3 курс, ОМ, ПМВС, TBL – Почки и беременность, ГТ, англ!

● Name: Neermunda Danish

● Date: Wednesday, May 31, 2023

● Группа/Group: 21-01

Results

Level: сдано
Score : 17 / 20
Percent : 85%
Time Elapsed : 23 min

Section Score Percent

1 Первая тема 17 / 20 85%

Questions

correct: 17
incorrect: 3

1 Первая тема

1. Pregnant 25 years, first pregnancy, 23 weeks. Makes no complaints. BP - 110/70 mm Hg .

during a routine examination in the OAM: protein- abs , L - 0-1 in p / sp , Er - a bs . Tank. urine
culture 2 times: E. coli culture 10 5 md . tel/ml. What are the significant factors that predispose
to the development of urinary tract infection during pregnancy?

- Congenital changes in the urinary tract: hydronephrosis

- Narrowing of the pyelocaliceal segment, expansion of the pelvis
v Physiological changes in the urinary tract: expansion of the pelvis and calyces
- Hypertonicity of smooth muscles: increased tone of the ureters and bladder
- Decreased plasma volume: increased urine concentration and increased bladder volume

Result
Correct answer.
Score: 1 / 1
Elapsed time: 1 min 19 sec

2. woman , 34 weeks pregnant. Was admitted with complaints of severe, aching pain in the
lower back on the left. Development and course of the disease: she was sick during the day,
when complaints appeared, the SMP was taken to the emergency room of the urological
department. Objective examination: the abdomen is soft, enlarged due to the pregnant uterus.
The symptom of effleurage is sharply positive on the left. There are no edema. According to
ultrasound examination of the kidneys: The kidneys are not enlarged, the size on the right is
10.8 * 4.6, on the left 10.9 * 4.6, the parenchyma is not thickened, the contours are even. The
pelvicalyceal system is expanded on the left, the pelvis is 19 mm, the cups are 10 mm, m / c
and in the top 3-6 mm. Bladder with a volume of 340 ml. The mouth, the lower third of the ureter
are not changed. Additional formations - in the upper third of the left ureter, at a distance of 4.0
cm from the pelvis, a hyperechoic structure of 4 mm with echo .
Laboratory: creatinine 200 µmol /l, urea 15 mmol /l. In the analysis of urine: white 0.099 g/l,
leukocytes entirely in p/ sp , erythrocytes 10-15 in p/ sp . Nephrostomy installed . What tactic is
next?

- Litholytics , antispasmodics
- Lithotripsy , antibiotic therapy
v Antibacterial, infusion therapy
- Spasmolytics, antibiotic therapy
 - Non-steroidal anti-inflammatory drugs, antispasmodics

Result
Correct answer.
Score: 1 / 1
Elapsed time: 15 sec

3. Girl 22 years old. Pregnancy I , 23-24 weeks. She went to the clinic due to changes in urine
tests. From the words before pregnancy, up to 4 times a year, there were changes in urine tests
in the form of leukocyturia (10-15 to 18-20 in p / sp ), episodes of increased urination and pain
without fever. The urine culture tank is negative. Ultrasound of the kidneys - PP 11x4.0 cm, TP
2.0 cm, LA 11.5x4.3 cm, TP 2.0 cm, PCS not dilated. Specify a group of antimicrobial drugs for
the treatment of urinary tract infections contraindicated in pregnancy:

- Carbapenems
- Penicillins
v Fluoroquinalones
- Cephalosporin
- Phosphonic acid derivative

Result
Correct answer.
Score: 1 / 1
Elapsed time: 12 sec

4. Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the clinic with a high body
temperature of up to 38.8 g , with complaints of pain in the lumbar region, headache, fatigue.
On examination: no edema, BP 100/70 mm Hg . The examination revealed changes in urine
tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++. In the blood: leukocytes 12
thousand , ESR 40 mm/h. Ultrasound of the kidneys - PP 12.0x4.5 cm, TP 1.5 cm, pelvis 3.5
cm, cups 1.0-1.5 cm. LP 11.0x3.8 cm.
Antibacterial therapy was prescribed, stenting of the right ureter was performed. How long is the
stent in the ureter?
 v 4-6 weeks postpartum
- On the 1st day after birth
- Before delivery
- 3 months after birth
- 6 months after birth

Result
Correct answer.
Score: 1 / 1
Elapsed time: 11 sec

5. To the previous test: Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the
clinic with a high body temperature of up to 38.8 g , with complaints of pain in the lumbar
region, headache, fatigue. On examination: no edema, BP 100/70 mm Hg . The examination
revealed changes in urine tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++.
In the blood: leukocytes 12 thousand , ESR 40 mm/h. Specify the most important predisposing
factor for the development of urinary tract infection during pregnancy:

- The presence of foci of infection

- Hormonal imbalance
- Number of births/pregnancies
v Violation of the urodynamics of the upper urinary tract
- Activation of opportunistic flora during pregnancy

Result
Correct answer.
Score: 1 / 1
Elapsed time: 38 sec

6. A 27-year-old woman, 26-27 weeks pregnant. Was admitted with complaints of pain in the
lumbar region, more on the right, fever. According to the words, she fell ill acutely, for 3 days
she has a fever up to 39 ° C, she is worried about the pain syndrome. The pain began to
gradually increase. During the last 6 hours, vomiting was noted 2 times. There is no significant
medical history other than an uncomplicated episode of cystitis 3 months ago. Objectively: t
39.5°C, heart rate 120 bpm, blood pressure 104/68 mm Hg. The abdomen is soft, sensitive in
the iliac regions, urination b / b. During the examination in the clinic: beats weight 1015, traces
of protein, leukocytes completely, erythrocytes 5-8 in p/ sp , bacteria 2+. Laboratory data:
Hb 12.3g / dL _ 12.0-14.0
Leukocytes 25.2x10 9 / l 4.0-9.0
platelets 144х10 9 / l 180-320
NST 42% 39.0-49.0
ESR 50 m/h 2-10
Creatinine 106 µmol /l 50-70
Urea 14.0 mmol /l 2.8-8.0
total protein 62 g/l 65-80
SRP 310 mg/l < 5
Analysis of urine
Oud weight 1012
Protein 0.33 g/l
Leukocytes All the way to the p / s
red blood cells 10-12 in p / sp
Which condition is at the highest risk of developing?

v Urosepsis
- Urolithiasis disease
- Recurrent cystitis
- Chronic pyelonephritis
- Infectious-toxic shock

Result
Correct answer.
Score: 1 / 1
Elapsed time: 16 sec

7. Pregnant 25 years, first pregnancy, 23 weeks. Makes no complaints. BP - 110/70 mm Hg .

during a routine examination in the OAM: protein- abs , L - 0-1 in p / sp , Er - a bs . Tank. urine
culture 2 times: E. coli culture 10 5 md . tel/ml. What diagnostic criteria do NOT apply to
asymptomatic bacteriuria?

- Lower back pain

v The presence of leukocyturia
- No leukocyturia
- No clinical signs of urinary tract infection
- Isolation of the same strain of bacteria in two consecutive urine samples taken at intervals
of 3-7 days in a titer of 105 or more CFU/ml

Result
Incorrect answer.
Score: 0 / 1
Elapsed time: 2 min 23 sec

8. Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the clinic with a high body
temperature of up to 38.8 g , with complaints of pain in the lumbar region, headache, fatigue.
On examination: no edema, BP 100/70 mm Hg . The examination revealed changes in urine
tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++. In the blood: leukocytes 12
thousand , ESR 40 mm/h. Which of the following is the gold standard for diagnosing urinary
tract infection?

- Zimnitsky's test
- General urine analysis
- Urinalysis according to Nechiporenko
- Urinalysis according to Addis -Kakovsky
v Bacteriological examination ¬(urine culture for sterility)

Result
Correct answer.
Score: 1 / 1
Elapsed time: 1 min 51 sec

9. A pregnant woman, 24 years old, 14-15 weeks , at a scheduled appointment with a therapist,
complains of frequent urination, without any pain, slight pain in the lumbar region. On
examination: pale skin, pastosity of the legs. BP - 90/60 mm Hg . Urination frequent, painless.
Laboratory data:
Hb 10.0 _ g/ dL 1 2.0-1 4.0 _ _
Leukocytes 6.8х10 9 / l 4.0-9.0
platelets 130х10 9 /l 180-320
NST thirty% 39.0-49.0
Analysis of urine
Protein neg
Leukocytes 6-8 in p / sp
What tactics of conducting is the most expedient?

- Antibacterial therapy, CT scan of the spine, ultrasound of the kidneys in control

- Antibacterial therapy, antispasmodics, kidney ultrasound, anemia correction
- Hospitalization in a hospital, antibiotic therapy, ultrasound of the kidneys in control
- Uroseptics , analgesics, urinalysis control, renal ultrasound, anemia correction
v Dynamic observation and control of urinalysis, ultrasound of the kidneys, correction of
anemia

Result
Correct answer.
Score: 1 / 1
Elapsed time: 23 sec

10. Pregnant 25 years, first pregnancy, 23 weeks. Makes no complaints. BP - 110/70 mm Hg .

during a routine examination in the OAM: protein- abs , L - 0-1 in p / sp , Er - a bs . Tank. urine
culture 2 times: E. coli culture 10 5 md . tel/ml. Microbiological diagnosis based on the result of
bacteriological examination of urine is called:

- Acute cystitis
- Acute urethritis
- Acute pyelonephritis
v Asymptomatic bacteriuria
- Urinary tract infection

Result
Correct answer.
Score: 1 / 1
Elapsed time: 41 sec

11. To the previous test: Woman, 27 years old, pregnant at 26-27 weeks. Was admitted with
complaints of pain in the lumbar region, more on the right, fever. According to the words, she
fell ill acutely, for 3 days she has a fever up to 39 ° C, she is worried about the pain syndrome.
The pain began to gradually increase. During the last 6 hours, vomiting was noted 2 times.
There is no significant medical history other than an uncomplicated episode of cystitis 3 months
ago. Objectively: t 39.5°C, heart rate 120 bpm, blood pressure 104/68 mm Hg. The abdomen is
soft, sensitive in the iliac regions, urination b / b. During the examination in the clinic: beats
weight 1015, traces of protein, leukocytes completely, erythrocytes 5-8 in p/ sp , bacteria 2+.
Laboratory data:
Hb 12.3g / dL _ 12.0-14.0
Leukocytes 25.2x10 9 / l 4.0-9.0
platelets 144х10 9 / l 180-320
NST 42% 39.0-49.0
ESR 50 m/h 2-10
Creatinine 106 µmol /l 50-70
Urea 14.0 mmol /l 2.8-8.0
total protein 62 g/l 65-80
SRP 310 mg/l < 5
Analysis of urine
Oud weight 1012
Protein 0.33 g/l
Leukocytes All the way to the p / s
red blood cells 10-12 in p / sp
What is the most appropriate treatment strategy?

- Uroseptics, NSAIDs
- Phytotherapy, antispasmodics
- Antimicrobials, analgesics
v Antibacterial, infusion therapy
- Antibacterial therapy, antispasmodics

Result
Correct answer.
Score: 1 / 1
Elapsed time: 42 sec

12. To the previous test: Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the
clinic with a high body temperature of up to 38.8 g , with complaints of pain in the lumbar
region, headache, fatigue. On examination: no edema, BP 100/70 mm Hg . The examination
revealed changes in urine tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++.
In the blood: leukocytes 12 thousand , ESR 40 mm/h. A "step-by-step" antibiotic treatment
regimen is planned. What antibiotic therapy is called "stepping"?

- "Step" change of antibiotic therapy with an interval of 48 hours

- "Step" change of antibiotic therapy with an interval of 72 hours
- Increasing the dose of an antibacterial drug in order to achieve a clinical effect
v Parenteral administration of the drug with subsequent transfer, when the condition
improves, to oral administration of the same drugs
- The use of a combined regimen of antibacterial drugs with the ineffectiveness of
monotherapy in the first 72 hours

Result
Correct answer.
Score: 1 / 1
Elapsed time: 39 sec

13. Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the clinic with a high body
temperature of up to 38.8 g , with complaints of pain in the lumbar region, headache, fatigue.
On examination: no edema, BP 100/70 mm Hg . The examination revealed changes in urine
tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++. In the blood: leukocytes 12
thousand , ESR 40 mm/h. What diagnosis and treatment are indicated in this case?

- SARS, oseltamivir p / os
v Urolithiasis, ketonal i/m
- Tuberculous meningitis, isoniazid p / os
- Asymptomatic bacteriuria, fosfomycin p / os
- Complicated infection of the urinary system, amoxiclav IV

Result
Incorrect answer.
Score: 0 / 1
Elapsed time: 2 min 39 sec

14. A pregnant woman, 24 years old, 14-15 weeks , at a scheduled appointment with a
therapist, complains of frequent urination, without any pain, slight pain in the lumbar region. On
examination: pale skin, pastosity of the legs. BP - 90/60 mm Hg . Urination frequent, painless.
Laboratory data:
Hb 10.0 _ g/ dL 1 2.0-1 4.0 _ _
Leukocytes 6.8х10 9 / l 4.0-9.0
platelets 130х10 9 /l 180-320
NST thirty% 39.0-49.0
Analysis of urine
Protein neg
Leukocytes 6-8 in p / sp
What additional research needs to be done?

- HIV blood test

- Blood test for hepatitis
- Urinalysis according to Nechiporenko
v Bacteriological culture of urine
- Blood test for sexually transmitted infections

Result
Correct answer.
Score: 1 / 1
Elapsed time: 29 sec

15. Pregnant 20 years, first pregnancy, 28 weeks. Makes no complaints. BP - 90/60 mm Hg .

During a planned examination: OAM: protein- abs , L - 0-1 in p / sp , Er - a bs , bacteriuria 3+.
Bacteriological culture of urine in work. Assuming asymptomatic bacteriuria, how many colony
forming units per ml of urine would confirm the diagnosis?

- 10 1 cfu/ml
- 10 2 cfu/ml
- 10 3 cfu/ml
- 10 4 cfu/ml
v 10 5 cfu/ml

Result
Correct answer.
Score: 1 / 1
Elapsed time: 10 sec

16. Girl 22 years old. Pregnancy I , 23-24 weeks. She went to the clinic due to changes in urine
tests. From the words before pregnancy, up to 4 times a year, there were changes in urine tests
in the form of leukocyturia (10-15 to 18-20 in p / sp ), episodes of increased urination and pain
without fever. The urine culture tank is negative. Ultrasound of the kidneys - PP 11x4.0 cm, TP
2.0 cm, LA 11.5x4.3 cm, TP 2.0 cm, PCS not dilated. Assuming a likely diagnosis, what
pathogenic mechanism is most likely?

v Persistence of microorganisms on the urothelium (formation of intracellular bacterial

communities)
- Hyperactivity of the humoral link of immunity increase in serum and secretory
immunoglobulins and circulating immune complexes
- pro-inflammatory mediators of endogenous origin from the primary focus with
generalization of the inflammatory response
- Damage to endothelial cells with deposition of platelets and fibrin, followed by
fragmentation of circulating erythrocytes and occlusion of microvessels
- Aseptic damage to the endothelium of microvessels by circulating immune complexes,
manifested by widespread microthrombosis , hemorrhages and microcirculation disorders

Result
Correct answer.
Score: 1 / 1
Elapsed time: 8 min 16 sec

17. To the previous test: Girl 18 years old. Pregnancy I , 36 weeks. She was admitted to the
clinic with a high body temperature of up to 38.8 g , with complaints of pain in the lumbar
region, headache, fatigue. On examination: no edema, BP 100/70 mm Hg . The examination
revealed changes in urine tests: cloudy, protein 0.066%, leukocytes - entirely, bacteriuria +++.
In the blood: leukocytes 12 thousand , ESR 40 mm/h. Ultrasound of the kidneys - PP 12.0x4.5
cm, TP 1.5 cm, pelvis 3.5 cm, cups 1.0-1.5 cm. LP 11.0x3.8 cm.
Antibacterial therapy was prescribed. What is the goal of therapy for urinary tract infection in
this case?

- Clinical and laboratory recovery

- Clinical recovery and normalization of urine tests
- Clinical recovery and normalization of the level of blood leukocytes, ESR and CRP
v Clinical-laboratory and microbiological recovery with the achievement of abacteriuria
- Clinical, laboratory and microbiological recovery without achieving abacteriuria

Result
Correct answer.
Score: 1 / 1
Elapsed time: 24 sec

18. Pregnant 20 years, first pregnancy, 28 weeks. Makes no complaints. BP - 90/60 mm Hg .

During a planned examination: OAM: protein- abs , L - 0-1 in p / sp , Er - a bs , bacteriuria 3+.
Bacteriological culture of urine in work. In the structure of pathogens of urinary tract infections,
the main role belongs to:

- Proteus spp.
v Enterobacteriacea
- Klebsilla pneumoniae
- Staphylococcus aureus
- Streptococcus agalactiae

Result
Correct answer.
Score: 1 / 1
Elapsed time: 16 sec

19. To the previous test: Woman, 27 years old, pregnant at 26-27 weeks. Was admitted with
complaints of pain in the lumbar region, more on the right, fever. According to the words, she
fell ill acutely, for 3 days she has a fever up to 39 ° C, she is worried about the pain syndrome.
The pain began to gradually increase. During the last 6 hours, vomiting was noted 2 times.
There is no significant medical history other than an uncomplicated episode of cystitis 3 months
ago. Objectively: t 39.5°C, heart rate 120 bpm, blood pressure 104/68 mm Hg. The abdomen is
soft, sensitive in the iliac regions, urination b / b. During the examination in the clinic: beats
weight 1015, traces of protein, leukocytes completely, erythrocytes 5-8 in p/ sp , bacteria 2+.
Laboratory data:
Hb 12.3g / dL _ 12.0-14.0
Leukocytes 25.2x10 9 / l 4.0-9.0
platelets 144х10 9 / l 180-320
NST 42% 39.0-49.0
ESR 50 m/h 2-10
Creatinine 106 µmol /l 50-70
Urea 14.0 mmol /l 2.8-8.0
total protein 62 g/l 65-80
SRP 310 mg/l < 5
Analysis of urine
Oud weight 1012
Protein 0.33 g/l
Leukocytes All the way to the p / s
red blood cells 10-12 in p / sp
What additional tests should be prescribed to clarify the diagnosis?

- Lipid spectrum, liver tests

 - Protein fractions of blood, urinalysis according to Nechiporenko
v Procalcitonin , bacteriological cultures of blood and urine
- Bacteriological culture of urine, analysis of urine for daily protein
- Blood test with the determination of the adhesive-aggregative ability of platelets

Result
Correct answer.
Score: 1 / 1
Elapsed time: 24 sec

20. To the previous test: Woman, 27 years old, pregnant at 26-27 weeks. Was admitted with
complaints of pain in the lumbar region, more on the right, fever. According to the words , she
fell ill acutely, for 3 days she has a fever up to 39 ° C, she is worried about the pain syndrome.
The pain began to gradually increase. During the last 6 hours, vomiting was noted 2 times.
There is no significant medical history other than an uncomplicated episode of cystitis 3 months
ago. Objectively: t 39.5°C, heart rate 120 bpm, blood pressure 104/68 mm Hg. The abdomen is
soft, sensitive in the iliac regions, urination b / b. During the examination in the clinic: beats
weight 1015, traces of protein, leukocytes completely, erythrocytes 5-8 in p/ sp , bacteria 2+.
Laboratory data:
Hb 12.3g / dL _ 12.0-14.0
Leukocytes 25.2x10 9 / l 4.0-9.0
platelets 144х10 9 / l 180-320
NST 42% 39.0-49.0
ESR 50 m/h 2-10
Creatinine 106 µmol /l 50-70
Urea 14.0 mmol /l 2.8-8.0
total protein 62 g/l 65-80
SRP 310 mg/l < 5
Analysis of urine
Oud weight 1012
Protein 0.33 g/l
Leukocytes All the way to the p / s
red blood cells 10-12 in p / sp
Bacteriological urine culture revealed E. coli 10 5 . An additional virulence factor for Escherichia
coli, which ensures its penetration and presence in the urinary tract, is:

- Hemolysin
- Cilia
- Villi
- Endotoxin
v exotoxin

Result
Incorrect answer.
Score: 0 / 1
Elapsed time: 1 min 13 sec
© 2023 StartExam Platform