Clinical testes for theme N 25.

“Glomerulonephritis and nephrotis syndrome”

289. Patients of 18 years old, is followed up concerning changes in the general

analysis of urine. Complaints are not present. Similar changes were found one year
ago. Objectively: insignificant pallor of a skin, the face bloated. Pulse 80 – beats
per minute. A BP 130-80 mm Hg. Pasternatsky’s symptom is negative. The
analysis of blood is of no pathology. The urine analysis: protein - 0,99 g/l,
Leucocytes - 4-6 in the field of vision, Erythrocytes 8-10 in the field of vision,
cylinders hyaline - 3-5in the field of vision. Your preliminary diagnosis?

A. chronic pyelonephritis, a pyuria

B. chronic glomerulonephritis, the nephrotic form
C. chronic glomerulonephritis, the latent form
D. chronic pyelonephritis, an urinary syndrome
E. Tubulointerstitial nephritis (TIN), urinary syndrome

290. 43 year-old patient was admitted to the nephrology department with massive
edemas. 2 years he was treated as an out-patient. Constantly found urine
changes. He was twice treated with Prednisolonum resulted positive effect. In
the urine: the relative density 1017, protein- 4,0 g/l, Erythrocytes - is not present,
Leucocytes - 5-7in the field of vision. What is the most probable diagnosis?

A. chronic pyelonephritis
B. Quick progressive a glomerulonephritis
C. amyloidosis of kidneys
D. Tubulointerstitial nephritis (TIN),
E. chronic glomerulonephritis

291. Patients of 26 years old 8 months ago got treatment for chronic
glomerulonephritis in the hospital. Treatment was effective, normalisation of all
indicators were marked.
What sanatorium treatment can be recommended?

A. Mirgorod
B. It is not recommended
C. Local sanatoriums
D. Southern coast of Crimea
E. Truskavets

292. Patients of 30 years old complain of a headache, the general weackness,

giddiness. He’s got ill this morning. 3 weeks ago he had quinsy. Objectively:
pulse 90 beats per minute , a BP-180/105 мм Hg. A rhythm correct, moderate
accent of ІІ tone over an aorta. Other changes it is not found. The blood analysis:
erythrocytes -3,4*1012/l ; leucocytes -6,8*109 /l, an ESR-12 mm/h. Analisis of
Urine: protein - 1,65 g/l, leucocytes-10-15 in the field of vision, erythrocytes 60-
80 in the field of vision, cylinders hyaline - 4-6 in the field of vision, cylinders
granular - 1-2 in the field of vision, density of urine 1024.
Specify the most possible diagnosis and a possible aetiology…

A. Quckly progressive a glomerulonephritis, syndrome Goodpajure

B. acute pyelonephritis, clebsiella/
C. chronic pyelonephritis, Esherichia coli.
D. acute glomerulonephritis, poststreptococcal
E. Tubulointerstitial nephritis (TIN), nonsteroid antiinflammatory preparations.

293. Patient complains of face edemas and feets, weackness. He got ill acutely,
after he had streptococcal infection of a skin of the left anticnemion. Objectively:
pallor of a skin, pulse - 94 beats per minute , rhythmic. Arterial pressure - 150/95
мм Hg. Heart activity is rhythmic, tones sonorous. The urine analysis: protein 1,5
g/l, leucocytes-10-12 in the field of vision, erythrocytes 10-15 in the field of
vision, cylinders hyaline - single in a preparation. A blood creatinine - 130
micromol/l.
Define the most probable diagnosis and a possible pathogenesis.

A. chronic pyelonephritis with neurogenic dysfunction of a bladder.

B. the acute glomerulonephritis, circulating immune complexes and immune
adjournment in glomuluses (deposites).
C. Quckly progressive glomerulonephritis with antibodies to a basal membrane
of glomulus.
D. acute pyelonephritis with urigenous way of being infected.
E. acute intersticial nephritis, an analgetic nephropathy (a calcareous
infiltration of papillas).

294. Patients 43 years old complains of a pain in lumbar area. For 5 years he has
been ill. Objectively: a skin dry, pallor, edemas of face and feets, edemas forward
abdominal wall. The urine analysis: protein - 4 g/l, a daily proteinuria 5 g,
erythrocytes - 20-25 in the field of vision, hyaline and epithelial cylinders 4-6 in a
preparation, the general protein of blood 49 g/l., the general cholesterol 8,3
mmol/l, Creatinine of blood - 102 micromol/l.
What is the most possible pathology which predetermines such clinical picture?

A. amyloidosis of kidneys, chronic renal insufficiency.

B. chronic glomerulonephritis, the latent form.
C. chronic glomerulonephritis, the nephrotic form.
D. chronic pyelonephritis, a nephrotic syndrome.
E. Quckly progressive a glomerulonephritis, acute renal insufficiency.
295. Patients of 38 years old, 10 years ago he had acute glomerulonephritis. Was
admitted with complaints to face, feet, a loin edemas. Headache and an aching
back pain. Arterial pressure - 200/110 mmHg. In the urine analysis: protein - 3,9
g/l, leucocytes - 3-4, erythrocytes - 10-12, cylinders hyaline 3-4 in the field of
vision, cylinders Wax-similarity - 2-3 in a preparation. A blood serum creatinine -
102 micromol/l. What treatment is the most expedient for given patient?

A. Chlorambucil (leykeran) + Prednisolonum + captopril

B. Prednisolonum + a heparin + nifedipine
C. Cyclosporine + clopidogrel + enalapril
D. Cyclophosphamide + Furosemidum + Dipiridamolum
E. Chlorambucil (leykeran) + Hydrochlorthiazidum + clopidogrel

296. Patients А, 40 years old was admitted with the diagnosis: the initially-
chronic glomerulonephritis, a nephrotic syndrome, anhypertensive stage.
Objectively: edemas of all trunk, of the face, extremities. A transudate in lungs,
and ascites. It is necessary to prescribe pathogenetic treatment.
What preparations should be prescribed first of all?

A. Diuretics.
B. Antibiotics
C. anti-agregations
D. anti-sensibility
E. glucocorticoids

297. Patient had quinsy. After that in 2 weeks there were face edemas, loins, a
hydrothorax. A BP 125/80 мм.Hg. The urine analysis: a specific gravity 1021,
protein of 9 g/l, a daily proteinuria 10,5 г, Erythrocyte 15-20 in the field of
vision, hyaline cylinders 2-4 in a preparation.
Diagnose the patient:

A. chronic glomerulonephritis.
B. acute glomerulonephritis with an urinary syndrome.
C. Quckly progressive a glomerulonephritis.
D. acute glomerulonephritis with a nephrotic syndrome.
E. system lupus erythematosus.

298. Patient D. 41 year old, complains of dryness in a mouth, weackness ,

reduction of quantity of daily urine. Is ill with a glomerulonephritis of 11 years. At
inspection: Hb - 90 g/l, plasma calcium - 1,9 mmol/l, a potassium of plasma of 5
mmol/l, a creatinine - 500 micromol/l, protein of urine - 1,2 g/l.
What complication has got the patient?
A. nephrotic syndrome.
B. iron deficiency anaemia.
C. chronic renal insufficiency ІІ nd (expressed).
D. chronic renal insufficiency І st (initial).
E. chronic renal insufficiency Ш th (serious).

299. Patient, 24 years old had quinsy. In 2 weeks has noticed edemas under eyes, a
body temperature 37,7 in the morning; the weackness, aching back pains. The
urine analysis: a specific gravity - 1026, fiber - 1,66 g/l, Erythrocytes - 25-30in the
field of vision, cylinders granular - 2-3in the field of vision, cylinders hyaline - 4-
5in the field of vision, a daily urine - 0,5 litres
The preliminary diagnosis?

A. acute pyelonephritis.
B. acute glomerulonephritis, a nephrotic syndrome.
C. chronic glomerulonephritis, the exacerbation period.
D. acute glomerulonephritis with the isolated urinary syndrome.
E. chronic pyelonephritis, the exacerbation period.

300. Patient of 68 years old, complains of the general weackness, constant

inexplicable ostealgias, muscular weackness. Last week on anticnemions there
were big edemas. In blood - the general protein 48 g/l, albumins of 35 %. In urine
– protein to 5,0 g a day. In bones of skull and pelvis is the considerable
quantity of roundish sites of a destruction in diameter from 0,8 to 2,5 cm at X-
ray roentgenograms.
What is the most possible pathogenesis of an urinary pathology in this case?

A. Osteolytic metastasises in a bone.

B. Multiple myeloma . An amyloidosis of kidneys with a nephrotic syndrome
C. tumour of kidneys with metastasises in a bone.
D. hyperparathyroid osteodystrophy.
E. chronic glomerulonephritis with nephrotic a syndrome.
Clinical testes for theme N 26.
“Pyelonephritises, tubulointerstitial nephritis (TIN), renal amyloidosis”

301. The patient of 42 years old was admitted with complaints of an aching back
pain, more on the right, a headache. The body temperature sometimes raises to the
subfebrile grades. 10 years ago during pregnancy there was a pain attack in the
right half of the loin with a fever, sharp rise of temperature. 5 years ago - rising of
BP to 200/110 mmHg. In the urine analysis: protein - 0,99 g/l, leucocytes - 10-15
in the field of vision., erythrocytes - 2-4 in the field of vision., cylinders hyaline 1-
2 in the field of vision. A blood serum creatinine - 0,102 mmol/l.
What of diagnoses is the most possible in the given patient?

A. An idiopathic hypertensia
B. chronic glomerulonephritis, the exacerbation stage
C. Tubulointerstitial nephritis (TIN), medicinal
D. amyloidosis of kidneys, primary (easy chains)
E. chronic pyelonephritis, the exacerbation stage

302. The woman of 42 years old came to see a doctor with complaints of a
headache, periodically aching back pain. From the anamnesis it is known, that
during her pregnancy (12 years ago) she had the pathology in the urine analysis,
she was not treated.
Objectively: borders of the heart are within norm. Tones are muffled, 72/ min. BP
160/100 mmHg. The electrocardiogram shows - signs of hypertrophy of the left
ventricle. Nechiporenko’s urine revealed Erythrocytes. – 1500/ ml, Leucocytes –
6000/ml. In this case the most probable diagnosis:

A. hypertrophic cardiomyopathy
B. chronic glomerulonephritis, the hypertensive form
C. renovascular arterial hypertensia
D. achronic pyelonephritis, the secondary arterial hypertensia
E. idiopathic hypertensia ІІ , constriction of the renal arteries

303. The woman of 40 years old underwent the hysterectomy. In a day there was
heavy pain in the loins on the left. The painful bottom edge of the left kidney is
defined by palpation. Pasternatsky’s is positive.
What from the listed methods of inspection can confirm the diagnosis provided by
you?

A. Ultrasound of kidneys
B. Exretory urography and the left ureter catheterization
C. Intravenous cystochromoscopy
D. retrograde urethrography
E. Radioisotope renography.
304. The patient В, of 34 years old complains of megalgias in the right lumbar
area, the cold fits accompanied by lifting the fever to 39 C. The abdomen is soft,
painful in the right flank. The palpation of kidneys area is painful on the right. In
the blood analyses: leucocytes 20,0*10 9/l, an ESR - 50 mm/hour. In the urine
analysis: reaction acidic, leucocytes in all field of vision. According to ultrasonic
examination - the left kidney has no pathological features, the right kidney
contours are enlarged.
What disease can be supposed in this case?

A. polycystic degeneration of kidneys.

B. right kidney tumour.
C. right kidney tuberculosis.
D. right-hand paranephritis.
E. acute purulent right-hand pyelonephritis.

305. The patient of 52 years old complains of pains of constant character in the
left kidney projection. Rise of temperature to 38 C with chill. In the right area of
an abdominal cavity the painful elastic formation in the size 12x18 cm is palpated.
Pyuria and proteinuria are found in the general analysis of urine.
What of additional methods of inspection should be applied first of all to this
patient?

A. Scanning of kidneys
B. Survey urography
C. Excretory urography
D. ultrasonic research of kidneys
E. Cystochromoscopy

306. The woman of 34 years old was admitted to hospital urgently. Owing to
inspection the diagnosis is established: acute primary bilateral pyelonephritis. The
hyperthermia to 39 C is observed. Serum concentration of filtrate nitrogen 31
mmol/l, creatinine of Serum - 0,095 mmol/l. Quantity of leucocytes of blood -
15,0 х 10 9/l is clinically observed; Erythrocytes - 2,9 x 10 12/l. In the analysis of
urine there are leucocytes in all fields of vision.
What from the listed is the most important for the decision of a matter
concerning stoppage of continuous antibacterial therapy?

A. Body temperature normalisation.

B. Normalisation of serumal concentration of filtrate nitrogen.
C. Normalisation of the analysis of urine
D. Normalisation of quantity of erythrocytes in blood.
E. Normalisation of quantity of leucocytes in blood.
307. The patient of 42 years old was hospitalised with complaints of a dull
aching back pain, more on the right, sometimes lifting body temperature to the
subfebrile. 10 years ago during pregnancy there was a pain attack in the right half
of the loins, rise of temperature to 39 C. She was treated by antibiotics. Last
years she felt well. 5 years ago noted rise of arterial pressure. In the urine
analysis: protein - 0,66 g/l, leucocytes - 10-15 in the field of vision, erythrocytes.
- 2-3 in the field of vision.
What is the most possible diagnosis?

A. tuberculosis of kidneys
B. idiopathic hypertensia
C. chronic glomerulonephritis
D. urolithiasis of kidneys
E. chronic pyelonephritis, an exacerbation stage

308. The man of 47 years old within last month had widespread edemas. 10 years
he was treated concerning heavy cavernous pulmonary tuberculosis. Objectively:
the face is bloated, edemas of feet, loins. It is marked moderate
hepatosplenomegaly. BP - 130/80 mmHg. The blood analysis: Erythrocytes- 3,0 х
1012/l, leucocytes. - 4,5 х 109/l, an ESR - 50 mm/hour. The general protein of
plasma - 60 g/l, albumins - 42 %, globulins - 58 %, including alpha 2 globulins -
16 %, the general cholesterol - 7,2 mmol/l. The general analysis of urine:
Specific gravity - 1020, Erythrocytes - 1-2 in the field of vision, Erythrocytes - 4-
5 in the field of vision, cylinders hyaline - 2-4 in the field of vision.; protein in
urine - 3,5 g/l. In biopsy mucous of the gum it is found glicoprotein positive to
Congo-red. What is the most probable diagnosis?

A. clottage of renal veins

B. chronic glomerulonephritis. An urinary syndrome
C. acute glomerulonephritis. A nephritic syndrome
D. amyloidosis of kidneys. A nephrotic syndrome
E. chronic pyelonephritis. An obstruction syndrome

309. The girl of 15 years old had a sudden fever (39,5 C ), arthralgia, headache,
nausea, vomiting, pain and strain of muscles in the field of a sacrum. Sharply
pronouneed positive Pasternatsky’s symptom on the right. In the urine -
bacteriuria, pyuria.
What is the most possible diagnosis?
A. cystitis.
B. renal colic.
C. acute glomerulonephritis.
D. perinephric abscess.
E. acute right-hand pyelonephritis
310. The patient of 36 years old, was taken ill acutely. Disease began with lifting
high body temperature profuse sweat. There were dull aches in the lumbar
department, unpleasant sensations at urination. Earlier in the maternity hospital
the patient was ill with pyelonephritis of pregnant women. Objectively: the strain
of muscles of lumbar department, a positive Pasternatsky’s symptom from both
sides becomes perceptible. In the general analysis of blood - leukocytosis to 12*10
9
/л, a neutrocytosis. In the general analysis of urine - 0,6 g/l of protein, leucocytes
all field of vision, there are more than 100 000 bacteria in 1 ml of urine.
What’s preliminary diagnosis, to your mind
A acute cystitis
B. nephrophthisis
C. acute glomerulonephritis
D. Acute a pyelonephritis
E. urolithiasis

311. The patient of 51 year old , TB- therapeutist, has been suffered from
pseudorheumatism for a long, she was treated with Delagilum, Diclofenac and
Prednisolonum. A half of a year ago she had diarrheas, a syndrome of
malabsorption. Just at that period there were proteinuria, edemas. Objectively:
she is exhausted, acyanotic. A BP - 140/80 mmHg. The Liver is 5 cm enlarged.
What is the most probable pathogenesis of proteinuria in the patient has?

A. tuberculosis of kidneys
B. Joining of diffusive glomerulonephritis
C. Development the secondary amyloidosis
D. Development of medicinal nephritis
E. Development of alimentary dystrophia

312. The patient of 16 years old who suffered from quinsy, prescribed the
injection of Cefazolinum and Biseptolum. 3 days eater from the beginning of
treatment the condition worsened. There were unpleasant sensations in lumbar
area, giddiness, nausea. The fever appeared again, on his skin - macula eruption
and arthralgias. BP of 140/800 mmHg. The blood analysis: Erythrocytes -
3,12*10 12/l, Hb 120 g/l, Leucocytes - 10*109/l, an ESR of 28 mm/h. The urine
analysis: specific density - 1008, protein - 0,99 g/l. Zimnitsky’s test : daily
quantity of urine of 3,2 l, fluctuation of specific density-- 1007-1010. Level of a
creatinine of blood - 0,180 mmol/l.
Diagnose the patient.

A. acute pyelonephritis.
B. acute glomerulonephritis, an urinary syndrome.
C. chronic glomerulonephritis, an urinary syndrome.
D. rapidly progressing (malignant) glomerulonephritis.
E. acute medicamental tubulointerstitial nephritis (TIN).
Clinical testes for theme N 27.
“Acute and chronic renal failure”.

313. The patient of 39 years old has arrived with complaints to fast fatigability, a
headache, appetite depression, a nausea, vomiting in the morning, periodic nasal
bleedings. At the age of 15 years had an acute glomerulonephritis. At inspection -
a BP 200/140 mmHg., pallor of a skin and mucous, traces to of comb a scratch and
hemorrhages on a skin. Urea level in plasma of 14,5 mmol/l; creatinine level - 750
miсromol/l; filtrate nitrogen level – 36,8 mmol/l; bilirubin – 25 miсromol/l; plasma
sodium - 156 mmol/l; a plasma potassium – 6,5 mmol/l; plasma calcium – 2,5
mmol/l. In the urine analysis: protein - 3,3 g/l, leucocytes - 3-5 in the field of
vision, erythrocytes - 8-10 in the field of vision, cylinders erythrocyte - 3-4 in the
field of vision. What of the specified laboratory or biochemical indicators are most
informative at estimation of a condition of the patient?

A. Blood bilirubin
B. Blood plasma sodium
C. Urea in blood
D. A blood filtrate nitrogen
E. a blood serum creatinine

314. The patient suffers a chronic glomerulonephritis for 7 years, complains of a

progressing dyspnea, palpitation, a nausea, vomiting, weariness. Objectively: a dry
skin , pallor with a yellow shade, an uremic smell from a mouth, a nasal bleeding.
A tachycardia - PS 120 beats per minute, a BP 170/120 mmHg, Hb bloods 76 g/l,
an ESR of 48 mm/h. Urea of blood of 52 mmol/l, a creatinine of 0,478 mmol/l.
What complication does the patient have?

A. A hypertensive crisis
B. Acute renal insufficiency
C. An acute left ventricular failure
D. A toxic cardiomyopathy
E. chronic renal insufficiency

315. The patient of 24 years old has a chronic glomerulonephritis in the urine
analysis: relative density - 1010, protein - 1,65 g/l, erythrocytes 5-7 in the field of
vision; leucocytes 2-3 in the field of vision. Blood creatinine - 0,350 mmol/l.
Serum sodium - 148 mmol/l, a potassium of serum of 4,9 mmol/l.

What is a principal cause of a hyperazotemia at the patient?

A. Depression of canalicular reabsorbtion
B. depression of glomerular filtration
C. The intense proteinuria
D. Reduction of a renal circulation
E. A delay a sodium in a organism

316. The patient of 45 years throughout 18 years suffers a chronic

glomerulonephritis. A BP - 180/120 mmHg., a creatinine in blood serum - 0,770
mmol/l, blood urea - 28 mmol/l, a glomerular filtration on a creatinine - 8 % from
due (10 ml/mines). Serum sodium – 128 mmol/l, a potassium of Serum 5,3 mmol/l,
Calcium – 1,8 mmol/l. What medical tactics should be given to this patient?

A. haemofiltration
B. enterosorption
C. hemosorption
D. plasmapheresis
E. hemodialysis

317. The woman of 48 years complains of weakness, growing thin, appetite

depression, a headache. In youth she had an acute glomerulonephritis. 25 years
since the age of she suffers an arterial hypertensia. Regularly she was not treated,
seldom she visited doctor. After medical examination signs of chronic renal
insufficiency 2-nd (Serum creatinine - 0,23 mmol/l) were found out.

What references concerning a food are the most proved for the given patient?

A. Restriction of carbohydrates and salt

B. Restriction of fats and salt
C. protein and salt restriction
D. Augmentation of carbohydrates and salt restriction
E. Augmentation of protein and salt restriction

318. The acute glomerulonephritis which has become complicated acute renal
insufficiency is diagnosed the patient 21 years. The prescribed medicamental
preparations are not effective. Objectively: pulse - 66 beats per minute, a BP -
130/110 mmHg. On an ECG peaked teeth T, complex QRS 0,12 sec, interval PQ
0,24 seconds are observed. For a days he has allocated 75 ml of urine, a blood
potassium - 7,3 mmol/l, a blood creatinine – 0,688 mmol/l; blood urea – 24 mmol/l.

What medical actions are necessary for the patient?

А. A peritoneal dialysis
B. decrease Potassium level in blood
C. Diuretiks
D. Correction of antihypertensive therapy
E. The hemodialysis

319. The patient of 28 years old on the second day after an alcoholic poisoning
has arrived with complaints to the general weakness, a nausea, desires to
vomiting, a headache and occurrence of urine of brown colour. Objectively: pulse -
80 for 1 minute, rhythmical, a BP - 160/105 mmHg. In the urine analysis - relative
density - 1030, protein - 0,66 g/l, a considerable quantity of erythrocytes. A blood
potassium - 6,8 mmol/l, a creatinine – 0, 750 mmol/l; urea – 28 mmol/l.

What is the most probable diagnosis?

А. toxic pancreatitis
B. toxic gastritis
C. Acute renal insufficiency
D. toxic hepatitis
E. acute tubulointerstitial nephritis (TIN),

320. The women of 18 years has got to infectious unit with the diagnosis an
infectious hepatitis? Complained of a fever, bad appetite, abdominal pains. The
icterus with prevalence of an indirect bilirubin became perceptible. For 3rd day of
hospitalisation the personnel has learnt, that the patient hid extra- hospital
abortion and is in a condition anuria. The gynecologist has established the
diagnosis the septic endometritis with punching of a uterus and a pelvioperitonitis.
A condition of the patient the heavy: anuria, a body temperature-38,5; pulse - 100,
a BP - 95/50 mmHg; Нв-100 g/l, Leucocytes 20 x 109/l ; urea - of 30 mmol/l, a
creatinine - 0,650 mmol/l, a potassium - of 6,5 mmol/l.

What tactics of treatment shoulde be chosen?

А. An urgent massive antibioticotherapia

B. An immediate uterus extirpation or uterus ablation.
C. An immediate application Reomacrodex and Mannitol.
D. An immediate hemodialysis or a hemosorption
E. An immediate application of high doses of Furosemidum.
321. To the patient of 23 years at inspection in therapeutic department concerning a
chronic glomerulonephritis the excretory urography has been done. After that the
patient had complaints to the general weakness, a nausea. The diuresis has
decreased to 100 ml a day. Objectively: a skin pallor, dry. A BP - 130-80 mm Hg,
pulse - 96/minute Cardiac sounds muffled. The blood analysis: Нв - 126g/l,
Erythrocytes - 4,9*1012/l, an ESR – 18 mm/h. Biochemical analyses of blood: - a
creatinine of 0,900 mmol/l, Potassium - 6,0 mmol/l.

Your diagnosis?

A. chronical renal insufficiency

B. a acute a glomerulonephritis
C. an acute renal insufficiency
D. A nephrotic crisis
E. The hypertensive a crisis

322. The patient of 35 years complains of a headache, weakness, a nausea,

appetite depression, reduction of quantity of urine for last days. From the
anamnesis it is known, that 2 days ago on work there was a contact to aniline
stains, thus it raspingly broke safety precautions. At inspection: a skin pallor,
cardiac sounds muffled, a BP - 120-70 mmHg. The biochemical analysis of blood :
a creatinine - 0,600 mmol/l, Potassium - 5,8 mmol/l. A daily urine – 200 ml. Your
preliminary diagnosis?

A. acute renal insufficiency

B. acute a glomerulonephritis
C. acute a pyelonephritis
D. amyloidosis of kidneys
E. chronical a glomerulonephritis

323. The patient of 30 years old. . Objectively: the heavy condition , productive
contact is absent. A body temperature 38,0 C. Skin is dry, pallor-cyanotically.
The patient has the unpleasant smell. Breath is noisy, deep and rare. Over all
surfaces of lungs the percussion sound is blunted, vesicular breath is weakened,
single dry rhonchuses, a pleural rub in the bottom departments of lungs. Cardiac
sounds muffled, frequency 52 beats per minute, ventricular extrasystoles. A
pericardial rub. A BP 100/70 mm Hg. The abdomen is soft, a liver +2 cm. The
diuresis is absent. Your diagnosis?
A. Acute insufficiency of kidneys (initial stage).
B. acute a hepatic unsufficiency.
C. croupous Pneumonia.
D. acute insufficiency of kidneys (the oligo- oligoanuria period).
E. Thromboembolism of a pulmonary artery.

324. The woman of 25 years old , had abortion on five days ago. In the
anamnesis - an acute rino-virus infection . Objectively: a heavy condition , Body
temperature - 39,5 C; flaccid, sleepy. A skin is dry, grey colour. Breath superficial,
frequency 30 for 1 min. Cardiac sounds is quiet, a normal sinus rhythm, frequency
100 beats per minute, a BP 120/70 mmHg. Diuresis for days of 120 ml.

What kind of the acute renal insufficiency period does the patient have?

A. Recovery.
B. Restoration of a diuresis (a phase of an initial diuresis).
C. Restoration of a diuresis (a polyuria phase).
D. Oligo-anuria.
E. The initial (shock).