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CONTROL QUESTIONS AND TASKS. 1. A female patient was transferred to the resuscitation department after a septic abortion with suspicion of acute renal failure

1. A female patient was transferred to the resuscitation department after a
septic abortion with suspicion of acute renal failure. What are of the most
significance for establishing ARF diagnosis in this case?

A. Findings of bacteriological examination

B. Biochemical indices

C. Clinical picture of sepsis

D. Anamnestic data of abortion

E. Results of gynecologist's examination

2. A victim was removed from under the debris of the destroyed building in 6
hrs. On examination: a crush syndrome of both extremities, uncompensated II
degree ischemia. A complex intensive care is being carried out. What combination
of infusion agents is the most expedient to use at the prehospital stage?

A. Ringer solution, "Lactosol"

B. Gelatinol, albumin

C. Physiologic solution, soda

D. 10% glucose solution

E. Fresh frozen plasma

3. In the patient on the 4-th day following a transfusion of incompatible (by
group) blood, his diuresis sharply decreased, anuria developed, general state
aggravated rapidly and arterial pressure elevated. In laboratory investigations:
plasma creatinine — 680 mmol/1, plasma urea — 24 mmol/1. What disease
and which stage of the disease should one think of, in the first turn?

A. Posttransfusion shock, postrenal acute renal failure, anuria

B. Hemotransfusion acute renal failure, anuria

C. Posthemorrhagic acute renal failure, anuria

D. Anaphylactic shock, acute renal failure, anuria

E. Acute interstitial nephritis, obstructive anuria

4. A patient, aged 35, is for four days in RICD after he had suffered from
blood loss and hemorrhagic shock. A diurnal urine excretion is 50 ml. For t.vo
days he notes vomiting and defines his state inadequately. CVP — 159 mm
water column, isolated moist rales are auscultated in the lungs for the last 3

hours. RR — 32 per min, in blood analysis: residual nitrogen — 82 mmol/1, K — 7.1 mmol/1, CI — 78 mmol/1, Na — 130 mmol/1, Ht — 0.32, Hb — 100 g/1, blood creatinine — 0.9mmol/l. What complication developed in the patient in all probability?

A. Acute cardiac failure

B. Dehydration in connection with hypovolemia

C. Acute renal failure

D. Hypostatic pneumonia

E. Posthypoxic encephalopathy

5. In the patient, aged 48, with a diagnosis of acute renal failure on the
background of crush syndrome and anuria, changes on the ECG developed in
the form of T wave elevation, PQ-interval elongation, deformed QRS complexes
appeared, plasma K⁺ 6.7 mmol/1. First of all, the patient should be prescribed:

A. Stimulation of diuresis, mannito! solution 15 gi/v

B. Nothing to introduce and rapidly prepare the patient for
hemodialysis

C. 7% sorbitol solution per os by 20 ml every hour, lasix 100 mg i/v

D. 100 ml 40% glucose i/v + insulin 10 Up/c, 10% CaCl_f 10 ml i/v,
100 ml 4% NaHCO, i/v,prepare the patient for hemodialysis

E. Polarizing mixture, strophantin 0.05% 0.5 ml

6. In acute renal failure, in blood it does NOT increase the level of:

A. Creatinine

B. Sodium

C. Potassium

D. Urea

7. Prevention of oliguria consists in:

A. Carrying out adequate preoperative hydration

B. Measuring specific gravity of urine

C. I/v administration of mannitol

D. Maintenance of normal water-electrolyte balance in the
postoperative period

8. The cause of renal function disorder in application of norepinephrine is:

A. Lesion of tubules *

B. Toxic effect on the medullary layer of the kidney

C. Spasm of arteries and veins of the medullary layer of the kidney

D. Norepinephrine does not cause a renal function disorder

E. The cause of kidneys' lesion is not clear

9. Initial effect of i/v administration of mannitol is manifested by:

A. Increase of blood viscosity

B. Increase of hematocrit index

C. Increase of intravascular volume

D. Decrease of extracellular volume

10. The following processes lie in the basis of renal function:

A. Ultrafiltration into the cavity of Bowman 's capsule

B. Reabsorption of substances having already filtrated from the lumen
of tubules into blood

C. Secretion of substances from blood into the lumen of tubules

D. Secretion of substances formed in the cell of the tubule into its
lumen and their entry into blood.

11. In transfusion of incompatible blood an occlusion of nephrons' tubules
may occur with:

A. Free hemoglobin

B. Hematin

C. Bilirubin

D. Fibrinogen

12. Urea may increase:

A. Osmotic blood pressure

B. VCB

C. Residual blood nitrogen

D. Hematocrit index

13. Thiamin (vit. B) participates, chiefly, in metabolism of:

A. Carbohydrates

B. Proteins

C. Fats

D. Mineral substances

14. One of the early signs of renal insufficiency is:

A. Presence of leukocytes in the urine

B. Elevation of urea nitrogen in blood

C. Low specific gravity of the urine

D. Presence of erythrocytes in the urine

-

15. Man's kidneys generate for 24 hours:

A. 5 liters of urine

B. 90 liters of ultrafiltrate

C. 250 liters of ultrafiltrate

D. 180 liters of ultrafiltrate

16. A renal blood flow increases due to:

A. Euphilline

B. Theophilline

C. Lasix

D. Caffeine

E. Norepinephrine

17. To osmodiuretics we refer:

A. Lasix

B. Furosemid

C. Euphilline

D. Mannitol

E. Urea

18. On the average, a diurnal urine excretion makes up:

A. 2-3 I

B. 0.5-J I

C. 1.5 I

D. More than 2 I

19. Water load in forced diuresis, on the average, makes up:

A. 1.5 l/day

B. By 2—3 1 more than normal amount of liquid
C About 4 l/day

D. Depends on the severity of initial condition

20. Mechanism of mannitol effect lies in:

A. Improvement ofrheologic properties of blood

B. Improvement of renal blood flow

C. Decrease of reabsorption in tubules

D. Increase of VCB

21. Indications for hemodialysis are:

A. Elevated content of bicarbonate ions

B. Elevated urea content

C. Elevated protein content

D. Elevated creatinine content

E. Nothing of the above-enumerated

22. In intravascular hemolysis are being blocked:

A. Renal tubules

B. Urinary tract

C. Renal arteries

D. Renal glomeruli

E. Renal tubules and glomeruli

23. In transfusion of incompatible blood:

A. Infusion of sodium hydrocarbonate is necessary

B. To carry out stimulation of diuresis with lasix, mannitol

C. To introduce 40% glucose solution to stimulate diuresis

D. To administer adrenalin

24. Hemodialysis:

A. Accompanied by significant losses of protein

B. Causes the increase of VCB

C. Causes a decrease of VCB

D. Increases osmotic pressure of plasma

E. Decreases osmotic pressure of plasma

25. To renal factors in ARF we refer:

A. Occlusion of glomeruli in hemolysis

B. Poisoning with mushrooms

C. Tumors of kidneys

D. Ischemia of the kidney in shock

26. Peritoneal dialysis:

A. Accompanied by significant losses of protein

B. Causes the increase of VCB

C. Causes a decrease of VCB

D. More physiological than hemodialysis

E. Applied only in peritonites

27. In ARF a daily dose of furosemid for the adult makes up:

A. 100 mg

B. WOmg/kg

C. lOOmg/kg

D. Up to I g

28. In oligoanuric stage of ARF occurs:

A. Cellular dehydration

B. Extracellular dehydration

C. Cellular hyperhydration

D. Extracellular hyperhydration

29. In oliguria we observe:

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypernatremia

30. In polyuria we observe:

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypernatremia

31. Hemodialysis is contraindicated:

A. If potassium content is higher than 6 mmol/l

B. If there is uncontrolled bleeding

C. In acute myocardial infarction

D. In expressed acidosis

32. Oliguria is considered as the condition if a diurnal urine excretion is:

A. Lower than 500 ml

B. Lower than 50-100 ml

C. Urine is absent

D. Lower than 1000 ml

33. Anuria is considered as the condition if a diurnal urine excretion is:

A. Lower than 500 ml

B. Lower than 50-100 ml

C. Urine is absent

D. Lower than 1000 ml

34. The following diuretics may be prescribed in oliguria:

A. Furosemid

B. Verospiron

C. Euphilline

D. Mannitol

35. The following factors of renal insufficiency are distinguished:

A. Renal

B. Prerenal

C. Postrenal

D. Alcohol

36. Causes of prerenal oliguria may be:

A. Cardiogenic shock

B. Tumors of the kidneys

C. Acute blood loss

D. Traumatic shock

37. Causes of postrenal ARF may be:

A. Hemorrhagic shock

B. Poisoning with mercury

C. Occlusion of the-ureter

D. Tumors of the kidneys

38. Treatment of postrenal ARF includes:

A. Prescription oflasix

B. Operation

C. Hemodialysis

D. Lithotripsy in occlusion with concrements.

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