Department of
Pathological Anatomy and
Forensic Medicine
DNIPROPETROVSK MEDICAL ACADEMY
DEPARTMENT OF PATHOLOGICAL ANATOMY AND FORENSIC
MEDICINE
PATHOMORPHOLOGY
KROK1 Qbook
for Medical Faculty students
3rd Edition
Updated 04/26/2020
Added KROK1 Anchor
MCQs 2016-2019 years
Dnipro, 2020
CONTENT
INTERMEDIATE UNIT #1:
Intracellular accumulations ……………………………………………
Extracellular accumulations …………………………………………..
Mixed accumulations and pigment disorders ……………………..
Necrosis …………………………………………………………………….
Hemodynamic disorders ……………………………………………….
3
7
10
15
20
INTERMEDIATE UNIT #2:
Inflammation ……………………………………………………………… 27
Immunopathology ……………………………………………………….. 38
Adaptation and compensation ………………………………………. 43
INTERMEDIATE UNIT #3:
Epithelial tumors …………………………………………………………..
Mesenchymal tumors ……………………………………………………
Melanocytic tumors. Tumors of the nervous system ……………….
Hemoblastosis ……………………………………………………………..
47
54
57
59
INTERMEDIATE UNIT #4
Atherosclerosis …………………………………………………………….
Ischemic heart disease ………………………………………………….
Rheumatic diseases ……………………………………………………..
Lung diseases
65
68
71
75
INTERMEDIATE UNIT #5
Gastrointestinal diseases ………………………………………………..
Liver diseases ………………………………………………………………
Kidney diseases …………………………………………………………...
Endocrine system disorders …………………………………………….
Pathology of pregnancy and reproductive system ………………
Disease of the nervous system, bones, avitaminosis ………………
80
83
85
92
96
99
INTERMEDIATE UNIT #6
Viral infections ……………………………………………………………..
Childhood infection ……………………………………………………...
Bacterial infections ……………………………………………………….
Tuberculosis ………………………………………………………………..
Syphilis ………………………………………………………………………
Other infections …………………………………………………………..
Sepsis ……………………………………………………………………….
Other ……………………………………………………………………….
103
106
111
118
126
128
130
132
2
Intracellular accumulations
Updated 04/26/2020
Added KROK 1 Anchor MCQs 2016-2019 years:
- brown – 2016-2018 years;
- green – 2019 year.
Intracellular accumulations
1. During an autopsy a parenchymal fatty
dystrophy of the myocardium was diagnosed.
What is the common or descriptive name of the
heart due to this dystrophy?
A. *'Tabby cat' heart ('Tiger's' heart)
B. Bovine heart
C. 'Hairy' heart
D. Solder plaque (bony heart)
E. Cor pulmonale
2. A patient with leukemia died from severe
chronic anemia. An autopsy revealed an
enlarged heart, with flabby myocardium It had a
dim pale-grey color, yellow spots and bars.
Which pathological process was found in the
heart at post-mortem?
A. * Parenchymal fatty dystrophy
B. Vacuolar dystrophy.
C. Hydropic dystrophy.
D. Mesenchymal fatty dystrophy.
E. Mixed dystrophy.
B. Carbohydrate dystrophy
C. Hydropic dystrophy.
D. Fatty mesenchymal dystrophy.
E. Amyloidosis.
5. A seven-year-old child presented with
diphtheria of the pharynx. He subsequently died
from acute cardiac insufficiency. Post-mortem
examination of the heart revealed that the
cavities of the heart were extended horizontally.
Muscle of the heart were dim and flabby. Gross
section showed motley appearance, with yellow
areas. Microscopically in the cytoplasm of some
rnyocardial
cells
small
vacu-oles
were
determined. The frozen sections showed
vacuoles within cells stained with sudan-III in
orange color. Which type of dystrophy was
found in myocardial cells?
A. *Fatty dystrophy
B. Carbohydrate dystrophy
C. Vacuolar dystrophy
D. Hyaline dystrophy
E. Hydropic dystrophy
3. A 53 year old patient died with symptoms of
liver insufficiency. A post-mortem examination
revealed the enlarged, flabby, yellow-brown
liver. Gross examination of the liver's section
showed
drops
of
fat.
Microscopically:
hepatocytes on the peripheries of the hepatic
lobules contained masses of small drops within
the cytoplasm. Which process most likely took
place in the liver?
A. *Fatty dystrophy of the liver
B. Glucosylceramide lipidosis (Gaucher's disease)
C. Sphingolopidosis (Niemann-Pick disease)
D. Gangliosidosis (Òàó-Sachs disease)
E. Systemic lipoidoses
6. A man died due to cardiac insufficiency. At
autopsy revealed the heart increased volume
and flabby. A myocardium was a clay-yellow
color and dim. From the side of the endocardium
a yellow-white striped pattern was visible ('tabby
cat'). Under the microscope the groups of
myocardial cells lost their normal structure, their
cytoplasm contained shallow drops which were
black when stained with sudan-IV. Which one of
the following is the correct diagnosis?
A. *Fatty dystrophy of myocardium
B. Cardiosclerosis
C. Rheumatic myocarditis
D. Obesity of the heart
E. Myomalacia
4. A patient died from chronic cardiovascular
insufficiency. At the post-mortem a 'tabby cat'
heart was found. From the side of the
endocardium, a yellow-white striped pattern was
noticeable. The myocardium was a dim with
gray-yellow color. Which process is most likely
diagnosed?
A. * Fatty parenchymal dystrophy.
7. A 66-year-old male died from cardiac
insufficiency. During the dissection an increase
volume heart was found. Observation of the
heart revealed a flabby consistency with
stretched chambers. The myocardium section
had a dim, clay-yellowish color. From the side of
the endocardium a yellow-white striped pattern
3
Intracellular accumulations
was present, which was especially noted in the
papillary muscles. Which pathological process is
the most credible?
A. *Fatty dystrophy of the myocardium
B. Obesity of the heart
C. Dilatation cardiomyopathy
D. Myomalacia
E. Cardiosclerosis
8. A patient died from pulmonary-cardiac
insufficiency. During the dissection a significantly
enlarged anemic liver, with yellow doughy
consistencies was found. A liver specimen
stained with hematoxylin and eosin exposed
various sizes of vacu-oles in the cytoplasm of the
hepatocytes. Which one of the following
dystrophies occurred?
A. *Parenchymal fatty
B. Parenchyma! carbohydrate
C. Hyaline
D. Mesenchymal fatty
E. Hydropic
9. A 38-year-old patient, suffering from chronic
alcoholism and cirrhosis of the liver, developed
profuse bleeding due to varicose veins of the
esophagus which resulted in death. During the
autopsy a liver was noted to be diminished in size
with micronodular tuberosity. The organ was
dense and rather yellow in color. A histological
evaluation of the cryostat specimens of the liver,
stained with hematoxylin and eosin, revealed
hepatocytes with large, optically empty
vacuoles. These vacuoles were black when
stained with osmium acid. These optically empty
vacuoles hepatocytes indicate:
A. *Fatty dystrophy
B. Inclusions of hyaline.
C. Alcoholic hyaline (Mallory bodies)
D. Vacuolar dystrophy.
E. Carbohydrates dystrophy.
10. A 16-year-old girl presents with the symptoms
of sharp pain during swallowing, lymph node
enlargement of the neck, and the body
.temperature of 38°C. The mucous membrane of
the tonsils revealed grayish membranes with
yellow tapes with were not easily separated from
the defect. The patient's state progressively
worsened which death occurring on the 8th day
of the disease due to cardiac insufficiency.
Which of following histological changes in the
myocardial cells will be the most likely finding?
A. * Fatty dystrophy
B. Hydropic dystrophy
C. Hyaline dystrophy
D. Ballooning dystrophy
E. Mucous dystrophy
11. A 44-year-old woman died from chronic
alcoholic intoxication. During the autopsy a
significantly enlarged liver of doughy consistency
and rather yellowish color was found.
Microscopically, after staining with hematoxylin
and eosin, cytoplasm of the hepatocytes
contained optically empty vacuoles. Which type
of dystrophy has taken place?
A. *Parenchymal fatty dystrophy
B. Carbohydrate parenchymal dystrophy
C. Hyaline dystrophy
D. Mesenchymal fatty dystrophy
E. Hydropic dystrophy
12. A patient has died from toxic sepsis. During
dissection a 'tabby cat' ('tiger's heart') was found.
Microscopically, lipids were detected in the
cytoplasm of the myocardial cells. What is the
primary
morphological
mechanism
for
development for this dystrophy?
A. *Decomposition
B. Infiltration
C. Transformation
D. Pathological synthesis.
E. Neoplastic alterations.
13. Ultrastructural investigation of a liver biopsy,
revealed that between the mitochondria there
were numerous flat cisterns and bubbles with
secretory
granules
circumscribed
with
membrane. Name a cell structure with the
hyperplasic constituents?
A. * Golgi apparatus
B. Pinocytosis bubbles
C. Endoplasmic reticulum
D. Lysosoms
E. Microtubes
14. A 42-year-old female became ill with
diphtheria and died from acute cardiac
insufficiency. During dissection it was noted that
the heart cavities were extended and that the
muscle of the heart was dim, motley and on a
cut surface had yellow areas. Which process was
exposed in the myocardial cells?
A. *Fatty dystrophy
B. Carbohydrate dystrophy
4
Intracellular accumulations
C. Ballooning dystrophy
D. Hyaline dystrophy
E. Hydropic dystrophy
15. During the examination of a newborn, some
apparent skin differences are noted. The skin is
dry, with an uneven surface and with the
presence of grey plates which can be removed
layer by layer. These changes are related to
which type of dystrophy?
A. *Homy dystrophy
B. Hydropic dystrophy
C. Hyaline dystrophy
D. Fibrinoid swelling
E. Mucoid swelling
16. A male patient had a prosthetic appliance
on the lower jaw. The ventral surface of tongue
revealed a dense, gray plaque with a clear
boundary. Histology revealed the thickened of
the stratified squamous epithelium due granular
and to basal layers thickening, hyperkeratosis,
acanthosis,
lymphocyte's
infiltration
of
connective tissue. Make a diagnosis.
A. *Leukoplakia
B. Erythroplakia
C. Papilloma
D. Cancer in sity (infra-epithelial neoplasia)
E. Condyloma
17. During the preventive examination of a
worker employed in the coal resins production
the areas of thickening and keratinization of the
mucous membrane in the oral cavity were
found. This occured mainly on the cheeks areas,
showing a whitish color with a rough surface.
They were not painful. Which pathology is this
related to?
A. * Leukoplakia
B. Papillomatosis
C. Glossitis
D. Stomatitis
E. Calcification
18. A 45-year old male is found to have a severe
intoxication. A diagnosis of sepsis is made.
Several days later he dies. At autopsy, his
myocardium grossly had a 'tiger heart' pattern. .
Microscopically, lipids were detected in the
cytoplasm of cardiac hystiocytes. What
morphogenetic mechanism prevails in the
development of this dystrophy?
A. * Decomposition..
B. Infiltration.
C. Transformation
D. Abnonnal synthesis.
E. Colliquation.
19. A 3-month- old infant dies and autopsy is
requested. Electron microscopic examination of
liver tissue revealed a great amount of flat
cisterns and vesicles with secretory granules,
surrounded by membrane, scattered among
numerous mitochondria. Which of the following
cell ultra structures has been shown to be hyperplastic?
A. *Golgi complex.
B. Pinocytic vesicles.
C. Endoplasmic reticulum.
D. Lysosomes.
E. Filaments.
20. A 36-year-old female develops liver failure
followed with lethal outcome. Autopsy has
shown an enlarged liver of yellow-brown color
and soft consistence. Drops of fat are noticed on
the liver cut surface and on the scalpel.
Microscopically: hepatocytes at peripheral zone
of a liver lobules contain small drops that fill
cytoplasm and push the nucleus to the
periphery. What process in the liver do the
following changes testify to?
A. *Fatty degeneration of liver.
B. Cerebrosidelipidosis (Gaucher's disease).
C. Sphingomyelinlipidosis (Niemann — Pick
disease).
D. Gangliosidelipidosis (Òàó —Sachs disease).
E. Generalized gangliosidosis (Norman—Landing
disease).
21. Autopsy of a menopausal woman with a ling
history of a chronic ischemic heart disease
revealed soft and enlarged heart. Its chambers
were extended; the myocardium sectional view
was lack-luster with grey- yellowish coloring. An
endocardium presented with yellow-white
banding, most evident in papillary muscles. What
is the most likely pathological process in woman's
heart?
A. *Fatty degeneration of myocardium.
B. Fatty heart.
C. Dilated cardiomyopathy.
D. Myomalation.
E. Cardiosclerosis.
5
Intracellular accumulations
22. A 77-year-old male with a dental prosthesis
on his upper jaw is seen by his dentist because of
a solid gray patch on his tongue. A lesion has
irregular contour, uneven surface, and clear
borders. Microscopic investigation of its biopsy
revealed the thickening of stratified squamous
epithelium, its hyperkeratosis, and acanthosis
accompanied
with
lymphocytes
and
macrophages
infiltration
of
subjacent
connective tissue. What is the most likely
diagnosis?
A. *Leukoplakia.
B. Erythroplakia.
C. Papilloma.
D. Cancer in situ.
E. Condyloma.
23. A 2-year-old child presents with acute
psychomotor retardation, vision and hearing
impairment, sharp enlargement of the liver and
spleen. The child is diagnosed with hereditary
Niemann-Pick disease. What genetic defect is
the cause of this disease?
A. Sphingomyelinase deficiency
B. Glucose 6-phosphatase deficiency
C. Amylo-1,6-glucosidase deficiency
D. Acid lipase deficiency
E. Xanthine oxidase deficiency
24. A mother of a 4-month-old male infant
brought him to pediatrician with complaints of
food rejection and weight loss. He started having
trouble latching onto his bottle. He has also
become extremely lethargic. Examination
reveals diminished muscle tone in all four limbs,
and hepatosplenomegaly. An ophthalmoscopic
exam reveals macular cherry red spots. During
the next few weeks, hepatosplenomegaly
progresses, the boy fails to thrive, and he
continues to reject food. Chest X-ray shows a
reticulonodular pattern and calcified nodules.
Biopsy of the liver shows foamy histiocytes. A
Niemann-Pick disease is suspected. Which of the
following is the most likely deficient enzyme in
this patient?
A.* Sphingomyelinase
B. Galactocerebrosidase
C. Phenylalanine-hydroxylase
D. Glucocerebrosidase
E. Glucose-6-phosphatase
6
Extracellular accumulations
Extracellular accumulations
1. A 56 year old female has been ill with chronic
fibrocavernous tuberculosis of the lungs for the
past 20 years. She entered the nephrology
department with an uremia syndrome. A test for
the presence of amyloid in kidneys was positive.
Which form of amyloid is indicated in this case?
A. * Secondary
B. Primary
C. Localized
D. Familial congenital
E. Senile
2. The dissection of a 49 year old male reveals a
deformed mitral valve, which is thickened and
does not completely close. Microscopically the
foci of the collagen fibers are eosinophilic and
give a positive reaction on a fibrin test? The most
credible explanation is:
A. *Fibrinoid swelling
B. Fibrinoid inflammation
C. Mucoid swelling
D. Hyalinosis
E. Amyloidosis
3. A 56 year old patient with a six year history of
peritonitis has died. During dissection the capsule
of the liver and the spleen was markedly
thickened in places and was noted as being
dense and semi-lucent. The most credible
explanation for this is:
A. *Hyalinosis
B. Necrosis
C. Mucoid swelling
D. Fibrinoid swelling
E. Amyloidosis
4. The dissection of a 48 year old patient who
suffered with rheumatoid arthritis reveals an
enlarged, dense spleen. A spleen's section
demonstrates its brown-reddish color with
enlarged follicles which have the appearance of
semi-lucent, grayish-white corns. What is the
name of these lesions in the spleen?
A. * Sago-like spleen.
B. Glazed spleen.
C. Sebaceous spleen.
D. Hyalinosis of spleen.
E. Porphyry spleen.
5. During the post-mortem performed on a 72
year old man there are noted some diminished
areas of the spleen with a pinkish color.
Microscopic examination revealed that the
follicles are diminished in volume and the walls of
the arterioles and trabeculas are thickened as
well as containing homogeneous eosinophilic,
PAS-positive masses. Staining with picrofuksin dye
reveals the masses to be a red color. These
changes indicate the presence of:
A. *Hyalinosis
B. Amyloidosis
C. Mucoid swelling
D. Fibrinoid swelling
E. Sclerosis
6. A 52 year old male died from a heart attack.
At the time of dissection a symmetric type of
severe obesity discovered. The rapture of the
right
ventriculum
wall
resulted
in
hemopericardium.
Under
epicardium
an
excessive fat tissue formation discovered. A
microscopy of the sample showed the excecive
growth of fatty tissue accompanied with atrophy
of myocardial fibers. Which pathological process
is most likely responsible for the patient's death?
A. * Simple obesity of the heart.
B. Fatty dystrophy of myocardium.
C. Ischemic heart disease.
D. Hypertension
E. Acute myocardium infarct
7. During dissection of a 65 year old patient, who
suffered from a fibrous-cavernous tuberculosis,
an enlarged, dense spleen was found. Spleen
section grossly had brown-pinkish color, smooth,
waxy-like surface. Which pathological process
listed below is the most credible?
A. * Sebaceous spleen.
B. Glazed spleen.
C. Porphyry spleen.
D. Sago spleen.
E. Cyanotic induration
8. A post mortem performed on a 50 year old
male who died of a heart attack indicated a
symmetric type of obesity of the III degree with
rupture of the walls of the right ventricle and
hemopericardium. Under the epicardium surplus
deposits of fat were found. Microscopically, fatty
tissue from the epicardium was dispersed in the
myocardium with an atrophy of the muscle
7
Extracellular accumulations
fibers. Which process listed below is the most
reliable?
A. *Obesity the heart.
B. Fatty dystrophy of myocardium.
C. Acute infarct of myocardium.
D. Ischemic heart disease.
E. Hypertension.
9. An autopsy of a 45-year-old female revealed
the kidneys were dense, yellow in color and
appear to have a greasy brilliance. Which
pathological process is most likely?
A. *Amyloidosis
B. Hyalinosis
C. Fatty dystrophy
D. Mucoid swelling
E. Hemochromatosis
10. Macroscopic examination of a stomach
delivered from surgery, revealed a round lesion
1.5cm in diameter which extended by the
muscle layer at the antral zone of a small
curvature. A semilucent dense area on the
bottom of the defect was also determined. It
resembled hyaline cartilage. Which process
developed in the bottom of the stomach lesion?
A. *Localized hyalinosis
B. Amyloidosis
C. Mucoid swelling
D. Fibrinoid changes
E. Generalized hyalinosis
11. A skin biopsy of a patient with allergic
vasculitis was submitted for examination. It is
discovered that the vessel walls were thickened
and homogeneous. Picro-fuxin stained a tissues a
yellow color. They were Shiff-positive. Which
pathological process developed in the walls of
the vessels?
A. *Fibrinoid swelling
B. Amyloidosis
C. Mucoid swelling
D. Hyalinosis
E. Lipidosis
12. The post-mortem of a patient revealed
feature of chronic kidney insufficiency. Grossly,
kidneys were enlarged, dense, wax-like, with foci
of irregular depressed scars on their surface.
Microscopically, the mesangeal areas were
expanded and the glomerular capillaries
obstructed
by
Congo
red
stain-positive
amorphous aceilular material. In some sections
the deposits took on nodular appearance.
Which of the following diagnoses is most reliable?
A. *Amyloidosis of the kidneys (Amyloid
nephropathy)
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Subacute glomerulonephritis
E. Lipoid nephrosis
13. At autopsy a 76-year-old male, with a history
of peritonitis 10 years ago, is found to have
thickened and dense both liver and spleen
capsules. They were translucent on a sectional
view. What is the most likely pathology of the
described organs capsules?
A. *Hyalinosis.
B. Necrosis.
C. Mucoid swelling.
D. Fibrinoid swelling.
E. Amyloidosis.
14. A 55-year-old female, with a long history of
rheumatoid arthritis, develops renal failure and
dies. An autopsy revealed an enlarged solid
spleen. On the sectional view, its tissue had
brown-reddish coloring with enlarged follicles
that look like translucent grayish-white grains.
What is the most likely pathological process?
A. *Sago spleen.
B. Frosted spleen.
C. Lardaceous spleen.
D. Spleen hyalinosis.
E. Porphyry spleen.
15. A 66-year-old female, with a long history of
post-traumatic osteomyelitis, is admitted to the
hospital for treatment of nephrotic syndrome. On
the night pf admission she suddenly dies. Autopsy
revealed dense, white kidneys with scars in the
cortical layer; they had a sebaceous glow on the
cut surface. What is the most likely kidneys
pathology?
A. *Secondary amyloidosis.
B. Primary amyloidosis.
C. Idiopathic amyloidosis.
D. Chronic glomerulonephritis.
E. Chronic pyelonephritis.
16. A 55-year-old man, with a long history of a
symmetrical type of severe obesity, developed
acute heart insufficiency followed with lethal
outcome. An autopsy revealed right ventricle
wall burst with hemopericardium and excessive
8
Extracellular accumulations
amount of fatty tissue under epicardium.
Microscopically: adipose tissue from epicardium
penetrates myocardium with muscle fibers
atrophy. Name the pathological process?
A. *Simple fatty heart.
B. Fatty degeneration of myocardium.
C. Ischemic disease.
D. Essential hypertension.
E.Acute myocardial infarction.
9
Mixed accumulations and pigment disorders
Mixed
accumulations
disorders
and
pigment
1. The necrotic Peyer's patches of the ileum from
the patient with typhoid fever are stained in a
yellow-brown color. Which pigment impregnates
the necrotic tissue?
A. * Bilirubin
B. Hemoglobin
C. Lipofuscin
D. Indol
E. Melanin
2. During post-mortem of a patient arrived from a
tropical country, it is discovered that there is a
hemomelanosis of a liver, spleen and elements of
the reticuloendo-thelial stroma. These changes
are characteristic for which disease?
A. *Malaria
B. Dysentery
C. Diabetes mellitus
D. Exanthematic typhus
E. Grippe
3. A patient who suffered from cancer of the
stomach died from cachexia. During the postmortem the characteristic alteration in the heart
were found. How would this condition be termed
in the heart?
A. *'Brown' atrophy
B. 'Hairy' heart
C. Solder plaque (bony heart)
D. Tiger's heart ('tabby cat')
E. Bovine heart
4. A man with insufficiency of the mitral valve
complained of a cough and sputum with a
brownish colouring. Which pigment results in this
color of the sputum?
A. *Hemosiderin
B. Melanin
C. Hemoglobin
D. Hemomelariin
E. Iron sulfate
5. The post-mortem of a man who presented in
the hospital with a history of a snakebite reveals
expressed
intravessels
hemolysis.
During
dissection it is noted that the spleen, bone
marrow and lymphatic nodes had a brown
colouring. Microscopic examination showed that
the cytoplasm of macrophages got a brown
pigment. Which pigment accumulated in the
tissues?
A. * Hemosiderin
B. Hematoidin
C. Hematin
D. Lipofuscin
E. Bilirubin.
6. The dissection of a patient who suffered from
rheumatism and chronic rheumatic valvulitis
revealed that mitral valve leaflet was thickened
with rough stony deposits. Name the pathology
presented with stony appearance of the valves?
A. * Dystrophy calcification
B. Metastatic calcification
C. Metabolic calcification.
D. Fibrinoid
E. Amyloidosis.
7. An endoscopy was performed on a patient
with a chronic stomach ulcer complicated with
hemorrhage. This procedure revealed a brownish
(coffee-like) liquid in the stomach. Which
pigment results in the color of the stomach
contents?
A. * Hematin hydrochloride
B. Hemosiderin
C. Bilirubin
D. Ferritin
E. Porphyrin
8. A 46-year-old man has an acute stomach
ulcer complicated by gastric bleeding and
vomiting. Gastric masses had a brown color and
"coffee-like"
appearance. Which
pigment
created such colouring?
A. * Hematin hydrochloride
B. Hemoglobin
C. Bilirubin
D. Hemomelanin
E. Iron sulfide
9. A 66-year-old patient complained of pain in
the hands and feet joints. Physical examination
revealed a deformation and painful of the joints.
Laboratory tests showed the increased level of
uric acid salts in the blood and urine. Which one
of following is not being fully metabolized?
A. *Nucleoprotein.
B. Calcium.
C. Chrornoprotein.
10
Mixed accumulations and pigment disorders
D. Lipoprotein.
E. Potassium.
10. A man died from chronic sepsis. A postmortem revealed an atrophy of the skeletal
muscles and brown atrophy of both myocardium
and liver. Which one of the following pigments
accumulated in tissues?
A. *Lipofuscin
B. Lipochrome
C. Hemosiderin
D. Hemomelanin
E. Melanin
11. A 58-year-old male has been ill for many
years with leukemia. A post-mortem exposed a
brown color in the marrow, spleen, liver, and
lymphatic nodes. The Perls' histochemical
reaction was conducted. It was determined that
the reticular, the endothelial cells and histiocytes
of these organs contained granules of a dark
blue color. Which pigment is responsible for the
colouring?
A. * Hemosiderin
B. Bilirubin
C. Hematoidin
D. Hemomelanin
E. Hematoporphyrin
12. The post-mortem of a patient who suffered
from malaria revealed jaundiced skin, sclera and
mucous membranes. Also, the spleen was
enlarged and had dark-grey color. This colour of
the spleen is due to the presence of:
A. *Hemomelanin
B. Hemosiderin
C. Lipofuscin
D. Melanin
E. Hemoporphyrin
13. A 56 year old patient died from chronic
cardiac insufficiency as a result of rheumatic
heart-disease. A post-mortem revealed that
lungs were enlarged, dense with red-brownish
coloring. What is the most likely diagnosis?
A. *Brown induration lungs
B. Acute bronchitis
C. Honey-comb lungs
D. Chronic bronchitis
E. Chronic emphysema
14. A patient with mitral valve insufficiency
presents in his sputum cells, filled with brown
pigment. The Perls' reaction is positive. Name this
pigment.
A. *Hemosiderin
B. Hematoidin
C. Melanin
D. Porphyrin
E. Bilirubin
15. A 66-year-old male, with a history of
hernatogenic tuberculosis was examined. This
revealed hyperpigmentation of skin and mucous
membranes, cachexia and insufficiency of the
cardio-vascular system. Which disease caused
such changes?
A. *Addison's disease
B. Phaeochromocytoma
C. Simraond's disease
D. Gushing disease
E. Greves' disease
16. A 52-year-old male with a history of sub-acute
septic endocarditis is examined by a physician. A
doctor revealed marked general pallor with
icteric skin, sclera and visible mucous
membranes. Blood test showed accumulation of
indirect
reacting
bilirubin
(unconjugated
bilirubin). The yellow staining of the skin, sclera
and mucous membranes indicates which one of
the following?
A. *Prehepatic jaundice
B. Fatty dystrophy
C. Hemosiderosis
D. Hepatic jaundice
E. Posthepatic jaundice
17. A 62-year-old female with a history of
stomach cancer with plural metastases died
from a cachexia. Select the characteristic
changes of the heart expected to be revealed
on dissection.
A. * Brown atrophy of myocardium.
B. Amyloid cardiomegaly.
C. Dilatation cardiomyopathy.
D. Hypertrophy cardiomyopathy.
E. "Tabby cat" ("Tiger's heart").
18. A patient developed a cyst in the cerebrum
following a hemorrhagic stroke. Two years later
the patient died from pneumonia due to a
complication of influenza. During examination of
11
Mixed accumulations and pigment disorders
the brain cyst it is noted that the walls have a
rusty tint. Perls' reaction is positive. Name the
process occurring in the wall of the cyst?
A. * Localized hemosiderosis
B. General hemosiderosis
C. Local hemomelanosis
D. Infiltration of bilirubin
E. Primary haemochromatosis
19. A patient with a long history of tuberculosis
was examined at the hospital. Physical
examination revealed a grayish-brown skin color,
lowered arterial pressure, hypodynamia and a
decline of the level of 17-oxycorticosteroids in
the urine and blood plasma. A problem with the
metabolism of which pigment is indicated by the
clinical signs of this patient?
A. *Melanin
B. Bilirubin
C. Lipofuscin
D. Lipochrome
E. Hemosiderin
20. A fragment of skin (1x2 centimeters) delivered
for histological research. Grossly a small (0,5 cm
in diameter) slightly elevated brown lesion,
sharply demarcated from the surrounding normal
skin, was recognized. Microscopically, a lesion
presented with nevus cells nests, rich with brown
pigment. This pigment had negative Perls'
reaction. Name the pigment.
A. *Melanin
B. Hematoidin
C. Hemosiderin
D. Bilirubin
E. Hemomelanin
are a brown color. Which pathological process is
most likely in the lungs?
A. *Hemosiderosis
B. Hemochromatosis
C. Icterus
D. Hemomelanosis
E. Lipofuscinosis
23. A post-mortem was performed on a 55-yearold male, who over last eight years suffered from
chronic form of malaria. At the dissection both
grey matter of the cerebrum and a spleen had
the ash-grey color. Which pigment is responsible
for this discoloration?
A. *Hemomelanin
B. Lipofuscin
C. Hematoporphyrin
D. Melanin
E. Hemosiderin
24. A 62-year-old male who has been ill with
diabetes mellitus for 15 years died from a
cerebral hemorrhage. Post-mortem revealed
kidneys diminished in size with a fine-grained
surface. The epithelium of the canaliculi of distal
nephron's segment was high, with a light foamy
cytoplasm.
The
Best's
carmine
staining
demonstrated a bright red coloring of the
cytoplasm's accumulations. These changes in the
epithelium resulted from the accumulation of:
A. *Glycogen
B. Lipids
C. Hyaline
D. Proteins
E. Amyloid
21. A 5 5-year-old male with a history of
bronchiectasis, pneuinosclerosis and cachexia
died. During the post-mortem examination the
heart was found to be diminished in size, flabby,
with thinned walls. A section revealed brownish
color of the heart's tissue. Which pigment was
indicated in the myocardium?
A. * Lipofuscin
B. Hemosiderin
C. Hematoidin
D. Melanin
E. Lipochrome
25. At autopsy 68-year-old male is found to have
cancer of the esophagus, accompanied with
cachexia. Grossly, fatty tissue disappeared, both
a liver and a heart were atrophic. Microscopy
revealed brown-yellowish corn-like deposited
next to nuclei of myocardial cells. These
accumulations had negative Perls' reaction.
Name the material of accumulations.
A. *Lipofuscin
B. Melanin
C. Hemosiderin
D. Ferritin
E. Hemomelanin
22. A post-mortem of a 44-year-old patient with a
history of mitral stenosis reveals dense lungs that
26. A 55-year-old patient with a bilateral adrenal
glands lesions presented with dark brown
12
Mixed accumulations and pigment disorders
colouring of the skin. During histochemical
examination of the skin the Perls' reaction was
negative. Which pigment is responsible for this
discoloration of the skin?
A. *Melanin
B. Hemosiderin
C. Porphyrin
D. Lipofuscin
E. Biliverdin
27. A 58-year-old female with a long history of
chronic dysentery died. At autopsy, the stroma
and parenchyma of the myocardium, kidneys,
the mucous membrane of the stomach, and the
connective tissue of lungs revealed violet color
amorphous masses, which had positive K.QSS'
reaction. Which pathological process developed
in the patient's organs?
A. *Metastatic calcification
B. Dystrophy calcification
C. Metabolic calcification
D. Amyloidosis
E. Hyalinosis
28. A 45-year-old male, with a long histoiy of
rheumatism and mitral valve insufficiency,
develops
a
chronic
cough
with
rusty
expectoration. What pigment colored sputum?
A. *Hemosiderin.
B. Melanin.
Ñ Hemoglobin.
D. Malarial pigment.
E. Iron sulfide.
29. A 67-year-old male, with a long history of
mitral
valve's
insufficiency,
has
been
experiencing a cough with red-brownish coloring
of a sputum. Cells with brown pigmentation and
positive Perls' test were detected in the sputum.
Which pigment responsible for the septum
coloring?
A. *Hemosiderin.
B. Hematoidin.
C. Melanin.
D. Porphyrin.
E. Bilirubin.
30. A 38-year-old female with chronic stomach
ulcer complicated with bleeding examined
endoscopically. Stomach masses had coffee
ground coloring. Which pigment responsible for
this coloring?
A. *Hematin chloride. Â Hemosiderin.
C. Bilirubin.
D. Ferritin.
E. Porphyrin.
31. A 47-year-old male, with a history of
secondary syphilis, has noticed foci of the skin
depigmentation at his neck. Name the
pathological process of the skin.
A. *Leukoderma.
B. Metaplasia.
C. Leukoplakia.
D. Dysplasia.
E. Parakeratosis.
32. a 38-year old female is found to have
bilateral adrenal adenopathy resulted in
brownish coloring of her skin. Perls' test of her
skin's biopsy was negative. What pigment altered
the color of the skin?
A. *Melanin.
B. Hemosiderin.
C. Porphyrin.
D. Lipofuscin.
E. Biliverdin.
33. A 70-year-old man has noticed recent
swelling of joints of his hands and feet. Joints are
painful and stiff. Laboratory tests revealed an
increased level of urates in blood and urine.
What is the most likely substance caused
described pathology?
A. *Nucleoproteins.
B. Calcium.
C. Chrornoproteids.
D. Lipoproteins.
E. Potassium.
34. A 70 year-old male with a history of chronic
shigellosis died. At post-mortem tissue samples
were collected for histopoly. Microscopic
investigation of hematoxylyn and eosin slides
revealed amorphous violet deposits in stroma of
the heart, kidneys, lungs and stomach mucosa.
Koss' reaction was positive. What is the most likely
pathological developed?
A. *Metastatic calcification.
B. Dystrophic calcification.
C. Metabolic calcification.
D. Amyloidosis.
E. Hyalinosis.
13
Mixed accumulations and pigment disorders
35.A patient with jaundice has high total bilirubin
that is mainly ind irect (unconjugated), high
concentration of stercobilin in the feces and
urine. The level of direct (conjugated) bilirubin in
the blood plasma is normal. What type of
jaundice can be suspected?
A. Hemolytic
B. Parenchymal (hepatic)
C. Mechanical
D. Neonatal
E. Gilbert’s disease
36. During autopsy of a man, who had been
suffering from mitral stenosis, the lungs are
revealed to be dense and brown-colored. What
pathologic process had occurred in the lungs?
A. Hemosiderosis
B. Hemochromatosis
C. Jaundice
D. Hemomelanosis
E. Lipofuscinosis
37. A 52-year-old man presents with fever and
pain
in
the
joints.
Both
of
his
first
metatarsophalangeal articulations are deformed,
swollen, and reddened. Blood urea is high. The
patient is diagnosed with gout. What is the main
developmental factor in the pathogenesis of this
disease?
A. Hyperuricemy
B. Argininosuccinic aciduria
C. Hyperazotemia
D. Hyperaminoacidemia
E. Citrullinuria
gray-black on section; cerebral gray matter is
brown-gray; cerebral white matter contains
numerous small hemorrhages. What infectious
disease can be suspected?
A. Malaria
B. Meningococcemia
C. Prion infection
D. Generalized herpetic infection
E. Generalized cryptococcosis
40. A 27-year-old patient presents with
pathologic changes in the liver and brain. Blood
plasma exhibits acute decrease in copper levels,
while urine copper levels are elevated. The
patient is diagnosed with Wilson disease. To
confirm this diagnosis it is necessary to measure
activity of the following enzyme in the patient’s
blood serum:
A.* Ceruloplasmin
B. Leucine aminopeptidase
C. Alcohol dehydrogenase
D. Xanthine oxidase
E. Carbonic anhydrase
38. Encephalopathy has developed in a child
with hemolytic disease of the newborn. What
substance had increased in the child’s blood,
resulting in damage to the CNS?
A. Unconjugated bilirubin
B. Bilirubin-albumin complex
C. Bilirubin glucuronide
D. Verdohemoglobin
E. Bile acids
39. A 34-year-old man died in a comatose state.
According to his family after a business trip to an
African country he developed periodical
jaundice attacks. Autopsy shows the following:
dense enlarged spleen with slate-black pulp;
enlarged plethoric liver,
14
Necrosis
Necrosis
1. A male had a surgery due to "acute
abdomen". During the operation it was noted
that the peritoneum was dull and in the lumen of
the rnesenteric artery superior a thrombus was
detected. About 80 centimeters of the ileac
intestine had a black colouring. Which process
was diagnosed in the intestine?
A. *Gangrene
B. Decubitus ulcer
C. White infarct
D. White infarct with a hemorrhagic crown
E. Coagulative necrosis
2. A patient with diabetes rnellitus presents to his
physician with an acute pain in the right foot. At
inspection the toe of foot had a black colour,
the tissues of foot were edematous, with bed
smell. Which form of necrosis was likely to be
diagnosed?
A. * Moist (wet) gangrene
B. Decubitus ulcer
C. Sequester
D. Dry gangrene
E. Infarct
3. A 63-year-old male died of an endemic
typhus. During the post-mortem it was revealed
that the muscles of the abdominal wail and legs
were dense with whitish-yellowish colouring. They
resemble a candle. Name the pathological
process?
A. *Waxy necrosis (Zenker's necrosis)
B. Apoptosis
C. Fibrinoid necrosis
D. Colliquative necrosis
E. Caseous necrosis
4. A 72-year-old-male had an infarct of the
dextral hemisphere of the brain. One year later a
computer tomography of the right hemisphere of
the brain reveals a cavity with smooth walls and
filled with liquid. Which pathological process is he
most likely to have?
A. * Post-infarct cyst
B. Hydrocephalus
C. Grey softening of a brain
D. Infarct of a brain
E. Hematoma
5. A post-mortem revealed a thrombus in the left
artery mesencephalicae and a large locus of
grey softening in the tissues of the left hemisphere
of a brain. Which pathological process is most
likely to be present in the brain?
A. * Ischemic infarct
B. Coagulative necrosis
C. Abscess
D. Moist gangrene
E. Sequestrum
6. At a post-mortem of the 46-year-old male a
large yellow - grey lesion was found in the left
ventricle of the heart. A fresh thrombus was
found in the coronary artery. What disease is he
most likely to have?
A. *Infarct of the myocardium
B. Cardiosclerosis
C. Myocarditis
D. Amyloidosis
E. Cardiomyopathy
7. At autopsy a 60-year-oid male is found to have
ischemic heart disease and atherosclerosis of the
coronary arteries of heart. A section of the
myocardium showed a white-yellowish focus,
surrounded by the zone of hemorrhages in the
apex, anterior and lateral walls areas of a left
ventricle. Which is the most likely diagnosis?
A. *Infarct of the myocardium
B. Post-infarction cardiosclerosis
C. Diffuse cardiosclerosis
D. Myocarditis
E. Fatty dystrophy of the myocardium
8. After a long staying in the bed a patient with
circulatory deficiency got the skin and soft tissue
darening above the sacrums. These tissues
became swallowed. Sloughing off the epidermis
in this area resulted in ulceration. Which
complication is most likely?
A. *Decubitus ulcer
B. Dry gangrene
C. Phlegmon
D. Infarct
E. Abscess
9. Histological investigation of liver's biopsy
revealed that some cells burn on small pieces
with separate organellas and nuclei fragments
surrounded by a membrane. The inflammatory
reaction was missing. Select pathological
15
Necrosis
process,
the
described
characteristic for:
A. *Apoptosis
B. Necrosis
C. Karyorrhexis
D. Plasmolysis
E. Plasmorrhexis
changes
are
10. A male who had a long history of the
intermittent claudication demonstrates the tissue
of the foot fingers as being dry with a black
colour, resembling a mummy. On small interval
from this place the dichromatic line (red colour, is
next to unchanged tissues, and white - yellow
colour close to a tered tissues). Which type of a
necrosis occurred?
A. *Gangrene.
B. Infarct.
C. Sequester.
D. Decubitus ulcer.
E. Maceration.
11. A 62-year-old male got a surgery due to the
inguinal hernia. Macroscopic examination
reveals that the wall of the intestine was a
cyanotic, inflated, swallowed and coated with
threads of a fibrin. Peristalsis was not heard.
Which pathological process occurred in the wall
of the intestine?
A. * Moist gangrene.
B. Dry gangrene.
C. Coagulate necrosis
D. Colliquative necrosis
E. Decubitus ulcer
12. A postmortem of a man, who died from
typhoid revealed muscles on the abdominal wall
and legs were dense, fragile, whitish-yellowish
colour, resembling a candle. Which term best
characterizes the muscles changes?
A. *Zenker's necrosis
B. Fibrinoid necrosis
C. Caseous necrosis
D. Colliquative necrosis
E. Apoptosis
13. A 48-year-old male, who had a history of
hypertension for 12 years, present acute
disturbance of the cerebral circulation. He
developed a headache and alteration of the
motion in the right extremity. Following righthanded hemiplegia resulted in fatal outcome. A
postmortem revealed a systemic hyalinosis of the
small arteries, thrombosis in the left arteria cerebri
media. In the left parietal-temporal area a lesion
was found, which is called:
A. *Ischemic infarct
B. Hemorrhage
C. Abscess of a brain
D. Hemorrhagic infarct
E. Edema of the brain
14. A 45-year-old male suddenly died with the
following
findings
revealed
during
the
postmortem. In the back wall of the left ventricle
of the heart a myocardial infarction was found.
Which of the following microscopic changes in
the myocardio-cytes can be seen in the locus of
an infarct?
A. *Karyolysis
B. Fatty dystrophy
C. Carbohydrate dystrophy
D. Calcification
E. Protein dystrophy
15. A postmortem of on a previously ill 48-yearold patient found an obturation of the lumen of
the middle cerebral artery due to a thrombus. In
the parietal-temporal area of the left hemisphere
of the brain a locus of grey colour tissue with soft
texture is found. Which tern best characterizes
the brain tissue changes?
A. *Infarct
B. Sequester
C. Gangrene
D. Caseous necrosis
E. Fibrinoid necrosis
16. A postmortem on the upper lobe of the right
lung reveals the large triangle-like locus of the
dark red dense tissue. Histological examination
indicates necrosis of the walls of the alveolus's
and the lumens filled with erythrocytes. Which is
the most likely associated finding?
A. *Hemorrhagic infarct
B. Carnification
C. Lung's gangrene
D. Hemorrhage
E. Atelectasis
17. A postmortem on an elderly male with
atherosclerosis reveals a thrombus in a branch of
the internal carotid artery as well as a grey locus
16
Necrosis
of a moist softening of the brain's tissue. Which
pathological process was found in the brain?
A. *Ischemic infarct
B. Hemorrhagic infiltration
C. Hematoma
D. Encephalitis
E. Tumor of a brain
18. A surgery on a patient, with a history of
syphilis revealed a locus of flabby tissue. Grossly,
this locus was yellowish, dry, structures and
gummy. The most likely diagnoses is:
A. *Caseous necrosis
B. Infarct
C. Waxy necrosis
D. Fibrinoid a necrosis
E. Steatonecrosis
19. The investigation of the liver's biopsy revealed
that some separately arranged cells burn on
small-sized pieces surrounded by a membrane. In
some of them there were organelles, other had
the fragments of dissolved nuclei. The
inflammatory reaction around these cells missed.
Name these changes:
A. *Apoptosis
B. Atrophy
C. Necrosis
D. Hypoplasia
E. Dystrophy
20. An ill elderly patient with a atherosclerosis,
develops pain in the left foot. Grossly was found
the foot enlargement, its tissues were black,
flabby and macerated. The demarcation zone
was
not
expressed.
Which
term
best
characterized the foot tissues changes?
A. * Moist (wet) gangrene.
B. Mummification.
C. Coagulate necrosis.
D. Dry gangrene.
E. Sequestrum.
21. A 62-year-old female with atherosclerosis was
admitted to the hospitalized. At surgery gross
examination revealed purulent peritonitis. During
the operation a thrombus in the mesenteric
arterias was found. Which was the most likely
cause of the peritonitis?
A. *Hemorrhagic infarct.
B. Angiospastic ischemia
C. Ischemic infarct
D. Stasis
E. Compressive ischemia
22. The examination of a child, who had a history
of measles, revealed reddish-black, uneven,
swollen, slightly fluctuated lesions of cheaks and
perineum area. Name the complication of
measles?
A. * Moist gangrene (noma)
B. Dry gangrene
C. Gas gangrene
D. Decubitus ulcer
E. Trophic ulcer
23. A postmortem was performed on a female
who died due to the cystadenocarci-noma
metastases. The postmortem revealed large
segments of a necrosis of the skin and soft tissues
within cubitus area. Name the form of the
necrosis.
A. *Decubitus ulcer
B. Infarct
C. Sequester
D. Caseous necrosis
E. Zenker's necrosis
24. A 58-year-old female with the history of
atherosclerosis dies suddenly due to acute heart
failure. Gross inspection of the left ventricle of the
heart revealed a whitish-yellowish 6x5 cm, dense
lesion with uneven boundaries and hemorrhagic
zone next to it. Which is most likely diagnose?
A. *Infarct of the myocardium
B. Postinfarction fibrosis
C. Healed infarct
D. Myocarditis
E. Ischemic cardiomyopathy
25. An ultrastructural examination of a salivary
gland revealed within cells pieces of the nuclei
surrounded by a membrane. Also condensate
fragments of nuclear material and separate
organelles were found. An inflammatory reaction
around these cells was missing. Which term most
correctly defines these alteration?
A. *Apoptosis
B. Karyorrhexis
C. Coagulation necrosis
D. Karyopyknosis
E. Karyolysis
17
Necrosis
26. A patient with tuberculosis has a kidney
biopsy performed. Histological investigation
revealed the caseous necrosis of the tissue
accompanied by disorderly arranged fine grains
of a chromatin. Which term most correctly
defines describe lesion?
A. * Karyorrhexis
B. Karyolysis
C. Karyopyknosis
D. Mitotic activity of nuclei
E. Apoptosis
27. A postmortem of a 48-year-old male who had
a history of typhoid fever revealed that the
rectus abdominis at the wall was dense, a whitish
colour, and resembled a candle. Which is the
most likely diagnosis?
A. * Waxy necrosis
B. Fibrinoid necrosis
C. Colliquative necrosis
D. Caseous necrosis
E. Apoptosis
28. A 44 year old ill patient died due to the
severe chronic heart failure. Pathologist
diagnosed
rheumatic
granulomatous
myocarditis. Microscopic evaluation of the
myocardium indicated the presence of
granulomas which consisted of macrophages
with hyperchromatic nuclei and clear cytoplasm.
Also necrosis was seen in the center of a lesion.
Which is the most likely type of necrosis in the
center of the lesion?
A. * Fibrinoid necrosis.
B. Waxy necrosis.
C. Caseous necrosis.
D. Colliquative necrosis.
E. Fatty dystrophy.
29. A 57-year-old patient has a long history of the
type II diabetes mellitus. Physical examination
revealed the alteration of the right foot tissues.
They are dense, black with precise boundaries
from normal tissues. Which term most correctly
describe the lesion?
A. *Dry gangrene.
B. Wet (moist) gangrene.
C. Gas gangrene.
D. Decubitus.
E. Trophic ulcer.
30. A postmortem examination of a dead body
revealed a cloudy corneas, dry skin with
yellowish - brown lesion. Which term most
correctly identifies describes a post-mortem
alterations?
A. *Cadaver desiccation
B. Clotting of blood
C. Livor mortis
D. Rigor mortis
E. Algor mortis
31. The postmortem of a 48-year-old male reveals
in the right temporal lobe of the brain a large
grey lesion with a softening, porridge-like texture.
The basal arteries of the brain had numerous
white - yellow thickenings of an intima which
significantly decreased lumen. Which is the most
likely diagnosis?
A. *Ischemic infarct
B. Abscess of a brain
C. Hematoma
D. Hemorrhagic infarct
E. Edema of the brain
32. At post-mortem, a 60-years-old man, with a
history of-typhoid fever, is found to have rectus
muscles of the anterior abdominal wall dense,
whitish, and look like a stearic candle. What is the
most likely diagnose?
A. *Zenker's necrosis.
B. Fibrinoid necrosis.
C. Colliquative necrosis.
D. Caseous necrosis.
E. Apoptosis.
33. A 65-year-old female, with a long history of
diabetes
mellitus,
presented
her
black,
edematous and painful thumb of the right foot.
Gross inspection revealed a focal epidermal
detachment and malodorous discharge. What is
the most likely clinico-pathologic form of
necrosis?
A. *Moist (wet) gangrene.
B. Decubitus ulcer.
C. Sequester.
D. Dry gangrene.
E. Infarction.
34. A 5-year-old boy with measles presents to his
pediatrician with necrotic changes of his cheeks.
Gross inspection revealed that the cheeks soft
tissues were edematous with reddish black
18
Necrosis
fluctuated indistinctly outlined foci. What is the
most likely complication of a measles?
A. *Moist gangrene.
B. Dry gangrene. Ñ Gas gangrene.
D. Decubitus ulcer.
E. Trophic ulcer.
35.A physical examination of 67-year old lady,
with a history of femoral bone fracture, revealed
a sequester formation accompanied with
chronic inflammation of a bone marrow and
adjacent tissues. What is the most likely disease
caused such lesions?
A. *Osteomyelitis.
B. Reticulosarcoma.
C. Multiple myeloma.
D. Osteoclastoma.
E. Periostitis.
36, An elderly woman with a history of a stroke
one year ago complains of a left limbs
immobility.
A
computer
tomography
examination revealed a cavity filled with liquor,
at right hemisphere of her brain. What is the most
likely diagnose?
A. *Postinfarction cyst.
B. Hydrocephaly.
C. Grey encephalomalacia.
D. Cerebral infarction.
E. Hematoma.
37. A 37-year-old man, who was working in a
caisson, after being lifted to the surface suddenly
developed signs of acute cerebral circulation
disturbance and loss of consciousness. Several
days later he died. On autopsy in the left
cerebral hemisphere there was detected a gray
soft irregular focus 5х6х3,5 cm in size. What
process had occurred in the brain?
A. Ischemic stroke
B. Hemorrhagic infarction
C. Abscess
D. Cyst
E. Tumor
38. Autopsy revealed a large wedge-shaped
patch of a dense dark red tissue with clear
margins in the upper lobe of the right lung.
Histological examination detected there necrosis
of the alveolar walls; the alveolar lumen is tightly
packed with erythrocytes.
occurred in the lungs?
A. Hemorrhagic infarction
B. Carneous degeneration
C. Gangrene
D. Hemorrhage
E. Atelectasis
What
process
39. Acute renal impairment caused death of a
patient with hemorrhage. Autopsy revealed
enlarged kidneys with broad pale pink cortical
layer expressively demarcated
from dark red renal pyramids. Macroscopic
examination revealed lack of epithelial nuclei of
the
convoluted
tubules,
tubulorrhexis,
phlebostasis. The cell nuclei of the choroid
glomus and straight tubules
were present. What pathology is it?
A. Necronephrosis
B. Infarction
C. Glomerulonephritis
D. Pyelonephritis
E. Nephrosis
40. A patient with femoral neck fracture, who for
a long time had to remain in bed in a forced
(supine) position, has developed dark-brown
lesions along the backbone; soft tissues are
swollen, in the areas of maceration there is a
foul-smelling liquid. Name the clinicopathologic
type of necrosis:
A. Bedsore
B. Infarction
C. Sequestrum
D. Coagulation necrosis
E. Dry gangrene
41. Autopsy revealed a large wedge-shaped
patch of a dense dark red tissue with clear
margins in the upper lobe of the right lung.
Histological examination detected there necrosis
of the alveolar walls; the alveolar lumen is tightly
packed with erythrocytes. What process
occurred in the lungs?"
A.* Hemorrhagic infarction
B. Hemorrhage
C. Gangrene
D. Carneous degeneration
E. Atelectasis
19
Hemodynamic disorders
E. Toxic dystrophy of a liver.
Hemodynamic disorders
1. The postmortem of a 48-year-old male, with a
long history of a chronic heart failure, revealed
an enlarged liver. Grossly, a liver had a motley
pattern. Macro-scopically, the sectional view
looked like a nutmeg on incision. Which term
most correctly defines these alteration?
A. * General venous plethora
B. General arterial plethora
C. Anemia
D. Hemorrhage
E. Bleeding
2. A post-mortem of a 43-year-old female
revealed multiple, hemorrhagic infarcts in lungs.
Some lungs' vessels had reddish-brown dense
masses within lumens, which were not attached
to the vessel walls. Varicose phlebectasia of the
legs with thromboses of some veins were also
determined.
Which
pathological
process
occurred in this case?
A. * Thromboembolism of pulmonary artery.
B. Fat embolism of pulmonary' artery.
C. Tissue embolism of pulmonary artery.
D. Foreign bodies embolism of pulmonary artery.
E. Gas embolism.
3. A male patient died after a abdominal
surgery. During the postmortem numerous
thrombuses were found in the veins of the pelvis.
Thromboembolic syndrome was diagnosed.
Where
it
is
necessary
to
search
for
thromboembolies?
A. *Lungs artery
B. Portal vein
C. Left ventricle of heart
D. Brain
E. Veins of the lower extremity
4. The histological investigation of a liver detects
venous plethora of center lobules, dystrophy and
atrophy of hepatocytes in the venous plethora's
area, fatty a dystrophy of hepatocytes on the
periphery of a lobe. The replacement fibrosis in
places of an atrophy of the hepatocytes was
also revealed. Which pathological process does
mis refer to?
A. * 'Nutmeg' liver with precirrhotic phenomena.
B. Biliary hepatic cirrhosis. Ñ Fatty hepatosis.
D. Hepatitis.
5. A 35-year-old patient complains of repeated
vomiting, diarrhea, decreased arterial pressure
and tachycardia. He supposes this condition
related to the food poisoning. Laboratory tests
detected Salmonella's infection. Hematological
examination revealed an increased munber of
erythrocytes per unit volume. Which circulatory
disturbance took place to create this pathology?
A. *Clotting of a blood.
B. Hemolysis of erythrocytes and compensatory
induction of ahemogenesis
C. General arterial plethora
D. Polycythemia
E. Hyperchromatic anemia
6. A male with a history of myocardial infarct
died of cardiovascular failure. A post-mortem
revealed a replacement fibrosis, hypertrophy of
the myocardium and dilatation of the cavities,
especially the right ventricle. The liver was
enlarged. Its surface was smooth. Grossly, a
motley pattern with dark red dots on the grey a
background was revealed. Histologically, central
zones of the lobules were hy-peremic. On the
periphery,
around
of
periportal
tracts
hepatocytes demonstrated fatty dystrophy.
Name these liver changes.
A. *"Nutmeg" liver (chronic venous plethora)
B. Pseudo 'nut-meg' liver
C. Amyloidosis
D. Cirrhosis of a liver
E. Steatosis of a liver
7. A male patient involved in the traffic accident
received a wound in the neck due to broken
glass. The bleeding was small, but a short time
after the accident he died of acute dyspnea. A
post-mortem of the heart revealed bubbles
excretion when pericardium filled with water.
Indicate which pathological process took place:
A. *Air embolism
B. Gas embolism
C. Fat embolism
D. Thromboembolism
E. Foreign bodies embolism
8. A 52-year-old male with long history of
rheumatic heart disease died of chronic heart
failure. A post-mortem revealed brown colour,
20
Hemodynamic disorders
enlarged dense lungs. Name the changes in
lungs.
A. *Brown induration of lungs
B. Acute bronchitis
C. Horny-comb lungs
D. Chronic bronchitis
E. Chronic emphysema
9. A patient, who had fast elimination of 10 liters
of an ascitic liquid from abdomen, suddenly lost
his consciousness. What was the cause of this
phenomenon?
A. * Anemia of the brain
B. Thrombosis of the cerebral arteries
C. Brain hemorrhage
D. Arterial hyperemia
E. Thrombosis of the cerebral veins
10. A young male with a history of rheumatic
heart disease since childhood, gradually
develops mitral stenosis, accompanied with
episodes of heart failure. He presents to a
hospital complaining of coughing with a reddishbrown sputum. Name probable changes at
patient's lungs.
A. *Brown induration of lungs
B. Emphysema of lungs
C. Atelectasis of lungs
D. Pneumosclerosis
E. Bronchiectasis
11. At autopsy an elderly female is found to have
a blood clot in the femoral artery, which grossly
had a striped pattern. Microscopy revealed a
congestions of fibrin fibers and broken down red
and white cells. Which is the most likely type of
thrombus ?
A. * Mixed thrombus
B. Postmortem convolutions of a blood
C. Thromboemboli
D. Hyaline thrombus
E. Red thrombus
12. A patient has a purulent otitis and thrombosis
of a sigmoid sinus of a dura mater. Name the
complication if thrombus breaks down and
fragments circulate to distal vessels.
A. *Thromboembolism of branches of pulmonary
artery
B. Thromboembolism of vessels of a brain with
development of a grey softening of the brain
C. Thromboembolism of vessels of a retina of an
eye and development of blindness
D. Thromboembolism of coronary arteries
E. Local anemia
13. A 43-year-old male, with a history of traffic
accident and poly trauma, including multiple
bone fractures, presented to the hospital. On the
second day after the trauma, he complained of
a pain in the right half of the chest, heavy
breathing. At night, he died due to progressive
heart and respiratory failure. Microscopic
investigation revealed Sudan-positive orange
drops in pulmonary and cerebral vessels that
completely
occlude
the
lumens
of
microcirculatory vessels. What is the most likely
complication led to a patient's death?
A. *Fat embolism.
B. Gaseous embolism.
C. Medicamentous embolism.
D. Microbial embolism.
E. Thromboembolism.
14. A 62-year-old patient had a surgery due to
acute appendicitis. She had been placed in a
bed for 5 days. After she decided to get out of
bed she experienced a shortage of air, her face
became
cyanotic
and
she
lost
her
consciousness. After unsuccessful resuscitation
the patient died. A post-mortem revealed a
thromboem-bolism of the pulmonary artery.
Which of the following is most likely source of
mromboembolism?
A. Thrombosis of veins of the lower extremity
B. Thrombosis of a portal vein
C. Thrombosis of mesenteric arteries
D. Thrombosis in a left ventricle of heart
E. Ball-shaped thrombus of an auricle
15. A male with a fracture of the shoulder bone
carried on overlapped plaster bandage.
Suddenly, an arm and the visible part of the
forearm
became
cyanotic,
cold,
and
edematous. Which of the following is most likely
happened?
A. *Local venous plethora
B. Local arterial plethora
C. Local anemia
D. Stasis
E. Thrombosis
21
Hemodynamic disorders
16. An elderly female develops acute disorder of
the cerebral blood circulation, followed with
coma, resulted in fatal outcome. A post-mortem
revealed in the right hemisphere of the brain a
large
cavity,
filled
with
blood.
Which
pathological process took place in the brain?
A. *Hematoma
B. Hemorrhagic infiltration
C. Infarct of the brain
D. Diapedesis
E. Edema of the brain
membranes. Microscopic examination indicated
marked dystrophic alterations of the nephron's
epithelium at proximal canaliculi of kidneys. Also,
the centrolobular hemorrhage and necrotic
zones were found in the liver. Name the type of
the blood circulation disorder.
A. * Acute general venous plethora.
B. Arterial hyperemia.
C. Chronic general venous plethora.
D. Acute anemia.
E. Chronic anemia.
17. A male suddenly died after an open fracture
of the clavicle. A post-mortem revealed in the
right ventricle of the heart and pulmonary
arteries the foamy blood. Which one was the
cause of death?
A. *Air embolism
B. Bacterial embolism
C. Hemorrhage
D. Tissue embolism
E. Fat embolism
21. A neonate died of intoxication. A
microscopic examination of an umbilical vein
revealed a diffuse inflammatory infiltration of the
vessel's wall. Also, its lumen was filled with
thrombus, rich with leucocytes and bacterial
colonies. Karyorrhexis was detected in many
leucocytes. Which is most likely outcome of a
thrombus in that case?
A. * Septic autolysis.
B. Aseptic autolysis.
C. Organization and vascularization of the
thrombus.
D. Thromboembolism.
E. Calcification of a thrombus.
18. A male with a history of the decompression
sickness developed symptoms of acute cerebral
circulation disorder and died soon. A postmortem revealed in the left hemisphere of the
brain the locus of a grey softening of the brain,
which was 6x5x3 cm. Which one is most likely to
cause the death of the patient?
A. *Gas embolism.
B. Fat embolism.
C. Thrombosis.
D. Thromboembolism.
E. Atherosclerosis of the vessels.
19. A post-mortem of an elderly man with a long
history of the ischemic heart disease and heart
failure revealed a nutmeg liver, brown induration
of lungs, cyanotic induration of kidney and
spleen. Indicate, what type of the blood
circulation disorder is most likely?
A. * Chronic general venous plethora.
B. Arterial hyperemia.
C. Acute general venous plethora.
D. Acute anemia.
E. Chronic anemia.
20. A 50-year-old male with a myocardial
infarction died from the heart failure. A postmortem revealed the edema of the lungs and
petechial hemorrhages at serous and mucus
22. A 68-year-old female is admitted to the
hospital for treatment of deep vein thromboses.
The next day she suddenly died. At autopsy a
large plug of laminated blood clot is found to
occlude the main pulmonary artery. Which is
likely to be found in her lungs?
A. * Thromboembolism
B. Thrombosis
C. Tissue embolism
D. Foreign bodies embolism
E. Fat embolism
23. A 77-years-old female with unstable angina
presents to physician with slowly increasing heart
failure symptoms. On the night of admission to
the hospital she dies. A post-mortem examination
revealed the enlarged liver with dense texture
and the rounded edges. Sectional view had a
nutmeg pattern with dark red dots on the
yellowish background. Which pathological
process resulted in liver's alteration?
A. * Chronic venous plethora
B. Acute venous plethora
C. Arterial plethora
D. Arterial anemia
22
Hemodynamic disorders
E. Chronic hemorrhage
24. A post-mortem of a 53-year-old male with a
long history of hypertension revealed the cavity
in the occipital lobe of the brain. It measured 2x1
cm, had a brownish smooth walls and filled with
transparent liquid. Which is the most likely
diagnosis?
A. * Cyst after hemorrhages
B. Softening of the brain
C. Abscess of a brain
D. Developmental defect of a brain
E. Cyst after softening of the brain
25. A 65-years-old patient, who presented with a
10 years history of ischemic heart disease, died
due to heart failure. An autopsy revealed the
cyanotic induration of both spleen and kidneys,
brown induration of lungs and "nutmeg" liver.
Which is the most likely type of the blood
circulation disorder, resulted in such changes of
internal organs?
A. * General chronic venous hyperemia
B. Genera! acute venous hyperemia
C. General arterial hyperemia after an anemia
D. Arterial ischemia as a result of reallocating a
blood
E. Local chronic venous hyperemia
26. A 63-year-old patient with long history of
ischemic
heart
disease
and
repeated
myocardial infarction died due to progressive
cardiovascular failure. A postmortem revealed
an enlarged, dense spleen with the dark red
colour of the sectional view. At the microscopic
examination of spleen the pulp's sclerosis and
atrophy of the follicles were found. Which term
most correctly defines theses changes?
A. *Cyanotic induration of a spleen
B. Sago spleen
C. Waxy spleen
D. Porphyry spleen
E. Septic spleen
27. A young male fractures his pelvis and femur in
a motor vehicle accident. On the third day he
dies after respiratory distress and cerebral
dysfunction. A histological examination revealed
Sudan-positive orange globules scattered within
cerebral
cortex,
kidneys
and
lung
microcirculatory vessels. Which is most likely
diagnoses?
A. * Fat embolism
B. Gas embolism
C. Tissue embolism
D. Microbial embolism
E. Thromboembolism
28. A cosmonaut died due to the air-tightless of
the
space-shuttle
cabin.
Microscopic
examination of the vessels of the internal organs
revealed multiple bubbles. Liver cells developed
fatty dystrophy. In the brain and spinal cord
multiple small, grey, soft lesions were discovered.
Indicate the most probable cause of such
alterations.
A. *Gas embolism
B. Air embolism
C. Fat embolism
D. Thromboembolism
E. Tissue embolism
29. A patient with a long history of rheumatic
disease died of cardiopulmonary failure. A postmortem revealed a stenosis of the mitral orifice
as well as a brown induration of lungs. Which
term most correctly defines this blood circulation
disorder?
A. *Chronic left ventricular failure.
B. Chronic right ventricular failure.
C. Acute left ventricular failure.
D. Acute right ventricular failure.
E. Portal hypertension.
30. A post-mortem of a 59-year-old patient with
long history of idiopathic hypertension revealed
in brain a cavity with rusty colour walls. Which
process preceded these changes?
A. *Hematoma
B. Diapedesis
C. Ischemic infarct
D. Plasmorrhagia
E. Abscess
31. A 65-year-old- patient presented with liver
cirrhosis. The removal from his abdominal cavity
of 10 liters of ascitic liquid resulted a collapse.
Grossly his peritoneum was hyperemic. Define
the type of hyperemia in peritoneum.
A. * Post-anemic hyperemia
B. Collateral hyperemia
C. Complementary hyperemia
D. Inflammatory hyperemia
E. Caused by arteriovenous fistula
23
Hemodynamic disorders
32. A post-mortem of a 60-year-old female with a
history of secondary hypertension revealed a
cavity at the right hemisphere of the brain 4x2,5
cm, filled with red clots of blood and softened
brain tissue. What term best characterized the
brain changes?
A. *Hematoma.
B. Hemorrhagic impregnation.
C. Ischemic infarct.
D. Cyst.
E. Abscess.
33. An inexperienced scuba diver ascends from
a depth of 55 meters to the surface in about 5
minutes. Shortly after surfacing he complains of
severe
muscle
contraction
and
intense
abdominal pain. What is most likely diagnose?
A. *Gas embolism
B. Air embolism
C. Fat embolism
D. Thromboembolism
E. Tissue embolism
34. A 78-year-old male, with a history of stroke 2
years ago, died of pneumonia as a complication
of severe influenza. At post-mortem, gross
investigation of his brain revealed a cerebral cyst
with rusty color of its walls. Perls' test was positive.
Name the process reveled within a cystic wall.
A. *Local hemosiderosis.
B. Common hemosiderosis.
C. Local hemomelanosis.
D. Infiltration of bilirubin.
E. Primary hemochromatosis.
35. A 54-years old male with a history of ischemic
heart disease presents at hospital with recurrent
myocardial infarction. Few days later, he died
due to cardiac failure. Post-mortem revealed an
enlarged solid spleen of dark cherry color on the
cut surface. Microscopically, pulp sclerosis and
follicles atrophy were found out. What is the most
likely term to define spleen's alterations??
A. *Cyanotic induration of spleen.
B. Sago spleen.
C. Lardaceous spleen.
D. Porphyry spleen.
E. Septic splenitis.
36. A post-mortem of 77-year-old male, with a
long history of cerebral atherosclerosis, revealed
an atrophy of his cerebral cortex. What was the
most likely cause of cortex alterations?
A. *Insufficiency of blood supply.
B. Pressure.
C. Physical and chemical factors.
D. Neurotic.
E. Dysfunctional.
37. A 56-year-old male with a history of cerebral
atherosclerosis suddenly dies. At, a there is a
thrombus within a middle cerebral artery's lumen.
Gross inspection revealed a grey flabby focus at
the parietotemporal part of the left hemisphere
of his brain .What are the most likely alterations
diagnosed in a brain tissues?
A. *Infarction.
B. Sequestrum.
C. Gangrene.
D. Caseous necrosis.
E. Fibrinoid necrosis.
38. An autopsy of a patient who died suddenly
at emergency room revealed in his brain a
cavity of irregular shape (5 x 3.5 cm) filled with
blood clots and macerated cerebral tissue. An
area of cavitary destruction had a rim of brown
discoloration. This lesion was found within the
subcortex nuclei at the right hemisphere of brain.
What is the most likely definition of described
pathology?
A. *Hematoma.
B. Hemorrhagic impregnation.
C. Ischemic infarction.
D. Cyst.
E. Abscess.
39. A patient with obliterating atherosclerosis has
undergone sympathectomy of the femoral artery
in the area of femoral triangle. What type of
arterial hyperemia was developed in the patient
due to this surgery?
A. Neuroparalytic
B. Reactive
C. Metabolic
D. Neurotonic
E. Functional
40. During the exam a student was unable to
correctly answer all the questions in his question
card, which was accompanied by the reddening
of his face and hot sensation. What type of
arterial hyperemia did the
24
Hemodynamic disorders
student develop in this case?
A. Neurotonic
B. Metabolic
C. Postischemic
D. Pathologic
E. Neuroparalytic
A. Adipose
B. Tissue
C. Thromboembolism
D. Gaseous
E. Air
41. A 45-year-old man diagnosed with hepatic
cirrhosis and ascites underwent drainage of 5
liters of fluid from his abdominal cavity, which
resulted in development of syncopal state due to
insufficient blood supply to the brain. What
circulatory disorder occurred in the abdominal
cavity in this case?
A. Arterial hyperemia
B. Ischemia
C. Venous hyperemia
D. Thrombosis
E. Embolism
45. A 65-year-old woman, who had been
suffering from deep vein thrombophlebitis of the
lower leg, suddenly died when awaiting her
appointment with the doctor.
Autopsy revealed loose friable red masses with
corrugated dull surface in the main pulmonary
artery and its bifurcation. What pathologic
process was discovered by the pathologist in the
pulmonary artery?
A. Thromboembolism
B. Thrombosis
C. Tissue embolism
D. Foreign body embolism
E. Fat embolism
42. A victim of a traffic accident was received by
the intensive care unit. The patient is in a grave
condition that can be characterized as a severe
pathologic process that leads to exhaustion of
vital functions and puts the patient into the
marginal state between life
and death due to critical reduction of capillary
circulation in the affected organs. The patient is
in the state of:
A. Shock
B. Collapse
C. Coma
D. Agony
E. Preagony
46. A man has suffered multiple bone fractures of
his lower extremities during a traffic accident.
During transportation to a hospital his condition
was further aggravated: blood pressure
decreased, there were signs of pulmonary artery
embolism. What kind of embolism is the most
likely in the given case?
A. Fat embolism
B. Air embolism
C. Gas embolism
D. Tissue embolism
E. Thromboembolism
43. A patient with chronic heart failure presents
with increased blood viscosity. Capillaroscopy
detected damage to the vessel walls of the
microcirculation system. What disorder is
possible in the given case?
A. Blood ”sludge” phenomenon
B. Thrombosis
C. Embolism
D. Arterial hyperemia
E. Venous hyperemia
44. A 54-year-old woman was brought to the
emergency department after a car accident. A
traumatologist diagnosed her with multiple
fractures of the lower extremities. What kind of
embolism is the most likely to develop in this
case?
47. Autopsy of a man, who had been suffering
from mitral stenosis, reveals dense brown lungs.
What pathologic process had occurred in the
lungs?
A.* Hemosiderosis
B. Jaundice
C. Lipofuscinosis
D. Hemochromatosis
E. Hemomelanosis
48. A 65-year-old woman presents to the
emergency department because of shortness of
breath and chest pain that started a few hours
ago. She did not have a fever, expectoration, or
any accompanying symptoms. She has a history
of right leg deep vein thrombosis that occurred 5
years ago. Sometime later, she dies of severe
respiratory distress. A pulmonary autopsy
25
Hemodynamic disorders
specimen reveals red loose mass that is lodged
in the bifurcation of the pulmonary trunk with
extensions into both the left and right main
pulmonary arteries. Which of the following is the
most likely diagnosis?
A.* Thromboembolism
B. Pneumothorax
C. Myocardial infarction
D. E. Pneumonia
26
Inflammation
Inflammation
1 A histological investigation of enlarged neck
lymphatic node revealed a congestion of
epithelial cells, lymphocytes and giant PirogovLanghan's cells. In the center of lesion a caseous
necrosis was present. Which pattern of
inflammation do the lymphatic node display?
A. * Tuberculosis
B. Rhinoscleroma
C. Sarcoidosis
D. Glanders.
E. Syphilis.
2. A 3-year-old child died of a meningococcal
infection. A macroscopic study revealed
swallowed meninges which had yellow-green
colouring. Which pattern of inflammation was
most likely in meninges?
A. *Fibrinous-purulent inflammation
B. Serous inflammation
C. Hemorrhagic inflammation
D. Catarrhal inflammation
E. Necrotic inflammation
3. A 37-year-old male presents with a fever,
dyspnea and pain in the right part of the chest.
The pleurocentesis gave 700 ml of thick yellowgreenish liquid. What pathological process was
diagnosed in a pleural cavity?
A. *Empyema of a pleura
B. Bronchopneumonia
C. Serous pleuritis
D. Hemorrhagic pleuritis
E. Carcinomatosis of a pleura
4. A 25 years old male presents with a 2-day
history of itching and redness in the buccal area
that
appeared
after
shaving.
Physical
examination by family physician revealed
vesicles filled with transparent fluid on the
background the hyperemic buccal area. What is
the most likely type of fluid in the vesicles?
A. *Serous exudate.
B. Transudate.
C. Purulent effluent.
D. Mucous exudate.
E. Hemorrhagic exudate.
5. An autopsy of a 34-years old female, with a
history of croupous pneumonia revealed opaque
fluid in her pleural cavity. There was also a grey
membrane on the visceral pleura. What is the
most likely type of the pleura's inflammation?
A. *Fibrinous.
B. Catarrhal.
C. Suppurative.
D. Granulomatous.
E. Hemorrhagic.
6. A 4-year-old girl with 3 days history of
diphtheria presents to the emergency with croup
symptoms. Intensive care was unsuccessful and
child died at the hospital. A post-mortem
revealed thickened, edematous, dull mucous
tunic of the larynx, trachea, and bronchi
covered by grayish membrane easily separated
from tissues underneath. What is the most likely
type of inflammation?
A. *Fibrinous.
B. Serous.
C. Suppurative.
D. Mixed.
E. Catarrhal.
7.At post-mortem a 5-year-old boy is found to
have a severe tracheobronchitis complicated
with asphyxia. Grossly, a thick, gray, leathery
membrane covered the mucous tunic of
trachea and bronchi. The membrane loosely
attached to underlying tissues and easily
removed with forceps. The lumen of the
segmental bronchi was blocked with gray
masses of tissue debris, which microscopically
consisted with necrotic tissues, neutrophils, fibrin
and bacteria. What is the most likely type of
inflammation?
A. *Croupous.
B. Catarrhal.
C. Diphtheritic.
D. Purulent.
E. Serous
8. An autopsy of a 50-year-old male, who died of
dysentery, revealed the hyperemic mucosa of
the colon, coated with grey membranes, which
can be removed from tissues underneath with
some effort. Which type of an inflammation
described in the intestine?
A. *Diphtheroid inflammation
B. Croupous inflammation
C. Hemorrhagic inflammation
D. Serous inflammation
E. Catarrhal inflammation
27
Inflammation
9. A 30-year-old male has a neck lymph node
removed
for
examination.
Histological
investigation
revealed granulomas, which
consisted
of
epithelioid,
lymphoid
and
rnultinuclear Langhans giant cells. Granulomas'
centers were presented with necrosis. What
causative agent needs to be revealed in the
necrosis zone for support of the diagnosis of
tuberculosis?
A. *Mycobacterium tuberculosis
B. Treponema pallidum
C. Staphylococcus
D. Frisch bacillus
E. Salmonella
10. An autopsy of a 53-year-old male, with a
history of crupous pneumonia, revealed in his
dextral pleural cavity 900 ml of cloudy, greyyellowish colored liquid. Pleural membranes were
found to be dim and plethoric. Name the clinical
-morphological form of the inflammation in the
pleural cavity?
A. * Empyema.
B. Fibrinous inflammation.
C. Phlegmon.
D. Chronic abscess.
E. Acute abscess.
11. An autopsy of a 53-year-old male, who died
from chronic renal failure, revealed the colon's
mucosa, covered with grey — yellow
membranes, densely coherent to tissues
underneath. The removal of the membranes
resulted in ulcers formation. Name a type of an
inflammation?
A. *Diphtheroid
B. Serous
C. Catarrhal
D. Croupous
E. Purulent
12. A 65-year-old female with a long history of
chronic glomerulonephritis died from chronic
renal failure. A post-mortem revealed on the
surface of the epicardium and pericardium greywhitish villous membranes. Which pathological
process took place in the pericardium?
A. *Fibrinous inflammation
B. Organization
C. Proliferative inflammation
D. Hemorrhagic inflammation
E. Arterial plethora
13. An elderly man presented to his physician
with the complicated nasal breathing. The
histological investigation of a biopsy from his
nose
septum
revealed
granulomatous
inflammation in the mucosa with groups of large
vacuolated histiocytes containing bacteria
(Mikulicz's cells). What is the most likely diagnosis?
A. *Rhinoscleroma
B. Syphilis
C. Tuberculosis
D. Malleus
E. Lepra
14. An elderly man, with a history of an
operation, presented with a sepsis, developed
on a background of a decreased immune
reactivity of an organism. A disease resulted in
fatal outcome. Microscopical investigation of the
abdominal
wall
revealed
the
diffuse
segmentonuclear leukocyte's infiltration of
intermuscular spaces, edema of a tissue and lysis
of muscle fibers. Define the type of
inflammation?
A. * Phlegmon.
B. Diphtheroid inflammation.
C. Abscess.
D. Necrosis.
E. Catarrhal inflammation.
15. A 64-years-old male died of rheumatism. An
autopsy revealed epicardium covered with
villiform grey color membranes, which were
easily separated from tissues underneath. The
separation of membranes presented an
edematous, hyperemic surface of epicardium.
What type of an inflammation revealed in
pericardium?
A. *Fibrinous pericarditis
B. Purulent pericarditis
C. Hemorrhagic pericarditis
D. Proliferative pericarditis
E. Catarrhal pericarditis
16. A 50-year-old male died of a pulmonary and
cardiac insufficiency. An autopsy revealed in a
left lung a 4 x 4 cm cavity, filled with pus. The wall
of a cavity had a rough pattern, presented by
pulmonary tissue. What is the most likely
diagnose?
A. *Acute abscess
28
Inflammation
B. Chronic abscess
C. Cavernous tuberculosis
D. Hydatidosis
E. Fibrosing alveolitis
B. Coagulative necrosis
C. Caseous necrosis
D. Alterative inflammation
E. Proliferation and derivation of macrophages
17. A post-mortem of a man revealed in his
abdominal cavity approximately 2.0 liters of a
purulent exudate. A peritoneum was found to be
dull, with a grayish tint. The intestinal serous
membranes were
covered with
grayish
membranes, which were removed easily. Which
of the following is the most accurate diagnosis?
A. * Fibro-purulent peritonitis
B. Hemorrhagic peritonitis
C. Serous peritonitis
D. Tuberculous peritonitis
21. A young male presented to his physician with
considerably enlarged, hypere-mic, painful
tonsils. A gross examination of tonsils revealed
dense, dirty-gray membranes on the surface.
These membranes have spread to the hard
palate and were intimately attached to tissues
underneath. An attempt to remove the
membranes resulted in bleeding. Which
pathological
process
indicates
these
morphological changes?
A. *Diphtheroid exudative inflammation.
B. Croupous exudative inflammation.
C. Catarrhal exudative inflammation.
D. Purulent exudative inflammation.
E. Hemorrhagic exudative inflammation.
18.
A
histological
examination
of
the
myocardium of a man, who died from heart
failure, revealed a sclerosis of the pericardial
connective tissue and diffuse infiltration by
lymphocytes, macrophages, plasmocytes and
single neutrophils. What is the most likely type of
inflammation in a heart?
A. * Interstitial productive.
B. Granulomatous.
C. Alterative.
D. Exudative diffuse.
E. Exudative focal.
19. A 28-year-old male presented to the hospital
with a fever and weakness, (asthenia). A biopsy
was taken from one of his enlarged neck lymph
nodes for histological examination. Microscopic
investigation revealed the foci of necrosis,
surrounded
by
epithelioid
cells,
giant
multinuclear
Langhans'
cells
and
also
lymphocytes. What is the most likely diagnosis?
A. *Tuberculosis
B. Hodgkin's disease
C. Lympholeukemia
D. Sarcoidosis
E. Syphilis
20. A microscopic examination of a kidney
biopsy revealed foci with granular, eosinophilic
masses in their centers. These lesions were
surrounded by an infiltrate, consisted of
lymphocytes, epithelioid cells and giant
Langhans1 cells. What is the most likely
pathological process?
A. * Granulomatous inflammation
22. A 38-year-old man, with a history of chronic
pyelonephritis, died from the chronic renal
failure. Medical record showed that an
auscultation in the hospital determined a
patient's "pericardial frictions rub". An'autopsy
revealed a dim, rough, and hairy - like
epicardium. What type of pericarditis presented
in that case?
A. * Croupous
B. Diphtheroid
C. Purulent
D. Ichorous
E. Serous
23. A child presented to a hospital with symptoms
of asphyxia. A physical examination revealed in
the larynx whitish membranes, which obstructed
lumen and were easily separated from tissues
underneath. Name the most probable type of an
inflammation in the larynx?
A. *Croupous inflammation
B. Hemorrhagic inflammation
C. Diphtheroid inflammation
D. Catarrhal inflammation
E. Purulent inflammation
24. A macroscopic investigation of trachea
revealed a dim, hyperemic mucosa, covered
with grey - white membranes. Which one is the
most likely form of the inflammation?
A. *Fibrinous
29
Inflammation
B. Purulent
C. Serous
D. Proliferative
E. Mixed
25. An elderly man presented with a
decomposition of some segments of spongy and
cortical layers of an anticnemion bones. The
cavities are filled with creamy greenish-yellow
masses. What is the type of inflammation?
A. *Purulent
B. Catarrhal
C. Serous
D. Proliferative
E. Mixed
26. A female patient presented to the hospital
with a fever, asphyxia and pain in the right part
of her chest. During a pleurocentesis procedure
700 ml of a viscid yellow-green liquid was
removed. What is the most likely diagnosis?
A. *Empyema of a pleura
B. Carcinomatosis of a pleura
C. Serous pleurisy
D. Fibrinous pleurisy
E. Hemorrhagic pleurisy
27. An autopsy of the 58-year-old man, revealed
in his liver a focus of tissue destruction, 4 cm in
diameter, filled with a yellow-green liquid. What is
the most likely diagnose?
A. * Abscess
B. Phlegmon
C. Anthrax
D. Empyema
E. Granuloma
28. A histological examination of biopsy from the
nose mucous revealed epithelioid cells,
plasmocytes, Mikulicz cells, and eosinophilic
(acidophilic, Russell's) bodies. What is the most
likely diagnosis?
A. * Rhinoscleroma
B. Syphilis
C. Tuberculosis
D. Droplet infection
E. Allergic rhinitis
29. A physical examination of a 5-year-old boy
reveals the fauces and the tonsils enlarged,
plethoric, and coated with irremovable whitish
membranes. Which one of the following
characterizes the changes in the fauces and
tonsils?
A. * Diphtheritic inflammation
B. Caseous necrosis
C. Fibrinous necrosis
D. Croupous inflammation
E. Purulent inflammation
30. A 49-year-old man, with 14 days history of
acute lobar staphylococcal pneumonia in the
left lower lobe of a lung, died of pulmonary and
cardiac insufficiency. A post-mortem revealed in
the upper lobe of a right lung an oval cavity,
approximately 5 cm in diameter, filled with pus
and
connected
with
bronchus.
Which
complication of acute pneumonia took place in
this case?
A. * Abscess of the lung
B. Gangrene of the lung
C. Thromboembolism of a pulmonary trunk
D. Bronchiectasis disease
E. Acute bronchitis
31. An autopsy of an elderly male revealed a
cavity with compacted walls filled with a thick,
greenish liquid, which had a stinking odor. What
is the most likely disease?
A. * Abscess of the lung.
B. Gangrene of the lung.
C. Infarct of the lung.
D. Cavern of the lung.
E. Tuberculoma of the lung.
32. A 62-year-old man died of croupous
pneumonia. A post-mortem revealed in the
pleural cavity an opaque liquid and a grayish
membrane on visceral pleura. What is the most
likely type of inflammation on the visceral
pleura?
A. * Fibrinous inflammation
B. Catarrhal inflammation
C. Purulent inflammation
D. Granulomatous inflammation
E. Hemorrhagic inflammation
33. A 5-year-old child has a fever and pain at
swallowing. A physical examination revealed
enlarged, dark-red palatine tonsils. They were
coated with a grey - yellow membrane which
was intimately attached to the surface of the
tonsils. Which kind of inflammation described in
the tonsils?
30
Inflammation
A. * Diphtheritic inflammation
B. Croupous inflammation
C. Hemorrhagic inflammation
D. Purulent inflammation
E. Catarrhal inflammation
34. An autopsy of a dead body revealed 200 ml
of a viscid yellow-green liquid in the abdominal
cavity. What is the most likely form of exudate
inflammation?
A. * Purulent inflammation
B. Serous inflammation
C. Fibrinous inflammation.
D. Hemorrhagic inflammation.
E. Ichorous inflammation
35. A post-mortem of a young male revealed
congested, thickened, opaque, yellowish-green
meninges. What type of exudative inflammation
these changes are characteristic for?
A. * Purulent inflammation
B. Serous inflammation
C. Hemorrhagic inflammation
D. Fibrinous inflammation
E. Catarrhal inflammation
36. A woman, with a history of her hands' skin
thermal burn, presented to physician painful
blisters, filled with opaque liquid. What is the most
likely type of inflammation?
A. * Serous inflammation
B. Productive inflammation
C. Croupous inflammation
D. Granulomatous inflammation
E. Diphtheritic inflammation
37. A 44-year-old male had a skin biopsy
procedure. Histological investigation of a tissue
sample showed a caseous necrosis surrounded
by infiltrate, consisted from lymphocytes, some
giant cells and the growth of connective tissue.
In addition, the endovasculitis was diagnosed.
What is the most likely pathological process?
A. * Productive granulomatous inflammation.
B. Productive interstitial inflammation.
C. Abscess.
D. Catarrhal inflammation.
E. Serous inflammation
38. A 7-year-old child, with a history of angina,
presented
with
enlarged
paratracheal,
bifurcation and neck lymph nodes. A histological
examination of his neck lymph node revealed
the foci of necrosis, surrounded by lymphocytes,
epithelioid cells and Pirogov-Langhans' cells.
Which one is the most likely pathology?
A. *Tuberculosis
B. Sarcoidosis
C. Rhinoscleroma
D. Malleus
E. Syphilis
39. The histological examination of a lung tissue
revealed a lesion presented with a locus of
necrosis, surrounded by regular lines of
epithelioid, lymphoid cells, plasma cells,
macrophages and giant Pirogov-Langhans' cells.
Define a kind of inflammation?
A. *Tuberculosis inflammation
B. Banal productive inflammation
C. Inflammation at a lepra
D. Exudative inflammation
E. Alterative inflammation
40. A 6-year-old child presented to infectious
disease department with a body temperature
38°C, punctulated, bright red rash on a skin. The
scarlet fever diagnosis is made. The fauces
mucosa was brightly hyperemic, edematous;
tonsils were markedly enlarged, with the dim
yellowish-grayish centers and sites of black color.
What inflammation underlies changes in fauces?
A. *Purulent-necrotic
B. Fibrinous
C. Hemorrhagic
D. Serous
E. Catarrhal
41. A rectoromanoscopy revealed edematous,
reddish color mucosa of rectum and sigmoid
colon, covered with a thick layer of mucus.
Name the kind of inflammation?
A. *Catarrhal
B. Purulent
C. Mixed
D. Hemorrhagic
E. Fibrinous
42 A patient died with symptoms of the brain's
edema and the dislocation of the stem. A postmortem revealed thickened, opaque, grayishgreen color pia mater. Which pathological
process took place in pia mater of meninges?
A. *Diffuse purulent leptomeningitis
31
Inflammation
B. Meningococcal leptomeningitis
C. Tuberculous leptomeningitis
D. Malignant arachnoendomelioma
E. Hydrocephalus
43. A 5-year-old child presented to a hospital
with acute fever (up to 38° C), rhinitis, cough,
lacrimation, and a patchy rash on the skin. His
pharyngeal mucosa was edematous and
hyperemic, with whitish maculae on the cheeks.
What type of inflammation is the background of
described changes?
A. *Catarrhal
B. Purulent
C. Fibrinous
D. Hemorrhagic
E. Serous
44. A 3-year-old child presented to a hospital
with asphyxia. Examination of the larynx revealed
whitish membranes, which occluded a lumen
and easily extracted. Diphtheria was suspected.
Which form of inflammation took place in the
larynx?
A. *Croupous inflammation
B. Catarrhal inflammation
C. Diphtheroid inflammation
D. Serous inflammation
E. Purulent inflammation
45. A 47-year-old male presented with a subfebrile temperature and enlarged lymph nodes.
A biopsy investigation of a lymph node revealed
numerous granulomas with a caseous necrosis in
the centers, surrounded by epithelioid cells, giant
multinuclear Langhans' cells and lymphocytes.
What is the most likely diagnosis?
A. * Tuberculosis
B. Lymphogranulomatosis
C. Lymphosarcoma
D. Lympholeukemia
E. Simple lymphadenitis
46. At a 45-year-old man the biopsy procedure
of his nasal cavity's mucosa was performed. The
diagnosis of rhinoscleroma made. What cells are
typical for the disease?
A. *Mikulicz's cells
B. Pirogov - Langhans' cells
C. Plasma cells
D. Lymphocytes
E. Schaumarm's bodies
47. An autopsy of a 53-year-old male showed
many white, millet sized nodules in his lungs. A
microscopic examination revealed granulomas
with a necrosis in their centers and epithelioid,
lymphoid, plasma cells, macrophages and
numerous large multinucleated cells (Langhans'
cells) on the periphery of a lesion. What is the
most likely form of granuloma?
A. *Giant - cell granuloma
B. Macrophagal
C. Foreign body granuloma
D. Epithelioid cells
48. A patient presented to the hospital with
combustion of his right hand. A physical
examination revealed a desquamation of
epidermis with blisters formation. The blisters were
filled with opaque liquid. What most probable
inflammation described in that case?
A. * Serous
B. Purulent
C. Catarrhal
D. Putrefactive
E. Fibrinous
49. A 43-year-old patient complains of hindered
nasal breaming. Histological investigation of a
biopsy of his nasal cavity mucosa revealed
lymphoid cells, epithelioid cells, plasma cells and
Mikulicz's cells. What is the most likely diagnosis?
A. *Rinoscleroma
B. Glanders (malleus)
C. Tuberculosis
D. Lepra
E. Syphilis
50. A 54-year-old patient complains of
complicated nasal breathing. A nasal mucosa
was thickened. Histological investigation of a
biopsy revealed Mikulicz's cells, epithelioid cells,
plasma cells, lymphoid cells, and hyaline spherelike aggregates. What is the most likely
diagnosis?
A. *Scleroma
B. Adenoviral rhinitis
C. Allergic rhinitis
D. Rhinoviral infection
E. Meningococcal nasopharyngitis
51. A sample of cervix uteri was taken for
histological
examination.
A microscopical
32
Inflammation
investigation revealed a tissue's inflammatory
infiltration with vascular walls involvement of
small vessels, arteries and veins. In addition, there
were also determined a presence of plasma
cells, lymphocytes, epithelioid cells in the infiltrate
and foci of sclerosis and hyalinosis of tissue. What
is the most likely disease?
A. *Syphilis
B. Tuberculosis
C. Leukoplakia
D. Erosion colli uteri
E. Condyloma
55. A 44-year-old man presented to the policlinic
with a local pain in occipital area of a head and
rise of a body temperature there. Gross
investigation of a lesion zone revealed the coneshaped cyanotic infiltration with a yellowgreenish apex, which rose above the surface of
skin. What is the most likely diagnosis?
A. * Furuncle
B. Phlegmon
C. Abscess
D. Carbuncle
E. Empyema.
52. A physical examination of tonsils and soft
palate mucosa revealed white-grey color
membranes, which are intimately attached to
tissues underneath. An attempt to take out
membranes results in formation of a deep tissue
defect. Diagnose pathology on a mucosa of
tonsils and a soft palate.
A. *Diphtheritic inflammation
 Serous inflammation
C. Croupous inflammation
D. Purulent inflammation
E. Mixed inflammation
56. A skin sample was taken for histological
research. Microscopical investigation revealed
granulomas, consisted of macrophages' knots
with adding of lymphocytes and plasma cells.
There were also determined large macrophages
with fatty vacuoles, which contained packed
layers of causative agents of a disease
(Virchow's cells). For what disease the given
description is characteristic?
A. *Lepra
B. Tuberculosis
C. Syphilis
D. Rhinoscleroma
E Glanders (malleus)
53. Histological investigation of a biopsy revealed
a granuloma, consisted of lymphocytes, plasma
cells, macrophages with foamy cytoplasm
(Mikulicz's cells) and numerous hyaline's spherelike aggregates. About what disease it is possible
to think?
A. *Rhinoscleroma
B. Lepra
Ñ Syphilis
D. Tuberculosis
E. Actinomycosis
54. A 40-year-old woman, with a history of the
right palm's burn, presented to her physician an
acute pain, reddening and swelling of a palm. In
a few minutes there was a bubble, filled with
transparent yellowish liquid. The display of what
pathological process the described changes
are?
A. *Exudative inflammation
B. Traumatic edema
C. Alterative inflammation
D. Proliferative inflammation
E. Vacuolar dystrophy
57. Histological investigation of a skin biopsy
revealed granulomas, which consisted of
epithelioid cells, surrounded mainly by Tlymphocytes.
In
addition,
few
giant
rnultinucleated cells (Langhans cells) were
determined among epithelioid cells. The caseous
necrosis was diagnosed within the centers of
granulomas. There was lack of blood vessels.
What is the most likely disease?
A. Tuberculosis
B. Syphilis
C. Lepra
D. Rhinoscleroma
E. Glanders (malleus)
58. A histological investigation of a liver biopsy
revealed granulomas, consisted of plasma cells
and lymphoid cells. Small vessels were
characterized by endo - and perivasculitis. Some
foci of caseous necrosis were also determined.
Such granulomas are typical for:
A. *Syphilis
B. Tuberculosis
C. Lepra
33
Inflammation
D. Rhinoscleroma
E. Glanders (malleus)
59. A young man had a removal of mucous
membrane new growths in his nasal cavity. A
histological
investigation
revealed
diffuse
lymphocytes, plasma cells and macrophages
infiltration. Name the type of inflammation.
A. *Inflammation with formation of polyps
B.
Inflammation
with
formation
pointed
condyloma
C. Interstitial inflammation
D. granulomatous inflammation
E. Exudative inflammation
60. A 4-year-old child presented to his physician
with a cold, high temperature, nausea and
vomiting. He was hospitalized and died in two
days. An autopsy revealed thickened, dim,
edematous, congested, greenish-yellow pia
mater of meninges. What variety of exudative
inflammation developed in pia maters?
A. *Purulent
B. Catarrhal
C. Hemorrhagic
D. Fibrinous
E. Serous
61. A young man was operated because of
phimosis. Histological investigation of a removed
prepuce
revealed
polymorphic
infiltrates,
consisted of randomly located plasmocytes,
epithelioid and lymphoid cells. The vasculitis was
diagnosed in vessels. What disease such
changes are characteristic for?
A. * Syphilis
B. Tuberculosis
C. Actinomycosis
D. Periarteritis nodosa
E. Lepra
62. Microscopic investigation an elderly man's
lungs revealed the foci of necrosis, surrounded
by the bank of epithelioid cells and lymphocytes.
Between lymphocytes and epithelioid cells the
rounded giant cells, with a considerable quantity
of nuclei, located on a periphery of a lesion were
determined. Give the name for these changes:
A. *Tuberculous granuloma
B. Sarcoid granuloma
C. Syphilitic granuloma
D. Lepromatous granuloma
E. Scleromatous granuloma
63. A 6-year-old child presented to department
of infectious diseases with acute pain in a throat,
difficulty at swallowing, rise of body temperature
up to 39°C and edema of neck. A gross oral
investigation revealed enlarged, hyperemic
tonsils, covered with
plenty
of
yellow
membranes, which intimately attached to the
mucous membrane. An attempt to take off
membrane results in deep, bleeding defect
formation. What type of inflammation takes
place?
A. *Diphtheritic
B. Purulent
C. Serous
D. Croupous
E. Hemorrhagic
64. A fragment of a stomach mucosa was taken
for histology during endoscopy procedure. A
microscopic
investigation
revealed
intact
mucous membrane, covered by mucus,
thickened, edematous and hyperemic with a
numerous tiny hemorrhages. Define the type of
acute gastritis?
A. * Catarrhal (simple)
B. Erosive
C. Fibrinous
D. Purulent
E. Necrotic
65. An operatively removed appendix was sent
to pathology department. Macroscopical
investigation
revealed markedly enlarged
appendix. His serous membrane was dim,
congested, covered by fibrin's membranes. The
appendix' walls were thickened. On a cut
section pus in the lumen was detected.
Microscopical investigation showed a plethora of
vessels, edema of all appendixes' layers and
diffuses infiltration by leucocytes. What is the
type of inflammation?
A. *Phlegmonous
B. Apostematous
C. Simple
D. Superficial
E. Gangrenous
66. A 18-year-old girl had a neck lymphatic node
removal at the biopsy procedure. Histological
investigation showed nodules, consisted of banks
34
Inflammation
of epithelioid, lymphoid cells and large
multinucleated cells (Langhans' cells), located
between them. In the centers of nodes a
caseous necrosis was determined. What
causative agent needs to be revealed in the
necrosis zone for making final diagnosis?
A. *Koch's mycobacterium
B. Mycobacterium leprae
C. Treponema pallidum
D. Rickettsia
E. Fungi
67. A young man complains of an itch and a skin
reddening, which has appeared after shaving.
Objectively: a cheek skin is hyperemic; the
blisters, filled with a transparent liquid, were
detected. What character of a liquid in blisters?
A. * Serous exudate
B. Transudate
C. Purulent exudate
D. Mucosal exudate
E. Hemorrhagic exudate
lymphoid cells and few giant multinuclear
Pirogov-Langhans cells. There were also small
vessels with signs of endo- and perivasculitis.
Choose the most likely diagnosis.
A. *Syphilis
B. Tuberculosis
C. Lepra
D. Rinoskleroma
E. Glanders (malleus)
71. An autopsy of 32-year-old male revealed
slightly swollen and hyperemic lungs, covered
with numerous millet-like grayish nodules.
Histological investigation determined lesions
consisted of lymphoid, epithelioid and Langhans
giant cells. What is the most likely diagnosis?
A. *Tuberculosis
B. Croupous pneumonia
C. Bronchopneumonia
D. Interstitial pneumonia
E. Bronchiectatic disease
68. A 4-year-old boy presented to a hospital with
pain in a throat at swallowing and malaise. A
physical examination revealed grayish - whitish
membranes on a pharynx and tonsils on a
background
of
moderate
edema
and
hyperemia. These membranes were intimately
attached to tissues underneath. What pathology
the described changes testify to?
A. inflammation
B. Dystrophy
C. Necrosis
D. Metaplasia
E. Reganerative process
72. An operatively removed appendix was sent
for histological examination. Macroscopical
investigation revealed thickened appendix. His
serous membrane was dim, congested, with
whitish, loose membranes; the lumen contained
turbid, whitish-yellow exudate. Histological study
showed the diffuse neutrophil's infiltration of the
appendix wall. Choose the most likely type of
appendicitis.
A. *Phlegmonous
B. Gangrenous
Ñ Simple
D. Superficial
E. Chronic
69. A 68-year-old man died from meningitis. An
autopsy revealed thickened, congested, dim,
edematous meninges (pia maters), which were
saturated by creamy greenish-yellow exudate.
Define the type of inflammation?
A. *Purulent
B. Serous
C. Fibrinous croupous
D. Fibrinous diphtheritic
E. Hemorrhagic
73. Autopsy of a patient, who died of bilateral
bronchopneumonia, shows in the left lung lower
lobe a cavity 5 cm in diameter, filled with liquid
yellowish-white substance. What complication of
the patient’s pneumonia had developed?
A. Abscess
B. Gangrene
C. Granuloma
D. Sequestrum
E. Tuberculoma
70. Biopsy of an oral cavity's ulcer presented for a
histological
research.
A
microscopical
investigation revealed areas of caseous necrosis,
surrounded
by
plasmocytes,
epithelioid,
74. Microscopy of the puncture sample
obtained from the inflammation focus of
the patient with cutaneous abscess revealed
numerous blood cells of different types.
35
Inflammation
What cells are the first to transfer from
vessels to tissues during inflammation?
A. Neutrophils
B. Monocytes
C. Basocytes
D. Eosinophils
E. Lymphocytes
75. A patient, who had received a thermal burn,
developed painful boils filled with turbid liquid on
the skin. What morphological
type of
inflammation has developed in the patient?
A. Serous
B. Proliferative
C. Croupous
D. Granulomatous
E. Diphtheritic
76. A patient suffers from high fever, apnoea,
pain in the thorax on the right. Pleurocentesis
yielded 700 ml of yellowgreen viscous liquid.
Make the diagnosis:
A. Pleural empyema
B. Bronchial pneumonia
C. Serous pleurisy
D. Hemorrhagic pleurisy
E. Pleural carcinomatosis
77. During autopsy approximately 2,0 liters of pus
have been found in the abdominal cavity of the
body. Peritoneum is dull and of grayish shade,
serous tunic of intestines has grayish-colored
coating that is easily removable. Specify the
most likely type of peritonitis in the patient:
A. Fibrinopurulent peritonitis
B. Hemorrhagic peritonitis
C. Serous peritonitis
D. Tuberculous peritonitis
78. A 7-year-old child has acute onset of
disease: temperature rise up to 38oC, rhinitis,
cough, lacrimation, and large-spot rash on the
skin. Pharyngeal mucosa is edematous,
hyperemic, with whitish spots in the buccal area.
What kind of inflammation caused the changes
in the buccal mucosa?
A. Catarrhal inflammation
B. Suppurative inflammation
C. Fibrinous inflammation
D. Hemorrhagic inflammation
E. Serous inflammation
79. During autopsy of a man, who died of acute
transmural cardiac infarction, the following has
been detected on the pericardium surface:
fibrous whitish-brown deposit connecting parietal
and visceral pericardial layers. What kind of
inflammation occurred in the pericardium?
A. Croupous
B. Diphtheritic
C. Serous
D. Suppurative
E. Granulomatous
80. At the post-mortem examination the stomach
of a patient with renal failure was found to have a
yellow-brown coating on the thickened mucosa.
The coating was firmly adhering to its surface
and had significant thickness. Microscopy
revealed congestion and necrosis of mucosal
and submucosal layers, fibrin presence. What is
the most likely diagnosis?
A. Fibrinous gastritis
B. Croupous gastritis
C. Gastric abscess
D. Esogastritis
E. Corrosive gastritis
81. Autopsy of a 28-year-old patient, who had
been suffering from rheumatism and died of
heart failure, revealed pancarditis. Histological
investigation of myocardium of the left ventricle
posterior wall and interventricular septum
detected perivascular cellular focal infiltrates
composed of macrophages and creating
palisade structures surrounding areas of fibrinoid
necrosis. Determine the type of myocarditis:
A. Granulomatous
B. Diffuse interstitial productive
C. Diffuse interstitial exudative
D. Focal interstitial exudative
82. Regional lymph nodes surrounding an
infected wound are enlarged. Histological
examination shows increased number of
macrophages, lymphocytes, and lymphatic
follicles in the cortical layer of the lymph nodes,
as well as a large amount of plasma cells. What
process in the lymph nodes is indicated by these
histological changes?
A.* Antigen stimulation
B. Neoplastic aberration
36
Inflammation
C. Transplant rejection
D. Congenital deficiency of lymphoid tissue
E. Acquired deficiency of lymphoid tissue
83. A 39-year-old man underwent a surgery for
peptic ulcer disease of the stomach. He died 7
days after the surgery. On autopsy the peritoneal
layers are plethoric, dull, and covered with
massive yellow-green membranous deposits. The
peritoneal cavity contains approximately 300 mL
of thick yellow-green fluid. What pathologic
process was detected in the peritoneal cavity?
A.* Fibrinopurulent peritonitis
B. Serous peritonitis
C. Fibrinohemorrhagic peritonitis
D. Serofibrinous peritonitis
E. Peritoneal commissures
84. Autopsy of a 58-year-old man, who for a long
time has been drinking alcohol in large amounts
and died at home, is being conducted.
Macroscopically the right lupg is dense and
enlarged, its tissue is gray and homogeneous on
section, its pleura is covered with grayish
membranous deposits. Microscopically the
alveolar
cavities
contain
fibrin
threads,
neutrophils, and hemolysed erythrocytes. Make
the diagnosis:
A.* Croupous pneumonia
B. Interstitial pneumonia
C. Caseous pneumonia
D. Focal pneumonia
E. Primary pulmonary tuberculosis
85. Histological analysis of a biopsy skin sample
obtained from a 24-year-old patient detects
caseous necrosis surrounded with cellular
infiltrate consisting of lymphocytes, among which
there are single giant cells; proliferation of
connective tissue and endovasculites are
observed. Characterize this pathologic process:
A.* Proliferative granulomatous inflammation
B. Proliferative interstitial inflammation
C. Abscess
D. Ichorous inflammation
E. Catarrhal inflammation
37
Immunopathology
Immunopathology
1. A 15 year old boy died of the heart failure. He
had a history of rheumatic heart disease in his
medical record. Histological investigation of the
left auricle of the heart revealed the rheumatic
granuloma (the Aschoff-Talalayev body) with a
central fibrinous focus associated, with a
perimeter plasma cells, macrophages and giant
cells. Which of following best describe the type
of immune response?
A. *Cell mediated (Type IV, delayed hyper
sensitivity reaction)
B. Anaphylactic (Type I, immediate)
C. Cytolytic (Type II, immediate)
D. Immune complex (Type III, immediate)
E. Reaction of transplant rejection.
2. A 4-yers-old boy presents with multiple
malformation of craniofacial bones. He died
soon
due
to
sepsis,
resulted
from
bronchopneumonia. Blood test revealed the
immunoglobulins within normal range. At autopsy
the thymical aplasia was identified. Name the
main cause of death.
A. *Cellular immunodeficiency
B. Combined immunodeficiency
C. Secondary immunodeficiency
D. Acute leukemia
E. Chronic intoxication
3. A 48-year-old women with asthma presents
with viral respiratory infection. The infection
caused a status asthmaticus with a fatal
outcome. Histological investigation of lung tissue
revealed a contracted bronchus and a luminal
plug containing mucus and cell debris. The
submucosa was edematous and contained a
mixed inflammatory infiltrate, including a lot of
eosinophils and degranulated must cells. What is
the mechanism of hypersensitivity presented in
this case?
A. *Humoral immunity (Type I, anaphylactic
reaction)
B. Inflammatory reaction
C. Autoimmune reaction
D. Immune complex reaction (Type III of
reaction)
E. Cell-mediated immunity (Type IV of reaction)
4. A young man presents with the enlargement
of the regional lymph nodes next to his inflamed
wound, Histological investigation of the lymph
node biopsy revealed the increased number of
macrophages, lymphocytes and lymphoid
follicules within cortex zone. Plasma cells number
also increased. These alterations are most likely
result of:
A. * Antigen stimulation
B. The acquired insufficiency of lymphoid tissue
(secondary immunodeficiency state)
C. Hereditary immunodeficiency state
D. Neoplastic transformation
E. Hypersensitivity reaction
5. A newborn died after 3 days of life, as a result
of a lethal outcome of intrauterine pneumonia.
At autopsy a newborn is sound have a great
reduction of his thymic weight and it's sizes.
Histological investigation of thymus revealed the
unclear boundary between cortex and medulla
zone as a result of lymphocytes amount
reduction. A few Hassall corpuscles were found.
They were focally keratinized and had
concentric aggregated of epithelial cells. The
gland was also exhibited lobe atrophy and
sclerosis. What pattern of reaction did the thymus
demonstrate?
A. *Accidental thymus transformation (involution)
B. Thymus atrophy
C. Thymus hypotrophy
D. Thymus aplasia (agenesis)
E. Thymus neoplasia
6. A 3-monm-old child died because of sepsis. An
autopsy revealed thymic hypoplasia, both sizes
and mass of spleen reduction. Histologically, in
spleen there was lack of the periarterial follicular
T-zone and remarkable absence of cells at a red
spleeny pulp. Lymph nodes investigation showed
also absence of cells within paracortical (T-cells
area). B-cells areas in immune system organs
looked normal. What term best characterizes
described above changes?
A. Di George's syndrome
B. Combined immunodeficiency syndrome
C.
Bruton's
disease
(X-linked
agammaglobulinemia)
D. Accidental thymus transformation
E. Acquired immunodeficiency syndrome (AIDS)
38
Immunopathology
7. A morphological investigation of a kidney graft
revealed a diffuse stromal infiltration by
lymphocytes,
plasmocytes,
lymphoblasts,
plasmablasts, and also a necrotic arteritis. What
pathology has developed in a graft?
A. *Immunological graft rejection
B. Glomerulonephritis
C. Ischemic kidney damage
D. Tubular necrosis
E. Pyelonephritis
8. 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?
A. * Immune complex mechanism
B. Granulomatous mechanism
C. Antibody-mediated mechanism
D. Reagin-mediated mechanism
E. Cytotoxical mechanism
9. At 46-year-old patient with autoimmune
gastritis a biopsy was taken. Histologically, there
was an infiltration by lymphocytes and
macrophages of a gastric mucous membrane.
What type of hypersensitivity presented in that
case?
A. * Type IY (cell-mediated hypersensitivity)
B. Type II (reagin type)
C. Type II (antibody-mediated cytotoxicity)
D. Type III (immune complex cytotoxicity)
E. Type V (granulomatous)
A. Cellular cytotoxicity
B. Reagin cytotoxicity
C. Antibody cytotoxicity
D. Granulomas formation
E. Immune complex
12. A 6-year-old child had the Mantoux test. In 3
days there was an inflammatory induration and a
reddening of a skin 15 mm in diameter. That was
considered as the positive test. What type of
hypersensitivity reaction presented in that case?
A. *Hypersensitivity of slow type
B. Immune complex hypersensitivity
C. Complement-mediated cytotoxicity
D. Hypersensitivity immediate type E.
13. Physical examination of a pregnant woman
with an Rh-negative blood revealed a high level
of antierythrocyte antibodies. The cutaneous flap
of her Rh-positive husband applied for
depression of antibodies. In 2 weeks a flap was
rejected. Microscopical investigation showed a
disturbance of blood circulation, edema and
cellular infiltration mainly by lymphocytes,
neutrophils and macrophages. What is the most
probable pathology?
A. *Transplantation immunity
B. Hypersensitivity reaction immediate type
C. Hypersensitivity reaction slow type
D. Granulomatous inflammation
E. Interstitial inflammation
10. Histological investigation of a lymph node
revealed a considerable quantity of the
enlarged lymphoid follicles with big germinal
centers, and plenty of mitotic figures. What
pathology these changes are characteristic for?
A. *Antigen stimulation with follicle hyperplasia
B. Atrophy of lymphoid tissue
C. Lymphosarcoma
D. Lymphogranulomatosis
E. Lympholeukemia
14. A 3-year-old child died of an acute
destructive
staphylococcal
pneumonia.
Macroscopically, thymus mass reduced to 3,0 gr.
Microscopical investigation of thymus showed
reduction of lobules, considerable decline of
lymphocytes quantity, stromal collapse, and
inversion of layers with cystic enlargement of the
Hassal's bodies. What is the most likely diagnosis?
A. *Accidental thymus involution
B. Thymomegaly
C. Thymus hypoplasia
D. Thymus dysplasia
E. Thymus agenesia
11. A child had a subcutaneous injection of
tuberculin for a testing. Twenty-four hours later a
physical examination revealed the expressed
hyperemia and induration of tissues in the place
of injection. What was the mechanism of these
changes?
15. The experiment animal with a history of
previous sensibilization received the next
subcutaneous dose of antigen. In the place of
injection a fibrinous inflammation with alteration
of vessels walls, matrix and fiber structures of
connective tissue (mucoid and fibrinoid swelling)
39
Immunopathology
and fibrinoid necrosis developed. What
immunological reaction takes place?
A. * Hypersensitivity reaction immediate type
B. Hypersensitivity reaction slow type
C. Reaction of transplantation immunity
D. Normergic reaction
E. Granulomatosis
was normal. What kind of an immunodeficiency
developed in that case?
A. *Brutone syndrome
B. Neselof syndrome
C. Severe combined immunodeficiency
D. Di-George syndrome
E. Viskotta-Oldrich syndrome
16. A man with a history of bronchial asthma
died of asphyxia. Microscopical investigation of
lungs revealed excess of mucus with lots of
eosinophils in the bronchial lumen, sclerosis of
interalveolar septas and alveoli dilatation. What
mechanism
of
hypersensitivity
reaction
presented in that case?
A. *Reagin reaction
B. Cytotoxic reaction
C. Immune complex reaction
D. Cytolysis, conditioned by lymphocytes
E. Granulomatosis
20. A patient with a history of serious radioactive
irradiation had bone marrow transplantation. In 2
months a rush on the skin and diarrhea
developed. Clinical and laboratory tests showed
hepatic insufficiency, local necrosis of the skin's
epithelial cells, intestinal crypts and liver
parenchymal cells. What was the reason for
symptoms aggravation?
A. * "Graft against the owner" disease
B. Sepsis development
C. An acute graft rejection
D. A chronic graft rejection
E. An exacerbation of a chronic hepatitis
17. The infiltration anesthesia by ultracain with
adrenaline solution has been done to a young
man. Then redness, edema of the skin with itchy
blisters suddenly developed. What type of
hypersensitivity took place?
A. * Anaphylaxis
B. Cytotoxicity
C. Immune complex damage
D. Hypersensitivity slow type
E. Granulomatosis
18. A 33-year-old patient with a history of acute
tonsillitis presented with the urinary syndrome
(haematuria, proteinuria and leukocyturia).
Kidneys biopsy revealed an intracapillary
proliferative
glomerulonephritis.
Electronic
microscopy determined large subepithelial
deposits. What is the pathogenesis of this
disease?
A.*Immune complex mechanism
B. Atopy
C. Cytotoxic, cytolytic action of antibodies
D. Cellularally caused cytolysis
E. Granulomatosis
19. A 10-month-old child has developed
pneumonia. Clinical and laboratory tests
revealed absence of mature B-lymphocytes in
peripheral blood and in B-zones of lymph nodes,
acute reduction of immunogiobulins in serum. In
peripheral blood a total quantity of lymphocytes
21. A 7-month-old child died of severe
pneumonia
complicated
by
sepsis.
A
postmortem revealed an absence of thymus. In
lymph nodes there were no lymphoid follicles
and cortical substance, in a spleen follicles were
markedly reduced, germinal centers were
absent. What is the most likely diagnosis?
A. *Thymus agenesia
B. Thymus aplasia
C. Thymus atrophy
D. Thymus hypoplasia
E. Acidental thymus involution
22. A 1 -year-old child died of a relapsing
pneumonia. A post-mortem revealed hypoplasia
of a thymus and peripheral lymphoid tissue,
atrophy of cerebellum cortex, angiotelectasis of
bulbar
conjunctiva.
Immunohistochemistry
revealed decreased level of immunoglobulins.
What is the most likely disease?
A. * Louis-Bar's syndrome
B. Di-George syndrome
C. Nezelof syndrome
D.West's syndrome
E. Brutone syndrome
23. A 20-year-old woman died of postnatal
sepsis. A post-mortem revealed enlarged
congested spleen with abundant curettage from
a cut section. Microscopical investigation
40
Immunopathology
showed
hyperplasia
and
infiltration
by
plasmocytes of the red pulp and spleen's follicles.
The red pulp was also rich with macrophages.
What pathology resulted in spleen's alteration?
A. * Antigenic stimulation of an organism
B. Hereditary insufficiency of a peripheric
lymphoid tissue
C. Reaction of hypersensitivity of immediate type
D. Reaction of hypersensitivity of the slowed type
E. Autoimmunization
24. Microscopical investigation of arterioles
showed plasmatic saturation, mucoid and
fibrinoid swelling, fibrinoid necrosis of walls, diffuse
infiltration by lymphocytes, plasmocytes and
monocytes. In addition, the focal proliferation of
hystiocytes, endotheliocytes and pericytes were
determined. The final diagnosis was the
"periarteritis nodosa". What type of inflammation
took place in arterioles?
A. * Acute immune inflammation
B. Acute not immune inflammation
C. Focal exudative inflammation
D. Diffusive exudative inflammation
E. Fibrinous inflammation
25. During operation of kidney transplantation in
15
minutes
after
vascular
anastomoses
application, transplant became flabby, cyanotic
and spotty; the pulsation was absent.
Microscopical investigation of a kidney specimen
revealed periendothelial
accumulation of
neutrophils in glomeruli vessels. In addition there
were also a thrombosis and necrosis of some
glomeruli. Specify the type of graft rejection.
A. *Hyperacute rejection
B. Accelerated rejection
C. Acute intersticial rejection
D. Acute vascular rejection
E. Chronic rejection
26. On autopsy of a 40-year-old woman, who
had been suffering from rheumatoid arthritis, her
liver is found to be dense and enlarged. On
dissection its tissue is red-brown colored, with
enlarged follicles resembling semi-transparent
grayish-white granules. What is the most likely
pathological process?
A. Sago spleen
B. Sugar-coated spleen
C. Lardaceous spleen
D. Splenic hyalinosis
E. Porphyry spleen
27. After sensitization a test animal received
subcutaneously a dose of antigen. At the site of
injection a fibrinous inflammation developed with
alteration of vessel walls, basal substance, and
fibrous structures of connective tissue. The
inflammation took form of mucoid and fibrinoid
degeneration, fibrinoid necrosis. What immune
response occurred in the test animal?
A. Immediate hypersensitivity
B. Delayed hypersensitivity
C. Transplantation immune reaction
D. Normergic reaction
E. Granulomatosis
28. A 22-year-old woman ate some seafood. 5
hours later her torso and distal parts of her limbs
developed small itchy papules which were
partially fused together. One day later the rash
disappeared
spontaneously.
Specify
the
hypersensitivity mechanism underlying these
changes:
A. Atopy (local anaphylaxis)
B. Systemic anaphylaxis
C. Cellular cytotoxicity
D. Immune complex hypersensitivity
E. Antibody-dependent cell-mediated cytolysis
29. Regional lymph nodes surrounding an
infected wound are enlarged. Histological
examination shows increased number of
macrophages, lymphocytes, and lymphatic
follicles, as well as a large amount of plasma
cells, in the cortical layer of the lymph nodes.
What process in the lymph nodes is indicated by
these histologic changes?
A. Antigen stimulation
B. Acquired deficiency of lymphoid tissue
C. Congenital deficiency of lymphoid tissue
D. Neoplastic aberration
E. Transplant rejection
30. A patient with clinical signs of a primary
immunodeficiency has functionally disturbed
mechanism of antigen-presentation to the
immunocompetent cells. What cells are likely to
have structural defects?
A. Macrophages, monocytes
B. T-lymphocyte
C. B-lymphocyte
D. Fibroblasts
41
Immunopathology
E. O-lymphocytes
31. When examining a biopsy material obtained
from the thyroid gland, the pathologist
discovered lymphocyte infiltration of the thyroid
tissues and destruction of the parenchymal
elements. Diffuse lymphocyte infiltration with
lymphoid follicles was detected in the stroma.
What is the most likely diagnosis?
A. Hashimoto’s thyroiditis (chronic lymphocytic
thyroiditis)
B. Papillary thyroid cancer
C. Undifferentiated thyroid carcinoma
D. Solid adenoma of the thyroid
E. Graves’ disease (toxic diffuse goiter)
32.
During
pathomorphological
renal
investigation of a patient, who for a long time
had been suffering from osteomyelitis and died
of progressing renal failure the following was
revealed: deposits of homogeneous eosinophilic
masses in glomerular mesangium, arterial and
arteriolar walls, and stroma, which colored red
when stained with Congo red. What pathological
process is this?
A. Amyloidosis
B. Mucoid swelling
C. Calcinosis
D. Carbohydrate degeneration
E. Hyalinosis
42
Adaptation and Compensation
Adaptation and compensation
1. A young male complains of diminishing leg
muscles in size and volume as a result of the
complicated femoral fracture. The innervations
of the muscles was not lost. Name the type of
atrophy?
A. * Disuse atrophy
B. Degeneration atrophy
C. Ischemic atrophy
D. Atrophy due to compression
E. Atrophy due to chemical and physical
influence.
2. At autopsy a male is found to have big kidneys
with marked dilatation of the renal pelvis and
calyces filled with transparent liquid. A thinning of
the renal parenchyma accompanied above
lesions. Which is the most likely finding?
A. *Hydronephrosis
B. Glomerulonephritis
C. Amyloidosis
D. Tuberculosis
E. Pyelonephritis
3. An autopsy of an elderly male revealed the
atherosclerosis
of
the
brain
arteries
accompanied with the thinning of the brains
cortex. Name the cause of the atrophy?
A. *Ischemia
B. Compression
C. Chemical and physical factors
D. Loss of innervations
E. Decreased workload
4. A 62-yer-old male died at the hospital after
developing heart failure. At autopsy the weight
of the heart was 500gm, with thickened right
ventricular wall and dilated chamber. Name the
alteration at the right ventriculum.
A. * Hypertrophy
B. Hyperplasic alteration due to inflammation
C. Metaplasia
D. Atrophy
E. Sclerosis
5. A young male presents with a large and
lacerated wound covered with pus. The
peripheral zone of the tissue defect was filled
with large amount of granulation tissue. Name
the type of healing?
A. * Healing by first intention
B. Healing by second intention
C. Healing under a scab
D. Covering a tissue defect with epithelial cells
E. Organization followed by scarring
6. An autopsy revealed marked enlargement of
a kidney. Gross examination of a kidney's section
presented with dilation of both renal pelvis and
calyces resulted from renal stones. What from
diagnoses is most faithful?
A. *Hydronephrosis
B. Simple cysts
C. Pyelonephritis
D. Benign nephrosclerosis
E. Polycystic kidney disease
7. A physical investigation of an elderly man with
history of esophagus cancer with stenosis but
without metastasis revealed an atrophy of
skeletal muscles and subcutaneous fat tissue. Skin
was grayish-brown color, an epidermis was
thinned, and size of the heart decreased.
Myocardium and liver also had a brown coloring.
What is the most likely diagnosis?
A. * Alimentary cachexia.
B. Myasthenia.
C. Cancer cachexia
D. Brown atrophy.
E. Addison disease
8. At the man with long history of smoking the
bronchial biopsy is taken. Microscopical
investigation showed the thickened mucous
membrane with chronic inflammation and
transformation of ciliated epithelium into
stratified one. What pathology such changes are
characteristic for?
A. *Metaplasia
B. Íóperplasia of epithelium
C. Planocellular cancer
D. Leukoplakia
E. Hypertrophy of epithelium
9. A patient with a history of frequent hemorrhoid
bleeding died of acute myocardial infarction. A
post-mortem revealed a red, succulent bone
marrow of a hip diaphysis. What pathology
developed in a bone marrow?
A. *Compensatory hyperplasia
B. Vicarious hypertrophy
C. Hypertrophy excrescences
D. Hormonal hyperplasia
43
Adaptation and Compensation
E. Work hypertrophy
10. A 59-year-old patient with a history of
prostate glandular hyperplasia operated in the
urology. An operation revealed a thickening of a
urinary bladder wall up to 1 cm. It may be
caused by:
A. *Work hypertrophy
B. Vicarious hypertrophy
C. Hormonal hypertrophy
D. Hormonal hyperplasia
E. Protective hyperplasia
11. A 7-year-old child presented with a
poliomyelitis. His somatic muscles are weak, their
volume is reduced, and skin is dry and pale.
Choose the most likely pathology, which takes
place in the soft tissues?
A. *Atrophy.
B. Hypertrophy.
C. Hyperplasia.
D. Metaplasia.
E. Hypoplasia.
12. An elderly man with a long history of smoking
presented with a cough accompanied by viscid
mucous sputum, weakness after the insignificant
physical activity and pale color of the skin. He
lost 12.0 kg of weight for the last two months.
Microscopical investigation of endoscopic
biopsy showed squamous cell carcinoma. What
pathology preceded the tumor formation?
A. *Metaplasia.
B. Hypoplasia.
C. Hyperplasia.
D. Necrosis.
E. Sclerosis.
13. A 48-year-old patient with a history of a
hypertensive disease died of heart failure. An
autopsy revealed an enlarged heart with dilated
chambers. A thickness of the left ventricle wall
was 2,5cm. Microscopically myocardial cells
were considerably enlarged, with fatty dystrophy
and hyperchromic barrel-shaped nuclei. What is
the most likely pathology diagnosed in a heart?
A. *Excentric hypertrophy
B. Myocarditis
C. Concentric hypertrophy
D. Angiogenic cardiosclerosis
E. Cardiomyopathy
14. A 60-year-old man has a history of chronic
bronchitis. Histological investigation of bronchus
biopsy showed thinned mucous membrane,
cystic transformation of mucous glands, and
replacement of prismatic epithelium on stratified
one. What of the listed pathological processes
the most likely?
A. * Metaplasia.
B. Hyperplasia.
C. Heterotopia.
D. Heteroplasia.
E. Displasia.
15. Microscopical investigation of tissue from the
edge of a chronic gastric ulcer showed necrosis,
granulation tissue, abundant development of
connective tissue and metaplasia of epithelium.
What type of pathology takes place in that
case?
A. *Pathological regeneration with disorder of
phases.
B. Hypertrophy.
C. Physiology regeneration.
D. Reparative regeneration (substitution).
E. Reparative regeneration (restitution).
16. At a patient with a chronic cystitis biopsy of
urinary
bladder
mucosa
was
taken.
Microscopical
investigation
revealed
a
transitional epithelium with foci of stratified
epithelium without keratinization. What process
underlies the described changes in an
epithelium?
A. *Metaplasia
B. Dystrophy
C. Hyperplasia
D. Dysplasia
E. Hyperkeratosis
17. After traumatic damage of a liver,
subsequently there was complete hepatic
structural and functional restoration. Name the
type of regeneration?
A. *Restitution
B. Incomplete regeneration
C. Pathological regeneration
D. Physiological regeneration
E. Substitution
18. At a patient with chronic bronchitis biopsy of
bronchus mucous membrane was taken.
Microscopical investigation revealed the areas
44
Adaptation and Compensation
of stratified epithelium without keratinization.
What pathology takes place in the mucous
membrane of bronchus?
A. *Metaplasia
B. Atrophy
C. Hypeiplasia
D. Dysplasia
19. A 42-year-old woman presented to the
gynecologist with acyclic, profuse hemorrhagic
discharge. A histological investigation of a
curettage material revealed increased quantity
of glands and their cystic dilation. What is the
most likely diagnosis?
A. * Endometrial hyperplasia
B. Endometrial atrophy
C. Endometrial hypertrophy
D. Metaplasia
E. Organization
20. A post-mortem of a 64-year-old woman with
a long story of hypertensive disease revealed
considerably diminished, dense kidneys with a
fine-grained surface. What pathology such
changes are characteristic for?
A. * Blood insufficiency atrophy
B. Atrophy from pressure
C. Senile atrophy
D. Dysfunctional atrophy
E. Hypoplasia
21. An elderly man died of cardiac insufficiency.
Twenty years ago he had the right lung
pulmonectomy because of a cyst. A postmortem revealed an enlarged left lung.
Diagnose pathology in the left lung.
A. *Vicarious hypertrophy
B. Neurohumoral hypertrophy
C. Dysfunctional atrophy
D. Dyscirculatory atrophy
E. Neurotic atrophy
22. A 42-year-old man had a lower extremity
amputation. After a while painful knots
appeared
in
a
stump.
Microscopical
investigation revealed amputation neuromas.
What pathology such changes are characteristic
for?
A. *Pathological regeneration
B. Complete reparative regeneration
C. Inflammation
D. Incomplete reparative regeneration
E. Metaplasia
23. A 38-year-old woman presented with
complaints about the frequent uterine bleeding.
The diagnostic curettage was performed. A
histological investigation of a curettage material
revealed increased quantity of coiled glands,
some of them were with cystic dilation. What
pathology these changes are characteristic for?
A. *Glandular-cystic hyperplasia.
B. Atrophy
C. Metaplasia
D. Dysplasia
E. Hypertrophic vegetations
24. A man had the right lung pulmonectomy
because of a tumor 7 years ago. Then the
volume of the left lung increased on 40%. What
process developed in the left lung?
A. *Vicarious hypertrophy
B. Neurohumoral hypertrophy
C. False hypertrophy
D. Work hypertrophy
E. Hypertrophic vegetation
25.
A
histological
investigation
of
an
endometrium revealed coiled extended glands
with 'saw-' and a 'spin-like' pattern. A strornal
proliferation with hyperplasia of its cells was also
determined. What is the most likely diagnosis?
A. * Glandular hyperplasia of endometrium
B. Acute endometritis
C. Leiomyoma
D. Hydatidiform mole
E. Placental polyp
26. A patient presented with small knots on a thin
peduncle
in
his
rectum.
Microscopical
investigation of the biopsy material revealed a
growth of connective tissue and glands. What is
the most likely pathology?
A. *Hyperplastic polyp.
B. Hypertrophy.
C. Metaplasia.
D. Atrophy.
E. Sclerosis.
27. The biopsy of central bronchus mucosa of
miner is taken. Microscopically, there is a
transformation of a cylindrical epithelium to the
mature stratified one. What pathology such
changes are characteristic for?
45
Adaptation and Compensation
A.* Metaplasia
B. Hyperplasia
C. Leukoplakia
D. Dysphasia
E. Reparative regeneration
28. The biopsy of a vaginal portion of uterus
cervix is taken. There is an augmentation of
quantity of cells, rising of mitotic activity and
alteration of polarity of cells in basal part of an
epithelial layer. What pathology such changes
are characteristic for?
A.* Dysphasia
B. Metaplasia
C. Atrophy
D. Acantosis
E. Hyperplasia
29. A 40-year-old man has a keloid scar after a
treatment of the left arm burn. This process may
be an example of:
A. *Pathologic regeneration
B. Hyperplasia
C. Metaplasia
D. Reparative regeneration
E. Vicarious hypertrophy
30. Histological investigation of the uterine
scrape of the 45-year-old woman with disturbed
ovarian menstrual cycle revealed increased
number of endometrial glands, some of which
are serrated, while others are dilated and cystlike. Make the diagnosis:
A. Endometrial cystic glandular hyperplasia
B. Placental polyp
C. Atypical endometrial hyperplasia
D. Glandular endometrial polyp
E. Endometrial adenocarcinoma
31. Section shows significant enlargement of the
patient’s right kidney. There is a nephrolith at the
place of incision. Renal pelvic lumen is distended
with accumulating urine. Renal parenchyma is
acutely thinned out. What is the most correct
diagnosis?
A. Hydronephrosis
B. Pyelectasis
C. Hydroureteronephrosis
D. Renal cyst
E.Nephroblastoma
46
Epithelial tumors
Epithelial tumors
1. A teenager male presents with slowly
enlarging, painless nodule on his right hand's skin.
Microscopic examination of removed lesion
revealed an increased number of epithelial
layers, with a stroma underneath, with
developed a papilloma-tous pattern. Identify
most likely type of atypia?
A. * Tissue
B. Cellular.
C. Metabolic.
D. Functional.
E. Hystochemical
2. A 35 year-old female with a family history of
colon
cancer inquires about screening.
Colonoscopy revealed a tumor and a tissue
sample was taken for histology. Microscopic
investigation has shown cells were arranged in
glandular-like
pattern.
They
exhibit
cell
pleomorphism, atypia, invasive growth and
pathologic mitosis's. What is the most likely
diagnose?
A. *Adenocarcinoma
B. Basal-cell carcinoma
C. Solid carcinoma
D. Mucous carcinoma
E. Undifferentiated carcinoma
3. A 50-year-old female is found to have a urinary
bladder neoplasm. Biopsy investigation revealed
that tumor consists of thin, branching out
papillae, covered with few layers of transitional
cell epithelium. What is the most likely diagnose?
A. *Papilloma
B. Basal cell
C. Transitional cell carcinoma
D. Squamous cell carcinoma
E. Fibroadenoma
4. A 60-year-old postmenopausal woman has
been feel unhealthy and weak for about 3
month. A gross investigation of her cervix uteri
revealed a lesion and a biopsy from this area
was obtained. Microscopically, a lesion
composed of atypical squamous cell, many of
them displayed pathological mitoses. Keratin
pearl formation was also observed histologically.
What is the most likely diagnose?
A.
*
Squamous
cells
carcinoma
keratin³sation
B. Transitional cell carcinoma
C. Squamous cells without keratinisation
D. Adenocarcinoma
E. Anaplastic carcinoma
with
5. A 48-year-old woman complains to her doctor
of
uterine
bleeding. Endometrial
biopsy
investigation revealed a presence of glandforming cells with enlarged hyperchromic nuclei,
cell atypia, abnormal mitoses. These cells were
also determined at myometrium. What term most
correctly identifies this pathological process?
A. * Adenocarcinoma of uterus.
B. Adenomatous endometrial hyperplasia.
C. Acute endometritis.
D. Placental polyp.
E. Chorionepitelioma of uterus.
6. A 39-year-old woman presented in oncology
with a stomach cancer. Physical investigation
revealed
metastatic
tumors
in
ovaries
(Krukenberg tumors). What is most likely pattern
of spread in that case?
A. * Lymphatic retrograde
B. Lymphatic orthograde
C. Gematogenous
D. Implantation
E. Along epithelium-lined surfaces
7. A 23-year-old female decided to have a
surgeon's removal of a small nodule at her leg's
skin. An operation material delivered to
pathology
department.
A
histological
examination of a new growth has shown that
parenchyma has been formed of integumentary
epithelium with an increased amount of layers.
Strorna together with epithelial proliferation forms
papillae. What is the most likely form of atypism?
A. *Tissue.
B. Cellular.
C. Histochemical.
D. Functional.
E. Metabolic.
8. A 45-year old male with a family history of a
gastric cancer inquires about screening. A
gastroscopic examination of a patient revealed
a pedunculated tumor mass 1.5 cm in diameter
in the area of the lesser curvature of stomach.
What kind of growth does the tumor have?
47
Epithelial tumors
A. *Exophytic.
B. Expansive.
C. Infiltrating.
D. Appositional.
E. Endophytic.
9. A 70 year-old male is found to have a nodule
at his right bronchus mucous membrane. A
microscopic examination of the biopsy material
from the tumor revealed the cell and tissue
atypism, keratin pearls formation. What is the
most likely pathologic process at biopsy
material?
A. *Malignant tumor.
B. Benign tumor.
C. Hyperplasia.
D. Metaplasia.
E. Hypoplasia.
10. A 57-year-old postmenopausal woman is
found to have a chronic nonhealing lesion at her
portio vaginalis uteri.A biopsy was taken form this
area. A histological examination of the biopsy
material revealed a cellular atypism within
epithelial layer, but basic membrane was
unchanged. What is the most likely diagnosis?
A. *Carcinoma in situ.
B. Erosion.
C. Adenocarcinoma.
D. Papillorna.
E. Endometriosis.
11. A 15-year-old boy is found to have a small,
dense, nodule at his right forearm skin. Grossly it
had a papillary surface, which looked like a
cauliflower. Microscopically, the tumor consists of
many
papillae.
Parenchyma
formed
of
integumentary epithelium with an increased
amount of layers. The polarity of epithelial cells,
their stratification and membrane wholeness are
preserved. A connective tissue forms a stroma
within a center of papillae. What is the most likely
diagnosis?
A. *Papilloma.
B. Fibroma.
C. Adenoma.
D. Fibroadenoma.
E. Cystadenoma.
12. A 66-year old male lost his appetite and has
been loosing his weight for about 5 months. X-ray
study revealed a stomach neoplasm. Histological
examination of a tumor's biopsy showed a great
amount of signet-ring cells. Name the histological
variant of cancer.
A. * Adenocarcinoma.
B. Solid carcinoma.
C. Sarcoma.
D. Mucinous carcinoma.
E. Carcinoid.
13. A 45-year-old woman has a small tumor of
her left breast. Histological examination of a
breast biopsy revealed poorly differentiated
atypical epithelial cells. They formed trabecules
separated from one another by connective
tissue. The cells arid stroma proportion was
approximately 1:1. What is the most likely
histological variant of the cancer.
A. * Solid carcinoma.
B. Adenocarcinoma.
C. Epidermoid carcinoma.
D. Sccirrhous fmrocarcinoma.
E. Small cell carcinoma.
14. Histological investigation of a node in the
removed mammary gland revealed complexes
of atypical polymorphic epithelial cells, which
had various sizes and forms. There were clear
spaces at the centers of complexes. The cells
had large nuclei, with presence of atypical
mitoses. Diagnose the pathology,
A. *Adenocarcinoma
B. Squamous cell nonkeratinous carcinoma
C. Solid carcinoma
D. Fibroadenoma of breast
E.
Nondifferentiated
polymorphocellular
carcinoma
15. A microscopical investigation of a tumour
revealed signet-ring cells. Name a histological
variant of a cancer.
A. *Mucinous carcinoma
B. Adenocarcinoma
C. Sarcoma
D. Solid carcinoma
E. Carcinoid
16. A 34-year-old woman presented with a
hoarseness of a voice, A laryngoscopy revealed
a tumour of a larynx. The neoplasm had a greywhite color and papillary surface. Microscopical
investigation showed a new growth of a
connecting tissue, covered by a stratified
48
Epithelial tumors
epithelium with the marked keratinization.
Cellular atypia was absent. Most likely the tumor
is:
A. *Papilloma
B. Fibroma
C. Polyp
D. Angioma
E. Angiofibroma
17. A microscopical investigation of a 50-year-old
woman's endometrial curettage material with
the clinical diagnosis « ovarian - menstrual cycle's
disorder » revealed growth of glandular
structures. These glands consisted of polymorphic
cells with hypercliromic nuclei and mitoses
figures. For what pathology the revealed
histological changes are characteristic?
A. *Adenocarcinoma of uterus
B. Placental polyps
C. Acute endometritis
D. Glandular hyperplasia of endometrium
E. Chorioepithelionia of uterus
18. A 52-year-old female patient with a history of
the chronic bronchitis and pneu-mosclerosis
presented to the hospital for biopsy diagnostics.
A microscopical investigation of a left bronchial's
mucous from the suspicious site revealed cellular
and tissue atypia. There were also found some
structures in the form of cancer pearls". What is
the most likely pathology presented in that case?
A. * Squamous cell keratinous carcinoma of
bronchus
B. Chronic polypous bronchitis
C. Bronchiectasis
D. Sharp bronchitis
E. Squamous cell metaplasia of mucous of
bronchus
19. Histological investigation of a bronchial
biopsy revealed a tumour which is constructed
from nests of stratified epithelium's atypical cells
with some characteristic "pearls". What is the
most likely diagnosis?
A. *Squamous cell keratinous carcinoma
B. Squamous cell nonkeratinous carcinoma
C. Solid carcinoma
D. Mucous carcinoma
E. Scirrhous carcinoma
20. A microscopical investigation of a breast
tumour revealed that the neoplasm was
constructed
of
undifferentiated
atypical
epithelial cells. These cells formed trabecules,
separated by layers of a connective tissue. A
parity of cells and stroma was approximately 1:1.
Name a histological variant of a cancer.
A. *Solid carcinoma
B. Adenocarcinoma
C. Squamous cell carcinoma
D. Fibrocarcinoma
E. Small cell carcinoma
21. Histological investigation of the removed
breast node revealed different sizes and the form
complexes of atypical polymorphic epithelial
cells among abundant stroma. The complexes
had a clear space center. Cells were
characterized by large nuclei, the increased
number of nucleoli, nucleoli organizers and
presence of atypical mitoses. What is the most
likely diagnosis?
A. *Adenocarcinoma
B. Fibroadenoma of breast
C. Solid carcinoma
D. Squamous cell nonkeratinous carcinoma
E.
Nondifferentiated
polymorphic
cells
carcinoma
22. A post-mortem of a 59-year-old man, who
died of a lung cancer, revealed plural
metastases. What kind from the listed below
metastases it is possible to regard as implantation
(contact) one according to a mechanism of
development?
A. *Multiple tumorous nodules of pleura
B. Metastasis in prebronchial, paratracheal
lymphatic knots
C. Metastasis in a brain
D. Metastases in an adrenal gland
E. Invasion of tumor from bronchus in an
esophagus
23. A 55-year-old man presented to a hospital
with the atelectasis of a right lung's middle lobe,
resulted from the obturation of a midlobar
bronchus by a node of soft tissues. A
bronchoscopy revealed a new growth within an
obturation zone. A microscopical investigation of
a biopsy sample showed the growths of an
atypical glandular epithelium with pathological
mitoses, which spread in tissues underneath and
a cartilage. What is the most likely disease?
A. *Bronchogenic carcinoma of lungs
49
Epithelial tumors
B. Dysplasia of epithelium of bronchus
C. Inflammatory polyps
D. Deforming bronchitis
E. Sarcoma of bronchus
24. A 65-year-old woman presented to the
hospital with the menopausal bleeding. At
histological investigation revealed in the
curettage material from the mucosa of her cervix
uteri revealed a new growth of atypical
epithelium with formation so-called " cancer
pearls ". What is the most likely diagnosis?
A. *Squamous cell keratinous carcinoma
B. Adenocarcinoma
Ñ Squamous cell nonkeratinous carcinoma
D. Mucous cancer
E. Nondifferentiated carcinoma
25. A post-mortern of a 48-year-old woman with
a history of an operated stomach tumour in the
past revealed markedly enlarged, dense, whitish
color ovary. Histo-logical investigation of the
ovarian tissue showedutterly atypical epithelial
cells, placed among layers and cords of a
connective tissue. What if the most likely disease?
A. *Krukenberg's carcinoma of ovary
B. Serous cystadenocarcinoma
C. Pseudomucinous cystcarcinoma
D. Malignant thecoma
E. Malignant granular cell tumor
26. A histological investigation of a lung biopsy
revealed atypical cells which form plural acinar
structures and produce mucus. What histological
form of a cancer of lungs takes place at the
patient?
A. *High differentiated adenocarcinoma
B. Low differentiated adenocarcinoma
C. Nondifferentiated carcinoma
D. Differentiated
E. Glandular squamous cell carcinoma
27. A gastroscopy of a 37-year-old man revealed
a tumorous formation 1,5 cm in diameter in a
small curvature of his stomach. What character
of a tumor growth?
A. *Exophytic
B. Expansive
C. Invasive
D. Infiltrating
E. Endophytic
28. Histological investigation of a biopsy from a
tumor of the right bronchus' mucous membrane
revealed a cellular and tissue atypia,
appearance of structures in the form of cancer
pearls '. Define the pathological process.
A. *Malignant tumor
B. Benign tumor
C. Hyperplasia
D. Metaplasia
E. Hypoplasia
29. A histological investigation of the biopsy from
cervix uteri of a 45-year-old woman revealed
signs of cellular atypia with intact basal
membrane. What is the most likely diagnosis?
A. * Carcinoma in situ
B. Erosion
C. Adenocarcinoma
D. Papilloma
E. Endometriosis
30. A physical examination of a 42-year-old
patient revealed enlarged supraclavi-cular
lymph nodes. A histological investigation of a
lymph node biopsy showed the metastasis of a
signet-ring cancer. Choose the most probable
localization of a primary tumour.
A. *Carcinoma of stomach
B. Cancer of esophagus
C. Cancer of thyroid gland
D. Carcinoma of lungs
E. Carcinoma of uterine cervix
31. A female patient in a climacteric period
presented with relapsing uterine bleedings. The
diagnostic curettage of a uterus is executed.
Microscopical investigation showed among
blood glandular elements of different size and
forms
created
by
atypical
cells
with
hyperchromatic
nuclei
numerous
mitoses
(including pathological). What is the most likely
pathology?
A. *Adenocarcinoma
B. Glandular hyperplasia of endometrium
C. Choriocarcinoma
D. Adenomatous polypus
E. Signs of the interrupted pregnancy
32. A bronchoscopy of a 65-year-old patient
revealed a polyp-like formation, 1,0 cm in
diameter, in the proximal part of the upper lobe
bronchus of his right lung. A histological research
50
Epithelial tumors
revealed the tumour which consisted from fine
lymphocyte-like cells with hyperchromic nuclei.
The cells grew like layers and cords. Specify,
what of the listed below kinds of tumors is the
most authentic?
A. *Nondifferentiated small cell carcinoma
B. Nondifferentiated large cell carcinoma
C. Squamous cell carcinoma
D. Adenocarcinoma
E Glandular squamous cell carcinoma
33. A gastroscopic study of a 50-year-old patient
revealed a crater-like lesion on small curvature in
pre-pyloric zone of stomach. From a regional site
of formation a biopsy is taken, áèîïñèÿ. A
histological investigation showed a tumor with
glands-like structures of the various form and the
sizes, growing into surrounding tissue. The cells
had marked signs pf atypia. Name a histological
variant of the presented tumor.
A. * Adenocarcinoma
B. Squamous cell carcinoma
C. Scirrhous carcinoma of stomach
D. Mucous carcinoma of stomach
E. Solid carcinoma of stomach
34. A patient presented to her physician with
gradually developed plaque on a skin of a
cheek. The formation had necrosis and an ulcer
in the center. A histological investigation of a skin
biopsy revealed a growth of atypical epithelial
cells with a lot of pathological mitoses. What is
the most likely diagnosis?
A. *Carcinoma of skin
B. Sarcoma
C. Papilloma
D. Trophic ulcer
E. Fibroma
35. A 48- year-old man with a history of a chronic
bronchitis has died of a cachexy. A post-mortem
revealed in a lumen of the right bronchus an
endophytic growth of a light- grey softish tissue.
Microscopic
investigation
showed
a
development of an atypical stratified epithelium
with a presence of an « epithelial [epidermic]
pearl, pearly body ». What is the most likely
diagnose.
A. *Squamous cell keratinous carcinoma
B. Squamous cell nonkeratinous carcinoma
C. Adenocarcinoma
D. Nondifferentiated carcinoma
E. Apudoma
36. An autopsy of a 50-year-old man, who died
of cancer intoxication, revealed the thickening
of a stomach's wall to 1, 2 cm. The mucosa was
fixed, with ill-defined gastric folds. On a cut view
a tissue was homogeneous, whitish with
chondroid density. For what macroscopical form
of a tumour the described changes are
characteristic?
A. * Infiltrate
B. Node
C. Ulcer
D. Ulcerous-infiltration
E. Cyst
37. A histological investigation of a breast tumor's
biopsy revealed solid layers of fine epithelial cells
with polymorphic nuclei and a considerable
quantity of pathological mitoses. In addition, the
tumor had very little stroma and a lymphocytic
infiltration. Name the kind of presented tumor.
A. *Medullary carcinoma
B. Scirrhous carcinoma
C. Paget's disease
D. Adenoma
E. Adenofibroma
38. A mucus membrane biopsy is taken from a
bronchus of a 52-year-old patient. A histological
investigation revealed cords of atypical epithelial
cells, which grew into the tissues underneath. In
the cord's center a concentric pink color
fonnations were determined ("cancer pearls",
"epithelial [epidermic] pearl, pearly body").
Name a kind of a tumor?
A. *Squamous cell keratinous carcinoma
B. Differentiated adenocarcinoma
C. Squamous cell nonkeratinous carcinoma
D. Melanoma
E. Transitional cell carcinoma
39. A patient has hoarseness of voice. During
laryngoscopy a gray-white larynx tumor with
papillary
surface
has
been
detected.
Microscopic investigation has shown the
following: growth of connective tissue covered
with multilayer, strongly keratinized pavement
epithelium, no cellular atypia. What is the most
likely diagnosis?
A. Papilloma
B. Fibroma
51
Epithelial tumors
C. Polyp
D. Angioma
E. Angiofibroma
40. A 67-year-old patient with clinical diagnosis
of chronic bronchitis, pneumosclerosis, and
cardiopulmonary decompensation has the
biopsy material taken from the suspicious area in
his right bronchus mucosa. Cellular and tissue
atypism along with pearly bodies can be
histologically detected. What pathologic process
is characterized by the described histological
changes?
A. Squamous cell carcinoma of bronchus with
keratinization
B. Polypoid chronic bronchitis
C. Bronchiectasis
D. Acute bronchitis
E. Squamous cell metaplasia of bronchial
mucosa
41. On bronchoscopy there is a polypoid growth
1,0 cm in diameter with ulcer in its center in the
upper lobe of the right lung. Histological
investigation revealed a tumor composed of
lymphocyte-like cells with hyperchromic nuclei,
the cells form layers and bands. What is the most
likely tumor type?
A. Undifferentiated small cell carcinoma
B. Undifferentiated large cell carcinoma
C. Squamous cell carcinoma
D. Adenocarcinoma
E. Glandular squamous cell carcinoma
42. A 30-year-old man has undergone surgical
removal of a thyroid tumor. Histologically the
tumor is made up of papillary structures varying
in size that emerge from the inner surface of
dilated cystic follicles and are covered with
atypical epithelium. What is the most likely
diagnosis?
A. Papillary carcinoma
B. Colloid nodular goiter
C. Macrofollicular adenoma
D. Follicular carcinoma
E. Medullary carcinoma
43. Histological analysis of a removed skin tumor
shows clusters and bands composed of atypical
stratified squamous epithelium cells that
penetrate into the underlying tissue. What
preliminary diagnosis can be
made?
A. Non-keratinizing squamous cell carcinoma
B. Solid cancer
C. Carcinoma in situ
D. Papilloma
E. Adenoma
44. A patient died of cancerous cachexia with
primary localization of cancer in the stomach.
Autopsy revealed acutely enlarged liver with
uneven surface and numerous protruding nodes;
the nodes had clear margins in the section,
rounded shape, gray-pink color, varying density,
sometimes
contained
necrotic
foci.
Histologically: there are atypical cells in the
nodes. What pathologic process occurred in the
liver?
A. Cancer metastases
B. Abscesses
C. Regeneratory nodes
D. Infarction
E. Hepatic cancer
45. Autopsy of a 5-year-old child revealed in the
area of the vermis of cerebellum a soft grayishpink node 2 cm in diameter with blurred margins
and areas of haemorrhage. Histologically this
tumour consisted of atypical monomorphous
small round cellswith large polymorphous nuclei.
What tumour is it?
A. Medulloblastoma
B. Meningioma
C. Glioblastoma
D. Astrocytoma
E. Oligodendroglioma
46. A 63-year-old man suffers from esophageal
carcinoma, presents with metastases into the
mediastinal lymph nodes and cancerous
cachexia.
What
pathogenetic
stage
of
neoplastic process is observed in the patient?
A.* Progression
B. C. Transformation
D. Promotion
E. Initiation
47. A patient has gradually developed a skin
plaque on his face. In the center of this plaque
there are necrotic patch and an ulcer.
Histopathological analysis of the biopsy material
reveals proliferation of atypical epithelial cells
52
Epithelial tumors
with large number of pathologic mitoses. What is
the most likely diagnosis?
A.* Skin cancer
B. Fibroma
C. Papilloma
D. Sarcoma
E. Trophic ulcer
53
Mesenchymal tumors
Mesenchymal tumors
1. A 30-year-old man has a node on his left leg
the skin. Physical investigation revealed dense,
mobile tumor, circumscribed by a connective
tissue capsule. Grossly it cut section was
presented
with
dense
witish
fibres.
Microscopically the tumor composed of mature
fibroblasts and a collagenous stroma. What is the
most likely diagnosis?
A. * Fibroma
B. Myoma
C. Histiocytoma
D. Dermatofibroma
E. Desmoid.
2. A 14x6x5 cm neoplasm excised from a
retroperitoneurn of a 66-year-old woman at
surgery department. Microscopic investigation
revealed atypical anaplastic cells, which
contained round cytoplasmic vacuoles of lipid
that scallop the nucleus. The majority of cells
were pleomorphic, some of them were round
with chromosomal abnormalities. What is the
most likely diagnosis?
A. *Liposarcoma
B. Lipoma
C. Myosarcoma
D. Fibrosarcoma
E. Mesothelioma
3. A physical examination of 47-year-old woman
of gynecology department revealed that her
uterus contained dicrete, firm, white nodules.
Histological
examination
excised
lesion
demonstrated a tissue atypia of a sample. It
presented well-defferentiated mature cells of
smooth muscules. What is the most likely
diagnosis?
A. *Leiomyoma.
B. Carcinoma of the uterus.
C. Fibromyoma.
D. Chorionepithelioma.
E. Leiomyosarcoma
4. A 20-year-old man has had a slowly growing
reddish nodule on his upper lip. He finally decides
to have a surgeon remove it. Microscopically the
nodule is composed of benign varying sized tiny
blood vessels. What is the most likely diagnosis?
A. * Capillary hemangioma.
B. Venous hemangioma.
C. Cavernous hemangioma.
D. Hemangiopericytoma.
E. Glomus-angioma.
5. The patient, a previously dealthy man of 25
years, presented with a painless neoplasm in a
soft tissues of his left thigh. Grossly, a tumor had
uneven boundaries and on cut section it looked
like a fish flesh. Microscopic investigation
revealed immature connective tissue cells with
pleomorphism, numerous mitotic figures and
lymphocyte infiltration at the edge of the tumor.
What is the most likely diagnosis?
A. *Fibrosarcoma
B. Myosarcoma
C. Fibroma
D. Carcinoma
E. Myoma
6. A 40-year-old woman presented with a very
slowly enlarging subcutaneous mass at the right
side of the chest wall. Physical examination
revealed a soft lobulated fluctuant swelling, not
attached to the skin or underlying muscle.
Histologically a neoplasm was well-encapsulated
and consisted of mature cells with clear
cytoplasm that varied considerably in size. What
is the most likely diagnosis?
A. *Lipoma.
B. Fibroma.
C. Hygroma.
D. Papilloma.
E. Hemangioma.
7. A macroscopical investigation of operatively
removed uterus revealed a tumour with a soft
consistence, hemorrhages and necroses. The
tumor cut surface reminds ' the fish meat '.
Histological research has found an expressed
cellular and tissue atypia; there were cells with
pathological mitoses figures. What is the most
likely diagnosis?
A. Sarcoma.
 Adenocarcinoma.
C. Angioma.
D. Fibroma.
E. Lipoma.
8. At the young man in a skin depth the dense,
mobile tumour, is defined. A microscopical
research revealed chaotically located fascicles
54
Mesenchymal tumors
of collagen fibers with a small amount of spindleshaped cells. What tumour is removed?
A. *Dense fibroma.
B. Leiomyoma.
C. Melanoma.
D. Lipoma.
E. Glomus-angioma.
9. A 4-year-old child presented with a flat red
color knot on his neck skin, which turns pale at
pressing by glass the knot. What is the most
probable diagnosis?
A. Hemangioma
B. Pigmented nevus
C. Melanoma
D. Leiomyoma
E. Lymphangioma
10. A 28-year-old man with a history of an elbow
bruise 3 years ago presented with a tumorous
growth in the area of an epiphysis of a humeral
bone. The formation did not have accurate
borders. A histological investigation of biopsy
material revealed a considerable quantity of
polymorphic cells of osteoblastic type with
numerous pathological mitoses. Make the
presumable diagnosis.
A. *Osteosarcoma
B. Chondrosarcoma
C. Osteoid-osteoma
D. Fibrosarcoma
E. Sinovial sarcoma
11. A 48-year-old man presented to physician
with mobile 1,0x0,7 cm formation under a skin of
mandible. It had precise borders, dough-like
consistence and slow growth. A histologic
research of formation revealed fat tissue cells
(lipocytes), which created lobules of different
forms and the sizes, divided by thin layers of a
connective tissue with vessels. What is the most
likely diagnosis?
A. *Lipoma
B. Fibroma
C. Angioma
D. Liposarcoma
E. Fibrosarcoma
12. A 33-year-old woman presented with a
tumor-like formation on a white line of her
abdomen, which during pregnancy has started
to increase in sizes. A histological research
revealed that a tumor is constructed of the
differentiated connective tissue, in which
collagen fibers prevail of cells. What tumor
presented in this case?
A. * Desmoid
B. Dense fibroma
C. Fibrosarcoma
D. Soft fibroma
E. Dermatofibroma
13. A 15-year-old young man presented with a
tumorous formation in the central site of his wrist
bone. The node grew slowly within last 3 years. A
histologica! research of a removed neoplasm
revealed mature chondrocytes without mitoses,
which randomly located in chondral lacunas.
Cartilages of a capsule had different form and
the sizes due to variable quantity of chondral
cells, between which there were basic substance
with liquid layers of a connective tissue. What is
the most likely diagnosis?
A. *Chondroma
B. Chondroblastoma
C. Chondrosarcoma
D. Teratoma
14. A 50-year-old patient presented to the doctor
with a ball-shaped, dense, motionless neoplasm,
2 cm in diameter, under a skin in the right
parietal site of his head. A histological research
of a removed neoplasm revealed a chaotic
osteal beams pattern with a connective tissue
between. What is the most likely diagnosis?
A. *Cancellous osteoma (Osteoma spongiosum)
B. Compact osteoma (Osteoma durum)
C. Osteoporosis
D. Osteomalacia
E. Osteosarcoma
15. At the young woman in the area of her distal
extremity of a femur the tumor, which quickly
grew, is removed. Grossly, it had a motley
pattern - from white-sulphur to brown-red color
and a quaggy consistence. Microscopical
investigation
revealed
the
basic
tissue
component of a tumor presented with osteal
and the ossi-form structures covered by atypical
osteoblasts, with numerous thin-walled vessels
and atypical mitoses figures. Make a diagnosis.
A. *Osteocarcoma
B. Chondroma
C. Osteoma
55
Mesenchymal tumors
D. E. Angiosarcoma
16. A 16-year-old child presented with a painful
sottish node in his femur diaphy-sis. The formation
grows quickly with destruction of a spongy layer
of a bone. Microscopical investigation revealed
monornorphic round cells little bit bigger than
mature
lymphocytes,
with
jejunely
light
cytoplasm which contains glycogen. In some
zones these cells form pseudo- rosettes with few
mitoses. Between cells there are fibrinous
membranes. What is the most likely diagnosis?
A. *Ewing's sarcoma
B. Limphoma
C. Rhabdomyosarcoma
D. Neuroblastoma
E. Hemangioma
17. A young woman presents with antumor along
the auditory nerve. The tumor is node-shaped, 3
cm in diameter, soft and elastic, pink-white
colored, and has
homogeneous structure. Microscopically the
tumor contains bundles of cells with oval nuclei.
These cellular fibrous bundles form regular
structures made up of parallel rows of regularly
oriented cells arranged
in the form of a palisade with acellular
homogeneous area in between (Verocay
bodies). Name this type of tumor:
A. Neurinoma
B. Malignant neurinoma
C. Ganglioneuroma
D. Neuroblastoma
E. Ganglioneuroblastoma
18. Autopsy of a 3-year-old child shows a tumor
in the cerebellum. The tumor has no clear
margins separating it from the surrounding
tissues. Histologically it is made of small atypical
cells with hyperchromic nuclei. This tumor is most
likely a:
A.* Medulloblastoma
B. Medullary sarcoma
C. Cancer metastasis
D. Glioblastoma
E. Sarcoma metastasis
56
Melanocytic tumors Tumors of the nervous system
Melanocytic tumors Tumors of the nervous
system
1. An eye of 53-year-old patient, excised at
surgery due to neoplasm, presented in
pathology department. Gross investigation
reveled a 1?0,4 cm black lesion in the retina.
Microscopic appearance of a tumor was
characterized by nests of immature cell with
eccentric nuclei, prominent macronucleoli and
cytoplasm brown pigment. What is the most likely
diagnosis?
A. *Melanoma
B. Neurinoma
C. Angiosarcoma
D. Neuroblastoma
E. Ganglioneuroblastoma
2. At autopsy a 8-year-old child is found to have
a poorly circumscribed tumor of cerebellum.
Histologically investigation reveled crowds of
small immature cells with hyperchromatic, roundoval nuclei and scant cytoplasm. A few rosettes
were also found by pathologist at slide
examination. What is the most likely diagnosis in
that case?
A. *Medullob!astoma
B. Astrocytoma
C. metastasis of cancer
D. metastasis of sarcoma
E. Glioblastoma
3. An elderly man with a 2-year history of right leg
amputation presents with 2 cm encapsulated
tumor at the area of a past surgical trauma of
soft tissue. Histology investigation revealed
disordered orientation of mature nerve fiber
bundles inter mixed with connective tissue.
Higher magnification showed bundles of axons,
Schwann cells, fibroblasts and perineuria! cells
within tumor mass. What is most likely diagnosis?
A. Neurinoma
B. Neurofibroma
C. Malignant neurinoma
D. Soft fibroma
E. Fibrosarcoma
4. A 66-year-old woman present with right eye
bad vision, ophtalmoscopy revealed a neoplasm
of retina which was soon excised, at surgery
together with an eye ball. Grossly, a neoplasm
was soft, irregular in contour 1x1 cm in size and
had a brown coloring. Under microscope a
lesion demonstrated nodular aggregates of
infiltrating cells. There cells contained large
brown pigment nuclei with chromatin clumped
at the periphery of nuclear membrane and
prominent nucleoli. Atypical mitoses figures were
also revealed. What is most likely diagnosis?
A. *Melanoma
B. Schwannoma
C. Glomus tumor
D. Paraganglioma
E. Angiosarcoma
5. A 38-year-old woman has a seizure while
shopping and is taken to the hospital. A scan of
a brain demonstrated a poorly circumscribed 5
cm tumor at right parietal lobe. A biopsy of this
area contains of increased number of glial cell
nuclei and an interening feltwork of file cell
processes that give the background a fibril lary
appearance. Abnormal mitoses and atypical
central nervous system cells were absent within
biopsy sample. What is the most likely diagnosis?
A. Astrocytoma
B. Oligodendroglioma
C. Ganglioneuroma
D. Ependimoma
E. Chorioid papilloma
6. A 50-year-old woman presented with a
pigmented painful skin lesion above the ankle. It
had been present for many years but in recent
months it had enlarged quite rapidly, its outline
got irregularity. Microscopic investigation of a
lesion biopsy revealed nests of atypical cells and
single cells with eccentric nuclei, prominent
macronucleoli and cytoplasmic brown pigment.
What is the most likely diagnosis?
A. * Melanoma
B. Basal cell carcinoma
C. Hemangioma.
D. Haematoma.
E. Carcinoid.
7. The man of 45 years has completely lost
hearing on the right ear. Physical investigation
has not revealed any pathological changes in
system of the right acoustic analyzer. The
tomography of a brain has revealed a
neoplasm, 7 cm in diameter, homogeneous,
57
Melanocytic tumors Tumors of the nervous system
without precise contours in a site
cerebellopontine angle. Name a neoplasm.
A. *Neurilemmoma
B.Gangliocytoma
C. Astrocytoma
D. Chorioidal papilloma
E. Neuroblastoma
of
8. The tumor of a brain is diagnosed for the
patient with neurologic disturbances. During
operation the tumor, which looks like the dense
node bound to a firm cerebral membrane, is
removed. Histological investigation revealed the
neoplasm constructed from endothelium-like
cells closely adjoining to each other. What is the
most likely diagnosis?
A. *Meningioma
В. Glioblastoma
C. Anaplastic meningeoma
D. Astrocytoma
E. Neuroblastoma
9. The tumour of a brain is diagnosed for the
patient with quickly increasing intrac-ranial
hypertension. The removed tumor of a parietal temporal part of brain had a soft consistence
and a motley pattern of a cut surface.
Histological investigation revealed neoplastic
tissue constructed of polymorphic cells with sites
of necroses and a hemorrhage. What is the most
likely diagnosis?
A. * Glioblastoma
B. Oligodendroglioma
C. Neuroblastoma
D. Astrocytoma
E. Meningioma
10. The woman on her face skin had a pigmental
formation in the form of a nodule which quickly
grew. The biopsy is made. Microscopical
investigation of biopsy sample revealed fields of
spindle-shaped and polymorphic cells which
contain a brown pigment. In addition, there
were diagnosed numerous mitoses. What is the
most likely diagnosis?
A. *Melanoma
B. Nevus
C. Cancer
D. Papilloma
E. Dermatofibroma
11. A physical investigation of a 60-year-old
woman with one year history of a formation on a
face revealed a brown skin plaque with irregular
form and black impregnations. A histological
research of a skin biopsy showed in epidermis
and through all derma polymorphic big cells with
pathological mitoses, large nucleoli and yellowybrown pigment in a cytoplasm of many cells. The
specified cells grow in a kind of fine groups and
also alone. Make a diagnosis.
A. * Melanoma
B. Nevus
C. Papilloma
D. Xeroderma
E. Melanosis
12. A young woman presents with antumor along
the auditory nerve. The tumor is node-shaped, 3
cm in diameter, soft and elastic, pink-white
colored, and has
homogeneous structure. Microscopically the
tumor contains bundles of cells with oval nuclei.
These cellular fibrous bundles form regular
structures made up of parallel rows of regularly
oriented cells arranged
in the form of a palisade with acellular
homogeneous area in between (Verocay
bodies). Name this type of tumor:
A. Neurinoma
B. Malignant neurinoma
C. Ganglioneuroma
D. Neuroblastoma
E. Ganglioneuroblastoma
13. Autopsy of a 3-year-old child shows a tumor
in the cerebellum. The tumor has no clear
margins separating it from the surrounding
tissues. Histologically it is made of small atypical
cells with hyperchromic nuclei. This tumor is most
likely a:
A.* Medulloblastoma
B. Medullary sarcoma
C. Cancer metastasis
D. Glioblastoma
E. Sarcoma metastasis
58
Hemoblastosis
Hemoblastosis
1. A 34- year-old male is found to have weakness
confusion, other neurologic manifestation and
polyuria X-ray examination revealed multifocal
destructive bone lesions throughout the skeletal
system.
Electrophoretic
analysis
revealed
increased level of Ig in the blood and Bence
Jones protein in the urine. What is the most likely
diagnosis?
A.*Myeloma
B. Acute monocytic leukemia
C. Chronic myeloleukemia
D. Lymphogranulomatosis
E. Histiocytosis
2. A 42-year-old female is admitted to the
hospital for treatment a blood disorder. A disease
complicated with pneumonia led to lethal
outcome. An autopsy revealed hyperplasia of a
bone marrow with "pus" - like appearance,
splenomegaly (5 kg weight), hepatomegaly (6
kg weight), systemic lymph nodes enlargement.
What is the most likely diagnosis?
A* Chronic myeloleukemia
B. Chronic lymphatic leukemia
C. Myeloma
D. Polycytemia vera (erythremia, Osier's disease)
E. Lymphogranulomatosis
3. An elderly male is admitted to the hospital for
treatment of humeral bone fracture. His fracture's
area X-ray showed a new growth and lytic zone
within lesion. Histological examination of a biopsy
revealed abnormal plasma cells. What is the
most likely diagnosis?
A. * Myeloma
B. Chronic osteomyelitis
C. Chondrosarcoma.
D. Bone fibrous dysplasia
E. Metastasis of adenocarcinoma
4. At autopsy an elderly female is found to have
enlarged groups of a neck, axillary and
mediastinal lymph nodes matted together. They
were firm and rubbery. The cut surface was graywhite, producing a "fish-flesh" appearance.
Microscopy revealed heterogeneous cellular
infiltrate wich contained lymphocytes, classic
and mononuclear Reed-Berezovsky-Sternberg
cells. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Chronic lymphatic leukemia
C. Lymphosarcoma
D. Retikulosarcoma
E. Mycosis fungoides
5. A 67-year-old female presented with painless
enlargement of lymph nodes. Histological
examination of a biopsy sample revealed that
the whole lymph node pattern was unclear, with
heterogeneous cellular infiltrate. It included
abnormal, immature cells admixed with
lymphocytes, eosinophils, plasma cells and
macro-phages. Binucleated Berezovsky-ReedSternberg cells, where surrounded by multiple
cell types. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Acute myeloleukemia
C. Chronic myeloleukemia
D. Mycosis fungoides
E. Tuberculosis
6. A 25-year-old patient presented with
peripheral adenopathy, involving a single
cervical lymph node. A biopsy sample
investigation revealed an unclear node pattern
with mixed cellular infiltration. Histologycal study
under higher magnification showed numerous
variants of Berezovsky-Reed-Stenberg cells,
lymphocytes, ne-crotic area and mild diffuse
fibrosis. What is the most likely diagnosis?.
A. * Lymphogranulomatosis
B. Nodular lymphoma
C. Burkitt's lymphoma
D. Lymphocytic lymphoma
E. Chronic lymphatic leukemia
7. A 65-year-old female is noted to be anemic.
He serum protein electrophoresis demonstration
a large monoclonal Ig G kappa protein. In her
bone marrow are increased numbers of atypical
plasma cells. Her skull X-ray show multiple lytic
areas. What is the most likely diagnosis?
A.* Myeloma
B. Polycytemia vera (erythremia, Osier's disease)
C. Lymphocytic lymphoma
D. Chondrosarcoma
E. Bone fibrous dysplasia
8. A thoracotomy of a 58-year-old woman
revealed in her anterior mediastinum the
enlarged and soldered together lymph nodes.
59
Hemoblastosis
Microscopical investigation revealed atypical
cells with predominance of Hodgkin cells and
giant Reed—Berezovsky -Sternberg cells. A
sclerosis was absent. What is the most likely
diagnosis?
A. *Lymphogranulomatosis with low-spirited
development of lymphoid tissue
B. Lymphogranulomatosis with predominance of
nodularis sclerosis
C. Lymphogranulomatosis with predominance of
lymphoid tissue
D. Lymphosarcoma
E.
Mixed-cellular
variant
of
lymphogranulomatosis
9. A tomography revealed enlarged lymphatic
nodes. A histological investigation of lymph
node's biopsy showed a circular growths of a
connective
tissue,
which
surrounded
a
granuloma - like formation, made from
lymphocytes, plasmocytes and giant doublenuclear cells. What is the most likely diagnosis?
A. *Lymphogranulomatosis
B. Lymphosarcoma
C. Tuberculosis
D. Sarcoidosis
E. Lymphatic leukemia
10. The young man presented to his physician
with
enlarged
neck
lymph
nodes.
A
microscopical investigation of a lymph node
biopsy sample revealed the lymphoid tissue
proliferation with presence of a giant Reed—
Berezovsky - Sternberg cells, eosinocytes, zones
of necrosis and sclerosis. What is the most likely
diagnosis?
A. *Lymphogranulomatosis
B. Chronic lymphatic leukemia
C. Multiple myeloma
D. Lymphosarcoma
E. Histiocytosis
11. A biopsy of the enlarged lymph node was
taken. A histological investigation revealed a
diffuse growth of lymphoid cells with adding of
eosinocytes, atypical histiocytes, solitary giant
Reed—Berezovsky - Sternberg cells with two and
more nuclei, cell's necrosis and sclerosis. What is
the most likely diagnosis?
A. * Lymphogranulomatosis
B. Lymphatic leukemia
C. Burkett's lymphoma
D. Sarcoidosis
E. Myeloleukemia
12. An autopsy of a 67-year-old man revealed
the systemic enlargement of lymph nodes with
formation of tumorous conglomerates. The
spleen was also enlarged with a motley pattern
of a cut surface. There were plural, tiny, yellowishwhite spots on a red background of a spleen's
pulp. What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Sarcoidosis
C. Lymphosarcoma
D. Carcinoma of lung
E. Lymphatic leukemia
13. Clinical investigation of a patient revealed
the enlarged lymph nodes, spleen and liver. A
microscopical study of the enlarged cervical
(neck) lymph node showed the blurring of its
structures and absence of lymphatic follicles. All
microscopical views were presented by cells with
round nuclei and narrow ring of a ba-sophilic
cytoplasm. What is the most likely diagnosis?
A. *Lymphatic leucosis
B. Lymphogranulomatosis
C. Lymphosarcoma
D. Myeloleukemia
E. Multiple myeloma
14. An autopsy of a 35-year-old woman revealed
the enlarged spleen, (weight SOOgm), liver
(weight 4000 gm) and lymph nodes. A bone
marrow of a femur diaphysis was juicy
(succulent), crimson-red color. Microscopical
study of a liver defined dense infiltrates within
portal tracts, consisted of immature blood cells.
These cells had a round nuclei and narrow ring of
a cytoplasm. What is the most likely diagnosis?
A. *Chronic lymphatic leukemia
B. Chronic myeloid leucosis
C. Generalizated form of lymphogranulomatosis
D. Acute myeloblastic leucosis
E. Acute lymphoblastic leucosis
15. A microscopic investigation of the enlarged
neck lymph node biopsy revealed the blurring of
its structures, plenty of proliferating lymphocytes
with adding of solitary giant Reed-—Berezovsky Sternberg cells. What is the most likely diagnosis?
A. *Lymphogranulomatosis, with predominance
of lymphatic tissue
60
Hemoblastosis
B. Lymphogranulomatosis, with exhaustion of
lymphatic tissue
C. Mixed cell variant of lymphogranulomatosis
D. Lymphosarcoma
E.
Nodular
sclerotic
variant
of
lymphogranulomatosis
16. At young men the increased cervical lymph
node is removed. Microscopic investigation
revealed the altered node's structure, an
absence of lymphoid follicles, sites of a sclerosis
and necrosis. The cellular infiltrate is polymorphic
with a presence of lymphocytes, eosinocytes,
and atypical one-nuclear cells and multinuclear
giant cells (Reed—Berezovsky - Sternberg cells).
What is the most likely diagnosis?
A. * Lymphogranulomatosis
B. Acute lymphatic leukemia
C. Chronic lymphatic leukemia
D. Burkett's lymphoma
E. Mycosis fungoides
17. A liver biopsy was taken from a 66-year-old
man, with a history of increased quantity of
lymphocytes and pro-lymphocytes in his blood. A
histological investigation of a liver sample
revealed plural accumulations of the mentioned
above cells, mainly between hepatic segments.
For what disease above listed changes are
characteristic?
A. *Chronic lymphatic leukemia
B. Acute lymphatic leukemia
C. Lymphogranulomatosis
D. Chronic persistence hepatitis
E. Hepatocellular carcinoma of liver
18. A 4-year-old girl died due to a posthemorrhagic anemia, resulted from a gas-trointestinal profuse bleeding. An autopsy revealed
an anemia of her organs, the enlargement of the
different groups of lymph nodes, thymomegaly,
mild hepatomegaly, splenomegaly and bright
red bone marrow. Microscopical study showed
hyper cellularity of a bone marrow with
monomorphic blast cells infiltrate, diffuse
inflammatory tumor-like infiltrates in a liver, a
spleen, lymph nodes, meninges and substance
of a brain. What is the most likely diagnosis?
A. * Acute lymphoblastic leucosis
B. Acute myeloblastic leucosis
C. Acute nondifferentiated leucosis
D. Acute monoblastic leucosis
E. Acute plazmoblastic leucosis
19. A 14-year-old boy presented to a hospital
with enlarged subrnaxillary and cervical lymph
nodes. A biopsy procedure was performed.
Microscopical investigation revealed the disorder
of a lymph node typical structure, a
heterogeneous cellular population with a
presence of giant multinuclear cells and plural
one-nuclear big cells. There were also
eosinocytes, neutrophils and lymphocytes in the
cell infiltrate. In addition, sites of necrosis and
sclerosis were found. What is the most likely
diagnosis?
A. *Lymphogranulomatosis
B. Hyperplasia of lymphatic nodes
C. Granulomatous lymphadenitis
D. Purulent lymphadenitis
E. Non-Hodgkin's lymphoma
20. A radiological investigation of a man's head
revealed in his maxillary and mandibular bones
numerous round defects with smooth walls. A
histological study showed osteolysis and
osteoporosis accompanied with insufficient bone
repair. The laboratory test of the urine detected
the Bence Jones protein. What is the most likely
diagnosis?
A. *Multiple myeloma
B. Chronic myeloleukemia
C. Chronic erythromyelosis
D. Acute myeloleukemia
E. Acute nondifferentiated leucosis
21. A physical examination of a young men's oral
cavity revealed the atrophy of mucous
membrane and red spots on his tongue
(atrophic; Hunter's; Moeller's glossitis). Sclera had
a yellow coloring. A blood test showed the color
index above one. For what anemia these
changes are characteristic?
A. * Nutritional anemia due to vitamine B,2
deficiency
B. Asiderotic anemia
C. Acute posthemorrhagic
D. Chronic posthemorrhagic
E. Hemolytic anemia
22. A physical examination of a 42-year-old man
revealed enlarged lymph nodes. A histological
investigation of a lymph node showed
lymphocytes, histiocytes, re-ticular cells, small
61
Hemoblastosis
and big Hodgkin's cells, multinuclear Berezovsky Reed-Sternberg cells (Sternberg-Reed cells)
infiltration with solitary necrotic areas. What
disease such changes characteristic for?
A. * Lymphogranulomatosis
B. Lymphosarcoma
C. Chronic leucosis
D. Acute leucosis
E. Metastasis of carcinoma of lungs
23. A gross examination of a dead body
revealed the skin's pallor and a yellowness of a
sclera. Livores mortis were not defined. The
volume of blood in a heart and large vessels was
reduced. A blood looked aqueous, hi a skin,
mucosa and serous membranes there were
petechial hemorrhages. The internal organs,
especially a spleen, a liver and kidneys had a
rusty color on a cut. A bone marrow of flat bones
was a crimson-red and succulent In cortical
[tubular, cylindrical] bones it looked like a
crimson jelly. Name the disease, connected with
a deficiency of vitamin Â12.
A. * Pernicious anemia
B. Drepancytic (sickle-cell) anemia
C. Panmyelophthisis
D. Toxic anemia
E. Acute posthemorrhagic anemia
24. A post-mortem of a 56-year-old woman
revealed the Hunter's (atrophic; Moeller's)
glossitis, atrophy of mucous membrane of a
stomach and liver's hemosidero-sis. A bone
marrow in all investigated bones was red. A
microscopical study showed hyper cellular
infiltration in a lamina propria of a stomach with
a presence of lymphatic follicles. In a spinal cord
there was a funicular myelosis and also
haemopoiesis foci detected in a spleen. What is
the most likely diagnosis?
A. *Addison-Biermer anemia
B. Fanconi's (congenital aplastic) anemia
C. Hypoplastic anemia
D. Chronic gastritis (type A)
E. Chronic gastritis (type B)
25. A post-mortem of a 4-year-old girl revealed
plural petechial hemorrhages on her skin, serous
and
mucous
membranes,
large
focal
hemorrhage in a brain and necrotic tonsillitis.
Microscopical study showed multiple cell
infiltrates with prevailing lymphocytes in a bone
marrow, a liver, a spleen, a thymus, lymph nodes,
tonsils and a skin. What is the most likely
diagnosis?
A. *Acute lymphatic leukemia
B. Chronic lymphatic leukemia
C. Hodgkin's lymphoma
D. Follicular non-Hodgkin's lymphoma
E. Mycosis fungoides
26. A post-mortem of a 15-year-old girl revealed
enlarged neck, mediastinal and mesenteric
lymph nodes, which were integrated in
conglomerates. On a cut section, the tissue
pattern of the nodes was non-uniform, with foci
of necrosis. Microscopical investigation showed
the uneven structure of lymph nodes, foci of
sclerosis and necrosis. The cell population was
also heterogeneous and included uninuclear
atypical cells, giant multinuclear atypical cells, a
significant
amount
of
eosinocytes
and
neutrophils, and sparse lymphocytes. What is the
most likely form of Hodgkin lymphoma
(lymphogranulomatosis)?
A. * Lymphogranulomatosis, mixed cell variant
B.
Lymphogranulomatosis,
lymphohistiocytic
variant
C. Lymphogranulomatosis, nodular sclerosis
D. Lymphogranulomatosis, variant with lowspirited development of lymphoid tissue
E. Hodgkin's sarcoma
27. A 63-year-old man, with 20 years history of
working as the engineer for the service of
electronic microscopes, died of a sepsis. An
autopsy revealed plural hemorrhages in serous
and
mucous
membranes,
a
general
hemosiderosis, a
fatty
dystrophy
of
a
myocardium, liver and kidneys, ulcerative necrotic and purulent processes in a gastro intestinal system. The red bone marrow was
replaced by a fatty. What is the most likely
diagnosis?
A. *Hypoplastic anemia
B. Megaloblastic anemia
C. Posthemorrhagic anemia
D. Iron deficiency anemia
28. A 38-year-old man, with a history of an ulcer,
resulted in a stomach's resection, in his blood test
had a normal quantity of erymrocytes, but
reduced hemoglobin's concentration and
decreased color index. An autopsy revealed
62
Hemoblastosis
pale skin and visible mucous membranes; bone
marrow of long tubular bones was brightly red.
Erythro-cytes in a smear had a normal form and
the sizes. They look very pale because of bad
staining by dyes. What pathological process took
place in this case?
A. * Hypochromic iron deficiency anemia
B. B12-folic acid deficiency anemia
C. Acute lymphoblast leukemia
D. Sicklemia sickle cell anemia
E. Aplastic anemia
29. A 44-year-old man presented to a
gastroenterologist with pains in his epigastrium. A
physical examination revealed an icteritiousness
of his skin and scleras, an alteration of a tongue's
mucous membrane. A tongue grossly looked
shining, smooth, with red spots. In peripheral
blood's smear there were found enlarged
erythrocytes (megaloblasts). A histological study
of a gastrobiopsy from a body of a stomach
showed a thinning of mucosa, a reduction of
glands quantity, superfluous growth of a
connective tissue. Specify, what of diagnoses is
the most probable in this case:
A. * B12-folic acid deficiency anemia
B. Chronic posthemorrhagic anemia
C. Hemolytic anemia.
D. Chronic myeloid leukemia.
E. Aplastic anemia
30. A man, with a history of getting a high doze
of ionizing radiation, presented to his physician
with
marked
stomatorrhagia
(gingival
hemorrhage), spontaneous skin and mucosas'
haemorrhages. A blood test showed a
normochromal anemia and pancytopenia. The
concentration of iron in blood's serum was
normal. A histological investigation of a bone
marrow
puncture
sample
revealed
a
replacement of a hemopoietic tissue by the fatty
tissue. What is the most likely diagnosis?
A. * Aplastic anemia
B. B12-fo!ic acid deficiency anemia
C. Hemolytic anemia
D. Myelodysplastic syndrome
E. Immune cytopenia
31. A patient presented with an infiltrative,
plaque-like polymorphic skin rash, which had
various contours, sizes and a congested cyanotic color. The lesions tended to peripheral
growth and fusion. A microscopical investigation
of a skin biopsy revealed massive lymphocytes'
proliferation, which occupied the entire derma
and a hypodermic fatty layer. What is the most
likely diagnosis?
A. *Limphomaof skin
B. Systemic lupus erythematosus
C. Mycosis fungoi'des
D. Intradermal nevus
32. A 7-year-old boy died of acute
posthemorrhagic anemia caused by profuse
hemorrhage in the gastrointestinal tract.
Postmortem study revealed the following:
macroscopically there were acutely enlarged
various
groups
of
the
lymph
nodes,
thymomegaly, hepatosplenomegaly, and bright
red bone marrow; microscopically there was
hypercellular bone marrow with monomorphic
infiltrations composed of blasts and diffuse-focal
tumor infiltrations in the liver, spleen, lymph
nodes, brain substance and tunics. Make the
diagnosis:
A. Acute lymphoblastic leukemia
B. Acute myeloblastic leukemia
C. Acute undifferentiated leukemia
D. Acute monoblastic leukemia
E. Acute plasmablastic leukemia
33. A 54-year-old man complains of general
weakness, frequent colds, and bruises constantly
appearing on his body. Blood test: erythrocytes 2.5 · 1012/L; Hb- 80 g/L; color index - 0.9;
reticulocytes - absent; platelets - 50 · 109/L;
leukocytes - 58 · 109/L; leukogram: basocytes 5%, eosinophils - 15%, myeloblasts - 6%,
myelocytes - 10%, juvenile - 18%, stab
neutrophils - 26%, segmented neutrophils - 10%,
lymphocytes - 8%, monocytes - 2%, ESR - 40
mm/hour. What hematologic conclusion can be
made?
A. Chronic myelogenous leukemia
B. Leukemoid response
C. Myeloblastic leukemia
D. Chronic lymphocytic leukemia
E. Basophilic eosinophilic leukocytosis
34. A patient presents with enlarged cervical
lymph nodes. Other lymph nodes and internal
organs are without changes. Peripheral blood
test results are normal. Histological examination
of biopsy material
63
Hemoblastosis
taken from the cervical lymph node shows
smoothed-out
pattern,
absent
follicles,
homogeneous cell composition represented by
lymphoblasts. The cells penetrate into the lymph
node capsule. What diagnosis can
be made?
A. Lymphoblastic leukemia
B. Myeloblastic leukemia
C. Erythroblastic leukemia
D. Sezary disease
E. Burkitt lymphoma
35. Autopsy of a body revealed bone marrow
hyperplasia of tubular and flat bones (pyoid
marrow),
splenomegaly
(6
kg)
and
hepatomegaly (5 kg), enlargement of all lymph
node groups. What disease are the identified
changes typical of?
A. Chronic myelogenous leukemia
B. Chronic lymphocytic leukemia
C. Multiple myeloma
D. Polycythemia vera
E. Hodgkin’s disease
36. Autopsy of a 30-year-old man shows
enlarged spleen (weight - 900.0 g), enlarged liver
(weight - 4000.0 g), and enlarged lynph nodes.
Bone marrow of the femoral shaft is bright red
and moist. Microscopically in the liver there are
thick infiltrates located mostly along the portal
tract. The infiltrates consist of juvenile
hemopoietic cells with round nuclei and thin
layer of cytoplasm. What disease can be
suspected?
A.* Chronic lymphocytic leukemia
B. Acute lymphoblastic leukemia
C. Generalized lymphogranulomatosis
D. Chronic myeloid leukemia
E. Acute myeloblastic leukemia
.
64
Atherosclerosis
Atherosclerosis
1. A 46-year-old male suddenly died after
developing a heart failure. An autopsy revealed
in abdominal aorta the yellow color areas, which
did not rise over its surface. Histological
investigation of aorta showed the aggregations
of cells with a foamy cytoplasm among smooth
mussels and macrophages. These cells had a
motley-orange coloring, when stained by a
Sudan Ø. For what stage of an atherosclerosis
such picture is characteristic?
A. *Lipoidosis
B. Liposclerosis
C. Atheromatosis
D. Ulceration
E. Atherocalcification
2. A post-mortem of an elderly male revealed
microscopic alteration of his coronary artery.
There was narrowing of vessel's lumen due to a
fibrous plaque with some admixture of lipids.
Name the stage of atherosclerosis:
A. *Liposclerosis
B. Lipoidosis
C. Pre-lipoidosis
D. Atheromatosis
E. Atherocalcification
3. At autopsy of 63-year-old male revealed an
atherosclerosis of the brain's arteries and a
thrombosis of the internal carotid artery's branch.
Gross investigation showed a focus of moist
softening in his brain's tissue. Define the
pathological process in the brain.
A. * Ischemic infarction
B. Hemorrhagic infiltration
C. Hematoma
D. Encephalitis
E. Tumour of the brain.
4. At autopsy of an elderly female an aorta tissue
sample collected for histology. Microscopic
investigation revealed in aorta's intima the
accumulation of xanthoma's cells. At what
disease such morphological picture is possible?
A. * Atherosclerosis
B. Hypertension
C. Syphilitic mesaortitis
D. Nonspecific aortoarteritis
E. Nodular periarteritis
5. A 54-year-old male died after developing a
heart failure. An autopsy revealed a chronic
venous hyperemia of the internal organs,
hypertrophy of the left ventricle of a heart and
focal cardiosclerosis. Gross investigation of aorta
showed yellow-white plaques in the intima with
fine-grained masses in their centers, which
infiltrated the aortal wall. Give the name of this
pathological process.
A. * Atheromatosis
B. Lipoidosis
C. Liposclerosis
D. Arteriolosclerosis
E. Calcinosis.
6. A 66-year-old male suddenly died on his way
to operation room. An autopsy revealed a
hemorrhage into retroperitoneal fat, a saccular
dilatation of the abdominal aorta wall with
rupture in arterial wall. The aorta's defect had
uneven edges and stony hardening of
surrounding tissues. Name the most likely disease,
resulted in described complication?
A. * Atherosclerosis
B. Hypertension
C. Systemic vasculitis
D. Visceral Syphilis E.
7. At autopsy of 52-year-old male revealed
yellowish areas at his aorta's intima, this did not
bulge above its surface. Histological investigation
showed the accumulation of cells with foamy
cytoplasm, stained by Sudan III in yellow color.
Name the most likely stage of atherosclerosis in
aorta?
A. *Lipidosis
B. Liposclerosis
C. Atheromatosis
D. Pre-lipoidosis
E. Atherocalcification
8. A post-mortem of a 65-year-old male revealed
yellowish streaks and spots in the abdominal
aorta's intima, which did not rise above
endothelial surface. These areas were stained by
Sudan III in orange color. What stage of
atherosclerosis such changes are characteristic
for?
A. *Lipidosis
B. Liposclerosis
C. Atheromatosis
D. Ulceration
65
Atherosclerosis
E. Atherocalcification
9. A 53-year-old female died from acute
myocardial infarction. An autopsy revealed
multiple whitish dense plaques in her coronal
arteries' intimae, which bulged in and narrowed
the vessel's lumen. Name the most likely stage of
a coronary atherosclerosis?
A. * Liposclerosis
B. Lipoidosis
C. Atheromatosis
D. Atherocalcification
E. Ulceration
10. A 45-year-old male died in a traffic accident.
A histological investigation of his aorta revealed
a lipid infiltration of its intima with fats
accumulation in myocytes and macrophages of
aortal medial layer. Name the stage of
atherosclerosis?
A. *Lipoidosis
B. Liposclerosis
C. Atheromatosis
D. Pre-lipoidosis
E. Atherocalcification
11. A 60-year old man with a history of
hypertension, diabetes and hyperlipidemia had
a sudden onset of right-sided weakness. By the
time the ambulance arrived, he had difficulty
speaking. Unfortunately, the patient died within
the next 2 hours and an autopsy was performed
immediately.The gross examination of the
cerebral left hemisphere showed brain swelling,
widened gyri and poorly demarcated gray-white
junction. Which of the following is the most likely
cause of this patient’s death?
A.* Ischemic stroke
B. Cyst
C. Tumor
D. Intracerebral hemorrhage
E. Abscess
66
Ischemic heart disease
Ischemic heart disease
C. Vacating arterial hyperemia
D. Acute vein hyperemia
E. Angioneurotic arterial hyperemia
1. An autopsy of a 49-year-old patient, who died
from lungs edema, revealed in myocardium a
yellow-grey, large focus and a fresh blood clot in
a coronal artery. What is the most likely
diagnosis?
A. *Myocardium infarction
B. Cardiosclerosis
C. Myocarditis
D. Amyloidosis
E. Cardiomyopathy
5. An autopsy of a 56-year-old male, with a
history of ischemic heart disease, revealed the
edema of lungs. What pathological changes
could cause a pulmonary disorder?
A. * Acute insufficiency of left ventricle
B. Acute general anemia
C. Acute insufficiency of right ventricle
D. Ischemia of small circle
E. Blood stasis
2. An autopsy of a 58-year-old female revealed
in myocardium a large, dense, grey focus, which
histologically consisted of the rough connective
tissue fibers. It was surrounded by the
hypertrophied muscular fibers. What changes
arose up in a heart?
A. *Postinfarction Cardiosclerosis
B. Ischemic stage of myocardial infarction
C. Necrotic stage of myocardial infarction
D. Diffuse Cardiosclerosis
E. Myocarditis
3. An autopsy of a 62-year-old male, with a
history of ischemic heart disease, revealed an
atherosclerosis of coronal arteries and signs of
hypertensive disease. On a cut of the heart, in
the area of the apex and left ventricle's frontal
and lateral walls, there was a well defined
yellowish focus, surrounded by hemorrhages.
What is the most likely pathological process in
the cardiac muscle?
A. * Myocardium Infarction
B. Postinfarction Cardiosclerosis
C. Diffuse Cardiosclerosis
D. Myocarditis
E. Fatty dystrophy of myocardium
4. A 32-year-old man suddenly died during the
emotionally strained work. An autopsy revealed
uneven
myocardium
blood
supply.
Histochemical
investigation
detected
a
decrease of the amount of glycogen. Electronmicroscopical study showed a destruction of
mitochondria, the contractures of myofibrils.
What is the most likely disorder of a blood
circulation?
A. *Acute ischemia
B. Chronic ischemia
6. A 48-year-old man, with a history of transmural
heart
infarction
of
the
left
ventricle's
myocardium, died from the veritable rupture of.
heart (the heart tamponade). What process in
an infarct zone could promote a heart's wall
rupture?
A. *Autolysis with melting of myocardium tissue
(myomalacia)
B. Substitution of connective tissue in area of
infarction (organization)
C. Rising of blood pressure in the small circulatory
circle
D. Scar formation with thinning of wall of the left
ventricle
7. A patient, with a history of myocardial
infarction, develops symptoms of blood
circulation insufficiency after physical exercises.
There is marked cyanosis and edema of
subcutaneous tissue of his lower extremities. What
changes have developed on a place of a
myocardial infarction at the recovered person?
A. *Cardiosclerosis
B. Intracellular regeneration
C. Myocarditis
D. Atrophy of myocardium E.
8. A 36-year-old man, with acute transmural
infarction of the left ventricle's myocardium, died
from the rupture of the heart and tamponade.
What process could be a reason of the heart
rupture in the zone of infarction?
A. *Autolysis with melting of myocardium fabric
(myomalacia)
B. Substitution of connective fabric in area of
infarction (organization)
C. Rising of blood pressure in the small circulatory
circle
68
Ischemic heart disease
D. Scar formation with thinning of wall of the left
ventricle
9. A 58-year-old male, with a history of
hypertensive disease, developed a long attack
of substernal pain. The infarction of myocardium
was diagnosed. A patient died soon. An autopsy
revealed flabby myocardium with uneven blood
filling.
Histological
and
histochemical
examinations
showed
disappearance
of
glycogen granules and decreased activity of
oxidizing enzymes. What stage of myocardial
infarction presented in that case?
A. *Ischemic stage
B. Necrotic stage.
C. Organization
D. Recurrent myocardial infarction
E. Acute relapsing myocardial infarction
10. A 64-year-old patient, with long history of
atherosclerosis
and myocardial
infarction,
developed the attack of substernal pain. A
patient was hospitalized in 3 days and died soon
from progressive cardiovascular insufficiency. An
autopsy revealed in the back wall of the left
ventricle and interventricular septum of heart a
white color focus, about 3 cm in a diameter. It
was fibred, falling back, with a clear boundary.
Give the name for these changes:
A. *Focal cardipsclerosis
B. Myocardial ischemia
C. Myocardial infarction
D. Myocarditis
E. Dystrophy of myocardium
11. A 52-year-old male, after repeated intramural
heart infarction of myocardium, gradually
returned to health and further supervision of a
district internist. In 2 years he died in a motor-car
accident. Define a pathological process in
myocardium, which wound be revealed at the
autopsy?
A. *Focal cardiosclerosis
B. Diffuse cardiosclerosis.
C. Atrophy.
D. Necrosis.
E. Hyperplasia
12. A patient developed substemal pains in the 7
o'clock in the morning. He presented at the
Emergency Department in 8 o'clock in the
morning, where electrocardiograph investigation
revealed a myocardial infarction. Ten minutes
later he died. What most reliable morphological
sign of myocardium infarction would be found at
histological investigation after the autopsy?
A * Disappearance of glycogen in myocardial
cells
B. Vacuolar dystrophy of myocardial cells
C. Fatty infiltration of myocardial cells
D. Necrosis of myocardial cells
E. Weakening of myofibril of myocardial cells
13. A patient died from progressive cardiac
insufficiency. An autopsy revealed a flaccid,
dilated in diameter heart. A cut surface
investigation showed the irregular blood filling of
a myocardium, resulted in the patchy pattern of
its tissue. A histological study determined a
hyperemia of myocardium
and
stromal
accumulations of small mononuclear cells. The
described morphological changes present:
A. *Nonpurulent interstitial myocarditis
B. Vein plethora
C. Fatty dystrophy of myocardium
D. Cardiosclerosis
E. Myocardial infarction
14. A 56-year-old patient presented to the
hospital with symptoms of acute myocardial
infarction. A diagnosis was confirmed by the EKG
and laboratory tests. For 5th days the condition
acutely worsened. A progressive cardiac
insufficiency resulted in patient's death. A
dissection confirmed the diagnosis of myocardial
infarction, complicated by the heart's wall
rupture and tamponade of pericardium. What
process developed in the area of myocardial
infarction?
A. *Aseptic autolysis
B. Organization
C. Encapsulation
D. Septic disintegration
E. Petrification
15. A 57-year-old man, with a long history of an
alcohol abuse, died at the increasing
phenomena of chronic heart failure. An autopsy
revealed the weight of a heart 580 grams; a
languid, clay color myocardium, with intensive
diffuse interstitial fibrosis. Coronal arteries were
intact. A microscopical study of myocardium
showed a combination of hydropic and fatty
dystrophy of cells; atrophy and hypertrophy of
69
Ischemic heart disease
cardiomyocites. There were also some foci of a
cells lysis, accompanied with sclerosis. What kind
of cardiomyopathy described in that case?
A. *Alcoholic
B. Hypertrophic
C. Dilatative
D. Restrictive
E. Metabolic
16. A 66-year-old patient presented in the
hospital with the acute recurrent myocardial
infarction of front-lateral wall of the left ventricle.
On the 4th day of disease, an acute, marked
difficulty in breathing, a cough with considerable
quantity of a foamy sputum discharge and facial
cyanosis developed. A patient died from
progressive cardiac insufficiency. An autopsy
revealed enlarged grey-pink color lungs. A
foamy liquid flowed down from the cut surface.
What pathological process in lungs caused a
death?
A. *Edema of the lungs
B. Lungs infarction
C. Hydro thorax
D. Pneumonia
E. Pneumosclerosis
19. A 60-year-old patient with a long history of
atherosclerosis and a previous myocardial
infarction developed an attack of retrosternal
pain. 3 days later the patient was hospitalized
and then died of progressive cardiovascular
insufficiency. During autopsy a white fibrous
depressed area about 3 cm in diameter with
clear margins was found within the area of
posterior wall of the left ventricle and
interventricular septum. The dissector considered
these changes to be:
A. Focal cardiosclerosis
B. Myocardial ischemia
C. Myocardial infarction
D. Myocarditis
E. Myocardial degeneration
17. Examination of the coronary arteries revealed
atherosclerotic plaques with calcinosis that close
the arterial opening by 1/3. In the muscle there
are numerous whitish layers of connective tissue.
Name the process detected in the myocardium:
A. Diffuse cardiosclerosis
B. Tiger heart
C. Postinfarction cardiosclerosis
D. Myocarditis
E. Myocardial infarction
18. A 37-year-old man, who was working in a
caisson, after being lifted to the surface suddenly
developed signs of acute cerebral circulation
disturbance and loss of consciousness. Several
days later he died. On autopsy in the left
cerebral hemisphere there was detected a gray
soft irregular focus 5х6х3,5 cm in size. What
process had occurred in the brain?
A. Ischemic stroke
B. Hemorrhagic infarction
C. Abscess
D. Cyst
E. Tumor
70
Rheumatic disease
Rheumatic diseases
1. An autopsy of 48-year-old female revealed a
mitral stenosis with valve's incompetence.
Histological investigation showed the postinflammatory
cardiosclerosis
and
AschoffTalalayev nodes (granulomas). What is the most
likely diagnosis?
A. *Rheumatism
B. Systemic scleroderma
C. Dermatomyositis
D. Nodular periarteritis
E. Lupus erythematosus
2. An autopsy of a 34year-old patient with a long
history of rheumatism, revealed the epicardial
surface of the heart with shaggy exudate formed
by grey strands which easily separate from
underlying tissues and described as 'bread-andbutter' pericarditis ('hairy heart'). What is the most
likely diagnosis?
A. *Fibrinous pericarditis
B. Purulent pericarditis
C. Hemorrhagic pericarditis
D. Proliferated pericarditis
E. Catarrhal pericarditis
3. A histology investigation of a mitral valve
sample of a patient who died from
complications of rheumatism revealed a mucoid
swelling, a damage of the endothelial cells and
also thrombi at the valve closure line. Name the
type of the rheumatic endocarditis?
A. * Acute warty endocarditis
B. Diffuse endocarditis
C. Fibroplastic endocarditis
D. Relapsing warty endocarditis
E. Polyps-ulcerated endocarditis
4. A 9-year-old boy presented with painless, firm
1-2 mm nodules at the skin around ulnar and
knee joints (at extensor's area). Biopsy
investigation revealed a central area of fibrinoid
necrosis of the connective tissue surrounded by
lymphocytes and macrophages. What disease
these nodules are characteristic for?
A. * Rheumatism.
B. Rheumatoid arthritis.
C. Systemic scleroderma.
D. Nodular periarteritis.
E. Lupus erythematosus.
5. A 28-year old female died from uremia. A postmortem revealed an enlarged kidneys, which
had a patchy pattern with hemorrhages on
there surface. Histological investigation showed
eosinophilic deposits (hematoxilin bodies), "wire
loop" lesions in the basement membrane of the
glomerular tuft, hyaline thrombi and foci of
fibrinoid necrosis and also 'onion skin' sclerosis at
the spleen's vessels. What is the most likely
diagnosis?
A. * Lupus erythematosus.
B. Rheumatism.
C. Systemic scteroderma.
D. Rheumatoid arthritis.
E. Nodular periarteritis.
6. A 56-year old male with a long history of a
rheumatic heart insufficiency died with symptoms
of hemiplegia shortly before death. Histological
examination of his mitral; valve revealed severe
sclerosis, nodular collection of inflammatory cells
and vegetations composed mainly of platelets
and fibrin. Name the most likely type of
endocarditis?
A. *Relapsing warty endocarditis
B. Acute warty endocarditis
C. Diffuse endocarditis
D. Fibroplastic endocarditis
E. Polyps-ulcerated endocarditis
7. Microscopic investigation of the heart auricle
from a patient with a history of mitral stenosis
revealed the Achoff- Talalayev's bodies
(granulomas). What was the most likely cause of
the heart insufficiency supported by the histology
results?
A. *Rheumatic
B. Atherosclerotic
C. Syphilitic
D. Innate
E. Septic
8. A 32-year-old female with a long history of
rheumatic valve's defect presented at the
hospital with tachypnea and dyspnea, leg's
edema, ascites and hepatomegaly. She died
from the chronic heart insufficiency. An autopsy
revealed a mitral stenosis. What was the most
likely factor of the mitral stenosis morphogenesis?
A. *Leaves union between itself
B. Sclerosis and bulge of leaves
71
Rheumatic disease
C. Sclerosis and shortening of leaves
D. Shortening of tendon filaments
E. Presence of small blood thromboses on the
surface of valve
9. An autopsy of 61-year-old male with a history
of rheumatoid arthritis revealed enlarged dense
kidneys, which had yellowish-whitish color and
waxy appearance. Grossly, foci of scars were
recognized at kidneys surface. Microscopically,
at the slides stained by Congo red,
homogeneous pink masses at capillaries of
glomeruli tufts, arterioles walls and arteries, basal
membranes of tubuli and in stroma were found.
Name
the
described
complication
of
rheumatoid arthritis?
A. *Secondary amyloidosis of kidneys.
B. Postinfective glomemlonephritis.
C. Quickly progressive glomerulonephritis.
D. Acute necrotic nephrosis.
E. Fibroplastic glomerulonephritis.
10. A 48-year-old female after exposure to cold
presents to her physician with painful deformed
fingers joints, which bones were restricted in their
movements. Physical examination revealed small
firm nodules near the joints. Histological
investigation of the nodules biopsy showed the
centrally located core of fibrinoid necrosis with
surrounding rim of macrophages and hystiocytes.
What is the most likely diagnosis?
A. *Rheumatoid arthritis.
B. Dermatomyositis.
C. Rheumatism.
D. Gout.
E. Deformed arthrosis.
11. A post-mortem of 40-year old female who
died from uremia revealed enlarged kidneys,
which had a patchy pattern of their surface.
Histological investigation of kidneys showed
eosinophilic deposits (hematoxylin bodies), "wire
loop" lesions in the basement membrane of the
glomerular tuft, hyaline thrombi and foci of
fibrinoid necrosis. Besides these, Libman-Sacks
endorcarditis was also determined. What is the
most likely pathology in kidneys?
A. *Lupus erythematosus nephritis.
B. Rheumatoid glomerulonephritis.
C. Choleric glomerulonephritis.
D. Sclerotic kidney.
E. Terminal glomerulonephritis
12. A 33-year old female died from chronic
kidney failure. A post-mortem revealed multiple
scars and infarcts in kidneys and spleen.
Histological investigation showed alteration of
small and medium sized arteries presented with
sclerosis and mild endothelial proliferation. A
severe lymphocytes and histiocytes infiltrates
were also recognized at the perivascular tissues.
What is the most likely disease caused these
alterations?
A. *Nodular periarteritis
B. Atherosclerosis
C. Hypertonic disease
D. Morphine's Disease
E. Visceral syphilis
13. A post-mortem of a 25-year old woman who
died from chronic kidney failure revealed a
reddish malar rash ('butterfly rash') and small (up
to 0,2 cm) pale tan spreading vegetations over
the mitral valve surface. Histological investigation
of kidneys showed foci of fibrinoid necrosis,
eosinophilic deposits (hematoxylin bodies), "wire
loop" lesions in the basement membrane of the
glomerular tuft and karyorrhexis. What is the most
likely diagnosis?
A. *Lupus erythematosus.
B. Nodular periarteritis.
C. Rheumatism.
D. Rheumatic arthritis.
14. Histological investigation of the mitral valves
of the heart revealed the focal desquamation of
endothelial cells replaced by thrombi. The
connective tissue had mucoid swelling areas
and also zones of sclerosis and revascularization.
Name the type of valve's endocarditis?
A. *Relapsing warty endocarditis
B. Diffuse endocarditis
C. Acute warty endocarditis
D. Fibroplastic endocarditis
E. Polyps-ulcerated endocarditis
15. A 62-year-old woman presents to her
physician with considerable deformation of
metacarpal phalangeal and feet joints.
Histological examination of the soft tissues
adjacent to the joints revealed a mucoid
swelling of the connective tissue, areas of a
fibrinoid necrosis surrounded by palisading
epithelioid macrophages and sclerosis. Few 'rice
72
Rheumatic disease
bodies' were found within a synovia! cavity. What
is the most likely diagnosis?
A. * Rheumatic arthritis
B. Rheumatism
C. Behterev's Disease
D. Hematogenic tuberculosis
E. Gout
16. A 44-year-old woman presents to her
physician ulnar deviation of the hands and
flexion-hypertension ('swan neck" or "walrus
flipper") deformities of the fingers. Her
metacarpal phalangeal joints are easily exposed
to a dislocation and a subluxation. Microscopical
examination revealed nodular proliferations of
synovium, cartilage destruction and "pannus"
formation. What is the most likely diagnosis?
A. *Rheumatoid arthritis
B. Rheumatic arthritis
C. Osteoarthritis.
D. Lupus erythematosus. E-
D. Nodular periarteritis
E. Rheumatism
19. A post-mortem of a 19-year old female
revealed multiple furuncles on her skin, a warty
endocarditis of the heart valves (Libman-Sacks
endocarditis), a focal hemorrhage under the
endocardium, ulcerative stomatitis, esophagus
ulcers, pneumonia, nephritis, and a spleen
hyperplasia with a perivascular sclerosis.
Morphological investigation of her brain showed
areas of necrosis and signs of vasculitis within
thalamus. What is the most likely diagnosis?
A. *Lupus erythematosus
B. Rheumatism.
C. Septic endocarditis.
D. Ischemic heart disease.
E. Hypertensive disease.
17. An autopsy of a child, who died of a heart
failure, revealed the dilated heart chambers.
Microscopic
investigations
showed
the
hyperemia of the myocardial stroma, edema,
and diffuse interstitial - infiltrates consists of
hystiocytes, lymphocytes, some
scattered
neutrophils and eosinophils. What is the most
likely diagnosis?
A. *Diffuse interstitial exudative myocarditis
B. Focal interstitial exudative myocarditis
C. Nodular productive myocarditis
D. Interstitial productive myocarditis
E. Alternative myocarditis
20. The woman of 45 years within several years
has difficulties at swallowing. She also notes the
limitation of fingers movements at printing on the
computer keyboard, though joints are not
painful. Physical investigation revealed her "stony
face" (no wrinkles) owing to tightening of the
facial skin and restricted motion of the mouth.
The skin biopsy showed a widespread fibrosis of a
derma without inflammatory infiltration. Diagnose
disease on the listed clinical and morphological
data.
A. * Scleroderma
B. Lupus erythematosus
C. Dermatomyositis
D. Amyloidosis
E. Rheumatic arthritis
18. A 35- year- old female presented her
physician intermittent episodes of ischemia of her
fingers, marked by pallor, paresthesias and pain,
accompanied by tightening and thickening of
the
skin
and
poliarthralgia.
Histological
investigation of the skin biopsy from affected
areas revealed mild epidermal atrophy,
hyalinosis of collagen fibers within derma,
scattered perivascular lymphocytes' infiltrates.
Underlying skeletal muscles expressed interstitial
edema, loss of cross-section striation, nidal
necroses followed with petrification. What is the
most likely diagnosis?
A. *Dermatomyositis
B. Systemic scleroderma
C. Lupus erythematosus
21. A 43-year-old woman presents to her
physician with pain and immobility of the bones
in metacarpal phalangeal and feet joints. Similar
complains in symmetric pattern were about ulnar
and knee joints, though not so severe. Physical
examination revealed pastous skin over the
joints, a partial ankylosis of metacarpal
phalangeal and feet joints, and also ulnar
deviation of the hands and flexion-hypertension
('swan neck"or"walrus flipper") deformities of the
fingers. In addition, movable firm, rubbery and
tender 1cm hypodermic nodules were found in
the phalangeal joints area. An aspirate of joint
fluid showed increased turbidity and presence of
white
"grains"
("rice
bodies").
Immunofluorescence
also
revealed
the
73
Rheumatic disease
rhematoid factor. What is the most
diagnosis?
A. *Rheumatic poliartritis
B. Systemic disease of connective tissue
C. Gout
D. Osteoartrosis
E-
likely
22. A post-mortem of the patient who died from
uremia revealed deformation of a spine column
with severe restriction of its mobility. Articular
cartilages of spine joints were destructed with
persistent chronic inflammation in tissues of joints.
The joints cavities filled with connective tissue, in
some places leading to ossification and ankylosis
formation. In an aorta, heart, lungs a chronic
inflammation and a focal sclerosis were
discovered. In kidneys an amyloidosis was
recognized. What diagnosis in this case is most
probable?
A. *Ankiloid spondiloartritis (the Behterev's
disease)
B. The Pedget's disease (deforming ostosis)
C. Rheumatoid arthritis.
D. Parathyroid osteodystrophy.
E. Osteopetrosis (marble disease).
23. At the patient with suspicion on a systemic
disease a biopsy from a site of the skin tightening
and restricted motility was taken. A histology
investigation revealed all kinds of disorganization
of connective tissue fibers with mild cellular
reaction and also transition in excessive sclerosis
and a hyalinosis. What is the most likely
diagnosis?
A. *Scieroderma
B. Nodular periarteritis
C. Lupus erythematosus
D. Psoriasis
E. Dermatomyositis
24. A 38-year-old man, who has been suffering
from systemic lupus erythematosus for 3 years,
developed diffuse renal lesions accompanied by
massive
edemas,
marked
proteinuria,
hyperlipidemia, and dysproteinemia. What is the
most
likely
mechanism
of
proteinuria
development in this case?
A. Autoimmune damage to the nephrons
B. Inflammatory damage to the nephrons
C. Ischemic damage to the tubules
D. Increased blood proteins
E. Morbid affection of the urinary tracts
25. Autopsy of a woman revealed the following
morphologic changes: stenosis of the
atrioventricular opening, mitral insufficiency.
Histologically there are focal cardiosclerosis and
”blooming” Aschoff nodules
in the myocardium. What is the most likely
diagnosis?
A. Rheumatism
B. Scleroderma
C. Dermatomyositis
D. Polyarteritis nodosa
E. Systemic lupus erythematosus
26. Autopsy of a 50-year-old woman, who had
been suffering from systemic connective tissue
disease, reveals small dense kidneys with lumpy
surface. Microscopy of the renal glomeruli
detects there foci of fibrinoid necrosis, hyaline
thrombi, hematoxylin bodies, and so-called ”wire
loop thickening” of the basement membranes.
What disease can be characterized by such
changes in the kidneys?
A. Systemic lupus erythematosus
B. Rheumatism
C. Scleroderma
D. Rheumatoid arthritis
E. Dermatomyositis
27. In a body of a 37-year-old woman, who died
with signs of pulmonary edema, there was
detected acute deformation of the aortic valve:
it is shortened, thickened, ulcerated, has areas of
stone-like density. On its external surface there
are large, up to 2 cm in diameter, thrombotic
plaques. Left ventricle wall is 2,2 cm thick.
Cardiac muscle is dull, matt, and flaccid. What
type of endocarditis corresponds with described
alterations of the aortic valve?
A. Ulcerative polypoid endocarditis
B. Diffuse endocarditis
C. Acute verrucous endocarditis
D. Recurrent verrucous endocarditis
E. Fibroplastic endocarditis
74
Lung diseases
Lung diseases
1. An autopsy of the miner, who had worked in
coal mine more of 10 years, revealed in a lung
whitish fibrous fibers and nodules 0,2-0,3 cm in
diameter. Histological investigation of nodules
showed bundles of interacting concentric pink
collagen with apparent hyalinosis. There was a
minimal inflammatory reaction and also
noticeable amount of a brownish dust. What is
the most likely type of pneumoconiosis in this
case?
A. *Silicosis
B. Talcosis
C. Asbestosis
D.Siderosis
E. Berylliosis
2. Histological investigations of the bronchus wall
biopsy material, from the patient with a history of
chronic bronchitis, revealed granulation tissue
and diffuse inflammatory infiltrate. What kind of a
bronchitis was diagnosed?
A. *Chronic polypous bronchitis
B. Chronic mucopurulent bronchitis
C. Chronic mucous bronchitis
D. Chronic purulent bronchitis
E. Chronic deforming bronchitis
3. A 72-year old female died of severe grippe. A
post-mortem revealed "the big motley lungs".
Histological
investigation
showed
acute
hyperemia, hemorrhages, an edema of a
pulmonary tissue, erythrocyte-rich exudate that,
filled the bronchi and alveoli. What is the most
likely kind of pneumonia?
A. *Hemorrhagic bronchopneumonia
B. Catarrhal bronchopneumonia
C. Purulent bronchopneumonia
D. Desquamative bronchopneumonia
E. Fibrinous bronchopneumonia
4. A 52-year old female, with a history of the
chronic glomerulonephritis and chronic renal
failure, presented to the hospital with coughing
spells accompanied by thick phlegm and
breathlessness.
Bronchoscopy
revealed
congested,
edematous,
bronchial
mucus
membrane wim small hemorrhages. A bronchial
lumen was narrowed by thick mucus. Name the
process in bronchi?
A. *Secondary acute catarrhal bronchitis
B. Primary acute catarrhal bronchitis
C. Chronic catarrhal bronchitis
D. Destructive - ulcerous bronchitis
E. Catarrhal - purulent bronchitis
5. A 68-year old patient, with a history of the
chronic inflammatory disease of lungs since his
childhood, presented to the hospital with
coughing accompanied by scanty sputum
(expectoration). The complications of pulmonary
and a heart failure resulted in his death. What
changes in heart have been found at postmortem?
A. *Right ventricular hypertrophy and dilatation
B. Left ventricular hypertrophy and dilatation
C. Ventricular hypertrophy
D. Ventricular dilatation
E. Heart without gross change
6. A female patient, with 10 years history of
cough with a purulent sputum and dyspnea,
died from respiratory and heart failure. A postmortem gross investigation of a dead body
revealed her fingers reminded drum sticks. A
dissection of lugs showed a bronchial alteration
with a saccular deformity and purulent
inflammation. What is the most likely diagnosis?
A. *Bronchiectatic disease
B. Tuberculosis
C. Chronic bronchitis
D. Abscess
E. Acute bronchitis
7. A patient died in 3 weeks of the pneumonia
onset. Macroscopic investigation of lungs
revealed the whole of a left inferior lobe
became enlarged, consolidated and airless.
Grossly lungs got the appearance of a grayish
brown, dry surface with fibrin fibers on the pleura.
Histological investigation showed the collapsed
and bloodless alveolar capillaries, the exudate
within alveoli consisted mainly of neutrophil
polymorphs. What is the most likely diagnosis?
A. * Croupous pneumonia
B. Focal bronchopneumonia
Ñ .[nfluenzal pneumonia ãðèïïîçíàÿ
D. Fibrinous pleuritis
E. Intestinal pneumonia
8. The biopsy is taken from a suspicious site at the
mucous the right bronchus of a 58-year old male,
with a history of the chronic bronchitis,
75
Lung diseases
pneumosclerosis
and
cardiopulrnonary
insufficiency. Flistological investigation revealed
cellular and tissue atypia, presence of a "cancer
pearls" structures. What pathological process
associated with histological changes listed
below?
A. *Squamous cell keratinous carcinoma
B. Chronic polypous bronchitis
C. Bronchiectasis
D. Acute bronchitis
E. Squamous metaplasia of the bronchial
epithelium
9. Histological investigation of a biopsy of a
bronchus revealed a tumor which is constructed
from clusters of atypical cells of a laminated
(stratified) squamous epithelium, some areas with
typical "pearls". What is the most likely diagnosis?
A. * Squamous cell keratinous carcinoma
B. Squamous cell nonkeratinous carcinoma
C. Solid carcinoma
D. Mucinous carcinoma
E. Scirrhous carcinoma
10. A 42-year old male, with a history of the
amyloidosis, died of chronic renal failure. A postmortem revealed in the lower lung lobe multiple
dilated bronchi filled with abundant foul sputum.
A gross investigation of a cut surface showed a
honey-comb pattern of a lungs tissue. A
microscopic study demonstrated the chronic
inflammation within bronchial wall and also a
replacement of elastic and muscular fibers by a
connecting tissue. These changes in a lung are
regarded as:
A. *Bronchiectasis
B. Bronchopneumonia
C. Chronic bronchitis
D. Chronic pneumonia
E. Abscesses of lungs
11. A 53-year old male, with a history of the
chronic diffusive bronchitis, presented to the
hospital
symptoms
of
cardiopulmonary
insufficiency, then resulted in the lethal outcome
of the disease. An autopsy revealed increased
volume and hyperinflation of lungs, which
covered a mediastinum with their edges and
keep their form when removed from the body
and put at autopsy table. Gross investigation
showed a pale grey colour of lungs and a
crunch sound while making an incision of a
pulmonal tissue. A pressing a finger on a lungs
tissue creates a fossa. A mucopurulent exudate
was determined within bronchi's lumen. What is
the most likely diagnosis?
A. *Chronic diffuse obstructive emphysema
B. Chronic focal emphysema
C. Intestinal emphysema
D. Primary idiopathic. emphysema
E. Vicarious compensatory emphysema
18. A 48-year old male, with a history of common
cold after acute cooling, presented to his
physician with symptoms of lung a heart
insufficiency. He died soon at the hospital. A
post-mortem revealed the right lung enlarged,
firm, hypoventilated, with a liver-like consistency
and fibrin fibers on the pleura. On a cut section
pulmonary tissue had a gray coloring and looked
granular. A turbid liquid flowed down the
surface. Histological investigation showed an
acute inflammation with the exudate within
alveoli
consisted
mainly
of
neutrophil
polymorphs. What is the most likely diagnosis?
A. *Croupous pneumonia
B. Focal pneumonia
C. Intestinal interalveolar pneumonia
D. Staphylococcal pneumonia
E. Idiopathic fibrosing alveolitis
19. A 52-year old male presented to hospital with
symptoms of acute pneumonia, complicated on
the 6th day by pulmonary edema. The latter one
resulted in the patient's death. A post-mortem
revealed the upper part of the right lung
enlarged, firm, with fibrin fibers on the pleura. On
a cut section pulmonary tissue had a gray
coloring and looked granular. A turbid liquid
flowed
down
the
surface.
Histological
investigation showed the exudate within alveoli
consisted of fibrin, neutrophil polymorphs,
macrophages, and disintegrated red cells. What
is the most likely diagnosis?
A. *Croupous pneumonia
B. Staphylococcal bronchopneumonia
C. Virus pneumonia
D. Hypostatic pneumonia
E. Adult respiratory distress syndrome
20. An autopsy of the middle age man with a
long history of bronchiectasis revealed markedly
enlarged adrenals volume at the expense of a
cortical layer. Adrenals were pale, dense, and
76
Lung diseases
sebaceous. Microscopic investigation showed
the unstructured, amorphous, eosinophilic,
Congo red positive deposits by reticular stroma
and within vessels walls. These changes indicate
a development of:
A. *Amyloidosis
B. Mucoid swelling
C. Fibrinoid swelling
D. Lipidosis
E. Hyalinosis
21. A post-mortem revealed the left lung
enlarged, firm, with fibrin fibers on the pleura. On
a cut section pulmonary tissue had a gray
coloring. A turbid liquid flowed down the surface.
What is the most likely diagnosis?
A. *Croupous pneumonia
B. Focal pneumonia
C. Intestinal pneumonia
D. Cancer of lungs
E. Bronchiectatic disease
22. A 42-year old woman, with a history of
common cold after acute cooling, presented to
his physician with symptoms of cough, chest
pain, fever, and difficulty in breathing. She died
on the 5th day staying at the hospital. A postmortem revealed the inferior lobe the right lung
enlarged, firm, with membranous fibrin fibers on
the pleura. On a cut section pulmonary tissue
had a gray coloring and looked granular. What is
the most likely diagnosis?
A. *Croupous pneumonia
B. Influenzal pneumonia
C. Bronchopneumonia
D. Caseous pneumonia
E. Measles pneumonia
sebaceous (waxy) cut surface. To what disease
there correspond such changes?
A. *Amyloidosis of kidney
B. Glomerulonephritis
C. Acute tubular necrosis
D. Pyelonephritis
E. Arteriolosclerotic nephrosclerosis
25. A 54-year old male, with a history of
destructive purulent bronchitis died of multiple
organ
failure.
An
autopsy
revealed
cardiomegaly, a sebaceous (waxy) kidney and
a sago spleen. What process has complicated
bronchitis?
A.* Secondary amyloidosis
B.Senile amyloidosis
C. Tumor-like amyloidosis
D. Primary amyloidosis
E. Generalized hyalinosis
D. Silicoanthracosis
E. Asbestosis
35. An autopsy of a patient, who had been
working within 20 years the coal worker, revealed
grayish-black dense, sclerotic lungs. The vast
areas of collagen tissue new growth and multiple
macrophages, carrying black pigment within
cytoplasm, were recognized under microscope.
What is the most likely disease?
A. *Anthracosis
B. Anthracosilicosis
C. Silicoanthracosis
D. Talcosis
E. Siderosis
23. Histological investigation of pulmonary
segment, removed from a coal worker's lung,
revealed multiple roundish, nodules composed
of concentric whorls of dense, hyaline fibers of
collagen. What is the most likely disease?
A. *Silicosis
B. Tuberculosis
C. Bronchitis
D. Fibrosing alveolitis
E. Cancer of lungs
36. An autopsy of the 60-year-old man with a
long history of over consumption of alcohol
revealed the right lung enlarged, firm, with fibrin
fibers on the pleura. On a cut section pulmonary
tissue had a gray coloring. Histological
investigation showed the exudate within alveoli
consisted of fibrin and disintegrated erythrocytes.
What is the most likely diagnosis?
A. *Croupous pneumonia
B. Focal pneumonia
C. Intestinal pneumonia
D. Primary tuberculosis of lung
E. Caseous pneumonia
24. A 46-year old male, with a history of the
chronic bronchiectasis, died from uremia. An
autopsy revealed enlarged, firm kidneys, with
37. An autopsy of the 47-year-old man revealed
the right lung firm with dry hypoinflated granular
pulmonary tissue. Visceral pleura presented with
77
Lung diseases
membranous gray-brown fibrin fibers on the
pleura. What is the most likely diagnosis? What is
the most likely diagnosis?
A. *Croupous pneumonia
B. Tuberculosis
C. Bronchopneumonia
D. Intestinal pneumonia
E. Pneumofibrosis
38. A 42-year old man presented to the hospital
with symptoms of malaise, complicated with a
collapse one hour later. He died soon, not
coming to consciousness. A post-mortem
revealed the lungs enlarged, congested, cut
with a sound of crunch. Whole of a right inferior
lobe had a liver-like texture with some fibrin fibers
superposed on the pleura. On a cut section
pulmonary tissue exhibited a gray-brown
coloring. What is the most likely diagnosis?
A. *Croupous pneumonia
B. Bronchopneumonia
C. Acute venous hyperemia in lungs
D. 1'oxic shock syndrome
E. Acute myocardial infarction
39. An autopsy of the 69-year-old man with a
long history of chronic bronchitis revealed
increased pulmonary volume and hyperinflation,
pale grey color, soft texture lungs that kept their
form when removed from the body and put at
autopsy table. Histological investigation showed
markedly dilated proximal acini, thinned and
somewhere ruptured interalveolar septas. For
what disease of lungs such morphological
picture is characteristic?
A. *Emphysema of lungs
B. Chronic intestinal pneumonia
C. Atelectasis of lungs
D. Bronchiectatic disease
E. Pleural empyema
40. An autopsy of a patient, who had been
working within 20 years the coal worker, revealed
enlarged, slightly firm and hypoinflated lungs. At
the gross investigation of the lungs sectional view
multiple, round, grayish-black, diffuse nodules
were discovered. Histological study showed
nodules composed of concentric whorls of
dense collagen fibers, some of them- with
hyaline degeneration. What is the most likely
disease?
A. *Nodular form of silicosis
B. Miliary tuberculosis of lung
C. Bronchiectatic disease
D. Croupous pneumonia
E. Diffusive - sclerotic form of silicosis
41. On autopsy the dissector determined that the
lungs are enlarged, pale, soft, do not deflate,
crunch when cut. Microscopically there are
dilated alveolar ducts, alveolar septa are thin,
and signs of intracapillary sclerosis are observed.
What pulmonary disorder are these presentations
characteristic of?
A. Emphysema
B. Pneumosclerosis
C. Pneumothorax
D. Atelectasis
E. Pneumonia
42. Autopsy of a patient, who died of bilateral
bronchopneumonia, shows in the left lung lower
lobe a cavity 5 cm in diameter, filled with liquid
yellowish-white substance. What complication of
the patient’s pneumonia had developed?
A. Abscess
B. Gangrene
C. Granuloma
D. Sequestrum
E. Tuberculoma
43. During autopsy of a 34-year-old man, who
died of chronic kidney failure due to renal
amyloidosis, in the lungs (mainly in the lower
lobes) the pathologist detected multiple
bronchial dilations filled with purulent masses
accumulated in the bronchial lumen. Surface of
the lungs section has fine-meshed pattern and
resembles a honeycomb. Histologically there is a
chronic inflammation detected in the bronchial
wall, muscle fibers are replaced with connective
tissue. These changes in the lungs can be
defined as:
A. Bronchiectases
B. Bronchopneumonia
C. Chronic bronchitis
D. Chronic pneumonia
E. Lung abscesses
44. Autopsy of the body of a man, who for a long
time had been working at the factory with high
content of silicon dioxide in the air, revealed
enlarged dense lungs with numerous round and
oval sclerotic foci. The foci were miliary and
78
Lung diseases
larger in size and colored gray or gray-black.
What is the most likely diagnosis?
A. Nodular silicosis
B. Diffuse sclerotic silicosis
C. Anthracosilicosis
D. Silicoanthracosis
E. Asbestosis
79
Gastrointestinal diseases
Gastrointestinal diseases
1. An operation of a male with a medical history
of a hematemesis revealed a stomach ulcer
penetrated into the muscular layer. Ulcer edges
were dense. A bleeding vessel was detected at
the ulcer's bottom. What is the type of an ulcer?
A. * Chronic ulcer with hemorrhage
B. Chronic ulcer with penetration
C. Ecute ulcer with bleeding
D. Chronic ulcer with perforation
E. Chronic ulcer with malignisation
2. A removed appendix delivered to pathology
department. Macroscopic investigation revealed
its thickening, enlargement, dull and hyperemic
serous membrane. A yellowish-green liquid lumen
was visible on a cut section within its lumen. What
is the most likely type of the appendicitis?
A. * Suppurative appendicitis.
B. Catarrhal appendicitis.
C. Superficial appendicitis.
D. Gangrenous appendicitis.
E. Apostematous appendicitis
3. A microscopic investigation of a colon biopsy
revealed a superficial defect of a mucosa,
decrease of goblet cells number with lack of
mucus in them. In addition, considerable
lympho- plasmocyte infiltration with presence of
segmented leucocytes and eosinocytes was
defined. Choose the most probable and exact
diagnosis.
A. *Nonspecific ulcerative colitis in exacerbation
B. Crohn's disease
C. Chronic ischemic colitis
D. Dysentery in the third stage
E. Amebiaz of intestine with forming of ulcers
4. Microscopic study of appendix determined
intensive leukocyte infiltration hyperemia, stases
throughout all its layers. What is the most likely
type of appendicitis?
A. * Suppurative appendicitis
B. Gangrenous appendicitis
C. Superficial appendicitis
D. Simple appendicitis
E. Chronic appendicitis
5. Macroscopic investigation of a removed
appendix revealed its thickening, enlargement,
dull and hyperemic serous membrane with
whitish membranaceous incrustation. A whitishyellow, opaque, viscous liquid detected on a cut
section within its lumen. What is the most likely
type of the appendicitis?
A. * Suppurative appendicitis.
B. Gangrenous appendicitis
C. Simple appendicitis
D. Superficial appendicitis
E. Chronic appendicitis.
6. The removed appendix thickened and
covered by fibrinopuralent incrustation. A
purulent exudate infiltrated all appendix layers;
the destruction of mucosa membrane was
evident. What is the most likely diagnosis?
A. Flegmonous-ulcerative appendicitis
B. Simple appendicitis
C. Suppurative appendicitis
D. Gangrenous appendicitis
E. Superficial appendicitis
7. An autopsy of a 48-year-old woman with a
history of the stomach neoplasm revealed the
markedly enlarged, firm, white color ovary.
Microscopic investigation showed markedly
atypical epithelial cells placed among the layers
and fibers of a connecting tissue. What is the
most likely diagnosis?
A. *Krukenberg tumor of ovary.
B. Serous cystadenocarcinoma
C. Pseudomucinous cystadenocarcinoma.
D. Malignant thecoma.
E. Malignant granulosa cell tumor.
8. A post-mortem of a male with a history of
anemia accompanied by vomiting by dark
gastric contents reveled in a stomach about 1
liter of liquid blood and bloody clots. A gross
investigation showed an on small curvature of a
stomach an oval solitary ulcer with the elevated
firm edgesand a smooth floor. What is the most
likely diagnosis?
A. *Chronic gastric ulcer
B. Chronic atrophic gastritis
C. Acute gastritis
D. Acute gastric ulcer
E. Chronic hyper-trophic gastritis
9. A 48-year old female presents to her physician
enlarged
supraclavicular
lymph
nodes.
Microscopic investigation of a biopsy from a
lymph node revealed the metastasis of the
80
Gastrointestinal diseases
signet-ring cancer. Choose the most probable
localization of a primary tumor.
A. *Cancer of stomach.
B. Cancer of oesophagus.
C. Cancer of thyroid.
D. Cancer of lung.
E. Cancer of cervix uteri.
10. A histological investigation of a gastric biopsy
revealed a thinning of a stomach mucosa with
reduction of a glands quantity. This was
accompanied with a considerable growth of a
connecting tissue, dilation of a glands lumen,
lymphocytes and plasmocytes infiltration of the
mucosa. What is the most likely diagnosis?
A. * Chronic atrophic gastritis
B. Chronic superficial gastritis
C. Chronic atrophic gastritis with an intestinal
metaplasia
D. Phlegmon of stomach
11. Microscopic study of appendix determined
intensive leukocyte infiltration throughout all its
layers. What is the most likely type of
inflammation?
A. * Suppurative appendicitis
B. Apostematous appendicitis
C. Gangrenous appendicitis.
D. Superficial appendicitis.
E. Flegmonous-ulcerative appendicitis
12. A histological investigation of the removed
stomach ulcer revealed in its floor the
fibrinopurulent exudate, a zone of the fibrinoid
necrosis, a granulation tissue with a fibrous tissue
underneath. What is the most likely diagnosis?
A. * Chronic ulcer
B. Acute ulcer
C. Acute erosion
D. Phlegmon of stomach
13. A macroscopic investigation of the appendix,
9 cm in length and 0.9 cm in thickness, revealed
dull
and
hyperemic
serous
membrane.
Microscopic study determined edema, stases in
capillaries and venules, fine hemorrhages
throughout the mucosa. Besides these, the
necrotic foci with leukocyte infiltration around
them were also verified. What is the most likely
diagnose?
A. * Superficial appendicitis.
B. Simple appendicitis.
C. Suppurative appendicitis
D. Flegmonous-ulcerative appendicitis
E. Gangrenous appendicitis.
14. A gastroscopy of a 44-year old patient, with a
history of a pain in epigastrium after meal,
revealed a hyperemia of the stomach mucosa
with the stomach folds reduction. Histological
study showed a thinning of the mucosa, a
reduction of the glands quantity accompanied
with the growth of a connecting tissue,
lymphocytes
and
plasmocytes
infiltration.
Specify, what of the listed diagnoses is the most
probable?
A. *Chronic atrophic gastritis.
B. Acute catarrhal gastritis.
C. Acute suppurative gastritis.
D. Chronic superficial gastritis.
E. Giant hypertrophic gastritis.
15. A physical examination of a fauces of a 12year-old child with tonsillitis revealed the
reddening and slight edema of mucosa, with
reactive enlargement of tonsils, dotted by
pinpoints of exudates emanating from the
tonsillar
crypts.What
clinical-morphological
variant of tonsillitis is the most probable in this
case?
A. *Lacunar tonsillitis
B. Catarrhal tonsillitis
C. Purulant tonsillitis
D. Fibrinous tonsillitis
E. Necrotic tonsillitis
16. A 44-year old patient, with a history of the
chronic duodenum peptic ulcer, died of
peritonitis. An autopsy revealed multiple
steatonecroses of a retroperitoneal tissue and a
pancreas. A gross investigation of a duodenum
demonstrated an ulcerative defect, which was 5
mm in diameter and 10 mm deep. The edges
presented necrotic masses. Diagnose the
complication of a duodenal peptic ulcer?
A. *Penetration
B. Hemorrhage
C. Stenosis
D. Perforation
17. A histological investigation of a gastric biopsy
of a 50-year old woman revealed a thinning of a
stomach mucosa with reduction of a glands
quantity, foci of an intestinal metaplasia; a
81
Gastrointestinal diseases
plethora, an edema and a stromal sclerosis.
These were accompanied with a diffuse
leucocytes, lymphocytes and plasmocytes
infiltration of the mucosa. What is the most likely
diagnosis?
A. *Chronic atrophic gastritis in an active phase
B. Chronic atrophic gastritis in a nonactive phase
C. Chronic superficial gastritis
D. Acute catarrhal gastritis
E. Acute fibrinouse gastritis
The coating was firmly adhering to its surface
and had significant thickness. Microscopy
revealed congestion and necrosis of mucosal
and submucosal layers, fibrin presence. What is
the most likely diagnosis?
A. Diphtheritic gastritis
B. Croupous gastritis
C. Phlegmonous gastritis
D. Catarrhal gastritis
E. Corrosive gastritis
18. A gross investigation of a stomach revealed a
deep defect of a gastric wall with a lesion of a
muscular layer. The proximal edge was
undermined and distal one was flat. A
histological study of the removed stomach
showed in its floor the zone of the fibrinoid
necrosis, a granulation tissue and massive fibrosis,
which replaced the muscular layer. What is the
most likely diagnosis?
A. *Chronic ulcer in exacerbation
B. Chronic ulcer in remission
C. Acute ulcer
D. Erosion
E. Cancer-Ulcer
22. In the course of an urgent surgery, the
vermiform appendix of the patient was excised.
The appendix was acutely distended and grayblack throughout its whole length. In the distal
segment a defect of the appendix wall was
detected, through which a foul-smelling graybrown substance was being discharged from the
appendix lumen. Histological analysis shows
necrotization of the appendix wall with
hemorrhagic foci; lumen of the mesenteric artery
is filled with a trombus. What type of appendicitis
is it?
A.* Acute gangrenous
B. Acute superficial
C. Acute simple
D. Acute phlegmonous
E. Chronic
19. Microscopic study determined edema,
diffusive leukocyte infiltration of appendix wall
and also a mucosa! lesion with alteration of its
muscular layer. What is the most likely diagnose?
A. * Flegmonous-ulcerative appendicitis
B. Suppurative appendicitis
C. Gangrenous appendicitis
D. Superficial appendicitis
E. Apostematous appendicitis
20. A gastroscopy of a 55-year old patient
revealed a diffusive swelling, hyperemia and
solitary small hemorrhage of the stomach
mucosa. These were accompanied with
considerable quantity of a muddy, viscous grey
exudate on a gastric surface. What gastritis has
developed at the patient?
A. *Catarrhal gastritis
B. Hemorrhagic gastritis
C. Flegmonous gastritis
D. Fibrinous gastritis
E. Corrosive gastritis
21. At the post-mortem examination the stomach
of a patient with renal failure was found to have a
yellow-brown coating on the thickened mucosa.
82
Liver diseases
Liver diseases
1. A microscopical investigation of a liver biopsy
revealed a dystrophy, necroses of hepatocytes,
a sclerosis, accompanied with destruction of a
hepatic beam and a lobular structure, a
formation of false lobes and regenerative nodes.
What is the most likely diagnosis?
A. * Cirrhosis of liver
B. Chronic gepatoz
C. Chronic hepatitis
D. Massive diffuse necrosis of liver
E. Acute hepatitis
2. An autopsy of a 53-year old patient, with a
history of a chronic alcoholism and repeated
attacks of an alcoholic hepatitis, revealed a firm,
yellow color liver with pointed edge. A liver
surface was coarsely scarred with multiple fine
knots on a cut surface. What is the most likely
diagnosis?
A. * Cirrhosis of liver.
B. Cancer of liver.
C. Fatty dystrophy of liver.
D. Chronic hepatitis.
E. Acute hepatitis.
3. A 62-year old patient, with a history of a
cholelithiasis accompanied with cholangitis and
cholangiolitis, presented to the hospital liver
cirrhosis. What is the most likely type of cirrhosis
presented?
A. *Biliary
B. Infection
C. Toxins
D. Nutritional deficiency
E. Circulatory
4. A patient presented to the hospital an ascites,
twice
enlarged
spleen,
a
varicose
esophagogastric veins and veins around and
within the rectum. A histological investigation of
liver biopsy revealed micronodular cirrhosis. What
process has complicated cirrhosis?
A. * Portal hypertension
B. Cardiac insufficiency
C. Hepatotenal syndrome
D. Hepatic-cellular insufficiency
5. A 62-year old patient, with a history of chronic
virus hepatitis, died of an acute posthemorrhagic
anaemia resulted from an esophageal varicose
veins bleeding. An autopsy revealed the
reduced, dense liver with coarsely scarred
surface. A microscopical investigation shpwed
regenerative false nodules separated by fibrous
tissue, contained the remnants of portal tracts.
What morphogenetic type of cirrhosis took place
in this case?
A. *Portal cirrhosis.
B. Postnekrotic cirrhosis.
C. Mixed cirrhosis.
D. Viral cirrhosis.
E. Biliary cirrhosis.
6. A 42-year-old male, with a history of rheumatic
stenosis of the left atrioventricular orifice resulted
in chronic heart insufficiency, presented at the
hospital with dyspnea at small physical exercises,
tachycardia, a cyanosis of his lips, bubbling rales
in the inferior segments of lungs, leg's edema.
What histological changes will be characteristic
for a liver?
A.*Necrosis of hepatocytes in the center of
lobule, fatty dystrophy on periphery
B. Necrosis of hepatocytes in the center of
lobule, hyalin dystrophy on periphery
C. Necrosis of hepatocytes in the center of
lobule, hydropic dystrophy on periphery
D. Fatty dystrophy of hepatocytes in the center
of lobule, necrosis on periphery
E. Hydropic dystrophy of hepatocytes in the
center of lobule, necrosis on periphery
7. A 52-year-old patient presented with fatigue,
loss of appetite, muscle and joint aches, an
increase in body temperature to 38°C. On the
7th day a patient exhibited a yellow color in the
skin, urine and around the whites of the eyes and
also an acute pain in right hypochondrium. A
histological investigation of his liver biopsy
revealed a destruction of the liver's beam
architecture,-vacuolar
and
ballooning
dystrophies of hepatocytes, some cells were
necrotic. The Councilman's bodies were also
determined. On the periphery of lobes were
registered the enlarged quantity of multinuclear
hepatocytes. What form of virus hepatitis is most
likely?
A. * Icteric hepatitis
B. Malignant hepatitis
C. Chronic hepatitis
D. Cholestatic hepatitis
83
Liver diseases
E. Anicteric hepatitis
8. An autopsy of a male, with a history of a drug
abuse,
revealed
vacuolar
dystrophy
of
hepatocytes, a Councilman's bodies, periportal
inflammation consisted mainly of chronic
inflammatory cells, lymphocytes, plasma cells
and histiocytes. What is the most likely etiology of
the disease?
A. *Viral
B. Bacterial
C. Toxic
D. Parasite
E. Fungus
9. The liver biopsy is taken from the patient with
symptoms of a parenchymatous icterus and a
portal hypertension. Histological investigation
revealed a fatty dystrophy of hepatocytes, a
destruction of a hepatic beam and a lobular
structure, a formation of false lobes and
regenerative nodes. These were accompanied
with a porto- portal fibrous septae formation and
periportal lympho- macrophageal infiltrates.
What is the most likely diagnosis?
A. * Cirrhosis of liver
B. Alcoholic hepatitis
C. Chronic hepatosis
D. Viral hepatitis
E. Toxic dystrophy
10. An autopsy of a male, with a history of a
chronic alcohol abuse, revealed a small, firm,
micronodular liver. Histological investigation
showed a fatty dystrophy of hepatocytes, a
formation of small regenerative (false) nodes
separated by fibrous septae with lymphomacrophageal infiltration. What is the most likely
diagnosis?
A, *Alcoholic cirrhosis.
B. Chronic active alcoholic hepatitis.
C. Chronic persistent alcoholic hepatitis.
D. Toxic dystrophy of liver.
E. Fatty hepatosis.
11. A patient presented with vomiting, loss of
appetite
and
jaundice.
A
histological
investigation of his liver biopsy revealed vacuolar
and ballooning dystrophies of hepatocytes and
necrosis of some cells. The Councilman's bodies
were also determined. Besides, a destruction of
the liver's beam architecture within lobes and
inflammation consisted mainly of chronic
inflammatory cells, lymphocytes, plasma cells
and histiocytes were registered. What form of
virus hepatitis is most likely?
A. Viral hepatitis
B. Purulent hepatitis
C. Cirrhosis of the liver
D. Toxic dystrophy of the liver
E. Malaria
12. A 35-year-old man exhibits clinical symptoms
of the virus hepatitis Â. À puncture liver biopsy
revealed: a destruction of the liver's beam
architecture with polymorphism of hepatocytes
and plural mitosis figures. Hepatocytes were
enlarged, filled by vacuoles which contained a
transparent liquid. What kind of a dystrophy is
characteristic for the described case?
A. * Hydropic dystrophy
B. Fatty dystrophy
C. Hyalin dystrophy
D. Carbohydrate dystrophy
13. An autopsy of a female, with a history of a
rheumatic disease with a mitral stenosis, resulted
in decompensation stage, revealed a general
venous plethora, small, firm and micronodular
liver. Gross investigation of a cut surface showed
a lobular structure and yellowish-brown color of
hepatic tissue. Define the most probable
pathology diagnosed in a liver.
A. *Portal cirrhosis
B. Fatty dystrophy
C. Billiary cirrhosis
D. Postnecrotic cirrhosis
E. Atrophy
14. After mushroom poisoning the patient
developed signs of acute hepatic failure leading
to his death. On autopsy the liver is diminished,
flaccid; the capsule is wrinkled; the tissue is
ochre-yellow on section. Microscopically: fatty
degeneration of hepatocytes, necrotic central
segments of the hepatic lobes. These changes
are characteristic of:
A. Massive progressive necrosis
B. Fatty hepatosis
C. Acute exudative hepatitis
D. Acute productive hepatitis
E. Hepatolenticular degeneration
84
Kidney diseases
Kidney diseases
1. 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?
A. *Secondary amyloidosis
B. Glomerulonephritis
C. Chronic pyelonephritis
D. Congenital kidney cysts
E. Secondary nephrosclerosis
2. A postmortem of a 65-year-old patient with a
history of the adenoma of a
prostate revealed big kidneys with markedly
dilated pelvis and calyces filled with a
transparent liquid. Name the kidneys pathology.
A. *Hydrohephrosis
B. Glomerulonephritis
C. Amyloidosis
D. Tuberculosis
E. Pyelonephritis
3. 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?
A. * Hyalinosis and sclerosis of capillaries of
glomerulus.
B. Spasm of afferent glomerular arteriole.
C. Hyaline cast in the lumen of renal tubules.
D. Necrosis of renal tubular epithelium.
E. Necrosis of renal cortex.
4. 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 tubularinterstitial component. Electronmicroscopic
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?
A. *Mesangiocapillary glomerulonephritis.
B. Mesangial proliferative glomerulonephritis
C. Membranous glomerulonephritis.
D. Rapidly progressive glomerulonephritis.
E. Postinfectious glomerulonephritis.
5. Histological investigation of the kidneys biopsy
revealed epithelial crescents
more than in 50% glomerular tufts, necrotic
capillary loops with fibrinous thrombi
within their lumens. In addition, expressed tubular
interstitial component was also
37 registered. What is the most likely kidneys
disease?
A. * Rapidly progressive glomerulonephritis.
B. Lipoid nephrosis.
C. Chronic glomerulonephritis
D. Amyloidosis
E. Necrotic nephrosis
6. A 49-year-old patient died of a massive
bleeding from an operating wound. A
post-mortem revealed enlarged kidneys with
strained fibrous capsule. A gross
investigation of a cut surface determined wide,
pale grey color cortical layer
accurately delimited from cyanotic, dark red
pyramids. Histological study showed a
necrosis and a marked dystrophy of an
epithelium convoluted tubules,
tubulorrhexis.What condition has developed in
kidneys?
A. * Acute necrotic nephrosis.
B. Postinfectious glomerulonephritis
C. Lipoid nephrosis.
D. Rapidly progressive glomerulonephritis.
E. Secondary amyloidosis of kidneys.
7. An autopsy of a 59- year-old man revealed the
coral-like stone filled all renal pelvis of a right
kidney. The kidney was enlarged, hyperemic with
the capsule, taken out hardly. The pelvis and
calyxes cavities were dilated, filled by a turbid,
greenish- yellowish viscous liquid. The mucosal
layer was dim with some hemorrhages. A cut
surface investigation showed motley pattern of
the kidney's tissue, with yellow spots in up to 1cm
85
Kidney diseases
in diameter. What complication to nephrolithiasis
has developed?
A. *Chronic pyelonephritis with exacerbation
B. Tumour of kidney
C. Postinfectious glomerulonephritis
D. Primary amyloidosis
E. Rapidly progressive glomeralonephritis.
8. Histological study of a renal biopsy revealed a
necrosis and a marked dystrophy of the
convoluted tubules epithelium, tubulorrhexis,
stromal edema and hyperemic medulla. Name
the pathological process?
A. *Necrotic nephrosis
B. Glomerulonephritis
C. Pyelonephritis
D. Cystic disease
E. Kidney stone disease
9. A 59-year-old man with a long history of
bronchiectasis disease, a pneumorrhagia,
presented with facial and back edema, and
proteinuria of 33mg/l. A pulmonary bleeding
soon resulted in his death. A post-mortem
revealed the enlarged firm kidneys with a
sebaceous (waxy) cut surface. Histological
investigation showed the accumulation at
glomeruli
and
under
tubular
epithelium
homogeneous eosinophilic, Congo-Red positive
masses, which gave a metachromasia reaction
with the methyl violet. Name process which has
developed in kidneys?
A. *Amyloidosis
B. Hyalinosis
C. Fatty dystrophy
D. Mucoid swelling
E. Fibrinoid swelling
10. An autopsy revealed substantial enlargement
of a right kidney. A gross investigation of a renal
cut section showed a stone in it with marked
dilation of the pelvis and calyces by urine and
thinning of the renal parenchyma. What of
diagnoses is the most likely?
A. * Hydronephrosis.
B. Pyelectasia
C. Pyelonephritis.
D. Cyst of kidney
11. An autopsy of a 44-year-old female revealed
a substantial enlargement of a right kidney
reminding grape clusters. The cut surface
showed cavities varying in size from 0, 5 to 3 cm
in diameter, which were filled by serous liquid
and colloid masses. Kidney parenchyma
between cavities was thinned to 0, 1 cm. What is
the most likely diagnosis?
A. *Renal cystic disease
B. Chronic pyelonephritis
C. Acute pyelonephritis
D. Nephrolithiasis
E. Dysphasia of kidneys
12. A post-mortem of a patient with a long history
of cystitis and a dyskinesia of ureters revealed
morphological signs of uremia. Kidneys were
contracted, with irregularly scarred surface. In
the renal pelvis fine urate stones and sand were
registered. Histological investigation showed 'the
thyroid kidney' and areas of an interstitial
inflammation. What is the most likely diagnosis?
A. *Chronic pyelonephritis
B. Acute pyelonephritis
C. Atherosclerotic-contracted kidney
D. Primary- contracted kidney
E. Amyloidal- contracted kidney
13. 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?
A. *Extracapillary productive glomeralonephritis
B. Intracapillary productive glomerulonephritis
C. Extracapillary exudative glomerulonephritis
D. Intracapillary exudative glomerulonephritis
E. Interstitial nephrite
14. 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?
A. * Amyloidosis of kidneys
B. Chronic glomerulonephritis
C. Subacute glomerulonephritis
D. Septic nephrite
E. Acute necrotic nephrosis
86
Kidney diseases
15. A post-mortem revealed the enlarged
kidneys with a lobulated surface due to plural
cavities, with the smooth wall, filled with a
transparent liquid. What is the most likely
disease?
A. *Renal cystic disease
B. Necrotic nephrosis
C. Pyelonephritis
D. Glomerulonephritis
E. Infarct
16. 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?
A. * Idiopathic nephrotic syndrome
B. Postinfectious glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Chronic glomerulonephritis
E. Acute necrotic nephrosis
17. A post-mortem of a 52- year-old man, with a
long history of chronic glomerulonephritis,
resulted in his death, revealed markedly
reduced, firm, finegrained kidneys. Microscopical
investigation showed fibrinous inflammation of
serous and mucosas, dystrophic changes of
parenchymatous organs and a brain edema.
What complication has led to the serous and
mucosas lesions?
A. *Uremia
B. Anaemia
C. Sepsis
D. DIC-syndrome
E. Thrombocytopenia
18. A young man died of a burn disease. A postmortem revealed the brain edema, liver and
kidneys enlargement. Gross investigation showed
the thickened pale-grey cortical layer and
hyperemic
medulla.
Histological
study
demonstrated focal tubular necrosis at different
points along the nephron with a disruption of
tubular basement membrane interstitial edema
with leukocytic infiltration and a hemorrhage.
What of the listed diagnoses the most authentic?
A. * Necrotic nephrosis.
B. Tubulointerstitial nephritis.
C. Pyelonephritis.
D. Gouty kidney.
E. Myeloma kidney.
19. Histological investigation of a kidney biopsy
showed
sclerosis,
lymphocyte-plasmocyte
infiltration of the renal pelvis walls and calyces;
tubules dystrophy and atrophy. The intact tubules
were dilated, stretched by colloid-like masses.
The epithelium was flattened. In whole, the
microscopic picture of tissue sample had 'a
thyroid kidney' pattern. What diagnosis is most
probable?
A. * Chronic pyelonephritis
B. Sharp pyelonephritis
C. Glomerulonephritis
D. Nephrosclerosis
E. Tubulointerstitial nephritis
20. The patient treated for a cold by the big
doses of paracetamol, presented symptoms of
an oliguria and a/otemia. In 5 days he died of an
acute
renal
insufficiency.
Histological
investigation of kidneys revealed the diffusive
edema of an interstitial tissue of a kidneys cortex,
its infiltration by lymphocytes, the eosinophils,
some neutrophils. Almost intact glomerules were
found along with a destruction of a tubular
epithelium. Name the most probable type of a
kidneys lesion?
A. * Tubulointerstitial nephritis
B. Acute glomerulonephritis
C. Nephrotic syndrome
D. Pyelonephritis
E. Necronephrosis
21. A macroscopic investigation of the removed
kidney reveled renal swallowing, congestion and
a capsule easily taken out. Renal pelvis and
calyxes were dilated, filled by turbid urine. Their
mucosa was dim, with the areas of hemorrhages.
The cut surface of a kidney had a motley
pattern; yellow-grey zones were surrounded by
plethora and hemorrhages areas. To what
disease there corresponds such macroscopic
picture of kidneys?
A. *Acute pyelonephritis
B. Acute glomerulonephritis
C. Amyloidosis of kidneys
D. Nephrolitiasis
E. Renal cystic disease
87
Kidney diseases
22.
Histological
investigation
revealed
proliferation of Bowman's capsule epithelial cells,
podocytes and macrophages, resulted in
crescents
formation,
which
compressed
glomeruli. 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?
A. * Rapidly progressive glomerulonephritis
B. Postinfectious glomerulonephritis
C. Chronic glomerulonephritis
D. Chronic pyelonephritis
E. Amyloidosis of kidneys
23. A 53-year-old patient with a history of a
chronic glomerulonephritis died of chronic renal
insufficiency. A post-mortem revealed smaller
than normal, firm kidneys. Their capsule was
taken out hardly, baring a granular renal surface.
On a cut section a cortical and cerebral layers
were thin with dry, anemic, grey color kidneys
tissue. How is called such kidneys?
A. * Secondary-scarring kidneys
B. Primary- scarring kidneys
C. Atherosclerotic - scarring kidneys
D. Amyloidal- scarring kidneys
E. Pyelonephrotis - scarring kidneys
24. A 5-year-old girl with a history of an acute
respiratory virus infection presented with
widespread swelling, a massive proteinuria, a
hypoalbummemia, 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?
A. *Lipoid nephrosis
B. Postinfectious glomerulonephritis
C. Rapidly progressive glomerulonephritis
D. Focal segmental glomerulosclerosis
E. Membranous glomerulonephritis
25. An autopsy of a patient, who died from
poisoning of ethylene glycol, revealed enlarged
edematous kidneys. Their capsule was taken out
very easily. Gross investigation showed the wide
pale-grey cortical layer and dark red medulla.
What disease has developed at the patient?
A. * Necrotic nephrosis
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Acute tubulointerstitial nephritis
E. Lipoid nephrosis
26. 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' colour). Immunohistochemistry
of kidneys biopsy revealed immune complexes
on basal membranes of capillaries and within
glomerular mesangium. What disease has
developed at the patient?
A. * Acute glomerulonephritis
B. Acute interstitial nephrite
C. Lipoid nephrosis
D. Acute pyelonephritis
E. Necrotic nephrosis
27. The young man presented in hospital with a
headache and giddiness. Within last year he
often 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?
A. * Rapidly progressive glomerulonephritis
B. Acute glomerulonephritis
C. Lupus glomerulonephritis
D. Wegener's granulomatosis
E. Chronic glomerulonephritis
28. 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?
A. * Subacute glomerulonephritis.
B. Acute glomerulonephritis.
C. Chronic glomerulonephritis.
D. Acute pyelonephritis.
E. Amyloidosis of kidneys.
29. A macroscopical investigation of a removed
kidney revealed in proximal area of an ureter the
concrement which obturated its lumen. The
88
Kidney diseases
kidney was markedly enlarged; a parenchyma
was atrophic with considerably dilated pelvis
and calyces. Microscopical study of kidney's
sample showed the diffusive sclerosis, an atrophy
of glomeruli and tubules. Survived tubules were
cystically dilated. What complication of a
nephrolithiasis developed at the patient?
A. * Hydronephrosis.
B. Pyonephrosis.
C. Pyelonephritis.
D. Glomerulonephritis.
E. Chronic paranephritis.
30. An autopsy of the 68-year-old man revealed
a sallow-grey colour of his skin with petechial
hemorrhages. His face and tongue had a
powdery 'uremic frost'. Fibrinous hemorrhagic
laryngitis, a tracheitis, a shaggy pericardium and
a catarrhal gastroenterocolitis were also
diagnosed. For what syndrome the given
complex
of
morphological
changes
is
characteristic?
A. *Chronic renal insufficiency
B. Acute hepatic insufficiency
C. Acute renal insufficiency
D. Chronic heart insufficiency
31. A man died of renal insufficiency. A postmortem 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?
A. * Subacute glomerulonephritis
B. Acute glomerulonephritis
C. Lipoid nephrosis
D. Chronic glomerulonephritis
E. Amyloidosis of kidneys
32. 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 stroina. What
of the listed diagnoses the most likely?
A. * Amyloidosis of kidneys
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Subacute glomerulonephritis
E. Lipoid nephrosis
33. A 60-year-old woman died of a chronic renal
failure. An autopsy revealed the irregularly
contracted and markedly lobulated kidneys with
a fibrous tissue alternated with an intact
parenchyma. Renal pelvises were dilated, their
walls -thickened. Histological
investigation
showed sclerosis, lymphocyte - plasmocyte
infiltration of the renal pelvis walls, and
interstitium. What diagnosis is most probable?
A. *Chronic pyelonephritis
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Tubulointerstitial nephritis
E. Chronic glomerulonephritis
34. The kidney biopsy is taken from the man who
is in clinic with symptoms of a mercury poisoning.
Histological investigation revealed focal tubular
necrosis, an edema, hyperemia, hemorrhages
and leukocytic infiltration in a stroma. What
condition has developed at the patient?
A. * Acute necrotic nephrosis
B. Acute glomerulonephritis
C. Chronic renal insufficiency
D. Acute pyelonephritis
E. Chronic pyelonephritis
36. 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?
A. * Subacute glomerulonephritis
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Focal segmental sclerosis
E. Membranous nephropathy
37. 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
89
Kidney diseases
showed epithelial crescents which compressed
capillaries. Nephrocytes exhibited a dystrophy; a
stromal edema and infiltration were also
recognized. What is the most likely diagnosis?
A. * Glomerulonephritis
B. Pyelonephritis
C. Nephrolithiasis
D. Nephrotic syndrome
E. Amyloidosis of kidneys
hyperemia. Nuclei of the cells of vascular
glomeruli and straight tubules were unchanged.
What pathology of kidneys has developed at the
patient?
A. * Necronephrosis
B. Infarct
C. Glomerulonephritis
D. Pyelonephritis
E. Nephrosis
38. 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?
A. *Fibrinous inflammation
B. Purulent inflammation
C. Catarrhal inflammation
D. Hemorrhagic inflammation
E. Serous inflammation
41. A 49-years-old- patient with a 10 days history
of dysentery presented with raised body
temperature, a pain in lumbar area, a fever and
a considerable quantity of leucocytes in urine.
Histological investigation of a puncture renal
biopsy revealed hyperemia, interstitial leukocytic
infiltration and numerous inflammatory cells
(mainly neutrophiles) with a desquamated
epithelium,
filling
renal
tubules.
What
complication has developed at the patient?
A. *Acute pyelonephritis
B. Chronic pyelonephritis
C. Pyelitis
D. Glomerulonephritis
E. Necrotic nephrosis
39. A postmortem of a 58-year-old male revealed
in
kidneys
asymmetrical,
coarse,
corticomedullary scars. Histological investigation
of a kidney showed atrophy of cyst-like dilated
tubules, filled with colloid eosinophilic masses.
Interstitium was characterized by pronounced
periglomerular sclerosis. What diagnosis is most
probable?
A. *Chronic pyelonephritis with scarring
B. Chronic glomerulonephritis with scarring of
kidneys
C. Amyloidosis of kidneys
D. Tuberculosis of kidneys
E. Kidneys at hypertension
42. Section shows significant enlargement of the
patient’s right kidney. There is a nephrolith at the
place of incision. Renal pelvic lumen is distended
with accumulating urine. Renal parenchyma is
acutely thinned out. What is the most correct
diagnosis?
A. Hydronephrosis
B. Pyelectasis
C. Hydroureteronephrosis
D. Renal cyst
E. Nephroblastoma
40. At the patient operated concerning a
widespread tumour of an abdominal cavity, the
considerable bleeding and declining of arterial
pressure took place. After operation the acute
renal insufficiency, resulted in the patient's death,
developed. An autopsy revealed the wide light
pink cortical layer, which was clearly delimited
from dark red pyramids. Histological investigation
showed the absence of nuclei in epithelium of
convoluted
tubules,
tubulorrhexis,
venous
43. Renal examination shows the kidney to be
swollen and plethoric, with easily removable
capsule. Renal pelvis and calyces are dilated
and filled with turbid urine; their mucosa is dull
and has hemorrhagic foci. On section the renal
tissue is variegated, there are yellow-gray areas
surrounded with plethoric and hemorrhagic zone.
What disease can be characterized by such
results of macroscopic examination?
A. Acute pyelonephritis
B. Acute glomerulonephritis
C. Renal amyloidosis
D. Nephrolithiasis
90
Kidney diseases
E. Polycystic kidney
44. A 12-year-old child developed nephritic
syndrome (proteinuria, hematuria, cylindruria) 2
weeks after a case of tonsillitis, which is a sign of
affected glomerular basement membrane in the
kidneys. What mechanism is the most likely to
cause the basement membrane damage?
A. Immune complex
B. Granulomatous
C. Antibody-mediated
D. Reaginic
E. Cytotoxic
45. A patient hospitalized due to mercury
intoxication presents with the following processes
in the kidneys: focal necrotic changes of tubules
of major renal regions, edema, leukocyte
infiltration and hemorrhages in the interstitial
tissue, venous congestion. What condition
developed in the patient?
A. Acute necrotic nephrosis
B. Acute glomerulonephritis
C. Chronic renal failure
D. Acute pyelonephritis
E. Chronic pyelonephritis
D. Chronic kidney failure
E. Acute kidney failure
48. A 38-year-old woman, who was diagnosed
with systemic lupus erythematosus (SLE) 3 years
ago, comes to her physician with a complaint of
facial swelling and decreased urination that she
first noticed 2 weeks ago. She currently takes
azathioprine and corticosteroid. Her vital signs
show blood pressure 150/90 mm Hg, pulse 91/min., temperature - 36.8°C and respiratory
rate- 15/min. On physical examination, the
doctor notices erythematous rash on her face
exhibiting a butterfly pattern. The laboratory
studies
reveal
hypercholesterolemia,
hypertriglyceridemia and proteinuria. Which of
the following is the most likely mechanism of
SLE’s complication in this patient?
A.* Immune complex-mediated glomerular
disease
B. Acute infection of the kidney
C. Decrease in renal blood flow (ischemic
nephropathy)
D. Increased plasma oncotic pressure
E. –
46. Autopsy of a 49-year-old woman who died of
chronic kidney failure shows small dense striated
kidneys
with
areas
of
hemotrhages.
Microscopically nuclei of epithelial channels
contain
hematoxylin
bodies;
glomerular
capillaries resemble wire loops, have thickened
basement membranes, and in places contain
hyaline thrombi and foci of fibrinoid necrosis.
What is the most likely diagnosis?
A.* Systemic lupus erythematosus
B. Amyloidosis
C. Atherosclerotic nephrosclerosis
D. Rheumatism
E. Arteriolosclerotic nephrosclerosis
47. A 30-year-old woman developed facial
edemas. Examination detected proteinuria (5.87
g/L), hypoproteinemia, dysproteinemia, and
hyperlipidemia. Such combination of signs is
characteristic of:
A.* Nephrotic syndrome
B. Chronic pyelonephritis
C. Nephritic syndrome
91
Endocrine pathology
Endocrine system disorders
1. A 23-years-old male presented to his physician
with excess of the somatotropic hormone, the
enlarged nose, lips, ears, a mandible, hands and
feet. What is the most likely diagnosis?
A. *Acromegaly
B. Pituitary nanism
C. Itsenko-Cushing disease
D. Addison's disease
E. Adiposogenital dystrophy
2. A histological investigation of the removed
enlarged thyroid gland revealed irregular form
and sizes follicles. The follicular epithelium
proliferated both into follicles lumen and outside.
Layers of the connective tissue separated various
sites of the thyroid. What is the most likely
diagnosis?
A. *Macro-microfollicular goiter
B. Diffuse goiter
C. Autoimmune thyroiditis
D. Follicular carcinoma
E. Riedel's thyreoiditis
3. A 42-year-old man presented with a thyroid
gland enlargement in two times. A physical
investigation revealed firm, irregular lobulated
gland. Histological investigation showed a
diffusive infiltration of thyroid gland by
lymphocytes, plasmocytes with follicles formation
and the enhanced growth of a connective
tissue. What is the most likely diagnosis?
A. * Hashimoto's goiter.
B. Endemic goiter.
C. Sporadic goiter.
D. Diffuse toxic goiter.
E. Riedel's thyreoiditis
4. A 52-year-old man with a history of
hematogenic tuberculosis presented to the
hospital with hyperpigmentation skins (melanosis)
and mucosas, a cachexia, cardiovascular
insufficiency. What disease caused such
changes?
A. *Addison's disease
B. Pheochromocytoma
C. Simmonds' disease
D. Itsenko-Cushing disease
E. Graves' disease
5. A 48-years-old woman presented with
insomnia (inability to get enough sleep, a bad
dream), a fatigue, irritability, exophthalmos
(protuberance of eyes) and tachycardia. The
thyroid gland was enlarged. She died soon due
to cardiovascular insufficiency. Histological
investigation of the thyroid tissue revealed a
proliferation of an epithelium with formation of
papillas, a colloid colliquation, lymphocyte and
plasmocyte infiltration and formation of
lymphatic follicles with the germinal centres.
What is the most likely diagnosis?
A. * Diffuse toxic goiter. (Basedow's disease)
B. Endemic goiter
C. Sporadic goiter
D. Hashimoto's thyreoiditis
E. Benign tumor of thyroid gland
6. A 48-year-old male, with a long history of living
in the mountain district of Central Asia, presented
with a thyroid gland enlargement, resulted in
complicated swallowing. A physical investigation
revealed an increasing of a body mass, slowness,
drowsiness, and puffy face. A microscopic study
of a thyroid gland showed irregular follicles with a
hypochromic colloid. What of diagnoses is the
most probable?
A.,* Endemic goiter.
B. Basedow's goiter.
C. Hashimoto's thyreoiditis.
D. Sporadic goiter.
E. Riedel's thyreoiditis.
6. A 56-year-old woman with a long history of
parathyroid glands disease, died from increased
renal insufficiency. A post-mortem revealed a
bones deformation of extremities, a vertebral
column, and ribs. Bones were fragile, soft and
easily deformed or cat. They had some motley
tumorous formations. Kidneys were contracted.
Histological investigation revealed lacunar bone
resorption. In addition, a microscopic study
demonstrated giant cell granulomas within the
centres of tumorous formations, accumulations
of erythrocytes and a hemosiderin. Name the
described disease.
A. *Parathyroid osteodystrophy.
B. Metastases of cancer in a bone
C. Chronic renal insufficiency
D. Paget's disease
E. Myeloma
92
Endocrine pathology
7. A 42-year-old woman presented with the
obesity, chiefly of the trunk and face, steroid
diabetes,
an
arterial
hypertension
and
secondary dysfunction of ovaries. An autopsy.
revealed a hypertrichosis, a hirsutism, strias on a
skin of hips and a abdomen. In the anterior lobe
of the pituitary gland a tumour was found.
Histological investigation showed the basophilic
adenoma of the pituitary and hyperplasia of a
fascicular layer in adrenals. What of the listed
diagnoses is the most likely?
A. * Itsenko-Cushing disease
B. Itsenko-Cushing syndrome
C. Simtnonds' disease
D. Adiposogenital dystrophy
E. Pituitary nanism
8. A histological investigation of a thyroid gland,
presented to pathology, revealed a mild atrophy
of a parenchyma, sclerosis, diffusive infiltration of
a stroma by lymphocytes and plasmocytes with
formation of lymphoid follicles. What is the most
likely diagnose?
A. *Autoimmune thyroiditis
B. Parenchymatous goiter
C. Toxic goiter D; Thyroiditis
E. Riedel's thyreoiditis
9. A 55-year-old woman died from uraemia. A
post-mortem revealed a parathyroid gland
adenoma, bones deformation of extremities, a
vertebral column, and ribs. Bones were soft, with
slight porousness. On a cut they had a motley
pattern
with
multiple
cysts.
Histological
investigation revealed marked bone remodelling
and lacunar resorption of osteoid and fibrous
tissues. What is the most likely diagnosis?
A. *Parathyroid osteodystrophy.
B. Chronic osteomyelitis
C. Osteoporosis
D. Fibrous dysplasia
E. Paget's disease
10. A 62-year-old man with a 14 years medical
history of a diabetes mellitus presented with
significantly worsened eye vision for the last two
years. What characteristic processes resulted in
worsening of the eye vision?
A. *Microangiopathy
B. Macroangiopathy
C. Calcinosis of hyaloid body
D. Dimness of cornea
E.
11. A 45-years-old male presented to the hospital
with enlarged nose, ears, a mandible and feet.
What is the most likely diagnosis?
A. *Acromegaly
B. Nanism
C. Cerebro-hypophyseal cachexia
D. Adiposogenital dystrophy
E.
12. A male patient presented with obesity of the
trunk and face. He also had a long medical
history of an arterial hypertension. The death
resulted from a hemorrhage in a brain. A
morphological
investigation
revealed
a
basophilic adenoma of a pituitary body and
hyperplasia of adrenals cortex. What is the most
likely preliminary diagnosis?
A. * Itsenko-Cushing disease
B. Diabetes mellitus
C. Acromegaly
D. Pituitary nanism
E. Adiposogenital dystrophy
13. A thyroid gland of a 48-year-old male was
removed at surgery department. Histological
investigation revealed various size follicles which
were lined by tall columnar epithelium. The latter
one was pilled up at places forming papillary
infoldings. Colloid appeared lightly staining,
watery and finely vacuolated. The stroma
showed increased accumulation of lymphoid
cells.
A. *.Basedow's goiter. Â Hashimoto's thyreoiditis
C. Riedel's thyreoiditis
D. De Quervain's thyroiditis
E. Nodular goiter
14. A 45-years-old male presented to the hospital
with gradual enlargement of feet, right hand,
nose and lips. The adenoma of a pituitary body
was diagnosed. What is the most likely disease?
A. * Acromegaly
B. Nanism
C. Basedow's disease.
D. Addison's disease
E. Diabetes mellitus
15. A histological investigation of a thyroid
revealed a considerable infiltration of a gland by
lymphocytes with formation of lymphoid follicles,
93
Endocrine pathology
a destruction of parenchyma, growth of
connective tissue fibers. What is the most likely
disease presented in that case?
A. * Hashimoto's goiter
B. Colloid goiter
C. Endemic goiter
D. Diffuse toxic goiter
E. Parenchymatous goiter
16. A 64-year-old patient died of a cachexia. A
post-mortem
revealed
an
adenoma
of
parathyroid glands, bones deformation of
extremities, a vertebral column, and ribs. Bones
were soft, with slight porousness and easily
deformed or cat. What of the listed diagnoses is
the most likely?
A. *Parathyroid osteodystrophy.
B. Osteopetrosis
C. Chondrodysplasia
D. Osteomyelitis
E. Fibrous dysplasia
17. A histological investigation of a thyroid gland
biopsy, presented to pathology, revealed
lymphoid structures with the germinal (growth)
centers among the follicles filled with a colloid.
What is the most likely disease presented in that
case?
A. * Hashimoto's goiter.
B. Endemic goiter
C. Sporadic goiter
D. Basedow's goiter
E. Riedel's thyreoiditis
18. An autopsy of the man revealed a bronze
coloring of a skin and mucosa of an oral cavity.
In addition, caseous masses were defined in
adrenals. What is the most likely disease in that
case?
A. * Addison's disease
B. Itsenko-Cushing syndrome
C. Basedow's disease.
D. Acromegaly
E. Pheochromocytoma
19. A 64-year-old man died with symptoms of a
hypoglycemic coma. A postmortem revealed
reduced,
dense
pancreas.
Histological
investigation of pancreas showed the growth of
a connecting tissue, an atrophy of Langerhans
islets. What disease caused such changes in a
pancreas?
A. *Diabetes mellitus.
B. Mucoviscidosis.
C. Acute pancreatitis.
D. Cancer of pancreas.
E. Hypoplasia of pancreas.
20. A 64-year-old man, with a medical history of
a diabetes mellitus, presented augmented
symptoms of renal failure. What disease caused
such changes in a pancreas?
A. *Glomerulosclerosis.
B. Necrosis of renal tubular epithelium.
C. Amyloidosis.
D. Proliferative glomerulonephritis
E. Membranous nephropathy.
21. A morphological investigation of a thyroid
removed due to thyrotoxicosis struma revealed a
diffuse infiltration of a gland by lymphocytes with
a destruction of parenchyma and an area of
connective tissue. What is the most likely
diagnose?
A. * Hashimoto's thyreoiditis
B. Anaphylactic reaction
C. Thyrotoxicosis
D. Cancer of thyroid
E. Adenoma
23. At operation of excision of a diffusive thyroid
gland struma a patient died from acute adrenals
insufficiency. An autopsy, besides the atrophy of
adrenals, revealed a left ventricle hypertrophy in
a heart, a hypertrophy and an intracellular
edema of cardiomyocytes, a serous edema and
lymphoid infiltration of a myocardial stroma.
What is the figurative name of a heart pathology
presented at post-mortem?
A. *Thyrotoxyc heart
B. Tabby cat heart
C. Cor bovinum
D. Cor pulmonary
E. Brown atrophy of heart
24. An autopsy of a 40-year-old woman revealed
the obesity, chiefly of the trunk and face
("moonface" and "buffalo hump"), strias on a skin
of hips and abdomen. She had in her medical
records an osteoporosis with spontaneous
fractures of bones, an amenorrhea, an arterial
hypertension, a hyperglycemia. What of the
listed diagnoses is the most likely?
A. * Itsenko-Cushing syndrome
94
Endocrine pathology
B. Addison's disease
C. Friderichsen-Waterhouse syndrome
D. Conn's syndrome
E. Sipple's syndrome
25. A renal puncture biopsy was taken from a
patient with elevated blood sugar levels and
high amounts of glucose in his urine. Histological
investigation revealed extension of mesangium
with focal accumulation of membranous
substances and periglomerular sclerosis of some
glomerules. In addition, there were found a
hyalinosis and plasmatic infiltration of arterioles;
lymphocytes, histiocytes and some leucocytes
infiltration of a stroma; glycogen deposits within
nephrocytes of narrow segment. What is the
most likely diagnosis?
A. *Diabetic glomerulonephritis
B. Arteriolosclerotic nephrocirrosis
C. Pyelonephritis
D. Acute glomerulonephritis
E. Subacute glomerulonephritis
26. A 40-year-old woman has undergone
thyroidectomy. Histological study of thyroid
gland found the follicles to be of different size
and contain foamy colloid, follicle epithelium is
high and forms papillae, there is focal
lymphocytic infiltration in the stroma. Diagnose
the thyroid gland disease:
A. Basedow’s disease
B. Hashimoto’s thyroiditis
C. Riedel’s thyroiditis
D. De Quervain’s disease
E. Nodular goiter
27. A 30-year-old man has undergone surgical
removal of a thyroid tumor. Histologically the
tumor is made up of papillary structures varying
in size that emerge from the inner surface of
dilated cystic follicles and are covered with
atypical epithelium. What is the most likely
diagnosis?
A. Papillary carcinoma
B. Colloid nodular goiter
C. Macrofollicular adenoma
D. Follicular carcinoma
E. Medullary carcinoma
28. When examining a biopsy material obtained
from the thyroid gland, the pathologist
discovered lymphocyte infiltration of the thyroid
tissues and destruction of the parenchymal
elements. Diffuse lymphocyte infiltration with
lymphoid follicles was detected in the stroma.
What is the most likely diagnosis?
A. Hashimoto’s thyroiditis (chronic lymphocytic
thyroiditis)
B. Papillary thyroid cancer
C. Undifferentiated thyroid carcinoma
D. Solid adenoma of the thyroid
E. Graves’ disease (toxic diffuse goiter)
29. Autopsy of a 40-year-old woman, who died
of cerebral hemorrhage during hypertensic crisis,
revealed: upperbody obesity, hypertrichosis,
hirsutism, stretchmarks on the skin of thighs and
abdomen. Pituitary basophil adenoma is
detected in the anterior lobe. What diagnosis is
the most likely?
A. Cushing’s disease
B. Essential hypertension
C. Alimentary obesity
D. Simmonds’ disease
E. Hypothalamic obesity
30. A woman complains of visual impairment.
Examination revealed obesity in the patient and
her
fasting
plasma
glucose
level
is
hyperglycemic. What diabetes complication can
cause visual impairment/blindness?
A. Microangiopathy
B. Macroangiopathy
C. Atherosclerosis
D. Neuropathy
E. Glomerulopathy
31. A 40-year-old woman dies of intracerebral
hemorrhage after the hypertensive emergency.
During an autopsy, the pathologist reveals severe
obesity, excess of body hair and wide purplish
stria on the abdomen. Microscopic examination
of pituitary gland reveals hyperplastic acini
populated by a homogenous cluster of deeply
basophilic cells. Which of the following was the
most likely underlying disease?
A.* Cushing disease
B. C. Hyperthyroidism
D. Arterial hypertension
E. Sheehan’s syndrome
95
Pathology of pregnancy and reproductive system
Pathology of pregnancy and reproductive
system
1. A 29-year-old woman presented to maternity
department with termination of pregnancy at 20
weeks of gestation. The fetus and fetal
membranes were delivered with some blood
clots. Histological investigation revealed fetal
membranes, chorion villi and decidual tissue.
Name the described pathology of pregnancy.
A. *Spontaneous complete abortion
B. Premature birth
C. Hydatidiform mole
D. Invasive hydatidiform mole
E. Artificial abortion
2. A young woman presented to the hospital with
an acute pain. Her uterine tube was removed at
gynecology
department.
Macroscopic
investigation of a tube revealed its local dilation
at the middle third and blood clots
accumulations within the lumen. A histological
research showed chorion villi, surrounded by
areas of erythrocytes with some leucocytes.
What is the most likely diagnosis?
A. *Tubal pregnancy
B. Acute purulent salpingitis
C. Hemorrhage in tube of the uteri
D. Hemorrhagic salpingitis
E. Tuberculous salpingitis
3. A 35-year-old woman had an operation of
uterine
tube
removal
at
gynecology
department. A histological research of a tube's
wall reveled chorion villi and decidual cells. What
is the most likely diagnosis?
A. *Tubal pregnancy
B. Placental polyp
C. Choriocarcinoma
D. Paper-doll fetus
E. Lithopedion
4. A- post-mortem of a pregnant woman
revealed
a
brain
edema,
hemorrhagic
pneumonia, motley liver with a hemorrhage.
Microscopic study showed disseminated blood
clotting of vessels, plural fine necroses, and
hemorrhages in internal organs. In addition, in
kidneys there were found cortical necroses and
a fibrinoid necrosis of a tubules epithelium within
a nephron. What is the most likely diagnosis?
A. *Eclampsia
B. Pre-eclampsia
C. Septicopyemia
D. Septicemia
E. Acute renal insufficiency
5. A 25-year-old woman with a medical history of
recent childbirth presented to gynecology
department with metrorrhagia. The histological
investigation of a curettage material revealed a
pathologic growth, consisted of fibrin clots,
chorion villi and decidual tissue, undergoing
organization. What is the most likely diagnosis?
A. * Placental polyp
B. Glandular hyperplasia of the endometrium
C. Hydatidiform mole
D. Choriocarcinoma
E. Endometritis
1. A 45-year-old woman with a medical history of
a menstrual cycle disturbance had curettage of
the uterine cavity to obtain endometrial tissue for
histopathologic
analysis.
Microscopic
investigation revealed the increased quantity of
the endometrial glands, their form irregularity.
Some of glands were dilated or had a saw-like
pattern. What is the most likely diagnosis?
A. * Cystic glandular hyperplasia of endometrium
B. Placental polyp
C. Atypical hyperplasia of endometrium
D. Glandular polyp of endometrium
E. Endometrial adenocarcinoma
2. An autopsy of an elderly man revealed
enlarged, soft, elastic, slightly nodular prostate. A
gross investigation of a cut section showed
separate nodes parted by layers of a connective
tissue. The compressed surrounding prostatic
tissue created a plane of cleavage about them.
A microscopic study found the increase of
glands quantity. There were variable number of
prostatic nodes and glands in them.
A. * Glandular nodular hyperplasia
B. Fibrpmuscular (stromal) hyperplasia
C. Mixed nodular hyperplasia
D. Adenocarcinoma
E. Undifferentiated carcinoma
3. A 30-year-old woman, with a history of a
chronic endocervicitis, passed routine inspection
at the gynecologist with no complaints. A
histological investigation of a biopsy, taken from
96
Pathology of pregnancy and reproductive system
the pars vaginalis neck of the uteri, revealed the
high cylindrical epithelium, secreting mucus and
branched out glands underneath. What is the
most likely diagnose?
A. * Endocervicosis
B. Squamons metaplasia
C. Glandular metaplasia
D. LeukopJakia
E. Erythroplakia
4. A 68-year-old man presented with difficulty of
a miction. The prostate was operatively
removed. A microscopical investigation revealed
an increase of glandular and muscular elements
numbers. A lobular structure of prostate was also
altered. What process in a prostate is the most
probable?
A. * Mixed nodular hyperplasia
B. Glandular hyperplasia
C. Fibromuscular hyperplasia
D. Prostatitis
E. Adenocarcinoma
5. A 42-year-old woman presented with acyclic,
plentiful, uterine bleedings. A histological
investigation of a curettage material revealed
increased quantity of glands and their cystic
dilation. What is the most likely diagnosis?
A. * Hyperplasia of endometrium
B. Atrophy of endometrium
C. Hypertrophy of endometrium
D. Metaplasia
E. Organization
6. A 42-year-old woman presented with
dysfunctional uterine bleeding. A histological
investigation of a curettage material revealed
increased quantity of coiled glands and their
cystic dilation. What is the most likely diagnosis?
A. * Cystic glandular hyperplasia
B. Atrophy
C. Metaplasia
D. Displasia
E. Hypertrophic vegetations
7.
A
microscopic
investigation
of
an
endometrium revealed coiled extended glands
with 'saw-' and a 'spin-like' pattern. A stromal
proliferation with hyperplasia of its cells was also
determined. What is the most likely diagnosis?
A. * Glandular hyperplasia of endometrium
B. Acute endometritis
C. Leiomyoma
D. Hydatidiform mole
E. Placental polyp
8. A histological investigation of curettage of the
cervical canal of the uteri revealed a prismatic
epithelium and a significant amount of gland-like
structures. They developed from the prismatic
epithelium cambial elements, originated from
the neck of a uterus. What is the most likely
diagnose?
A. *Proliferative endocervicosis
B. Simple endocervicosis
C. Endocervicosis, stage of healing
D. Cervical adenomatosis
E. Cervical polyps
9. A 52-year-old woman, with a medical history of
the
menstrual
cycle
disturbances
and
hemorrhages, had curettage of the uterine
cavity. Histological investigation revealed the
increased quantity of the endometrial glands.
Many glands had a morphological pattern of a
proliferation phase, clumped together and had
intraglandular
papillary
protrusions.
Some
glandular cells exhibited the signs of nuclear and
cytoplasm polymorphism. What is the most likely
diagnosis?
A. * Atypical hyperplasia of endometrium
B. Cystic glandular hyperplasia of endometrium
C. Glandular hyperplasia of endometrium
D. Glandular polyp of endometrium
E. Adenocarcinoma of endometrium
10. A physical examination of a 68-year-old man,
with complains to an acute ischuria (retention or
suppression of the urine), revealed the nodular
enlargement of a prostate. A microscopical
investigation showed that the majority of knots
were constructed of polymorphic glandular
structures, with some retention cysts. The latter
ones had thick secreta. What is the most likely
diagnose?
A. *Glandular hyperplasia of prostate
B. Fibromuscular hyperplasia of prostate
C. Hyperplasia of prostate mixed form
D. Adenoma of prostate
E. Carcinoma of prostate
11. A 24-year-old woman, on a 3rd day after
childbirth, presented with a diffusive edema and
painful palpation of the right breast. Physical
97
Pathology of pregnancy and reproductive system
examination revealed hyperemia of the breast
and a fervescence. Histological research of a
gland's tissue showed diffusive leucocytes
infiltration of stroma, an interstitial edema and
hyperemia of vessels. What is the most likely
diagnose?
A. *Acute phlegmonous mastitis
B. Acute apostematous mastitis
C. Acute serous mastitis
D. Chronic purulent mastitis
12. A 48-year-old woman with a grease bloody
flux from her genital tracts had a diagnostic
curettage of her uterus cavity. Microscopical
research of the uterus curettage material
revealed a thinning of a mucosal layer,
reduction of the endometrial glands number, a
fibrosis of a stroma and some lymphoid cells
infiltration. What is the most likely diagnosis?
A. *Chronic atrophic endometritis
B. Acute purulent endometritis D Chronic cystic
endometritis
E. Chronic hypertrophic endometritis
13. A gynecologic investigation of the 36-yearold woman revealed bright red brilliant maculae
on a uterus neck. They bleed easily at a touch.
Biopsy investigation showed that a tissue sample
was covered by a cylindrical epithelium with
papillary growths. There was also a growth of
glands within the thickness of a uterus neck
tissue. What pathology of a uterus neck was
diagnosed?
A. * Pseudoerosion
B. Cervical erosion
C. Endocervicitis
D. Glandular hyperplasia
E. Leukoplakia
14. A 23-year-old woman presents with her
menstrual cycle disorder went trough a
transvaginal puncture of Douglas' cul-de-sac
resulted in aspiration of blood and some other
material. A microscopic investigation of the
puncture fluid revealed blood, some decidual
cells and chorion villi. What is the most likely
diagnosis?
A. *Ectopic tubal pregnancy
B. Salpingitis
C. Rupture of Fallopian tube
D. Hydatidiform mole
E. Carcinoma uteri
15. Histological investigation of the uterine
scrape of the 45-year-old woman with disturbed
ovarian menstrual cycle revealed increased
number of endometrial glands, some of which
are serrated, while others are dilated and cystlike. Make the diagnosis:
A. Endometrial cystic glandular hyperplasia
B. Placental polyp
C. Atypical endometrial hyperplasia
D. Glandular endometrial polyp
E. Endometrial adenocarcinoma
16. On histological examination of uterine
mucosa the following is detected: sinuous
glands, serratiform and corkscrew-shaped
elongated growths of stroma with cell
proliferation. Make the diagnosis:
A. Glandular endometrial hyperplasia
B. Acute endometritis
C. Leiomyoma
D. Vesicular mole
E. Placental polyp
17. A young man came to a hospital with
complaints of disturbed urination. Examination of
his external genitalia revealed the urethra to be
split on the top, with urine flowing out of this
opening. What type of external genitalia
maldevelopment is observed in this case?
A. Epispadia
B. Phimosis
C. Hermaphroditism
D. Paraphimosis
E. Hypospadias
F.
18. After delivery of a child by pregnant woman,
the midwife notices a defect in external genitalia
of a newborn. The woman only had one prenatal
ultrasound that reported a male fetus. On
physical exam, the neonatologists notices a
short, broad penis with an orifice in its dorsal
aspect, both testicles are present in the scrotum.
Which of the following is the most likely
congenital abnormality?
A.* Epispadias
B. Ovotesticular disorder of sex development
C. Hypospadias
D. Paraphimosis
E. Phimosis
98
Disease of the nervous system, bones, avitaminosis
Disease of the nervous system, bones,
avitaminosis
1. An autopsy of the elderly woman revealed a
massive purulent bronchopneumonia. A brain
was slightly atrophic, gyri were thinned and sulci
were deep. A microscopical study of a brain
showed perivascular deposits of amyloid, Hirano
bodies and neurofibrillary "tangles".What is the
most likely main disease?
A. *Alzheimer's disease
B. Pick's disease
C. Parkinson's disease
D. Disseminated sclerosis
E. Lateral amyotrophic sclerosis
2. An autopsy of the 78-year-old woman
revealed
a
massive
purulent
bronchopneumonia. There were numerous grey
color plaques, up to 15 mm in diameter, found in
the brain and spinal cord. A microscopical study
of brain and spinal cord tissue showed plural
perivenular sites of a demyelization with
limphoplazmocytes infiltration and the plural foci
of gliosis. Diagnose a basic disease.
A. * Disseminated sclerosis
B. Pick's disease
C. Parkinson's disease
D. Alzheimer's disease
E. Lateral amyotrophic sclerosis
3. A 42- year-old forester, a week later after long
stay in spring wood, presented to the hospital
with a fever, a headache, consciousness
disturbance and epileptoid attacks. He died in 4
days. An autopsy revealed a brain edema, plural
petechial hemorrhages. A microscopical study
showed perivascular and pericellular edema,
plural perivascular, mainly lymphocytic, infiltrates.
Diagnose the basic disease.
A. Tick-borne encephalitis
B. Meningococcal infection
C. Poliomyelitis
D. Purulent encephalitis
E. Cerebro-vascula disease
4. An autopsy of the 68-year-old man revealed
the atrophy of brain's tissue. The cerebral atrophy
mainly involved the frontal, temporal, and
occipital regions. A hydrocephaly was also
found. A microscopical study showed atrophic
zones in the cerebral cortex, the senile (neuritic)
plaques in hippocampus, neurofibrillary "tangles",
damage of neurons and Hirano bodies. What is
the most likely main disease?
A. * Alzheimer's disease
B. Lateral amyotrophic sclerosis
C. Disseminated sclerosis
D. Encephalitis
E. Ganglioneuroma
5. A 75-year-old man, with a history of Alzheimer's
disease, died of a bronchopneumonia. A
microscopical study of the cerebral cortex
revealed
the
senile
(neuritic)
plaques,
neurofibrillary "tangles" and damaged neurons.
What formations characterize cytoskeleton
pathology of proximal dendrites at the
Alzheimer's disease?
A. *Hirano bodies
B. Councilman's bodies
C. Negri bodies
D. Mallory's bodies
E. Russell bodies
6. An elderly man presented to the hospital with
progressive dementia (aphrenia), with marked
emotional lability; thus the focal neurologic
symptoms were absent. After his death, a postmortem revealed the cortex thinning in frontal,
occipital and temporal lobes of the brain. A
histological study of a brain's tissue showed the
considerable
quantity of
senile plaques
(especially in a cortex), reduction of neurones'
sizes with cytoplasm vacuolation. In addition, the
little Hirano bodies were determined in dendrites.
What is the most likely pathology in the central
nervous system?
A. * Alzheimer's disease
B. Lateral amyotrophic sclerosis
C. Disseminated sclerosis
D. Tick-borne encephalitis
E. Viral meningoencephalitis
1. A morphological research of a femur reveled
the chronic purulent inflammation of compact
substance and a bone marrow with sequesters
formation. What is the most likely disease?
A. * Osteomyelitis
B. Retikulosarcoma
C. Multiple (plasma cell) myeloma (Kahler's
disease)
D. Osteoblastoclastoma
E. Periostitis
99
Disease of the nervous system, bones, avitaminosis
2. A 6-year-old girl presented to the hospital with
suddenly raised temperature and catarrh of
respiratory tracts. For 5th day of illness there was
a paralysis of her lower extremities muscles,
accompanied with respiratory disorders. In the
anterior horns of a spinal cord there was a
proliferation of a glia round necrotic neurons.
What is the most likely diagnosis?
A. *Poliomyelitis
B. Measles
C. Diphtheria
D. Meningococcemia
E. Scarlet fever
3. A 48- year-old man presented with advanced
staphylococcal purulent periodontitis, resulted in
a purulent inflammation of alveolar process'
bone marrow and then a mandible's body.
Microscopical investigation showed thinned
osteal beams, the necrosis centers and the
osteal sequesters, surrounded with a connective
tissue's capsule. What is the most likely disease?
A. *Chronic osteomyelitis
B. Acute osteomyelitis
C. Parodontome
D. Chronic fibrous periostitis
E. Purulent periostitis
4. A 52-year-old man with a 10 years history of
chronic osteomyelitis and 3 years a nephrotic
syndrome, died of uremia. An autopsy revealed
dense, white kidneys, with some cicatrices in their
cortical layer. They had sebaceous glitter on a
cut surface. Specify a pathology of kidneys
which has developed.
A. * Secondary amyloidosis
B. Primary amyloidosis
C. Idiopathic amyloidosis
D. Chronic glomerulonephritis
E. Chronic pyelonephritis
5. A 53- year-old man died of intoxication. An
autopsy revealed the enlargement of his hip with
some fistulas on a skin. There was yellow - green
thick liquid discharge from the fistulas. The gross
investigation showed the thickened femur with
sequesters formation. A microscopical study
determined sequestra! cavities, surrounded by
granulation and connective tissue with neutrophil
infiltration. The bone-marrow channels were
obliterated; the compact layer was thickened.
What is the most likely diagnosis?
A. *Chronic purulent osteomyelitis
B. Acute gematogenic osteomyelitis
C. Tuberculous osteomyelitis
D. Parathyroid osteodystrophy
E. Osteopetrosis
6. A 20-year-old woman presented with a several
years history of muscular weakness, resulted in
the motion, talking, chewing and swallowing
problems. A physical examination revealed the
ptosis
of
both
eyelids.
The
thorax
roentgenography
found
a
tumorous
conglomerate
in
anterior
mediastinum.
Histological investigation of the tumor biopsy
determined a thymoma. There were also some
dystrophic alterations in skeletal muscles.
Diagnose the disease.
A. * Myasthenia
B. Progressive muscles dystrophy
C. Muscles Erb's dystrophy
D. Dermatomyositis
E. Poliomyelitis
7. A 20-year-old woman with a history of
pathological cross- striated muscular weakness
and ptosis died of asphyxia. An autopsy revealed
the follicular hyperplasia of a thymus, atrophy
and a necrosis of skeletal muscles with focal
lymphocytic infiltrates among the cells. Specify
the form of a muscles lesion.
A. * Myasthenia
B. Atrophy myositis
C. Progressive myopathy
D. Mussels Leyden's dystrophy
E. Mussels Erb's dystrophy
8. An autopsy of a patient, with a lifetime history
of numerous pathological fractures, revealed
changes of his long tubular bones. The femurs
and tibia bones were curved or spiral with
uneven surface and the obliterated bonemarrow channels on a cut. There was also a
remodeling of a compact cortical layer into the
spongy type. Microscopical investigation showed
mosaicity. of osteal structures. There were
numerous cavities of the resorptions combined
with osteoblastic lying down of new bone. These
were accompanied with chaotic fine-fibered or
lamellar structures of osteal fragments. The
100
Disease of the nervous system, bones, avitaminosis
arteries were twisted and dilated. What is the
most likely diagnosis?
A. * Deforming osteodystrophy
B. Osteopetrosis
C. Parathyroid osteodystrophy
D. Fibrous dysplasia
E. Chronic osteomyelitis
chromosome 21 trisomy. What of the listed
diagnoses is the most likely?
A * Down's syndrome
B. Patau's syndrome
C. Shereshevsky-Turner's syndrome (gonadal
dysgenesis)
D. Edwards' syndrome
9. A 20-year-old woman presented with
weakness of the eye, chewing, speech and
swallowing groups of muscles. Thus, the normal
muscles contraction were completely ceased
after the vigorous activity and restored again
after the rest. Later, the muscles of extremities
and intercostals were also involved in
pathological process. Inadequate ventilation of
the lungs resulted in
secondary focal
pneumonia, followed by patient's death. An
autopsy showed the atrophy of cross-striated
muscles, their dystrophy with focal aggregates of
lymphocytes in interstitium. In the enlarged
thymic gland the follicular hyperplasia was found
out. Specify the most probable diagnosis:
A. * Myasthenia
B. Verdniga-Goffman's spinal amyotrophy
C. Dyushen's mussels dystrophy
D. Lateral amyotrophic sclerosis.
E. Erb's mussels dystrophy
12. A 3-year-old child, with history of alimentary
dyspepsia, presented with progressing gingival
hemorrhage, petechial hemorrhages on a skin
and a mouth mucosa. There was also a
peridental infection. The described changes
characteristic for:
A * Avitaminosis Ñ
B. Avitaminosis D
C. Avitaminosis Bl
D. Avitaminosis B6
E. Avitaminosis A
10. A 33-year-old woman gave birth to a dead
fetus with gestational age more than 43 weeks.
The fetal skin was dry and chap. An autopsy
revealed a general hypotrophy and nuclei of
ossification (Beclard's nuclei) in a proximal
epiphysis of tibial and humeral bones. Amniotic
fluid, an umbilical cord and placental
membranes were dyed by meconium. Name the
period of the described perinatal pathology?
A The antenatal period
B. The prenatal period
C. The intranatal period
D. The postnatal period
E. The progenesis period
11. A 3-month-old child died of pneumonia. A
macroscopical investigation revealed upward
slant of palpebral fissures of the eyes, a sinking
down dorsum of nose, dolichouranic, a low
locating of small auricles. An autopsy revealed a
defect of a heart and the main vessels'
development. A genetic study showed a
13. A 9-month-old child presented with retarded
dentition, the teething order disturbance, a
reconfiguration of the upper jaw in a horizontal
direction
(dolichouranic).
Microscopical
investigation of his teeth revealed the irregular
mineralization of the enamel and crumpled
enamel prisms. Some of them were rich with
vacuoles. There were also expansion of a
predentin zone and a presence of solitary
denticles. What is the most likely disease in that
case?
A *Rachitis, early stage
B. Rachitis, late stage
C. Osteomalacia
D. Gout
E. Hypervitaminosis D
14. A 1, 5-year-old child presented with focal
thickenings of ribs, wrists, and a curvature of legs.
A stomatologist pointed to retarded dentition,
the teething order disturbance, the irregular
mineralization of the enamel and dentine, a
reconfiguration of the upper jaw in a horizontal
direction (dolichouranic). What is the most likely
disease presented in that case?
A * Rachitis
B. A dystrophic calcification
C. A metabolic calcification
D. A metastatic calcification
E. Osteomalacia
101
Disease of the nervous system, bones, avitaminosis
15. A 9-month-old child presents with delayed
tooth eruption, improper sequence of tooth
eruption, and horizontal maxillary configuration
(high-arched palate). Microscopically enamel
mineralization pattern is irregular, enamel
columns are wrinkled, some of them are
vacuolated, predentin zones are widened, single
denticles can be observed. What disease is it?
A.* Early rickets
B. Gout
C. Osteomalacia
D. Hypervitaminosis D
E. Late rickets
102
Viral infections
Viral infections
1. A post-mortem of a patient, with a history of a
drug abuse, revealed red-purple papular
nodules and blotches on the skin of his lower
extremities (Kaposi's sarcoma). In addition, acute
pneumocystosis carinii pneumonia was also
determined. For what disease the given
symptoms are characteristic?
A. *AIDS
B. Influenza
C. Measles
D. Diphtheria
E. Anthrax
2. A 48-year-old woman died of pulmonary
insufficiency. A post-mortem revealed the
enlarged lung with the dark red and pinkishyellow colour areas ("the big motley lung") and
necrotic
tracheobronchitis.
What
is
the
preliminary diagnosis in that case?
A. * Influenzal pneumonia
B. Croupous pneumonia
C. Caseous pneumonia
D. Fibrosing alveolitis
E. Measles virus pneumonia
3. A 44-year-old man died of pulmonary
insufficiency and severe intoxication. A postmortem investigation of a lungs cut surface
revealed a motley pattern with plural focal
hemorrhages and the zones of emphysema.
Histological study showed a hemorrhagic
bronchopneumonia with abscesses formation. A
cytoplasm of bronchial epithelium cells had
eosinophilic and basophilic inclusions. What is the
most likely diagnosis?
A. * Influenza
B. Parainfluenza
C. Adenoviral infection
D. Respiratory syncytial infection
E. Staphylococcal bronchopneumonia
4. A young man presented with rash in the form
of roseolas and small hemorrhages (petechias)
on a skin of a stomach, thorax and petechial
rash on eyes conjunctiva. Lesion of his brain soon
resulted in his death. A microscopical
investigation revealed in destructive-proliferative
endo-trombovasculitis in medullar oblongata
and pons of a brain, also in a skin, kidneys and
myocardium. What is the most likely disease?
A. *Epidemic typhus
B. Sepsis
C. Periarteritis nodosa
D. Systemic Lupus Erythematosus
E. Brucellosis
5. A 67-year-old man died of pulmonary
insufficiency. A post-mortem investigation of a
lungs cut surface revealed multiple, bright, red,
deaerated 2,5 cm foci with irregular form and
inaccurate borders. A microscopic study showed
erythrocytes and some lymphocytes within
alveoli. The described changes are characteristic
for:
A. * Influenzal pneumonia
B. Croupous pneumonia
C. Hemorrhagic infarction of the lung
D. Measles virus pneumonia
E. Aspiration pneumonia
6. A 42-year-old man, with a history of an acute
respiratory
disease,
died
of
pulmonary
insufficiency.
A
post-mortem
investigation
revealed fibrinous -hemorrhagic inflammation in
a larynx and trachea mucosa, destructive
panbronchitis and enlarged lungs. Multiple
abscesses, hemorrhages and necroses created a
motley appearance of a pulmonal tissue. What
of the listed diagnoses the most likely?
A. * Influenza
B. Parainfluenza
C. Respiratory syncytial infection
D. Measles
E. Adenoviral infection
7. A post-mortem of a 40-year-old patient
revealed a pneumocystosis carinii pneumonia,
Kaposi's sarcoma and B-cell lymphoma. Medical
records suggested that he actively practiced
unsafe sexual intercourse with multiple partners
at his life. What is the most likely diagnosis?
A *A human immunodeficiency virus infection,
AIDS'Stage
B. A human immunodeficiency virus infection,
pre- AIDS stage
C. A secondary immunodeficiency as a result of
primary B-cell lymphoma
D. A secondary immunodeficiency as a result of
Kaposi's sarcoma
8. A 38-year-old man presented with an acute
fever, elevated temperature to 40°C, a
103
Viral infections
headache, a cough and dyspnea. He died on
the 5th day of a disease. An autopsy revealed
enlarged lungs with a motley pattern of a
pulmonary tissue - "the big motley lung". For what
disease the described signs are characteristic?
A.* Influenza
B. Adenoviral infection
C. Croupous pneumonia
D. Respiratory syncytial infection
E. Bronchiectasis
destructive-proliferative
endo-trombovasculitis
and Popov's granulomas in the central nervous
system, in a skin, and adrenals. An interstitial
myocarditis was diagnosed in his heart. What is
the most likely disease?
A * Epidemic typhus
B. Q fever
C. Typhoid fever
D. Periarteritis nodosa
E. HIV-infection
9. A 35-year-old narcomaniac (drug abuser) with
a history of HTV-infection died at the hospital. A
post-mortem revealed that both lungs were
dense, dark-red-grey color, with little air.
Histological study showed that interalveolar septs
were
infiltrated
by
lymphocytes.
Some
alveolocytes were transformed to the big cells,
with a centrally located round nucleus with a
light rim of cytoplasm ("an owl's eye"). What
opportunistic infection caused pneumonia in
that case?
A *Cytomegalovirus
B. Pneumocystis carinii
C. Atypical mycobacterium
D. Herpes-virus
E. Toxoplasma
12. A post-mortem of a woman revealed a
septicopyemia with metastatic abscesses of
lungs and kidneys; pyosalpinx, a purulent
peritonitis, a cachexia and lymphadenopathy.
Medical records indicated HIV- positive blood
test results within Jast 5 years. What clinical
period of AIDS corresponds with the given
pathomorphologic signs?
A. *Acquired immunodeficiency syndrome (AIDS)
B. Incubation period
C. Persisten generalised lymphadenopathy
D. Pre-AIDS (AIDS -related complex)
E. Reactive lymphadenopathy
10. A 48-year-old male presented with a
sustained high fever, severe headache, a
dyspnea, palpitation. A physical investigation
revealed a pediculosis, a rash in the form of
roseolas and small hemorrhages (petechias) on
his thorax skin. In addition, decubituses of legs
and foot gangrene were also determined. He
died of a heart failure. A histological study
showed in the medullar oblongata a hyperemia,
stasis, perivascular plasmocytes infiltrates and a
proliferation of a microglia (Popov's granuloma).
What is the most likely diagnosis?
A *Epidemic typhus
B. Antrax meningocephalitis
C. Meningococcal meningitis
D. Typhoid fever
E. Rubella
11 A patient died as a result of a heart failure.
Macroscopically traces of a preexisted rash in
the form of maculae and spots were recognized.
A gross investigation revealed decubituses at the
areas of breeches and spinous processes of
vertebra. Microscopical study showed a
13. A gross investigation of a brain at a postmortem revealed the edema, a plethora, and
fine hemorrhage in medulla oblongata. A
microscopical
investigation
showed
a
chromatolysis, hydropy and a necrosis of nervous
cells.
In
addition,
the
eosinophilic
intracytoplasmic formations (little bodies the
Babesh- Negri bodies) were defined in pyramidal
neurons of the hippocampus. What diagnosis
answers
the
described
morphological
implications?
A. * Rabies
B. Meningococcal meningitis
C. Encephalitis
D. Encephalomyelitis
E. Brucellosis
14. A post-mortem investigation of a 42-year-old
man revealed serous -hemorrhagic inflammation
in a larynx and trachea mucosa, a focal
pneumonia, areas of atelectases and acute
lungs emphysema. Histological research showed
a vacuolar dystrophy and loss of cilia within the
epithelium layer, an exfoliating of cells with
oxyphile inclusions. Such changes in lungs are
caused:
A. * Influenza viruses
104
Viral infections
B. Parainfluenza viruses
C. Measles virus
D. Adenoviruses
E. RS-viruses
15. A 66-year-old man presented with acute
tracheitis and bronchitis, soon resulted in
bronchopneumonia. He died on the 12th day at
the hospital from the pulmonal-heart failure. An
autopsy
revealed
fibrinous
-hemorrhagic
inflammation in a larynx and trachea mucosa,
enlarged lungs. On a cut section lungs had a
motley pattern due to areas of pneumonia,
hemorrhages in lung parenchyma, acute
abscesses and atelectases. In
addition,
circulative disturbances and dystrophies were
determined in internal organs. What is the most
likely diagnosis?
A. *Influenza, severe form
B. Influenza, moderately severe form
C. Parainfluenza
D. Respiratory syncytial infection
E. Adenoviral infection
C. Derraatomycosis
D. Phoma of skin
E. Inflammatory dermatitis
18. A man, with a history of frequent drinking nonboiled water from the river, has developed
vomiting and explosive 'rice-water' diarrhea. The
abdominal pains were absent; the body
temperature did not rise. The intestine biopsy
revealed a plethora, a marked swallowing, an
edema of enterocytes, and some infiltration of
villi by lymphocytes, plasmocytes, and few
leucocytes. What is the most likely disease?
A. *Cholera
B. Salmonellosis
C. Typhoid fever
D. Dysentery
E. Lambliasis
16. A post-mortem of a patient, who died of a
HIV- infection, revealed alterations of his brain. A
histological
investigation
determined
in
subcortical white matter, midbrain and a brain
stem fine, perivascular necroses, microglial
nodules with multinuclear giant cells, focal gliosis
and fibrosis. Name the most likely lesion of the
central nervous system?
A. *Subacute meningocephalitis
B. Metabolic encephalopathy
C. Cytomegaloviral encephalitis
D. Primary lymphoma of CNS
E. Vacuolar myelipathy
17. A patient presented to his physician with
expressed immunodeficiency, lymphopenia with
change of parity T-helpers to T- suppressors, the
lesion of a skin of the lower extremities. The
cutaneous pathology was characterized by
plural tumorous nodules, dome-shaped purple
plaques, involved in skin breakdown with
resulting fungating lesions. A histological
investigation of the skin's biopsy showed the
neoplasm of blood vessels, a dilatation of
capillaries, slit-like blood-filled vascular spaces.
What is the most likely diagnosis?
A. *Kaposi's sarcoma
B. Basalioma
105
Childhood Infections
Childhood infection
1. An autopsy of 3-year-old child revealed
hyperemic, turbid arachnoids, which had a form
of yellowish-greenish 'cap'. At microscopic
investigation a characteristic findings of
arachnoids thickening, hyperemia, purulent with
fibrin exudate infiltration was present. What is the
most likely diagnosis?
A. *Meningococcal infection
B. Tuberculosis
C. Anthrax
D. Ifluenza
E. Measles
2. A child presented with catarrhal conjunctivitis,
pharyngitis, a laryngotracheobronchitis. A gross
investigation of the oral cavity revealed white
spot on the buccal mucosa opposite the first
molar. In addition, a blotchy and papular rash
appeared on the patient's face, trunk and
extremities later. What is the most likely
diagnosis?
A. * Measles
B. Scarlet fever
C. Meningococcal infection
D. Epidemic typhus
E. Influenza
3. A 4-year-old child presented to the hospital
with a fever and a sore throat. An oral cavity
examination revealed an edema of a soft palate
and grey membranes on tonsils. These
membranes left a raw hemorrhagic surface
when forcibly removed. What the most likely
diagnosis is among listed below?
A. *Diphtheria fauces
B. Simonovsky-Vensans' angina
C. Lacunar angina
D. Infectious mononucleosis
E. Necrotic angina
4. An autopsy of 11-year-old child revealed plural
hemorrhages, mainly in skin of breeches and
lower extremities, serous and mucosas, and also
in a brain. Gross investigation determined a focal
necrosis and massive hemorrhages in adrenals, a
necrotic nephrosis in kidneys, a purulent arthritis,
an iridocyclitis and vasculitis. Choose the correct
diagnosis.
A. *Meningococcemia
B. Epidemic typhus
C. Periarteritis nodosa
D. Systemic lupus erythematosus
E. Radiation syndrome
5. A 7-year-old child presented with raised body
temperature up to 38,5°, rhinitis, conjunctivitis,
and cough. A physical investigation revealed
blotchy and papular skin rash and whitish branlike rashes in a buccal mucosa. On the fourth
day appeared a dyspnea and wet pulmonary
rhonchuses. Soon, difficulty of breath resulted in
patient death from asphyxia. What is the most
likely diagnosis?
A. *Measles
B. Meningococcemia
C. Influenza
D. The pulmonary form of a mucoviscidosis
E. Pneumonia
6. A 7-year-old boy presented to the hospital with
an acute catarrh in pharynx and tonsils which
had extended on a mouth mucosa, tongue and
fauces. A tongue was fiery red (crimson red) with
prominent papillae ('raspberry' or 'strawberry'
tongue). A gross investigation of tonsils showed
superficial necroses. A casting-off necrotic tissue
resulted in ulcers formation. Cervical lymphatic
nodules
were
enlarged.
A
punctuate
erythematous rash was determined over the
trunk, arms and legs. Face was also involved but
a small area about the mouth remained
unaffected to produce circumoral pallor. What is
the most likely diagnosis?
A. * Scarlet fever
B. Diphtheria
C. Angina
D. Measles
E. Meningococcal nasopharyngitis
7. An autopsy of 4-year-old child revealed
hyperemic,
yellowish-greenish
arachnoids,
infiltrated by purulent and fibrinous exudate
resembled a 'cap'. What is the most likely
diagnosis?
A. * Meningococcal meningitis
B. Tubercular meningitis
C. Influenzal meningitis
D. Anthrax meningitis
E. Epidemic typhus meningitis
8. An autopsy of a child revealed a necrotic
tonsillitis, neck phlegmon, purulent otitis and
106
Childhood Infections
purulent meningitis. These alterations are the
most typical for:
A. * Septic scarlet fever
B. Meningococcal infection
C. Toxic scarlet fever
D. Fauces diphtherias
E. Otogenic sepsis
9. A child presented with acute a catarrhal
nasopharyngitis. In 2 days he died. An autopsy
revealed arachnoids were markedly hyperemic,
edematous, infiltrated with turbid, thick,
yellowish-greenish liquid. A brain was swelled,
cerebellum tonsils were enlarged in volume, and
sulcus of the cerebrum impaction was well
defined. The described changes are the most
typical for:
A. * Meningococcal infection
B. Influenza
C. Whooping cough
D. Diphtheria
E. Measles
10. A 5-year-old child presented with raised body
temperature,
punctulated
rash,
and
conjunctivitis. He died of the superimposed
pneumonia. A histological research of lungs
revealed endo - mezo - panbronchitis and giantcell pneumonia. For what disease the presented
changes are characteristic?
A. *Measles
B. Scarlet fever
C. Croupous pneumonia
D. Diphtheria
E. Smallpox
11. Ë 43-year-old male, with a history of kidney
transplantation, followed by immunosuppressive
therapy, died of intoxication. A histological
investigation of his lungs, kidneys and pancreas
revealed strikingly enlarged (giant) cells with
basophilic cytoplasm and large nucleus. The
violet intranuclear inclusions surround by a small
clear halo, reminded an eye of an owl. What is
the most likely diagnosis?
A. *Cytomegaly
B. Tuberculosis
C. Syphilis
D. Lepra
E. Plague
13. 11 -year-old child presented with a body
temperature up to 40°C, an acute headache,
vomiting, anxiety and a fever. In four days
appeared a hemorrhagic skin rash, an oliguria
and adrenal insufficiency, resulted in patient's
death. A bacteriological study of smear
preparation from a pharynx revealed a
meningococcus. What form of disease is found
out?
A. Meningococcemia
B. Meningococcal meningitis
C. Meningocephalitis
D. Meningococcal nasopharyngitis
E.
12. A young 19-year-old man, with an acute
onset of disease, died of an infectious-toxic
shock. An autopsy revealed the enlarged tonsils,
covered with grey-white membranes, which
extended on the palatine arch. In addition, an
edema of the neck soft tissues determined.
Histological investigation showed the necrosis of
an epithelium of tonsils and the palatine arch.
Tissues underneath were infiltrated by a fibrinous
exudate, which formed massive stratifications on
a surface. What is the most likely diagnosis?
A. * Diphtheria
B. Scarlet fever
C. Adenoviral infection
D. Infectious mononucleosis
E. Staphylococcal infection
14. An oral cavity examination of a 4-year-old
child, revealed a hyperemia of the fauces and
tonsils mucus membranes. Gross investigation
showed enlarged tonsils, covered by dense,
whitish-yellowish membranes. They left a raw
surface, with deep defect, when forcibly
removed. Soft tissues of a neck were edematous,
regional lymph nodes were enlarged and
painful. What the most likely diagnosis is among
listed below?
A. * Diphtheria
B. Scarlet fever
C. Measles
D. Parotitis
E. Adenoviral infection
15. An autopsy of 2-year-old child revealed
hemorrhagic enanthesis (skin rash), mild
hyperemia and edema of nasopharynx mucous,
fine hemorrhages in mucosas and internal
107
Childhood Infections
organs, severe dystrophy in a liver and
myocardium,
an
acute
necrotic
nephrosis,'massive hemorrhages in adrenals.
What disease is the most likely to present such
symptoms?
A. * Meningococcal infection
B. Scarlet fever
C. Diphtheria
D. Measles
E. Epidemic typhus
16. A child presented to a hospital with an acute
fever, sore throat and swelling of submaxillary
(submandibular)
lymph
nodes.
A
gross
investigation of fauces revealed the edematous
and slightly hyperemic mucous membrane,
enlarged tonsils, covered by the grayish-whitish
membranes. They left a raw surface, when
forcibly removed. What is the most likely
diagnosis?
A. * Diphtheria
B. Catarrhal angina
C. Scarlet fever
D. Meningococcal infection
E. Measles
17. A 7-year-old girl developed an acute disease.
She presented to the hospital with a sore throat,
and a fever, accompanied with a widespread
rash. A physical examination revealed severe
hyperemia of a pharynx, a 'raspberry' tongue,
and enlarged bright red tonsils with some grayish
and yellowish dim areas. These zones also
extended on peritonsillar tissues. Submandibular
lymph nodes were enlarged. For what disease
the given changes are characteristic?
A. * Scarlet fever
B. Measles
C. Fauces diphtheria
D. Larynx diphtheria
E. Meningococcal nasopharyngitis
18. A 9-year-old child developed a sharp pain at
swallowing and a neck edema. His body
temperature had risen to 39°C. A motley-red,
punctulated , widespread rash appeared. A
physical examination revealed severe hyperemia
of a pharynx ('fiery pharynx') and a 'raspberry'
tongue. The enlarged bright red tonsils presented
with some grayish necrotic zones. What is the
most likely diagnosis?
A. * Scarlet fever
B. Meningococcal nasopharyngitis
C. Diphtheria
D. Influenza
E. Measles
19. A 6-year-old boy developed pain at
swallowing and raised body temperature. On a
second day of the disease, a physical
investigation revealed the appearance of the
fine, densely set, widespread skin rash with a
small unaffected circumoral area. An oral cavity
examination showed the bright reddening of a
pharynx, enlarged tonsils and raspberry-red
tongue. What is the most likely diagnose?
A. *Scarlet fever.
B. Adenoviral infection.
C. Fauces diphtheria.
D. Measles.
E. Streptococcal angina.
20. An 8-year-old child presented with raised
body temperature up to 39° C, rhinitis,
conjunctivitis,
and
cough.
A
physical
investigation revealed blotchy skin rash and
whitish rashes on a buccal mucosa. Suddenly
appeared pant resulted in asphyxia, followed by
patient death. What is the most likely diagnosis?
A. *Measles
B. Scarlet fever
C. Diphtheria
D. Meningococcal nasopharyngitis
E. Influenza
21. A 3-year-old girl presented with a sharp pain
at the swallowing, a marked neck edema, and
the body temperature raised to 40° C. A gross
investigation of tonsils revealed the grayishyellowish membranes, which left a raw surface
with bleeding ulceration, when forcibly removed.
What is the most likely diagnosis?
A. *Diphtheria
B. Scarlet fever
C. Measles
D. Meningococcal nasopharyngitis
E. Influenza
22.
A
child
died
of
a
spontaneous
pheumothorax. A post-mortem revealed a
collapse and interstitial emphysema of the right
lung, focal atelectases of lungs, a punctual
hemorrhage in a brain and a conjunctiva of
eyes. What is the most likely diagnosis?
108
Childhood Infections
A.* Whooping cough
B. Bronchopneumonia
C. Measles
D. Diphtheria of respiratory tracts
E. Scarlet fever
23. A child presented to the clinic with paralysis
of a phrenic nerve and dysphagia, resulted in his
death soon. An autopsy revealed ulcers of tonsils
with a cuticularization, a hemorrhage in
adrenals, and flaccidity of a myocardium.
Specify disease for which the described changes
and complications are characteristic.
A.* Diphtheria
B. Scarlet fever
C. Agranulocytosis
D. Measles
E. Poliomyelitis
24. A child complains of the general weakness, a
pharyngalgia at swallowing and nausea.
Objectively, a bright reddening revealed in
fauces; tonsils were enlarged. Later, the fine,
densely
located
maculae,
size
about
papaverous grain, appeared on a neck, in the
top of a back and a breast. Microscopical
investigation showed in a mucosa and tonsils
tissue an acute plethora and grayish, dim areas
of necroses. On the periphery of the necrotic
zones, within the edema and fibrinous
inflammation
areas,
the
chains
of
streptococcuses were defined. What is the most
likely diagnosis?
A. * Scarlet fever
B. Diphtheria
C. Measles
D. Influenza
E. Meningococcal nasopharyngitis
25. A 7-year-old child presented to the hospital
with a punctuated bright-pink rash on hyperemic
skin of a forehead, a neck, in the bottom of
abdomen and popliteal fossa. A nasolabial
triangle remained pale. Physical investigation of
a stomato-pharynx revealed circumscribed
bright red hyperemia of mucosa, 'raspberry'
tongue. His tonsils were friable and edematous;
lacunas filled with pus. Lymph nodes of a neck
were enlarged, dense and painful. What is the
most likely diagnosis?
A. *Scarlet fever
B. Rubella
C. Whooping cough
D. Diphtheria
E. Infectious mononucleosis
26. A child with a history of an acute catarrh of
the upper respiratory tract, conjunctivas and
blotchy, papular skin rash, died of pulmonary
insufficiency.
A
histological
investigation
revealed an interstitial pneumonia with focal
serous macrophageal inflammation and set of
giant cells within alveoli walls. What is the most
likely diagnosis?
A. *Measles
B. Influenza
C. Parainfluenza
D. Adenoviral infection
E. Cytomegaly
27. A 4-year-old child died of respiratory
insufficiency as a result of a respiratory
musculation paralysis. Histological investigation
revealed a hyperemia of the moracal part of a
spinal cord, the unclear pattern of the grey
substance, punctual hemorrhages and fine
sinking down sites of an encephalomalacia. In
addition, there was an inflammation with a
neuroglia proliferation around and by the
necrotic neurons. What is the most likely
diagnosis?
A. *Poliomyelitis
B. Meningococcal infection
C. Cytomegaly
D. Toxoplasmosis
E. Adenoviral infection
28. Microscopy of the myocardium of a girl, who
died of diphtheria due to heart failure, shows
fatty
degeneration,
multiple
foci
of
cardiomyocytes necrosis, and small foci of
cellular infiltrates in the interstitium. What type of
myocarditis is it?
A. Alterative
B. Diffuse exudative
C. Focal exudative
D. Interstitial
E. Granulomatous
29. A 6-year-old girl presents with acute onset of
a disease. She developed sore throat and high
temperature that were later accompanied by a
punctate skin rash. Oral examination reveals
acute pharyngeal hyperemia, raspberry tongue,
109
Childhood Infections
and enlarged bright red tonsils with dull gray and
yellow foci that spread to the peritonsillar tissues.
The submandibular lymph nodes are enlarged.
What disease are these changes characteristic
of?
A.* Scarlet fever
B. Laryngeal diphtheria
C. Measles
D. Meningococcal nasopharyngitis
E. Pharyngeal diphtheria
110
Bacterial Infections
Bacterial infections
1. An autopsy of a 54-year-old man revealed a
fibrinous inflammation at colon. What is your
diagnosis?
A *Dysentery
B. Amebiasis
C. Typhoid fever
D. Cholera
E. Balantidiasis
2 A patient, the inhabitant of a seaside city in the
south of the country, presented to the hospital
with severe diarrheas and vomiting, resulted in his
death from dehydration. An autopsy revealed
an
acute
gastroenteritis
with
serousdesquamative inflammation in a small bowel.
Choose the most likely diagnosis.
A *Cholera
B. Bacterial dysentery
C. Typhoid
D. Amebiasis
E. Salmonellosis
3. A 52-year-old woman died in surgery
department of a diffuse purulent peritonitis. A
post-mortem revealed in a distal part of a small
intestine enlarged Peyer's patches, which
projected into the intestine's lumen. There
surface was covered by brownish-greenish scab.
In the centre of some patches were found deep
defects, extended to a serous layer. For what
disease described intestinal changes are
characteristic?
A *Typhoid
B. Dysentery
C. An intestine tuberculosis
D. Crohn's disease
E. Staphylococcal enteritis
4. A 38-year-old man died of diffuse
fibrinopurulent
peritonitis.
A
post-mortem
revealed an ulcer in a small bowel, which
replicated a form of a Peyer's patch and
perforated the intestine's wall. Microscopical
investigation showed an alteration of lymphoid
tissue pattern with replacement of lymphocytes
by proliferating monocytes, followed by
granulomas formation. The complication of what
disease resulted in patient's death?
A *Typhoid.
B. Dysenteries.
C. Cholera.
D. Brucellosis
E. Nonspecific ulcerative colitis.
5. An autopsy of a 48-year-old man, with a history
of typhoid fever, revealed groups of enlarged
lymphoid follicles in small bowel. The follicles
protruded above the mucosal surface; they had
a grey-red coloring, juicy appearance and a
surface, which reminded gyri and sulci.
Microscopical investigation showed granulomas
formation. Specify, what of the listed stages of
typhoid is the most likely?
A *Medullar swelling.
B. Necrotic.
C. Formation of ulcers.
D. Pure ulcers.
E. Healing.
6. An autopsy of a child, with a history of
diarrhea, revealed an exicosis and a widespread
fibrinous colitis. A mucosal smear imprint study
showed gram-negative rod bacteria. What is
your diagnosis?
A *Dysentery
B. Cholera
C. Staphylococcal intestinal infection
D. Typhoid
E. Salmonellosis
7. A patient presented with a sustained fever,
enlarged and painful spleen. On the 10th day of
a disease a rash of flat, rose-colored spots
appeared. On the 21st hospital day he died after
developing peritonitis. An autopsy revealed in
the ileum deep ulcers within the area of
necrotized group of lymphoid follicles (Peyer's
patches). One of ulcers was perforated; there
was a flbrinopurulent diffuse peritonitis. What is
the most likely disease?
A *Typhoid
B. Dysentery
C. Intestine amebiasis
D. Cholera
E. Salmonellosis
8 A post-mortem of a 57-year-old male, with a
history of typhoid, revealed a dense, fragile
whitish-yellowish color of the rectus abdominis
and a hip muscles. They reminded a stearin
candle. The described changes are the result of:
A *Zenker's necrosis
111
Bacterial Infections
B. Fibrinoid necrosis
C. Caseous necrosis
D. Colliqative necrosis
E. Apoptosis
9. Histological investigation of a rectum revealed
large areas of necrosis in mucosa. Necrotic
masses were impregnated by fibrin, resulting in
membrane formation. Mucous and submucous
on periphery of necrotic zones were hyperemic,
edematous, with hemorrhages and leukocytic
infiltration. What is the most likely diagnosis?
A *Dysentery
B. Cholera
C. Amebiasis
D. Typhoid
E. Salmonellosis
10. A patient died of a diffuse peritonitis. An
autopsy revealed in the distal part of a small
bowel multiple oval ulcers with rounded edges,
which were parallel to the longitudinal axis of the
intestine. A bottom of ulcers was clean, smooth
and glitter. Base of the ulcers presented either by
muscular layer of ileum or its serosa. Two ulcers
had perforation apertures 0,5cm in diameter
each. What disease resulted on a death of a
patient?
A * Typhoid
B. Dysentery
C. Cholera
D. Tuberculosis
E. Epidemic typhus
He died soon of intoxication. At post-mortem a
pathologist found a perforation of iliac wall and
diffuse purulent peritonitis. For what stage of
disease
the
described
complication
is
characteristic?
A * Stage of pure ulcers
B. Stage of a medullar swelling
C. Necrotic stage
D. Stage of healing of ulcers
E. Bacteriemia
13. A 42-year-old patient, with a history of
dysentery,
presented
with
symptoms
of
paraproctitis. What is the most probable stage of
local changes presented in that case?
A * Formation of ulcers
B. Fibrinous colitis
C. Follicular colitis
D. Catarrhal colitis
E. Stage of healing
14. A child presented with diphtheria and died
on the 2nd week of the disease from an acute
heart failure. A post- mortem revealed numerous
fine centres of a myolysis, accompanied with
some perifocal lymphoid infiltration. What
became a cause of death?
A * Myocarditis, caused by bacterial ectotoxin
B. Bacterial myocarditis
C. Septic myocarditis
D. Myocardial infarction
E. Metabolic myocardial necrosis
11. A 44-year-old man presented to a surgery
department with diffuse flbrinopurulent peritonitis.
An operation revealed an ulcer of ileum with a
perforation. An ulcer closure, followed by
abdomen cavity drainage was performed. Four
days later patient died. At post-mortem iliac
ulcers of Peyer's patches, parallel to the
longitudinal axis of the intestine, were found. A
base of the ulcers was presented by serosa. For
what disease such changes are characteristic?
A *Typhoid
B. An intestine tuberculosis
C. Dysentery
D. Intestinal tumours
E. An intestine amebiasis
15 A 39-year-old patient died on the 4th day
after operation concerning perforation of a
colon wall, resulted in diffuse purulent peritonitis.
An autopsy revealed the mucosa of a colon wall
thickened, covered by fibrinous membrane.
Some single ulcers got on different depth.
Histological study of a colon wall showed a
necrosis of mucous, a fibrinous inflammation,
infiltration by leucocytes with focuses of
hemorrhages. What complication of disease
became a cause of patient's death?
A *Dysentery.
B. Typhoid.
C. Nonspecific ulcerative colitis.
D. Crohn's disease
E. Amebiasis.
12 A man, with 4 weeks history of the typhoid,
presented with symptoms of 'acute abdomen'.
16 A 45-year-old man presented in the infectious
diseases hospital with a profuse diarrhea,
112
Bacterial Infections
exicosis, acute decline of his body temperature.
He died soon of an uremia. An autopsy revealed
in his small bowel lumen a colorless liquid in the
form of rice broth and edematous mucosa.
Microscopical investigation of a small bowel
showed a hyperemia of vessels, a focal
hemorrhage, a desquamation ofenterocytes, a
hypersecretion of a beaker (goblet) cells and
lympho- leucocytes infiltration of a mucosal
stroma. What is the most likely diagnosis?
A *Cholera
B. Salmonellosis
C. Dysentery
D. Typhoid
E. Crohn's disease
17. An autopsy of 47- year-old man revealed in
sigmoid and rectum plural red ulcers with
irregular form, A mucous between ulcers was
covered by dirty grey membrane. What is the
most likely etiology of the disease?
A *Shigella
B. Ameba
C. Mycobacterium tuberculosis
D. Salmonella
E. Staphilococcus
18. The worker of a cattle-breeding farm died in
4, 5 months of the disease beginning. A postmortem revealed in his internal organs the
granulomas consisted of epithelioid, giant
Pirogov- Langhans cells, plasmocytes and
eosinophyles. There were many vessels within a
granuloma. A histological investigation showed a
productive-destructive vasculitis in the vessels of
internal organs. What is the most likely disease?
A * Brucellosis
B. Anthrax
C. Tuberculosis
D. Epidemic typhus
E. Lepra
19. The worker of a stockbreeding farm
presented to the hospital with acute disease and
died soon of intoxication. An autopsy revealed
the enlarged, flaccid spleen, which had a darkcherry colouring of its cut surface. The scrape of
the spleen's pulp was plentiful. Arachnoids of the
brain's fornix and base were edematous,
impregnated by blood, had a dark red colouring
("cardinal's hat"). Microscopical investigation
found the serous- hemerrhagic inflammation of
brain's membranes and tissues with destruction of
fine vessels walls. Diagnose a disease.
A * Anthrax
B. Tularemia
C. Brucellosis
D. Plague
E. Cholera
20. An autopsy of a 53-year-old man revealed
few 4-5cm ulcers. The margins were elevated
above the mucosa. The walls of ulcers were
covered by the yellowish-grayish crumble
masses. The Widal test was positive. Diagnose a
disease?
A * Typhoid
B. Paratyphoid
C. Recurrent typhus
D. Dysentery
E. Crohn's disease
21. A histological investigation of a myocardium
revealed fatty dystrophy and plural necroses of
cardiomyocytes, few focal cellular interstitial
infiltrates. A medical record showed that a child
had diphtheria, resulted in the heart failure. What
kind of myocarditis is the most likely?
A * Alterative myocarditis
B. Diffusive exudative myocarditis
C. Focal exudative myocarditis
D. Intersticial myocarditis
E. Granulomatous myocarditis
22. An autopsy of a 45-year-old man, who died
on the 5th day of typhoid fever, revealed groups
of enlarged, hyperemic lymphoid follicles in small
bowel. The follicles protruded above the
mucosal surface; their surface reminded brain's
gyri and sulci. Microscopical investigation
showed hyperemia, edema and granulomas
formation. Specify, what period of local changes
of typhoid is the most likely?
A * Stage of medullar swelling
B. Necrotic stage
C. Stage of healing
D. Stage of pure ulcers
E. Stage of ulcers' formation
23. An autopsy 54-year-old man revealed
markedly dilated lumen of a small bowel filled
with a liquid, which reminded "rice broth". The
intestine wall was edematous with multiple
113
Bacterial Infections
petechial hemorrhages. For what infectious
disease the described enteritis is characteristic?
A *Cholera
B. Dysentery
C. Salmonellosis
D. Amebiasis
E. Typhoid
24. A histological investigation of a skin biopsy
showed serous-hemorrhagic inflammation and a
focus of necrosis. His medical records revealed
the beginning of the disease from a small red
maculae formation with the bubble in the
centre, filled by serous-hemorrhagic liquid.
Subsequently the central part became black.
What disease is the most probable?
A *Carbuncle at a malignant anthrax
B. Actinomycosis of skin
C. Allergic dermatitis
D. Streptococcal carbuncle
E. Chemical dermatitis
25. A 48-year-old patient with severe typhoid
developed an acute renal failure, resulted in a
lethal outcome of a disease. An autopsy
revealed enlarged and swollen kidneys. On a cut
section, the cortex was pale grey, while pyramids
were dark red. A histological investigation
showed that in the majority of tubules the lumen
was narrowed, epithelial Cells were enlarged
and lost their nuclei; glomeruli were collapsed. A
renal stroma was edematous with a small
leukocytic infiltration and fine hemorrhage. What
pathology of kidneys presented in that case?
A *Necronephrosis
B. Acute pyelonephritis
C. Acute glomerulonephritis
D. Pyonephrosis
E. Hydronephrosis
26. An autopsy revealed groups of enlarged,
hyperemic lymphoid follicles in small bowel. The
follicles protruded above the mucosal surface;
their surface reminded brain's gyri and sulci. The
cut surface of follicles was succulent; with grayred coloring. Microscopical investigation showed
monocytes
and
histiocytes
proliferation.
Macrophages formed aggregates (typhoid
granulomas). Name a morphological stage of
typhoid.
A *Medullar swelling
B. Necrotic
C. Formation of ulcers
D. Pure ulcers
E. Healing
27. A 48-year-old butcher died of a sepsis. A gross
investigation of his right cheek revealed a dense,
dark red, 6 cm in diameter, corn-shape infiltrate
with a black crust in its centre. The right half of his
face and neck were edematous and solid. A
microscopical investigation of a lesion showed
the peracute serous- hemorrhagic inflammation
with epidermal and adjacent tissue necrosis
within the central zone of an infiltrate. What is the
most likely diagnosis?
A * Anthrax
B. Plague
C. Tularemia
D. Phlegmon of a neck
E. Furuncle
28. An autopsy of a 45-year-old man revealed in
his small bowel the enlarged, hyperemic groups
of lymphoid follicles. The follicles protruded
above the mucosal surface; their surface
reminded
child's
brain
gyri
and
sulci.
Microscopical investigation showed monocytes,
histiocytes and reticular cells proliferation.
Macrophages formed aggregates (typhoid
granulomas), which replaced lymphocytes. For
what disease the described changes are
characteristic?
A * Typhoid
B. Cholera
C. Dysentery
D. Salmonellosis
E. Amebiasis
29. A 38-year-old patient was on mountain
pastures and then presented to the hospital in
severe condition, with high body temperature. A
physical investigation revealed the lymph nodes
were markedly enlarged, soldered to surrounding
tissue, motionless, a skin over them was red and
very painful. A microscopical study of a lymph
node showed the peracute serous-hemorrhagic
inflammation.
For
what
disease
it
is
characteristic?
A * Plague
B. Tularemia
C. Syphilis
D. Brucellosis
E. Anthrax
114
Bacterial Infections
30.
A
39-year-old
milkmaid
died
of
cardiovascular insufficiency. A post-mortem
reveled in the aortal valve a polypous -ulcerative
endocarditis. A microscopical study of the valve
showed the polymorph cellular inflammatory
infiltration, zones of destruction and thrombuses
with the organization. In addition, a sclerosis with
granulomas, consisted of randomly located
epithelioid, giant, plasmatic, eosinophyie cells
were diagnosed within a stroma of a
myocardium. A vasculitis was also determined in
the heart vessels. For what disease the described
changes in heart are characteristic?
A * Brucellosis
B. Chronic sepsis
C. Rheumatic disease
D. Systemic lupus erythematosus
E. Systemic scleroderma
31. A 42-year-old woman, who worked at a fur
atelier, suddenly died. An autopsy revealed dark
red, impregnated by blood arachnoids of the
brain's fornix and base, which reminded a red
cap. Microscopical investigation found the
serous-hemorrhagic inflammation of brain's
membranes and tissues with necrosis of fine
vessels walls and numerous hemorrhages. What is
the most likely diagnosis?
A * Anthrax
B. Cerebral hemorrhage in case of hypertension
disease
C. Cerebral hemorrhage due to trauma
D. Meningococcal infection
E. Tubercular leptomeningitis
32. An autopsy of an 8-year-old child revealed in
his colon multiple irregular form and various
depth defects with uneven edges. In addition,
there were grey-white membranes intimately
connected with tissues underneath. What is the
most likely diagnosis?
A * Dysentery
B. Salmonellosis
C. Cholera
D. Typhoid
E. Amebiasis
33. An autopsy of a 65-year-old man , who died
in week from the beginning of a profuse
diarrhea, revealed severe exicosis, dry all tissues
and
thick,
concentrated
blood.
A
bacteriological study of contents of a small
bowel, which reminded the rice broth,
determined vibrioes. What disease resulted in the
patient's death?
A * Cholera
B. Dysentery
C. Typhoid
D. Salmonellosis
E. Alimentary toxic infection
34. A male patient, with 5 days history of
diarrhea, had a colonoscopy. The investigation
revealed a colon mucosa inflammation with
grey-green membranes, intimately connected
with tissue underneath. What is the most likely
diagnosis?
A * Dysentery
B. Typhoid
C. Nonspecific ulcerative colitis
D. Salmonellosis
E. Crohn's disease
35. An autopsy of the patient who died of a
plague revealed a hemorrhagic syndrome,
accompanied with the hemorrhagic necrosis of
a hip skin, a lymphangitis and an inguinal
hemorrhagic lymphadenitis. Name the plague
form.
A * Dermo-bubonic
B. Bubonic
C. Primary septic
D. Primary pulmonic
E. Hemorrhagic
36. A 38-year-old man died of intoxication. A
post-mortem revealed in a small bowel an
edema of lymphoid follicles groups. The follicles
protruded above the mucosal surface like a soft
plaques with irregular surface pattern, which
reminded brain's gyri and sulci. What diagnosis is
most probable?
A * Typhoid
B. Dysentery
C. Salmonellosis
D. Acute enteritis
E. Cholera
37. A young man died of intoxication on 4th day
after eating the crude eggs. An autopsy
revealed the stomach and small bowel mucosa
inflamed, covered by a mucous exudate. In
115
Bacterial Infections
addition, abscesses were found in lungs, brain
and liver. What diagnosis is the most likely?
A *Salmonellosis (septic form)
B. Dysentery
C. Salmonellosis (typhoid form)
D. Salmonellosis (intestinal form)
E. Typhoid
38. An autopsy of a 52- year-old man revealed in
sigmoid and rectum plural brown-green
membranes, hemorrhages, some blood in the
lumen of intestine. Histological study showed a
fibrinous colitis. Bacteriological investigation
found S. Sonne. What is the most likely diagnosis?
A * Dysentery
B. Cholera
C. Salmonellosis
D. Yersiniosis
E. Crohn's disease
39. A histological research of an autopsy material
revealed in a brain tissue a wide zone of
proliferating microglia cells round small vessels. In
addition, the marked proliferation of an
endothelium, an adventitia and pericytes were
determined in the skin vessels. Perivascular
moderate lymphocytes infiltration with single
neutrophiles added was also found. The vessels
walls underwent various signs of destruction.
Name the causative organism of described
infection disease?
A. * Rickettsia
B. Spirochete
C. Meningococcus
D. Streptococcus
E. Human immunodeficiency virus
40. A 7-year-old child, on the 3ld week of
disease, presented with hectic fever, skin and
sclera icterus. He died soon of the hepatorenal
failure. An autopsy reveled in a rectum many
irregular form defects with uneven edges. These
defects
were
covered
by
grey-white
membranes, intimately soldered to a tissue
underneath. In addition, there was a purulent
thrombophlebitis of the intestinal vessels. Plural
pylephlebitic abscesses and fatty dystrophy of
hepatocytes were diagnosed in a liver. An acute
necrotic nephrosis was found in kidneys. What
disease caused a lethal outcome?
A. *Dysentery
B. Salmonellosis
C. Cholera
D. Typhoid
E. Amebiasis
41. A worker of the agricultural enterprise
presented with an acute disease and died soon
of intoxication. An autopsy revealed the
enlarged and flaccid spleen with a dark-cherry
coloring of a cut surface. There were a
superfluous pulp's scrape from the lien cut
surface. Arachnoids of the brain's fornix and base
were edematous, impregnated by blood ('red
cap'
or
'cardinal's
hat').
Microscopical
investigation found the serous- hemorrhagic
inflammation of brain's membranes and cerebral
tissues. What is the most likely diagnosis?
A. * Anthrax
B. Tularemia
C. Plague
D. Cholera
E. Brucellosis
42. An autopsy at the Forensic Pathology
Department of an unknown man, with a history
of alcohol intoxication, revealed in his small
bowel the enlarged Peyer's patches, which
protruded above the mucosal surface. They
were soft, with irregular surface, which reminded
brain's gyri and sulci. The cut surface had a grayred coloring. For what disease the described
changes are characteristic?
A. * Typhoid
B. Dysentery
C. Lamb lias is
D. Amehiasis
E. Enteritis due to Campylobacter
43. A post-mortem of a patient, who died of
diffuse fibropurulent peritonitis, revealed in the
wall of a small bowel multiple oval ulcers with
rounded edges, which were parallel to the
longitudinal axis of the intestine. A base of the
ulcers presented either by muscular layer of
ileum or its serosa. Two ulcers had perforation
apertures 0,3cm in diameter each. Define a
typhoid stage.
A. * Stage of pure ulcers
B. Stage of "dirty ulcers" formation
C. Necrotic stage
D. Stage of a medullar swelling
E. Stage of healing
116
Bacterial Infections
44. A 65 -year-old patient addressed to a doctor
his complains to frequent urge and painful
passage of stool, with mucous and some blood
in feces. Proctosigmoidoscopy revealed marked
narrowing of a colon's lumen, especially in its
distal part. A mucosa was edematous,
hyperemic, with areas of necrosis and
hemorrhages. A bacteriological study of feces
determined the Shigella flexneri. Define the
disease?
A. * Dysentery
B. Typhoid
C. Anthrax
D. Crohn's disease
E. Paratyphoid
E. Dysentery
45. Autopsy of a 9-year-old child shows
numerous irregular defects of varying depth with
uneven margins and gray-white films tightly
attached to the underlying tissue on the rectal
mucosa of the body. What disease can be
suspected?
A. Dysentery
B. Salmonellosis
C. Cholera
D. Typhoid fever
E. Amebiasis
46. A patient was hospitalized into the infectious
diseases unit on the 11th day since the disease
onset and provisionally diagnosed with typhoid
fever. What biological material should be
collected from the patient for the analyzes at this
stage?
A. Blood serum
B. Urine
C. Feces
D. Bile
E. Roseola secretion
47. Autopsy of the body revealed waxy
degeneration of the rectus abdominis muscles. In
the terminal segment of the small intestine there
are ulcers 3-5 cm in diameter. The ulcer walls are
covered in a crumbling grayish-white substance.
The ulcer edges are markedly raised above the
mucosa. Widal test is positive. Make the
diagnosis:
A. Typhoid fever
B. Nonspecific ulcerative colitis
C. Relapsing fever
D. Crohn’s disease
117
Tuberculosis
Tuberculosis
1. A histological investigation of the cervical
lymph node revealed the aggregation of
epithelioid cells, lymphocytes and giant Pirogov Langhans cells. In the centre of a lesion a
caseous necrosis was present. Specify the most
likely pathology.
A. * Tuberculosis
B. Rhinoscleroma.
C. Sarcoidosis (Boeck's disease)
D. Glanders
E. Syphilis
2. An autopsy of a 42-year-old man revealed in
the second segment of the right lung the focus of
consolidation, 5 cm in diameter, surrounded with
a thin capsule. The centre was presented by a
dense dry crumbling tissue with a dim surface.
Morphological
changes in a lung are
characteristic for:
A. Tuberculoma
B. Carcinoma of lung
C. Chondromas
D. The tumorous formof a silicosis
E. Postinflammation pneumosclerosis
3. An autopsy of a 63-year-old man revealed in
the second segment of the right lung a
tubercular panbronchitis, with the focus of a
caseous bronchopneumonia. The focus was
surrounded by a wall of epithelioid cells with
some lymphocytes and few giant Pirogov Langhans cells. What form of a pulmonary
tuberculosis presented in this case?
A. *Acute pulmonary tuberculosis
B. Primary tuberculous complex
C. Growth of primary affect
D. Acute miliary tuberculosis
E. Infiltration tuberculosis
4. A 26-year-old patient arrived in a hospital with
complaints to a fever and weakness. One of the
enlarged cervical lymph nodes was taken for
histological study. Microscopical investigation
showed in lymphoid tissue the centers of necrosis,
surrounded
with
epithelioid
cells,
giant
multinuclear
Pirogov-Langhans
cells
and
lymphocytes. What is the most likely disease?
A. * Tuberculosis
B. Lymphogranulomatosis (Hodgkin's disease)
C. Lymphatic leukemia
D. Sarcoidosis (Boeck's disease)
E. Syphilis
5. An autopsy of a 44-year-old man revealed
tuberculosis. A macroscopical investigation
showed in the apex of the right lung the foci of
caseous pneumonia. There were caseous
lymphadenitis of enlarged lymph nodes of
mediastinum and plural milium nodules in many
organs. Name
the
described
form
of
tuberculosis?
A. * Primary with mixed form of progressing
B. Primary with gematogenic spreading
C. Primary with lymphogenic spreading
D. Primary with growth of a primary affect
E. Gematogenic
6. A 7-year-old boy with a history of tonsillitis
presented with markedly enlarged paratracheal,
bifurcate and cervical lymph nodes. A
microscopical investigation of the removed
cervical lymph node revealed the centers of a
necrosis
surrounded
with
lymphocytes,
epithelioid cells and Pirogov-Langhans cells.
Specify the most likely pathology.
A. *Tuberculosis
B. Sarcoidosis (Boeck's disease)
C. Rhinoscleroma.
D. Glanders
E. Syphilis
7. A 40- year-old man died of a pulmonary
bleeding. An autopsy revealed in the upper lobe
of the right lung a cavity, 4cm in diameter, with
dense walls and a rough internal surface, filled
with blood clots. A microscopical study of the
wall showed the inner layer, presented with fell to
pieces leucocytes; the middle layer formed by
epithelioid, lymphoid and giant multinuclear cells
with nuclei located like a horseshoe. The
changes found out in a lung are characteristic
for:
A. Tuberculous cavern (cavity)
B. Bronchiectatic cavern (cavity)
C. Abscess of lungs
D. Congenital cyst
E. Infarct of lung with septic disintegration
8. A post-mortem of a 43-year-old man revealed
in the 3 segment of the right lung under the
pleura an area of consolidation, 1,5 cm in
diameter, with the accurate borders, surrounded
118
Tuberculosis
with a whitish fibrous tissue. A gross investigation
of a cut section showed the white-yellow
crumbling foci. Presence of the described focus
is characteristic for:
A. Encapsulation of primary affect
B. Peripheral carcinoma
C. Chondroma
D. Fibroma
E. Infarct of lung with organization
9. A 48- year-old man died of a pulmonary -heart
failure. An autopsy revealed pneumosclerosis,
emphysema of lungs, and hypertrophy of a right
ventricle of heart. In both lungs, mainly under
pleura, there were plural foci, 1 cm in diameter.
Histological investigation of the foci showed a
necrosis zone in the centre and a wall of
epithelioid cells, lymphocytes with some
macrophages and plasmocytes on periphery.
Giant Pirogov -Langhans cells were also defined.
The small numbers of vascular capillaries were
present on a periphery of the foci. What is the
most likely disease?
A. Gematogenic tuberculosis.
B. Actinomycosis of lungs.
C. Sarcoidosis (Boeck's disease)
D. Syphilis.
E. Silicosis.
10. A 56-year-old man with a long history of
fibrous - cavernous pulmonary tuberculosis died
of a chronic pulmonary and heart failure. Within
last months the expressed proteinuria was
observed. A post-mortem revealed enlarged,
firm kidneys, with a waxy surface. What changes
developed in kidneys at this form of tuberculosis?
A. Amyloidosis of kidney
B. Tuberculosis of kidney
C. Glomerulonephritis
D. Nephrolithiasis
E. Necrotic nephrosis
1. A child died of a diffuse peritonitis. An autopsy
revealed the primary intestinal tubercular
complex with primary affect, a lymphangitis and
regional caseous lymphadenitis. In addition, an
ulcer of an empty intestine with perforation was
found within the primary affect focus. What is the
most likely way of tuberculosis infection in
presented case?
A. Alimentary (nutritional)
B. Transplacental
C. Aero genie
D. Mixed
E. Contact
12. A 24-year-old man presented with enlarged
cervical
lymphatic
node.
A histological
investigation revealed the growth of epithelioid,
lymphoid cells and macrophages with nuclei in
the form of a horseshoe. In some centers the
aggregates of unstructured light pink color
masses with nuclei fragments were determined.
For what disease the described changes are
characteristic?
A. Tuberculosis
B. Lymphogranulomatosis (Hodgkin's disease)
C. Actinomycosis
D. Metastasis of tumor
E. Syphilis
13. A patient with a history of fibrous - cavernous
tuberculosis died of a renal failure. A postmortem revealed a urine smell, left ventricle
hypertrophy, fibrinous pericarditis, and fibrinous hemorrhagic enterocolitis. Kidneys were small,
reduced in sizes, dense, with plural foci of
shrinkage. Histological investigation of the slides
with Congo-Red staining showed pink masses
within glomuleruli and vessels walls. In addition,
destruction and an atrophy of the majority of
nephrons, accompanied with a nephrosclerosis
were determined. What is the most likely
pathology of kidneys?
A. Amyloid- contracted kidneys
B. Contracted kidney
C. Arteriolosclerotic kidney
D. Atherosclerotic contracted kidneys
E. Pielonephritic contracted kidneys
14. An autopsy of a 7-year-old child revealed in
the apex of the right lung, under the pleura, a
focus of caseous necrosis, 15 mm in diameter.
There were also enlarged bifurcational lymph
nodes with small necrotic foci. A microscopical
investigation of the pulmonal focus and the
lymph node's lesion showed necrotic masses
surrounded by epithelioid cells, lymphocytes and
solitary giant multinuclear Pirogov- Langhans'
cells. What is the most likely disease?
A. *Primary tuberculosis
B. Gematogenic tuberculosis with the lesions of
lungs
C. Gematogenic generalized tuberculosis
119
Tuberculosis
D. Secondary inflammatory tuberculosis
E. Secondary fibre-inflammatory tuberculosis
15. A post-mortem of a 58-year-old patient
revealed plural pathological cavities in both
lungs. Microscopical study showed the inner
layer of one cavity presented with necrotic
masses and diffuse neutrophil infiltration; the
middle one contained an infiltrate of epithelioid
cells, lymphocytes and multinuclear giant cells.
The external layer consisted of a mature
connective tissue. Diagnose the form of
secondary tuberculosis.
A. *Fibrocavernous tuberculosis
B. Acute inflammatory
C. Fibre-inflammatory
D. Acute cavernous
E. Cirrhotic tuberculosis
16. An autopsy of a 74- year-old man revealed
the enlargement and deformation of the right
knee
joint.
A
histological
investigation
determined the massive foci of a caseous
necrosis, surrounded by peripheral mantle of
epithelioid,
lymphoid
cells
and
some
multinucleated giant cells. What is the most likely
disease?
A. *Tuberculous arthritis
B. Syphilitic arthritis
C. Rheumatic arthritis
D. Gonorrheal arthritis
E. Deforming osteoarthrosis
17. A 52- year-old man with a long history of
tuberculosis died of a bleeding from lungs. An
autopsy revealed in lungs some oval and round
cavities. The walls of cavities were presented with
necrotic masses and a pulmonal tissue. What is
the most likely form of tuberculosis presented in
that case?
A. * Acute cavernous
B. Fibrocavernous
C. Tuberculoma
D. Caseous pneumonia
E. Acute inflammatory
18. A post-mortem of a 58-year-old patient, with
a history of tuberculosis, revealed in the upper
lobe of the right lung a cavity, 3x2cm in sizes,
which connected with a bronchus. A cavity had
dense walls and three layers. The internal layer
was pyogenic; the middle one was presented
with tubercular granulation tissue and the
external coating of connective tissue. What of
the listed diagnoses the most likely?
A. * Fibrocavernous tuberculosis.
B. Fibrous focal tuberculosis
C. Tuberculoma.
D. Acute focal tuberculosis.
E. Acute cavernous tuberculosis
19. A 42-year-old patient complained of a voice
timbre change. The larynx biopsy was taken. A
histological
investigation
revealed
the
aggregates of large, oblong form cells with light
nuclei, rich with a cytoplasm. The nuclei were
located on periphery in the form of a horseshoe.
The
described histological
changes are
characteristic for:
A. *Tuberculosis
B. Leprosy
C. Syphilis
D. Rhinoscleroma
E. Lymphogranulomatosis (Hodgkin's disease)
20. A histological investigation of the enlarged
cervical lymph nodes revealed the nodules
consisted mainly of flat, slightly extended cells
with pale nucleus. There were also giant cells
with spherical-oval form, light pink cytoplasm
and with nuclei located on a cell periphery. The
centre of some nodules was presented with the
unstructured, light pink colored masses. The
described changes are characteristic for:
A. Tuberculosis
B. Lymphogranulomatosis (Hodgkin's disease)
C. Sarcoidosis (Boeck's disease)
D. Brucellosis
E. Nonspecific hyperplasic lymphadenitis
21. A histological investigation of the enlarged
supraclavicular lymph nodes, removed from a
40-year-old woman, revealed an alteration of
their structure with aggregates of slightly
extended cells with a light nucleus. The
multinuclear, large, oval-round form cells were
also determined. These cells were rich with a
cytoplasm and their nuclei were located on
periphery in the form of a paling. The lymphoid
cells created the next layer. The unstructured
pinkish masses were seen within the centers of
lesions. What the described changes are
characteristic for?
A. Tuberculous lymphadenitis
120
Tuberculosis
B. Metastasis of tumor
C. Lymphogranulomatosis (Hodgkin's disease)
D. Hyperplasic lymphadenitis
E. Sarcoidosis (Boeck's disease)
22. A lung lobe was removed at Surgery
Department due to preliminary diagnosed
purulent inflammation of a cyst. A gross
investigation of the operative material revealed
within the 8 segment a dense focus with irregular
roundish form, 1,8 cm in diameter. On a cut, it
had white-yellow coloring with a dim surface
and fine sites of osteal density. The described
macroscopical picture characteristic for:
A. * Tuberculous affect with healing
B. Peripheral carcinoma of lung
C. Chondromas
D. Carnification
E. Chronic pneumonia
23. A 52-year-old man with a long history of a
tubercular
prostatitis
died
of
a
meningocephalitis. An autopsy revealed in
arachnoids of the basis and lateral surfaces of a
brain, in a spleen, kidneys and liver a
considerable quantity of dense grey color
nodules 0, 5-lmm in diameter. Histological
investigation of nodules showed epithelioid,
lymphoid and some giant cells with nuclei
located on a cell periphery in the form of a
horseshoe. What is the most likely diagnosis?
A. *Acute milliary tuberculosis
B. Acute tuberculous sepsis
C. Chronic milliary tuberculosis
D. Disseminated tuberculosis
E. Septicopyemia
24. A post-mortem of a 40-year-old patient, with
a 10 years history of tuberculosis, revealed a
cavity in the 1 and Ï segments of his right lung. It
had dense walls. The inner layer was rough, with
beams formed by the obliterated bronchi and
the thrombosed vessels. The middle and lower
lobes were firm, with the yellow foci on a cut
surface. What form of tuberculosis is the most
likely in that case?
A. * Fibrocavernous
B. Acute cavernous
C. Fibrous inflammatory
D. Tuberculoma
E. Cirrhotic
25. A 40-year-old prisoner died in penitentiary of
tuberculosis. An autopsy revealed a deformation
and reduction of the both lungs apexes, plural
cavities with dense, 2-3 mm thick walls in the
upper lobes of both lungs. In addition,
disseminated foci of a caseous necrosis, 5mm-2
cm in diameter, were found in the lower lobes of
lungs. Diagnose the tuberculosis form.
A. * Secondary fibrocavernous
B. Secondary fibre-inflammatory
C. Gematogenic inflammatory with lesion of
lungs
D. Primary, growth of primary affect
E. Secondary cirrhotic
26. A 10-year-old girl arrived in traumatological
unit with symptoms of pathological fracture of
the right femur. A histological investigation of an
operational material revealed in a bone marrow
of a femur fragment, a plural foci of a caseous
necrosis with peripheral mantle of epithelioid
cells, lymphocytes and solitary Pirogov-Langhans'
giant cells. Zones of a caseous necrosis extended
on adjoining sites of a bone tissue, resulting in
osseous destruction. What is the most likely
disease?
A. *Tuberculous osteomyelitis
B. Tuberculous spondylitis
C. Tuberculous koxitis
D. General(common) macrofocal tuberculosis
E. Secondary acute focal tuberculosis
27. An autopsy of a 48-year-old man revealed in
the first segment of the right lung the round
formation, 5 cm in diameter, surrounded with a
thin connective tissue layer. The centre was
presented by write, brittle masses. Diagnose the
form of secondary tuberculosis.
A. * Tuberculoma.
B. Caseous pneumonia
C. Acute cavernous tuberculosis
D. Acute inflammatory tuberculosis
E. Fibrocavernous tuberculosis
28. A post-mortem of the 17-year-old girl, who
died of a pulmonary insufficiency, revealed
confluent zones of a caseous necrosis in the
lower lobe of the right lung. The caseous necrosis
was also determined in broncho- pulmonal,
bronchial and bifurcational lymph nodes. What
of the listed diagnoses the most likely?
A. *Growth primary affect at primary tuberculosis
121
Tuberculosis
B. Gematogenic form of progress of primary
tuberculosis
C. Gematogenic tuberculosis with lesion of lungs
D. Tuberculoma
E. Caseous pneumonia at the secondary
tuberculosis
29. A 50-year-old man with a history of
tuberculosis died of a chronic pulmonary and
heart failure. A post-mortem revealed a lobar
lesion of the right lung. The upper lobe of the
right lung was enlarged, dense, with fibrinous
membranes on pleura. A gross investigation of a
cut surface showed the yellow brittle tissue. What
is the most likely form of secondary tuberculosis
described in that case?
A. *Caseous pneumonia
B. Fibrous-focal tuberculosis
C. Infiltrative tuberculosis.
D. Tuberculoma
E. Acute focal tuberculosis
30. An autopsy of a man with a history of
tuberculosis revealed in the second segment of
the right lung the white-grey focus, 3 cm in
diameter,
surrounded
with
a
capsule.
Microscopic study showed a focus of necrosis
with a capsule and lack of a perifocal
inflammation. Name the tuberculosis form.
A. * Tuberculoma
B. Acute cavernous tuberculosis
C. Fibrocavernous tuberculosis.
D. Cirrhotic tuberculosis
E. Caseous pneumonia
31. A died woman had a chronic pulmonal
abscess in her medical records. An autopsy
revealed in 2nd segment of the right lung a
roundish cavity, 5cm in the size. The internal
surface of a cavity was created by caseous
masses; the external one - by a dense pulmonal
tissue. A pyogenic membrane was absent. What
is the most likely pathology?
A. * Acute cavernous tuberculosis
B. Fibrocavernous tuberculosis.
C. Acute abscess.
D. Chronic abscess.
E. Primary pulmonary cavity (cavern).
32. A lungs roentgenograrn investigation
revealed a dark patch. During a diagnostic
express biopsy of a lymph node of a bronchus
was removed. A histological study showed a
caseous tissue necrosis, round which lied
epithelioid and lymphoid layers with few
multinuclear large cells (Langhans' cells). Specify
the cause of the lymphadenitis.
A. * Tuberculosis
B. Pneumonia
C. Syphilis
D. Metastases of cancer
E. Adenoviral infection
33. A 68-year-old woman, with a 20 years history
of fibrous - cavernous pulmonary tuberculosis,
presented to the Department of Nephrology with
symptoms of uremia, Intravital test on amyloid in
kidneys appeared positive. What is the most likely
form of an amyloidosis presented in this case?
A. * Secondary systemic
B. Primary systemic
C. Limited (local)
D. Familial congenital
E. Senile (gerontal)
34. An 8-year-old child, with no disease in his
medical history, presented to the hospital with a
dyspnea. An x-ray inspection showed the air and
a liquid in a pleural cavity. During operation in
the right lung the subpleural cavity, 2,4 cm in
diameter was found. It had an irregular form with
the residual caseous masses inside. The lesion
was connected with the pleural cavity. The
similar caseous masses were found at a cut of
the enlarged radical lymph nodes. A histological
research of a cavity's wall determined
lymphocytes, epithelioid cells and multinuclear
giant cells. How correctly to name a cavity?
A. * Primary pulmonary cavity (cavern) at
tuberculosis
B. Abscess of lungs
C. Empyema of pleura
D. Cavity (cavern) at acute cavernous
tuberculosis
E. Cavity at fibrocavernous tuberculosis.
35. The girl within last 3 months ate the crude
cow milk. She arrived in the hospital with the
"acute abdomen" symptoms. An operation
revealed in a caecum a circular ulcer with
perforation. A histological study of the ulcer
edges'
determined
necrotic
masses,
lymphocytes,
epithelioid
cells,
and
few
122
Tuberculosis
multinucleated giant cells. What is
diagnosis?
A. * Primary intestinal affect at tuberculosis
B. Nonspecific ulcerous colitis
C. Amebiasis
D. Carcinoma of blind gut (cecum)
E. Dysentery
your
36. A histological study of the enlarged cervical
lymph nodes revealed nodules with giant,
spherical-oval form cells. These cells had a light
pink cytoplasm and nuclei located on a
periphery. The found out changes are
characteristic for:
A. *Tuberculosis
B. Lymphogranulomatosis (Hodgkin's disease)
C. Sarcoidosis (Boeck's disease)
D. Brucellosis
E. Nonspecific hyperplastic lymphadenitis
37. A 63-year-old man with a long history of a
tubercular
prostatitis
died
of
a
meningocephalitis. An autopsy revealed in
arachnoids of the basis and lateral surfaces of a
brain, in a spleen, kidneys and liver a
considerable quantity of dense grey color
nodules 0, 5-lmm in diameter. Histological
investigation of nodules showed epithelioid,
lymphoid and some giant cells with nuclei
located on a cell periphery in the form of a
horseshoe. What is the most likely diagnosis?
A. *Acute military tuberculosis
B. Chronic milliary tuberculosis
C. Acuter tubercular sepsis
D. Macrofocal disseminated tuberculosis
E. Septicopyemia
38. A man died of liver cirrhosis. An autopsy
revealed in the 1-2 segment of the right lung
three grey-yellow, dense foci, 1-1,5ñì in diameter
with a dim surface. A histological research
showed the tubercular endobronchitis, foci of a
caseous bronchopneumonia, surrounded with a
wall of epithelioid, lymphoid and giant PirogovLanghans cells. For what form of a tuberculosis
the described changes are characteristic?
A. * Acute focal tuberculosis
B. Infiltrative tuberculosis
C. Fibrous-focal tuberculosis
D. Caseous pneumonia
E. Primary pulmonary tuberculous complex
39. An autopsy of a 40-year-old man with a
history of AIDS revealed both lung lobes
enlarged, dense, air free, with fibrinous
membranes on pleura. A gross investigation of a
cut surface showed the yellow dim pulmonal
tissue. A histological investigation determined in
alveoli the seroftbrinous and fibrinous exudate
with large foci of a pulmonal tissue necrosis. For
what disease the described changes in lungs are
characteristic?
A. * Caseous pneumonia
B. Infiltrative tuberculosis
C. Croupous pneumonia
D. Lymphogranulomatosis of lungs (Hodgkin's
disease)
E. Carcinoma of lung
40. A 47- year-old man died of an acute anemia,
resulted from the pulmonary bleeding. An
autopsy revealed in the 2 segment of the right
lung the cavity, 5-6 cm in the size, which had
connection with the bronchus lumen. The cavity
had irregular roundish form and filled with blood.
The internal surface of a cavity was rough and
covered by a flabby unstructured yellowish
tissue. A wall was thin, presented by the
condensed, inflammatorily changed pulmonary
tissue A histological investigation showed that the
cavity inside layer consisted of the fused caseous
masses with a considerable quantity of
segmented leucocytes. What is the most likely
pathology presented in that case?
A. * Acute cavernous tuberculosis
B. Abscess of lung
C. Disintegrating carcinoma of lung
D. Infarction of lung with septic disintegration
E. Bronchiectatic cavity (cavern)
41. A 56-year-old man died of a progressing
heart failure. A post-mortem revealed small,
dense lungs; the upper lobes were deformed,
penetrated by a cicatrical tissue, with the
encapsulated foci of a caseous necrosis, 0, 20,5cm in diameter. In the upper and middle
lobes there were cavities, 3-4 and 4-5cm in the
size, with dense walls and fiber internal surface,
filled with the opaque yellow-green liquid. The
surrounding pulmonary tissue was sclerotic. The
heart was enlarged at the expense of the
hypertrophied right ventricle. Define the form of
secondary pulmonary tuberculosis
A. * Cirrhotic tuberculosis
123
Tuberculosis
B. Fibrous-focal tuberculosis.
C. Infiltrative tuberculosis
D. Acute cavernous tuberculosis
E. Fibrocavernous tuberculosis
42. A post-mortem of a 72-year-old vagabond,
with marked kypho-scoliosis, revealed the
partially destructed thoracal vertebral bodies
due to formation of cavities (sequesters), filled
with white-yellow brittle masses. A histological
investigation determined within altered vertebras
big foci of a caseous necrosis, surrounded with
solitary giant multinucleated Pirogov-Langhans'
cells, epithelioid cells and lymphocytes. Similar
changes were diagnosed at mediastinum lymph
nodes and disseminated in lungs and kidneys.
What is the most likely diagnosis?
A. *Tuberculous osteomyelitis
B. Purulent osteomyelitis
C. Syphilitic osteomyelitis
D. Osteoporosis
E. Osteoarthrosis
43. An ultrasound investigation of the young 17year-old
man's
right
kidney
revealed
pyeloectasis, accompanied with disturbance of
outflow of urine by urethra. Microscopical
investigation of the renal biopsy showed a
diffusive infiltration of the interstitium by
lymphocytes and hystiocytes. In the cortical and
medullar zones there were the foci of a
destruction with formation of the cavities,
surrounded by peripheral mantle of epithelioid ,
lymphoid cells and some multinucleated PirogovLanghans' giant cells. What disease is the most
probable?
A. * Tuberculosis of kidney
B. Suppurative (apostematous) nephritis
C. Nonspecific tubular-interstitial nephritis
D. Polycystic kidney
E. Chronic pyelonephritis
44. An autopsy of a child, who died of
meningocephalitis revealed under pleura and in
pulmonal tissue plural, punctual, yellow-white
lesions which reminded millet grains. Histological
investigation showed granulomas with a necrosis
zone in the centre and a wall of epithelioid cells,
lymphocytes, macrophages and some giant
Pirogov -Langhans cells. What is the most likely
disease?
A. *Primary milliary tuberculosis
B. Secondary tuberculosis
C. Focal pneumonia
D. Croupous pneumonia
45. A medical record of a dead child reveled
meningeal symptoms in his medical history. His Xray showed a dark patch in the III segment of the
right lung and enlarged radical lymph nodes. At
autopsy, in cerebral arachnoids, the millet grainslike nodules were found. Microscopical study of a
nodule determined a focus of a caseous necrosis
with wall of epithelioid, lymphoid cells with giant
cells between them. These giant cells had big
nuclei, situated on periphery in the form of a half
moon. What is the most likely kind of meningitis?
A. *Tuberculous
B. Syphilitic
C. Brucellous
D. Influenza!
E. Meningococcai
46. A 40-year-old prisoner died of tuberculosis in
the corrective labor camp. Autopsy of the body
revealed deformation and diminishing of both
lung apices; in the both upper lobes there are
multiple cavities with dense walls 2-3 mm thick;
in the lower lung lobes there are disseminated
foci of caseous necrosis varying from 5 mm to 2
cm in diameter. Diagnose the type of
tuberculosis:
A. Secondary fibro-cavitary tuberculosis
B. Secondary fibrous-focal tuberculosis
C. Hematogenous macrofocal
pulmonary
tuberculosis
D.
Primary
tuberculosis,
primary
affect
development
E. Secondary cirrhotic tuberculosis
47. Autopsy of the body of a 50-yearold man,
who had been suffering from tuberculosis and
died of cardiopulmonary decompensation,
shows lobar affection of the lungs: the upper lobe
of the right lung is enlarged, dense, yellow on
section, crumbling, with pleural fibrin deposition.
What type of secondary tuberculosis can be
characterized by this pathology?
A. Caseous pneumonia
B. Fibrous focal tuberculosis
C. Infiltrative tuberculosis
D. Tuberculoma
E. Acute focal tuberculosis
124
Tuberculosis
48. Autopsy of a man with tuberculosis revealed
a 3x2 cm large cavity in the superior lobe of the
right lung. The cavity was interconnected with a
bronchus, its wall was dense and consisted of
three layers: the internal layer was pyogenic, the
middle layer was made of tuberculous
granulation tissue and the external one was
made of connective tissue. What is the most
likely diagnosis?
A. Fibrous cavernous tuberculosis
B. Fibrous focal tuberculosis
C. Tuberculoma
D. Acute focal tuberculosis
E. Acute cavernous tuberculosis
49. A man is 28 years old. Histological
investigation of the cervical lymph node
revealed a change of its pattern due to
proliferation of epithelioid, lymphoid cells and
macrophages with horseshoe-shaped nuclei. In
the center of some cell clusters there were nonstructured light-pink areas with fragments of
nuclei. What disease are these changes typical
of?
A. Tuberculosis
B. Hodgkin’s disease
C. Actinomycosis
D. Tumor metastasis
E. Syphilis
125
Syphilis
Syphilis
1. A 10-year-old boy presented with Hutchinson's
triad: parenchymatous keratitis, sensorineural
deathess and deformed Hutchinson's teeth (the
barrel form), along with saddle-nose deformity.
For what illness the presented changes are
characteristic?
A. * Syphilis.
B. Toxoplasmosis
C. Leprosy.
D. Tuberculosis.
E. Opisthorchiasis.
2. An autopsy of a 36-year-old man revealed in
his liver s roundish formation, 0,5 cm in diameter.
Microscopical investigation showed in the centre
of lesion necrotic masses, surrounded by the
granulation tissue with some plasmatic and
lymphoid cells. There were also signs of the
vasculitis in the blood vessels. What is the most
likely diagnosis in that case?
A. *Solitary gumma of liver
B. Solitary adenoma of liver.
C. Solitary leproma of liver.
D. Chronic abscess of liver.
E. Carcinoma of liver.
3. An autopsy of a 54-year-old man reveled
above valvular rupture of an aorta with resulted
in
a
cardiac
tamponade.
Histological
investigation of ascending part of an aorta
showed in its external and middle layers
inflammatory infiltrates. They consisted of
lymphoid, plasmatic and epithelioid cells. There
were also recognized the necrosis centers and
proliferation of a vessels' wall. Changes in an
aorta are characteristic for:
A. * Syphilitic aortitis
B. Septic aortitis
C. Rheumatic aortitis
D. Atherosclerosis
E. Hypertension diseases
4. A 20-year old woman presented with
enlarged, not painful, condensed inguinal lymph
nodes. In her genital mucosa there was a small
ulcer with firm edges and the "varnished" grayish
color floor. What is the most likely diagnosis?
A. * Syphilis
B. Tuberculosis.
C. Leprosy.
D. Trophic ulcer.
E. Gonorrhea.
5. A biopsy of cervix uteri was taken from the 34year-old woman. Histological investigation
revealed the inflammatory infiltration with
involving of fine arteries and veins walls. The
infiltrate
composed
of
plasmocytes,
lymphocytes, and epithelioid cells. There were
also zones of sclerosis and a tissue hyalinosis.
What is the most likely disease?
A. * Syphilis
B. Tuberculosis
C. Leukoplakia
D. Cervical erosion
E. Condyloma
6. The prepuce was removed from a young man.
A microscopical investigation revealed the
polymorphic infiltrate consisting from randomly
located plasmatic, lymphoid and epithelioid
cells. There was marked vessels' vasculitis. For
what disease the described changes are
characteristic?
A. *Syphilis
B. Tuberculosis
C. Actinomycosis
D. Periarteritis nodosa
E. Leprosy
7. A man's oral cavity investigation revealed an
oval, cartilaginous density, slightly elevated ulcer
at his buccal mucosa. A meaty, reddened floor
was covered with grayish sebaceous deposits. A
microscopical investigation showed lymphocyte
infiltration, situated mainly round fine vessels.
There was also an endothelium proliferation
within the vessel's walls..What disease has
developed in that case?
A. * Syphilis
B. Traumatic ulcer
C. Erosive-ulcerated leukoplakia
D. Ulcer-Carcinoma
E. Ulcero-necrotic Vensan's stomatitis
8. A histological study of a biopsy from an oral
cavity ulcer revealed the foci of caseous necrosis
surrounded with plasmocytes, epithelioid ,
lymphoid cells and solitary giant multinucleated
Pirogov-Langhans' cells. There were also signs of
126
Syphilis
endo - and a perivasculitis in fine vessels. Specify
the disease.
A. * Syphilis
B. Tuberculosis
C. Leprosy
D. Rhinoscleroma
E. Glanders
127
Other infections
Other infections
1. A 48-year-old patient presented to the hospital
with deep cerebral coma. It was known, that
during lifetime he experienced periodic attacks
of a fever. An autopsy revealed grey-flaky colour
of a bone marrow, lymph nodes; enlarged a liver
and a spleen. Histological investigation showed
the haemomelanosis and a hemosiderosis in
mentioned organs. What of diagnoses is most
probable?
A. * Malaria
B. Hemolytic anemia
C. Addison disease
D. Septicemia
E. Black pox
2. A 54-year-old man presented to the hospital
with reddening and edema of the neck's skin,
and then resulted in a small abscess formation.
On a cut, a tissue was dense with yellow-green
coloring. In purulent masses there were visible
white grains. Histological study showed fungus'
druses,
plasmatic,
xanthome
cells,
and
macrophages. Specify the most probable kind of
a mycosis.
A. *Actinomycosis
B. Aspergillosis
C. Candidosis
D. Sporotrichosis
E. Coccidioidomycosis
3. An autopsy of 48-year-old woman, resident of
Middle Asia, with long history of exhausting fever,
revealed enlarged liver and a spleen. They were
grey-flaky color. The same color had hyperplastic
bone marrow. A cerebral cortex also had greysmoky coloring. What is the most likely diagnosis?
A. * Malaria
B. AIDS
C. Epidemic typhus
D. Sepsis
E. Hepatitis
4. A 38-year-old man died of cerebral coma. It
was known, that after foreign business trip in one
of the African countries, the icteruses periodically
developed. An autopsy revealed the enlarged,
dense spleen, with a black pulp. A liver was also
enlarged, hyperemic, and grey-black. A gross
investigation of the brain determined brown-grey
coloring of a grey matter and plural fine
hemorrhages in white matter. What infectious
disease should be suspected?
A. * Malaria
B. Meningococcemia
C. Prion infection
D. Generalized herpes infection
E. Generalized cryptococcosis
5. A 69-year-old man presented to the hospital
with edema and a painmlness of a skin and soft
tissues of his neck. The phlegmon of a neck and
a mediastinitis were diagnosed. The patient died.
An autopsy revealed enlarged, dense left tonsil.
On a cut, the tonsil was yellow-green, with set of
fine cavities similar to porous structures.
Microscopical investigation determined fine
abscesses with basophilic formations in their
centers. These formations consisted of short
rhabdoid elements. What is the most likely
diagnosis?
A. *Actinomycosis
B. Brucellosis
C. Amebiasis
D. Lambliasis
E. Leishmaniasis
6. A 40-year-old man developed skin redness
and swelling in the neck area, where eventually
a small abscess appeared. On section the focus
is dense and yellow-green colored. In the
purulent masses there are white granules.
Histologically there are fungal druses, plasma
and xanthome cells, and macrophages
detected. Specify the most correct etiological
name of this pathological process:
A. Actinomycosis
B. Furuncle
C. Carbuncle
D. Syphilis
E. Leprosy
7. Brain autopsy revealed an edema, hyperemia,
and small hemorrhages in the medulla
oblongata.
Microscopically
chromatolysis,
hydropia and nerve cell necrosis are observed;
within the cytoplasm of hippocampal nerve cells
there are eosinophilic structures (Negri bodies)
detected. What diagnosis corresponds with the
described morphological signs?
A. Rabies
B. Meningococcal meningitis
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Other infections
C. Encephalitis
D. Encephalomyelitis
E. Brucellosis
8. A worker of an agricultural enterprise had
been suffering from an acute disease with
aggravating intoxication signs, which resulted in
his death. On autopsy: the spleen is enlarged,
flaccid, dark cherry-red on section, yields
excessive pulp scrape. Soft meninges of the
fornix and base of the brain are edematous and
saturated with blood (”cardinal’s cap”).
Microscopically:
serous
hemorrhagic
inflammation of meninges and cerebral tissues.
Make the diagnosis:
A. Anthrax
B. Tularemia
C. Plague
D. Cholera
E. Brucellosis
9. Autopsy of a Middle-Eastern woman, who had
been suffering from wasting fever for a long time,
revealed enlarged blackened liver and spleen.
Bone marrow was hyperplastic and blackcolored as well. Cerebral cortex was smoky
grey. What disease is it characteristic of?
A. Malaria
B. AIDS
C. Epidemic typhus
D. Sepsis
E. Hepatitis
10. A 34-year-old man died in a comatose state.
According to his family after a business trip to an
African country he developed periodical
jaundice attacks. Autopsy shows the following:
dense enlarged spleen with slate-black pulp;
enlarged plethoric liver, gray-black on section;
cerebral gray matter is brown-gray; cerebral
white
matter
contains
numerous
small
hemorrhages. What infectious disease can be
suspected?
A.* Malaria
B. Generalized cryptococcosis
C. Generalized herpetic infection
D. Meningococcemia
E. Prion infection
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Sepsis
Sepsis
1. A 48-year-old patient with a history of
croupous pneumonia died of the pulmonary and
heart failure. A post-mortem revealed a
hyperplasia of a spleen, a thickening and
defects of the aortal valve leaflet with large, up
to 2 cm in diameter, thrombuses attached to
tissues underneath. What is the most likely
diagnosis?
A. * Polypous-ulcerative endocarditis
B. Acute warty endocarditis
C. Recurrent warty endocarditis
D. Diffuse endocarditis
E. Fibroplastic endocarditis
2. An autopsy of a 48-year-old man revealed the
infarct of the left hemisphere of a brain. A
macroscopic study also showed a big septic
spleen,
immunocomplex
glomerulonephritis,
ulcers in aortal valve leaflets, covered with
polypous thrombi. The latter ones had colonies of
staphilococcuses, determined by microscopic
study. What disease resulted in cerebral
thromboembolism?
A. * Septic bacterial endocarditis
B. Septicemia
C. Acute rheumatic valvulitis
D. Septicopyemia
E. Rheumatic thromboendocarditis
3. A 46-year-old man died of an odontogenic
sepsis. An autopsy revealed the marked
thickening of semilunar aortic valves. They were
whitish, opaque and stiff, with thrombotic
masses, 1x1.5 cm in the size on the external
surface. What is the most likely form of an
endocarditis?
A. * Polypous-ulcerative endocarditis
B. Diffuse endocarditis
C. Acute warty endocarditis
D. Fibroplastic endocarditis
E. Recurrent warty endocarditis
4. A 32-year-old man with a long history of a drug
abuse, presented with a fever, the intoxication
and a pyuria. An echocardioscopy revealed
massive superimpositions (vegetations) on the
heart valves. Microbiological blood test showed
a presence of a staphylococcus. The patient
died of a thromboembolism of a pulmonary
artery. Specify the changes of heart, revealed at
post-mortem?
A. * Polypous-ulcerative endocarditis
B. Libman-Sacks endocarditis
C. Diffuse valvulitis
D. Acute warty endocarditis
E. Recurrent warty endocarditis
5. A young woman with a history of the out-ofhospital abortion presented with advanced
purulent endomyometritis resulted in a lethal
outcome. A post-mortem revealed numerous
abscesses of lungs, pustules under kidneys'
capsule and spleen hyperplasia. What form of a
sepsis has developed?
A. * Septicopyemia
B. Septicemia
C. Chroniosepsis
D. Lung sepsis
E. Urosepsis
6. A 30-year-old woman with a history of abortion
presented with purulent endometritis resulted in a
death from sepsis. A post-mortem revealed a
purulent lymphadenitis, abscesses in lungs,
kidneys, a myocardium, a spleen hyperplasia,
and dystrophy of parenchymatous organs.
Define the clinico-anatomic form of a sepsis.
A. * Septicopyemia
B. Septicemia
C. Septic endocarditis
D. Granulomatous sepsis
E. Chroniosepsis
7. A 28-year-old woman died in the postnatal
period. A post-mortem revealed a purulent
endometritis and thrombophlebitis of a uterus
veins, plural abscesses of lungs, kidneys and a
spleen. In addition, there were an apostematous
myocarditis and purulent meningitis. What is the
most likely kind of a sepsis?
A. * Septicopyemia
B. Septicemia
C. Chroniosepsis
D. The prolonged septic endocarditis
E.
8. A man with a history of a lower extremity
wound, presented with persistent pyesis of a
lesion, resulted in death of intoxication. An
autopsy revealed a cachexia, dehydration; a
brown atrophy of a liver, a myocardium, a
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Sepsis
spleen and cross-striated muscles. In addition,
there was amyloidosis of kidneys. What of the
listed diagnoses is most probable?
A. * Chroniosepsis
B. Septicopyemia
C. Septicemia.
D. Chernogubov's disease.
E. Brucellosis
9. A post-mortem revealed on the external
surface of the aortal valve the large, 1-2 cm,
brownish-red, easily crumbling superimpositions
(vegetations). They covered ulcerative defects in
the valves. What is the most likely diagnosis?
A. * Polypous-ulcerative endocarditis
B. Recurrent warty endocarditis
C. Acute warty endocarditis
D. Fibroplastic endocarditis
E. Diffuse endocarditis
131
Other
OTHER
Autopsy of a man, who served on a nuclear
submarine, revealed the following pathologies:
bone marrow atrophy (panmyelophthisis),
anemia,
leukopenia,
thrombocytopenia,
lymphocytes disintegration in the lymph nodes,
spleen, gastrointestinal lymphatic system, and
hemorrhages into the adrenal glands. What
disease was developed in this case?
A. Acute radiation sickness
B. Decompression sickness
C. Acute leukemia
D. Acute anemia
E. Vibration disease
Autopsy of a man, who served on a nuclear
submarine, revealed the following pathologies:
bone marrow atrophy (panmyelophthisis),
anemia,
leukopenia,
thrombocytopenia,
lymphocytic disintegration in the lymph nodes,
spleen, gastrointestinal lymphatic system, and
hemorrhages into the adrenal glands. What
disease had developed in this case?
A.* Acute radiation sickness
B. Acute anemia
C. Acute leukemia
D. Vibration disease
E. Decompression sickness
132