosis of class IV lupus nephritis is made. Which of the following histologic changes is most characteristic of class IV lupus nephritis? Mesangial deposits form a "holly leaf" pattern Positive immunofluorescence staining forms a "string of popcorn" pattern Splitting of the basement membrane forms a "tram-track" pattern Thickening of the basement membrane forms a "spike and dome" appearance @Thickening of the glomerular capillaries forms a "wire-loop" appearance # Chronic glomerulonephritis was diagnosed in a 34-year-old patient 3 years ago. Edema has developed in the last 6 monthes. What caused it? Hyperaldosteronism Hyperproduction of vasopressin Hyperosmolarity of plasma Disorder of albuminous kidneys function @Proteinuria # Tubulopathy # All the following renal disease cause hypertension EXCEPT @small, bilateral renal infarction renal artery arteriosclerosis fibromuscular dysplasia of the renal artery hydronephrosis pyelonephritis # Physical examination of a 3-day-old male infant reveals urine leaking from the area of the umbilicus. Which of the following is the most likely diagnosis? Balanoposthitis Meckel's cyst Meckel's diveniculum Omphalocele @Urachal fistula # A sexually active man who has had a negative evaluation for gonococcal infection and who complains of persistent dysuria but no other symptoms should be considered to have prostatic hypertrophy epididumitic orchitis @nonspecific uretritis renal stones # A 35-year-old woman during her first pregnancy develops oligohy-dramnios. At 34 weeks of gestation she delivers a stillborn infant with abnormal facial features consisting of wide-set eyes, low-set floppy ears, and a broad-flat nose. Which of the following abnormalities is most likely to be present in this still-born infant? Absence of the thymus @Bilateral renal agenesis Congenital biliary atresia Cystic renal dysplasia Urinary bladder exstrophy # During the complicated labour the symphysis pubis ruptured. What organ can be damaged the most? Rectum @Urinary blader Uterus Uterine tubes Ovaria # Acute tubular necrosis (ATN) is a fairly common renal lesion and is associated with all the following EXCEPT @red cell casts in the urine proteinuria proximal tubular damage in toxic ATN oliguria acute renal failure # Shock and signs of acute renal failure (ARF) developed in the patient due to severe injury. What is the leading cause of development of ARF in the case? Date: 2016-03-03; view: 1488
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