HOLIK OLENA
MOSKALENKO LYUDMYLA
PIDMAZINA OKSANA
ZAKHAROVA VALERIYA
MYROSLAVA VAKHNOVAN
ENGLISH FOR
MEDICINE
1
CONTENT
1. HUMAN BODY……………………………..........3
2. MAKING A DIAGNOSIS………………………11
3. PHARMACOLOGY……………………........….21
4. RESPIRATORY SYSTEM………………….......29
5. CARDIOVASCULAR SYSTEM……………......38
6. DIGESTIVE SYSTEM…………………........…..47
7. ENDOCRINE SYSTEM…………………........…55
8. NERVOUS SYSTEM…………………….........…63
9. URINARY SYSTEM………………….........……73
10.INTERGUMENTARY SYSTEM...................….81
REFERENCES………………………............….….93
2
UNIT 1
___
_HUMAN BODY
REVIEW OF BASIC TERMINOLOGY
A
Surface anatomy
General Anatomy
 Brain
 Brain stem
 Neuron
tubes
 Heart
trachea
lungs
esophagus
small intestine
colon
liver
kidneys
ureter
bladder
gallbladder
ovaries
fallopian
stomach
pancreas
spleen
uterus
BA. Physical actions
You can breathe through your nose or your mouth, so people breathe about 12-15 times
a minute.
3
People usually walk to relax and to keep fit.
When people don’t feel well, they cannot stand still and basically sway from side to side.
When you pick up something heavy, you must bend your knees and keep your back
straight.
If you have got some difficulties and can’t extend your fingers, you have damaged some
nerves.
To have a good posture, you should straighten your back.
CA. The Human Skeleton
Medical term
1. cranium
2. mandible
3. clavicle
4. sternum
5. humerus
6. radius, ulna
7. pelvic girdle
8. femur
9. patella
10. tibia, fibula
11. cervical spine
12. scapula
13. rib cage
14. spine
Lay term
skull
jaw bone
collar bone
breast bone
arm
forearm
hip bone
thigh bone
knee cap
shinbone
neck bone
shoulder blade
ribs
back bone
Latin-derived adjectives referring to body parts:









cerebral
cranial
cardiac
buccal
dermal
gastric
hepatic
dental
ocular
osseous
oral
lingual
pulmonary
renal
nasal
thoracic
abdominal
sternal
costal
lacrimal
pelvic
spinal
mandibular
maxillary
appendicular
vertebral
femoral
Body systems:



D
cardiovascular
digestive
endocrine
integumentary
muscular-skeletal
nervous
respiratory
reproductive
urinary
A case report containing the major parts of the human torso
A 27-year-old male was brought to the hospital because of apparent injuries to
the head and neck obtained in an automobile accident. The patient suffered minor
4
head trauma and may have a concussion. There is no visible injury to the neck. As
for the torso, there are small scratches on the chest and waist. Bruising was observed
on the abdomen and the rib cage. There is no damage to the legs or groin. The
patient complains of pain below the right shoulder blade. He also has a deep cut on
the small of his back. However, the patient’s arms and legs appear to be in good
condition.
 cervix
breastbone
 trunk
inguina
 thorax
scapula
 midsection
lower –back or lumbar region
 belly
upper and lower extremities
PRACTICE
1. Use eight of these words to fill the gaps in the sentences
eyes, abdomen, bladder, legs, chest, gallbladder, shoulder, nose
1. Babies crawl around on their hands and _________
2. She has had an intense sharp pain in the right side of her __________ during
breathing for 10 days.
3. Before the pain starts, people start seeing “spots” in front of their ___________ and
during the headache they cannot tolerate light.
4. A doctor is going to feel patient’s ____________ for any fractures.
5. Before I examine your _____________ , you might need to go to the toilet: I need
to examine you with an empty _____________!
6. Steroid sprays or drops relieve blocked____________ and ease breathing by
reducing swollen sinuses.
7. A physician demonstrated results of ultrasound scan: a number of gallstones in the
____________.
2. Write the adjective form of these nouns by adding suffixes: - al, - ar.
Noun
1.
2.
3.
4.
5.
6.
7.
8.
9.
Adjective
abdomen
cerebrum
brachium
umbilicus
radius
lymph
ulna
face
reticulum
5
10. humerus
3.
Match the words (1-8) with the definitions (A-H).
1. ----shoulder blade
5. ----neck
2. -----abdomen
6. ---groin
3. -----waist
7. ----chest
4. ----torso
8. ----small of the back
A the upper front of the torso
B area between the legs
C the part of the body between the neck and the groin
D lower portion of the back
E part of the body that contains the digestive organs
F part of the body that allows the head turn and connects the head to the torso
G upper backbone that connects to the shoulders
H area between the ribs and the pelvis
Replace the underlined words with a word that has a similar meaning.
1. The axial skeleton consists of the skull, vertebral column, sternum and ribs.
2. The mandible is the only movable bone of the cranium.
3. The collar bone provides the only bony link between the upper extremity
and the axial skeleton.
4. The scapula is a flat triangular-shaped bone, lying on the posterior chest
wall.
5. The posterior surface of the knee cap articulates with the patellar surface of
the thigh bone in the knee joint.
6. The bones of the hip bone are two innominate bones and one sacrum.
7. The head of the humerus articulates with the glenoid cavity of the shoulder
blade forming the shoulder joint.
4.
5.
Match the following words with their definitions:
1. They contain a variety of a) macrophages
substances that promote blood
clotting; they are tiny nonnucleated discs.
2. They have large nuclei and
b) platelets
defend the body against microbes
and other foreign materials.
3. They have important functions c) lymphocytes
in inflammation and immunity and
function closely with monocytes
and lymphocytes.
6
4. They serve as a repair system
d) leukocytes
for the body and cannot do
specific functions but develop in
many different types of cells.
5. They are formed in the red bone e) stem cells
marrow and characterized by
maturation of the cell and
formation of hemoglobin inside
the cell.
6. They have big nuclei, circulate f) erythrocytes
in the blood and are present in
great number in lymphatic tissue.
6.
Identify each of the following terms by associating it with one of the
major anatomical systems of the body: skeleton, circulatory system, skin,
nervous system, digestive system or muscles. A term may belong to more than
one system.
rib cage
dermis
vertebra
peristalsis
teeth
periosteum
skull
bursa
plasma
marrow
dendrite
rectum
pulse
pelvis
capillary
trachea
cerebrum
ventricle
ligament
neuron
platelet
colon
kidney
bile
flexor
bronchioles
teeth
taste buds
eye
pancreas
liver
tendon
synapse
salivary
glands
hemoglobin
capillary
7. Fill in the gaps with the words from the box related to cranial nerves.
facial
optic
vagus hypoglossal
glossopharyngeal olfactory
accessory
trigeminal
1. These nerves pass to the ……. bulb, a group of nerve cell bodies of the second
neurons.
2. …….. nerves contain motor and sensory fibers and are among the largest of
the cranial ones.
3. The motor fibers supply the muscles of …… expression.
4. ……… nerves have a more extensive distribution than any other cranial
nerves.
5. The nerves that arise from nerve cells in the medulla oblongata and in the
spinal cord are called ……
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6. The central retinal artery and vein enter the eye enveloped by the fibers of the
…….. nerve.
7. The nerves supplying the muscles of the tongue and contributing to
swallowing and speech are ………..
8. The motor fibers of ……….. nerves stimulate the muscles of the tongue and
pharynx and the secretory cells of the parotid glands.
EXAMPLES OF THE EXAM TASKS
Case presentation 1
During surgery performed on the abdominal cavity one placed (fixed) the ligament
of the liver stretching from the anterior abdominal wall (navel) to the inferior surface
of the liver. What ligament is it?
A. Round ligament of the liver
B. Falciform ligament of the liver
C. Coronary ligament of the liver
D. Venous ligament of the liver
E. Triangular ligament of the liver
Case presentation 2
A 50-year-old woman complains of persistent thirst. She drinks a lot of liquid and
she has increased diuresis. Her blood glucose is 12 mmol/L and urine contains
glucose. Which endocrine organ is likely to be impaired in this patient?
A. Thyroid gland
B. Neurohypophysis
C. Adrenal glands
D. Pancreas
E. Parathyroid gland
Case presentation 3
Histological micro slide shows a gastrointestinal organ. The walls of this organ
consists of four layers: mucosal, submucosal, muscular and serous. The mucosal
layer has folds and pits. Which organ does have such appearance?
A. Esophagus
B. Small intestine
C. Duodenum
D. Appendix
E. Stomach
Case presentation 4
A 12-year-old boy presents with progressive clumsiness and difficulty walking and
experiences frequent falls. His muscle tone and strength in limbs are slightly
decreased. He is unable to stand still and sways from side to side. Which of the
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following brain regions is most likely affected and caused the symptoms described
above?
A. Right hemisphere
B. Substantia nigra
C. Red nucleus
D. Cerebellum
E. Reticular formation
Case presentation 5
A laboratory assistant is performing a complete blood count to detect if the bone
marrow is making the right amount of blood cells. These blood cells have no nucleus
and respond to bleeding of an injured blood vessel by initiating a blood clot. Which
of the following items should be tested?
A. Prothrombin
B. Stem cells
C. Leukocytes
D. Platelets
E. Macrophages
Case presentation 6
A specimen shows an organ covered with the inward organ. There is also cortex
containing lymphoid cells. What organ is under study?
A. Thymus
B. Lymph node
C. Tonsils
D. Red bone marrow
E. Spleen
Case presentation 7
During intensive physical exertion, one of the energy sources for the working
muscles is glucose produced as the result of gluconeogenesis. This process is the
most intensive in the following organ:
A. Liver
B. Brain
C. Lungs
D. Muscles
E. Stomach
Case presentation 8
A patient complains of pain in the upper umbilical region. On palpation, there is a
mobile painful intestine. What intestine is being palpated by the doctor?
A. Transverse colon
B. Jejunum
C. Duodenum
D. Ileum
E. Sigmoid colon
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Case presentation 9
A man was brought to the casualty department with a trauma of the right shoulder.
Examination revealed a displaced humeral fracture on the right in the middle onethird of the humerus; the patient cannot extend the fingers of his right hand. Which
nerve is damaged?
A. Radial
B. Ulnar
C. Median
D. Musculocutaneous
E. Axillary
Case presentation 10
After a case of a common cold, a patient developed numbness of the right side of
the face. Examination revealed aching pain and thermal sensitivity in the right half
of the face. Which nerve was damaged?
A. Trigeminal
B. Facial
C. Glossopharyngeal
D. Vagus
E. Hypoglossal
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UNIT 2
____
MAKING A DIAGNOSIS
REVIEW OF BASIC TERMINOLOGY
A
Taking a history
For serious illness, a person is usually admitted to the hospital (1). A
patient complains of (2) some symptoms that she (he) suspects of (3). A
doctor asks about past medical (4) and family history (5) that provides
information concerning the symptoms the patient has experienced (6),
previous diseases as well as genetic predisposition. During taking a history
the physician reveals (7) some details and facts that the patient can deny (8).
So, the doctor administers to do some laboratory and instrumental studies
(9) to confirm the diagnosis (10). When the patient feels better, he or she is
discharged (11) from the hospital.











B
to be brought to
to make a complaint about
to have a suspicion
previous
genealogical chart
to have, to feel
to detect, find out
refuse, contradict
findings
to prove the diagnoses
to release
Common symptoms and signs
rash ( eruption, hives, urticaria, exanthema)
cyanosis (bruising, bluish color of the skin)
constipation (infrequent bowel movement,
cough (air expelling from the lungs with a sudden sharp sound)
cramp ( spasm, paroxysm)
dizziness ( vertigo, light-headedness, drowsiness)
itching ( scratch, pruiritis)
lump ( tumor, bump, growth, neoplasm)
nausea ( sickness, being sick)
numbness ( insensibility, apathy, stupor)
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vomiting ( emesis, nauseated)
coryza ( a runny nose)
edema ( swelling)
sore throat ( pain in the throat)
tiredness ( fatigue, exhaustion, prostration)
insomnia ( sleepiness, somnolence)
dyspnea ( shortness of breath, breathlessness)
malaise ( discomfort, restlessness)
fever (high temperature)
sweating( perspiration, diaphoresis)
System
General symptoms
Cardio-vascular system
(CVS)
Gastro-intestinal system
(GIS)
Urinary system
Respiratory system
Neurological system
Skin problems
C
Symptoms
malaise, weakness, myalgia, weight loss,
anorexia, drowsiness, delirium, bleeding,
vomiting, chills, photophobia
dyspnea, palpitation, chest pain,
hypertension, arrhythmia
diarrhea, melena, constipation, heartburn,
flatulence
dysuria, frequency, urgency, discoloration,
hematuria, nocturia, oliguria, polyuria
cough, coryza, sore throat, dyspnea, sputum,
hemoptysis
blurred vision, blackouts, diplopia,
photophobia, numbness
rash, pruritis, bruising, itching, pigmentation,
Describing pain
excruciating
stabbing
tingling
aching
Dull
Gnawing
pain can be mild,
moderate, severe,
occasional , frequent
and constant
cramping
burning
sharp
throbbing
shooting
pressing
12
D
Diagnostic studies
Physical examination:
visual inspection (assessment of the general appearance)
palpation( feeling with hands)
auscultation( listening to the heart and lungs with the stethoscope)
percussion( tapping a part of the body)
body mass index (BMI) measurement
pulse check
respiratory rate assessment
blood pressure measurement
tilt test (blood pressure and heart rate monitoring
when the patient is lying down and standing up)
Laboratory methods:
urinalysis or urine test
blood sample
full blood count
complete blood count(CBC)
fasting blood sugar
gastric juice analysis
bile examination
stool test
liver function tests
allergy test
serologic test
pus smear
throat swab
biopsy
Instrumental studies. Imaging techniques:
echocardiogram (ECG)
colonoscopy
exercise tolerance test (ETT)
gastroscopy
electrocardiogram (EKG)
ultrasound scanning
doppler sonography (ultrasound)
scintigraphy
X-ray
magnetic resonance imaging (MRI)
computed tomography scanning ( CT)
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PRACTICE
1.
2.
Match these words for types of pain with their descriptions
1.
a throbbing pain
a)
feels like it is eating you
2.
a sharp pain
b)
travels fast along part of
your body
3.
a burning pain
c)
4.
a stabbing pain
d)
feels like a muscle is being
squeezed
5.
a shooting pain
e)
feels like something sharp is
stuck into you
6.
a dull ache
f)
comes and goes
rhythmically
7.
a gnawing pain
g)
feels like fire
8.
a cramping pain
h)
is strong and sudden
is steady and not too painful
Write the words in the box in the correct columns
a)
aching b) pressing c) unbearable d) hot e) slight
f) excruciating g) tingling h) stabbing i) blunt j) throbbing k)
annoying l) intense m) dull
Intensity of pain
Severe
Character of pain
Mild
3.
Read this report about a patient with appendicitis and find three
mistakes.
Two days ago Miss Jabarti had a mild fever and complained of a loss appetite.
Later she suffered nausea and vomiting with an occasional pain in the center of her
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stomach. She was admitted hospital yesterday. Today her abdomen is swollen and
she is suffering a constant sharp pain her lower right side.
a) Write a report on this patient who has food poisoning using these notes.
Patient name: Ivan Abashev
History:
Yesterday – vomiting with headaches, diarrhea
On admission – severe abdominal pain, high fever
This morning – weakness, shivering. Pain in left abdomen- constant, stabbing
4. Make the diagnosis according to the symptoms
a) Gastro-esophageal reflux (hiatal hernia) b) Pleuritis
infarction d) Pulmonary embolism e) Pericarditis
c)Myocardial
1. Sharp retrosternal chest pain, which is often improved by sitting forward.
Worse with inspiration and associated shortness of breath, palpitations, shoulder
discomfort, and cough. Change of posture and breathing influence the pain.
2. Continuous, pressing, retrosternal chest pain. Lasts about 20 minutes.
Possibly radiating to the arms (usually to the left arm), back, neck or the lower jaw.
Intensity does not alter. Breathing or changing posture does not influence the
severity of the pain. Episodes of pain are related to activity: relief with rest.
3. Nausea and vomiting are sometimes the main symptoms. Sometimes
hypotension, presenting as dizziness or fainting. A localized stabbing pain when
breathing. Associated with recent or present respiratory illness. Fever, malaise.
Aggravated by coughing and deep breathing.
4. Burning or pressing pain in the middle of the chest. Associated with eating.
May be triggered by exercise. Nausea. Worse lying down.
5. Central stabbing chest pain; also may be burning, aching or dull, heavy
sensation. Rapid breathing. Tachycardia. Pain is often not severe although the
onset is sudden. May be worsened by breathing deeply, coughing, eating, or
bending.
5. Read this article about the four techniques used during a patient examination
and complete the gaps.
Regardless of which part of the body you are examining, you will use four
techniques. These must be used in sequence unless you are carrying out an
abdominal assessment.
a) __________ involves using a stethoscope to listen for different breath, heart and
bowel sounds. Hold the bell of the stethoscope lightly against the patient’s skin to
15
listen for low-pitched sounds. Close your eyes to focus while you are carrying out
the technique.
b) ___________ entails touching the patient with different parts of the hand, using
varying degrees of pressure. This technique requires you to have short fingernails
and warm hands. Use a light form of this technique to assess surface abnormalities
in texture, tenderness, temperature, moisture, pulsations and masses.
c) ____________ can be done via smell and hearing as well as vision, in order to
observe both normal conditions in a patient and deviations from the norm. If it is
done correctly, it can reveal more than any other of the four techniques. Observe
the patient for the following pointers: color, size, location, movement, texture,
symmetry, as well as sounds and odors.
d) _____________ requires tapping the fingers or hands quickly and sharply against
parts of the patient’s body. The technique is usually used on the chest or abdomen
to locate organ borders, to identify shape and position of an organ or determine its
consistency. Listen to the sounds produced: observe their loudness, pitch and
duration.
 Research the symptoms of one of these illnesses and give a short presentation
describing them to the class.
 AIDS
 tuberculosis
 malaria
 gangrene
 rabies
 leprosy
6. Work in groups. Present summaries of the following cases using medical
language.
Case 1.
Name: Charmine Plantz
Age: 31
Occupation: Sales Manager
Chief Complaint: Lump on front of neck for one month
Other symptoms: Palpitations. Heat intolerance. Nervousness. Insomnia.
Breathlessness. Increased bowel movements. Light menstrual periods.
Physical examination: Enlarged thyroid, Tachycardia. Slight hypertension. Warm,
moist, smooth skin. Exophthalmos. Tremor. Weight loss. Muscle weakness. Hair
loss.
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Case 2.
Name: Selina Burton
Age: 37
Occupation: Typist
Chief Complaint: Tingling of first three fingers and thumb that gets worse at
night
Other symptoms: Weakness of fingers (has difficulty-buttoning clothes).
Sometimes pain in forearm.
Physical examination: Muscle wasting at base of thumb. Unable to distinguish
hot from cold.
Case 3.
Name: Bob Smithson
Age: 50
Occupation: Construction worker
Chief Complaint: Attacks of dizziness with nausea and vomiting. During attack,
high pulse rate and rapid breathing. No pattern to attacks.
Other symptoms: Hissing or ringing in ears (on both sides), loss of hearing.
Physical examination: Vital signs normal. Nystagmus. Positive Romberg test.
Case 4.
Name: Chuck Talavera
Age: 38
Occupation: Farmer
Chief Complaint: Low subjective fever, cough with bad tasting phlegm, night
sweats, and weight loss getting worse over the last four months
Social History: Long-term smoker
Physical examination: Temperature of 38°C, gingival disease and dullness to
percussion; absent breath sounds in lower right lobe of lung. Clubbing of fingers.
EXAMPLES OF THE EXAM TASKS
Сase presentation 1
General practitioner performs a physical examination of the patient. In the course
of examination, it is necessary to measure the palpable regular expansion of a
superficial artery caused by the ejection of blood into the vessels through heart
contraction. What sign does the doctor measure?
A. Saturation
B. Heart electricity
C. Blood pressure
17
D. Pulse
E. Heartbeat
Case presentation 2
A 23-year-old woman was brought into the emergency department complaining of
bloody diarrhea, tiredness and dizziness. A few days ago, she went to a fast food
restaurant for a birthday party. Her friends are experiencing similar symptoms.
Laboratory studies show anemia. What samples should be obtained for
microbiologic testing in this case?
A. Urine
B. Bile
C. Cerebrospinal fluid
D. Blood
E. Stool
Case presentation 3
A 27-year-old female presents with a severe sore throat, hoarseness, painful
swallowing and low-grade fever. On intraoral examination, a large gray membrane
is noticed on the oropharynx. Removal of the membrane reveals a bleeding
edematous mucosa. Which of the following is the most likely diagnosis?
A. Streptococcal pharyngitis
B. Diphtheria
C. Meningococcal disease
D. Scarlet fever
E. Measles
Case presentation 4
A 25-year-old male presents to an emergency department with sudden-onset rightsided pleuritic chest pain and breathlessness. On examination, he has arterial blood
saturation of 90% in air and is afebrile. An X-ray shows a lung edge visible in the
right hemi thorax, beyond which no lung markings are seen. Which of the following
conditions has most likely occurred in this patient?
A. Pneumonia
B. Acrophagy
C. Pleurisy
D. Pneumothorax
E. Rib fracture
Case presentation 5
Autopsy of the body of a 48-year-old man shows that the bone marrow in the flat
bones, as well as in the cylindrical bone diaphysis and epiphyses, is moist, colored
gray-red or gray-yellow, and puri-form (pyoid bone marrow). The spleen weight is
7 kg; it is dark red on section, with signs of ischemic infarctions. All the lymph nodes
are enlarged, soft, and grey-red in color. In the liver, there are signs of fatty
degeneration and leukemic infiltrates. What is the most likely diagnosis?
18
A.
B.
C.
D.
E.
Chronic myeloid leukemia
Multiple myeloma
Acute myeloid leukemia
Acute lymphoid leukemia
Lymphogranulomatosis
Case presentation 6
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 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 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. Myocardial infarction
C. Pneumonia
D. Pneumothorax
E. Lung cancer
Case presentation 7
The disease onset occurred 3 days ago. The patient complains of body temperature
up to 38°C, stomachache, and frequent loose bloody stools. Bacillary dysentery was
clinically diagnosed in the patient. What method of microbiological diagnostics
would be advisable in this case and what samples should be obtained from the patient
to confirm this diagnosis?
A. Bacteriology, feces
B. Bacterioscopy, feces
C. Bacterioscopy, blood
D. Bacteriology, urine
E. Serology, blood
Case presentation 8
A patient suffers from a condition, which is characterized by a restriction in blood
supply to tissues, which leads to inadequate oxygen delivery to cells and
contravention of cell metabolism. It is often caused by partial or total blockage of
arteries. Which of the following is developed in this patient?
A. Ischemia
B. Hypoxia
C. Inflammation
D. Spasm
E. Embolism
19
Case presentation 9
A 49-year-old man complains of pain in his metatarsophalangeal joint and joint
deformation. In blood, hyperuricemy can be observed. X- ray has revealed
metatarsophalangeal joint space narrowing, erosion, per articular calcification of the
both joints, osteoporosis. Microscopy has detected inflammatory granulomatous
reaction surrounding necrotizing masses in the area of the first metatarsophalangeal
joint. Choose the most likely diagnosis:
A. Rheumatoid arthritis
B. Hyperparathyroidism
C. Urolithiasis
D. Pyrophosphate arthropathy
E. Gout
Case presentation 10
A 10-year-old child has painful swallowing, neck edema, temperature rise up to 39.0
C; the whole body is covered with bright-red petechial rash. Back of the throat and
tonsils are hyperemic, the tongue is crimson-colored. Tonsillar surface is covered with
isolated grayish –colored necrosis nidi. What disease is it?
A. Diphtheria
B. Measles
C. Influenza
D. Scarlet fever
E. Meningococcal nasopharyngitis
20
UNIT 3
PHARMACOLOGY
REVIEW OF BASIC TERMINOLOGY
Drug Description
Drugs are chemical substances used in medicine to treat diseases that can
be obtained from various parts of plants, animals and are synthesized in
pharmaceutical laboratories. Drugs are classified by how they work, what
they treat and their chemical structure. They are classified so, in order, to be
used properly, more effectively, to get the most benefit, to prevent harmful,
unwanted side effects andto identify drug-to-drug interaction and the
potential for drug resistance. There are many drug classifications in modern
pharmacology. You are offered the most general, so drugs can be divided in
these classes:
Drug Categories
1. Analgesics – drugs that provide pain relief.
2. Anaesthetics – drugs that induce anaesthesia.
3. Antiemetics – drugs that help with nausea and vomiting
4. Antibiotics – drugs that kill bacteria
5. Anticoagulants – drugs that prevent blood clotting.
6. Antacids – drugs that neutralize acid in digestive system, lowering acidity
7. Antihistamines – drugs that treat allergic conditions.
8. Antiarrhythmics – drugs that correct abnormal heart rrythm.
9. Anticholinergic – drugs that block the action of acetylcholine.
10. Anti-Inflammatory (NSAIDS – Non-steroid Anti-Inflammatory Drugs) drugs that reduce inflammation and pain.
11. Antidotes – drugs that neutralize the effects of another drug or poison.
12. Antiviral – drugs that deal with variety of viruses.
13. Antimicrobials – drugs that prevent or treat conditions caused by bacteria,
fungi, protozoa.
14. Antidepressants – drugs that relieve the symptoms of depression.
15. Bronchodilators – drugs that relax the muscles that surround airways.
16. Laxatives – drugs that loose the stool, also increasing bowel movement.
17. Vitamins - drugs that make the body develop and function normally.
21
Routes of drug administration
Administration of drugs is a common, but important clinical procedure.
There are various routes of administration available; each one of them has
their own advantages and disadvantages.
There are such routes of administation of drugs as:
 Oral
 Nasal
 Ophthalmic
 Otic
 Sublingual
 Rectal
 Topical
 Inhalation
 Parenteral
 Intravenous
 Intramuscular
 Intrathecal
 Subcutaneous
 Transdermal
Groups of drugs prescribed to treat health problems of various body
systems:
* Antipsychotics
*Cardiac glycosides
*Diuretic
*H2-Antagonists
*Laxatives
*Statines
*Sympathomimetics
*Hormones
*Ointments
*Vasodilators
*Vasoconstrictors
*Corticosteroids
*Antidiarrheal
*Antimicrobials
22
PRACTICE
1. Complete each sentence with a type of medicine.
A painkiller, a sedative, an anti-inflammatory, an inoculation, an antibiotic, an
antihistamine, a stimulant, an antidepressant, a laxative, a supplement.
1. … kills bacteria and other microorganisms.
2. … protect you against infectious diseases.
3. … relives pain.
4. … reduces swelling.
5. … encourages bowel movement.
6. … provides a substance that the body lacks.
7. … treats allergies.
8. … increases activity in the body.
9. … reduces feelings of extreme sadness.
10.… makes you relaxed and sleepy.
2. Work in pairs. Match these pictures with the medical problems. What
groups of drugs should be prescribed for these cases? What is the way of
drugs’ administration?
1. An infection
2. A cut
3. An insect bite
23
4. Constipation
5. Obesity
6. Vitamin deficiency
7. An infectious disease
8. An allergy
9. An infection
10.A cut
11.An insect bite
12.Constipation
13.Obesity
14.Vitamin deficiency
15.An infectious disease
16.An allergy
3. Correct the following statements. Comment your answer.
1. Digital glycosides are drugs, which relax the muscles of vessel walls and can
be made synthetically.
2. Nitrites are used to prevent the formation of clots.
3. Digitoxin is also used as a vasodilator.
4. Heparin is administered only intravenously.
5. Diuretics are used to increase blood pressure.
6. People take antibiotics to stop the pain of heartburn and indigestion.
7. Antacid products irritate peptic ulcers and come in the form of injecti
8. H-2 antagonists cause many serious side effects.
24
9. Omeprazole and lansoprazole are more effective than H-2 antagonists.
10.Antibiotics aren’t usually prescribed in combination with other drugs.
3. Rewrite the sentences replacing the words in capitals with groups of drugs.
1. People suffering from hypertension are recommended to take drugs to
reduce blood pressure.
2. Everyone should control cholesterol levels by taking drugs lowering it.
3. Poisoning must be treated by taking drugs that neutralize the poison of toxin.
4. A child was prescribed some medicines that widen the airways and keep the
smooth muscles of the bronchioles relaxed.
5. As she was complaining of neuroses and couldn’t fall asleep, a physician
administered drugs that induce sleep and sedation.
6. Diarrhea can be relieved by taking drugs which alleviate loose bowel
movement.
7. Frequent intake of medicines that reduce inflammation and pain can promote
gastritis or even peptic ulcers.
4. Match names of medicines on the left with their description on the right
1. Celecoxib
1. Can be administered in case of breathing is
inhibited as an antidote (oral, parenteral).
2. Protamine
2. A calcium channel blocker that promotes
sulfate
antianginal and hypotensive action (tablets).
3. Piracetam
3. A non-steroidal used to treat some types of
arthritis (oral).
4. Proserin
4. A medicine used to reverse the effects of
heparin during surgery (intravenously).
5. Adrenalin
5. Used to treat hypothyroidism by providing
more thyroid hormone (orally, tablets).
6. Tolbutamide
6. A medicine that acts on your brain and
nervous system (tablets).
7. L-thyroxine
7. Used to treat severe allergic reactions as well
as cardiac arrest, superficial bleeding.
8. Amlodipine
8. A medication used in the treatment of severe
heart failure given intravenously.
9. Dobutamine
9. An oral antihyperglycemic agent used to treat
non-insulin-dependent diabetes mellitus.
5. Match the words with their definitions:
1. Intramuscular
a) given into the eye by drops, gel or ointment
2. Topical
b) held under the tongue
25
3.
4.
5.
6.
7.
8.
9.
Ophthalmic
Intravenous
Rectal
Otic
Intrathecal
Sublingual
Transdermal
etc
10. Oral
c) given by drops into the ear
d) applied to the skin
e) injected into the spine
f) injected into a vein or into an IV line
g) injected into muscle with a syringe
h) inserted into the rectum
i) swallowed by mouth as a tablet, lozenge,
j) given through a patch placed on the skin
EXAMPLES OF THE EXAM TASKS
Case presentation 1
Muscle relaxant Tubocurarine was administered during surgery. After the
operation the patient’s breathing wasn’t restored. What antidote should be given
to the patient to restore his breathing?
A. Clonidine
B. Bemegride
C. Propranolol
D. Proserin*
E. Atropine sulfate
Case presentation 2
A woman poisoned with unknown substance was hospitalized to the
Toxicological department. What group of drugs can be administered to disease
absorption and introduction of the poison to her body?
A. Antioxidants
B. Cholinesterase inhibitors
C. Neuroleptics
D. Adsorbents
E. Organic nitrates
Case presentation 3
A patient suffering from ischemic heart disease was prescribed some calcium
channel blockers. Name this drug:
A. Amlodipine*
B. Altiopril
C. Nitroglycerin
D. Carvedilol
E. Thiotriazolin
26
Case presentation 4
A 46-year- old patient suffering from ulcer disease of the stomach is diagnosed
with rheumatoid arthritis. What anti-inflammatory drug would be the most
advisable in this case?
A. Celecoxib
B. Prednisolone
C. Analgin
D. Promedol
E. Paracetamol
Case presentation 5
A patient with acute myocardial infarction has been administered heparin as a
part of complex therapy. Sometime after heparin was injected the patient
developed hematuria. What heparin antagonist should be injected to remove the
complication?
A. Fibrinogen
B. Aminocaproic acid
C. Neodicumarin
D. Protamine sulfate*
E. Vicasol
Case presentation 6
An alcoholic has alcoholic psychosis with evident psychomotor agitation. What
neuroleptic drug should be administered for emergency aid?
A. Diazepam
B. Reserpine
C. Halothane
D. Aminazine*
E. Sodium bromide
Case presentation 7
Prolonged treatment of hypothyroidism has caused general dystrophy, dental
caries, tachycardia, tremor of extremities. What drug is the cause of these side
effects?
A. L-thyroxin*
B. Parathyreoidinum
C. Prednisolone
D. Thyrocalcitonin
E. Humulin (Human insulin)
Case presentation 8
A man complaining of memory deterioration, reduced mental capabilities, sleep
disorders, and vertigo was brought to the neurologic department. The patient
27
explains these symptoms as consequences of the brain concussion received in a
traffic accident 2 year ago. Choose the drug, which can improve the patient’s
brain metabolism and would be the most advisable in this case:
A. Piracetam*
B. Sydnocarb (Mesocarb)
C. Sodium oxibutirate
D. Cordiamin (Nikethamide)
E. Caffeine
Case presentation 9
A 46-year-old man presents with fatigue and joint pain in his lingers and wrists
for the last 2 months. The pain is present in both hands and the wrists are swollen.
Furthermore, he described morning stiffness in his joints lasting about 2 hours,
which improves with use. His past medical history reveals he was successfully
treated for H. pylori related ulcers last year. He denies smoking and stopped
drinking when his gastric symptoms started. Which of the following drugs is the
best choice for his joint’s pain management?
A. Prednistone
B. Celecoxib*
C. Paracetamol
D. Aspirin
E. Morphine
Case presentation 10
In the morning, a man diagnosed with diabetes mellitus, received a prescribed
dose of long-action insulin on an empty stomach. He missed his regular meal and
soon after that, he developed weakness, headache, and vertigo, body tremors,
convulsions, feeling of hunger, and signs of hypoglycemia. Glucose
administration did not improve the patient’s condition. What medicine should be
administrated to provide quick relief to the patient?
A. Adrenaline*
B. Triamcinolone
C. Noradrenaline
D. Prednisolone
E. Hydrocortisone
28
UNIT 4
________RESPIRATORY SYSTEM
REVIEW OF BASIC TERMINOLOGY
A
Basic terms
The components of the respiratory system
The respiratory system is made up of air passages, pulmonary vessels,
the lungs and breathing muscles.
The upper respiratory tract includes the nose and nasal cavities, pharynx,
and larynx. The air enters the nasal cavity through the nostrils or external nares.
The cilia (hair-like projections) help get rid of the trapped airborne particles
through sneezing. The pharynx (the throat) opens into the larynx and is divided
into the nasopharynx, the oropharynx, and the laryngopharynx. The larynx
(the voicebox or glottis) is the air passage between the pharynx and the trachea.
The lower respiratory tract is composed of the trachea, bronchi,
bronchial tree, and the lungs. The trachea (the windpipe) is the main airway
into the lungs. It splits into the right and left bronchi. The primary bronchi branch
into smaller passageways until they terminate in tiny air sacs called alveoli. The
smallest branch of the tracheobronchial tree is the bronchioles and terminal
bronchioles. The lungs are paired organs that are soft and spongy. Each lung is
covered by a serous membrane, called the pleura. The space between the visceral
and parietal pleura is the pleural cavity. It contains serous fluid that acts as
lubricant to reduce friction, and it helps to hold the two layers of pleura together
as the lungs inflate and deflate.
The base of the lung is found near the diaphragm (the midriff) that is the
main muscle of respiration.
Medical terms related to respiration:
quiet breathing
diaphragmatic breathing
costal breathing
forced breathing
internal respiration
external respiration
cellular respiration
aerobic respiration
29
anaerobic respiration
inhalation (inspiration, breathing in)
exhalation (expiration, breathing out)
gas exchange
ventilation
diffusion
B
Specific symptoms and signs of the respiratory diseases
thoracalgia (chest pain)
cough
(persistent,
“barking”,
troubled, spasmodic)
sneezing
sore throat
coryza (runny nose)
sputum
production
(purulent
sputum, streaked with blood,
transparent sputum)
mucus plugs (thick and sticky)
expectoration (bringing up and
spitting out phlegm, sputum or
mucus)
hemoptysis (coughing up and
spitting out blood)
wheezing (a high-pitched whistling
sound)
rales (fine crackles)
rhonchi (a low-pitched sound that
resembles snoring)
C
perfusion
conducting zone
respiratory zone
respiratory cycle
respiratory rate
respiratory compliance
stridor (a high-pitched loud sound
that sounds like a bark)
dysphonia (hoarse voice)
egophony (a sound that resembles
the bleating of a goat)
fremitus (palpable vibration of the
walls of the chest)
dysphagia (difficult swallowing)
orthopnea (difficult breathing when
lying down)
tachypnea (rapid breathing)
dyspnea
(difficulty
breathing,
shortness of breath)
hypopnea (shallow breathing)
hyperpnea (deep breathing)
apnea (absence of breathing)
expanded chest
cyanosis (bluish discoloration)
finger
clubbing
(bulbous
enlargement of the fingertip
Diagnostic studies
Physical examination:
inspection
palpation (feeling with the hands)
percussion
auscultation (listening with a stethoscope)
Laboratory methods:
a) microbiological tests
complete blood count
30
blood chemistry study
sputum examination
Disease
Pulmonary embolism
Inherited emphysema
Cystic fibrosis
Lung cancer
Pneumonia
(Latent) tuberculosis infection
Sarcoidosis
Asthma
Eosinophilic disease
Connective tissue disorders
Pleural effusion
Test
D-dimer
a1-antitrypsin
Specific genetic tests
Tumour marker
Procalcitonin
Tuberculin skin test
Angiotensin-converting enzyme
Total and specific immunoglobulin E,
skin testing with allergens
Eosinophils
Immunological
tests
such
as
rheumatoid factor
Total
protein,
LDH
(lactate
dehydrogenase), glucose, cholesterol
and others in pleural fluid
b) histological and cytological examination
Respiratory function tests:
spirometry
lung capacity
diffusing capacity
blood gas analysis
cardiopulmonary exercise testing
Imaging techniques:
chest X-ray
high resolution computed tomography
pulmonary and bronchial angiography
magnetic resonance imaging
fluoroscopy
utrasonography
Invasive biopsy techniques:
bronchoscopy
percutaneous needle biopsy
thoracentesis and pleuroscopy
surgical methods
31
D
Laboratory and instrumental findings
abnormal breathing patterns (apnea, orthopnea, dyspnea, hyperpnea,
tachypnea, hyperventilation, hypoventilation)
chest wall deformities (sunken chest, pigeon chest)
oedema (swelling)
lymphadenopathy (enlarged lymph nodes)
points of tenderness (sensitivity to pain)
pleural effusion (dullness)
pneumothorax (hyperresonance)
abnormal breathing sounds (wheezes, crackles, pleural friction rub)
PRACTICE
1. Agree or disagree with the following statements. Comment on your
answer.
1. The larynx is the air passage between the oropharynx and the trachea.
2. The sound production includes the windpipe that vibrates as the expelled
air passes through it.
3. The respiratory system filters, warms, and humidifies the expired air.
4. The right lung has a greater volume than the left lung.
5. The primary bronchi branch into the largest passageways until they
terminate in tiny air sacs called alveoli.
6. The nose is made up of soft tissue and is located in the lower face area.
7. The lungs are soft and spongy organs.
8. The term “breathing” is the same as “ventilation”.
2. Match the definitions with the phrases in the box.
quiet breathing diaphragmatic breathing costal breathing forced
breathing
aerobic respiration anaerobic respiration
1. a shallow breath ___________________
2. taking place in the presence of oxygen to produce energy
_________________
3. hyperpnea, a mode of breathing that occurs during exercise
________________
4. eupnea, a mode of breathing that occurs at rest ____________________
32
5. taking place in the absence of
__________________
6. deep breathing ___________________
oxygen
to
produce
energy
2. Match words in column A to words in column B to make phrases. Then
match the phrases to the terms 1-10.
A
thick and sticky
spitting out
shortness of
difficult
bulbous enlargement of
runny
bluish
hoarse
fine
a high-pitched
B
nose
swallowing
discoloration
expectoration
voice
whistling sound
crackles
fingertips
blood
breath
1. finger clubbing ___________________
2. dyspnea _________________________
3. dysphonia _______________________
4. dysphagia _______________________
5. cyanosis _________________________
6. hemoptysis _______________________
7. rales ___________________________
8. wheezing _______________________
9. coryza __________________________
10.mucus plugs _____________________
3. Complete a case history with the words/phrases in the box. Explain
these concepts.
sick contacts sputum specimens pleuritic chest pain
chest computed tomography scan
hemoptysis sweats
a cavitary lesion DNA probe method first-line therapy
duration laboratory abnormalities
A 40-year-old male presented to the emergency department complaining
of ______________of 8 days’___________. This was associated with mild
right-sided _________________and night ___________. The patient didn’t
33
have any shortness of breath, fever, or weight loss. The patient did not report
any history of _____________. On admission, the patient had a normal
physical examination and no significant _________________. A
_________________ showed ______________with an air-crescent sign in
the apical segment of his right lower lobe, suggestive of fungal infection.
Acid fast bacillus and fungal cultures were performed on three consecutive
early morning _________________after admission; all were positive for acid
fast bacteria but were negative for fungi. M. tuberculosis infection was
confirmed by the________________. The patient was discharged on
________________with isoniazid, rifampin, pyrazinamide, and ethambutol
with pyridoxine.
4. a) Read a case report.
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. Some time later,
she dies of severe respiratory distress. A pulmonary autopsy 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.
b) Find phrases in the text that mean the following.





Respiratory failure
Elevated temperature
Sputum
Coexisting manifestations
Sample
 Obstruction of blood flow due
to a blood clot
 Dyspnea
 Thoracalgia
 Division
c) Present this case report to your partner in the group. Answer your
partner’s questions about the case.
5. Work in different pairs. What are the causes of the conditions below?
Discuss their management (assessment of patients, summary of
investigations, choice of treatment).
 Tuberculosis
 Bronchitis
 Emphysema
 Pneumonia
 Asthma
 Lung cancer
34
EXAMPLES OF THE EXAM TASKS
Case presentation 1
A 6-year-old boy is brought to the pediatrician by his mother, who complains of
low-grade fever, chronic cough and night sweats in her child. She describes the
cough as productive, producing white sputum that is sometimes streaked with
blood. She also says that her son has lost some weight in the last month. His vital
signs include blood pressure of 115/75 mm Hg, heart rate of 110/min., respiratory
rate of 18/min. and temperature of 36.6o C . On physical examination, the patient
is ill looking. Pulmonary auscultation reveals some fine crackles in the right upper
lobe. The pediatrician suspects an active infection and performs Mantoux test.
Intradermal injection of which of the following substances has been most likely
used by pediatrician for screening test in this clinical case?
A.Tuberculin
B.Bacillus Calmette-Guerin (BCG) vaccine
C. Diphtheria-tetanus toxoids -acellular pertussis vaccine (DTaP)
D.Tetanus and diphtheria toxoids vaccine (Td)
E.Case presentation 2
A 6-year-old child with suspected active tuberculous process has undergone
diagnostic Mantoux test. What immunobiological preparation was injected?
A. Tuberculin
B. BCG vaccine
C. DTP vaccine
D. Tularinum
E. Td vaccine
Case presentation 3
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
35
Case presentation 4
A 5-year-old child has been diagnosed with acute right distal pneumonia. Sputum
inoculation revealed that the causative agent is resistant to penicillin and senstive
to macrolides. What drug should be prescribed?
A. Azithromycin
B. Tetracycline
C. Gentamycin
D. Streptomycin
E. Ampicillin
Case presentation 5
Autopsy of a man who had 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
Case presentation 6
Analysis of sputum taken from a patient with suspected pneumonia revealed
slightly elongated grampositive diplococci with pointed opposite ends. What
microorganisms were revealed in the sputum?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Klebsiella pneumoniae
D. Neisseria meningitidis
E. Neisseria gonorrhoeae
Case presentation 7
A child is 10 years old. The following presentations have developed: sharp pain
during swallowing, swollen neck, body temperature rise up to 39, 0o C , brightred finely papular rash all over the body. Pharynx and tonsils are sharply
hyperemic ("flaming pharynx"), "crimson tongue". On the tonsils surface there
are isolated greyish necrosis focuses. What disease it might be?
A. Scarlet fever
B. Meningococcal nasopharyngitis
C. Diphtheria
D. Influenza
E. Measles
36
Case presentation 8
When studying the signs of pulmonary ventilation, reduction of forced expiratory
volume has been detected. What is the likely cause of this phenomenon?
A. Obstructive pulmonary disease
B. Increase of respiratory volume
C. Increase of inspiratory reserve volume
D. Increase of pulmonary residual volume
E. Increase of functional residual lung capacity
Case presentation 9
An HIV-positive patient’s cause of death is acute pulmonary insufficiency
resulting from pneumonia. Pathohistological investigation of lungs has revealed
interstitial pneumonia, alveolocyte desquamation and methamorphoses:
alveolocyte enlargement, large intranuclear inclusions surrounded by lightlycoloured areas. Transformed cells resemble owl’s eye. Name the causative agent
of pneumonia:
A. Cytomegalovirus
B. Pneumococcus
C. Influenza virus
D. Candida fungi
E. Toxoplasma
Case presentation 10
A 28-year-old patient undergoing treatment in a pulmonological department has
been diagnosed with pulmonary emphysema caused by splitting of alveolar
septum by tissular tripsin. The disease is caused by the congenital deficiency of
the following protein:
A. α1 -proteinase inhibitor
B. α2 -macroglobulin
C. Cryoglobulin
D. Haptoglobin
E. Transferrin
Case presentation 11
A 30-year-old man has sustained an injury to his thorax in a traffic incident, which
caused disruption of his external respiration. What type of ventilatory difficulty
can be observed in the given case?
A. Restrictive extrapulmonary ventilatory impairment
B. Restrictive pulmonary ventilatory impai- rment
C. Obstructive ventilatory impairment
D. Impaired ventilation regulation dysfuncti- on
E. Cardiovascular collapse
37
UNIT 5
____CARDIOVASCULAR SYSTEM
REVIEW OF BASIC TERMINOLOGY
A
Basic terms
The components of the cardiovascular system
The cardiovascular system consists of the heart, blood, and blood vessels.
There are five general classes of blood vessels in the cardiovascular system:
arteries, arterioles, capillaries, venules, and veins.
The human heart is a hollow and cone-shaped muscular organ. The walls
of the heart are composed of three layers: the outer epicardium, middle
myocardium, and inner endocardium. The heart is enclosed in a tough fibrous sac
known as the pericardium.
The heart is divided into four chambers: two atria and two ventricles.
Between each atrium and ventricle, there are valves that allow blood to flow in
one direction and prevent backflow. The atrioventricular valves include the mitral
(bicuspid) valve on the left and the tricuspid valve on the right. The pulmonary
and aortic valves are known as semilunar valves.
There are two types of blood circulation: systemic and pulmonary.
Medical terms related to the work of the heart:
blood circulation
cardiac conduction system
cardiac cycle
cardiac output
systole
diastole
stroke volume
vasoconstriction
vasodilation
heartbeat
B
Specific symptoms and signs of the cardiovascular diseases
unequal pulses (heartbeats varying
hypertension (high blood pressure)
in force)
hypotension (low blood pressure)
tachycardia (fast resting heart rate)
38
palpitation
heartbeat)
arrhythmia
heartbeat)
(rapid
or
irregular
(abnormal/irregular
heart murmur (whooshing or
swishing heart sound)
atrial fibrillation (erratic twitching
of the heart)
cholesterol plaques (fatty deposits)
impaired
blood
coagulation
(abnormal blood clotting)
congestion (blockage)
Chest pain description:
 burning
 cramping
 crushing
 blinding
 gripping
 pounding
C
angina (chest pain)
hypoesthesia (numbness in the face
and limbs)
paresthesia
(tingling/prickling/
burning sensation in the face and
limbs)
globus
sensation
(choking
sensation)
edema (swelling)
presyncope (lightheadedness)
diaphoresis (abnormal sweating)
visual disturbances:
diplopia (double vision) and blurred
vision






shooting
stabbing
tingling
throbbing
oppressive
squeezing
Diagnostic studies
Physical examination:
assessment of the general appearance
body mass index (BMI) measurement
checking pulse and radiofemoral delay
respiratory rate assessment
blood pressure measurement
tilt test (blood pressure and heart rate monitoring
when the patient is lying down and standing up)
chest and abdominal palpation (feeling with the hands)
cardiac auscultation (listening with a stethoscope)
cardiac percussion
Laboratory methods:
urinalysis for protein and blood
serum creatinine, potassium and uric acid measurement
full blood count
39
fasting blood sugar
troponin blood test
cholesterol level and lipid profile tests
liver function tests
Imaging techniques:
echocardiogram (ECG)
exercise tolerance test (ETT)
electrocardiogram (EKG)
doppler sonography (ultrasound)
myocardial perfusion scan (scintigraphy)
chest X-ray
magnetic resonance imaging (MRI)
cardiac computed tomography (Cardiac CT)
Invasive biopsy techniques:
left and right heart catheterization
coronary angiography
left ventricular and/or right ventricular angiography
endomyocardial biopsy
pericardiocentesis
percutaneous pericardioscopy
epicardial or pericardial biopsy
D
Laboratory and instrumental findings
ejection sounds (clicks)
pericardial friction rub
ventricular gallop
atrial gallop
heart murmurs
decreased cardiac output
distention, bulging or protrusion of
jugular vein
enlarged heart
vascular congestion
pulse inequality
pulse deficit
weak pulses
bounding and firm pulse
pulsations
bradycardia
irregular rhythms
loss of blood vessel elasticity
narrowed blood vessels
40
PRACTICE
6. Agree or disagree with the following statements. Comment on your
answer.
1. The only function of the cardiovascular system is to transport nutrients
and gases.
2. There are two general classes of blood vessels in the cardiovascular
system.
3. The smallest blood vessels are arterioles and venules.
4. The heart is divided into two chambers.
5. The atrioventricular valves include the mitral (bicuspid) valve on the
left and the tricuspid valve on the right.
6. The superior vena cava carries blood from the lower trunk and legs.
7. Four pulmonary arteries supply the left atrium with oxygen-rich blood
that is transported from the lungs.
8. Blood is directed through the aortic valve into the largest artery in the
body, known as the aorta.
7. Complete the sentences with the words and word-combinations in the box.
deoxygenated blood
finer arterioles
reservoirs for blood
diffusion of blood
midline of the thoracic cavity
waste rich blood
mitral valve
backflow
1. Between each atrium and ventricle, there are valves that allow blood to
flow in one direction and prevent ___________.
2. Arteries subdivide into thinner vessels that branch into ____________.
3. The human heart is a muscular organ situated to the left of the _______.
4. Capillary walls allow the _____with high level of oxygen and nutrients.
5. ____________ flows into the right atrium from the veins known as the
superior vena cava and inferior vena cava (the largest veins in the body),
and the coronary sinus.
6. Veins also serve as __________in certain conditions, such as during
arterial haemorrhage.
7. Blood passes from the left atrium into the left ventricle through the
___________.
8. Then carbon dioxide and ________ drains into the veins through the
venules and returns to the right atrium of the heart through the vena
cava.
41
8. Match words in column A to words in column B to make phrases. Then
match the phrases to the terms 1-10.
A
swishing
fast resting
abnormal blood
heartbeats
tingling
double
erratic
fatty
abnormal
choking
B
varying in force
twitching of the heart
deposits
vision
sweating
heart rate
sensation
sensation in the face and limbs
heart sound
clotting
11.tachycardia __________________________
12.unequal pulses ________________________
13.heart murmur ________________________
14.cholesterol plaques _____________________
15.impaired blood coagulation ______________
16.atrial fibrillation _______________________
17.paresthesia ___________________________
18.globus sensation _______________________
19.diplopia ______________________________
20.diaphoresis ___________________________
9. Complete a case history with the words/phrases in the box. Explain
these concepts.
tachypneic murmur palpitation a diabetic edema syncope
heart disease palpable diaphoretic nocturnal breathlessness
hypertensive
A 48-year-old man presented to the emergency room with recent worsening
of breathlessness. His dyspnea was worse at night. His _______________woke
him up frequently. For the past 5 months he had experienced increasing fatigue
on walking and climbing stairs. He was not ___________or ______________and
denied any chest pain, ______________or _______________. He did not smoke
but took 5-6 pegs of alcohol on most days of the week, for the last 30 years. None
of his family members had history of _________________.
42
On examination, he was _____________and ______________. Pulse was
rapid and feeble with a changing volume in alternate beats and the extremities
were cold. His heart rate was 120 beats/min with a BP of 106/74 mm Hg. The
JVP was clearly elevated and there was also ____________over his ankles. The
liver edge was _____________6 cm below the right costal margin. There was a
soft pansystolic ______________over the mitral area with an audible gallop
sound in early diastole.
10.
a) Read a case report.
A 58-year-old man presented to the cardiology facility with fatigue,
difficulty in breathing and increasing swelling over his ankles. He had noticed
an increase in his abdominal girth and had loss of appetite, but there was no
weight loss. There was no history of fever, productive cough, chest pain or
hemoptysis. He also denied palpitations or episodes of syncope. The patient
was not hypertensive or diabetic.
On examination, he was tachypneic. The pulse was 90 beats/min with a
BP of 114/72 mm Hg. There was no cyanosis or jaundice but pitting edema
was present around the ankles. There was no murmur or pericardial friction
rub.
d) Find phrases in the text that mean the following.
 Angina
 Exhibiting abnormally rapid
breathing
 Dyspnea
 A swollen tissue remains
indented after being pressed




Lightheadedness
Rapid or irregular heartbeat
Extreme tiredness
Having
increased
blood
pressure
 Swishing heart sound
e) Present this case report to your partner in the group. Answer your
partner’s questions about the case.
11.
Work in different pairs. What are the causes of the conditions
below? Discuss their management (assessment of patients, summary
of investigations, choice of treatment).




Chronic stable angina
Hypertension
Atherosclerosis
Acute
coronary
syndromes
 Myocardial infarction




Arrhythmias
Cardiomyopathies
Pericarditis
Acute
mitral
regurgitation
 Congenital heart disease
43
 Heart failur
EXAMPLES OF THE EXAM TASKS
Case presentation 1
A patient with ciliary arrhythmia was prescribed digoxin. What mechanism of
action of this medicine results in its anti-arrhythmic effect?
A. Inhibition of Na, K-ATPase
B. Increased potassium concentration in the cardiomyocytes
C. Decreased sympathetic influences
D. Decreased permeability of the cell membrane to calcium
E. Decreased permeability of the cell membrane to sodium
Case presentation 2
A 27-year-old woman suffering from rheumatic heart disease since her childhood
has developed cardiac decompensation and died. Autopsy shows mitral stenosis;
mitral valve cusps are sharply thickened, sclerotic, and fused together along the
closure line. Specify the type of endocarditis in this case:
A. Fibroplastic endocarditis
B. Diffuse endocarditis
C. Recurrent verrucous endocarditis
D. Acute verrucous endocarditis
E. Ulcero-polypoid endocarditis
Case presentation 3
A microspecimen of heart shows rectangular cells from 50 to 120 micrometers
large with central position of nucleus and developed myofibrils. The cells are
connected by intercalated discs. These cells are responsible for the following
function:
A. Function of heart contractions
B. Function of impulse conduction
C. Endocrine
D. Protective
E. Regeneratory
Case presentation 4
Increased HDL levels decrease the risk of atherosclerosis. What is the mechanism
of HDL anti-atherogenic action?
A. They remove cholesterol from tissues
B. They supply tissues with cholesterol
C. They are involved in the breakdown of cholesterol
44
D. They activate the conversion of cholesterol to bile acids
E. They promote absorption of cholesterol in the intestine
Case presentation 5
A 43-year-old-patient has arterial hypertension caused by increase in cardiac
output and general peripheral resistance. Specify the variant of hemodynamic
development of arterial hypertension in the given case:
A. Eukinetic
B. Hyperkinetic
C. Hypokinetic
D. Combined
E. Case presentation 6
Angiocardiography of a 60-year-old man revealed constriction of the vessel
located in the left coronary sulcus of his heart. Name this pathological vessel:
A. Ramus circumflexus
B. Ramus interventricularis posterior
C. A. coronaria dextra
D. V. cordis parva
E. Ramus interventricularis anterior
Case presentation 7
A patient with acute myocardial infarction has been administered heparin as a
part of complex therapy. Some time after heparin injection the patient developed
hematuria. What heparin antagonist should be injected to remove the
complication?
A. Protamine sulfate
B. Vicasol
C. Aminocaproic acid
D. Neodicumarin
E. Fibrinogen
Case presentation 8
When treating a patient with chronic cardiac failure a doctor detected bradycardia
and deterioration of the patient’s general state. Such condition is caused by
cumulative effect of a drug. Which drug of those listed below has cumulative
action?
A. Digoxin
B. Diphenhydramine (Dimedrol)
C. Hydrochlorothiazide
D. Isosorbide
E. Retinol acetate
45
Case presentation 9
In an elderly person the change in heart force and vessels physical properties
were detected; they can be clearly observed on graphic recording of carotid
pulse waves. What method was applied?
A. Sphygmography
B. Plethysmography
C. Rheography
D. Myography
E. Phlebography
Case presentation 10
A patient has developed paroxysmal ventricular tachycardia against the
background of cardiac infarction. What anti-arrhythmic drug should be chosen to
avoid lowering cardiac output?
A. Lidocaine hydrochloride
B. Procainamide
C. Verapamil
D. Propranolol
E. Potassium chloride
Case presentation 11
Cholesterol content in blood serum of a 12-year-old boy is 25 mmol/l. Anamnesis
states hereditary familial hypercholesterolemia caused by synthesis disruption of
receptor related proteins for:
A. Low-density lipoproteins
B. High-density lipoproteins
C. Chylomicrons
D. Very low-density lipoproteins
E. Middle-density lipoproteins
Case presentation 12
A 27-year-old patient with injury to the neck has lost approximately 30% of the
blood volume. The patient’s condition is severe: blood pressure is 60/40 mm Hg,
heart rate is 140/min., respiratory rate is 30/min., conscious. Characterize the
condition of the patient’s circulatory system:
A. Hypovolemic shock
B. Cardiogenic shock
C. Collapse
D. Coma
E. Arterial hypertension
46
UNIT 6
DIGESTIVE SYSTEM
Review of basic terminology
Basic terms
1. In peritonitis patient’s peritoneum is usually plethoric or hypovolemic and has
yellow-green deposit or film which looks like a membrane.
2. After the surgery on the intestine the patient developed a complication: his walls
of operated intestine adhered together to form commissure.
3. The lesser peritoneal sac (which is also known as omental bursa) is the potential
space that exists within the abdomen between the stomach and the pancreas
4. The foramen of Winslow or omental foramen provides its only communication
with the greater omental sac or peritoneal cavity.
5. Agranular endoplasmic reticulum the smooth endoplasmic reticulum is
concerned with the manufacture of lipid molecules.
6. Hydrolysis involving organic compounds may be illustrated by the reaction of
water with an ester of a carboxylic acid
7. Trypsin can be used as protease. Chymotrypsin facilitates the cleavage of peptide
bonds by a hydrolysis reaction which occurs extremely slowly in the absence of
a catalyst.
8. Patients with hepatitis usually have yellow sclerae or whites of the eyes.
Specific symptoms and signs of diseases of digestive system
1.
2.
3.
4.
5.
Loose stool = diarrhoea
Yellow whites of the eyes = icteric sclerae
Jaundice = icterus
Enlarged liver = hepatomegaly
Discoloured faeces = faecal hypocholia
Diagnostic studies
1. Bacteriology analysis is the method used to identify the number of bacteria
2. Serology analysis is the laboratory procedure carried out on a sample
of blood serum for the purpose of detecting antibodies or antibodylike substances that appear specifically in association with certain diseases.
3. Bacterioscopy is the method of identifying bacteria with the help of microscope
47
4. Autopsy is the surgical procedure of examining dead body to identify the cause
of death
5. Histological microslide is the tissue put on the glass for examination
6. Solid-phase enzyme-linked immunosorbent assay is the method that describes
the detection and quantitation of antibodies IgG and IgM in blood serumen.
Laboratory and instrumental findings
Prefix Hypo– = decrease, low level
Prefix Hyper– = increase, high level
Suffix –emia = a substance that is contained in the blood
Example: Hypo+protein+emia = low level of protein in the blood
Example: Hyper+bilirubin+emia = high level of bilirubin in the blood
Haema (blood) + glutination (joining together) = Haemagglutination (the reaction
when erythrocytes are stuck together)
Suffix –uria = a substance that is contained in the urine
Example: Urobilinuria (the presence of urobilin in the urine)
Bilirubinuria (the presence of bilirubin in the urine)
Fibrin (connective tissue)+purulent(containing pus)=fibrinopurulent (containing
fibrin and pus)
Suffix –itis = inflammation
Peritoneum (abdominal membrane) + itis (inflammation) =
= peritonitis (inflammation of abdominal membrane)
Entero (intestine) + –ase (forming a name of an enzyme) = enterokinase (an enzyme
of the duodenum that activates trypsinogen into trypsin)
Immuno (antibodies) + electrophoresis (directed transition of charged particles)= =
immunoelectrophoresis (electrophoretic separation of antibodies followed by
identification
by
the
formation
of
precipitates
through
specific immunologic reactions)
48
Immuno(antigen, antibodies)+fluorescence (refers to the invisible wavelengths of
light that become "visible" when exposed to ultraviolet radiation) =
immunofluorescence (the labeling of antibodies or antigens with fluorescent dyes
especially for the purpose of demonstrating the presence of a particular antigen or
antibody in a tissue
PRACTICE
1. Match the words from the left column with words from the right column to
have word combinations. Compose sentences with these word combinations
1. Omental
2. Foramen of
3. Agranular endoplastic
4. Loose
5. Icteric
6. Enlarged
7. Faecal
8. Serology
9. Histological
10.Plethoric
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
reticulum
stool
bursa
sclerae
hypocholia
Winslow
microslide
peritoneum
liver
analysis
2.Match the term with its explanation
1. Hydrolysis
a. the method of identifying
bacteria with the help of
microscope
2. Trypsin
3. Diarrhoea
b. enlarged liver
c. discoloured faeces
4. Icterus
d. involving
organic compounds may be
illustrated by the reaction of
water
with
an ester of
a carboxylic acid
49
5. Hepatomegaly
e. is the surgical procedure of
examining dead body to
identify the cause of death
6. Faecal hypocholia
f. inflammation of abdominal
wall
g. is an enzyme secreted by
pancreas and acts on the
proteins
h. liquid stool
i. jaundice
j. an enzyme of the duodenum
that activates trypsinogen into
trypsin
7. Autopsy
8. Enterokinase
9. Bacterioscopy
10.Peritonitis
3.Fill in the gaps in the sentences
Plethoric, icteric, body temperature, protein hydrolysis, bloody diarrhea,
omental foramen, bacteriology of faeces.
1. A 23-year-old woman presents to the emergency department complaining of,
___________________ fatigue and confusion.
2. ___________________would be advisable to take from the patient to confirm
bacillary dysentery?
3. On autopsy the peritoneal layers are_______________, dull, and covered
with massive yellow-green membranous deposits.
4. Activity of chymotrypsin and trypsin depends on the presence or absence of
enterokinase
5. Objectively, patient’s skin and sclerae are _______________, he has elevated
body temperature, enlarged liver, dark urine, fecal hypocholia.
6. The patient complains of _______________ up to 38°C, stomachache, and
frequent loose bloody stools.
7. During an invasive operation the surgeon needs to access the omental bursa
of the peritoneal cavity via the __________________ (foramen of Winslow).
8. ___________________occurs in the duodenum under the action of
enterokinase.
50
4.Match the parts of the sentences
1. To test donor blood for
hepatitis B antigens,
2. Autopsy is the surgical
procedure of examining
dead body
a. identify the number of bacteria
3. Bacteriology analysis is the
method used to
c. it is necessary to use solid-phase
enzyme-linked immunosorbent
assay
d. to identify the cause of death
4. Serology analysis is the
method of diagnostics
5. Histological microslide is
the tissue put on the glass
6. Bacterioscopy is the method
of
7. Disturbed activity of trypsin
and chymotrypsin leads to
8. On physical examination
patients
with
hepatitis
usually have
b. disturbed protein breakup in the
small intestine.
e. used
to detect antibodies or antibodylike substances.
f. yellow sclerae or whites of the
eyes.
g. identifying bacteria with the help
of microscope
h. for examination
1. Agree or disagree with the statements. Prove your idea.
1. In order to prove the diagnosis of dysentery one should perform
bacteriological test of faeces.
2. Thick yellow-green fluid from the patient’s cavity evidences serous
inflammation.
3. Enterokinase deficiency can stimulate the activity of trypsin.
4. The wall of the stomach consists of 4 layers: mucosal, submucosal, muscular,
and serous.
5. In peritonitis patient’s peritoneum is usually without morphological changes.
6. Antibiotics are usually prescribed after surgery on the intestine to avoid
formation of commissures.
7. After the surgery on the intestine the patient developed a complication: his
walls of operated intestine adhered together to form commissure.
51
8. Hypoproteinemia is high level of protein in blood.
9. Hyperbilirubinemia is low level of bilirubin in blood.
10. Immunofluorescence test is used for labeling of antibodies or antigens with
fluorescent dyes especially for the purpose of demonstrating the presence of a
particular antigen or antibody in a tissue.
2. Answer the questions
1. What is haemoglutination?
2. What is urobilinuria? (the presence of urobilin in the urine)
3. What is bilirubinuria? (the presence of bilirubin in the urine)
4. What is fibrinopurulent peritonitis?
5. What is immunoelectrophoresis and immunofluorescence?
6. What can cause long-term taking of medicines in the liver?
7. What is the function of enterokinase?
8. What can be the clinical manifestations of hepatocellular parenchymal
jaundice?
EXAMPLES OF EXAM TASKS
Case presentation 1
A 23-year-old woman presents to the emergency department complaining of bloody
diarrhea, fatigue and confusion. A few days earlier, she went to a fast food restaurant
for a birthday party. Her friends are experiencing similar symptoms. Laboratory
studies show anemia. Which of the following would you most likely obtain for
microbiologic testing?
A. Blood
B. Urine
C. Bile
D. Cerebrospinal fluid
E. Stool
Case presentation 2
The disease onset occurred 3 days ago. The patient complains of body temperature
up to 38°C, stomachache, and frequent loose bloody stools. Bacillary dysentery was
clinically diagnosed in the patient. What method of microbiological diagnostics
would be advisable in this case and what samples should be obtained from the
patient to confirm this diagnosis?
A. Bacteriology, feces
B. Bacterioscopy, feces
C. Bacterioscopy, blood
52
D. Bacteriology, urine
E. Serology, blood
Case presentation 3
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. Peritoneal commissures
B. Serous peritonitis
C. Serofibrinous peritonitis
D. Fibrinopurulent peritonitis
E. Fibrinohemorrhagic peritonitis
Case presentation 4
During an invasive operation the surgeon needs to access the omental bursa of the
peritoneal cavity via the omental foramen (foramen of Winslow). What anatomical
structure makes up the anterior border of this foramen
A. Hepatorenal ligament
B. Hepatoduodenal ligament
C. Visceral surface of liver
D. Superior part of duodenum
E. Greater omentum
Case presentation 5
Long-term taking of medicines can affect cells of the liver. Particularly, it can cause
marked hypertrophy of agranular endoplasmic reticulum due to the following
function of this organelle:
A. Protein synthesis
B. Nucleic acid synthesis
C. Detoxication of harmful substances
D. Formation of maturation spindle 0%
E. Intracellular digestion
Case presentation 6
A 45-year-old woman presents with insufficient secretion of enterokinase enzyme.
Enterokinase deficiency can cause disturbance of the following digestive function:
A. Lipid absorption
B. Carbohydrate hydrolysis
C. Lipid hydrolysis
D. Vitamin absorption
E. Protein hydrolysis
53
Case presentation 7
Disturbed activity of trypsin and chymotrypsin leads to disturbed protein breakup
in the small intestine. Activity of these enzymes depends on the presence of the
following factor:
A. Bile acids
B. Pepsin
C. Enterokinase
D. Hydrochloric acid
E. N a+ salts
Case presentation 8
To test donor blood for hepatitis B antigens, it is necessary to use highly sensitive
detection methods. What test should be used for this purpose
A. Complement binding
B. Immunoelectrophoresis
C. Indirect hemagglutination
D. Solid-phase enzyme-linked immunosorbent assay
E. Indirect immunofluorescence
Case presentation 9
Histological microslide shows a gastrointestinal organ. The wall of this organ
consists of 4 layers: mucosal, submucosal, muscular, and serous. The muscular layer
has folds and pits. What organ has such appearance?
A. Stomach
B. Appendix
C. Duodenum
D. Small intestine
E. Esophagus
Case presentation 10
A 28-year-old man complains of nausea, vomiting, and right-sided subcostal pain.
Objectively, his skin and sclerae are icteric, he has elevated body temperature,
enlarged liver, dark urine, fecal hypocholia, hyperbilirubinemia (direct and indirect
bilirubin), bilirubinuria, urobilinuria, hypoproteinemia, and decreased blood
coagulability. What condition can be characterized by these changes?
A. Acute pancreatitis
B. Post-hepatic jaundice
C. Acute cholecystisis
D. Pre-hepatic hemolytic jaundice
E. Hepatocellular parenchymal jaundice
54
UNIT 7
_
ENDOCRINE SYSTEM
Review of basic terms
Basic terms
1.
Extracellular matrix is a threedimensional network consisting
of extracellular macromolecules a
nd minerals, such
as collagen, enzymes, glycoprotei
ns that provide structural
and biochemical support to
surrounding cells.
2. Follicular epithelium is spheroidal
collections
of epithelial
cells
(thyrocytes).
3. Cuboid
cells
is
a
type
of epithelium that consists of a
single layer of cuboidal (cubelike) cells which have large,
spherical and central nuclei.
4. Squamous cells are thin, flat cells
that look like fish scales, and are
found in the tissue that forms the
surface of the skin or the lining of
the hollow organs of the body.
5. Colloid is the sticky fluid
which fills follicles of
thyroid gland.
55
6. Glucose uptake is the process of glucose absorption.
7. Glucose reuptake is the process of glucose reabsorption.
8. Metformin is hypoglycemic drug which inhibits the process of gluconeogenesis
in the liver, increases sensitivity of cells to insulin, delays the absorption of
glucose in the intestine.
9. Glibenclamide is hypoglycemic drug which stimulates secretion of insulin by
beta cells of pancreas
10.Hyper/hypothyroidism is the condition when the thyroid gland produces too
much/little of thyroid hormones
11.Renin is a proteolytic enzyme of the kidney that plays a major role in the
release of angiotensin
12.Angiotensin is the part of the renin angiotensin aldosterone system (RAAS),
a classic endocrine system that helps to regulate long-term blood pressure and
blood volume in the body.
Specific symptoms and signs of endocrine diseases
1. The biggest risk factors for general hyperpigmentation are sun exposure and
inflammation, as both situations can increase melanin production.
2. Smell of acetone. If a person's breath smells like acetone, it may indicate that
there are high levels of ketones bodies in the blood.
3. Increased level of glucose in blood can provoke thirst or polydipsia in a
patient.
4. Dryness in the mouth or xerostomia can mark the beginning of diabetes.
5. Glucosuria appears when kidneys eliminate the excess amount of glucose in
urine.
6. Weight loss can be triggered by hypersecretion of triiodothyronine (T3
hormone) since it increases metabolism.
7. Stress situation can provoke palpitations which are feeling of heartbeat.
8. Protruding eyes of a patient or exophthalmos may indicate Graves’ disease.
Diagnostic studies
1. Blood test for glycated hemoglobin is a diagnostic procedure that shows the
level of glucose chemically linked to hemoglobin.
2. Fasting blood glucose test is type of blood test that shows how well body's
insulin responds to periods without food.
56
Laboratory and instrumental findings
1. Pancreatic islet insufficiency = inability of pancreatic islets to produce insulin
2. Ovarian insufficiency = inability of ovaries to produce female sex hormones
3. Insulin insufficiency = inability of pancreas to secrete insulin
PRACTICE
1. Match the words from the left column with words from the right column
to have word combinations. Compose sentences with these word
combinations
1.
2.
3.
4.
5.
6.
7.
8.
Extracellular
Follicular
Cuboid
Glucose
Ovarian
Blood test for
Acetone
Insulin
a.
b.
c.
d.
e.
f.
g.
h.
reuptake
glycated hemoglobin
epithelium
production
matrix
insufficiency
cells
smell
2. Match the medical term with its explanation
1. Pancreatic islet insufficiency
a network consisting
of extracellular macromolecules and
minerals to support surrounding
cells
2. Exophthalmos
a condition when the thyroid gland
produces too little of thyroid
hormones
a condition when the thyroid gland
produces too much of thyroid
hormones
sticky fluid inside the thyroid follicle
inability of beta cells of pancreas to
produce insulin
protruding eyes of a patient
3. Glucosuria
4. Hyperpigmentation
5. Extracellular matrix
6. Hypothyroidism
57
7. Hyperthyroidism
excess pigmentation in a bodily part
or tissue (such as the skin)
presence of glucose in urine
8. Colloid
3. Fill in the gaps in the sentences below.
Colloid, renin, acetone smell, angiotensin, palpitations, metformin,
squamous cells, glucose uptake, xerostomia, exophthalmos
1.
2.
3.
4.
A 26-year old woman is complaining of thirst and____________.
Hyperfunction of the thyroid gland can cause _____________ in a patient.
Each lobule contains a cluster of follicles filled with ________________.
Follicular epithelium consists of low columnar, cuboidal or
_______________depending on the level of activity of the follicle.
5. _______________________can be detected in patients with Diabetes
Mellitus.
6. ______________is the drug which inhibits the process of gluconeogenesis in
the liver, increases sensitivity of cells to insulin, delays the absorption of
glucose in the intestine.
7. Acarbose belongs to the class of hyperglycemic drugs that delays the
_______________in the duodenum.
8. _______________is the substance in blood that provides vasoconstrictive
effect and in this way increases blood pressure.
9. _______________ is the substance which is produced by kidneys and is in
the control of blood pressure and various other physiological functions.
10. Patients with ischaemic heart disease often experience ___________ at rest.
4. Match two parts of the sentences
1. Hyperpigmentation is present
over many areas of her body,
2. The examination has revealed
3. Past medical
significant for
history
is
4. A patient complaining of
weight loss (10 kg during 2
months), palpitation and
exophthalmos
a. came
to
the
endocrinologist.
b. depending on the level of
activity of the follicle.
c. quite frequently, but denies
any dysuria or pain on
urination.
d. most prominently over the
face, neck and back of
hands (areas exposed to
light).
58
5. A 24-year-old man undergoes
surgery and during the
operation, an organ is excised
6. Follicular epithelium consists
of low columnar, cuboidal or
squamous cells
7. Analysis of urine from a 24year-old man revealed the
following changes:
8. The patient says he has to
urinate
e. daily diuresis - 10 l,
relative density - 1,001,
qualitative alterations are
absent.
h. glucosuria
and blood
glucose content of 6,5
mmol/l.
i. and sent for histological
evaluation.
j. diabetes mellitus type 2
and hypertension, both
managed medically.
5. Answer the questions
1. In what conditions can people develop hyperpigmentation?
2. What kind of cells does thyroid gland consist of?
3. What hormones are produced by thyroid gland?
4. What are the symptoms of hyperthyroidism?
5. Why does the patient develop high blood sugar level?
6. How can high sugar level be detected?
7. How can diabetes mellitus be clinically manifested?
8. What hypoglycemic drugs do you know?
9. What substances take part in blood pressure regulation?
10.What can ovarian insufficiency result in?
EXAMPLES OF THE EXAM TASKS
Case presentation 1
A 45-year-old woman comes to her physician with complaints of excessive fatigue
and weakness. She says that these symptoms have been present for the past month.
On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On
physical examination, she is a tiredappearing thin woman. Hyperpigmentation is
present over many areas of her body, most prominently over the face, neck and back
of hands (areas exposed to light). Increased production of which of the following
hormones is the most likely cause of hyperpigmentation in this patient?
A. Melanocyte-stimulating hormone (MSH)
B. Growth hormone (GH)
C. Gonadotropins
D. β-Lipotropin
59
E. Thyroid-stimulating hormone (TSH)
Case presentation 2
A 16-year-old girl concerned about her sexual development comes to the physician.
She mentions that she has still not had a menstrual period. However, she is otherwise
a healthy girl with no significant medical problems since birth. On physical
examination, her vital signs are stable. She does not have pubic hair and her breast
is slightly elevated with areola remaining in contour with surrounding breast. Which
of the following is the most likely cause of this abnormal physical development?
A. Pancreatic islet insufficiency
B. Hyperthyroidism
C. Hypothyroidism
D. Ovarian insufficiency
E. Adrenal medulla hyperfunction
Case presentation 3 A 26-year old woman is complaining of thirst and dryness in
her mouth. The examination has revealed glucosuria and blood glucose content of
6,5 mmol/l. What condition are these symptoms the most typical for?
A. Diabetes insipidus
B. Diabetes mellitus
C. Steroid diabetes
D. Renal diabetes
E. Alimentary glucosuria
Case presentation 4
On your physiology class, the professor asks you to report about the effects of
various body hormones and neurotransmitters on the metabolism of glucose. You
begin your report with the statement that the use of glucose by the cell is preceded
by absorption through the plasma membrane from the extracellular matrix into the
cell. Which of the following hormones is most likely responsible for the glucose
uptake by the cell?
A. Thyroxine
B. Glucagon
C. Insulin
D. Aldosterone
E. Epinephrine
Case presentation 5
A 56-year-old man presents for a checkup. The patient says he has to urinate quite
frequently, but denies any dysuria or pain on urination. Past medical history is
significant for diabetes mellitus type 2 and hypertension, both managed medically.
Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide.
Laboratory findings are significant for the following: Glycated Hemoglobin (Hb
A1c) - 8.0%, Fasting Blood Glucose - 12 mmol/L. His doctor decides to add
60
glibenclamide to the therapy. Which of the following is the most likely mechanism
of this drug’s action?
A. Inhibition of insulin release
B. Stimulation of glucose reuptake by the cell
C. Facilitation of glucose absorption in the intestine
D. Stimulation of insulin release
Case presentation 6
A patient complaining of weight loss (10 kg during 2 months), palpitation and
exophthalmos came to the endocrinologist. For the hyperfunction of what gland
(glands) are these complaints the most typical?
A. Pancreas
B. Ovaries
C. Adrenal glands
D. Parathyroid glands
E. Thyroid
Case presentation 7
A 24-year-old man undergoes surgery and during the operation, an organ is excised
and sent for histological evaluation. A light microscopic examination reveals the
organ encased by thin connective tissue capsule that enters the substance of the lobes
to further subdivide the organ into irregular lobular units. Each lobule contains a
cluster of follicles filled with colloid. Follicular epithelium consists of low
columnar, cuboidal or squamous cells depending on the level of activity of the
follicle. Which of the following organs does this tissue most likely belong to?
A. Parotid gland
B. Pancreas
C. Thyroid gland
D. Thymus
E. Parathyroid gland
Case presentation 8
An unconscious patient was brought into the hospital. The smell of acetone can be
detected from the patient’s mouth. Blood glucose - 25 mmol/L, ketone bodies -0.57
mmol/L. What hormone deficiency can result in the development of this condition?
A. Somatotropin
B. Thyroxin
C. Glucocorticoids
D. Aldosterone
E. Insulin
Case presentation 9
61
A 27-year-old woman complains of insomnia, irritability, hand tremor, acute weight
loss despite high appetite, and constant fever with body temperature of 37,2-37,5
C^o. What endocrine gland is likely to be functionally impaired in this
case?
A. Pancreas
B. Parathyroid gland
C. Thyroid gland
D. Adrenal glands
E. Neurohypophysis
Case presentation 10
Analysis of urine from a 24-year-old man revealed the following changes: daily
diuresis - 10 l, relative density - 1,001, qualitative alterations are absent. A patient
complains of excessive thirst, frequent urination. What is the most likely cause of
this disease?
A. Vasopressin hypersecretion
B. Vasopressin hyposecretion
C. Glucocorticoid hypersecretion
D. Relative insulin insufficiency
E. Aldosterone hypersecretion
62
UNIT 8
NERVOUS SYSTEM
Review of basic terminology
Basic terms
1. Nasolabial fold 2. Optic chiasm 3. Trigeminal nerveve
4. Chorda tympany
6.Gustatory sensation
5. Gyrus (pl. gyri)
7. Ganglionitis – inflammation of a ganglia
Gyrus (pl. gyri)
8. Neuropathy – damage or dysfunction of one or more nerves
9.Muscle tone – the resistance of a muscle to active or passive stretch.
63
Specific symptoms and signs of the nervous system
Impaired
consciousness
Facial asymmetry
Tingling
sensation
Loss of
sensitivity
Nuchal rigidity
Brudzinski’s sign
Diminishing peripheral
vision
Hemianopsia
Meningeal
signs
Kerning’s sign
Clumsiness
Loss of sensitivity
1. Facial asymmetry is a condition in which the face is not symmetrical or
even balanced.
2. Meningeal signs involve nuchal rigidity refers to neck stiffness; Kerning’s
sign refers to severe stiffness of the hamstring causes inability to
strengthen the leg when hip is flexed to 90 degrees; Brudzinski’s sign is
considered positive when passive forward flexion of the neck causes the
patient to involuntary raise his knees or hips in flexion.
3. Tingling sensation is an abnormal pin-or-needles sensation that is often
felt in arms, hands, legs or feet
4. Diminishing peripheral vision is condition when a patient can poorly see
objects unless they are in front of him.
5. Hemianopsia is loss of sight in half of patient’s visual field
6. Loss of sensitivity is inability to feel pain or touch
7. Clumsiness is being awkward
8. Impaired consciousness is a state when consciousness has been affected
by damage to the brain.
64
Diagnostic studies &instrumental findings
1. Nerve conduction study is a diagnostic procedure that measures how fast
an electrical impulse moves through the nerve
2. Autopsy is a post-mortem examination to find out the cause of death.
3. Nerve compression is a condition when a nerve is squeezed or compacted
4. Poorly demarcated grey white junction refers to the disbalance between
cerebral and cerebellar white and gray matter in the brain
5. Subarachnoid hemorrhage is bleeding under the arachnoid mater of the
brain
6. Intracerebral hemorrhage is bleeding into the brain
7. Brain concussion is jarring injury of the brain resulting in disturbance of
cerebral function
PRACTICE
1. Choose the correct option:
1. What forms nasolabial triangle?
a. The nasolabial folds, the nose and the upper lip
b. The eyes, the nose and the lips
c. The chin, the cheeks and the ears
d. The cheeks, the forehead and the nose
2. What nerve has three branches?
a. Optic
b. Oculomotor
c. Trigeminal
d. Abducent
3. The pathology that involves inflammation of nerve ganglia is known as:
a. Arthritis
b. Neuritis
c. Ganglionitis
d. Stomatitis
4. Some pathologic condition of a particular nerve is called:
a. Neuritis
b. Neuropathy
c. Neurology
d. Neuroglia
5. A post-mortem examination to find out the cause of death is called:
65
a.
b.
c.
d.
Biopsy
Autopsy
Gastroscopy
Bronchoscopy
6. Hemianopsia refers to:
a. Total blindness
b. Monochromatic vision
c. Loss of sight in half of patient’s visual field
d. Double vision
7. Impaired consciousness can be the sign of:
a. Intracerebral haemorrhage
b. Rhinitis
c. Sinusitis
d. Otitis
8. An awkward gait usually results in:
a. Vertigo
b. Dizziness
c. Paralysis
d. Clumsiness
9. Decreased muscle tone can be the sign of serious infectious disease like:
a. Brain stroke
b. Meningitis
c. Superlative tonsillitis
d. Myocarditis
10.Facial asymmetry can occur as the manifestation of:
a. Damage to the facial nerve
b. Damage to the glossopharyngeal nerve
c. Hyperactivity of the vagus nerve
d. Damage to the vestibulocochlear nerve
2. Correct the statements and explain your idea.
1. Optic chiasm is s the part of the spinal cord where the optic nerves cross.
2. Сhorda tympani is a branch of the optic nerve that runs through the middle
ear, and carries taste messages to the brain.
66
3. Peripheral or central nervous system disorders clinically can be manifested
with altered gustatory sensation.
4. The gustatory
sensation
system is
partially
responsible
for
the perception of smell.
5. Meningeal signs, used to diagnose meningitis, involve rigidity of abdominal
muscles and Chvostek’s sign.
6. Tingling sensation is a symptom of neurologic disorder when the patient
cannot feel his extremities.
7. Nerve conduction study is a diagnostic procedure used to measure the level
of patient’s sensation.
8. Brain concussion is the injury of the brain resulting in damage of brain
meninges.
9. Kerning’s sign is considered positive when a patient has stiffness of neck’s
muscles.
10. Subarachnoid hemorrhage is bleeding which occurs on the arachnoid mater
of the brain.
3. Match the words from the left column with words from the right
column to have word combinations. Compose sentences with these
word combinations
9. Tingling
10.Nerve
11.Meningeal
12.Subarachnoid
13.Impaired
14.Facial
15.Diminished
16.Nuchal
17.Brudzinski’s
18.Muscle
i. compression
j. consciousness
k. tone
l. sign
m. sensation
n. peripheral vision
o. signs
p. haemorrhage
q. asymmetry
r. rigidity
4. Match the parts of the sentences
1. A 37-year-old man suddenly
developed acute headache
2. The pain started as an
occasional throb and she could
ignore it
reveal nerve compression.
brain swelling, widened gyri and
poorly demarcated gray-white
junction.
67
3. Nerve conduction studies
accompanied by nausea, vomiting,
and impaired consciousness.
4. By the time the ambulance
arrived,
5. The gross examination of the
cerebral left
hemisphere
showed
6. Parenchyma of the spinal
ganglion is composed of
he had difficulty speaking.
or take ibuprofen.
he sways from side to side, unable to
stand still.
7. The loss of taste sensation of Improves metabolism in the brain
the tongue
8. When the patient is asked to pseudounipolar neurons localized
stand with his eyes closed and under the capsule of connective
with both feet close together, tissue.
9. After a long drive with the was caused by the damage to chorda
window
open
a
man tympani.
developed
10.Piracetam is the drug that
facial asymmetry and he cannot
close his right eye now.
5. Fill in the gaps
Cerebrospinal, optic chiasm, spinal ganglion, clumsiness, brain
concussion, nerve compression, cerebellum, skin sensitivity, impaired
consciousness, tingling sensation
1. A 37-year-old man suddenly developed acute headache accompanied by
nausea, vomiting, and ____________________.
2. Analysis of the ________________fluid revealed blood in it.
3. A 37-year old female presents to the clinic complaining of severe pain in her
left wrist and ______________in her left thumb, index finger, and middle finger,
and some part of her ring finger.
4. Nerve conduction studies reveal __________________.
5. The reason of patient’s bitemporal hemianopsia is pathology
of_____________.
6. Memory deterioration, reduced mental capabilities, sleep disorders, and
vertigo appeared as a consequences of the __________________.
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7. A 52-year-old woman came to the neurologist with complaints of loss of
_________________on the right half of her face.
8. The __________________is composed of pseudounipolar neurons localized
under the capsule of connective tissue.
9. A 12-year-old boy presents with progressive ________ and difficulty
walking.
10. The __________ controls the ability of a person to stand still.
6. Answer the questions
1. What is ganglionitis?
2. What does the term neuropathy mean?
3. What does the muscle tone show?
4. What are the specific symptoms of nervous disorders?
5. What meningeal signs do you know?
6. Where does a patient usually feel tingling sensation?
7. What is haeminopsia?
8. What is brain concussion?
EXAMPLES OF THE EXAM TASKS
Сase presentation 1
After a long drive with the window open a man developed facial asymmetry; he
cannot close his right eye, his right nasolabial fold is smoothed out, movements of
expression are absent on the right, there is a disturbance of gustatory sensation in
the tongue on the right. No other neurological pathologies were detected. What
disease can be provisionally diagnosed in this patient?
A. Neuropathy of the facial nerve
B. Neuropathy of the trigeminal nerve
C. Trigeminal ganglionitis
D. Neuropathy of the oculomotor nerve
E. Ischemic stroke
Сase presentation 2
A 37-year-old man suddenly developed acute headache accompanied by nausea,
vomiting, and impaired consciousness. Objectively blood pressure is 190/120 mm
Hg, the face is hyperemic. Patient’s consciousness is clouded, his answers to the
69
questions are short, monosyllabic. Movement and sensory disturbances are absent.
Meningeal signs are positive. Cerebrospinal fluid contains blood. What provisional
diagnosis can be made?
A. Cerebral vascular embolism
B. Meningitis
C. Ischemic stroke
D. Encephalitis
E. Subarachnoid hemorrhage
Сase presentation 3
A 37-year old female presents to the clinic complaining of severe pain in her left
wrist and tingling sensation in her left thumb, index finger, and middle finger, and
some part of her ring finger. The pain started as an occasional throb and she could
ignore it or take ibuprofen but now the pain is much worse and wakes her up at night.
She works as a typist and her pain mostly increases after typing all day. Her right
wrist and fingers are fine. Nerve conduction studies reveal nerve compression.
Which of the following nerves is most likely compressed in this patient?
A. Ulnar nerve
B. Median nerve
C. Radial nerve
D. Axillary nerve
E. Musculocutaneous nerve
Сase presentation 4
A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles
are usually regular, occurring at 28-30 day interval with moderate bleeding and some
abdominal discomfort. She also complains of progressively diminishing peripheral
vision. Her doctor reveals loss of vision in the lateral halves of both eyes.
Involvement of which of the following structures would you most likely expect to
be the reason of bitemporal hemianopsia?
A. Left optic nerve
B. Left optic tract
C. Right optic tract
D. Optic chiasm
E. Right optic nerve
Сase presentation 5
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
70
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. Intracerebral hemorrhage
B. Ischemic stroke
C. Abscess
D. Cyst
E. Tumor
Сase presentation 6
A man complaining of memory deterioration, reduced mental capabilities, sleep
disorders, and vertigo was brought to the neurologic department. The patient
explains these symptoms as consequences of the brain concussion received in a
traffic accident 2 years ago. Choose the drug that can improve the patient’s brain
metabolism and would be the most advisable in this case:
A. Sydnocarb (Mesocarb)
B. Sodium oxybutirate
C. Piracetam
D. Cordiamin (Nikethamide)
E. Caffeine
Сase presentation 7
A 52-year-old woman came to the neurologist with complaints of loss of skin
sensitivity on the right half of her face in the area of the lower eyelid, nasal arch,
and upper lip. What branch of what nerve is damaged in this patient?
A. A Maxillary branch of the trigeminal nerve
B. B Greater petrosal nerve branching from the facial nerve
C. C Ophthalmic branch of the trigeminal nerve
D. D Mandibular branch of the trigeminal nerve
E. E Chorda tympani branching from the facial nerve
Сase presentation 8
Parenchyma of an organ is composed of pseudounipolar neurons localized under
the capsule of connective tissue. Central place belongs to nerve fibers. Name this
organ:
A. Nerve trunk
B. Sympathetic ganglion
C. Intramural ganglion
D. Spinal ganglion
E. Spinal cord
Сase presentation 9
71
A 25-year-old man came to the family doctor complaining of the loss of taste
sensation in the front two- thirds of his tongue. The doctor determined that this
condition was caused by the damage to a certain nerve. What nerve is likely to be
functionally impaired in this case?
A. Glossopharyngeal nerve
B. Accessory nerve
C. Hypoglossal nerve
D. Vagus
E. Chorda tympani
Сase presentation 11
A 12-year-old boy presents with progressive clumsiness and difficulty walking. He
walks “like a drunk man” and has experienced frequent falls. His muscle tone and
strength in all 4 limbs are slightly decreased. When he is asked to stand with his eyes
closed and with both feet close together, he sways from side to side, unable to stand
still. Which of the following brain regions is most likely affected and caused the
symptoms described above?
A. Red nucleus
B. Substantia nigra
C. Cerebellum
D. Reticular formation
E. Right hemisphere
72
UNIT 9
URINARY SYSTEM
Review of basic terminology
Basic terms
1.Glomerular permeability is the ability of water and microsubstances to pass
through ultrafilration membrane
2. Glomerular hydrostatic pressure is pressure which pushes water and solutes in
blood plasma through the glomerular filter.
3. Oncotic pressure is the pressure exerted by plasma proteins on the capillary wall
4. Primary urine is the fraction of blood plasma which is filtered out by renal
glomeruli.
5. Residual urine is the amount of urine that remains in the bladder after urination
6. Tubular reabsorption is the process of water absorption in renal tubules of
nephron
7. Nephrotic syndrome is a syndrome characterized by edema and large amounts of
protein in the urine.
8. Nephritic syndrome is a clinical syndrome that presents as hematuria, elevated
blood pressure, decreased urine output, and edema.
9. Pyelectasis is an increased collection of urine in part of the baby's kidney called
the renal pelvis.
10. Nephroblastoma is a rare kidney’s malignant tumour that primarily affects
children.
11. Eosinophilic mass is the collection of eosinafils.
12. Glomerular mesangium is a space which is continuous with the smooth muscles
of the arterioles. It is outside the capillary lumen but surrounded by capillaries. It is
in the middle (meso) between the capillaries (angis).
13. Glomerular filtration rate is a blood test that checks how fast blood is filtrated
through glomeruli.
14. Tubulopathy is pathology of renal tubules.
15. Pitting oedema is when a swollen part of the body has a pit after it is pressed
for
a few seconds.
73
Specific symptoms and signs of the urinary diseases
Urine disorders
1. Polyuria
large amount of secreted urine
6.
2.
Hypostenuria
low urine density
3. Oliguria
reduced excretion of urine
URIA
Nocturia
frequent urination
at night
5. Haemoturia
blood in urine
4.
Isosthenuria
a condition in which the kidneys produce urine
with the specific gravity of protein-free blood
plasma
Diagnostic studies& laboratory/instrumental findings
1.
2.
3.
4.
5.
6.
7.
Foamy urine = urine covered with foam
Azotemia = the presence of nitrogen in the urine
Microhaemoturia = presence of a few erythrocytes in blood
Urolithiasis = kidney stone disease
Contracted kidney = shrinking kidney
Dimished kidney = a kidney which is smaller in size
Congo red = a dye that is red in alkaline and blue in acid solution
PRACTICE
1. Match the words from the left column with words from the right column
to have word combinations. Compose sentences with these word
combinations
1. Nephrotic
2. Residual
3. Glomerular
4. Primary
5. Pitting
6. Nephritic
7. Tubular
a.
b.
c.
d.
e.
f.
g.
urine
syndrome
oedema
permeability
urine
mass
pressure
74
8. Glomerular
9. Oncotic
10.Eosinophilic
h. mesangium
i. syndrome
j. reabsorption
2. Match the term with its explanation
1. Pyelectasis
a. kidney stone disease
2. Tubulopathy
b. a dye that is red in alkaline
and blue in acid solution
3. Urolithiasis
c. blood in urine
4. Azotemia
d. an increased collection of
urine in part of the baby's
kidney called the renal pelvis
5. Haematuria
e. reduced excretion of urine
6. Congo red
f. the presence of nitrogen in
the urine
7. Hyposthenuria
g. urine with the protein-free
blood plasma
8. Oliguria
h. pathology of renal tubules
9. Isosthenuria
i. frequent urination at night
10. Nocturia
j. low urine density
3. Fill in the gaps in the sentences
Nephroblastoma, microhaematuria, renal failure, foamy urine, contracted,
diminished, glomerular filtration rate, primary urine, oedema, polyuria.
1. An 11-year-old girl is brought to the doctor’s office by her mother who states
her daughter has been weak and has _____________of the face for 3 days.
2. Upon inquiry, the girl mentioned that she had ________
__________
but denied blood in urine, urinary frequency at night, or pain during urination.
3. Analysis detects glucose and amino acids in the __________ ___________.
4. Autopsy of a 60-year-old woman shows significantly _____________
kidneys (weight of both kidneys is 80 g) with finely granular surface.
5. ____________ is a malignant tumour that primarily affects children’s
kidneys.
6. 52-year-old patient suffers chronic glomerulonephritis that is why his
______________ is reduced by 20 % compared to normal.
7. Laboratory study revealed proteinuria and _______________________ in the
patient with glomerulonephritis.
8. On section ____________ kidney looks like uniform renal cortical thinning.
75
9. ____________ (increased volume of urine) and hyposthenuria (low specific
gravity of urine; N=1,010 – 1,025) are the signs of diluted urine, i.e. urine
with great volume of water.
10.Chronic diseases of kidneys can lead to chronic ____________results from
progressive and irreversible loss of large numbers of active functioning
nephrons.
4. Match the parts of the sentences
1. Physical examination reveals
generalized swelling of the
face and
2. Clinical course of urolithiasis
was complicated
3. Section shows significant
4. A patient with a history of
chronic
glomerulonephritis
presents
5. Upon inquiry, the girl
describes a foamy appearance
of her urine
6. In the residual urine glucose
and amino acids are
7. Due to the use of poor-quality
measles vaccine
8. During pathomorphological
kidney investigation of a
patient, who died from
progressing renal failure, the
following was revealed:
9. A process of water absorption
in renal tubules of nephron
10.Ultrasonic
examination
revealed small stones
a. enlargement of the patient’s right
kidney.
b. but denies blood in urine, urinary
frequency at night, or pain during
urination.
c. pitting edema on the lower limbs.
d. for preventive vaccination, a child
developed an autoimmune renal
injury.
e. deposits
of
homogeneous
eosinophilic masses in glomerular
mesangium, and stroma, which
became red when stained with
Congo red.
f. is known as tubular reabsorption
g. by the passage of a renal calculus.
h. in the kidneys that provoked renal
colic attacks.
i. with azotemia, oliguria, hypo- and
isosthenuria, proteinuria.
j. absent due to tubular reabsorption
of these substances.
5. Answer the questions
76
1. What are the most common symptoms of renal diseases?
2. What is urolithiasis?
3. What are the typical symptoms of nephrotic syndrome?
4. How can contracted kidney look like on section?
5. What is nephrolith? What can it cause in a kidney?
6. What are the three stages of urine formation?
7. What is amyloidosis?
8. What hormonal disorder can trigger the formation of urine stones?
9. What are the most common symptoms of glomerulonephritis?
10.What is the most common complication of glomerular nephritis?
EXAMPLES OF THE EXAM TASKS
Case presentation 1
An 11-year-old girl is brought to the doctor’s office by her mother who states her
daughter has been weak with swollen face for 3 days. The mother states her daughter
had always been healthy and active until the initiation of symptoms. Upon inquiry,
the girl describes a foamy appearance of her urine but denies blood in urine, urinary
frequency at night, or pain during urination. Physical examination reveals
generalized swelling of the face and pitting edema on the lower limbs. Laboratory
study shows proteinuria and microscopic hematuria. Which of the following is the
most likely cause of findings in the laboratory study of urine?
A. Increased plasma oncotic pressure
B. Increased glomerular hydrostatic pressure
C. Increased hydrostatic pressure in Bowman’s capsule
D. Increased permeability across the glomerular capillary wall
E. –
Case presentation 2
Analysis detects glucose and amino acids in the primary urine. In the residual urine
they are absent due to tubular reabsorption of these substances. Where in the
nephron does this process occur?
A. Proximal convoluted tubule
B. Distal convoluted tubule
C. Henle’s loop
D. Collecting duct
E. Macula densa
77
Case presentation 3
Clinical course of urolithiasis was complicated by the passage of a renal calculus.
Where in the ureter is it most likely to stop?
A. In the renal pelvis
B. At the border between the abdominal and pelvic segments
C. In the middle of the abdominal segment
D. 2 cm above the entrance to the urinary bladder
E. 5 cm above the pelvic segment
Case presentation 4
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. Nephritic syndrome
B. Chronic pyelonephritis
C. Acute kidney failure
D. Chronic kidney failure
E. Nephrotic syndrome
Case presentation 5
Autopsy of a 60-year-old woman, who for a long time had been suffering from
essential hypertension, shows significantly diminished kidneys (weight of both
kidneys is 80 g) with finely granular surface. Uniform renal cortical thinning can be
observed on section. Name the described changes in the kidneys:
A. Secondary contracted kidney
B. Pyelonephritic contracted kidney
C. Primary contracted kidney
D. Amyloid contracted kidney
E. Diabetic nephrosclerosis
Case presentation 6
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. Pyelectasis
B. Hydronephrosis
C. Hydroureteronephrosis
D. Renal cyst
E. Nephroblastoma
Case presentation 7
78
Due to the use of poor-quality measles vaccine for preventive vaccination, ej 1year-old child developed an autoimmune renal injury. The urine was found to
contain macromolecular proteins. What process of urine formation was disturbed?
A. Reabsorption and secretion
B. Secretion
C. Filtration
D. Secretion and filtration
E. Reabsorption
Case presentation 8
During pathomorphological kidney investigation of a patient, who for a long time
had been suffering from osteomyelitis and died from progressing renal failure, the
following was revealed: deposits of homogeneous eosinophilic masses in
glomerular mesangium, arterial and arteriolar walls, and stroma, which became red
when stained with Congo red. What pathological process is this?
A. Amyloidosis
B. Mucoid swelling
C. Calcinosis
D. Carbohydrate degeneration
E. Hyalinosis
Case presentation 9
Periodic renal colic attacks are observed in a woman with primer
hyperparathyroidism. Ultrasonic examination revealed small stones in the kidneys.
What is the most plausible reason of the stones’ formation?
A. Hypercholesterinemia
B. Hyperphosphatemia
C. Hyperuricemia
D. Hyperkalemia
E. Hypercalcemia
Case presentation 10
A patient with a history of chronic glomerulonephritis presents with azotemia,
oliguria, hypo- and isosthenuria, proteinuria. What is the leading factor in the
pathogenesis of these symptoms development under chronic renal failure?
A. Tubular hyposecretion
B. Intensification of glomerular filtration
C. Mass decrease of active nephrons
D. Disturbed permeability of glomerular membranes
E. Intensification of sodium reabsorption
79
Case presentation 11
In 52-year-old patient with chronic glomerulonephritis, the glomerular filtration rate
(GFR) was reduced by 20 % compared to normal. What causes the decrease in GFR
in patient with chronic renal failure?
A. Obstruction of urinary tract
B. Renal artery thrombosis
C. Renal ischemia
D. Reduced number of active nephrons
E. Tubulopathy
Case presentation 12
A 29-eyar-old patient with pyelonephritis has been found to have hyposthenuria
combined with polyuria. According to this data, what process is most likely to be
disrupted?
A. Glomerular filtration
B. Tubular excretion
C. –
D. Tubular secretion
E. Tubular reabsorption
80
UNIT 10
INTEGUMENTARY SYSTEM
REVIEW OF BASIC TERMINOLOGY
Applied anatomy and physiology
The skin, nails, hair, glands, and associated nerve
endings make up the “integumentary system”.
Skin
The skin acts a physical, biochemical, and
immunological barrier between the outside world and the body. It also has a role in
temperature regulation, synthesis of Vitamin D, prevention of water loss, antigen
presentation, and sensation.
The skin made up of three layers – epidermis, dermis, and hypodermis.
Epidermis
This is the outermost layer and is formed of a modified stratified squamous
epithelium.
Dermis
Below the epidermis lies a layer of connective tissue consisting of collagen, elastic
fibers, and ground substance. It is here where the “skin appendages”, muscles
nerves, and blood vessel lie.
Hypodermis
Also called the subcutaneous layer or superficial fascia, this consists of adipose
tissue, serves both as a lipid store, and provides insulation. It also contributes to the
body contours and shape.
Glands
Sweat glands secrete a mixture of water, electrolytes, urea, urate, ammonia, and
mild acids. Eccrine sweat glands are found all over the body surface, besides the
mucosa.
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Common skin diseases and conditions
*Acne
*Hives
*Cellulitis
*Moles
*Dermatitis
*Psoriasis
*Kaposi’s sarcoma * Athlete’s foot
*Shingles
*Rosacea
*Impetigo
* Burns
* Ringworm
* Lupus
* Candidiasis
*Vitiligo
*Eczema
*Warts
Typical symptoms and signs of the skin diseases
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


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raised red or white bumps (lumps, nodes)
a painful or itchy rash (sore or pruritic eruption)
scaly skin (skin desquamation)
ulcers (cankers)
dry, cracked skin (rough, bumpy )
discolored patches of skin (plaques)
warts or other skin growths (boil, protuberance)
erythema (excessive redness of the skin)
open sores or lesions (ulceration, boil, abscess)
peeling skin (exfoliated skin)
depigmentation (discoloration)
pruiritis (itching)
cicatria (scars)
macule (spot)
xerosis (dry skin)
exanthema (rah, eruption)
urticaria (hives)
excoriation (abrasion)
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Characteristic features of rashes
red
painful
sore
blistering
swollen
Description of skin
dry
combination
oily
normal
sensitive
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
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spotty
filled with liquid or oozing
bumpy
swollen
itchy
profuse
scabby
scaly
calloused
clear
waxen
wrinkled
Morphological elements of skin rash
patch
blister
pustule
petechiae
turbecle
E
purpura
birth mark
roseola
crust
node
papulae
scale
erythema
erosion
vesicle
scar
abrasion
ulcer
spot
lesion
Diagnostic studies.
Physical examination
Visual inspection
Assessment of the color, size, shape, depth, border, symmetry, location
Palpation of the skin
History taking
Laboratory findings
Instrumental findings. Imaging testing
Biopsy
CT scan
Punch biopsy
dermographism
scraping
optical ultrasound imaging(OUI)
culture
magnetic-resonance image
wood light(black light)
scanning(MRI)
Tzanck testing
optical coherence tomography(OCT)
diascopy
phototesting
X-ray examination
skin tests(use test, patch test, prick test, intradermal test)
dermoscopy
diascopy
immunofluorescence test
blood test
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PRACTICE
1. Agree or disagree with the following statements. Comment on your
answer.
1. The integumentary system is composed of skin, hair, and sebaceous
glands.
2. The integumentary system acts only as a physical barrier- protecting the
body from bacteria, infection, injury and sunlight.
3. The skin is the largest and heaviest organ in the body, weighing about
6 pounds or more.
4. The skin consists of four layers: dermis, epidermis, hypodermis and
cutaneous tissue.
5. Dermis is the top layer of the skin, which contains sweat and oil glands
as well as hair follicles.
6. The glands of the integumentary system comprise sweat, sebaceous,
mammary and ceruminous ones.
7. Eccrine sweat glands are located all over the body, except for mucosa.
8. Skin conditions contribute nearly 2 % of the global burden of disease
worldwide and can be life threatening.
2. Complete the sentences with the words and word-combinations in the
box.
patches widespread
resolve on its own antihistamines
autoimmune
fungal position
greasy more noticeable
hyperpigmentation
1. In seborrheic dermatitis, the affected skin appear to be erythematous, ----- and swollen.
2. Lupus is a complex----- disorder, resulting in inflammation and pain, red
rings, sunburn like rash on the nose and cheeks.
3. The typical symptoms of psoriasis include itchy---- of skin with an unusual
appearance.
4. Eczema is incurable, however, it may------- and medications that relieve
the symptoms are available.
5. Since Vitiligo causes a loss of pigmentation, it is typically ---- in people
with dark or tanned skin.
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6. Acne is one of the most ------skin conditions characterized by dark spots
known as ------.
7. The treatment of hives usually involves------or corticosteroids.
8. Athlete’s foot is a-------which multiplies in warm, damp conditions, such
as inside sneakers.
3. Match words in column A to words in column B to make phrases. Then
match the phrases to the terms 1-10.
A
B
rough
rash
fluid-filled
skin
skin
on one side of the body
itchy
sores
red
redness
swollen
appearance
painful
area on the skin
Raised
eruption
scars
desquamation
discoloration
bumps
1. depigmentation___________________
2. pruiritis ________________________
3. erythema ______________________
4. blisters _____________________
5. cicatria ______________
6. scaly skin _______________________
7. lumps __________________________
8. edematous _______________________
9. ulceration _______________________
10. xerosis _________________________
4. a) Read an extract below and explain the condition as if you were
talking to a patient.
Erythema nodosun is an inflammatory disorder that produces tender, red nodules
under the skin, most often over the shins, but occasionally on the arms and other
areas. Quite often, erythema nodosun is a symptom of other disease or sensitivity
to a drug. Young adults, particularly women, are most prone to the disorder,
which may recur for months or years. Bacterial, fungal or viral infections may
also cause erythema nodosun. Erythema nodosun nodules resemble raised bumps
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and bruises that gradually change from pink to bluish brown.Fever and joint pain
are common. Lymph nodes in the chest occasionally become enlarged and are
detected with a chest X-ray. The painful nodules are usually the tell-tale sign for
the doctor.
b) Find phrases in the text that mean the following:





Excessive redness of the skin
Sensitive skin
Susceptibility to a medicine
Erythematous blisters
Elevated nodules
 Lesions that turn pink to pale
blue
 Arthralgia
 Swollen lymph nodes
 Evident signal (symptom)
5. Match the following terms with their definitions:
a flat circumscribed area of skin or an area of altered
skin color
a very small blister in the skin, often no bigger than a
2) purpura
pinpoint that contains a clear fluid
a bruise: an initially bluish-black mark on the skin,
3) wheal
resulting from the release of blood into tissues
an outer layer or coating formed by the drying of a
4) ecchimosis
bodily exudates such as pus or blood a scab
a flat area of color change in the skin that is 1 cm or
5) pustule
more in width
an open, painful sore on an external or internal surface
6) scale
of the body caused by a break in the skin
1) crust
7) macule
8) ulcer
9) patch
10) vesicle
a raised itchy (pruritic) area of the skin that is
sometimes an over sign of allergy
a small pus-containing blister on the skin
a skin rash resulting from bleeding into the skin from
small blood vessels, purple spots of the rash
any of the flakes of dead epidermal cells shed from the
skin
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6. Work in groups. Describe the pictures and identify the types of skin
condition shown.
a) What are the causes of each?
b) Why are dermatological problems especially distressing?
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7. Work in pairs. What lesions do the diagrams show? When you have
answered as many as you can, look at the list at the bottom to help
you
crust
purpura
wheal
ecchimosis
pustule
scale
macule
ulcer
patch
vesicle
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EXAMPLES OF THE EXAM TASKS
Case presentation 1
A 5-grade pupil complains of extensive skin rash accompanied by intensive
itching, especially at night. Objectively: there are small red papules set mostly in
pairs in the region of interdigital folds on both hands, on the flexor surface of
radicarpal articulations, abdomen and buttocks skin as well as internal surface of
thighs. In the centre of some papules, vesicles or serohaemorrhagic crusts can be
seen. There are multiple excoriations. What is the most likely diagnosis?
A. Scabies
B. Dermatitis
C. Ringworm in body
D. Toxicoderma
E. Eczema
Case presentation 2
A 43-year-old female patient complains of eruption on her right leg skin, pain,
weakness, body temperature rises up to 38°C. The disease is acute. Objectively:
there is an edema on the right leg skin in the region of foot, a well-defined bright
red spot in form of flame tips, which feels hot. There are isolated vesicles in focus.
What is your provisional diagnosis?
A. Erysipelas
B. Microbial eczema
C. Contact dermatitis
D. Toxicoderma
E. Haemorrhagic vasculitis
Case presentation 3
A 19-year-old patient complains about skin rash that appeared 2 days ago after
eating smoked fish. The rash disappears after 4-6 hours but then turns up again.
It is accompanied by itching. Objectively: trunk and upper limbs are covered with
multiple pink blisters as big as a pea or a bean. What is the most likely diagnosis?
A. Acute urticaria
B. Allergic dermatitis
C. Quincke’s edema
D. Toxicodermia
E. Purigo
Case presentation 4
After a serious nervous stress, a 35-year-old patient has developed redness and
swelling on the dorsal surface of hands that were later replaced by small
inflammatory nodules, vesicles and following erosion with a significant serous
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discharge. The process is accompanied by severe itching. What is the most likely
diagnosis?
A. True eczema
B. Allergic dermatitis
C. Microbial eczema
D. Simple contact dermatitis
E. Toxicodermia
Case presentation 5
A 36-year-old patient complains of skin rash that appeared a week ago and
doesn’t cause any subjective problems. Objectively: palm and sole skin is covered
with multiple lenticular disseminated papules not raised above the skin level. The
papules are reddish, dense on palpation and covered with keratinous squamae.
What is the provisional diagnosis?
A. Secondary syphilis
B. Verrucosis
C. Palmoplanar psoriasis
D. Palmoplanar rubrophytosis
E. Palm and sole callosity
Case presentation 6
A full-term infant is 3 days old. On the different parts of skin there are erythemas,
erosive spots, cracks, areas of epidermis peeling. The infant has scalded skin
syndrome. Nikolsky’s symptom is positive. General condition of the infant is
grave. Anxiety, hyperesthesia, febrile temperature are evident. What is the most
probable diagnosis?
A. Exfoliative dermatitis
B. Phlegmon of newborn
C. Finger’s pseudofurunculosis
D. Impetigo neonatorum
E. Mycotic erythema
Case presentation 7
A 72-year-old male patient complains of itching in his left shin, especially around
a trophic ulcer. Skin is reddened and edematous; there are some oozing lesions,
single yellowish crusts. Focus of affection is well defined. What is the most likely
diagnosis?
A. Microbial eczema
B. Allergic dermatitis
C. Seborrheic eczema
D. Cutaneous tuberculosis
E. Streptococcal impetigo
90
Case presentation 8
A patient with femoral neck fracture, who had to remain in bed in a forced
(supine) position for a long time, has developed dark-brown lesions along the
backbone; soft tissues are swollen, in the areas of maceration there is a foulsmelling liquid. Name the clinic-pathological type of necrosis:
A. Dry gangrene
B. Bedsore
C. Coagulation necrosis
D. Infarction
E. Sequestrum
Case presentation 9
Granulomas containing lymphocytes and macrophages were detected during
analysis of skin biopsy. Among macrophages there are large cells with fat
inclusions, which contain microorganisms in spheric packages (Virchow’s cells).
The following disease is based on the described type of hypersensitivity:
A. Rhinoscleroma
B. Syphilis
C. Leprosy
D. Tuberculosis
E. Epidemic typhus
Case presentation 10
A 45-year-old female patient has worked as a painter for 14years.Contacts with
synthetic paint result in face skin redness, swelling, intense itching, oozing
lesions. The symptoms disappear after the exposure to chemical agents, but recur
even at the smell of paint. The symptom intensity progresses with relapses. A
provisional diagnosis:
A. Occupational eczema
B. Simple contact dermatitis
C. Contact- type allergy
D. Toxicodermia
E. Recessive mutation
Case presentation 11
An 8-year-old girl has been admitted to the cardiology department. Objectively:
there is skin lesion over the extensor surfaces of joints with atrophic cicatrices,
depigmentation, and symmetrical affection of skeletal muscles (weakness,
edema, and hypotrophy) .What disease are these changes most typical for?
A. Dermatomyositis
B. Systemicscleroderma
C. Nodular periateritis
D. Systemic lupus erythematosus
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E. Reiter’s disease
Case presentation 12
A 40-year-old man developed skin redness and swelling in the neck area, where
eventually a small abscess developed. On section, the focus is dense and yellowgreen 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
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REFERENCES
1. Baker T., Nicolic G., O’Connor S. Practical Cardiology: An Approach to
the Management of Problems in Cardiology/ T. Baker, G. Nicolic, S.
O’Connor. – Elsevier Australia, 2008 – 405 p.
2. Bender J.R., Russel K.S., Rosenfeld L. E., Chaudry S. Oxford American
handbook of cardiology / J.R. Bender, K.S. Russel, L. E. Rosenfeld, S.
Chaudry. – Oxford University Press, 2011 – 706 p.
3. Dave A.M., Adelrahman A., Mehta V., Cavalieri S., Vivekanadan R.
Verification of Diagnosis in Tuberculosis: A Case Report and Discussion
/ A.M. Dave, A. Adelrahman, V. Mehta, S. Cavalieri, R. Vivekanadan.
– Cureus, 2017; 9(9): e1650 / https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC5669528/
4. Eldridge L. Alveoli Function, Structure, and Lung Disorders That Affect
Them – Verywellhealth, 2022 /https://www.verywellhealth.com/what-arealveoli-2249043
5. Glendinning Eric H., Holmström Beverly. English in Medicine: A Course
in Communication Skills. Cambridge University Press, 2005. 150p.
6. Kluwer
W.
Heart
and
Neck
Vessel
Assessment
/
http://downloads.lww.com/wolterskluwer_vitalstream_com/samplecontent/9780781762403_weber/ch18.pdf
7. Luthra A. 50 Cases in Clinical Cardiology: A Problem-Solving Approach
/ A. Luthra. – Jaypee Brothers Medical Publishers (P) LTD, 2014 – 253 p.
8. Maisch B., Pankuweit S., Karatolios K., Ristic A.D. Invasive Techniques
– from Diagnosis to Treatment / B. Maisch, S. Pankuweit, K. Karatolios,
A.D. Ristic. – Rheumatology, Volume 45, Issue suppl_4, October 2006,
Pages iv32–iv38, https://doi.org/10.1093/rheumatology/kel307
9. Mohan Harsh. Textbook of pathology. New Delhi/London/Philadelphia/
Panama. 7th edition. 2015, 954p.
10.Physiology. Frequently Asked Questions. Reasoning of tests tasks of
license exam ”Krok 1”for individual preparation for English-medium
students of medical and dental faculties / compilers: D.I. Marakushin,
L.V.Chernobay, R.V. Alekseienko, I.S. Karmazina, I.М. Isaeva, N.S.
Hloba , O.V. Vasylieva, S.V. Shenger, A.V. Goncharova. – Kharkov:
KhNMU, 2018.– 111 p.
11.Redman Stuart. English Vocabulary in Use. Intermediate. Cambridge
University Press, 2003, 263 p.
12.Study.com / https://study.com/learn/lesson/abnormal-sensations-medicalterms-esthesia-paresthesia.html
13.Teachmeanatomy / https://teachmeanatomy.info/neck/viscera/ larynx/
organ/
14.TestKrokorg.ua https://testkrok.org.ua/?lang=ru
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