Topic 1: Subject, tasks and methods of pathophysiology.
Topic 2: General nosology, etiology and pathogenesis.
1. A 49-year-old man was suffering 12 years ago from rheumatic myocarditis, endocarditis, and
insufficiency of mitral valve. Examinations showed the absence of inflammatory process,
sufficient minute blood volume. What is it?
A. Pathological reaction
B. Pathological process
C. Typical pathological process
D. Compensatory reaction
E. Pathological condition
2. The 12-year-old boy took part in sport events in light athletic. Weakness, headache, loss of
appetite, and rise in temperature to 37,8oC appeared in him on the next day. What period of
disease is it?
A. Final period of disease
B. Period of manifestation
C. Contact period
D. Latent period
E. Prodromal period
3. Pain in a left half of the chest and dyspnea appear in a patient during walking. This pain
increases during respiration. The attack of the pain was stopped by using narcotics. At
examination of the patient following data were revealed: severe condition, respiratory rate is 28
per min., respiration is shallow and is dull in left axillary region. Blood pressure is 140/80
mmHg. Patient has sputum with blood. This patient has varicose dilation of veins. In purpose to
correct main pathogenetic link it is necessary to use: A. Antibiotics
B. Anticoagulants
C. Antihistamin preparations
D. Spasmolytics
E. Coronarilytics.
4. A 39-years-old patient has been suffering from gastric ulcer for last 4 years. Pain in epigastric
region, heartburn, nausea, and constipation appear mainly in autumn and spring. Name this
condition.
A. Remission
B. Acute period
C. Complication
D. Pathologic condition
E. Relapse
5. Gasping respiration appears in a patient with severe lung pathology. What terminal condition
is this characteristic for?
A. Agony
B. Pre-agony
C. Clinical death
D. Biological death
E. Terminal pause
6. A 10-yeaes-old child endured several rheumatic attacks. At examination of him it was
established that he had inflammatory process in his joints and signs of mitral valve insufficiency.
What pathological appearance in this patient may be attributed to “disease”?
A. Mitral valve disease
B. Mitral valve insufficiency
C. Rheumatism
D. Inflammation of joints
E. Arthritis
7. Which scientist emphasized senescence of connective tissue cells cytoplasm?
A. Bogomolets
B. Mechnikov
C. Dilman
D. Frolkis
E. Berdichev
8. A 12-year-old boy starts complaining on the headache, nausea, rigor, periodic myalgia, loss of
appetite, tiresome. Which period of disease characterizes by such symptoms?
A. Prodromal period
B. Latent period
C. Period of contact
D. Period of manifestation
E. Final period
9. A 28-year-old patient with symptoms of acute appendicitis was admitted to the surgical
department. Acute pains in his right epigastric area and near the umbilicus were registered during
palpation on examination. Schetkin-Blumberg symptom was positive. Which period of disease
was observed in that patient?
A. Period of manifestation
B. Latent period
C. Prodromal period
D. Final period
E. Period of functional disorder
10. Increase in pulse rate, respiratory rate, and increase of BP were noticed on a height of 1000
m above the sea in a 25-year-old woman, coming for holyday at mountainous resort. In some
time all those symptoms disappeared. Which process was noticed in a woman?
A. Adaptation
B. Compensation
C. Decompensation
D. Stress
E. Parabiosis
11. In a 50-year-old man, who was treated for gastric ulcer, digestion normalized, pains
disappeared, and mood is getting better. But in few weeks pains in epigastrium, heartburn, and
acid eructation develop again. How can one characterize such course of disease? A. Relapse
B. Remission
C. Terminal condition
D. Typical pathological process
E. Latent period
12. A man with the complex of deviation of his health is considered sick. What is the more
typically for disease?
A. Disorder of physiological regulation of functions
B. Decrease of ability to work
C. Disorder of immunity
D. Psychological deviations
E. Decrease of adaptation
ANSWERS:
1.-E, 2.-E, 3.-B, 4.-B, 5.-A, 6.-C, 7.-A, 8.-A, 9.-A, 10.-A, 11.-A, 12.-A.
Topic 3. Pathogenic action of environmental factors
1. A worker of radiological department was exposed to radiation once as result of violation of the
rules of safety appliances. Ulcerogangrenous stomatitis developed in him in 8 days. Patient’s
blood test showed: RBC – 3.2 x 1012/L, reticulocytes – 0.01 %, Hb – 60 g/L, WBC – 2.3 x 109/L,
and platelets – 50 x 109/L. Which period of radiation sickness are described changes typical for?
A. Period of primary reactions
B. Period of manifestation
C. Latent period
D. Pretended well-being period
E. Outcomes
2. Respiratory standstill developed in a man as a result of action of electric current from town
mains for 0.1 seconds with position of electrodes “right hand – head”. Indicate the most probable
reason for this complication.
A. Paralysis of inspiration center
B. Emotional stress
C. Paralysis of respiratory muscles
D. Reflex respiratory standstill (pain shock)
E. Total paralysis of respiratory center
3. Increase of body temperature up to 38.5oC, tachycardia, and BP of 160/85 mmHg were
noticed in a worker after prolonged work in conditions of “warming” microclimate. Disturbances
of heart rhythm were revealed in the patient at auscultation. Which electrolyte primary loss
affects adversely the heart work?
A. Potassium
B. Calcium
C. Magnesium
D. Sodium
E. Phosphate
4. Elevation of arterial pressure, tachycardia, and increase in body temperature to 38,8oC
developed in a patient during narcosis with myorelaxants. Which disturbance of heat exchange
appeared in this patient?
A. Fever
B. Physical hyperemia
C. Hit heat
D. Hypothermia
E. Hyperthermia
5. At violation of the rules of safety appliances an electric welder took electric wire by
unprotected and wet hand. Tonic contractions of muscles and involuntary urination developed in
him. Which effect of electric current becomes apparent in this case?
A. Electrochemical
B. Biological
C. Heat
D. Mechanical
E. -6. During long hypothermia of the organism phase of decompensation developed. Its feature is:
A. Decrease in blood pressure
B. Constriction of peripheral vessels
C. Rare respiration
D. Increase in muscle tone
E. Rigor
7. A man took electric wire with high tension by both hands. He died momentary in result of:
A. Intracerebral bleeding
B. Respiratory standstill
C. Cardiac fibrillation
D. Burns
E. Tearing extremities off
8. The main link in pathogenesis of kinetosis under radial acceleration is:
A. Excitation of motor nuclei of vagus nerve
B. Irritation of tactile receptors
C. Increase in muscular tone
D. Irritation of nuclei of vestibular nerve
E. Bradycardia
9. A worker, taking part in nuclear power plant breakdown elimination, was exposed to wholebody irradiation. Which organ or which tissue will tumor develop in?
A. Lung
B. Bone marrow
C. Stomach
D. Skin
E. Bone tissue
10. A worker, taking part in nuclear power plant breakdown elimination, was exposed to ionizing
radiation in dose of 6Gr. What changes in the blood will happen after 10 days?
A. Agranulocytosis
B. Limpocytosis
C. Leucocytosis and limphocytopenia
D. Basophilia
E. Eosiniphilia
11. A man had electric trauma. Current went through the myocardium. What dangerous
disorders in heart work needing emergency correction can appear in such situation?
A. Fibrillation of ventricles
B. Fibrillation of atria
C. Bradycardia
D. Tachycardia
E. Extrasystolia
12. A worker was exposed to ionizing radiation in dose of 5Gr after accident at nuclear power
plant. Agranulocytosis was revealed in him in a week. What is the basic pathogenic mechanism
in this case?
A. Increased outcome of mature leukocytes from bone marrow
B. Development of autoimmune processes
C. Increase in migration of granulocytes to tissues
D. Elevated destruction of leukocytes
E. Oppression of leucopoiesis
13. A patient has bone marrow form of radiation diseases. What lineages of hemopoiesis are
affected in this case?
A. All
B. Erythrocytic
C. Megakariocytic
D. Granulocytic
E. Agranulocytic
14. Symptoms of hemorrhage syndrome appeared in a patient with radiation sickness. Which
mechanism is leading one in pathogenesis of this syndrome?
A. Thrombocytopenia
B. Lymphopenia
C. Erythropenia
D. Eosinopenia
E. Neutropenia
15. A doctor revealed in a patient affected by electric current respiratory arrest and disturbances
of heart functions. What pathway did electric current go in this case?
A. Right hand - head
B. Left leg - right leg
C. Right leg - right hand
D. Left leg - right hand
E. Abdomen - right leg
16. Diver, working at depth of 60 m, was raised very quickly on surface after an accident. After a
time pain in the joints, skin itching appeared in him. What happened to diver?
A. Decompression diseases
B. High altitude diseases
C. Hyperbaric oxygenation
D. Lowering of reactivity
E. Compensatory adaptation
17. A galvanizer addressed to a doctor because of appearing of pink itching spots and vesicles on
his arms skin. He worked a lot with nickel compounds recently. What is the mechanism of these
lesions development?
A. Modification of skin proteins due to action of nickel ions with immunopathological
reaction development
B. Irritant action of nickel compounds on skin
C. Vegetative disorders related to nickel compounds received by respiratory tract
D. Infection of skin due to microtraumas
E. Nickel is a complete antigen
18. In consequence of accident in laboratory man was exposed to radiation in dose of 6Gr.
Which symptom is the most typical for latent period of acute radiation diseases?
A. Leukocytopenia
B. Headache
C. Depression
D. Vomiting
E. Diarrhea
19. A patient was admitted to the hospital with extensive burns of the body surface. Which
pathogenic factor of burn disease has to be liquidated in the first turn?
A. Intoxication of decay products
B. Plasma loss
C. Pain
D. Infection through the injured skin
E. Autoallergy
20. During running parallel experiments rats were exposed to prolonged direct solar radiation in
open chambers and in ones covered by glass. Tumor development at hair uncovered places of
skin was marked in animals residing in open chambers. Which factor influence does this
phenomena connected to?
A. Sun heat
B. Ultraviolet radiation
C. Biologic carcinogens
D. Exogenous chemical carcinogens
E. Infrared radiation
21. In consequence of accident at nuclear power plant radio-active products escape occurred.
Peoples, who were in zone of increased radiation, got dose of radiation about 250 – 300 Gr.
What symptom would be the leading one in these people?
A. Lymphocytosis
B. Anemia
C. Thrombocytopenia
D. Neutropenia
E. Leukocytosis
22. A man was admitted to the hospital after exposure to radiation in dose of 3Gr. Which
physiological system develops changes in the first turn in this patient?
A. Blood system
B. Cardiovascular system
C. Immune system
D. Alimentary system
E. Endocrine system
23. Headache, pain in ears, nasal hemorrhages appeared in the passengers during flight by
balloon. What serves the pathogenic base for these changes development?
A. Explosive decompression syndrome
B. Decompression syndrome
C. Hypoxia
D. Gas embolism
E. Toxic influence of gases dissolved in the blood
24. What is the reason for pneumonia development in children after cooling?
A. Microorganisms
B. General cooling
C. Decrease in reactivity due to previous diseases
D. Insufficiency of nutrition
E. All these factors
25. Which changes are connected to direct injurious action of ionizing radiation?
A. Inhibition of DNA-synthesis under the influence of radiotoxines
B. Radiolysis of water
C. Edema
D. Interaction between free radicals and enzymes
E. Injury of chromosomes
26. What reasons does high radiosensitivity of cells and tissues depend on?
A. High mitotic activity
B. Activation of glycolysis
C. Level of differentiation
D. Number of mitochondrias
E. Decrease of DNA-synthesis
27. Which changes in blood are typical for the first period of bone marrow form of acute
radiation diseases?
A. Leukocytosis
B. Agranulocytosis
C. Thrombocytopenia
D. Erithrocytopenia
E. Leukocytopenia
28. Among many factors determining severity of electrical injury the first place belongs to injury
of internal organs localized at the way which electric current passes through the body. Which
organ injury is the most dangerous?
A. Heart
B. Cerebrum
C. Lungs
D. Liver
E. Kidneys
29. A patient with III – IV degree burns of 50% of the body surface was admitted to the hospital.
He has depressed consciousness, bradycardia, and reduced blood pressure. What is the most
possible diagnosis?
A. Burn shock
B. Intoxication
C. Preagony
D. Collapse
E. Coma
30. A patient very often has diseases of nasopharynx, which appear under the influence of
different factors and in the most cases manifest by inflammation. Which of listed factors is the
most probable reason for these diseases?
A. Microorganisms
B. General cooling of organism
C. Overstrain
D. Immunodeficiency
E. Insufficiency of nutrition
31. A woman, who took part in liquidation of accident at Chernobyl nuclear power plant, was
admitted to the hospital with complaints of headache, pain in the heart, and worsening of general
condition. Changes of subcellular structures were found out in her, except:
A. Proteins
B. Nucleus
C. Lisosomes
D. Mitochondrion
E. Endoplasmic reticulum
32. A 45-year-old man suffering from hematoporphiria complains of burns of skin, appeared
after short-time (no more than 10 to 20 minutes) exposure to the sun, headache, nausea, and
dizziness. Explain the reason for this pathology?
A. Photoallergy
B. Sun stroke
C. Heat stroke
D. Photochemical burn
E. Hyperthermia
33. A liquidator of accident at Chernobyl nuclear power plant after carrying out works addressed
to a doctor with complaints of abrupt worsening of general state, significant weakness, increase
in body temperature up to 37,8oC, multiple punctate hemorrhages on skin and mucous
membranes, diarrhea. In the patient’s blood analysis ESR – 25 mm/h, RBC – 2,4x1012/L, WBC 2,2x109/L, platelets – 70x109/L. What period of radiation disease does this picture typical for?
A. Manifestation
B. First reaction
C. Pretended well-being period
D. Recovery
E. Outcome
ANSWERS:
1.-B, 2.-E, 3.-A, 4.-E, 5.-B, 6.-A, 7-C, 8.-D, 9.-B, 10.-A, 11.-A, 12.-E, 13.-A, 14.-A, 15.-A, 16.A, 17.-A, 18.-A, 19.-C, 20.-B, 21.-D. 22.-A, 23.-B, 24.-A, 25.-E, 26.-A, 27.-A, 28.-A, 29.-A,
30.-A, 31.-A, 32.-A, 33.-A.
Topic 4. The role of heredity and constitution
(somatotypes) in pathology
1. Three chromosomes of 21st pair were revealed in a baby by karyotyping. Mark the phenotypic
manifestation of this mutation.
A. Patau’s syndrome
B. Edward’s syndrome
C. Down’s syndrome
D. Turner’s syndrome
E. Polisomia Y-syndrome
2. Test of amniotic fluid for determination of sexual chromatin showed that fetus’s cells include
2 bodies of sexual chromatin (Bar’s bodies). Which disease was revealed in the fetus?
A. Klinefelter’s syndrome
B. Patau’s syndrome
C. Down’s syndrome
D. Edward;s syndrome
E. Trisomy X-syndrome
3. A 20-year-old man complains of headache, failing sight, muscular weakness. His height is
2.00 m, weight is 80 kg, he has long extremities, and kyphosis. On X-ray examination the skull
film showed enlargement of Turkish saddle. Sexual chromatin is absent. What pathway is the
most possible in appearance of gigantism in the young man?
A. Excess of growth hormone
B. Somatoliberin insufficiency
C. Gonadoliberin insufficiency
D. Testosterone insufficiency
E. Chromosomal mutation
4. A woman addressed to the medical-genetic consultation. Short neck with wing-shaped skin
folds (“sphinks’s neck”), broad chest, and mammary hypoplasia were revealed in her on
examination. What is the most possible diagnosis?
A. Patau’s syndrome
B. Syndrome of “cat’s cry”
C. Turner’s synrome
D. Morris’s syndrome
E. Klinefelter’s syndrome
5. A child being born in late marriage has short stature, mental retardation, thick geographic
tongue, narrow palpebral fissures, and flat broad face. What disturbance underlies development
of described syndrome?
A. Hereditary chromosomal pathology
B. Birth injury
C. Intrauterine intoxication
D. Intrauterine infection
E. Intrauterine immunoincompatible
6. Mother’s karyotype has 45 chromosomes. There was revealed that it connects with
translocation of the 21st chromosome to the 15th one. Which disease more possible would
develop in her child if the father’s karyotype is normal?
A. Down’s syndrome
B. Patau’s syndrome
C. Klinefelter syndrome
D. Morris’s syndrome
E. Edward’s syndrome
7. A child with hereditary defects manifested characteristic syndrome named “cat’s cry” just
after the birth. At that newborns have “meowing” timbre of their voice. In examination of the
karyotype of this child following was revealed:
A. Additional Y-chromosome
B. Additional 21st chromosome
C. Deletion of segment of 5th chromosome
D. Additional X-chromosome
E. Lack of X-chromosome
8. A woman addressed to the hospital with complaints of suppurating incised wound. A doctor
was cleaning the wound surface with 3% solution of H2O2. But foam did not form. What does
absence of preparation activity connected with?
A. Superficial wound
B. Low concentration of H2O2
C. Hereditary insufficiency of katalase
D. Hereditary insufficiency of erythrocyte phosphatdehydrogenese
E. Presence of pus in the wound
9. Sexual chromatin was revealed at examination of the buccal epithelium of a man. Which
chromosomal disease is characterized by this symptom?
A. Down’s disease
B. Trisomy X-chromosome
C. Turner’s syndrome
D. Hypophosphatemic rickets
E. Klinefelter’s syndrome
10. A 10-month old baby has fair hair, very white skin and blue eyes. His parents have dark hair.
He had normal appearance, but during last three months impairment of cerebral circulation and
mental retardation developed in him. The reason for such condition can be:
A. Glycogenose
B. Acute porphyry
C. Hystidinemia
D. Lactosemia
E. Phenylketonuria
11. Daltonism (color blindness) was revealed in a 7-year-old boy at examination. His parents are
healthy. But his mother’s father had the same anomaly. Which is the type of inheritance of this
anomaly?
A. X-linked dominant
B. Autosomal dominant
C. X-linked recessive
D. Autosomal recessive
E. Partial dominance
12. Two types of cells with chromosomal set 46XY and 47XXY in the equal quantity were
revealed at examination of karyotype of the patient. What is the most possible diagnosis?
A. X-syndrome monosomia
B. Down’s syndrome
C. Normal karyotype
D. Kleinefelter’s syndrome
E. Patau’s syndrome
13. A 14-year old girl has short stature, absence of pubescence, very short neck, broad shoulders,
and normal intelligence. What disease does the girl have?
A. Klinefelter’s syndrome
B. Patau’s syndrome
C. Edward’s syndrome
D. Down’s syndrome
E. Turner’s syndrome
14. A 5-year old girl’s karyotype has 46 chromosomes. But one chromosome of the 15th pair is
longer than normal one, since it joins chromosome from 21st pair. What type of mutation is
present in the girl?
A. Duplication
B. Deletion
C. Inversion
D. Shortage
E. Translocation
15. The father of a pregnant woman suffers from gemeralopia. This is an X-linked recessive
disorder. Her husband’s relatives didn’t suffer from this disease. What is possibility that her
child will suffer from gemeralopia, if it is a boy?
A. 50%
B. 0%
C. 75%
D. 100%
E. 25%
16. There is regurgitation of milk to the nose in an infant during a meal. Mark the possible
reason for this disturbance?
A. Harelip
B. Fracture of basis of skull
C. D. Septal deformity
E. Cleft palate
17. Elementary discrete unit of inheritance in both sexual and asexual reproduction is:
A. One chain of DNA molecule
B. One gene
C. One pair of nucleotides
D. Two chains of DNA molecule
E. One nucleotide
18. A 12-year-old boy has lower jaw carcinoma. What type of mutation underlies the tumor
development?
A. Non-lethal mutation of somatic cell
B. Lethal mutation of somatic cell
C. Non-lethal mutation of sexual cell mother or father
D. Non-lethal mutation of somatic cell in embryogenesis
E. Lethal mutation of somatic cell in embryogenesis
19. Child was born with hereditary pathology - cleft palate. What type of mutation underlies this
pathology?
A. Non-lethal mutation of somatic cell in embryogenesis
B. Non-lethal mutation of somatic cell
C. Lethal mutation of somatic cell
D. Non-lethal mutation of sexual cell mother or father
E. Lethal mutation of somatic cell in embryogenesis
20. A 10-year-old boy with mental retardation has typical appearance: small head with
chamfered nape, oblique slant of palpebral fissures, low-bridged nose, and half-open mouth. A
doctor is keeping him under observation in connection with congenital heart disease. What
violation of karyotype causes the pathology in this boy?
A. Trisomy of 21 pare of chromosome
B. Trisomy of 13 pare of chromosome
C. Trisomy of 18 pare of chromosome
D. Trisomy X
E. Monosomy of X-chromosome
21. A 25-year-old man complains of sterility. He is tall; he has asthenic body build and decrease
in intelligence. Bar’s bodies were revealed in biopsy of his buccal epithelium. What pathology it
may be?
A. Klinefelter’s syndrome
B. Adipopse-genital dystrophy
C. Acromegaly
D. Adrenogenital syndrome
E. Eunohoidism
22. Few drops of 5% solution of trichloroacetic iron were added to urine of a newborn. Color of
urine did not change. Phenylketonuria with irreversible brain injury was diagnosed in this child
at the age of two. Why was not phenylketonuria diagnosed in this newborn?
A. Analytic mistake was made
B. Wrong substrate was chosen
C. Wrong time was chosen
D. Reagent was prepared incorrectly
E. Wrong interpretation of results
23. Discharge of milk from nose was observed in a newborn during first feeding. Which inborn
defect of oral cavity can cause such condition?
A. This is normal occurrence
B. Absence of soft palate
C. Splitting of alveolar bone
D. Harelip
E. Cleft palate
24. A patient is short; he has mental retardation, epicanthic folds, and short fingers. The trisomy
of 21st pare of chromosome has been revealed in his karyotype. How is this chromosomal
anomaly referred to?
A. Down’s syndrome
B. Klinefelter’s syndrome
C. Turner’s syndrome
D. Trisomy X-syndrome
E. Specific fetopathy
25. In the second half of pregnancy a woman has disorders of blood circulation in placenta with
violation of all its functions: respiratory, trophic, protective, excretory, and hormonogenic. This
has led to development of secondary placental insufficiency syndrome. Which pathologic
process can develop in such conditions?
A. Gametopathy
B. Blastopathy
C. Embriopathy
D. Fetopathy
E. Galactosemia
26. A patient was exposed to ionizing radiation by accident. It has led to development of deletion
– a loss of chromosome segment. How is this pathologic happening referred to?
A. Mutation
B. Exudation
C. Alteration
D. Enzymopathy
E. Reparation
27. Mutation, inversion of one chromosome, has developed in a patient as a consequence of
ionizing radiation influence. How is pathogenic factor called, which evoked these pathologic
changes?
A. Physical mutagen
B. Chemical mutagen
C. Biological mutagen
D. Carcinogen
E. Virus
28. A patient has mutation of gene which is responsible for hemoglobin synthesis. It has lead to
development of sickle-cell anemia. What kind of pathological hemoglobin is found out this case?
A. Hb A
B. Hb A1
C. Hb F
D. Hb S
E. Bart-Hb
29. A patient has pathological processes resulted from X-linked gene mutation. This disease is
accompanied by deficiency of VIII factor of blood coagulation and prolongation of blood
coagulation time to 25 min. What is this disease?
A. Glaucoma
B. Hemophilia
C. Hemeralopia
D. Daltonism
E. Galactosemia
30. A teenager has asthenic body build, gynecomastia, and testicular atrophy. For verification of
diagnosis he was sent to medical-genetic consulting room. What karyotype will be found out in
this case?
A. 47 XXY, one Bar’s body
B. 47 XXY, two Bar’s bodies
C. 46 XY, Bar’s bodies are absent
D. 45 XO, Bar’s bodies are absent
E. 47 XXX, two Bar’s body
31. Healthy parents gave birth to a girl with blue eyes and fair hair. During the first months the
girl developed irritability, anxiety, disturbances of nutrition and sleep. Neurologist’s examination
established development delay in her. What genetic method has to be applied in this case?
A. Biochemical
B. Cytological
C. Gemellary
D. Genealogical
E. Population-statistic
32. In which variant of karyotype in nucleus of somatic cells only one Bar’s body can be found?
A. 47 XX, 15+
B. 45 XO
C. 45 XY
D.47 XY, 21+
E. 48 XXXY
33. A percentage of concordancy among monozygotic and dizygotic twins at following diseases
comprises relatively: tuberculosis – 66 and 23, schizophrenia - 69 and 10, epilepsy – 56 and 10,
harelip – 33 and 5, endemic goiter – 71 and 70. Taking into account this information, genotype is
not important for formation of
A. Endemic goiter
B. Harelip
C. Epilepsy
D. Schizophrenia
E. Tuberculosis
34. A 32-year-old man has tall stature, high-pitched voice, gynecomastia, adult woman pattern of
hair distribution, mental retardation, infertility. Klinefelter’s syndrome was diagnosed in him
previously. For diagnosis verification it is important to examine:
A. Karyotype
B. Rhesus-factor
C. Spermatogenesis
D. Blood group
E. Genealogy
35. 46 chromosomes were revealed at patient with signs of Down’s syndrome. What kind of
chromosomal anomalies have led to this disease?
A. Translocation
B. Inversion
C. Deletion
D. Duplication
E. Circling
36. Father has astigmatism and mother is healthy. What is possibility that their children will
suffer from astigmatism?
A. 50%
B. 100%
C. 75%
D. 25%
E. 0%
37. A 3-year-old child has edematous skin, frequent inflammations with marked exudations, and
prolonged allergic reactions. Which type of diathesis does this child have?
A. Exudative
B. Asthenic
C. Lymphohypoplastic diathesis
D. Gouty diathesis
E. Hemorrhage
38. Congenital diseases are diseases, which are:
A. Manifesting at birth of a child
B. All hereditary diseases
C. Hereditary dominant disorders
D. Result from pathologic labor
E. Transplacental infectious diseases
39. Which disorder is X-linked?
A. Hemophilia A
B. Klinefelter’s syndrome
C. Trisomy X-syndrome
D. Hypophosphatemic rickets
E. Short fingers
40. A patient has hernias, aortic aneurysm, long thin extremities, lens ectopia. Which hereditary
disease are these symptoms typical for?
A. Ehlers-Danlos’ syndrome
B. Marfan’s syndrome
C. Shegren’s syndrome
D. Mucopolysaccharidoses
E. Incomplete osteodgenesys
ANSWERS № 5
1.-C, 2.-E, 3.-A, 4.-C, 5.-A, 6.-A, 7.-C, 8.-C, 9.-E, 10.-E, 11.-C, 12.-D, 13.-E, 14.-E, 15.-A, 16.E, 17.-B, 18.-A, 19.-A, 20.-A, 21-A, 22.-C, 23.-E, 24.-A, 25.-D, 26.-A, 27.-A, 28.-D, 29.-B, 30.A, 31.-A, 32.-A, 33.-A, 34.-A, 35.-A, 36-A, 37.-A, 38.-A, 39.-A, 40.-A.
Topic 5. Role of reactivity in pathology. Immunologic reactivity.
1. There are no reactions of delayed type hypersensitivity in mice without hairs (nude mice). The
most possible reason for this pathology is:
A. Defect of phagocytosis
B. Disorders of hematopoiesis
C. Absence of thymus
D. Deficiency of components of complement system
E. Absence of gamma globulins in blood
2. Transplantation of skin was performed in a patient with wide spread burns. Graft swelled and
changed its color at 8th day and was rejected at 11th. What cells participate in this process?
A. Erythrocytes
B. Basophils
C. Eosinophils
D. B-lymphocytes
E. T-lymphocytes
3. Deficient content of immunoglobulins was revealed in a patient. What cells of immune system
produce immmunoglobulins?
A. Plasma cells
B. T-killers
C. B-lymphocytes
D. T-helpers
E. T-suppressors
4. Three times immunization of population was carried out by pertussis-diphtheria-tetanus
vaccine when the number of diphtheria cases rose. The levels of anybodies increased in the
blood of immunized people as a consequence of immunization. What cells produce these
proteins?
A. Acidophilic granulocytes
B. Neutrophilic granulocytes
C. Macrophages
D. Monocytes
E. Plasmocytes
5. It is known that plasma cells produce specific antibodies against the given antigen. Number of
plasma cells increases after introduction of antigen. What cells of peripheral blood serve as
precursors of plasma cells?
A. Neutrophils
B. B-lymphocytes
C. Basophils
D. T-lymphocytes
E. Eosinophils
6. Formation of T-helpers is held up in thymus. What processes of immunogenesis in connective
tissue will be violated at first?
A. Phagocytosis of antigens by macrophages
B. Opsonization
C. Conversion of B-lymphocytes to plasma cells
D. Phagocytosis of foreign entities
E. Formation of precursors of T-lymphocytes
7. Transplantation of donor heart was performed in a patient. What conditions have to be
observed to prevent transplant rejection?
A. Selection of donor according to HLA
B. Transplantation of bone marrow
C. Transfusion of donor’s blood
D. Removal of spleen
E. Administration of immunomodulators
8. A patient was operated for acute purulent appendicitis. He cannot be discharged from the
hospital for a long time because of bed healing of post-operative wound. He has diabetes
mellitus for many years, repeated pyoderma, furunculosis, stomatitis, and gingivitis. What is the
reason for decreased immunologic reactivity?
A. Hyperglycemia
B. Hypercholesterolemia
C. Hyperketonemia
D. Hypohydration
E. Protein metabolism violation
9. It is known that reactivity of the organism is opposite to its resistance during some
pathological processes. What pathological process can appear in such situation?
A. Fever
B. Shock
C. Inflammation
D. Posthemorrhage anemia
E. Arterial hypertension
10. Macrophages surrounded with alien erythrocytes were found at microscopic examination of
smear of exudation took from a rat suffering from aseptic peritonitis with addition of bird
erythrocytes. What stage of phagocytosis does this occurrence correspond to?
A. Incomplete phagocytosis
B. Adhesion
C. Hemotaxis
D. Engulfment
E. Intracellular digestion
11. A 3-year-old boy suffering from chronic pneumonia has low indices of B-lymphocyte
system. Bruton’s hypogammaglobulinemia was diagnosed in him. What is the consequence of Blymphocyte system deficiency?
A. Decreased resistance of organism to pyogenic coccus flora
B. Decreased resistance of organism to viruses
C. Decreased resistance of organism to fungous and tuberculosis infection
D. Absence of graft rejection reactions
F. Increased risk of tumor development in organism
12. Considerable edema of lips appeared in a 25-year-old man in dentist’s office few minutes
later washing his mouth with solution of furacillin. Which type of allergic reaction is observed in
this case?
A. Immune complex-mediated
B. Delayed-type hypersensitivity
C. Anaphylactic
D. Stimulating
E. Cytotoxic
13. Child has congenital heart disease, face defect, absence of thyroid gland and thymus, and Tlymphocytes in blood. What hereditary pathology are these symptoms connected with?
A. Di George syndrome
B. Luis-Barr syndrome
C. Turner’s syndrome
D. Down’s disease
F. Bruton’s disease
14. A patient with thyrotoxicosis has antithyroid antibodies in his blood. Which type of allergic
reactions is observed in this case?
A. Cytotoxic
B. Stimulating
C. Delayed-type hypersensitivity
D. Anaphylactic
E. Immune complex-mediated
15. A 2-month-old girl with pneumonia was admitted to pediatric department. She bore otitis and
pneumonia a month ago. Dicrease in levels of gamma-globulins by 2 times was found at her
examination. Which disorder of immune system is it?
A. Luis-Barr syndrome
B. Physiological hypogammaglobulinemia
C. Late hypogammaglobulinemia
D. Swiss type of immune deficiency
E. Di George syndrome
16. A 2-year-old boy has frequent bacterial infections since 2 months. Allergic reaction to
tuberculin (IV type) is positive. Which immunodeficiency is more possible at this patient?
A. Congenital B-lymphocytes insufficiency
B. Congenital T-lymphocytes insufficiency
C. Congenital T-suppressors defect
D. Congenital total immunodeficiency
E. Acquired immunodeficiency
17. Association of staphylococcus aureus and staphylococcus epidermidis are found in numerous
skin pustules at 25-year-old patient. Pneumocysta carinia is found in his sputum analysis.
Cryptosporidia, proteus vulgaris and fungi of candida genus are found in his stool. Which
disease is accompanied by such multiple infections with conditionally-pathogenic
microorganisms?
A. Dysbacteriosis
B. AIDS
C. Sepsis
D. Diabetes mellitus
E. Drag agranulocytosis
18. A 25-year-old man complains of frequent inflammation diseases of different localization. He
is injection drug addict. HIV-test was positive at him. What types of cells are damaged more
substantially in case of HIV?
A. Neutrophilic granulocytes
B. Plasmocytes
C. Macrofages
D. T-helpers
E. NK-cells
19. A 12-year-old boy with hereditary disease has eczema, 4 cases of pneumonia in his
anamnesis, bleedings. Low level of T-lymphocytes, decreased levels of IgM, normal levels of
IgA was found in his blood. What disease does the boy have?
A. Wiskott-Aldrich syndrome
B. Luis-Barr syndrome
C. Bruton’s disease
D. Late hypogammaglobulinemia
E. Early hypogammaglobulinemia
20. A newborn has recurring respiratory tract diseases, pustule affections of the skin, severe
clinical course of herpes infection and recurring candidiasis (thrush). Inoculation against
smallpox and BCG-vaccination was accompanied by severe complication in him. All classes of
immunoglobulins were decreased in his immunological test. Delayed-type hypersensitivity
reactions were absent in him. What cells insufficiency underlies this immunodeficiency
syndrome?
A. Neutrophiles
B. T- and B-lymphocytes
C. Macrophages
D. Fibroblasts
E. T-suppressors
21. Father has rhesus-positive erythrocytes and mother’s blood is rhesus-negative. Severe
hemolytic anemia has developed just after birth in their second child. What is the mechanism of
massive hemolysis at newborn’s organism?
A. Toxemia of pregnancy
B. Antenatal intoxication
C. Antenatal infection
D. Genetic deficit of erythrocytes
E. Immune hemolysis
22. A 1-year-old boy becomes very often ill with respiratory and pustular skin diseases. Even
little damages become complicated by long-time purulent inflammation. All classes of
immunoglobulins are nearly absent from the child’s blood. Contents of all leukocyte types and
reactions of delayed-type hypersensitivity are normal. What cells inherited decrease in functional
activity underlies this syndrome?
A. T-lymphocytes
B. B-lymphocytes
C. Neutrophils
D. Eosinophils
E. Endoteliocytes
23. Decrease in levels of IgG and particularly IgA, IgM was found during examination of
immune status in 5-year-old boy. B-lymphocytes and plasma cells are absent from his blood and
lymph nodes. Reactions of T-lymphocytes are normal. This is inherited sex-linked disease. What
diagnosis is more possible?
A. Bruton’s disease
B. Luis-Barr syndrome
C. Wiskott-Aldrich syndrome
D. Swiss type of immunodeficiency
E. Early hypogammaglobulinemia
24. The reasons for disturbances of phagocytosis may be qualitative disorders of phagocytes.
What changes of intracellular structures are more typical for “lazy leucocytes” syndrome?
A. Chemotaxin and opsonin receptors
B. Microfilaments
C. Specific membrane glycoprotein (GP 110)
D. Microtubules
E. Bactericidal system
25. A 9-year-old girl was getting breast feeding during the first year of life. She suffered
prolonged severe pneumonia in the end of the first year. She started walking late. Her gait was
unsteady and her movements were discoordinated. Telangiectasia appeared in her skin and
conjunctivas. IgA is absent from and levels of T-lymphocytes is decreased in her blood. What
immunodeficiency disease does the girl have?
A. Luis-Barr syndrome
B. Wiskott-Aldrich syndrome
C. Chediak-Higashi syndrome
D. Swiss type of immunodeficiency
E. Di George syndrome
26. Immune system is depressed in a patient with HIV-infection. What cells damage contributes
more to immunodeficiency at this patient?
A. T-suppressors
B. Macrophages
C. T-helpers
D. B-lymphocytes
E. T-killers
27. A 2-year-old patient suffering from chronic pneumonia has decrease in quantity of Blymphocytes, IgM and IgG. What microorganisms can cause development of this disease?
A. Candidas
B. Mycobacterium tuberculosis
C. Herpes virus
D. Adenovirus
E. Staphylococcus
28. Disorder of cellular immunity was revealed during investigation of immune system in the
patient with chronic fungus affection of the skin. What indexes decrease more typically in this
case?
A. IgG
B. IgE
C. T-lymphocytes
D. B-lymphocytes
E. Plasma cells
29. Mantoux test was made to sick child on suspicion of tuberculosis. Swelling, hyperemia and
painfulness occur in the allergen injection place in 24 hours. What components determinate this
reaction of organism?
A. Mononuclear cells, T-lymphocytes and lymphokines
B. B-lymphocytes and IgM
C. Plasma cells, T-lymphocytes and lymphokines
D. Granulocytes, T-lymphocytes and IgG
E. Macrophages, B-lymphocytes and monocytes
30. A patient was suffering from chronic renal insufficiency. He has renal transplantation from
donor, who died in motorcar accident. Donor had blood group same as recipient. Renal
insufficiency occurs in patient again after a time. Which system incompatibility takes part in
transplant rejection?
A. ABO
B. RH
C. MNS
D. HLA
E. Kel-Chelano
31. HIV-infection was suspected at a patient of dental clinics. What cells are damaged at first in
patient with AIDS?
A. T-helpers
B. T-suppressors
C. T-killers
D. B-lymphocytes
E. Macrophages
32. A 48-year-old patient suffers from frequent mycotic lesions and pyoderma at surface of trunk
for a long time. He has alcohol abuse in his anamnesis. What promotes realization of disease
reason in this case?
A. Damage of the blood-brain barrier
B. Primary immunodeficiency
C. Decreased barrier function of the liver
D. Allergy
E. Chronic pneumonia
33. A 10-year-old girl suffers from viral and mycotic diseases very often. She has congenital
heart disease and insufficiency of thyroid gland. T-lymphocytes is absent from her
immunological test. What disorder of immune system takes place in this case?
A. Bruton’s hypogammaglobulinemia
B. Mixed immunodeficiency
C. Terner’s syndrome
D. Hypoplasia of thymus
E. Inherited defect of complement system
34. Pneumonias and pyodermas very often occur in 5-year-old boy, as well as in his grandfather.
B-lymphocytes are absent from their immunological test. What disorder of immune system takes
place in this case?
A. Bruton’s hypogammaglobulinemia
B. Hypoplasia of thymus
C. Mixed immunodeficiency
D. Terner’s syndrome
E. Inherited defect of complement system
35. Viral and bacterial infections, eczema often occur in a 12-year-old boy. Decreased quantity
of T-lymphocytes and IgM and normal levels of IgG and IgA are found in him at examination.
What kind of immune pathology is observed in this case?
A. Hypoplasia of thymus
B. Mixed immunodeficiency
C. Bruton’s hypogammaglobulinemia
D. Terner’s syndrome
E. Inherited defect of complement system
36. A 20-year-old woman with intestinal polyposis has frequent mycotic and viral diseases in her
anamnesis. What link of immune system is insufficient more possibly in this case?
A. T-lymphocytes
B. B-lymphocytes
C. Natural killers
D. Complement
E. Phagocytosis
37. Which of following is immunodeficiency disease?
A. Inherited disorder of immune system
B. Decrease of immune reactions under avitaminosis
C. Insufficiency of immune reactions after exposure to ionizing radiation
D. Disorder of formation antibodies as consequences of protein starvation
E. Decrease in immune reactions under cytostatic drugs action
38. A Patient needs renal transplantation. What kind of transplantation more expedient?
A. Syngenic
B. Xenogenic
C. Autogenic
D. Allogenic
E. Explantation
39. Heart transplantation is indicated for the patient. What kind of transplantation more
expedient?
A. Syngenic
B. Xenogenic
C. Autogenic
D. Allogenic
E. Explantation
40. The main role in pathogenesis of diseases, which occur in case of B-lymphocytes
immunodeficiency, plays:
A. Immunoglobulin synthesis disorders
B. Cellular type immune reaction disorders
C. Loss of ability to graft rejection
D. Decrease in delayed-type hypersensitivity
E. Decrease in antitumor immunity
41. A newborn has convulsive syndrome and heart interventricular septum defect. Thymic
hypoplasia was revealed by X-ray examination of his chest. What immunodeficiency may be
supposed in this patient?
A. Di George syndrome
B. Bruton’s disease
C. Wiskott-Aldrich syndrome
D. Good’s syndrome
E. Luis-Barr syndrome
42. A 15-year-old patient was admitted to allergologic department with bronchial asthma. What
immunoglobulins excessive production can result in main clinical symptoms development in this
patient?
A. IgE
B. IgA
C. IgG
D. IgM
E. IgD
ANSWERS:
1-C, 2-E, 3-A, 4-E, 5-B, 6-C, 7-A, 8-E, 9-B, 10-B, 11-A, 12-C, 13-A, 14.-B, 15-B, 16-A, 17-B,
18-D, 19-A, 20-B, 21-E, 22-B, 23-A, 24-A, 25-A, 26-C, 27-E, 28-C, 29-A, 30-D, 31-A, 32-C,
33-D. 34-A, 35-B, 36-A, 37-A, 38-A, 39-D, 40-A, 41-A, 42-A.
Allergy
1. Pain in the heart and joints and pneumonia appeared in a patient three weeks later acute
myocardial infarction. What is the main mechanism of development of post-infarction Dressler’s
syndrome?
A. Ischemia of myocardium
B. Resorption of enzymes from necrotized area of myocardium
C. Secondary infection
D. Thrombosis of vessels
E. Autoimmune inflammation
2. A patient addressed to a dentist with complaints of redness and edema of mucous membrane
of his mouth a month later dental prosthesis. Allergic stomatitis was diagnosed in this patient.
What type of allergic reaction by Gell and Cumbs underlies this disease?
A. Cytotoxic
B. Delayed-type hypersensitivity
C. Immune complex-mediated
D. Anaphylactic
E. Stimulating
3. Anaphylactic shock developed in a patient with botulism after second injection of antitoxic
antibotulinus serum mixture. What is the main mechanism of anaphylaxis?
A. Interaction of T-lymphocytes with mediators
B. Interaction of antigen with IgM
C. Interaction of macrophages with antigens
D. Interaction of antigen with IgE
E. Interaction of T-lymphocytes with tissue basophils
4. In a 27-years-old man tuberculin test was carried out. Following was observed 24 hours later:
infiltration with size of 40x35 mm at the site of injection and hyperemia of skin above it. What
group of biologic active substances causes development of allergic inflammation in this patient?
A. Lymphokines
B. Biogenic amines
C. Prostaglandins
D. Leukotriens
E. Kinins
5. Purulent endometritis developed in a woman after delivery. Treating with antibiotics inhibitors of murein synthesis was ineffective. Wide spectrum bactericidal antibiotic was
administered to her. 6 hours later temperature rapidly increased up to 40 oC with shivering, pains
in muscles appeared, BP dropped down to 70/40 mmHg, and oligura developed in this woman.
What is the main reason for this condition development?
A. Endotoxic shock
B. Toxic effect of preparation
C. Internal bleeding
D. Anaphylactic shock
E. Bacteremia
6. A 24-years-old patient has edema of face and increase in BP, which appeared 1.5 weeks later
severe streptococcus tonsillitis. The patient has hematuria and proteinuria of 1.2 g/L. Antistreptococcus antibodies and decrease in content of compliment system components were
revealed in patient’s blood. Which microvessels do deposits of immune complexes localize in
and cause nephropathy?
A. Proximal tubules
B. Glomerule
C. Descendent tubules
D. Loop of Henle
E. Pyramids
7. Nausea, fatigue, stomachache, palpitation, difficult respiration, and skin blisters developed in
a patient 25 minutes later injection of antibiotics. What stage of allergic reaction is observed in
this patient?
A. Pathochemical
B. Biochemical
C. Pathophysiological
D. Immunological
E. Sensibilization
8. Skin tuberculin test was carried out in a patient with chronic lung tuberculosis. Local
hyperemia and edema appeared in the site of inracutaneous introduction of tuberculin
preparation within 24-48 hours. What cells are primary effectors in mechanism of this reaction?
A. Neutrophils
B. T-lymphocytes
C. B-lymphocytes
D. Endotheliocytes
E. Smooth muscle cells of microvessels
9. Hyperemia, swelling and then necrosis of tissue, their rejection and ulcer (Arthus
phenomenon) develop at the rabbit in the place of secondary intracutaneus injection of a
substance with strongly pronounced antigenic properties (for example horse serum). What
factors play the main role in pathogenesis of this phenomenon?
A. Antibodies presented by IgE
B. Antibodies presented by IgD
C. Antibodies presented by IgA
D. Antibodies presented by IgG and/or IgM
E. Specific T-lymphocytes-effectors
10. Skin rash, itching, swelling and pain in joints, increase in body temperature, and proteinuria
appeared in a patient in 5-8 days after use lots of medical serum. Serum sickness was diagnosed.
What is the main factor in pathogenesis of this syndrome?
A. Primary systemic accumulation of circulating immune complexes in the blood
B. Primary systemic degranulation of mast cells in the organism
C. Primary systemic activation of T-killers
D. Primary systemic activation of endoteliocytes
E. Primary systemic cytolysis of blood cells
11. Allergic diagnostic tests are used for the diagnosis of many infectious diseases (tuberculosis,
brucelosis, tularemia etc). Diagnosis is confirmed if papula and redness appear in the place of the
allergen injection. Antigens interaction reaction is conditioned by:
A. IgE and lymphokines
B. IgM and macrophages
C. T-lymphocytes and lymphokines
D. IgE and T-lymphocytes
E. IgM and tissue basophiles
12. Catarrhal inflammation of bulbar conjunctiva and nose mucous membrane develop in patient
every year in spring and early summer, when trees and flowers are in blossom. Production of
specific antibodies to pollen underlies this syndrome. What cells activate and develop exocytosis
in this syndrome?
A. Neutrophils
B. Macrophages
C. Lymphocytes
D. Mast cells
E. Throbocytes
13. An 18-year-old man with shoulder phlegmon got intramuscular injection of penicillin.
Tachycardia, thread-like pulse; decrease in BP down to 80/60 mmHg occur after that. What kind
of pharmacologic reaction develops?
A. Potentiation
B. Reflex action
C. Central action
D. Anaphylaxis
E. Peripheral action
14. Patient has been wearing removable dental prosthesis for 7 days. Soreness, swelling and
hyperemia of prosthesis bed appear in the patient after that. Inflammation subsides after
prosthesis taking off and develops again after prosthesis putting on. What process underlies the
inflammation development?
A. Mechanical irritation
B. Hypersalivation
C. Hyposalivation
D. Resorption
E. Secretion
15. Thyrotoxicosis was diagnosed in a patient. Antithyroid antibodies were found in his blood.
Which type of allergic reaction is observed at development of this disease?
A. Immune complex-mediated
B. Stimulating
C. Anaphylactic
D. Cytotoxic
E. Delayed type hypersensitivity
16. Hives, itching of the skin, swelling of the skin and mucous membranes, swelling of
lymphatic nodes develop in the patient in 9 days after injection of medicinal serum. What disease
develops?
A. Pollinosis
B. Serum sickness
C. Shwartzman’s phenomenon
D. Overy phenomenon
E. Quincke’s edema
17. Dressler’s syndrome was diagnosed at the patient 1.5 month later myocardium infarction. It
is characterized by pericarditis, pleurisy, and pneumonia. What is the reason for this syndrome?
A. Sensitization of the organism by myocardium antigens
B. Decrease in resistance to microorganisms
C. Activation of saprophytic microflora
D. Intoxication of organism by products of necrosis
E. Release of myocardial enzymes to the blood
18. It is known that bronchial asthma develops by mechanism of immediate hypersensitivity,
which includes 3 sequential stages:
A. Immunological, pathochemical, pathophisiological
B. Pathochemical, pathophisiological, immunological
C. Pathochemical, immunological, pathophisiological
D. Pathophisiological, immunological, pathochemical
E. Pathophisiological, pathochemical, immunological
19. A 20-year-old man has injury of the right testicle. What danger does it brings for the left
(healthy) testicle?
A. Mimicry of antigens and development of antibody-mediated damage
B. Development of infectious process
C. Development of atrophy
D. Development of hypertrophy
E. No danger
20. Guinea-pig’s nephrocytotoxic serum was injected to the rabbit under the experiment. What
human disease is modeled in this case?
A. Nephrotic syndrome
B. Acute pyelonephritis
C. Chronic renal insufficiency
D. Acute diffuse glomerulonephritis
E. Chronic pyelonephritis
21. Acute glomerulonephritis appeared in the patient 2 weeks later purulent tonsillitis.
Antibodies against microorganism antigens were found at the patient. Which microorganism are
these antibodies against?
A. Hemolytic streptococcus
B. Staphylococcus
C. Pneumococcus
D. Mycobacterium tuberculosis
E. Meningococcus
22. Severe edema of soft tissues of upper and lower jaws, rash on the skin of face, redness, and
itching appear in the patient in response to using anesthetic drag at tooth extraction. Which
pathological process underlies the reaction to anesthetic?
A. Inflammation
B. Drag toxic action
C. Allergy
D. Insufficiency of blood circulation
E. Disorder of lymph outflow
23. Novocain was injected by dentist for anesthesia at tooth extraction. Symptoms of
anaphylactic shock appeared at the patient few minutes later. Patient has drop of BP, tachypnea,
loss of consciousness and convulsions. What type of reaction is it?
A. Immediate type hypersensitivity
B. Cytolytic or cytotoxic reactions
C. Arthus phenomenon reactions
D. Delayed type hypersensitivity
E. Stimulating allergic reaction
24. Man with the caries is subjected to constant sensitization by streptococcus antigen. What
disease can appear due to this etiological factor?
A. Glomerulonephritis
B. Pancreatitis
C. Myocarditis
D. Pulpits
E. Periodontitis
25. Antitoxic diphtheria serum was introduced to a child suffering from diphtheria. Skin eruption
accompanied by itching, increase in body temperature to 38oC, and pain in joints occurred in
patient 10 days later. What is the reason for these symptoms?
A. Contact allergy
B. Serum sickness
C. Atopy
D. Anaphylactic reaction
E. Delayed type hypersensitivity
26. Tuberculin was injected intraperitoneally to animal, which was sensitized by it. Venous
hyperemia and peritoneal edema were revealed 24 hours later in laparotomy. High quantity of
lymphocytes and monocytes were found in peritoneum smears. What pathological process does
the animal have?
A. Fibrinous inflammation
B. Allergic inflammation
C. Aseptic inflammation
D. Serous inflammation
E. Purulent inflammation
27. A dentist injected ultracain to a patient before tooth extraction for the purpose of anesthesia.
Sensitivity test was not made. Anaphylactic shook developed in the patient in few minutes after
drag injection. What cells produce reagins, which take part in development of anaphylactic
reaction?
A. Plasma cells
B. B-lymphocytes
C. T-lymphocytes
D. Mast cells
E. Eozinophiles
28. Tooth was extracted in a teenager under Novocain anesthesia. Paleness of skin, dyspnea and
hypotension occurred in the patient 10 minutes later. What type of allergic reaction is it?
A. Anaphylactic
B. Cytotoxic
C. Arthus phenomenon type
D. Delayed type hypersensitivity
E. Stimulating
29. Tooth was extracted in a teenager under Novocain anesthesia. Paleness of skin, dyspnea and
hypotension occurred in the patient 10 minutes later. What substance does allergen react with on
the surface of mast cells?
A. IgE
B. T-lymphocytes
C. IgA
D. IgD
E. IgM
30. A 27-year-old woman instilled drops with penicillin to the eyes. Itching and burning pain of
skin, edema of lips and eyelids, cough with whistling, decreasing in BP occur in her some
minutes later. What immunoglobulin participates in development of these allergic reactions?
A. IgE
B. IgG and IgM
C. IgA
D. IgM
E. IgG
31. A 43-year-old woman is suffering from pneumonia. She began complaining of weakness,
face and arms burning pain in 10 minutes after ampicillinum injection. Cough, dyspnea, pain in
the chest developed in her. At clinical examination patient has cyanosis, eyelids swelling, face
red rashes, heart rate – 120 per minute, BP – 120 mmHg, muffled heart sounds, hypopnoe and
tachypnea, respiration with different moist rales. What is the reason for worsening of patient’s
condition?
A. Anaphylactic shook
B. Urticaria
C. Quincke’s edema
D. Attack of asthma
E. Pulmonary thromboembolism
32. 0.1 ml of horse serum was injected to the guinea-pig for sensitization. What are external
signs of sensitization?
A. No external signs
B. Skin rashes
C. Joints swelling
D. Increase in body temperature
E. Pain
33. A 15-year-old girl is suffering from bronchial asthma. Severe attack of expiratory dyspnea
develops in her during the spring blossoming period. What biological active substance causes
spasm of bronchial smooth muscle in this case?
A. Leukotriene
B. Thromboxane A2
C. Prostacyclin
D. Bradykinin
E. Serotonin
34. Patient addressed to a doctor with complaints of headache, rhinitis, weakness, and increase in
body temperature developing every spring in blossoming period. What type of allergic reaction
by Gell and Cumbs underlies this disease?
A. Anaphylactic
B. Cytotoxic
C. Antibody-dependent cell-mediated cytotoxicity
D. Immune complex-mediated
E. Delayed type hypersensitivity
35. Weakness, itching of skin, acute spasmodic pain in the abdomen, hyperemia and rash on
skin, tachycardia, and decrease in BP down to 70/40 mm Hg suddenly developed in a patient few
minutes later Novocain injection by the dentist. Which type of allergic reactions does this
pathology belong to?
A. Anaphylactic
B. Cytotoxic
C. Stimulating
D. Cell-mediated
E. Immune complex-mediated
36. Contact dermatitis of upper extremities developed in the nurse, who has been working in
manipulation room for 20 years. Which type of allergic reactions does this pathology belong to?
A. Delayed-type hypersensitivity
B. Primary immunodeficiency
C. Immediate type hypersensitivity
D. B-cells immunodeficiency
E. T-cells immunodeficiency
37. Pain in the joints and loins, hemorrhagic eruptions on the skin, and increase in body
temperature occur in the patient with toxemic stage of burn disease in 2 hours after allogenic
plasma transfusion. What allergic reaction takes place in this case?
A. Serum sickness
B. Urticaria
C. Quincke’s edema
D. Anaphylactic
E. Autoimmune vasculitis
38. Hyperergic inflammation form of upper respiratory tract (larynx, trachea, bronchi) develops
at 6-year-old child. Threat of respiratory impairment develops and then necessity of using antiinflammatory hormones occurs. Which hormone has anti-inflammatory property?
A. Cortisol
B. Adrenaline
C. Growth hormone
D. Testosterone
E. Insulin
39. Swelling, increased BP, proteinuria, hematuria, decreased urine excretion were revealed in
the patient, which suffered severe tonsillitis before. These symptoms are typical of acute
glomerulonephritis, resulting from damage of glomerular basement membrane. What is
mechanism of this disease?
A. Anaphylactic allergic reactions
B. Cytotoxic allergic reactions
C. Immune complex-mediated allergic reaction
D. Delayed-type hypersensitivity
E. Stimulating allergic reaction
40. An 18-year-old patient has insulin-dependent diabetes mellitus I type. What type of allergic
reactions underlies beta cells damage?
A. II type, cytotoxic
B. I type, anaphylactic
C. III type, immune complex-mediated
D. IV type, delayed-type hypersensitivity
E. Pseudoallergic reaction
ANSWERS:
1-E, 2-B, 3-D, 4-A, 5-A, 6-B, 7-C, 8-B, 9-D, 10-A, 11-C, 12-D, 13-D, 14-D, 15-B, 16-B, 17-A,
18-A, 19-A, 20-D, 21-A, 22-C, 23-A, 24-A, 25-B, 26-B, 27-A, 28-A, 29-A, 30-A, 31-A, 32-A,
33-A, 34-A, 35-A, 36-A, 37-A, 38-A, 39-C, 40-A.
Topic 7. Disorders of microcirculation
1. A patient was admitted to the hospital with diagnosis of acute left-ventricle heart failure.
Patient’s condition suddenly became worse and edema of lungs developed in him. What kind of
disorders of peripheral blood circulation causes the lungs edema?
A. Arterial hyperemia neurotonic type
B. Arterial hyperemia neuroparalytic type
C. Arterial hyperemia metabolic type
D. Ischemia
E. Congestion (venous hyperemia)
2. Dependence of blood pressure upon level of peripheral vascular resistance was measured in
animal under experimental conditions. Indicate vessels, which have the most resistance.
A. Capillaries
B. Arteries
C. Aorta
D. Arterioles
E. Veins
3. A patient has obstruction of right calf profound veins, which results in increasing in amount of
blood in the impaired part of tissue. What is the name for increase in amount of blood resulted
from impeded blood outflow?
A. Venous hyperemia (congestion)
B. Thrombosis
C. Ischemia
D. Stasis
E. Arterial (active) hyperemia
4. A patient with paradontitis has edema of gums. His gums are dark red. What kind of local
blood flow disturbance takes place in patient’s gums?
A. Venous (passive) hyperemia
B. Arterial (active) hyperemia
C. Embolism
D. Thrombosis
E. Ischemia
5. Pain in leg at walking, cyanosis, and edema of calf appeared in a patient with varicosity. His
foot is cold. What kind of disturbances of regional blood flow appeared in this patient?
A. Angiospastic ischemia
B. Ischemic stasis
C. Compressive ischemia
D. Venous (passive) hyperemia
E. Obstructive ischemia
6. Edema and cyanosis of low extremities appear in a food shop assistant at the end of workday.
What is the main factor of edema development in this patient?
A. Dilatation of resistant vessels
B. Orthostatic increase of venous pressure
C. Increase of number of functional capillaries
D. Increase of collateral blood flow
E. Increase of tissue drainage
7. Redness and increase in volume of affected place of tissue, and increase in local temperature
are observed in a patient with burn of thigh. What pathologic process do indicated symptoms
correspond to?
A. Arterial hyperemia
B. Venous hyperemia
C. Thrombosis
D. Ischemia
E. Stasis
8. A 23-year-old woman had intense psycho-emotional excitement. Hyperemia of face skin,
tachycardia and increase in BP were observed in her. What is the mechanism of redness of her
face skin?
A. Congestive venous hyperemia
B. Neuroparalytic arterial hyperemia
C. Post-ischemic arterial hyperemia
D. Neurotonic arterial hyperemia
E. Stasis
9. Dyspnea, sharp pain in the chest, cyanosis, and jugular venous distention suddenly develop in
a patient with thrombophlebitis of lower extremities. What is the most possible disorder of blood
circulation developed in the patient?
A. Thromboembolism of coronary vessels
B. Thromboembolism of mesenteric vessels
C. Thromboembolism of cerebral vessels
D. Thromboembolism of portal vein
E. Thromboembolism of pulmonary artery
10. Burning in the mouth appears after taking of food with pungent dressings. At examination
mucosa of oral cavity is edematous, hyperemic, and bright red. What major reasons underlie
disorders of microcirculation?
A. Congestion
B. Neuroparalitic arterial hyperemia
C. Postischemic arterial hyperemia
D. Atonic hyperemia
E. Degranulation of tissue basophiles
11. A woman experienced a strong psycho-emotional excitement during dentist’s reception.
Redness of her face skin and profuse salivation were noticed at that time. What is the mechanism
of these phenomena?
A. Manifestation of sympathetonic effect
B. Stagnant venous hyperemia
C. Neuroparalitic arterial hyperemia
D. Postischemic arterial hyperemia
E. Neurotonic arterial hyperemia
12. Patient’s arm was put in plaster cast on account of simple fracture of humeral bone. Swelling,
cyanosis, and decrease in temperature of the traumatized arm appear next day. What disorder of
peripheral blood flow do these symptoms testify to?
A. Thrombosis
B. Venous hyperemia
C. Ischemia
D. Embolism
E. Arterial hyperemia
13. Injury of sympathetic fibers of the sciatic nerve developed in a patient due to trauma. What
kind of peripheral blood flow disorder takes place in the patient?
A. Neurotonic arterial hyperemia
B. Venous hyperemia
C. Angiospastic ischemia
D. Neuroparalitic arterial hyperemia
E. Obturative ischemia
14. A 42-year-old woman, shop assistant by profession, complains of edema of the lower
extremities at the end of a workday. Her legs are cyanotic, their temperature is decreased.
Venous hyperemia of lower extremities was established, which is due to constitutional weakness
of the elastic apparatus of veins and the occupation. What is the major pathogenic factor causing
local changes in venous hyperemia?
A. Disorders of metabolism
B. Hypoxia
C. Atrophy
D. Dystrophy
E. Sclerosis
15. Puncture of abdominal cavity for the extraction of fluid was performed to a 45-year-old
patient with diagnosis “cirrhosis of liver, ascites”. State of unconsciousness suddenly developed
in the patient as a result of decrease in blood pressure after extraction of 5L of fluid. That was
considered as a manifestation of brain blood circulation insufficiency. Which disorder of
microcirculation occurs in this case?
A. Ischemia
B. Arterial hyperemia
C. Venous hyperemia
D. Thrombosis
E. Embolism
16. Signs of disorders of microcirculation in form of venous hyperemia were observed in a
patient with gingivitis. This condition manifested by cyanosis and edema of mucosa and
decrease in local temperature. What is the major mechanism of congestion development?
A. Blood factors
B. Perivascular changes
C. Disturbances of lymph outflow
D. Exudation from vessels
E. Increased permeability of vessel wall
17. C. Bernard observed increase in secretion of submandibular salivary gland and development
of arterial hyperemia irritating chorda tympani (branch of nervus facialis) in an experiment.
What sort of arterial hyperemia it is according to mechanism of its development?
A. Neuroparalytic
B. Neurotonic
C. Metabolic
D. Reactive
E. Working
18. Thrombosis of coronary artery results in myocardial infarction. Which mechanisms will be
dominating ones in this disease?
A. Electrolytic-osmotic
B. Acidosis
C. Protein-dependent
D. Lipid-dependent
E. Calcium-dependent
19. One of the most dangerous points in myocardial infarction pathogenesis is enlargement of the
zone of necrosis, dystrophy, and ischemia. Increase in myocardial oxygen consumption plays
important role in development of indicated processes. What substances contribute to this
process?
A. Chlorine ion
B. Cholesterol
C. Catecholamines
D. Acetylcholine
E. Adenosine
20. High level of arterial blood pressure is observed in a patient with renal disease accompanied
by ischemia of renal parenchyma. What is the leading factor of increase in arterial blood pressure
in this patient?
A. Excess of angiotensin II
B. Excess of antidiuretic hormone
C. Augmentation of cardiac output
D. Increase in tonus of sympathetic nervous system
E. Hypercatecholaminemia
21. Patient has acute retrosternal pain irradiating into left arm, which cannot be controlled by the
nitroglycerine for 30 minutes. What kind of changes develop in the patient’s heart?
A. Myocardial ischemia
B. Pathological hypertrophy of myocardium
C. Sharp increase in coronary blood flow
D. Mitral valve insufficiency
E. Inflammation of pericardium
22. Severe stress was induced in an experimental animal. Under this condition, necrotic changes
of myocardium developed in the animal. What is the leading reason for pathogenesis of this
injury?
A. Increase in calcium content in cardiomyocytes
B. Decrease in mitochondrial ATP synthesis
C. Affection of Na-K pump functions
D. Coronary blood flow insufficiency
E. Increase in myosin ATP-activity
23. After fast surgical removing of coronary artery occlusion in a patient with ischemic heart
disease, secondary injury of myocardium develop (reperfusion syndrome) characterized by
necrobiotic changes in the focus of previous ischemia. This complication results from:
A. Accumulation of hydrogen ions
B. Deficiency of potassium ions
C. Deficiency of adenosine triphosphate
D. Excessive accumulation of calcium ions
E. Deficiency of creatine phosphate
24. Phlebothrombosis of the profound veins of lower extremities with subsequent pulmonary
thromboembolism develop in a patient operated for chronic ulcer of duodenum at the
postoperative period. Which functional disorder of those that develop in this case is the most
important?
A. Abrupt drop of arterial blood pressure
B. Increase in central venous pressure
C. Increase in pressure in pulmonary artery
D. Acute right ventricular failure
E. Changes of ventilation-perfusion ratio in the lungs
25. A 57-year-old man complains of heart pain that has developed after prolonged negative
emotions. An emergency doctor diagnosed ischemic heart disease manifesting by stenocardia.
What kind of ischemia is the most probable?
A. Compressive
B. Obliterative
C. Angiospastic resulting from deficiency of vasodilators
D. -E. Obturative
26. Condition of a patient with thrombophlebitis of lower extremities suddenly became worse.
Weakness, giddiness, dyspnea, pain in the chest, and cyanosis developed in him. It was
established that pulmonary thromboembolism results in acute cor pulmonale. What is the leading
link in forming of this syndrome?
A. Increased blood pressure in pulmonary artery
B. Increase in central venous pressure
C. Abrupt arterial blood pressure drop in systemic circulation
D. Weakening of heart function resulting from myocardial hypoxia
E. Disorders of external respiration
27. Atophan, which leads to vessel sclerosis, was introduced to gastric arteries of an
experimental animal with purpose of gastric ulcer modeling. Which mechanism of gastric
mucosa injury is the leading one in this experiment?
A. Hypoxic
B. Neurodystrophic
C. Mechanical
D. Dysregulative
E. Nerohumoral
28. The theory exists that atherosclerosis plays an important role in periodontitis development,
affecting vessels of gums. What kind of local blood circulation disorders develops under
atherosclerosis of vessels?
A. Active hyperemia
B. Passive hyperemia
C. Embolism
D. Ischemia
E. Disorders of lymph outflow
29. Instantaneous death of pilots occurs under depressurization of airplane cabin at the altitude of
19 km. What is the reason for it?
A. Multiple gas embolisms
B. Hemorrhage to the brain
C. Gas embolism of cerebral vessels
D. Bleeding
E. Paralysis of respiratory center
30. A patient has acute pain in his chest, dyspnea, tachycardia, cyanosis, and decreased BP.
Pulmonary infarction was diagnosed in this patient. Which factor is the most common cause of
pulmonary infarction?
A. Embolism by thrombus from veins of lower extremities
B. Congestion in the pulmonary circulation
C. Increase in number of platelets
D. Activation of fibrinolytic system
E. Pneumothorax
31. A 50-year-old patient suffers from endarteritis. Which of the following symptoms is the most
characteristic one for this pathology?
A. Decreased temperature of lower extremities
B. Cyanosis
C. Increased temperature of lower extremities
D. Edema
E. Enlargement of volume of extremities
32. Pulmonary embolism developed in a patient with coxal bone fracture. What kind of
embolism does this patient have?
A. Fat
B. Thromboembolism
C. Tissue
D. Gas
E. Air
33. Gas embolism developed in a diver who was lifted to the surface very fast. It results from
fast change:
A. From increased atmospheric pressure to normal
B. From normal atmospheric pressure to increased
C. From normal atmospheric pressure to decreased
D. From decreased atmospheric pressure to normal
E. -34. Acute heart arrest develops in a patient with thrombophlebitis of calf profound veins. What is
its reason?
A. Pulmonary thromboembolism
B. Left ventricle hypertrophy
C. Myocardial dystrophy
D. Endocarditis of mitral valve
E. Atherosclerosis
35. Convulsions and loss of consciousness develop in a diver during the emergency raising from
the depth. What is the major pathogenic mechanism in these disorders development?
A. Gas embolism
B. Hypoxia
C. Toxic action of oxygen
D. Toxic action of nitrogen
E. Hypercapnia
36. Destruction of endothelial layer of vessel leads to vasoconstriction. Decreased secretion of
endothelial-derived factor plays the leading role in this phenomena development. What is this
factor?
A. Nitric oxide
B. Adenosine
C. Histamine
D. Bradykinin
E. Adenosine monophosphate
37. What changes develop in human organism in case of depressurization of airplane cabin at
altitude of 19 km?
A. Gas embolism
B. Compensatory augmentation of biologic oxidation in tissues
C. Increase in body temperature
D. Compensatory augmentation of heart work
E. Disorders of muscular coordination
ANSWERS:
1-E, 2-D, 3-A, 4-A, 5-D, 6-B, 7-A, 8-D, 9-E, 10-E, 11-E, 12-B, 13-D, 14-B, 15-A, 16-E, 17-B,
18-E, 19-C, 20-A, 21-A, 22-A, 23-D, 24-D, 25-C, 26-A, 27-A, 28-D, 29-A, 30-А, 31-А, 32-А,
33-А, 34-А, 35-А, 36-А, 37-А.
Topic 8,9. Pathophysiology of inflammation.
1. A 7-year-old child fell ill sharply. Hi has catarrh, cough, lacrimation and large-spot rash on
skin; his temperature is increased up to 38oC. Mucous membrane of patient’s pharynx is
edematous and red; buccal mucous membrane has whitish spots. What is the character of
inflammation underlying changes of buccal mucous membrane?
A. Hemorrhagic
B. Serous
C. Purulent
D. Catarrhal
E. Fibrinous
2. Painfulness of tooth and edema of lower part of face at the side of ill tooth are present in a
patient with acute pulpitis. What is leading mechanism of edema development in this case?
A. Increase in production of aldosterone
B. Disturbances of trophic function of nervous system
C. Disorder of neural regulation of water-salt metabolism
D. Disorders of microcirculation at the focus of injury
E. Hypoproteinemia
3. A 63-year-old woman has signs of rheumatic arthritis. Which of below enumerated indices of
blood test will be most significant for diagnosis verification?
A. R-glycosidase
B. Lipoproteins
C. Acid Phosphatase
D. Summary glycosaminoglycans
E. General cholesterol
4. A 5-year-old girl has high temperature and sore throat. At the examination of this patient the
following was revealed: edema of soft palate, gray films on tonsils, which were removed
difficulty and left after themselves deep hemorrhagic defects of tissue. Which disease of bellow
enumerated is the most possible?
A. Lacunar tonsillitis
B. Simanovsky-Vincent’s tonsillitis
C. Necrotic tonsillitis
D. Diphtheria of pharynx
E. Infectious mononucleosis
5. A cook burnt his arm with steam. What substance increased and led to development of
redness, edema and painfulness of affected area of skin?
A. Lysine
B. Histamine
C. Thiamine
D. Galactosamine
E. Glutamine
6. A child with asphyxia was taken to the hospital. On examination of the child whitish and
difficulty separating films were revealed in his larynx. What type of inflammation is observed in
this case?
A. Croupous inflammation
B. Diphtheritic inflammation
C. Purulent inflammation
D. Catarrhal inflammation
E. Serous inflammation
7. Enlargement and deformation of joints were revealed in a patient with rheumatism. What type
of inflammation underlies these changes?
A. Alterative
B. Proliferative
C. Exudative
D. Fibrinous
E. Hemorrhagic
8. A painful blisters full of opaque fluid has formed in patient after thermal burn. What type of
inflammation has appeared?
A. Granulomatous
B. Croup
C. Serous
D. Proliferative
E. Diphtheritic
9. Prevalence of proliferative processes was revealed in a patient with chronic inflammation of
skin and subcutaneous adipose tissue. Which hormone deficiency can lead to this situation?
A. Cortisol
B. Aldosterone
C. Insulin
D. Growth hormone
E. Thyroxin
10. A patient complains of a pain in joints. Edema and redness are visible above joints. Which
enzyme activity has to be analyzed for establishing the diagnosis?
A. Hyaluronidase
B. Creatine kinase
C. Alkaline phosphatase
D. Acid phosphatase
E. Urease
11. Indicate inflammatory mediators which have to be inhibited for decrease in exudation:
A. Catecholamines
B. Histamine
C. Heparine
D. Thromboxan
E. Interleukine-1
12. Condition of biological active substances (BAS) prevalence over there inhibitors usually
occurs in inflammation. Indicate correct correspondence of BAS to their inhibitor
A. Histamine - carboxypeptidase
B. Catecholamines - cholinesterase
C. Kinins - monoaminooxidase
D. Leukotriens - arylsulfatase
E. Serotonin-protease inhibitor
13. Edema has developed as a result of oncotic pressure elevation in the site of inflammation.
What is the main reason of hyperoncia?
A. Activation of endotheliocytes
B. Protein catabolism
C. Drainage disorders
D. Macromolecules accumulation
E. Gluconeogenesis intensification
14. What factor promotes proliferation in focus of chronic inflammation?
A. Phospholipase activation
B. Hyperosmia
C. Protein catabolism
D. Hypoxia
E. Prostacyclin synthesis
15. A patient has high body temperature, redness, edema, painfulness on her right forearm. What
biological active substances intensify inflammatory reaction?
A. Vasopressin
B. Prostacyclins
C. Phospholipase D
D. Proteolysis inhibitors
E. Kinins
16. A patient with inflammation of a forefinger has acute pain, edema, enlargement of local
lymph nodes, temperature rising to 38,5oC. What factors lead to exudation in the inflammatory
focus?
A. Lymph flow augmentation
B. Proliferation
C. Resistive vessels tone increase
D. Increase of volumetric flow rate of blood
E. Increasing in endothelial permeability
17. Pleurisy with sequential formation of purulent exudation developed in a patient after the
chest trauma. What is the main factor of pus formation?
A. Change of blood flow rate
B. Chemotaxis
C. Change of physicochemical properties in the site of inflammation
D. ATP production disorders
E. Hyperosmia
18. A patient has an inflammatory process on the outer surface of calf. Redness, edema, pain,
enlargement of local lymph nodes, and body temperature rising are noticed in patient. What are
the principles of pathogenetic therapy of acute inflammation?
A. Proteolysis activation blockage
B. Energy formation processes improving
C. Free radical oxidation increase
D. Introduction of mineralocorticoids
E. Introduction of thyroid hormones
19. A patient with finger inflammation has sharp pain and edema in the inflammatory focus.
After opening of an abscess these symptoms have disappeared. What favors disappearance of
pain?
A. Decrease of osmotic pressure
B. Increase in c-AMP concentration
C. Alkalosis
D. Kallikrein-kinin system activation
E. Mast cells degranulation
20. There are edema, redness and soreness in a place of injury. What is the reason for
inflammation’s symptoms appearance?
A. Sympathetic nervous system activation
B. Monoamine oxidase activation
C. BAS discharged by cells
D. Carboxypeptidase activation
E. Limited proteolysis inhibition
21. Condition of biological active substances (BAS) prevalence over there inhibitors usually
occurs in inflammation. Indicate correct correspondence of BAS to their inhibitor
A. Histamine - carboxypeptidase
B. Catecholamines - cholinesterase
C. Kinins – monoamine oxidase
D. Serotonin - arylsulfatase
E. Kallikrein - protease inhibitor
22. A 37-year-old male patient was admitted to the surgical department with symptoms of acute
pancreatitis. Which preparation is the most advisable for use in the first turn?
A. Platyphyllin
B. Contrycal
C. Analgin
D. Ephedrine
E. Nospanum
23. Female patient, aged 32, was stung by wasp. On the skin of left cheek (place of sting) there is
a zone of hyperemia and edema. What is the primary mechanism of edema in this case?
A. Decrease of oncotic pressure
B. Lymph drainage decease
C. Increase of oncotic pressure
D. Increase in capillary permeability
E. Increase of hydrostatic pressure in capillaries
24. What inflammatory mediator is formed due to limited proteolysis of plasma globulins?
A. Histamine
B. Leukotriens
C. Bradykinin
D. Prostaglandins
E. Lymphokines
25. Fever and increase of antibodies and leukocytes have appeared in animal under experimental
modeling of inflammation. What substances conditioned to all these common reactions in
inflammation?
A. Leukotriens
B. Interleukins
C. Mineralocorticoids
D. Glucocorticoids
E. Somatomedins
26. In a patient with eczema there are 5 typical symptoms of inflammation (Celsius - Halen
pentad). Find the one of them:
A. Cyanosis
B. Jaundice
C. Pigmentation
D. Redness
E. Albinism
27. A patient sustained trauma of knee joint and posttraumatic hemorrhagic bursitis appeared.
After 3 months passive movements limitation in extend was observed. Limitation was a result of
scar formation. What inflammatory component was a basis of this complication?
A. Secondary alteration
B. Exudation
C. Tissue hyperplasia
D. Proliferation
E. Primary alteration
28. In female patient, 28, abscess opening was performed and fast wound reparation was
observed. Reparation was preceded without score formation. What cells play the main role in
proliferation?
A. Eosinophils
B. Neutrophils
C. Fibroblasts
D. Lymphocytes
E. Monocytes
29. In examination of abscess punctate under a microscope different blood cells were revealed.
Which of them appears the first in inflammatory focus?
A. Monocytes
B. Mast cells
C. Eosinophils
D. Neutrophils
E. Lymphocytes
30. What is the main factor of pain formation in pulpitis?
A. BAS action
B. Hydrostatic pressure increasing
C. Excess of pain receptors excitability
D. Ischemia
E. Excess of brain centers sensitivity
31. What is the main factor of edema formation in pulpitis?
A. Capillaries permeability increasing
B. Hypoproteinemia
C. Tissue hyperosmia
D. Blood hyperosmia
E. Capillaries hydrostatic pressure increasing
32. Which of following inflammatory mediators are formatted under the influence of
lypooxygenases?
A. Leukotriens
B. Prostaglandins E1, E2
C. Prostacyclins
D. Thromboxans
E. Thrombocytes activation factor
33. Patient has a caries complicated with pulpitis. This condition is accompanied by unbearable
pain. What is the main reason of pain?
A. Ischemia
B. Emigration
C. Primary alteration
D. Exudation
E. Proliferation
34. It is known, that inflammatory mediators play the main role in inflammation pathogenesis.
What is the histamine action on inflammation?
A. Chemotaxis
B. Blood vessel permeability increasing
C. Thrombocytes aggregation
D. Blood vessels constriction
E. Blood coagulation
35. Female patient, 19, complains of pain in gums, gingival hemorrhage. These symptoms have
appeared 3 days after sulphamide drugs taking. Objectively: gingival papilli and gum margin are
reddened and swollen; there is a hemorrhage appeared in response of touching. What type of
inflammation is observed in patient?
A. Acute cattharal inflammation
B. Hemorrhagic inflammation
C. Fibrinous inflammation
D. Pus inflammation
E. Chronic cattharal inflammation
36. A patient 6 years old was admitted to the hospital with asphyxia. The membranous coats on
mucosa of fauces were revealed. The coats can be removed easy. What type of inflammation is
in patient?
A. Fibrinous
B. Necrotic
C. Pus
D. Cattharal
E. Hemorrhagic
37. In child patient there are following symptoms of inflammation over the skin scratch: pain,
swallowing, redness. These sings are symptoms of immediate hypersensitivity. What blood cells
lead to such changings?
A. Lymphocytes
B. Eosinophils
C. Basophiles
D. Monocytes
E. Neutrophils
38. In a girl patient, 5, there are intense throat pain and fever. Objectively were revealed edema
and membranous coats on mucosa of fauces. The coats cannot be removed easy. What of the
followings are more probably?
A. Simanovsky - Vensann tonsillitis
B. Infectious mononucleosis
C. Diphtheria of fauces
D. Necrotic tonsillitis
E. Lacunar tonsillitis
39. Patient has a caries complicated with pulpitis. This condition is accompanied by unbearable
pain. What is the main factor of pain appearing?
A. High pressure of fluid in inflammatory areaB. Bradykinin
C. Prostaglandins
D. Histamine
E. Serotonin
40. There are lots of neutrophils in abdominal pus exudates in a patient with peritonitis. What is
the main function of neutrophils in inflammatory area?
A. Phagocytosis
B. Prostaglandins secretion
C. Degranulation
D. Histamine liberation
E. Local blood flow regulation
41. Keloid cicatrix has formatted in a place of abscess. Name the stage of inflammation, which
caused scar appearing.
A. Proliferation
B. Exudation
C. Primary alteration
D. Secondary alteration
E. Emigration
42. A male patient, 16, was admitted to the hospital with acute appendicitis. What typical
pathological process is the basis of this disease?
A. Inflammation
B. Hypoxia
C. Fever
D. Tumor
E. Allergy
43. Eyeball inflammation resulted pus in the anterior chamber of the eye (hypopyon). What stage
of inflammation was it?
A. Exudation
B. Proliferation
C. Primary alteration
D. Secondary alteration
E. Emigration
44. In a patient with skin pathological process which has 5 typical symptoms: tumor, rubor,
calor, dolor, functio laesa. The development of such process includes 3 stages: Alteration,
exudation, proliferation. What is the second one?
A. Exudation
B. Regeneration
C. Reparation
D. FibrosisE. Petrification
45. The secondary alteration is caused by:
A. Lysosomal enzymes
B. Kinins
C. Lympokynes
D. Prostaglandins
E. Complement components C3a and C5a
46. In proliferation cells multiplying and defect compensation take place. What is the reason of
cells growth in specific clones?
A. Keylones
B. Platelet-derived grow factor
C. Interleukins
D. Somatomedine
E. Lymphocytes peptide
47. There are following components in pleural effusion: proteis-62g/l, abundance of neutrophils.
What is the type of inflammation in this case?
A. Serous
B. Suppuratuve
C. Fibrinous
D. Hemorrhagic
E. Putrefactive
48. Necrotic focus has appeared on burn, swallowing and red skin. What is the main mechanism
of necrobyosis improvement in inflammatory area?
A. Secondary alteration
B. Primary alteration
C. Emigration of leucocytes
D. Dyapedesis of erythrocytes
E. Fibroblasts proliferation
49. Glucocorticoid treatment is usefull in rheumatic arthritis. What is the basal action of
glucocoricoids?
A. Histamine decreasing
B. Emigration inhibition
C. Phagocytosis inhibition
D. Prostaglandins synthesis inhibition
E. Cell membranes stabilization
50. A patient with abscess of finger has some local and general symptoms of inflammation. What
from following is a local inflammatory sing?
A. Swelling
B. Fiver
C. Headache
D. Lymphangitis
E. Leucocytosis
51. It is known that inflammatory mediators are cellular or humoral. What from the following is
a humoral mediator?
A. Kallidine
B. Histamine
C. Serotonin
D. Interleukine-2
E. Hydrogenium peroxide
ANSWERS:
l.-E, 2.-D, 3.-D, 4.-D, 5.-В, 6.-В, 7.-В, 8.-С, 9.-А, 10.-А, 1 l.-B, 12.-D, 13.-А, 14.-D, 15.-Е.16.Е, 17.-В, 18.-А, 19.-А, 20.-С, 21.-Е, 22.-В, 23.-D, 24.-С, 25.-В, 26.-D, 27.-D, 28.-С, 29.-D, ЗО.-В,
31.-А, 32.-А, 33.-D, 34.-В, 35.-В, 36.-А, 37.-С, 38.-С, 39.-А, 40.-А, 41.-А, 42.-А' 43.-А, 44.-А,
45.-А, 46.-А, 47.-В, 48.-А, 49.-Е, 50.-А, 51.-А.
Topic 10. Fever
1. A 52-year-old woman complains to bad pain around her abdomen and back. Acute
appendicitis was diagnosed. There is suspicion of complication of pancreatitis by abscess. Which
type of fever would corroborate appearance of abscess?
A. Hectica
B. Continuous
C. Remittent
D. Intermittent
E. Atypical
2. Polyuria developed in a patient with fever after period of olyguria. What is the leading factor
of diuresis change at the end of the second period of fever?
A. Normalization of hormonogenesis by adrenal medulla
B. Normalization of hormonogenesis by reticular zone of adrenal cortex
C. Normalization of hormonogenesis by glomerular zone of adrenal cortex
D. Normalization of hormonogenesis by fascicular zone of adrenal cortex
E. Normalization of thyroid gland function
3. A patient has felt cold, chills, “goose flesh”, increase of body temperature. Which else
changes characterize the first period of rapid elevation of body temperature?
A. Tachycardia
B. Equilibration between heat production and heat loss
C. Dilation of skin vessels
D. Decrease of arterial pressure
E. Increase of metabolism on 100-200%
4. Body temperature of patient becomes pyretic. Which substances have to act to neurons of
thermoregulation for fever development?
A. Interferon
B. Kallidinum
C. Prostaglandins
D. Free radicals
E. Leucotriens
5. Fever in a patient develops in following succession of stages:
A. Incrementi; fastigii; decrementi
B. Incrementy; decrementy; fastigii
C. Fastigii; decrementi; incrementi
D. Fastigii; incrementi; decrementi
E. Decrementi; fastigii; incrementi
6. The temperature of a patient with infectious disease increased to 39.5-40.5 0 C in a day and
kept that level about 1 hour, but then it returned to the normal level. Which type of fever is
described in that case?
A. Continuous
B. Intermittent
C. Remittent
D. Recurrent
E. Atypical
7. The body temperature of a patient with infectious disease increased to 39.5-40.5 0 C in a day
and kept this level about 1 hour, but then became normal again. Which disease is characterized
by described type of fever?
A. Tuberculosis
B. Influenza
C. Peritonitis
D. Brucellosis
E. Malaria
8. A patient had fever after injection of pyrogenal. His skin has become pale, cold; chill appeared
in him, oxygen consumption increased. How do the processes of thermoregulation change in
described period of fever?
A. Increase of heat production and decrease of heat loss
B. Decrease of heat loss
C. Heat loss is equal heat production
D. Decrease of heat production and increase of heat loss
E. Decrease of heat production
9. Body temperature of the 8-year-old Sasha with meningitis was on the level 39-40 0C for a
week. After 8 days under the influence of antibiotics the temperature has decreased to 36.8 0C in
1.5 hours. There were acute hyperemia of skin, profuse sweating, decrease of arterial pressure,
and loss of consciousness in him. Which medicine is the pathogenetic remedy?
A. Vasoconstrictors
B. Antibiotics
C. Antipyretics
D. Pyrogenal
E. Sulfanilamide
10. After being in the room with air temperature 40 0C and humidity 80% a patient has been
brought to hospital in grave condition. He was unconscious; he had tachypnea, tachycardia, and
body temperature 41 0C. Reanimation was failed. The patient has died. What is the most possible
direct reason of death in this case?
A. Paralysis of the breath center
B. Collapse
C. Coagulation of blood and decrease of volume of circulating blood
D. Dehydration
E. Heart failure
11. Fever of the patients with relapsing fever is characterized by several periods of pyretic
temperature per day and several periods of normal temperature. Such type of temperature curve
is called:
A. Febris hectica
B. Febris intermittens
C. Febris continua
D. Febris recurrens
E. Febris atypica
12. Sharp increase of the temperature to 38.7 0C was marked in a patient with acute purulent
periodontitis. His body temperature has decreased to normal level after opening the pulp cavity.
Which type of fever was in the patient?
A. Efemeral
B. Septic
C. Recurrent
D. Remittent
E. Continua
13. A patient suffers from osteomyelitis of maxilla. His body temperature increases to 40 0C and
then sharply decreases to 35.6 0C every day. Which type of fever curve is characterized by these
changes?
A. Continua
B. Intermittent
C. Reccurens
D. Atypica
E. Hectica
14. Pallor of the skin, “goose flesh” and increase of oxygen consumption appeared in the
patient’s skin after injection of pyrogenal. Which stage of fever is characterized by these
changes?
A. Stadium incrementi
B. Stadium fastigii
C. The stage of falling temperature by crisis
D. The stage of falling temperature by lysis
15. Acute increase of body temperature, dyspnea, tachycardia, nausea, convulsions, and loss of
conciousness developed in a worker, working in the thick uniform in summer. What was the
most possible reason of development of those symptoms?
A. Equilibration between heat loss and heat production
B. Decrease of heat production
C. Decrease of heat loss
D. Increase of heat production
E. Increase of heat loss
16. A man in light clothes is staying in a room with air temperature +14 0C. Windows and doors
are closed. Which way of heat loss is the most considerable in this case?
A. Evaporation
B. Perspiration
C. Conduction
D. Radiation
E. Convection
17. Experimental mice were kept in a lodge with air temperature 4 0C. Which adaptive reaction
supplies its thermal homeostasis?
A. Limitation of heat loss
B. Decrease of oxygen consumption
C. Anabiosis
D. Increase of blood consumption
E. Decrease of oxidation enzyme activity
18. Inclination of the set point of thermoregulation to higher level due to action of IL-1 is in a
patient. What is the name of this typical pathological process?
A. Fever
B. Hyperthermia
C. Hypothermia
D. Inflammation
E. Hypoxia
19. The body temperature of a patient with crupous pneumonia is 39 0C. The difference between
the morning and evening temperature of his body didn’t exceed 1 0C during 9 days. Which type
of the fever curves was that?
A. Continua
B. Hectica
C. Intermittent
D. Hyperpyretic
E. Reccurens
20. A patient has fever with following stages: incrementi, fastigii, decrementi. Which disease
these features can characterize?
A. Acute pneumonia
B. Acromegaly
C. Diabetes mellitus
D. Hyperaldosteronism
E. Myocardial hypertrophy
21. Body temperature of patient is pyretic; his skin is hot and red. What was the correlation
between processes of heat production and heat loss in described stage of fever?
A. Heat loss is equal heat production
B. Heat loss is more then heat production
C. Heat production is more then heat loss
D. Heat loss is less then heat production
E. Heat production is less then heat loss
22. The body temperature of a patient with pneumonia was keeping on the level 38.3-38.5 0C all
the first week of disease. Such fever is called:
A. Febrile
B. Hyperpyretic
C. Pyretic
D. Subfebrile
23. Increase of “acute phase” proteins level in blood such as ceruloplasmin, fibrinogen, Creactive protein is typical for development of fever. Indicate the possible mechanism of this
phenomenon.
A. Stimulative influence of IL-1 on hepatocytes
B. Destructive action of elevated temperature to the cells of the organism
C. Proliferate action of IL-2 to T-lymphocytes
D. Adaptive reaction of the organism to pyrogen
E. Degranulation of mast cells
24. Most infectious diseases are characterized by development of fever. It can be explained:
A. Formation of IL-1 during phagocytosis of microorganisms
B. Intoxication of the organism
C. Degranulation of mast cells
D. Activation of T- and B-lymphocytes
E. Processes of exudation
25. Attacks of fever in a patient occur periodically. During the attack the body temperature
sharply increases, keeps pyretic level nearly 2 hours and then decreases to normal level. This
type of fever is typical for:
A. Tertian fever
B. Sepsis
C. Brucellosis
D. Relapsing fever
E. Epidemic typhus
26. Body temperature of a patient is 39 0C for several hours (stadium fastigii). Indicate which
changes of physiological functions are the most typical for this stage of fever.
A. Bradycardia
B. Ingibition of phagocytosis
C. Increase of heat production
D. Increase of heat production
E. Heat production is equal heat loss
27. In a patient with pneumonia the increased body temperature was revealed. What sort of
biological active substances play the most important role in development of fever?
A. Interleukin-1
B. Leukotriens
C. Serotonin
D. Histamine
E. Bradykinin
28. In a patient with prolonged fever after the course of treatment body temperature begins
decreasing. What is the possible mechanism of temperature decrease?
A. Protective activation of immune system
B. Decrease of heat production due to reducing metabolic rate
C. Decrease of production of pyrogens
D. Increase of resistance of organism to action of the pyrogens
E. Increase of heat loss due to peripheral vasodilatation
29. What is the most efficient mechanism of heat loss in case of following environmental
conditions: 80% air humidity and +35oC (95 degree Fahrenheit) air temperature?
A. Hyperventilation
B. Sweating
C. Conduction
D. Convection
E. Irradiation
30. During the examination of the patient following symptoms were revealed: redness of skin,
skin is hot and dry to touch, heart bit rate is 92 per minute, respiratory rate is 22 per minute, body
temperature is 39,2oC (102.5 degree Fahrenheit). What is the correlation between heat
production and heat loss in described period of fever?
A. Heat production surpasses heat loss
B. Heat production equals to heat loss
C. Heat production is less than heat loss
D. Decreasing of heat production without changes of heat loss
E. Increasing of heat production without changes of heat loss
31. Animal was injected with pyrogen to reproduce fever. What mechanism starts process of
temperature increasing?
A. Activation of non-shivering thermogenesis
B. Activation of shivering thermogenesis
C. Rise of set point of thermoregulation in hypothalamus
D. Reduction of heat loss
E. Dissociation of oxidation and oxidative phosphrilation in tissues
32. In a patient with third stage of fever reaction following manifestations observed: abundant
sweating, tachypnea (increase in respiratory rate), decrease of body temperature. What is the
mechanism of development of these symptoms?
A. Reduction of shivering thermogenesis
B. Secondary aldosteronism
C. Rise of set point of thermoregulation in hypothalamus
D. Predomination of heat production over the heat loss
E. Peripheral vasodilatation
33. Patient, who has been suffering from malaria, has weakness of heart activity and tachycardia
during the stage of heart loss. What is the name of this complication?
A. Infectious-toxic collapse
B. Bacterial shock
C. Hemorrhage collapse
D. Ortostatic shock
E. Hemorrhage shock
34. Adaptation of organism disturbances to decrease of environmental temperature when using
medicines alpha-adrenoblokators. Which mechanism is responsible for this?
A. Formation of primary heat
B. Constriction of skin vessels
C. Contractile thermogenesis
D. Sweating
35. After blood trasfusion patient complaints feeling of heat, rigor, increase of body temperature
to +400C. Its known the cause of elevation temperature is secretion of endogenous pyrogens.
Which cells produce endopyrogens?
A. Erythrocytes
B. Platelets
C. Endotheliocytes
D. B-lymphocytes
E. Macrophages
36. The different types of temperature curve are reported on examination of the infected patients.
What other pathological conditions can lead to the fever?
A. Isoosmotic hyperhydratation
B. Sistemic immune complex diseases
C. Excess production of glucocorticoids
D. Protein starvation
E. Hypohonadism
ANSWERS:
1.-С. 2.-D. З.-В. 4.-В. 5.-А. 6.-А. 7.-А. 8.-В. 9.-А. 10.-Е. 11.-С. 12.-В. 13.-А. 14.-С. 15.-А 16.В. 17.-Е. 18.-А. 19.-А. 20.-А. 21.-D. 22.-A. 23.-Е. 24.-А. 25.-С. 26.-D 27.-А. 28.-А. 29.-А. ЗО.А. 31.-А. 32.-А. ЗЗ.-А. 34.-А. 35.-А. 36.-Е.
Topic 11. Pathophysiology of tissue growth. Tumors.
1. Rate of appearance of tumors is increased in elderly people. One of the main reasons for this
is:
A. Increase in activity of cellular immunity
B. Decrease in activity of cellular immunity
C. Rise of disorders of mitoses
D. Decrease of intensity of antibody production
E. Increase of intensity of antibody production
2. In a patient with metastases of lung carcinoma introduction of cytostatics led to suspension of
metastases growth at first but later metastases resumed spread. What is the most possible
mechanism of secondary growth of metastases?
A. Absence of contact braking
B. Absence of Heiflik’s limit
C. Rise of genetic heterogeneity of tumor cells
D. Increased glucose consumption by tumour
E. Increased amino acids consumption by tumour
3. A 56-years-old patient, who had contact with diethylnitrozamine at his work place, complains
of pain in right subcostal area, weakness, loss of appetite, and decreased workability. At
examination of this patient: surface of his liver is rough, splenomegaly and ascites are present in
him; his body temperature is 37.2oC; in his blood analysis ESR is 25 mm/hour, besides
neutrophilic leukocytosis, and hypochromic anemia were found. What disease developed in the
patient’s organism?
A. Cancer of liver
B. Hepatitis
C. Cirrhosis of liver
D. Gallstone disease
E. Dyskinesia of bile ducts
4. Approximately 60% of tryptophan is oxidized through serotonin pathway in case of malignant
intestine carcinoma. What vitamin demand is increased for a patient with malignant carcinoma
of intestine?
A. Nicotinic acid
B. Pantothenic acid
C. Folic acid
D. Pyridoxine
E. Riboflavin
5. Malignant tumor of lung was diagnosed in a patient. What feature of tumour growth testifies
its malignancy?
A. Infiltrative growth
B. Unregulated growth
C. Unlimited growth
D. Expansive growth
E. Appearance from one cell
6. Tumor has developed in a patient with innate immunodeficiency. What factor of non-specific
immunity participates in anti-tumor defense?
A. Lysozyme
B. Interleukin-1
C. Lactoferrine
D. Arylsulfatase
E. Properdine
7. The woman complained to the doctor for changing of voice, appearance of hair on the face,
and reduction of breast. Where would a tumor develop that could lead to these symptoms?
A. Tumor of zona reticulata of adrenal glands
B. Tumor of ovaries
C. Tumor of anterior lobe of pituitary gland
D. Tumor of zona glomerulata of adrenal glands
E. Tumor of zona fasciculata of adrenal glands
8. Gamma-interferon was used for treatment of the patient, suffering from tumor. What property
of this substance was used for treatment of this tumor disease?
A. Activation of synthesis of Ig
B. Activation of B-lymphocytes
C. Activation of killer effect
D. Activation of complement system
E. Activation of macrophages
9. Following changes can occur in development of tumor:
A. Pheochromocitoma – hypotension
B. Insulinoma – hypoglycemia
C. Aldosteroma – hypohydratation
D. Tumor of zona reticulata of adrenal glands – inhibition of sexual growth
E. Tumor of thyroid gland – hypothyroidism
10. Cancer of lung developed in a patient, smoking for a long time. Which cancerogenous
substance is present in tobacco smoke, related to polycyclic aromatic carbohydrates?
A. Benspyren
B. Dimethylaminobenzol
C. Beta-naphthylamine
D. Dietilnitrozamine
E. Orthoaminoazotoluol
11. A male patient, 40, has stenotic (without metastases) esophagus cancer. The following
changes were revealed in that patient: muscular and fat tissue atrophy, brownish color of the
skin, thin epidermis, and cardiac atrophy. What’s the reason of such symptoms?
A. Alimentary cachexy
B. Myasthenia
C. Addison’s disease
D. Cancer cachexy
E. Brown induration
12. In 1910 Rhauss managed to cause sarcoma in chickens by cell-free infiltrate inserting. What
was the method of experimental modeling?
A. Induction
B. Explantation
C. Isotransplantation
D. Homotransplantation
E. Heterotransplantation
13. There is high stage of interaction between lung cancer and tobacco smoking. What chemical
carcinogen is contained in tobacco smog?
A. 3,4-benspyren
B. Orhtoaninotoluol
C. Aphlatoxin
D. Methylcholatren
E. Dyethylnitrosamine
14. Patient complained of weight loss and weakness, in blood analysis hypoglycemia and
hyperinsulinemia were revealed. An additional study tumor of beta-cells was discovered. Insulin
synthesis improvement in this case is a result of:
A. Biochemical athypia
B. Morphological athypia
C. Functional athypia
D. Differentiation athypia
E. Immunological athypia
15. What biological process augmentation is typical for tumor cells?
A. Anaerobic glycolysis
B. Decarboxilation
C. Tissue respiration
D. Lipolysis
E. Gluconeogenesis
16. Erlich’s tumor was transplanted to animal. What is the evidence of tumor progression?
A. Unlimited growth
B. Resistance to cytostatics
C. AnaplasiaD. Infiltration
E. Tumor weight increasing
17. Unpainted formation under the jaw was appeared in liquidator of Chernobyl’s disaster after
12 years of accident. The size of it has increased till last month. The blood analysis is in norm.
What pathological process is most suspicious in this case?
A. Lymphadenitis
B. Syaloadenitis
C. Abscess
D. Malignant tumor
E. Cyst
18. What is the most effective manner of experimental transplantation of tumor?
A. Isotransplantation
B. Autotransplantation
C. Heterotransplantation
D. Homotransplantation
E. Allotransplantation
19. There is a tumor of tongue in patient. What characteristics of tumor may be considered as
malignant?
A. Dysplasia
B. Expansion
C. Infiltration
D. Pasteur’s positive effect
E. Mitosis increasing
20. What cell structure is a «target» for chemical cancerogens?
A. Nuclear DNA
B. Lysosomes
C. Mitochondria
D. Cytoplasmic membrane
E. Ribosomes
21. A patient with lung cancer has been smoking 30 cigarettes per day for 20 years. What the
group of cancerogens is in tobacco smog?
A. Polycyclic carbohydrates
B. Aminoasosubstances
C. Nitrosamines
D. Amines
E. Heterocyclic carbohydrates
22. A female patient was admitted to the hospital with diagnosis «uterine cervix cancer». What
from the following processes are not typical for tumor cells?
A. Anaerobic glycolysis
B. High glucose metabolism
C. Aerobic glucolysis
D. High aminoacides metabolism
E. Organospecificity absence in aminoacides consumption
23. A patient with urinary bladder cancer was working in coke factory. What substance was the
most probable reason of this pathological condition?
A. Naphtylamine
B. Dichlorethane
C. Vinegar acid
D. Alcohol
E. Pethroleynic aether
24. It is established that tumor tissue receives in 20-25 times less of glucose that intact tissue in
equal glucose amount. What metabolic changings lead to such event?
A. Aerobic glycolysis enhancement
B. Oxydation improvement
C. Normal interaction of these processes
D. Tissue respiration improvement
E. Decreasing of anaerobic glycolysis
25. They got nitrogenous nitrite to experimental animals. A tumor was developed in 80% of
animals. What was the group of cancerogens?
A. Nitrosamines
B. Aminoasosubstances
C. Polycyclic carbohydrates
D. Simple chemical substances
E. Hormones
26. After Chernobyl disaster morbidity of tumors has been increasing. What action of the
radiation has been appearing?
A. Oncogenic
B. Thermal
C. Mutagenic
D. Cytostatics
E. Immunostimulative
ANSWERS:
1.-В. 2.-С. З.-А. 4.-А. 5.-А. 6.-Е. 7.-А. 8.-С. 9.-В. 10.-А. 11.-А. 12.-А. 13.-А. 14.-С. 15.-А. 16.В. 17.-D. 18.-В. 19.-С. 20.-А. 21.-А 22.-А. 23.-А. 24.-А. 25.-А. 26.-А.
Topic 12.Pathophysiology of metabolism.
1. A patient was admitted to the hospital in comatose state. Accompanying people said that hi
lost consciousness at training while he was finishing the Marathon distance. What sort of coma is
the most possible in this patient?
A. Hyperglycemic
B. Hypoglycemic
C. Hypothyroid
D. Hepatic
E. Diabetic ketoacidosis
2. Patient has hyperglycemia, glucosuria, polydipsia, polyphagia, and polyuria. What hormone
hyposecretion do these changes develop due to?
A. Antidiuretic hormone
B. Atriopeptide
C. Glucagon
D. Insulin
E. Cortisone
3. A patient, aged 80, complains of increased appetite, thirst, elevated urination, and worsening
of general condition after the taking some sweet food. What disease is it?
A. Hypercortisolism
B. Hyperthyroidism
C. Hypothyroidism
D. Diabetes insipidus
E. Diabetes mellitus
4. A man, aged 38, is under the course of treatment for schizophrenia at in-patient department.
Contents of glucose, ketone bodies, and urea in his blood are normal. Shock therapy with regular
injections of insulin has led to development of insular coma, and after that state of patient
becomes better. What is the most possible reason for insular coma?
A. Glucosuria
B. Dehydration of tissues
C. Hypoglycemia
D. Metabolic acidosis
E. Ketonemia
5. In worker at polar station, who has been working there for a long time, hemorrhage form gums
occur, his teeth sway and pull out. What vitamin deficiency leads to these changes?
A. Tocopherol
B. Ergocalciferol
C. Ascorbic acid
D. Folic acid
E. Nicotinic acid
6. A patient, aged 50, complains of increased appetite, thirst, and loss of body weight, weakness.
At laboratory examination rise of amount of glucose in his blood revealed. What type of cells is
injured in case of this disease development?
A. Lipotropocytes
B. Thyrocytes
C. B-cells of Langerhans islets
D. A-cells of Langerhans islets
E. Pancreatocytes.
7. In 18-years-old patient, while laboratory examining presence of glucose in urine and normal
concentration of glucose in blood plasma were revealed. What disorder is the most possible
cause of these changes?
A. Disorders of glomerular filtration
B. Disorders of tubular secretion
C. Disorders of glucocorticoids secretion
D. Disorders of insulin secretion
E. Disorders of tubular reabsorption
8. Dyspepsia and vomiting are observed in a newborn after feeding with milk. These phenomena
disappear after feeding with glucose solution. What enzyme that takes part in carbohydrate
digestion is deficient in case of these changes development?
A. Amylase
B. Lactase
C. Maltase
D. Isomaltase
E. Saccharase
9. In patient painfulness along large nervous trunks and increase of pyruvate in blood are
revealed. What vitamin deficiency may lead to these changes?
A. Pantothenic acid
B. Nicotinic acid (PP)
C. Biotin
D. Riboflavin (B2)
E. Thiamin (B1)
10. A newborn was admitted to the emergency department with following symptoms: vomiting,
diarrhea, disorders of growth and development, cataract, and mental retardation. Galactosemia
was diagnosed. What enzyme deficiency takes place in this case?
A. Glucose-1-phosphate uridiltransferase
B. Glucokinase
C. Glucose-6-phosphate dehydrogenase
D. UDP glucose pyrophosphorilase
E. UDP glucose-4-epimerase
11. Flatulence, bowel spasms, abdominal pain and diarrhea often develop in some people after
taking milk. These symptoms arise in 1 - 4 hours after intake only one glass of milk. What
component of milk these symptoms develop due to?
A. Galactose
B. Lactose
C. Maltose
D. Saccharose
E. Fructose
12. Newborn has been refusing food, having vomiting and diarrhea, and some time later its
crystalline lens become opaque. At examination of newborn: glucose in blood – 8.5 mmol/L and
in urine – 1%. What is the most possible diagnosis?
A. Galactosemia
B. Phenylketonuria
C. Tyrosinosis
D. Cystinuria
E. Alkaptonuria
13. In woman, aged 45, without symptoms of diabetes mellitus, content of glucose in blood on
an empty stomach reaches 7.5 mmol/L. What test is necessary to be performed?
A. Determination of residual nitrogen in blood
B. Determination of glucose in blood on an empty stomach
C. Determination of tolerance to glucose
D. Determination of ketone bodies in urine
E. Determination of glycosylated hemoglobin
14. In man, aged 60, who is 170 cm tall and 110 kg weight, content of glucose in blood is 6.8–
7.0 mmol/L. Content of insulin in his blood is normal. Tolerance to glucose is decreased, as well
as number of insulin receptors, in this patient. What signs allow us to evaluate this diabetes
mellitus as non-insulin dependent?
A. Decreased tolerance to carbohydrates
B. Recurrent hyperglycemia
C. Patient’s age
D. Normal content of insulin in blood
E. Obesity
15. In a patient, suffered from frequent hemorrhages from internal organs and mucous
membranes, proline and lysine were found in structure of collagen fibers. What vitamin
deficiency contributes disorders of these amino acids hydroxylation?
A. Vitamin C
B. Vitamin E
C. Vitamin K
D. Vitamin A
E. Vitamin B1
16. In patients who suffered from alcoholism B1 hypovitaminosis is often observed, as a
consequence of nutrition disturbances. Symptoms of vitamin B1 deficiency are disorders of
nervous system, psychoses, and amnesia. Why cells of nervous tissue are particularly susceptible
to thiamine deficiency?
A. Aerobic decay of glucose is broken
B. Liplysis in adipose tissue is increased
C. Oxidation of fatty acids is broken
D. Glycolysis is intensified
E. Glycolysis is decreased
17. According to results of gastric juice analysis following traits were revealed: common acidity
– 24 mmol/L, free hydrochloric acid – 1.5 mmol/L, content of gastric mucoprotein is decreased.
What vitamin deficiency is observed in organism?
A. Cobalamin
B. Folic acid
C. Pantothenic acid
D. Nicotinamide
E. Bioflavonoids
18. A 24-years-old woman complains of dryness in mouth and loss of weight in spite of good
appetite. At examination of the patient: height – 162 cm, weight – 65 kg, content of glucose in
blood – 8.3 mmol/L, and presence of glucose in urine. What disease does these symptoms
characteristic for?
A. Diabetes mellitus
B. Steroid diabetes
C. Diabetes insipidus
D. Alimentary glucosuria
E. Renal diabetes
19. A man, who have been suffering from diabetes mellitus for a long time, was admitted to the
hospital because of rapid worsening of his condition: general malaise, polyuria, polydipsia,
nausea and vomiting, confusion, sleepiness. Kussmaul respiration and scent of acetone from
mouth were observed in this patient. In his urine high contents of glucose and acetone bodies
were found. What is the reason for worsening of patient’s condition?
A. Diabetic ketoacidosis
B. Gas acidosis
C. Heart failure
D. Renal failure
E. Hypoglycemic coma
20. Treatment of the child for rachitis using vitamin D3 was not efficient. What is the most
possible reason for ineffectiveness of treatment?
A. Disorders of hydroxylation of vitamin D3
B. Deficit of lipids in food
C. Disorders of including vitamin D3 into enzyme
D. Intensified using vitamin D3 by intestine microflora
E. Disorders of transport of vitamin D3 with blood plasma proteins
21. Content of glucose in patient’s blood is: on an empty stomach – 5.65 mmol/l, in one hour
after taking sugar – 8.55 mmol/l, and in two hours after taking sugar – 4.95 mmol/l. These signs
are characteristic for:
A. Healthy person
B. Person suffered from hidden diabetes mellitus
C. Person suffered from non-insulin-dependent diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
22. Patient, aged 26, who suffered from hypoglycemic coma resulted from insulin overdosage,
was intravenously infused with 20% solution of glucose. After this manipulation patient’s
condition improved. What process helps glucose enter the cell?
A. Osmotic transport
B. Pinocytosis
C. Active transport
D. Secretion
E. Phagocytosis
23. A 40-years-old man is suffering from diabetes mellitus. After he has endured tonsillitis,
reinforcement of thirst, nausea, vomiting, abdominal pain, and sleepiness develop in him.
Patient’s BP is 80/45 mmHg, pulse rate 125 bpm, and his skin is dry. Content of glucose in blood
is 28 mmol/L. What complication of diabetes mellitus appears in this patient?
A. Lactic acidosis
B. Diabetic ketoacidosis
C. Hepatic coma
D. Hyperosmolar coma
E. Hypoglycemic coma
24. After the break of diet (taking the easy for assimilation carbohydrates) in a woman, who has
been suffering from diabetes mellitus for a long time, general malaise and increase of blood
pressure gradually develop and hallucinations and cramps appear. Woman has dry skin and
distinct signs of dehydration. What is the reason for worsening of patient’s condition?
A. Hypoglycemic coma
B. Hyperosmolar hyperglycemic coma
C. Diabetic ketoacidosis
D. Heart failure
E. Respiratory failure
25. During the experiment rat was injected with 5% alloxan solution in dose 200 mg per kg of rat
weight. What kind of pathology arises in this case?
A. Arterial hypertension
B. Acute renal failure
C. Diabetes insipidus
D. Diabetes mellitus
E. Hepatic failure
26 One-year infant lags in mental development from infants of the same age. The infant has
vomiting, cramps, and loss of consciousness in the mornings. What enzyme deficiency these
changes are connected to?
A. Phosphorylase
B. Arginase
C. Glycogen syntase
D. Saccharase
E. Lactase
27. In patient with constant hypoglycemia blood analysis does not change after injection of
adrenalin. A doctor supposes hepatic disorder. What function disorder it is?
A. Cholesterol formation
B. Excretion
C. Glycolysis
D. Ketogenesis
E. Glycogen deposition
28. A woman, aged 58, was admitted to the hospital in severe condition. She has confused
consciousness; dry skin, hollow eyes, cyanosis, and scent of rotten apples from her mouth. At
laboratory examination of her: glucose in blood – 15.1 mmol/L, glucose in urine – 3.5%. What is
the most possible reason for this condition?
A. Hypoglycemic coma
B. Hyperglycemic coma
C. Hypovolemic coma
D. Uremic coma
E. Anaphylactic shock
29. A doctor reveals in child symmetric roughness on cheeks, diarrhea, and disorders of neural
activity. What nutrition factors deficit underlies this condition?
A. Methionine, lipoic acid
B. Lysine, ascorbic acid
C. Nicotinic acid, tryptophan
D. Threonine, pantothenic acid
E. Phenylalanine, pangamic acid
30. The most of participants of Magellan expedition to America died of avitaminosis. This
disease displays as general malaise, subcutaneous hemorrhage, pulling teeth out, hemorrhage
from gums. What is the name for this avitaminosis?
A. Scurvy
B. Pellagra
C. Addison-Birmer’s anaemia
D. Polyneuritis (beriberi)
E. Rachitis
31. In a woman, of 52 years old and of 125 kg weight, diabetes mellitus develops. It happens due
to:
A. Decrease of number of insulin receptors
B. High-affinity binding insulin to synalbumin
C. Reduced cell susceptibility to insulin
D. Increase activity of insulinase
E. Broken insulin synthesis
32. Unconscious patient was admitted to the hospital. He has Kussmaul respiration, blood
pressure 80/50 mmHg, and acetone scent from his mouth. What substances accumulation in
organism may lead to these disturbances?
A. Complex carbohydrates
B. Carbonic acid
C. Lactic acid
D. Modified lipoproteins
E. Ketone bodies
33. In patient suffered from diabetes mellitus metabolic acidosis develops due to accumulation of
ketone bodies (beta-oxybutyric acid and acetoacetic acid). At this condition pH of arterial blood
is:
A. 7.40
B. 7.48
C. 7.56
D. 7.32
E. 7.66
34. A patient, 56 years old woman, who have been suffering from diabetes mellitus for 6 years,
complains of compressing pain behind her sternum. What mechanism of heart affection is the
most possible in this case?
A. Myocardial dystrophy
B. Microangiopathy of myocardial vessels
C. Macroangiopathy of coronary vessels
D. Myocarditis
E. Vegetative neuropathy of heart
35. Content of glucose in patient’s blood is: on an empty stomach – 4.52 mmol/l, in one hour
after taking sugar – 6.23 mmol/l, and in two hours after taking sugar – 2.56 mmol/l. These signs
are characteristic for:
A. Healthy person
B. Person suffered from insulinoma
C. Person suffered from hidden diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
36. What complication may develop when treating diabetic ketoacidosis with large doses of
insulin?
A. Arterial hypertension
B. Leukocytosis
C. Arterial hypotension
D. Hypoglycemia
E. Hyperkalemia
37. A female patient, aged 24, complains of dryness in her mouth, loss of weight despite good
appetite. Her height is 157 cm her weight is 72 kg. What analysis we have to perform at fist in
this patient?
A. Urinalysis by Zemnitsky
B. Determination of glucose content in 24-hour urine quantity
C. General urinalysis
D. Determination of protein fractions in blood serum
E. Coagulogram
38. A patient D., 40-years-old woman, was admitted to the hospital with complaints of weakness,
giddiness, hunger, cold sweat, and cramps. At examination of the patient: distension of pupils of
the eyes, weakening of respiration, and BP is 90/50 mmHg. Biochemical analysis of her blood
shows: general bilirubin is 16.0 mcmol/L, urea is 4.7 mmol/L, creatinine is 98 mcmol/L, and
glucose is 2.0 mmol/L. What kind of coma may develop in this patient?
A. Hyperglycemic
B. Hepatic
C. Renal
D. Hypoglycemic
E. At adrenal glands deficiency
39. The woman B., aged 45, was admitted to the emergency department from a street. At
examination of patient following symptoms was revealed: loss of consciousness, loss of reflexes,
absence of reflexes from pupil of the eye and sclera, Kussmaul respiration, BP is 70/40 mmHg,
and body temperature is 35oC. Biochemical analysis of patient’s blood displays: general bilirubin
is 16.0 mcmol/L, urea is 3.6 mmol/L, creatinine is 108 mcmol/L, and glucose is 22 mmol/L.
What kind of coma has developed in this patient?
A. Hypoglycemic
B. Hepatic
C. Renal
D. At adrenal glands deficiency
E. Hyperglycemic
40. Diabetes mellitus develops in animals after injection to them some alloxan. What is the main
mechanism of this type of diabetes mellitus?
A. Selective damage of lambda-cells of pancreatic islets
B. Damage of beta- and lambda-cells of pancreatic islets
C. Formation of antibodies to insulin
D. Selective damage of beta-cells of pancreatic islets
E. Gluconeogenesis activation
41. A patient address to a doctor with complaints of constant thirst. Hyperglycemia, polyuria and
increased content of 17-ketosteroids in urine were revealed. What is the most probable disease in
this case?
A. Addison’s disease
B. Myxedema
C. Glycogenosis of I type
D. Insulin dependent diabetes mellitus
E. Steroid diabetes
42. In 62-years-old woman cataract (crystalline lens dimness) develops at the diabetes mellitus
background. What process enhancement due to diabetes mellitus is the cause of cataract?
A. Ketogenesis
B. Lipogenesis
C. Proteolysis
D. Glycosilation of proteins
E. Gluconeogenesis
43. A 19-years-old patient has suffered from diabetes mellitus since he was 8. He took cure
irregularly. He was admitted to the hospital in connection to diabetes ketoacidosis development.
What kind of respiration is the most possible in this condition?
A. Kussmaul respiration
B. Biot’s respiration
C. Chane-Stocks respiration
D. Inspiratory breathlessness
E. Expiratory breathlessness
44. A patient aged 60 has been suffering from diabetes mellitus for 18 years. He complains of
cold of his lower extremities and intermittent lameness during last years. What is the mechanism
of indicated symptoms development?
A. Macroangiopathy of lower extremities
B. Hyperketonemia
C. Neuropathy
D. Disturbances of metabolism of muscles
E. Hyperglycemia
45. An adolescent aged 17 addressed to a physician in connection with enter a college. He has no
complaints. His height is 178 cm; his weight is 96 kg without essential changes during a year. He
has even distribution of subcutaneous adipose tissue. His pulse rate is 82 bpm; his BP is 115/80
mmHg. At laboratory examination of a youth: content of glucose in blood is 8.2 mmol/L;
glucosuria – 4.6 g/L. What type of diabetes mellitus is the most probable in this patient?
A. Non-insulin-dependent diabetes mellitus with obesity
B. Insulin-dependent diabetes mellitus
C. Symptomatic diabetes mellitus is due to dyencephalic syndrome
D. Steroid diabetes mellitus is due to Cushing’s syndrome
E. Symptomatic diabetes mellitus is due to acromegaly
46. Signs of fatty dystrophy of liver are revealed in 38-years-old female patient who has been
suffering from diabetes mellitus for a long time. What factor deficiency is leading in this state
development?
A. Lipocain
B. Lecithin
C. Insulin
D. Glycogen
E. Acetyl-CoA
47. Hyperglycemia and decreased number of insulin receptors on the lipocytes are established in
mice with hereditary obesity. What is the primary mechanism of lipogenesis intensification in
these animals?
A. Hyperinsulinemia
B. Hypoinsulinemia
C. Hyperfunction of lipocytes
D. Decreased tolerance to glucose
E. Increased fat deposition
48. A patient with diabetes mellitus did not take the dose of insulin in time. Thus gyperglycemic
coma developed (content of glucose in patient’s blood is 50 mmol/L). What is the leading factor
for such coma development?
A. Hyperosmolarity of blood plasma
B. Hypokalemia
C. Hypoxia
D. Hyponatremia
E. Acidosis
49. What is the mast important mechanism of hypoglycemic coma development?
A. Carbohydrate starvation of brain
B. Reinforcement of glycogenilysis
C. Oppression of glycogenesis
D. Oppression of gluconeogenesis
E. Intensification of ketogenesis
50. What is the reason for glucosuria appearance under diabetes mellitus?
A. Hyperglycemia
B. Increase of renal threshold
C. Rise of hexokinase activity
D. Increase of glomerular membrane permeability
E. Polyuria
51. In a patient with diabetes mellitus loss of consciousness and cramps were observed after
insulin injection. What is a possible result of blood test for glucose in this case?
A. 5.5 mmol/L
B. 3.3 mmol/L
C. 8.0 mmol/L
D. 10 mmol/L
E. 2.5 mmol/L
52. A patient was admitted to the hospital in connection to osteomyelitis of lower jaw. When
laboratory examining of the patient glucose was found in her urine. Content of glucose in her
blood is normal. What is the reason for glucosuria?
A. Insufficiency of tubular enzyme systems
B. Increase of glomerular filtration
C. Enhancement of tubular secretion
D. Decrease of renal concentration function
E. Rise of osmotic pressure in tubules
53. In a patient, who has poisoning with flodzine, glucosuria was revealed; concentration of
glucose in patient’s blood is 5.6 mmol/L. What is the mechanism of glucosuria in this case?
A. Disturbances of tubular reabsorption
B. Reduction of glomerular filtration
C. Increase of glomerular filtration
D. Disorders of tubular secretion
E. Rise of oncotic pressure of blood
ANSWERS:
1.- B. 2.-D. 3.- E. 4.-C. 5.-C. 6.- C. 7.- E. 8.-B. 9.-E 10.-A. 11.- B. 12.- A. 13.-C. 14.-D. 15.-A.
16.-A. 17.-A. 18.-A. 19.-A. 20.-A. 21.-A. 22.-C. 23.-D. 24.-B. 25.-D. 26.-C. 27.-E. 28.-B. 29.-C.
30.-A. 31.-A. 32.-E. 33.-D. 34.-C. 35.-B. 36.-D. 37.-B. 38.-D. 39.-E. 40.-D. 41.-E. 42.-D. 43.-A.
44.-A. 45.-A. 46.-A. 47.-A. 48.-A. 49.-A. 50.-A. 51.-E. 52.-A. 53.-A.
Topic 13. Final class “Typical pathological processes”
Topic 14.
Diabetes mellitus.
1. A patient was admitted to the hospital in comatose state. Accompanying people said that hi
lost consciousness at training while he was finishing the Marathon distance. What sort of coma is
the most possible in this patient?
A. Hyperglycemic
B. Hypoglycemic
C. Hypothyroid
D. Hepatic
E. Diabetic ketoacidosis
2. Patient has hyperglycemia, glucosuria, polydipsia, polyphagia, and polyuria. What hormone
hyposecretion do these changes develop due to?
A. Antidiuretic hormone
B. Atriopeptide
C. Glucagon
D. Insulin
E. Cortisone
3. A patient, aged 80, complains of increased appetite, thirst, elevated urination, and worsening
of general condition after the taking some sweet food. What disease is it?
A. Hypercortisolism
B. Hyperthyroidism
C. Hypothyroidism
D. Diabetes insipidus
E. Diabetes mellitus
4. A man, aged 38, is under the course of treatment for schizophrenia at in-patient department.
Contents of glucose, ketone bodies, and urea in his blood are normal. Shock therapy with regular
injections of insulin has led to development of insular coma, and after that state of patient
becomes better. What is the most possible reason for insular coma?
A. Glucosuria
B. Dehydration of tissues
C. Hypoglycemia
D. Metabolic acidosis
E. Ketonemia
5. In worker at polar station, who has been working there for a long time, hemorrhage form gums
occur, his teeth sway and pull out. What vitamin deficiency leads to these changes?
A. Tocopherol
B. Ergocalciferol
C. Ascorbic acid
D. Folic acid
E. Nicotinic acid
6. A patient, aged 50, complains of increased appetite, thirst, and loss of body weight, weakness.
At laboratory examination rise of amount of glucose in his blood revealed. What type of cells is
injured in case of this disease development?
A. Lipotropocytes
B. Thyrocytes
C. B-cells of Langerhans islets
D. A-cells of Langerhans islets
E. Pancreatocytes.
7. In 18-years-old patient, while laboratory examining presence of glucose in urine and normal
concentration of glucose in blood plasma were revealed. What disorder is the most possible
cause of these changes?
A. Disorders of glomerular filtration
B. Disorders of tubular secretion
C. Disorders of glucocorticoids secretion
D. Disorders of insulin secretion
E. Disorders of tubular reabsorption
8. Dyspepsia and vomiting are observed in a newborn after feeding with milk. These phenomena
disappear after feeding with glucose solution. What enzyme that takes part in carbohydrate
digestion is deficient in case of these changes development?
A. Amylase
B. Lactase
C. Maltase
D. Isomaltase
E. Saccharase
9. In patient painfulness along large nervous trunks and increase of pyruvate in blood are
revealed. What vitamin deficiency may lead to these changes?
A. Pantothenic acid
B. Nicotinic acid (PP)
C. Biotin
D. Riboflavin (B2)
E. Thiamin (B1)
10. A newborn was admitted to the emergency department with following symptoms: vomiting,
diarrhea, disorders of growth and development, cataract, and mental retardation. Galactosemia
was diagnosed. What enzyme deficiency takes place in this case?
A. Glucose-1-phosphate uridiltransferase
B. Glucokinase
C. Glucose-6-phosphate dehydrogenase
D. UDP glucose pyrophosphorilase
E. UDP glucose-4-epimerase
11. Flatulence, bowel spasms, abdominal pain and diarrhea often develop in some people after
taking milk. These symptoms arise in 1 - 4 hours after intake only one glass of milk. What
component of milk these symptoms develop due to?
A. Galactose
B. Lactose
C. Maltose
D. Saccharose
E. Fructose
12. Newborn has been refusing food, having vomiting and diarrhea, and some time later its
crystalline lens become opaque. At examination of newborn: glucose in blood – 8.5 mmol/L and
in urine – 1%. What is the most possible diagnosis?
A. Galactosemia
B. Phenylketonuria
C. Tyrosinosis
D. Cystinuria
E. Alkaptonuria
13. In woman, aged 45, without symptoms of diabetes mellitus, content of glucose in blood on
an empty stomach reaches 7.5 mmol/L. What test is necessary to be performed?
A. Determination of residual nitrogen in blood
B. Determination of glucose in blood on an empty stomach
C. Determination of tolerance to glucose
D. Determination of ketone bodies in urine
E. Determination of glycosylated hemoglobin
14. In man, aged 60, who is 170 cm tall and 110 kg weight, content of glucose in blood is 6.8–
7.0 mmol/L. Content of insulin in his blood is normal. Tolerance to glucose is decreased, as well
as number of insulin receptors, in this patient. What signs allow us to evaluate this diabetes
mellitus as non-insulin dependent?
A. Decreased tolerance to carbohydrates
B. Recurrent hyperglycemia
C. Patient’s age
D. Normal content of insulin in blood
E. Obesity
15. In a patient, suffered from frequent hemorrhages from internal organs and mucous
membranes, proline and lysine were found in structure of collagen fibers. What vitamin
deficiency contributes disorders of these amino acids hydroxylation?
A. Vitamin C
B. Vitamin E
C. Vitamin K
D. Vitamin A
E. Vitamin B1
16. In patients who suffered from alcoholism B1 hypovitaminosis is often observed, as a
consequence of nutrition disturbances. Symptoms of vitamin B1 deficiency are disorders of
nervous system, psychoses, and amnesia. Why cells of nervous tissue are particularly susceptible
to thiamine deficiency?
A. Aerobic decay of glucose is broken
B. Liplysis in adipose tissue is increased
C. Oxidation of fatty acids is broken
D. Glycolysis is intensified
E. Glycolysis is decreased
17. According to results of gastric juice analysis following traits were revealed: common acidity
– 24 mmol/L, free hydrochloric acid – 1.5 mmol/L, content of gastric mucoprotein is decreased.
What vitamin deficiency is observed in organism?
A. Cobalamin
B. Folic acid
C. Pantothenic acid
D. Nicotinamide
E. Bioflavonoids
18. A 24-years-old woman complains of dryness in mouth and loss of weight in spite of good
appetite. At examination of the patient: height – 162 cm, weight – 65 kg, content of glucose in
blood – 8.3 mmol/L, and presence of glucose in urine. What disease does these symptoms
characteristic for?
A. Diabetes mellitus
B. Steroid diabetes
C. Diabetes insipidus
D. Alimentary glucosuria
E. Renal diabetes
19. A man, who have been suffering from diabetes mellitus for a long time, was admitted to the
hospital because of rapid worsening of his condition: general malaise, polyuria, polydipsia,
nausea and vomiting, confusion, sleepiness. Kussmaul respiration and scent of acetone from
mouth were observed in this patient. In his urine high contents of glucose and acetone bodies
were found. What is the reason for worsening of patient’s condition?
A. Diabetic ketoacidosis
B. Gas acidosis
C. Heart failure
D. Renal failure
E. Hypoglycemic coma
20. Treatment of the child for rachitis using vitamin D3 was not efficient. What is the most
possible reason for ineffectiveness of treatment?
A. Disorders of hydroxylation of vitamin D3
B. Deficit of lipids in food
C. Disorders of including vitamin D3 into enzyme
D. Intensified using vitamin D3 by intestine microflora
E. Disorders of transport of vitamin D3 with blood plasma proteins
21. Content of glucose in patient’s blood is: on an empty stomach – 5.65 mmol/l, in one hour
after taking sugar – 8.55 mmol/l, and in two hours after taking sugar – 4.95 mmol/l. These signs
are characteristic for:
A. Healthy person
B. Person suffered from hidden diabetes mellitus
C. Person suffered from non-insulin-dependent diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
22. Patient, aged 26, who suffered from hypoglycemic coma resulted from insulin overdosage,
was intravenously infused with 20% solution of glucose. After this manipulation patient’s
condition improved. What process helps glucose enter the cell?
A. Osmotic transport
B. Pinocytosis
C. Active transport
D. Secretion
E. Phagocytosis
23. A 40-years-old man is suffering from diabetes mellitus. After he has endured tonsillitis,
reinforcement of thirst, nausea, vomiting, abdominal pain, and sleepiness develop in him.
Patient’s BP is 80/45 mmHg, pulse rate 125 bpm, and his skin is dry. Content of glucose in blood
is 28 mmol/L. What complication of diabetes mellitus appears in this patient?
A. Lactic acidosis
B. Diabetic ketoacidosis
C. Hepatic coma
D. Hyperosmolar coma
E. Hypoglycemic coma
24. After the break of diet (taking the easy for assimilation carbohydrates) in a woman, who has
been suffering from diabetes mellitus for a long time, general malaise and increase of blood
pressure gradually develop and hallucinations and cramps appear. Woman has dry skin and
distinct signs of dehydration. What is the reason for worsening of patient’s condition?
A. Hypoglycemic coma
B. Hyperosmolar hyperglycemic coma
C. Diabetic ketoacidosis
D. Heart failure
E. Respiratory failure
25. During the experiment rat was injected with 5% alloxan solution in dose 200 mg per kg of rat
weight. What kind of pathology arises in this case?
A. Arterial hypertension
B. Acute renal failure
C. Diabetes insipidus
D. Diabetes mellitus
E. Hepatic failure
26 One-year infant lags in mental development from infants of the same age. The infant has
vomiting, cramps, and loss of consciousness in the mornings. What enzyme deficiency these
changes are connected to?
A. Phosphorylase
B. Arginase
C. Glycogen syntase
D. Saccharase
E. Lactase
27. In patient with constant hypoglycemia blood analysis does not change after injection of
adrenalin. A doctor supposes hepatic disorder. What function disorder it is?
A. Cholesterol formation
B. Excretion
C. Glycolysis
D. Ketogenesis
E. Glycogen deposition
28. A woman, aged 58, was admitted to the hospital in severe condition. She has confused
consciousness; dry skin, hollow eyes, cyanosis, and scent of rotten apples from her mouth. At
laboratory examination of her: glucose in blood – 15.1 mmol/L, glucose in urine – 3.5%. What is
the most possible reason for this condition?
A. Hypoglycemic coma
B. Hyperglycemic coma
C. Hypovolemic coma
D. Uremic coma
E. Anaphylactic shock
29. A doctor reveals in child symmetric roughness on cheeks, diarrhea, and disorders of neural
activity. What nutrition factors deficit underlies this condition?
A. Methionine, lipoic acid
B. Lysine, ascorbic acid
C. Nicotinic acid, tryptophan
D. Threonine, pantothenic acid
E. Phenylalanine, pangamic acid
30. The most of participants of Magellan expedition to America died of avitaminosis. This
disease displays as general malaise, subcutaneous hemorrhage, pulling teeth out, hemorrhage
from gums. What is the name for this avitaminosis?
A. Scurvy
B. Pellagra
C. Addison-Birmer’s anaemia
D. Polyneuritis (beriberi)
E. Rachitis
31. In a woman, of 52 years old and of 125 kg weight, diabetes mellitus develops. It happens due
to:
A. Decrease of number of insulin receptors
B. High-affinity binding insulin to synalbumin
C. Reduced cell susceptibility to insulin
D. Increase activity of insulinase
E. Broken insulin synthesis
32. Unconscious patient was admitted to the hospital. He has Kussmaul respiration, blood
pressure 80/50 mmHg, and acetone scent from his mouth. What substances accumulation in
organism may lead to these disturbances?
A. Complex carbohydrates
B. Carbonic acid
C. Lactic acid
D. Modified lipoproteins
E. Ketone bodies
33. In patient suffered from diabetes mellitus metabolic acidosis develops due to accumulation of
ketone bodies (beta-oxybutyric acid and acetoacetic acid). At this condition pH of arterial blood
is:
A. 7.40
B. 7.48
C. 7.56
D. 7.32
E. 7.66
34. A patient, 56 years old woman, who have been suffering from diabetes mellitus for 6 years,
complains of compressing pain behind her sternum. What mechanism of heart affection is the
most possible in this case?
A. Myocardial dystrophy
B. Microangiopathy of myocardial vessels
C. Macroangiopathy of coronary vessels
D. Myocarditis
E. Vegetative neuropathy of heart
35. Content of glucose in patient’s blood is: on an empty stomach – 4.52 mmol/l, in one hour
after taking sugar – 6.23 mmol/l, and in two hours after taking sugar – 2.56 mmol/l. These signs
are characteristic for:
A. Healthy person
B. Person suffered from insulinoma
C. Person suffered from hidden diabetes mellitus
D. Person suffered from insulin-dependent diabetes mellitus
E. Person suffered from thyrotoxicosis
36. What complication may develop when treating diabetic ketoacidosis with large doses of
insulin?
A. Arterial hypertension
B. Leukocytosis
C. Arterial hypotension
D. Hypoglycemia
E. Hyperkalemia
37. A female patient, aged 24, complains of dryness in her mouth, loss of weight despite good
appetite. Her height is 157 cm her weight is 72 kg. What analysis we have to perform at fist in
this patient?
A. Urinalysis by Zemnitsky
B. Determination of glucose content in 24-hour urine quantity
C. General urinalysis
D. Determination of protein fractions in blood serum
E. Coagulogram
38. A patient D., 40-years-old woman, was admitted to the hospital with complaints of weakness,
giddiness, hunger, cold sweat, and cramps. At examination of the patient: distension of pupils of
the eyes, weakening of respiration, and BP is 90/50 mmHg. Biochemical analysis of her blood
shows: general bilirubin is 16.0 mcmol/L, urea is 4.7 mmol/L, creatinine is 98 mcmol/L, and
glucose is 2.0 mmol/L. What kind of coma may develop in this patient?
A. Hyperglycemic
B. Hepatic
C. Renal
D. Hypoglycemic
E. At adrenal glands deficiency
39. The woman B., aged 45, was admitted to the emergency department from a street. At
examination of patient following symptoms was revealed: loss of consciousness, loss of reflexes,
absence of reflexes from pupil of the eye and sclera, Kussmaul respiration, BP is 70/40 mmHg,
and body temperature is 35oC. Biochemical analysis of patient’s blood displays: general bilirubin
is 16.0 mcmol/L, urea is 3.6 mmol/L, creatinine is 108 mcmol/L, and glucose is 22 mmol/L.
What kind of coma has developed in this patient?
A. Hypoglycemic
B. Hepatic
C. Renal
D. At adrenal glands deficiency
E. Hyperglycemic
40. Diabetes mellitus develops in animals after injection to them some alloxan. What is the main
mechanism of this type of diabetes mellitus?
A. Selective damage of lambda-cells of pancreatic islets
B. Damage of beta- and lambda-cells of pancreatic islets
C. Formation of antibodies to insulin
D. Selective damage of beta-cells of pancreatic islets
E. Gluconeogenesis activation
41. A patient address to a doctor with complaints of constant thirst. Hyperglycemia, polyuria and
increased content of 17-ketosteroids in urine were revealed. What is the most probable disease in
this case?
A. Addison’s disease
B. Myxedema
C. Glycogenosis of I type
D. Insulin dependent diabetes mellitus
E. Steroid diabetes
42. In 62-years-old woman cataract (crystalline lens dimness) develops at the diabetes mellitus
background. What process enhancement due to diabetes mellitus is the cause of cataract?
A. Ketogenesis
B. Lipogenesis
C. Proteolysis
D. Glycosilation of proteins
E. Gluconeogenesis
43. A 19-years-old patient has suffered from diabetes mellitus since he was 8. He took cure
irregularly. He was admitted to the hospital in connection to diabetes ketoacidosis development.
What kind of respiration is the most possible in this condition?
A. Kussmaul respiration
B. Biot’s respiration
C. Chane-Stocks respiration
D. Inspiratory breathlessness
E. Expiratory breathlessness
44. A patient aged 60 has been suffering from diabetes mellitus for 18 years. He complains of
cold of his lower extremities and intermittent lameness during last years. What is the mechanism
of indicated symptoms development?
A. Macroangiopathy of lower extremities
B. Hyperketonemia
C. Neuropathy
D. Disturbances of metabolism of muscles
E. Hyperglycemia
45. An adolescent aged 17 addressed to a physician in connection with enter a college. He has no
complaints. His height is 178 cm; his weight is 96 kg without essential changes during a year. He
has even distribution of subcutaneous adipose tissue. His pulse rate is 82 bpm; his BP is 115/80
mmHg. At laboratory examination of a youth: content of glucose in blood is 8.2 mmol/L;
glucosuria – 4.6 g/L. What type of diabetes mellitus is the most probable in this patient?
A. Non-insulin-dependent diabetes mellitus with obesity
B. Insulin-dependent diabetes mellitus
C. Symptomatic diabetes mellitus is due to dyencephalic syndrome
D. Steroid diabetes mellitus is due to Cushing’s syndrome
E. Symptomatic diabetes mellitus is due to acromegaly
46. Signs of fatty dystrophy of liver are revealed in 38-years-old female patient who has been
suffering from diabetes mellitus for a long time. What factor deficiency is leading in this state
development?
A. Lipocain
B. Lecithin
C. Insulin
D. Glycogen
E. Acetyl-CoA
47. Hyperglycemia and decreased number of insulin receptors on the lipocytes are established in
mice with hereditary obesity. What is the primary mechanism of lipogenesis intensification in
these animals?
A. Hyperinsulinemia
B. Hypoinsulinemia
C. Hyperfunction of lipocytes
D. Decreased tolerance to glucose
E. Increased fat deposition
48. A patient with diabetes mellitus did not take the dose of insulin in time. Thus gyperglycemic
coma developed (content of glucose in patient’s blood is 50 mmol/L). What is the leading factor
for such coma development?
A. Hyperosmolarity of blood plasma
B. Hypokalemia
C. Hypoxia
D. Hyponatremia
E. Acidosis
49. What is the mast important mechanism of hypoglycemic coma development?
A. Carbohydrate starvation of brain
B. Reinforcement of glycogenilysis
C. Oppression of glycogenesis
D. Oppression of gluconeogenesis
E. Intensification of ketogenesis
50. What is the reason for glucosuria appearance under diabetes mellitus?
A. Hyperglycemia
B. Increase of renal threshold
C. Rise of hexokinase activity
D. Increase of glomerular membrane permeability
E. Polyuria
51. In a patient with diabetes mellitus loss of consciousness and cramps were observed after
insulin injection. What is a possible result of blood test for glucose in this case?
A. 5.5 mmol/L
B. 3.3 mmol/L
C. 8.0 mmol/L
D. 10 mmol/L
E. 2.5 mmol/L
52. A patient was admitted to the hospital in connection to osteomyelitis of lower jaw. When
laboratory examining of the patient glucose was found in her urine. Content of glucose in her
blood is normal. What is the reason for glucosuria?
A. Insufficiency of tubular enzyme systems
B. Increase of glomerular filtration
C. Enhancement of tubular secretion
D. Decrease of renal concentration function
E. Rise of osmotic pressure in tubules
53. In a patient, who has poisoning with flodzine, glucosuria was revealed; concentration of
glucose in patient’s blood is 5.6 mmol/L. What is the mechanism of glucosuria in this case?
A. Disturbances of tubular reabsorption
B. Reduction of glomerular filtration
C. Increase of glomerular filtration
D. Disorders of tubular secretion
E. Rise of oncotic pressure of blood
ANSWERS:
1.- B. 2.-D. 3.- E. 4.-C. 5.-C. 6.- C. 7.- E. 8.-B. 9.-E 10.-A. 11.- B. 12.- A. 13.-C. 14.-D. 15.-A.
16.-A. 17.-A. 18.-A. 19.-A. 20.-A. 21.-A. 22.-C. 23.-D. 24.-B. 25.-D. 26.-C. 27.-E. 28.-B. 29.-C.
30.-A. 31.-A. 32.-E. 33.-D. 34.-C. 35.-B. 36.-D. 37.-B. 38.-D. 39.-E. 40.-D. 41.-E. 42.-D. 43.-A.
44.-A. 45.-A. 46.-A. 47.-A. 48.-A. 49.-A. 50.-A. 51.-E. 52.-A. 53.-A.
Topi15. Pathophysiology of water-salt metabolism.
1. It is characteristically for cholera to lose large quantity of water and sodium ions from the
organism. The basis of biochemical action of cholera toxin is:
A. Oxidation of aldosterone in the cortex of adrenal glands
B. Activation of adenilat cyclase in enterocytes of small intestine
C. Intensification of renin secretion by the cells of juxtaglomerular apparatus
D. Decrease of synthesis of antidiuretic hormone in hypothalamus
E. Activation of synthesis of atrial natriuretic hormone
2. Wasp has stung a woman. Oedema and hyperemia develop at woman’s left cheek (site of the
bite). What mechanism of oedema development is primary in this case?
A. Decrease of osmotic pressure of blood
B. Impediment for lymphatic drainage
C. Increase of oncotic pressure of tissue fluid
D. Increase of capillary permeability
E. Increase of hydrostatic pressure of blood in capillaries
3. In worker of fusing workshop thirst develops due to enhanced sweating. He drinks a lot of
water without salt. What kind of water-salt balance disturbance the most possibly develops in
this case?
A. Hyperosmolar hyperhydration
B. Hyperosmolar hypohydration
C. Hypoosmolar hyperhydration
D. Hypoosmolar hypohydration
E. Isoosmolar hypohydration
4. A boy, aged 9, with oedemas was admitted to the hospital. What proteins content in blood is
decreased in this case?
A. Albumins
B. Protamines
C. Globulins
D. Hemoglobin
E. Hystons
5. Worker of fusing workshop, man of 23 years old and of 60 kg weight, was admitted to the
emergency department. Examination of water-salt exchange in this patient displays: content of
general water is 33 liters (55% of body weight), extracellular sector constitutes 28.6% of body
weight (17.2 liters), intravascular fluid constitutes 4% of body weight (2.4 liters), and
intracellular sector constitutes 26.3% of body weight (15.8 liters). Osmotic pressure of patient’s
blood is 340 mosm/l; content of sodium in it - 160 mmol/l. Patient’s urination is 0.4 liters per 24
hours. Determine the type of dyshydration.
A. Hyperosmolar hyperhydration
B. Hyperosmolar hypohydration
C. There is no dyshydration
D. Isoosmolar hyperhydration
E. Hypoosmolar hypohydration
6. A patient with severe nephropathy accompanied by severe oedema syndrome that develops as
complication of bronchiectasis. Laboratory examination of this patient displays abundant
proteinuria, cylinderuria, distinct decrease of protein content in blood serum, hyperlipidemia,
hypokalemia, and other pathological changes. What is the most important link in development of
oedemas in this patient?
A. Decrease of oncotic pressure of blood
B. Increase of osmotic pressure of interstitial fluid
C. Increase of hydrostatic pressure of blood
D. Blockade of lymphatic drainage
E. Increase of microvessel permeability
7. A patient has increased osmolarity of urine and decreased urination due to intensive sweating
and dehydration. What hormone secretion changes provide compensatory retention of water at
first?
A. Antidiuretic hormone
B. Aldosterone
C. Corticosterone
D. Thyroxin
E. Insulin
8. Content of sodium in patient’s blood serum is 100 mmol/l. What does this condition may
manifest in?
A. Edemas
B. Arrhythmias
C. Dehydration
D. Heart arrest
E. Tachycardia
9. In a patient, aged 44, thirst develops after burns. What receptors generate impulses that
underlie thirst development in this case?
A. Osmoreceptors
B. Pain receptors
C. Thermal receptors
D. Tactile receptors
E. Chemoreceptors
10. Isoosmolar hypohydration has been formed in a patient due to severe diarrhea. What
symptoms are characteristic for this disturbance of water exchange?
A. Edematous syndrome
B. Decrease of content of water inside cells
C. Hypovolemic shock
D. Polyuria
E. Arterial hypertension
11. In patient with affection of kidneys hypoosmolar hyperhydration (water poisoning) has
developed. What is the main pathogenic factor of this syndrome?
A. Anuria
B. Hypoaldosteronism
C. Polyuria
D. Hypoproteinemia
E. Increase of microvessel permeability
12. Hyperosmolar hypohydration has been formed while prolonged water starvation. Which of
following manifestations are typical for this condition?
A. Arterial hypertension
B. Hypoisostenuria
C. Hypothermia
D. Increased salivation
E. Cramps and hallucinations
13. In patient suffered from severe chronic glomerulonephritis retention of isoosmolar fluid in
organism and distinct edematous syndrome occur. What is the major factor of edema
development in case of glomerulonephritis?
A. Hyperproteinemia
B. Secondary aldoseronism
C. Hypoproteinemia
D. Hypoaldosteronism
E. Arterial hypertension
14. In patients with myeloma content of proteins in blood plasma is increased up to 200 g/l. This
leads to redistribution of water between intracellular, interstitial, and intravascular spaces. What
direction does water mainly move at in this case?
A. From interstitium to blood vessels
B. From cells to interstitium
C. From interstitium to cells
D. From blood vessels to interstitium
E. From lymphatic vessels to interstitium
15. A patient of 18 years old and of 60 kg weight was admitted to the hospital with signs of
hemic hypoxia resulting from poisoning by nitric compounds. Examination of water exchange of
this patient displays: general water – 64% of body weight, extracellular fluid – 18%,
intravascular fluid – 5%, and intracellular fluid – 46%; osmotic pressure of blood plasma is 250
mosm/l; urination is 0.8 L per 24 hours. Define the type of dyshydration?
A. There is no dyshydration
B. Isoosmolar hyperhydration
C. Isoosmolar hypohydration
D. Hypoosmolar hyperhydration
E. Hypoosmolar hypohydration
16. Edemas at lower extremities occur in a patient suffered from severe heart failure. What is the
leading mechanism of edema development in this case?
A. Centralization of blood circulation
B. Lowering of hydrostatic pressure
C. Secondary hyperaldosteronism
D. Orthostatic increase of venous pressure
E. Hypoproteinemia
17. What is the initial link in formation of heart edemas?
A. Increase of vascular permeability
B. Decrease of minute heart volume
C. Activation of renin-angiotensin system
D. Increase of content of aldosteron in blood
E. Increase of secretion of antidiuretic hormone
18. What is the leading factor of edema development in case of nephrotic syndrome?
A. Increase of hydrostatic pressure in capillaries
B. Increase of vascular permeability
C. Hypoalbuminemia
D. Dynamic lymphatic insufficiency
E. Increase of blood volume
19. Patient suffered from cirrhosis of liver was given with 500 ml of 5% glucose solution with
medicines. What disturbances of water-salt balance may appear in this patient?
A. Hypoosmolar hyperhydration
B. Hyperosmolar hyperhydration
C. Isoosmolar hyperhydration
D. Hypoosmolar hypohydration
E. There is no dyshydrotation
20. Patient has edema of right lower part of face and pulsing pain in tooth, which intensifies
when taking some hot food. Dentist has diagnosed acute pulpitis. What is the leading mechanism
of edema development in this case?
A. Disorders of microcirculation in the focus of inflammation
B. Disorders of trophic function of nervous system
C. Hypoproteinemia
D. Hyperosmia
E. Lymphocytosis
21. Toxic lung edema was modeled in rat using solution of ammonium chloride. What is the
leading mechanism of edema development in this case?
A. Reducing of colloid-osmotic pressure
B. Rising of venous pressure
C. Increase of vascular permeability
D. Disorders of neural and humoral regulation
E. Intensification of lymphatic drainage
22. A rat was intravenously injected by 10 ml of 40% glucose solution. In 60 min coma develops
due to hyperosmolar dehydration in this rat. What is the mechanism of edema development in
this case?
A. Loss of water and salts
B. Reduction of vasopessin synthesis
C. Increase of oncotic pressure of extracellular fluid
D. Increase of osmotic pressure of extracellular fluid
E. Disturbance of acid-base balance
23. Patient has extracellular edema of tissues (dimensions of soft tissues of extremities, liver, and
others are enlarged). What parameter of homeostasis decrease do these changes result from?
A. Viscosity
B. pH
C. Hematocrite
D. Oncotic pressure of blood plasma
E. Osmotic pressure of blood plasma
24. At complete starvation (with taking water) generalized edemas develop. What is the leading
pathogenic factor in this case?
A. Increase of oncotic pressure of interstitial fluid
B. Decrease of osmotic pressure of blood plasma
C. Decrease of oncotic pressure of blood plasma
D. Increase of osmotic pressure of interstitial fluid
E. Decrease of hydrostatic pressure of interstitial fluid
25. When treating for dehydration by means of salt-poor fluids at the background of sharply
reduced excretory renal function resulted from tubular necrosis the worsening of general
condition, confused consciousness, convulsive readiness, and brain edema with vomiting
develop. What kind of water-salt exchange disturbances takes place in this case?
A. Hypoosmolar hyperhydration
B. Isoosmolar hyperhydration
C. Hyperoosmolar hyperohydration
D. Hypoosmolar hypohydration
E. Hyperosmolar hypohydration
26. As it is known, general amount of water in an organism depends on age, body weight, and
sex. Besides, pathogenetic classification of dehydration is important. This classification includes
forms of mineral salt deficiency, forms of water deficiency, and transitional forms. What
reasons, according to this classification, belong to form of mineral salt deficiency?
A. Loss of electrolytes through the stomach
B. Loss of water is due to polyuria
C. Reduced intake of water
D. Loss of water with a bleeding
E. Loss water is due to hyperventilation
27. A patient has uneasiness in the chest and difficult breathing after physical exertion. Some
time later cough with foamy liquid phlegm appears. Significant cyanosis develops in the patient.
What is the leading mechanism for edema development in this case?
A. Hydrodynamic
B. Colloid
C. Membranogenous
D. Lymphogenic
E. Osmotic
28. In inflammation increased vascular permeability and increase of hydrostatic pressure are
observed in microcirculatory vessels. The level of colloid-osmotic pressure of blood does not
significantly changes. There are shift of pH towards acid state, rise of osmotic pressure, and
increase in dispersion of proteins in the interstitial fluid. What kind of edema is observed in this
case?
A. Mixed
B. Hydrodynamic
C. Colloid-osmotic
D. Lymphogenic
E. Membranogenous
29. A person, who has been starving for along time, has edemas. What is the main mechanism of
edema development in this case?
A. Decrease of oncotic pressure of the blood
B. Increase of oncotic pressure of tissues
C. Increase of hydrostatic pressure of venous blood
D. Decrease of hydrostatic pressure of tissues
E. Decrease of blood circulating volume
30. In person, who was bitten by bees, edema of the face and the upper extremities developed.
What is the main mechanism of edema development in this case?
A. Increase of vascular permeability
B. Increase of hydrostatic pressure in capillaries
C. Decrease of hydrostatic pressure of tissues
D. Increase of oncotic pressure of tissues
E. Decrease of oncotic pressure of blood
31. Pulmonary hypertension and right-ventricle heart insufficiency with ascites and edemas
develop in a patient suffered from pneumosclerosis. What is the main mechanism of edema
development in this case?
A. Increase of hydrostatic pressure in veins
B. Increase of oncotic pressure of tissues
C. Decrease of oncotic pressure of blood
D. Reduction of heart stroke volume
E. Increase of vascular permeability
32. Which of followings may cause the isoosmolar hypohydration?
A. Acute blood loss
B. Diarrhea
C. Vomiting
D. Perspiration
E. Hyperventilation
33. Where does fluid accumulate predominantly in case of edema?
A. Intercellular space
B. Intracellular space
C. Pleural cavity
D. Abdominal cavity
E. Intravascular space
ANSWERS:
1.-B. 2.-D. 3.-C. 4.-A. 5.-B. 6.-A. 7.-A. 8.-C. 9.-A. 10.-C. 11.-A. 12.-E. 13.-B. 14.-A. 15.-D. 16.C. 17.-B. 18.-C. 19.-A. 20.-A. 21.-C. 22.-D. 23.-D. 24.-C. 25.-A. 26.-A. 27.-A. 28/-A. 29.-A.
30.-A. 31.-A. 32.-A. 33.-A.
Topic16. Pathophysiology of acid-base balance and phosphate-calcium metabolism.
1. At examination of patient following were found: hyperglycemia, ketonuria, polyuria,
hyperstenuria, and glucosuria. What kind of acid-base balance disturbances occurs in this case?
A. Gas alkalosis
B. Non-gas alkalosis
C. Metabolic alkalosis
D. Metabolic acidosis
E. Gas alkalosis
2. Acidosis develops in case of severe form of diabetes mellitus. What buffer system components
change at first?
A. Bicarbonate
B. Phosphate
C. Hemoglobin
D. Oxihemoglobin
E. Protein
3. Prolonged convulsions occur in patient suffered from epilepsy. After that following data of
laboratory analysis of this patient were received: pH – 7.14, pCO2 – 45 mmHg, HCO3- – 14
mmol/l, Na+ - 140 mmol/l, Cl- - 98 mmol/l. What kind of acid-base balance disturbances occurs
in this patient?
A. Metabolic ketoacidosis
B. Metabolic lactoacidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
E. There are no disorders of acid-base balance
4. While ascending to mountain in alpinist excitation developed that was replaced with headache,
giddiness, breathlessness, and after that apnea occurred. What kind of acid-base balance
disturbances occurs in this case?
A. Non-gas acidosis
B. Excretory acidosis
C. Gas alkalosis
D. Non-gas alkalosis
E. Gas acidosis
5. A patient suffered from chronic glomerulonephritis has increasing general malaise,
tachycardia with recurrent arrhythmia, confusion, and sleepiness. What kind of acid-base balance
disturbance accompanies uremic coma?
A.Non-gas excretory acidosis
B. Non-gas excretory alkalosis
C. Gas acidosis
D. Gas alkalosis
E. Respiratory alkalosis
6. Pregnant woman has toxicosis accompanied by vomiting of 24 hours duration. After that
tetany cramps and dehydration develop. What kind of shift of acid-base balance leads to
described changes?
A. Gas alkalosis
B. Gas acidosis
C. Non-gas metabolic acidosis
D. Non-gas metabolic alkalosis
E.Non-gas excretory alkalosis
7.A patient suffered from diabetes mellitus was admitted to the hospital because of worsening of
his condition. He has general malaise, polyuria, lethargy, and sleepiness. Kussmaul respiration,
heart arrhythmia, and acetone scent in expired air are noticed in this patient. What kind of shift
of acid-base balance contributes these symptoms?
A. Gas alkalosis
B. Gas acidosis
C. Non-gas metabolic alkalosis
D. Non-gas metabolic acidosis
E. Non-gas excretory alkalosis
8. A group of alpinists was undergone blood analysis in mountains at height 3000 meters.
Following was revealed: decrease of HCO3- down to 15 mmol/l (norm is 22-26 mmol/l). What is
the mechanism of decrease of HCO3- in the blood?
A. Decrease of reabsorption of bicarbonate in kidneys
B. Hyperventilation
C. Intensification of acidogenesis
D. Hypoventilation
E. Reduction of ammoniogenesis
9. pH of blood of patient suffered from diabetes mellitus sets to 7.3. What component of buffer
system determination is used to diagnose disorders of acid-base balance?
A. Bicarbonate
B. Oxihemoglobin
C. Phosphate
D. Hemoglobin
E. Protein
10. Buffer capacity of blood decreases in worker as a result of exhausting muscle work. What
acid substance income to the blood this may be explained?
A. Alpha-ketoglutaric acid
B. 3-phosphoglycerate
C. Lactic acid
D. Pyruvate
E. 1,3-biphosphoglycerate
11. Repeated vomiting occurs in patient suffered from pylorostenosis which is accompanied by
loss of chloride ions from the organism and development of non-gas alkalosis. What conditions
these changes of acid-base balance may result from?
A. Hyperchloridemia
B. Hyponatremia
C. Hypokalemia
D. Hypernatremia
E. Hyperhposphatemia
12. 48-years-old patient with diabetes mellitus was admitted to the hospital in severe pre-coma
state. When examining of acid-base balance metabolic acidosis was revealed. Patient was treated
with complex therapy including insulin intramuscular injections and sodium bicarbonate solution
intravenous infusion. What is the main possible mechanism of found changes development?
A. Disorders of O2 using in cells
B. Disorders of buffer systems of blood
C. Decrease of CO2 removing
D. Excretion of alkali elements with urine
E. Formation of products of incomplete oxidation
13. Patient has disturbances of airways passage at the level of small and medium bronchi. What
kind of acid-base disorders may develop in this patient?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Metabolic acidosis
E. Acid-base balance does not change
14. In patient suffered from diabetes mellitus coma has developed due to disorders of acid-base
balance. What kind of acid-base disorders develops in this case?
A. Exogenous acidosis
B. Respiratory acidosis
C. Metabolic acidosis
D. Gas alkalosis
E. Non-gas alkalosis
15. A woman has distinct hypersalivation syndrome. Patient has to remove saliva from her
mouth with napkin because of hard pain when she is swallowing. What kind of acid-base
disorders may develop in this patient in some time?
A. Non-gas excretory acidosis
B. Gas alkalosis
C. Metabolic acidosis
D. Non-gas excretory alkalosis
E. Gas acidosis
16. During bronchial asthma attack patient developed gas acidosis (hypercapnia). What buffer
system of blood plays the main role in compensation of this condition?
A. Bicarbonate
B. Hemoglobin
C. Phosphate
D. Protein
E. Ammoniogenesis
17. At examination of a patient hyperglycemia, ketonuria, polyuria, hyperstenuria, and
glucosuria were revealed. What type of acid-base balance disorder takes place in this case?
A. Metabolic acidosis
B. Gas acidosis
C. Metabolic alkalosis
D. Non-gas alkalosis
E. Gas alkalosis
18. A 65-years-old patient with multiple fractures of ribs was admitted to the hospital. What type
of acid-base balance disorder may develop in him?
A. Gas acidosis
B. Gas alkalosis
C. Non-gas acidosis
D. Non-gas alkalosis
E. There are no disorders of acid-base balance
19. A pregnant woman has toxicosis, which accompanied by prolonged vomiting. Data of her
biochemical analyses show: pH of blood – 7.38, pCO2 of arterial blood – 46 mmHg, SB – 17
mmol/L, BE – (+ 6 mmol/L). What type of acid-base balance disorder takes place in this case?
A. Compensated non-gas alkalosis
B. Decompensated non-gas alkalosis
C. Compensated non-gas acidosis
D. Decompensated non-gas acidosis
E. Compensated gas alkalosis
20. A 58-years-old female patient was admitted to the hospital in severe state. Data of her
biochemical analyses show: pH of blood – 7.33, pCO2 of arterial blood – 36 mmHg, SB – 17
mmol/L, BE – (+ 6 mmol/L). What type of acid-base balance disorder takes place in this case?
A. Compensated non-gas alkalosis
B. Decompensated non-gas alkalosis
C. Compensated non-gas acidosis
D. Decompensated non-gas acidosis
E. Compensated gas alkalosis
21. What is the reason for gas alkalosis?
A. Pulmonary hyperventilation
B. Loss of gastric juice
C. Loss of intestine juice
D. Pulmonary hypoventilation
E. Hyperaldosteronism
22. What kind of acid-base balance disturbances may be observed in case of diabetes mellitus?
A. Non-gas acidosis
B. Gas acidosis
C. Gas alkalosis
D. Non-gas alkalosis
E. Excretory acidosis
ANSWERS:
1.-D. 2.-A. 3.-B. 4.-E. 5.-A. 6.-E. 7.-D. 8.-B. 9.-A. 10.-C. 11.-C. 12.-E. 13.-C. 14.-C. 15.-A. 16.B. 17.-A. 18.-A. 19.-A. 20.-B. 21.-A. 22.-A.
Topic. 1.2.3. Pathophysiology of blood and hemopoietic organs.
1. Anemia, leuko- and thrombocytopenia, color index-1.3, presence of megaloblasts and
megalocytes were determined in the laboratory analysis of blood of a patient a year later
after he was operated on for subtotal resection of the stomach for the ulcer of lesser
curvature of the stomach. What factor deficiency results in these changes?
A. Gastromucoprotein
B. Gastrin
C. Pepsin
D. Chlorine hydrate
E. Mucin
2. Amino acids replacement in alpha and beta chains of hemoglobin takes place in a
number of hemoglobimopathies. Which of them is typical for HbS (sickle-cell anemia)?
A. Glycine to serine
B. Aspartate to lysine
C. Methionine to histidine
D. Glutamate to valine
E. Alanine to serine
3. Hereditary microspherocytic hemolytic anemia (Mincovsky-Shoffar disease) was
diagnosed in a woman aged 34. What mechanism caused hemolysis of erythrocytes in the
patient?
A. Enzymopathy
B. Hemoglobinopathy
C. Autoimmune impairment
D. Membranopathy
E. Hypoplasia of bone marrow
4. Megaloblastic anemia was diagnosed in a patient. What substance deficiency may cause
the development of this disease?
A. Cyanocobalamin
B. Cholecalciferol
C. Magnesium
D. Glycine
E. Copper
5. Three years ago a man aged 45 was operated on for stomach resection. After the
operation the content of erythrocytes in the blood is 2.0x1012, Hb 85 g/l, color index-1.27.
What vitamin absorption is impaired that causes the change of erythropoiesis?
A. C
B. P
C. A
D. B6
E. B12
6. A patient, carrier of hereditary sickle-cell erythrocytes anomaly, had pneumonia
accompanied by hemolytic crisis and development of anemia. What is the main cause of
hemolytic crisis in this case?
A. Hyperoxia
B. Heterozygosis HbS
C. Mutation of structural gene
D. Hypoxia caused by pneumonia
E. Blood osmolarity change
7. Examining the oral cavity of a patient, a dentist paid attention to the presence of
inflammatory-dystrophy process in the mucous membrane (Gunter’s glossitis, atrophic
stomatitis). Blood analysis revealed hyperchromic anemia. What factor is a cause of this
disease?
A. Hypovitaminosis B6
B. Hypovitaminosis A
C. Increase of stomach juice acidity
D. Hypovitaminosis B1
E. Hypovitaminosis B12
8. A female patient complains of malaise, weakness, breathlessness, rapid fatigability, and
dizziness. Her blood test data: erythrocytes-1.8x1012/L, Hb-80 g/L, leukocytes-3.2x109/L,
color index-1.5. Anisocytosis, poikilocytosis, megaloblasts, megalocytes were found in
smear. What is the possible diagnosis?
A. B12-deficiency anemia
B. Posthemorragic anemia
C. Acute leukemia
D. Iron deficiency anemia
E. Immunohemolytic anemia
9. A patient, aged 50, complains of a bad appetite, loss of weight, weakness, pain in the
stomach area, and eructation. At laboratory examination of him: Hb-2x1012/L, stomach
secretion 0.4 l, pH of stomach juice-7. Pernicious anemia is diagnosed in this patient. What
compound of gastric juice deficiency is the cause of the disease?
A. Pepsin
B. Renin
C. Secretin
D. HCL
E. Castle’s factor
10. Funicular myelosis and hyperchromic anemia developed in a man 7 years later after the
stomach resection due to ulcer. What pathogenic mechanism of changes in spinal cord is
the most possible one?
A. Hypoxia impairment in anemia
B. Accumulation of methylmalonic acid in cyanocobalamin deficiency
C. Impairment of DNA in cyanocobalamin deficiency
D. Deficiency of folic acid
E. Deficiency of iron containing enzyme
11. On the seventh day after hemorrhage caused by a trauma, the following was revealed in
a patient’s blood: erythrocytes - 2.8x1012/l, Hb - 3.9mmol/l, reticulocytes - 15%,
acidophilic and polychromatophilic normoblasts were found in smear. What is the
mechanism of appearance of regenerative forms of blood erythrocytes?
A. Going out of blood deposition
B. Increase permeability of erythrocyte sprout of bone marrow
C. Intensification of regeneration of erythroid cells in bone marrow
D. Inhibition of maturation of erythroid cells in bone marrow
E. Inhibition of synthesis of erythroprotein inhibitor
12. When treating a patient for malaria with primachine, hemolysis occurs in him. At
examination deficiency of Glucose-6-phosphate Dehydrogenase in patient’s erythrocytes
was revealed. What metabolic process is impaired in this patient?
A. Aerobic carbohydrate oxidation
B. Glycogenesis
C. Glycolysis
D. Gluconeogenesis
E. Pentose-phosphate pathway
13. B12-folate deficient anemia was diagnosed in a patient aged 55. What hematological
index will be the most sensitive for pathogenetic treatment?
A. Increase of number of erythrocytes
B. Increase of number of reticulocytes
C. Reduction of anisocytosis
D. Decrease of ESC
E. Decrease of amount of hemoglobin
14. In a pregnant woman, in the 7th month of pregnancy, anemia begins rising fast. In her
blood test: number of erythrocytes is 2.7x1012/L, amount of hemoglobin is 90 g/L,
anisocytosis, poicilocytosis, megaloblasts and megalocytes were found, reticulocytes of
0%. What sort of anemia develops in this case?
A. Thalassemia
B. B12-deficiency anemia
C. Post-hemorrhagic anemia
D. Iron-deficiency anemia
E. Hemolytic anemia
15. In an infant, who is under an artificial nutrition with cow milk, severe anemia has
developed. At the blood count of the infant: number of erythrocytes is 4x1012/L, content of
hemoglobin is 68 g/L, reticulocytes of 0%. What kind of anemia developed in the infant?
A. Sickle-cell anemia
B. Inborn hemolytic anemia
C. B12-deficiency anemia
D. Hypopastic anemia
E. Iron-deficiency anemia
16. Predomination of erythroblasts, normoblasts and megaloblasts was revealed in blood
analysis of a patient with anemia. The same cells were found in bone marrow. What type of
anemia do these changes characteristic for?
A. Post-hemorrhagic
B. Hemolytic
C. Aplastic
D. B12-folate deficiency anemia
E. Iron-deficiency anemia
17. Two years ago a patient was operated on for resection of pyloric portion of the
stomach. There is weakness, periodical appearance of dark circles under eyes,
breathlessness in this patient. In the blood analysis: HB-70g/L, erythrocytes-3.3x1012/L,
color index-0.7. What erythrocyte changes in the blood smear are the most typical for the
given state?
A. Microcytes
B. Megalocytes
C. Schizocytes
D. Ovalocytes
E. Macrocytes
18. Singular oxyphilic normoblasts appeared in the blood of a patient after acute posttraumatic hemorrhage composing 15% of blood volume. On supravital staining 25% of
reticulocytes were found. What is the patient anemia according to its ability of
regeneration?
A. Hyperregenerative
B. Regenerative
C. Hyporegenerative
D. Aregenerative
E. Hypo- and aregenerative
19. What index of blood analysis is the most typical for beta-thalassemia?
A. Considerable decrease of erythrocytes and hemoglobin
B. Erythrocytes with basophilic stippling
C. Increase of fetal hemoglobin
D. Target-like erythrocytes
E. Increase of met-hemoglobin
20. A patient had anemia due to profuse blood loss. What blood changes are typical at the
beginning of development of acute post-hemorrhagic anemia?
A. Presence of megalocytes in the blood
B. Absence of reticulocytes
C. Poikilocytosis, anisocytosis
D. Hyperchromia
E. Normochromia
21. Erythropenia, hyperchromia, normocytes, macrocytes, megalocytes, poikilocytosis
were found out in a patient’s blood at examination. What is the cause of this pathology?
A. Ascariasis
B. Deficiency of gastromucoprotein
C. Iron deficiency in food
D. Trichocephaliasis
E. Fequent loss of blood
22. While studying a blood smear different forms of erythrocytes were found. Which of
them are regenerative?
A. Anisocytes
B. Poikilocytes
C. Ploychromatophils
D. Ovalocytes
E. Megalocytes
23. The presence of agranulocytosis was determined in the blood analysis of a liquidator of
accident at Chernobyl atomic power station who had got 5 Gr dose of irradiation. What
pathogenetic mechanism is the leading one in its appearance?
A. Inhibition of leucopoiesis
B. Increased penetration of granulocytes into tissues
C. Increase of leucocytes destruction
D. Impairment of going out of mature leukocytes from bone marrow
E. Development of autoimmune process.
24. During the development of acute pulpitis a patient complained of paroxysm of pain in
the upper jaw, which is increasing at night, fever. At examination leucocytosis was
established in the blood. What kind of leucocytosis is possible in this case?
A. Basophilic leucocytosis
B. Lymphocytosis
C. Eosinophilic leucocytosis
D. Monocytosis
E. Neutrophilic leuccytosis.
25. Considerable increase of the number of eosinophils in a unit of blood volume was
determined during the examination of a 5 years old boy. What may cause eosinophilia in
this patient?
A. Helminthic invasion
B. Obesity
C. Hypodynamia
D. Hypothermia
E. Physical exertion
26. In the patient’s blood analysis the number of leukocytes is 250*109/L. What syndrome
does this patient have?
A. Leukemia
B. Leucocytosis
C. Leucopoenia
D. Leucomoid reaction
E. Hyperleucocytosis.
27. Leucocytosis was found out in a person who didn’t complain of his health. The cause of
this may be that fact that the blood was taken for analysis after:
A. Physical load
B. Mental work
C. Rest at a health resort
D. Considerable use of water
E. Usage of alcohol
28. Lymphocytosis was revealed in a patient. What diseases may be accompanied by
lymphocytosis?
A. Sepsis
B. Helminthic invasion
C. Somatotropin insufficiency
D. Pertussis, chicken pox
E. Bronchial asthma
29. Neutropoenia is found out in a patient who has the manifestations of
immunodeficiency. What diseases may neutropoenia be determined in?
A. After profuse haemorrhage
B. Fuzarium fungus poisoning
C. Myeloleukemia
D. Insufficiency of sexual gland function
E. Septic process
30. Increase of the number of eosinophils was determined in a patient with endocrine
pathology during examination. Which of the named diseases may be accompanied by
eosinophilia?
A. Pheochromocytoma
B. Conn’s disease
C. Acromegaly
D. Cushing disease
E. Addison’s disease
31. Functional insufficiency of monocytes is accompanied by immunodeficiency. What
BAS produced by monocytes stimulate specific response?
A. Interleukin-2
B. Lysocime
C. Interleukin-1
D. Fibronectin
E. Myeloperoxidase
32. Relative neutropoenia with degenerative shift was revealed in the blood of a patient
with TB during examination. What change of differential blood count corresponds to this
state?
A. Decrease of the number of segmented forms and increase of band forms of neutrophils
B. Decrease of lymphocyte number
C. Increase of monocyte number
D. Increase of basophil number
E. Decrease of eosinophil number
33 Neutrophil leukocytosis was revealed in worker during examination. What pathologic
condition may neutrophil leukocytosis result from?
A. Chronic loss of blood
B. Septic condition
C. Viral infection
D. Radiation sickness
E. Benzene poisoning
34. A patient aged 32 with massive hemorrhage due to car accident trauma was admitted to
the hospital. Pluse-100 beats per min, respiratory rate-22 per 2 min, BP-100/60 mmHg.
What blood change will be the most characteristic in an hour after hemorrhage?
A. Erythropoenia
B. Hypoproteinemia
C. Hypovolemia
D. Leucopoenia
E. Erythrocyte hypochromia
35. During the examination of peripheral blood of a patient aged 42, it was revealed: Hb80g/L, erythrocytes-3.2 x 1012/L, leukocytes-25 x 109/L, leukocytic formula: basophils-5%,
eosinophils- 9%, myeoblasts- 3 %, promyelocytes-8%, neutrophils-17%, segmented- 19%,
lymphocytes- 3 %, monocytes- 3%. What blood pathology is the most possible in this
patient?
A. Panmyelophthisis
B. Erythroleukemia
C. Acute myeloblast leukemia
D. Chronic myelogenous leukemia
E. Promyelocytic leukemia
36. The experiment was carried out on a rabbit. The increase of the number of erythrocytes
and hemoglobin in the blood due to the stimulation of erythropoiesis by erythropoietin was
determined 2 weeks later after the narrowing of renal artery. What increases the formation
of erythropoietin?
A. Hypoosmia
B. Hypercapnia
C. Hypoxemia
D. Hyperosmia
E. Hypovolemia
37. Hemolytic anemia with decrease of osmotic erythrocyte resistance that averaged 0.60.5 was revealed in a smear of venous blood during microscopic examination. What
substance accumulation in the blood plasma may also indicate the development oh
hemolytic anemia?
A. Creatinine
B. Urea
C. Indirect bilirubin
D. Lactic acid
E. Inorganic phosphate
38. Hypochromia of erythrocytes, micro-, anisocytosis, poikilocytosis, are determined in
the blood in case of development of iron deficiency and iron refractory anemia. What index
must be determined to carry out differential diagnosis of these anemias?
A. Serum chlorine
B. Serum phosphorous
C. Serum magnesium
D. Serum calcium
E. Serum iron
39. B12 folic deficiency anemia developed in a patient after stomach resection. What color
index is typical for this disease?
A. 1.30
B. 1.15
C. 1.0
D. 0.85
E. 0.70
40. A victim of a car accident has lost much blood. What impairment of general blood
volume takes place?
A. Simple hypovolemia
B. Polycythemic normovolemia
C. Olygocysthemic normovolemia
D. Polycystehmic hypovolemia
E. Oligocysthemis hypovolemia
41. Excessive flow of estrogens into the blood due to follicle persistence (a state when
follicle does not reach complete maturation and ovulation does not take place) often cause
uterine bleeding. What anemia may develop in this case?
A. Iron deficiency
B. Sideroachrestic
C. Sickle cell
D. Hypoplastic
E. Metaplastic.
42. Which of the below named anemias relevant to hemoglobinopathies?
A. Minkovsky-Shoffar disease
B. Iron deficiency anemia
C. B12 deficiency
D. Thalassemia
E. Iron refractory anemia
43. Evaluate the blood analysis: erythrocytes 3.10; Hb 90g\L reticulocytes 0.5%. In the
smear there are poikilocytes hypochromatic erythrocytes. Blood serum iron is 80
micromol/l. What pathology is this typical for?
A. Minkovsky-Shoffer disease
B. Iron deficiency anemia
C. B12 deficiency
D. Sickle cell anemia
E. Iron refractory anemia
44. What conditions are accompanied by neutrophilic leukocytosis with shift of differential
count to the left?
A. Purulent inflammation
B. Tuberculosis
C. Infections mononucleiosis
D. Agranulocytosis
E. Alimentaray leukocytosis
45. What blood pathology is the presence of Philadelphia chromosomes in the blood cells
and bone marrow cells typical for?
A. Acute myelogenous leukemia
B. Chronic myelogenous leukemia
C. Hodgkin’s disease
D. Burkitt’s lymphoma
E. Chronic lymphocyte leukemia
46. Patient M, aged 20 was admitted to the hospital complaining of high temperature, pain
in the bones, and hemorrhage from his gums. Blood analysis of this patient shows:
erythrocytes-2.5x1012/L; Hb-80g/L; leucocytes-2.0x109/L; thrombocytes-6.0x109/L;
differential count: eosinophils-1%; stab neutrophils-1%; segmented neutrophils-10%;
lymphocytes-10%; monocytes-3%; blast cells-75%. What pathology is this blood analysis
typical for?
A. Hodgkin’s disease
B. Burkitt’s lymphoma
C. Acute leukemia
D. Infections mononucleosis
E. Chronic leukemia
47. General amount of leucocytes is 90x109/l. In differential count: eosinophils-1%;
basophils-0%; juvenile neutrophils-0%; stab neutrophils-2%; segmented neutrophils-20%;
prolymphocytes-2%; lymphocytes-70%; Botkin-Gumprecht cells. Cervical, submandibular
lymph nodes are enlarged. What pathology is such blood picture typical for?
A. Acute lymphoblastic leukemia
B. Hodgkin’s disease
C. Infectious mononucleosis
D. Chronic lymphocytic leukemia
E. Chronic myelogenous leukemia
48. Hypochromic anemia was found out in a patient aged 54, who had a prolonged contact
with lead at his work. Treatment with iron preparations for a month didn’t give any effect.
The increased amount of iron was determined in blood serum. What is this anemia due to?
A. Vitamin B12 deficiency
B. Porphirin synthesis impairment
C. Folic acid deficiency
D. Hypoplasia of red bone marrow
E. Erythrocyte hemolysis
49. A patient aged 20, has periodically yellowness of sclera and skin that is accompanied
by weakness. Minkovski-Shoffar disease is diagnosed. What is the most typical for blood
picture in this disease?
A. Reticulositosis
B. Agranulocytosis
C. Macrocytosis
D. Microspherocytosis
E. Thrombocytosis
50. Posthemorrhagic anemia has developed in a patient with periodical bleeding due to
uterus fribromyoma. What type of chronic post hemorrhagic anemia takes place in this
case?
A. Megaloblastic, hyperchromic, hyperegenerative.
B. Megaloblastic, hypochromic, hyporegenerative.
C. Erythroblastic, hyperchromic, hyporegenerative.
D. Erythroblastic, hypochromic, hyperregenerative.
E. Erythroblastic, hypochronic, hyporegenerative.
51. A female patient with impairment of menstrual cycle accompanied by prolonged
bleeding the blood analysis was made which revealed hypochromia, decrease of
reticulocytes, microcytosis. What group does this anemia belong to according to
pathogenesis?
A. B12 folic deficiency anemia
B. Iron deficiency anemia
C. Hypoplastic anemia
D. Hemolytic anemia
E. Metaplastic anemia
52. Patient R. aged 12 was operated on for acute phlegmonous appendicitis. At the
examination of his blood, the amount of leukocytes is 12.109/L. On the blood smear there
are: basophils – 0%; eosinophils – 2%; monocytes – 2%; juvenile neutrophils – 0%; stab
neutrophils – 30%; segmented neutrophils – 43%; lymphocytes – 23%; monocytes – 0%.
Stab (immature) neutrophils have pyknosis of nuclei. There is anisocytosis of neutrophils;
some of them have toxic granulation. What form of change of leukocyte blood composition
takes place in this case?
A. Neutrophilia with degenerative shift to the left.
B. Neutrophilia with regenerative shift to the left.
C. Neutrophilia with hyperegenerative shift to the left.
D. Leukemoid reaction of neutrophil type.
E. Neutrophilia with the shift to the right.
53. Which of the below given hematological characteristics corresponds to chronic posthemorrhagic anemia?
A. Hyperregenerative, hypochromic with erythroblasts type of bleeding.
B. Regenerative, hypochromic with erythroblasts type of bleeding.
C. Hyporegenerative, hypochromic with megaloblasts type of bleeding.
D. Hyporegenerative, hypochromic with erythroblasts type of bleeding.
E. Hyporegenarative, hyperchromic with megaloblasts type of bleeding.
54. A female patient, aged 25, was admitted to the hematological department with
complains of the appearance of hemorrhages of different sizes on the body; during
menstruation there are uterine bleedings. She has been ill for ten years. Paleness of skin
and mucous membranes were determined on examination; there are hemorrhages of
different size and color on the upper and lower extremities. Pulse = 100 beats/minute, AP
110/70 mmHg. Blood analysis shows: erythrocytes 3.3*1012 /L, Hb 80g/L, thrombocytes
33*109/L; time of blood coagulation: beginning is at 2nd minute, end is at 6th minute; time
of bleeding (according to Duke) - 15 minutes. What is the possible diagnosis?
A. Marchiafava-Michelli disease.
B. Thrombocytopoenic purpura.
C. Glanzman’s thrombasthenia.
D. Willeberandt-Yurgens thrombocytopathia
E. Chronic myelogenous leukemia.
55. Neutrophil leukocytosis is determined in a patient with chronic myelogenous leukemia.
Which variant of nuclear shift of differential count to the left is the most typical for chronic
myelogenous leukemia?
A. Regenerative
B. Degenerative.
C. Hyper regenerative.
D. Regenerative and degenerative.
E. Hyporegenerative.
56. A patient with atrophic gastritis has vitamin B12 deficiency. What variant of nuclear
shift of differential count is most typical for B12 hypovitaminosis?
A. Hyper regenerative to the left
B. Degenerative to the left.
C. Regenerative and degenerative to the left.
D. To the right
E. Regenerative to the left
57. Hypochromic anemia was diagnosed in a patient on the 7th day after acute hemorrhage.
What mechanism is the leading one in its development?
A. Increase of iron excretion from the organism;
B. Impairment of globin synthesis;
C. Increased erythrocyte destruction in the spleen;
D. Impairment of iron absorption in the intestine;
E. Increased penetration of immature erythrocytes from bone marrow.
58. Hemiparesis appeared in a patient with acute promyelocytic leukemia. What is the main
mechanism of the impairment of CNS in this case?
A. Intoxication by leukemic cells decay products;
B. Formation of leukemic infiltrates;
C.Impairment of desintoxicative function of the liver;
D. Cachexia;
E. Increase of thrombogenesis.
59. Acute pain in the lower jaw, swelling of the cheek, temperature of 37.6oC occurred in
the patient who had had dental caries for some years. What changes in the patient’s blood
may be observed in this case?
A. Neutrophilic leukocytosis;
B. Leucopoenia;
C. Moncytosis;
D. Anemia;
E. Eosinophilia.
60. A patient aged 43 has stomatitis, glossitis, the tongue is crimson colour, smooth. Blood
analysis revealed: Hb 100 g/l; erythrocytes 2.3x1019/l; color index 1.30. What is the
patient’s state due to?
A. Erythrocytes haemolysis
B. Hypoplasia of red bone marrow
C. Impairment of porphyrin synthesis
D. Iron deficiency
E. Vitamin B12 deficiency
61. After resection of small intestine a patient complained of increased fatigability,
infringement of taste, brittleness of nails, quick decay of dental enamel, and appearance of
breathlessness on physical exertion. Which of the below given substances is the source of
impairments in the patient’s organism?
A. B12-folic deficiency anemia
B. Hypocalcaemia
C. Vitamin D deficiency
D. Hyponatriaemia
E. Iron deficiency anemia
62. A female patient took analgin because of toothache. Dark urine, icteric sclera,
weakness appeared in her two days later. Which of the causes given below is the most
possible one?
A. Immune hemolytic anemia
B. Hypoplastic anemia
C. Thrombocytopoenia
D. Thrombocytopathy
E. Agranulocytosis
63. A patient with acute pulpitis has an increased body temperature and a number of
leukocytes up to 14.109/L, differential count represents: basophils-0%; eosinophils-2%;
megakaryocytes-0%; juvenile neutrophils-2%; stab neutrophils-8%; segmented
neutrophils-58%; lymphocytes-26%; monocytes-4%. How can you evaluate such changes
in blood?
A. Neutrophilic lekocytosis with regenerative shift to the left
B. Neutrophilic lekocytosis degenerative shift to the left
C. Neutrophilic lekocytosis with hyperregenerative shift to the left
D. Lymphocytosis
E. Neutrophilic leukocytosis with shift to the right
64. A patient aged 30 took sulfaethidole for infectious process of mucous membrane in the
mouth locally (as powder). Preparation has hemotoxic action and the treatment was
complicated by the development of agranulocytosis. At examination it was revealed:
A. Increase of agranulocytes in the blood;
B. Decrease of the number of granulocytes in the blood on the background of
leukocytosis;
C. Decrease of the number of granulocytes in the blood on the background of
leucopoenia;
D. Decrease of the number of neutrophylic granules with their simultaneous
increase;
E. Loss of their granules by granulocytes.
65. A women fell ill with purulent stomatitis. What index of complete blood count is
characteristic for this disease?
A. Lymphocytosis
B. Thrombocytosis
C. Leukocytosis
D. Anemia
E. Monocytosis
66. It is recommended to perform a clinical examination of blood in an empty stomach.
What compounds of peripheral blood may be changed after taking food?
A. Decrease in number of platelets
B. Elevation of number of leukocytes
C. Elevation of number of erythrocytes
D. Increase in content of plasma proteins
E. Reduction of number of erythrocytes
67. Acute inflammatory disease of upper airways and eyes appears in 45-years-old woman
at the period of blossom of grass. Symptoms of this disease are hyperemia, edema, and
mucous secretions. What kind of leukocytosis is the most characteristic one for this
disease?
A. Neutrophilia
B. Monocytosis
C. Eosinophilia
D. Basophilia
E. Lymphocytosis
68. Enlargement of liver and spleen, anemia, and myeloblasts in peripheral blood were
revealed in a patient with acute leukemia. What is the main trait, which allows to
distinguish acute myelogenous leukemia from chronic one?
A. Pancytopoenia
B. Blast cells in peripheral blood
C. Anemia
D. Leukemic gap
E. Thrombocytopoenia
69. Extraction of a tooth, in a patient with chronic lymphocytic leukemia, was complicated
by prolonged bleeding. What may cause the hemorrhagic syndrome in this patient?
A. Anemia
B. Lymphocytosis
C. Eosinopoenia
D. Neutropoenia
E. Thrombocytopoenia
70. In blood analysis of 37-years-old woman following data were revealed: content of
hemoglobin is 60 g/L, number of erythrocytes is 3.0x1012/L, and color index of 0.6;
differential count of leukocytes without any changes; number of platelets is 200x109/L;
reticulocytes count of 0.3%; ESR of 18 mm/hour; microcytosis and poikilocytosis of
erythrocytes. Indicate the most probable type of anemia according to mechanisms of its
development.
A. Hypoplastic anemia
B. Hemolytic anemia
C. Acute post-hemorrhagic anemia
D. Iron deficiency anemia
E. B12-folate deficiency anemia
71. In a patient aged 35 autoimmune hemolytic anemia developed. What index of blood
serum is the most increased in this case?
A. Mesobilinogen
B. Stercobilinogen
C. Direct bilirubin
D. Indirect bilirubin
E. Protoporphirin
72. A patient addressed a dentist with complaints of affections of mucous membrane of his
mouth. During the examination of the patient ulcerous stomatitis with necrosis in center
was revealed at him in area of his palate. In the history of disease of the patient recently
endued pneumonia and taking of medicines (sulfonilamides) were present. After
administering treatment the doctor pointed the patient for blood analysis. What pathology
from below mentioned does doctor suppose?
A. Immune agranulocytosis
B. Iron deficiency anemia
C. Thrombocytopoenia
D. Infectious mononucleosis
E. Infectious lymphocytosis
73. A 40-years-old male patient, who was bitten by snake, was admitted to the hospital.
What place does hemolysis occur at in this case?
A. In vessels
B. In hepatic cells
C. In the spleen
D. In the bone marrow
E. In renal parenchyma
74. Myocardial infarction was diagnosed in 65-years-old man. Neutrophilic leukocytosis
with left shift is present in the blood of this patient. What factors underlie this
phenomenon?
A. Products of tissue decay
B. Elevation of mass of muscular fibers
C. Disorders of alveolar ventilation
D. Decrease in glycogen content in the myocardium
E. Increase of arterial pressure
75. B12 deficiency anemia was diagnosed in a man aged 57 after examination of him.
Treatment was administered to this patient. Control blood test in this patient was performed
in 3 years. What is the most adequate criterion for enhancement of erythropoiesis?
A. Increase in number of reticulocytes
B. Increase in hemoglobin content
C. Decrease in color index
D. Normoblastic hematopoiesis
E. Increase in number of leukocytes
76. Patient with chronic hypoacidic gastritis has hypochromic anemia. In the blood smear
of this patient agranulocytes, micro- and anisocytosis, and poikilocytosis are revealed.
Name this anemia.
A. Iron deficiency anemia
B. Acute post-hemorrhagic anemia
C. Thalassemia
D. Sickle-cell anemia
E. Pernitious anemia
77. Increased concentration of leukopoietins in blood was found in a patient with acute
appendicitis. What kind of lekocytosis occurs in these conditions?
A. Neutrophilic
B. Basophilic
C. Eosinophilic
D. Lymphocytosis
E. Monocytosis
78. A patient has deficiency of cyancobalamine and folic acid that leads to disorder of
leucopoiesis. What changes takes place in these conditions?
A. Leucopoenia
B. Eosinophilia
C. Basophilia
D. Hemophilia
E. Hyperemia
79. A patient, who was exposed to ionizing radiation, has panmyelophtisis and secondary
infections. What changes occur in blood analysis in this case?
A. Agranulocytosis
B. Leucocytosis
C. Eosinophilia
D. Basophilia
E. Hyperemia
80. A patient with leukemia has general number of leukocytes of 120.0x109/L. What kind
of leukemia does this patient have?
A. Leukemic
B. Leucopenic
C. Subleukemic
D. Aleukemic
E. Erythremia
81. In a woman hypochromic anemia was diagnosed after delivery accompanied by marked
bleeding. What pathologic forms of erythrocytes are characteristic ones for this type of
anemia?
A. Anisocytes
B. Target-like erythrocytes
C. Sickle-cell anemia
D. Spherocytes
E. Microcytes
82. Patient with chronic leukemia has sharply increased temperature, breathlessness,
marked muscular weakness at insignificant physical exertion, increased sweating, cough.
What mechanism of leukemia influence upon organism underlies complications in this
patient?
A. Immunodeficiency due to functional inability of leukocytes
B. Internal bleeding because metastases into vessel wall
C. Anemia
D. Tumor progression
E. Airway obstruction because of development of metastases
83. When examining a blood in a patient, who endued bleeding three days ago, following
data was revealed: number of leukocytes is 12x109/L, basophils count is 0%, eosinophils
count is 3%, myelocytes count 0%, juvenile neutrophils count is 3%, stab neutrophils count
is 12%, segmented neutrophils count is 62%, lymphocytes count 16%, and monocytes
count is 4%. What kind of changes of leukocyte differential count takes place in this case?
A. Neutrophilia with regenerative shift to the left
B. Neutrophilia with degenerative shift to the left
C. Neutrophilia with shift to the right
D. Absolute lymphopoenia
E. Absolute monocytopoenia
84. A 40-years-old patient, who was admitted to the surgical department with diagnosis of
phlegmona of thigh, had high temperature, tachycardia, and breathlessness. On the blood
test of this patient: number of leukocytes is 25x109/L; eosinophils count is 1%, myelocytes
count is 1%, juvenile neutrophils count is 15%, band neutrophils count is 25%, segmented
neutrophils count is 40%, lymphocytes count 14%, monocytes count is 4%. What kind of
shift in differential count is present in this case?
A. Regenerative
B. Hyperregenerative
C. Degenerative
D. Regenerative-degenerative
E. Leukemoid
85. What is the cause of intracellular hemolysis?
A. Genetic infringements of erythrocytes
B. Malaria
C. Action of hemolytic poison
D. Infection with hemolytic streptococcus
E. Transfusion of incompatible blood
86. What kind of disorders of total blood volume appears in case of absolute
erythrocytosis?
A. Polycytemic hypervolemia
B. Oligocytemic hypervolemia
C. Oligocytemic hypovolemia
D. Simple hypervolemia
E. Simple hypovolemia
87. Beta-thalassemia was revealed in a patient, who came from Tunis. The disease was
accompanied by hemolysis and jaundice. The disease was diagnosed on the base of
presence in blood:
A. Target-like erythrocytes
B. Grained erythrocytes
C. Polychromatophil erythrocytes
D. Normocytes
E. Reticulocytes
88. During the examination of adolescents that reside in mounting region increase in level
of erythrocytes and hemoglobin in peripheral blood was found out. What is the reason for
indicated erythrocytosis?
A. Exogenous hypoxia
B. Diseases of lungs
C. Congenital heart disease
D. Condensation of blood due to large loss of water
E. Vakes’s disease
89. Content of hemoglobin and number of erythrocytes significantly decreases in a
patient’s blood from time to time. It was found out that such attacks appear after taking
some horse beans. What kind of anemia takes place in this case?
A. Enzymopathy
B. Membranopathy
C. Iron deficiency anemia
D. Hemoglobinopathy
E. Acquired hemolytic anemia
ANSWERS:
1.-A. 2.-D. 3.-D. 4.-A. 5.-E. 6.-D. 7.-E. 8.-A. 9.-E. 10.-B. 11.-C. 12.-E. 13.-C. 14.-B. 15.-E.
16.-D. 17.-A. 18.-A. 19.-C. 20.-E. 21.-B. 22.-C. 23.-A. 24.-E. 25.-A. 26.-A. 27.-A. 28.-D.
29.-B. 30.-E. 31.-C. 32.-A. 33.-B. 34.-C. 35.-D. 36.-C. 37.-C. 38.-E. 39.-A. 40.-E. 41.-A.
42.-D. 43.-E. 44.-A. 45.-B. 46.-C. 47.-D. 48.-D. 49.-D. 50.-E. 51.-B. 52.-D. 53.-D. 54.-B.
55.-C. 56.-D. 57.-E. 58.-B. 59.-A. 60.-E. 61.-E. 62.-A 63.-A 64.-C. 65.-C. 66.-B. 67.-C.
68.-D. 69.-E. 70.-D. 71.-D. 72.-A. 73.-A. 74.-A. 75.-A. 76.-A. 77.-A. 78.-A. 79.-A. 80.-A.
81.-A. 82.-A. 83.-A. 84.-B. 85.-A. 86.-A. 87.-A. 88.-A. 89.-A.
Topic 4. Pathophysiology of hemostasis and antihemostasis.
1. A 32-years-old male patient has hemorrhage after injury of vessel that connected to
formation of friable thrombi. What coagulation factor deficiency has led to this disorder?
A. II (prothrombin)
B. III (thromboplastin)
C. VII (proconvertin)
D. XII (Hageman’s factor)
E. XIII (fibrin stabilizing factor)
2. A man, who has been to Arctic for a long time, has hemorrhage from gums, his teeth
sway and pull out. What is the initial mechanism in scurvy development?
A. Infringement of elastin synthesis
B. Affection of alveolar process
C. Impairment of collagen synthesis
D. Fragility of capillaries
E. Insufficient tightness of round ligament of tooth
3. Preliminary exfoliation of placenta and hemorrhagic shock develop in a pregnant woman
during the delivery. While taking woman’s blood for analysis it coagulates in syringe. The
acute DIC syndrome is diagnosed in this woman. What pathogenic mechanism appears to
be initial in disorder of hemostasis in this case?
A. Activation of sympathetic-adrenal system
B. Elevation of platelet aggregation
C. Activation of tissue thromboplastin derived from destroyed tissues
D. Cascade activation of plasma coagulation factors
E. Oppression of aticoagulative system of blood
4. It was found out before operating on that the patient has bleeding time increased up to 9
min. What blood cells deficiency do these changes result from?
A. Monocytes
B. Platelets
C. Erythrocytes
D. Lymphocytes
E. Leukocytes
5. Breathlessness, acute pain in the chest, cyanosis, and enlargement of neck veins rapidly
develop in a patient suffered from thrombophlebitis. What is the most possible disorder of
blood circulation in this patient?
A. Pulmonary thromboembolism
B. Cerebral thromboembolism
C. Coronary thromboembolism
D. Mesenterial thromboembolism
E. Portal thromboembolism
6. Numerous subcutaneous hemorrhages appear in a patient suffered from hepatic cirrhosis.
What is a possible reason for this?
A. Excessive decay of vitamin C
B. Disorder of vitamin K synthesis
C. Hypocalemia
D. Reduction in synthesis of factor II (prothrombin)
E. Deficiency of factor III (thromboplastin) in blood plasma
7. Hemorrhagic syndrome with disorders of the third stage of blood coagulation develops
in a patient after she was operated on uterus. What is the most probable mechanism of
hemostasis disorder in this case?
A. Qualitative abnormalities of fibrinogen
B. Activation of fibrinolysis
C. Deficit of fibrin stabilizing factor
D. Decrease in ptothrombin synthesis
E. Decrease in fibrinogen synthesis
8. Hemorrhagic diathesis has developed in a patient with streptococcus infection. What is
the reason for hemorrhage development?
A. Elevation of heparin content in the blood
B. Vitamin A deficiency
C. Increase in callicrein content in blood
D. Enhanced fibrinolysis
E. Vitamin C deficit
9. Point hemorrhages appear on a forearm of a patient after putting a tourniquet on a
patient’s arm. What functions of blood cells do these changes connect to?
A. Neutrophils
B. Platelets
C. Erythrocytes
D. Basophils
E. Macrophages
10. A teeth was pulled out from the patient with chronic hepatitis. Bleeding, which
developed after that, could not be seized for 2 hours. Performed blood analysis establishes
increase in content of several coagulation factors. What kind of hemostasis is damaged in
this case?
A. Platelet-vascular
B. Coagulation
C. Vascular stasis
D. Platelet reaction
E. Vascular reaction
11. Numerous hemorrhages and bruises were found out on the patient’s body. At
examination of this patient: his bleeding time by Duke is 25 min, his number of platelets is
25x109/L. What disease are these symptoms characteristic for?
A. Hemophilia B
B. Von Willebrand’s disease
C. Vitamin C deficiency
D. Hereditary defect of platelet formation
E. Hemophilia A
12. A 65-years-old male patient suffered from atherosclerosis was admitted to the surgical
department because of diffuse purulent peritonitis. When the patient was operated on
thrombosis of mesenterial vessels was diagnosed in him. What is the most possible reason
for peritonitis development?
A. Hemorrhagic infarction
B. Agiospastic ischemia
C. Ischemic infarction
D. Stasis
E. Compressive ischemia
13. Hemorrhagic syndrome connected to disorders of the third phase of coagulation
developed in a patient after hi was operated on pancreas. What is the possible mechanism
of development of hemostasis disorder?
A. Elevation in content of heparin in patient’s blood
B. Reduction in fibrinogen synthesis
C. Activation of fibrinolysis
D. Deficit of fibrin stabilizing factor
E. Reduction in prothrombin synthesis
14. Sharp pain and edema of tissues develop in a patient with thrombosis of veins of his
right calf. What is the possible consequence of thrombosis?
A. Hypertrophy of tissues
B. Circulatory hypoxia
C. Enhancement of drainage of tissues
D. Intensification of metabolism
E. Enhancement of functional activity of tissues
15. Thrombosis of coronary arteries occurs in a patient with atherosclerosis of cordial
vessels. What is the reason for formation of thrombi?
A. Heparin deficiency
B. Thrombocytopenia
C. Acceleration of blood flow
D. Activation of fibrinolysis
E. Vitamin K deficiency
16. An elderly patient was admitted to the hospital with thrombosis of veins of his calf.
What is the reason for thrombosis development?
A. Decrease in prothrombin concentration in blood
B. Increase in heparin concentration in blood
C. Injury of vessel wall
D. Slowing-down of blood flow
E. Activation of plasmin
17. When examining a patient increased blood coagulation (thrombophilia) was found out
in him. What reasons favor such state development?
A. Intensification of prostacyclin synthesis in vessel wall
B. Low concentration of thrombin in blood
C. High concentration of heparin in blood
D. Deficit of inhibitors of proteolytic enzymes
E. High concentration of adrenalin in blood
18. Thrombocytopenia was found out in blood of a patient with Werlgoff’s disease. Why
the pathology of platelets leads to hemorrhage?
A. Decrease in thromboplastin formation
B. Decrease in concentration of prothrombin in blood
C. Decrease in concentration of heparin in blood
D. Activation of fibrinolytic system
E. Decrease in concentration of fibrinogen in blood
19. Hemophilia A was diagnosed in a patient with hemorrhagic syndrome. What is the
reason for this disease development?
A. Absence of Stewart’s factor (factor X)
B. Absence of Christmas’s factor (factor IX)
C. Absence of factor VIII
D. Absence of Rosenthal’s factor (factor XI)
E. Low concentration of Hageman’s factor (factor XII) in blood
20. A patient was admitted to the hospital with abundant hemorrhoid bleeding. This patient
has been suffering from hepatic cirrhosis for a long time. What is the reason for
hemorrhage development under hepatic cirrhosis?
A. Activation of fibrinolysis
B. Plasmin deficiency
C. Prothrombin deficiency
D. Low concentration of thrombostenin in blood
E. Excess of heparin
21. Shonlein-Henoch disease was diagnosed in a patient. What changes in blood cells
number are characteristic for this disease?
A. Eosinophilia
B. Thrombocytopenia
C. Erythropoenia
D. Polycytemia
E. Eosinopoenia
22. Patient has hemorrhage from gums, subcutaneous hemorrhages, and frequent nasal
bleedings. Significant Thrombocytopenia was revealed in blood test of this patient. What is
the reason for bleeding development in case of thrombocytopenia?
A. Thrombin deficiency
B. Reduction of thromboplastin formation
C. Excessive heparin formation
D. Activation of fibrinolysis
E. Excess of prostacyclins
23. While performing intravenous injections trauma of venous vessels leads to thrombosis.
What favors thrombosis under injury of vessel wall?
A. Activation of plasmin
B. Activation of fibrinolysis
C. Activation of phospholipase D
D. Enhanced production of prostacyclin by endotheloicytes
E. Accumulation of thromboxan A2
24. Changes of some indices of blood were revealed at examination of a patient suffered
from hemophilia. What of enumerated indices corresponds to this condition?
A. Thrombocytopenia
B. Bleeding time by Duke takes longer
C. Eosinophilia
D. Time of coagulation takes longer
E. Afibrinogenemia
25. A boy has congenital disorder of hemostasis: he has prolonged hemorrhage even in
case of insignificant injuries, subcutaneous bruises, and bleedings in joint cavities, which
restrict the movement activity. Patient’s blood does not coagulate for a long time if it is
taken out from the organism and it does not contain coagulation factor VIII. Blood cells
count including number of platelets is within norm. What underlies the congenital disease
of this boy?
A. Hereditary gene defect linked with X chromosome
B. Toxicosis of pregnancy in boy’s mother
C. Intrauterine infection
D. Intrauterine intoxication
E. Intrauterine immune conflict
26. Hemophilia B was diagnosed in a child who has hemorrhagic syndrome. This type of
hemophilia results from absence of:
A. Coagulation factor IX (Christmas’s factor)
B. Coagulation factor II (prothrombin)
C. Coagulation factor VIII (antihemophilic globulin)
D. Coagulation factor XI (thromboplastin)
E. Coagulation factor XII (Hageman’s factor)
27. It is known that thrombus undergo same changes after its formation. What sort of
finishing of thrombus formation is the most dangerous for a patient?
A. Aseptic lysis
B. Septic lysis
C. Organization without recanalization
D. Organization with recanalization
E. Calsification of thrombus
28. Such appearances as petechiae and ecchymoses develop in a boy aged 7, who often fall
ill with acute respiratory diseases. Pathology of internal organs is absent in this patient.
What pathology is present in this case?
A. Hypoplastic anemia
B. Thrombocytopenia
C. Acute leukemia
D. Hemophilia
E. Chronic leukemia
29. Course of atherosclerosis in 70-years-old patient is complicated by thrombosis of
vessels of lower extremities and development of gangrene of left foot toes. The beginning
of thrombosis is connected to:
A. Activation of prothrombinase
B. Adhesion, aggregation and agglutination of platelets
C. Conversion of prothrombin to thrombin
D. Conversion of fibrinogen to fibrin
E. Decreased heparin synthesis
30. Antihemophilic globulin A (factor VIII) is absent in the blood plasma of a boy with
significant hemorrhagic syndrome. What phase of hemostasis is infringed primarily in this
boy?
A. Retraction of blood clot
B. Conversion of fibrinogen to fibrin
C. Conversion of prothrombin to thrombin
D. Extrinsic pathway of prothrombinase (thrombokinase) activation
E. Intrinsic pathway of prothrombinase (thrombokinase) activation
31. Which of essential factors of thrombus formation the most often serves as the reason
for thrombosis?
A. Decrease in activity of anticoagulative system
B. Activation of systems of blood sedimentation
C. Injury of vessel wall
D. Acceleration of blood flow
E. Turbulence of blood
32. A patient complains of hemorrhage from gums. What vitamin deficiency may lead to
this phenomenon?
A. B1
B. D
C. B2
D. A
E. K
33. Prolonged bleeding complicated pulling out of a tooth in a patient, who suffered from
chronic leukemia. What may serve a reason for hemorrhagic syndrome in this patient?
A. Thrombocytopenia
B. Anemia
C. Erythropenia
D. Lymphocytosis
E. Neutropenia
34. Bleeding developed in a 15-years-old patient after her teeth was pulled out. It was
found out that after endued hepatitis A this patient has point hemorrhages (petechiae and
ecchymoses) and bruises on her skin, and she had three accidents of nasal bleeding. Before
this she did not have hemorrhages even after pulling out of her tooth. It was established
under examination that the bleeding time is increased in this patient. At the patient’s blood
test hypochromic anemia, decrease in number of platelets, and markedly reduced adhesion
of platelets are present. Prothrombin and thrombin time are normal in this patient. Her
differential blood count is normal too. What is the most possible diagnosis?
A. Hereditary thrombocytopathy
B. Acquired thrombocytopenia
C. Hereditary thrombocytopenia
D. Hemophilia
E. Acquired thrombocytopathy
35. A patient complains of frequent hemorrhages from gums. When carrying out blood test
in this patient deficiency of factor of hemocoagulation (prothrombin) was revealed. What
phase of blood coagulation is primarily impaired in the patient?
A. Formation of thrombin
B. Fibrinolysis
C. Formation of fibrin
D. Retraction of blood clot
E. Formation of prothrombinase
36. A 12-years-old patient was admitted to the hospital with hemarthrosis of knee joint
(hemorrhage into joint cavity). This patient has been suffering from hemorrhages since
early childhood. What disease does this boy suffer from?
A. Hemophilia
B. Hemorrhagic vasculitis
C. Iron deficiency anemia
D. Vitamin B12 deficiency anemia
E. Thrombocytic purpura
37. A 30-years-old female patient, who is suffering from megrim, often takes analgin.
Hemorrhages on skin and frequent nasal bleedings appear in her at the recent time. At her
blood analysis: number of platelets is 30x109/L; bleeding time is increased. What do these
changes result from?
A. Autoimmune thrombocytopenia
B. Hemorrhagic vasculitis
C. Hemolytic anemia
D. Angiohemophilia
E. Thrombocytopathy
38. What kind of pathologic processes underlie formation of thrombus?
A. Astringent metamorphose of thrombocytes
B. Increase of osmotic pressure
C. Decrease in number of thrombocytes
D. Increase of oncotic pressure
E. Decrease in number of erythrocytes
39. A worker at pharmaceutical plant addresses the doctor with complaints of general
malaise, significant hemorrhages from gums, nasal bleedings, and numerous subcutaneous
hemorrhages. At blood analysis of this patient following was revealed: number of
erythrocytes is 2.2x1012, content of hemoglobin is 48 g/L, presence of neutropenia with
relative lymphocytosis, and number of platelets is 35x109/L. What is the possible
pathogenesis of thrombocytopenia in this patient?
A. Decrease of platelet production
B. Enhanced platelet destruction
C. Increase platelet utilization
D. Redistribution of platelets
E. Increased loss of platelets
40. Intravenous injection of mercury chloride to experimental animal evokes development
of thrombosis in it. What is the basic pathogenic factor in development of this pathologic
process?
A. Injury of vessel wall
C. Activation of coagulation system
B. Activation of platelets adhesion
D. Slowing-down of blood flow
E. Decrease in anticoagulants activity
ANSWERS:
1.-E, 2.-C, 3.-C, 4.-B, 5.-A, 6.-D, 7.-B, 8.-D, 9.-B, 10.-B, 11.-D, 12.-C, 13.-C, 14.-B, 15.-A,
16.-C, 17.-D, 18.-A, 19.-C, 20.-C, 21.-A, 22.-B, 23.-E, 24.-D, 25.-A, 26.-A, 27.-B, 28.-B,
29.-B, 30.-E, 31.-C, 32.-E, 33.-A, 34.-E, 35.-A, 36.-A, 37.-A, 38.-A, 39.-A, 40.-A.
Topic 6.Pathophysiology of cardiovascular system.
1. Thrombosis of coronary artery caused the development of myocardial infarction. What
mechanism of the impairment will be dominating in this disease?
A. Electrolyte-osmotic;
B. Asidotic;
C. Protein;
D. Lipid;
E. Calcic.
2. Acute cardiac insufficiency appeared in a patient with arterial hypertension due to
hypertensive crisis. What mechanism of cardiac insufficiency is the main in this case?
A. Overload of heart by resistance;
B. Absolute coronary insufficiency;
C. Relative incompetence;
D. Overload of heart by rush of blood;
E. Myocardial impairment.
3. A patient aged 59 was hospitalised at cardiological department in a severe state with the
diagnosis of acute myocardial infarction of the posterior wall of the left ventricle and
septum, and starting pulmonary edema. What is primary mechanism which causes the
development of pulmonary oedema in the patient?
A. Pulmonary arterial hypertension;
B. Left ventricular failure;
C. Pulmonary venous hypertension;
D. Hypoxemia;
E. Decrease of alveolocapillary diffusion of oxygen.
4. A female patient aged 18, complains of general weakness, quick fatigability, depressed
mood. She has asthenic type of constitution. Pulse 68 per min., AP-90/60mm Hg. Primary
neurociculatory arterial hypertension was diagnosed. What is the main factor of decreasing
of arterial pressure in a patient?
A. Decrease of minute volume of the blood;
B. Decrease of cardiac output;
C. Decrease of the tension of resistant vessels;
D. Hypovolemia;
E. Deposition of the blood in the vines of systemic circulation.
5. A patient has stable and marked increase of arterial pressure, increased extracellular
fluid volume, increased content of Na+ and decrease of K+ in the blood, positive effect of
saluretic treatment. What is the mechanism of development of hypertension in the patient?
A. Mineralocorticoid
B. Renin-angiotensine
C. Renovascular
D. Reflexogenic
E. Cento-ischemic
6. While climbing upstairs on the 5th floor a patient has got an increased arterial pressure.
The cause is the increase of:
A. Minute volume of the blood
B. The number of functioning capillaries
C. Content of ions in blood plasma
D. Viscosity of the blood
E. Circulating volume of the blood
7. On the diagnosis of myocardial infarction the main role belongs to enzymodiagnosis.
The definition of content level in the blood of what enzyme is the most important during
the first 2-4 hours after infarction?
A. Aldolase
B. Lipoprotein lipase
C. Alanine aminotranspherase
D. Creatin phosphokinase
E. Acetylcholinesterase
8. On analysis ECG it was determined: sinus rhythm, correct, interval RR is 0.58 sec,
location and duration of other intervals, waves and segments are not changed. Call the type
of arrhythmia:
A. Sinus tachycardia
B. Sinus bradycardia
C. Indioventricular rhythm
D. Sinus arrhythmia
E. Ciliary arrhythmia
9. One of the most dangerous moments in pathogenesis of myocardial necrosis is the
further increase of the zones of necrosis, dystrophy and ischemia. The important role in this
belongs to the increase of the use of the oxygen by myocardium. What substance
contributes to this process?
A. Chlorine ion
B. Cholesterol
C. Catecholamine
D. Acetylcholine
E. Adenosine
10. The functioning of certain structures is stopped on the isolated heart by means of
cooling. What structure is cooled if due to this the contractions stopped at first, but then
they began with a rate 2 times slower than initial one?
A. Sinoatrial node
B. Purkinje’s fibres
C. Limbs of His’ bundle
D. Atrioventricular node
E. His’ bundle
11. A patient with chronic glomerulonephritis has edema, BP is 210/100 mmHg; the rate of
heartbeat is 85 per minute; the borders of the heart are dilated. What is the leading
mechanism in the development of arterial hypertension?
A. Increase of the activity of sympathetic adrenal system
B. Hyperfunction of the heart
C. Activation of renin-angiotensin-aldosterone system
D. Increase of circulating volume of the blood
E. Increase of vasopressin output
12. The patient’s ECG shows that interval RR=1.5 sec, heart rate - 40 per min. What is the
pacemaker of the heart?
A. Left limb of His’ bundle
B. Sinus node
C. His’ bundle
D. Right limb of the His bundle
E. Atrioventricular node
13. Pulmonary edema developed in a patient with hypertonic crisis. What is the main factor
in the pathogenesis of his state?
A. Increase of arterial pressure
B. Permeability increase of the vessels of pulmonary circulation
C. Increase of hydrostatic pressure in the capillary of the lungs.
D. Resistibility increase of the lung vessels
E. Decrease of oncotic pressure of blood plasma.
14. During the examination of blood for activity of AsAT and AlAT in the patient who
complained of pain in the chest and in upper part of the abdomen, the following results
were received: activity of AsAT 2 times higher than AlAT activity. What disease does the
patient have?
A. Acute infectious hepatitis
B. Acute pancreatitis
C. Myocardial infarction
D. Chronic hepatitis
E. Cirrhosis of the liver
15. Redistribution of organ blood supply took place in a young man, aged 20 during the
load. What organ did the blood flow increase in most of all?
A. Brain
B. Kidneys
C. Liver
D. Skeletal muscles
E. Heart
16. Clinical signs of developing pulmonary edema appeared in a patient with cardiac
insufficiency of left ventricular type. Which of the pointed pathogenic mechanism is the
primary in such pathology?
A. Hydrodynamic
B. Congestive
C. Colloid-osmotic
D. Lymphogenous
E. Membranogenous
17. A patient has cyanosis, increase of the liver, oedema of the lower extremities due to the
right ventricular insufficiency. What is the cause of the development of right ventricular
failure?
A. Cardiogenic cirrhosis of the liver.
B. Functional shunting in lungs
C. Hypercatecholaminemia
D. Increase of venous pressure
E. Hypotension of pulmonary circulation
18. A woman, aged 25, complains of constant pain in the heart area, breathlessness on
movement, and general malaise. She has pale and cold skin, acrocyanosis. Her pulse is
96/min and her BP is 105/70 mmHg. Heart border in her shifted 2 cm left. The first sound
is weakened over the apex of heart; there is systolic murmur over the apex. Diagnosis is
insufficiency of the mitral valve of the heart. What is the cause of the blood circulation
failure?
A. Myocardial overload by the increased blood volume
B. Myocardial overload by the increased of resistance of blood outflow
C. Myocardial failure
D. Volume decreased of circulating blood
E. Volume increased of vascular bed
19. A patient with acute myocardial infarction was being given 1500ml of different
solutions intravenously during 8 hours, oxygen intranasally. Death occurs due to
pulmonary edema. What was the cause of the pulmonary edema?
A. Overload of the left ventricle by the volume
B. Decrease of oncotic pressure due to hemodilution
C. Allergic reaction
D. Neurogenic reaction
E. Oxygen inhalation
20. Functional hypertrophy of the left ventricle of the heart developed in a sportsman, aged
20, due to constant physical load. What morphofunctional process do these changes result
from?
A. Increase of cell size and number of contractile organelles
B. Increase of fibroblast number
C. Increase of the number of conductive cardiomyocytes
D. Increase of the amount of connective tissue
E. Increase of the amount of fat tissue
21. A patient with renal disease accompanied by parenchyma ischemia has a high arterial
pressure. What leading factor is the cause of the increase of AP in this patient?
A. Excess of angiotensin II
B. Excess of antidiuretic hormone
C. Increase of heart output
D. Increase of sympathetic nervous system tonus
E. Hypercatecholaminemia
22. During the operation reflex increased of vagus nerve influence on the heart happened.
What may occur in this case?
A. Cardiac arrest
B. Increase of atrioventricular node conduction
C. Increase of myocardium conduction
D. Intensification of myocardium contractions
E. Increase of heart rate
23. Decrease of R-R interval was revealed on ECG of a man. What changes in the heart
work are observed in this case?
A. Increase of heart rate
B. Decrease of heart rate
C. Increase of force of contractions
D. Decrease of force contraction
E. Decrease of force and rate of contractions
24. Large amount of isoenzymes of creatine kinase of MV-form was revealed in the blood
of the patient with destructive changes in the muscular tissue. What is the most possible
diagnosis?
A. Myocardial infarction
B. Muscular atrophy
C. Muscular dystrophy
D. Polymyositis
E. Myopathy
25. Patient’s attack of tachycardia was stopped by pressing on the eyeballs (Danini-Ashner
reflex). In the decrease of the heart rate there is intensification of the influence on the
sinoatrial node of:
A. Vagus nerves
B. Sympathetic nerves
C. Autonomic nervous system
D. Sympathoadrenal system
E. Catecholamines
26. Considerable increase of PQ interval was found out on ECG. It means that conduction
of stimulation is delayed by:
A. AV node
B. Atria
C. His’ bundle
D. Purkinje’s fibres
E. Ventricles
27. Sharp marked pains in the substernal area that radiate to the left arm cannot be
controled by nitro-glycerine for 30 minutes. What changes developed in the patient’s
hearts?
A. Myocardial ischemia
B. Pathological myocardial hypertrophy
C. Sharp increase of coronary blood flow
D. Mitral incompetence
E. Inflammation of pericardium
28. The activity of what enzymes is it necessary to determine in pathology of cardiac
muscle with diagnostic and prognostic aim?
A. Arginase, peptidase, phosphatase
B. Decarboxylase, decanidase, lactate dehydrogenase
C. Creatin kinase, transaminase, lactate dehydrogenase
D. Lysozyme, citrate synthatase, succinate dehydrogenase
E. Neuroaminase, aldolase, hexakinase.
29. A severe stress was caused in an experimental animal. Necrotic injuries of myocardium
developed in this stage. What is the main cause in the pathogenesis of these injuries?
A. Increase of calcium content in cardiomyocytes
B. Decrease of adenosine triphosphoric acid synthesis in mitochondria
C. Changes in the work of Na+-K+ pump
D. Insufficiency of coronary circulation
E. Decrease of adenosine triphosphoric acid activity of myosin
30. A patient male has had a chronic disease of kidneys for 12 years. AP - 200/130mmHg.
Pulse –75 beats per min. The main factor that causes the increase of pressure in this case is
the increase of:
A. Minute volume of the heart
B. Heart rate
C. Circulating volume of the blood
D. Systemic peripheral resistance
E. Venous recurrence.
31. During the attack of heartbeat a patient with thyrotoxicosis has an irregular pulse of
different filling, pulse deficiency is observed. Waves P are absent; small in amplitude,
disorderly undulations (P waves), and irregular ventricular complexes of ordinary
configuration are noted. What kind of rhythm impairment is observed in a patient?
A. Sinus tachycardia
B. Sinoatrial block
C. Ciliary arrhythmia
D. Paroxysmal tachycardia
E. Ventricular extrasystole
32. At examination of a patient strengthening of a second pulmonic sound, hypertrophy of
the right ventricle wall are determined. What changes of hemodynamic take place in
pulmonary circulation?
A. Hyperperfusion of the lungs
B. Hypoperfusion of the lungs
C. Manifestation of Hering-Breuer reflex
D. Development of broncho-alveolar vascular anastomosis
E. Spasm of resistant vessels in the lungs.
33. A patient with mitral failure has an enlargement of the liver, edema of lower limbs.
What is the leading mechanism of the development of cardiac edema?
A. Increase of venous recurrence
B. Increase of tissue drainage
C. Participation of renin-angiotensin-aldosteron system
D. Decrease of oncotic pressure
E. Decrease of transudation.
34. At examination a patient’s arterial pressure is 190/100 hg. What factors leads to
increase of arterial pressure?
A. Spasm of resistance vessels
B. Increase of venous recurrence
C. toxygenic dilation of cardiac muscle
D. Aler-Lilestrand reflex
E. Kitaevs reflex.
35. A patient with myocardial infarction has a mark paleness of skin, oliguria, AP 100/90
mm Hg, and pulse 100 beats/min. What compensative mechanism maintains relative high
level of AP?
A. Hypokalemia
B. Hypoperfusion of the lungs
C. Centralization of blood circulation
D. Increase of the level of vasodilators in blood
E. Secondary aldosteronism
36. Marked frequency of the patients pulse was determined during the examination, what is
sinus tachycardia due to?
A. Hypothyrosis
B. Hypokalemia
C. Tonus increase of vagus nerve
D. Increase of speed of slow diastolic depolarisation
E. Excess of acetylcholine
37. Considerably slow pulse was determined in a patient at examination. What is sinus
bradycardia due to?
A. Decrease of speed of slow diastolic depolarisation
B. Hypercatecholaminemia
C. Decrease of circulating blood volume
D. Hyperkalemia
E. Haemic hypoxia
38. In cardiac pathology homeometric mechanism of compensation in the work of the left
ventricle takes place in:
A. Stenosis of atrioventricular foramen
B. Mitral incompetence
C. Aortic incompetence
D. Hypertension of pulmonary circulation
E. Hypertension of systemic circulation.
39. In cardiac pathology heterometric mechanism of compensation connected with
overloading of left ventricle volume takes place in:
A. Stenosis of atrioventricular foramen
B. Stenosis of aortic osteum
C. Aortic incompetence
D. Hyper tension of pulmonary circulation
E. Hypertension of systemic circulation.
40. Sharp increase of AsAT activity was determined in the blood serum of a patient 12 hrs
later after an acute attack of pain in the substernal area. Which of the pathogenesis is the
most possible?
A. Collagenosis
B. Diabetes mellitus
C. Myocardial infarction
D. Virus hepatitis
E. Diabetes insipidus
41. Pressing pain in the heart area with irradiation to the left arm, neck and under the left
shoulder blade suddenly appeared in a male patient aged 45, after considerable psychoemotional exertion. His face became pale and covered with cold perspiration. Nitroglycerin relieved the attack of pain. What process in the patient?
A. Angina pectoris
B. Perforation of stomach ulcer
C. Psychogenetic shock
D. Myocardial infarction
E. Insult
42. In recreation of the arterial hypertension in a dog a thickness in the left ventricle wall
increased 1.7 times in a month, but the circulating blood volume was not changed in
comparison with the initial data. What stage of myocardial hypertrophy is observed in the
animal?
A. Initial
B. Repair
C. Complete hypertrophy
D. Decompensation
E. Progressive cardiosclerosis
43. The rate of spread of pulse wave turned out to be considerably higher in a man aged 70,
than in a man aged 25. The cause of this is decrease of:
A. Arterial pressure
B. Cardiac output
C. Elasticity of vascular wall
D. Rate of cardiac contractions
E. Circulation rate
44. On recording ECG of a patient with hyperfunction of the thyroid gland increase of rate
of cardiac contractions was registered. Shortening of what ECG element indicates this?
A. Interval R-R
B. Interval P-Q
C. Interval P-T
D. Segment P-Q
E. Complex QRS
45. A patient excretes water from the organism less than he uses it for 24 hours. What
disease may lead to this state?
A. Cardiac insufficiency
B. Pancreatitis
C. Cystitis
D. Hepatitis
E. Infectious diseases
46. A man has got an electro trauma. Current went through the cardiac muscle. What
dangerous impairment in the work of the heart demanding urgent measures may appear in
this situation?
A. Bradycardia
B. Extrasystole
C. Atrial fibrillation
D. Ventricular fibrillation
E. Tachycardia
47. A patient who underwent myocardial infarction a month and a half ago had Dressler’s
syndrome with typical triad: pericarditis, pleurisy, and pneumonia. The cause of its
development is:
A. Sensibilization of the organism by myocardial antigens
B. Decrease of resistance to infectious agents
C. Activation of saprophytic micro flora
D. Intoxication of the organism by necrotic products
E. Injection of myocardial enzymes in the blood.
48 A patient with rheumatism had incompetence of the left atrioventricular foramen and
decompensation of cardiac activity. The characteristic hemodynamic index of this state is:
A. Decrease of cardiac output
B. Slowing down of blood flow
C. Decrease of arterial pressure
D. Increase of venous pressure
E. Widening of microcirculatory bed
49. A patient with rheumatic myocarditis began to feel intermissions in the work of heart.
By means of auscultation of the heart, feeling the pulse and ECG investigation it was
determined that this was connected with the appearance of ventricular extra systoles the
characteristic feature of which is compensatory pause. Its appearance is due to:
A. Refractivity of ventricular myocardium to the next impulse
B. Retention of stimulation in atrioventricular node
C. Retrograde conduction of stimulation to atria
D. Inhibition of function of sinoatrial node
E. Impairment of contraction of ventricular myocardium
50. Considerable increase of myocardial mass of left ventricle was determined in a patient
with hypertension. It was due to:
A. Increase of cardiomyocyte volume
B. Increase in amount of cardiomyocytes
C. Enlargement of connective tissue
D. Retention of water in myocardium
E. Fat infiltration of myocardium
51. A patient with aortic atherosclerosis has left ventricular hypertrophy as a compensatory
phenomenon. Compensatory role of hypertrophy comes to:
A. Normalization of load on each cardiomyocyte
B. Improvement of delivery of oxygen to myocardium
C. Activation of synthesis of macroergs in myocardium
D. Economical use of energy by cardiomyocytes
E. Increase of stroke volume of the blood
52. A patient who is treated for myocardial infarction at the in-patient department has lost
suddenly his consciousness several times a day. During the attack pulse is absent, heart
sounds are not heard, face is cyanotic, and convulsions appear, arterial pressure is not
determined. The diagnosis is Morgagni-Adams-Stokes syndrome. It appears due to:
A. Development of full atrioventricular blockade
B. Weakness of sinoatrial node
C. Attack of ventricular paroxysmal tachycardia
D. Impairment of excitability of ventricular myocardium
E. Cardiosclerotic changes in the heart
53. Electrocardiography examination of a patient with hypertension showed such results:
right sinus rhythm, rate of cardiac constrictions is 92 per min; duration of PQ - 0.2 sec,
QRS without change, a patient has disturbance of:
A. Refractivity
B. Conduction
C. Automatism
D. Stimulation
E. Contractility
54. By electrocardiogram investigation the following data were determined in a patient
who had suffered the grippe; the rate of heart is 140 beats per min, sinus rhythm, the range
of R-R is not more than 0.15 c; duration of PQ-0.2 c; QRS is not changed. These indicate
of the development of:
A. Sinus tachyarrhythmia
B. Sinus tachycardia
C. Nonparoxysmal tachycardia
D. Paroxysmal tachycardia
E. Ventricular fibrillation
55. The signs of heart failure appeared in a man aged 56, during carrying out hard work,
feelings of air shortage, heart beating, and general weakness. Objectively heart borders are
dilated, the heart rate is 92 beats per min and arterial pressure is 180/110 mm hg. These
signs are due to:
A. Increase of peripheral resistance
B. General hypoxia of an organism
C. Insufficiency of coronary circulation
D. Increase of diastolic filling
E. Neurotrophic disturbances
56. A patient aged 47 with mitral incompetence has the symptoms of cardiac insufficiency:
breathlessness, cyanosis, oedema of lower limbs. Objectively: the borders of the heart are
dilated, the heart rate is 104 beats per min, and arterial pressure is 125/85 mm hg. These
symptoms are due to:
A. Increase of peripheral resistance
B. Autoallergic changes of myocardium
C. Increase of diastolic filling
D. Insufficiency of coronary circulation
E. Neurotrophic disturbances
57. Dilation of the heart, AP-155/100 mm hg, the heart rate 95 beats per min, was revealed
in a patient aged 63 with hypertension during the examination. The most effective
mechanism, which will contribute to the normalization of AP, is:
A. Inhibition of aldosteron synthesis
B. Blocking of angiotensin synthesis
C. Inhibition of catecholamine action
D. Blocking of vasopressin action
E. Administration of salt low diet
58. After suffered rheumatism a patient had aortic stenosis. Point out what mechanism of
compensation takes place in the left ventricle:
A. Homeometric
B. Heterometric
C. Systolic
D. Diastolic
E. Coronary
59. After suffered rheumatism a patient had aortic incompetence. Indicate what mechanism
of compensation takes place in the left ventricle in this case:
A. Homeometric
B. Heterometric
C. Systolic
D. Diastolic
E. Coronary
60. Acute myocardial infarction of a patient includes three areas: zone of necrosis,
dystrophy and ischemia. The changes of what ECG wave characterises the place of
necrosis in this case?
A. R
B. S
C. Q
D. T
E. P
61. A patient with acute myocardial infarction, which was caused by thrombosis of
coronary arteries, was treated with fibrinolytc preparation urkinase that led to the
development of reperfusion syndrome. Which of the mentioned syndromes is associated
with reperfusion?
A. Dressler’s
B. Chediak-Higashi
C. Morgagni-Adams-Stokes
D. No-reflow
E. Wolff-Parkinson-White
62. Which of the factors is the most frequent cause of formation of acquired valvular heart
disease?
A. Septic endocarditis
B. Syphilis
C. Atherosclerosis
D. Mechanical factor
E. Rheumatism
63. Acute pain in the heart area, marked skin paleness and loss of consciousness developed
in a patient after short intensive physical excretion. What heart failure may be suspected in
this patient?
A. Mitral incompetence
B. Stenosis of aortic osteum
C. Stenosis of mitral orifice
D. Aortic incompetence
E. Stenosis of the right atrioventricular opening
64. A patient aged 40, complains of increased fatigue, appearance of pain in the heart area
on physical exertion. Objectively: cyanotic skin (especially on the fingers of the hands and
legs, lobule of the ear), pulse rate 96 beats/min, AP-110/85 mm of hg. There are oedemas
in the lower and middle third of the cruses. The edge of the liver projects 3 cm from under
the costal arch. Which form of circulatory insufficiency may be suspected in this patient?
A. Acute left ventricular failure
B. Acute vascular insufficiency
C. Chronic left ventricular failure
D. Chronic right ventricular failure
E. Acute right ventricular failure
65. A patient complains of breathlessness that appears even on slight physical exertion,
cough with sputum, which recently has obtained bloody character. Objectively: the skin of
the face and mucous membrane of the lips particularly are cyanotic. Which impairment of
the heart work may be suspected in this patient?
A. Stenosis of mitral orifice
B. Mitral incompetence
C. Stenosis of aortic osteum
D. Aortic incompetence
E. Stenosis of the right atrioventricular opening
66. A patient has constant high arterial pressure - 160/110 mm of hg. Periodically it may
rise up to 220-240/120-130 mm of hg. What type of hypertension has this patient?
A. Psycho emotional
B. Cerebral
C. Renal
D. Adrenal
E. Essential
67. A patient, female, aged 48 complains of breathlessness on slight physical exertion,
pains of pressing character in substernal area, appearance of syncope on exertion.
According to a case history the patient suffered rheumatism. Heart failure was diagnosed stenosis of aortic osteum, myocardial hypertrophy. What is the main mechanism of the
development of myocardial hypertrophy?
A. Hypertrophy of myocardiocytes
B. Diffuse oedema of interstice
C. Synthesis increase of contractile proteins in myocardium
D. Hyperplasia of intermediate tissue of myocardium
E. Accumulation of water and electrolytes in myocardiocytes
68. A patient 45 complains of breathlessness on slight physical exertion, oedema of the
legs, frequent quinsies are pointed out in case history, she is being ill for 2 years.
Rheumocarditis, combined mitral incompetence, insufficiency of blood circulation were
diagnosed. What is hemodynamic mechanism of decompensation?
A. Decrease of circulating blood volume
B. Decrease of venous pressure
C. Increase of arterial pressure
D. Decrease of minute volume of the heart
E. Tachycardia
69. A patient with ischemic heart disease had a sudden severe attack of angina pectoris: the
face is pale, cold, damp skin, AP-70/50 mm Hg, extrasystolia. Myocardial infarction and
cardiogenic shock were diagnosed. Name the leading link of pathogenesis?
A. Hypotension
B. Pain syndrome
C. Toxaemia
D. Extrasystolia
E. Decrease of minute blood volume
70. Mitral incompetence without impairment of blood circulation was revealed in a patient
aged 25. What mechanism provided the state of the heart compensation?
A. Heterometric mechanism
B. Homeometric mechanism
C. Inotropic action of catecholamines
D. Increase of the heart mass
E. Strengthening of protein synthesis
71. Aortic stenosis was revealed in a girl aged 15, but without impairments of blood
circulation. What the mechanism provided the condition of heart compensation?
A. Homeometric mechanism
B. Inotropic action of catecholamines
C. Heterometric mechanism
D. Decrease of heart mass
E. Strengthening of protein synthesis
72. ECG of a child aged 5 shows the impairment of action of cardiac rhythm. On holding
breathing the cardiac rhythm becomes normal. What kind of impairment was found out on
ECG?
A. Sinus extrasystole
B. Ciliary arrhythmia
C. Respiratory arrhythmia
D. Atrial extrasystole
E. Transversal heart block
73. Strong palpitation, pain in the heart, sharp weakness, increase of AP, irregular pulse
with deficiency developed suddenly in a man aged 50. ECG showed absence of wave P and
different R-R intervals. What impairment of cardiac rhythm has a patient?
A. Transversal heart block
B. Paroxysmal tachycardia
C. Respiratory arrhythmia
D. Ciliary arrhythmia
E. Sinus extrasystole
74. ECG show that wave P overlaps the wave T what is observed in case of atrial
obstruction. At what rate of the heart contractions will it occur?
A. 150 beats per minute
B. 160 beats per minute
C. 170 beats pr minute
D. 140 beats per minute
E. 130 beats per minute
75. During the experiment a white rat was given intraperitoneal injection of 0.1% adrenalin
solution at 1 mg/100g of body mass. 30 minutes later respiration become hurried and
shallow, then sharp and convulsive, foamy fluid appeared from the nasal cavity, there was
acrocyanosis. The animal died when acute pulmonary edema developed. What
pathogenetic mechanism is the leading in this case?
A. Toxic
B. Membranogenous
C. Lymphogenous
D. Hydrodynamic
E. Colloid-osmotic
76. Patient V., aged 67 suffers from atherosclerosis of heart vessels and brain vessels.
Hyperlipidemia was revealed on examination. What class of lipoproteins of blood serum is
of greatest importance in the pathogenesis of atherosclerosis?
A. Lipoproteins of low density
B. Chylomicrones
C. Beta lipoproteins
D. Lipoproteins of high density
E. Complex of fat acids with albumins
77. The planned investigation of cardiohemodinamics readings of patient M. with chronic
cardiac insufficiency was carried out. Which of the named readings is the main sign of the
development of cardiac decompensation?
A. Development of tachycardia
B. Decrease of stroke volume
C. Tonogenic dilatation
D. Increase of peripheral vascular resistance
E. Increase of central venous pressure
78. While analyzing the ECG of the patient with myocardial infarction attention was paid
to absence of wave P, presence of wavy isoelectric line with plenty of small waves,
frequent and irregular location of QRS complex. What impairment of rhythm does the
described picture of ECG correspond to?
A. Ventricular fibrillation
B. Idioventricular fibrillation
C. Atrial fibrillation
D. Paroxysmal tachycardia
E. Ventricular extrasystole
79. Periodical appearance of ventricular extrasystole was revealed during ECG
investigation of patient P. It was determined that wave P was absent before extrasystole.
What is the cause of its disappearance?
A. Appearance if refractory period in atria
B. Impulse block in sinus node
C. Appearance of refractory period in ventricles
D. Block of impulse conduction round the atria
E. Impossibility of retrograde conduction through A-V node
80. During ultra-sound investigation dilation of heart cavities was revealed in patient S.
who suffered from hypertension. Which of the below mentioned signs are evidence of
development of tonogenic dilation?
A. Dilation of heart cavities with increase if stroke volume
B. Dilation of cavities without change if stroke volume
C. Dilation of cavities with change of stroke volume
D. Uniform dilations of heart borders
E. Irregular dilations of heart borders
81. Quick fatigue, breathlessness on physical exertion, feeling of “sink” and momentary
cardiac arrest appeared in a patient D, aged 13, 2 weeks later after secondary suffered
tonsillitis. ECG showed decrease of voltage of waves periodical prolapse of some cardiac
cycles PQRST, RCC-55 beats/minute. What is the most possible mechanism of the
impairment of heart functions?
A. Toxic impairment of sinus node
B. Impairment of sinus node by immune complexes
C. Sclerotic changes in sinus node
D. Ischemic impairment of sinus node
E. Parasympathetic irritation of sinus node
82. During ECG investigation irregular atrioventricular extrasystoles were determined in a
patient aged 38. The impairment of what properties of myocardium composes the base of
extra systole pathogenesis?
A. Excitability
B. Automatism
C. Conduction
D. Contractility
E. Tonicity
83. Patient Y, aged 40, is treated for pulmonary tuberculosis, acrocyanosis, breathlessness,
extension of heart borders, increase of AP and number of erythrocytes, pachyemia,
neutrophilic leukocytosis are marked on examination. Which of the below mentioned
symptoms of chronic hypoxia are regarded as lasting compensatory mechanisms of
organism.
A. Pachyemia
B. Dilation of the cavities and myocardial hypertrophy
C. Leucocytosis
D. Increase of AP
E. Increase of respiratory rate.
84. Increase of blood viscosity was revealed in a patient with chronic cardiac insufficiency,
the damage of the walls of vessels of microcirculatory channel was found out on
capillaroscopy. Which of the impairments of peripheral circulation are possible in this
case?
A. Slage phenomenon
B. Thrombosis
C. Arterial hyperemia
D. Embolism
E. Venous hyperaemia.
85. Changes that testify to the impairment of cardiomyocytes were recorded on the ECG of
an experimental animal after the injection of uabain (substance which blockades K+/Na+depending ATP). What molecular mechanisms had decisive significance in this case?
A. Electrono-osmotic
B. Lipid
C. Acidotic
D. Calcic
E. Protein
86. Patient, aged 44, complains of strangulation, palpitation, pains in the right costal
interspace, and edemas on the legs. Pulsation of cervical veins, enlargement of the liver,
edemas of the lower extremities were found out on examination. ECG shows the signs of
hypertrophy of both ventricles and right auricle. Tricuspid incompetence was diagnosed.
What is pathophysiological variant of this incompetence?
A. Overloading of the heart by exertion
B. Primary myocardial insufficiency
C. Overloading of the heart by volume
D. Coronary insufficiency
E. Cardiac tamponade.
87. Acceleration of the heartbeat during breathing in and deceleration during breathing out
were revealed in a youth, aged 16, on examination. ESG showed shortening of RR interval
during inspiration and its lengthening during expiration. Name the kind of arrhythmia.
A. Ciliary arrhythmia
B. Sinus tachycardia
C. Idioventricular rhythm
D. Sinus arrhythmia
E. Sinus bradycardia
88. Choose in what form below mentioned states that cause of cardiac insufficiency
heterometric mechanism of compensation (Frank-Starling) takes place:
A. Hypertension of systemic circulation
B. Hypertension of pulmonary circulation
C. Stenosis of mitral orifice
D. Stenosis of aortic osteum
E. Aortic incompetence
89. A patient, aged 58, was hospitalised with complaints of unpleasant feelings in the heart
area; there was myocardial infarction in anamnesis. ECG shows registration of fibrillation
waves (F) instead of P-waves; QRST complexes are widened and deformed. Ventricular
rhythm is right; the rate of contractions of ventricles is 48 per minute. What is the most
possible impairment of the rhythm in this case?
A. Frederic’s syndrome
B. Morgagni-Adams-Stokes syndrome
C. Wolf-Parkinson-White syndrome
D. Atrioventricular block of II stage. Mobits’ type I
E. Atrioventricular block of II stage. Mobits’ type II
90. Name the condition, which accompanied by pressure overload of left ventricle.
A. Stenosis of mitral orifice
B. Stenosis of aortic orifice
C. Incompetence of mitral valve
D. Incompetence of aortic valve
E. Pulmonary hypertension
91. A 24-year-old female patient was admitted to the hospital with complaints of headache,
pain in kidney area, and general weakness. She was suffered from tonsillitis one month
before. At examination patient has BP of 180/110 mmHg; in patient’s blood analysis
erythrocytes – 3.1x10^12/L, leucocytes – 12.6x10^9/L, ESR – 28 mm/hour; in patient’s
urinalysis – marked proteinuria, hematuria, leukocyturia. What is the mechanism of
hypertension development?
A. Renovascular
B. Reflexogenic
C. Aldosteron-induced
D. Renal
E. Mineralocorticoid-induced
92. In a patient with hypertension the pulse rate dropped from 72 to 52 bpm during
hypertonic crisis and maintained at this level for 10 days. Intramuscular injection of 1 mg
of atropine led to increasing of pulse rate at 16 bpm. What group of arrhythmias does
described disorder of cardiac rhythm belong to?
A. Ventricular fibrillation
B. Atrial palpitation
C. Disturbance of rhythm formation
D. Disturbance of rhythm conduction
E. Disturbance of automatism
93. Decrease in pulse rate down to 50 bpm was observed in a patient with cerebral
hemorrhage. His pulse was rhythmic. What is the mechanism of this disorder of cardiac
rhythm?
A. Irritation of nervus vagus
B. Reduction of rate of free diastolic repolarization
C. Influence of sympathetic mediator
D. Extension of site of sinoatrial node
E. Elevation of rate of free diastolic repolarization
94. A patient died from myocardial infarction, which was proved by data of clinical and
electrocardiographical examinations. No changes of coronary vessels were found at
autopsy of this patient. What evokes myocardial infarction in this patient?
A. Increase in tonus of sympathetic nervous system
B. Enhanced secretion of catecholamines
C. Obstruction of vessel with embolus
D. Thrombosis of coronary vessels
E. Rheumatic coronaritis
95. A patient with neuro-circulatory distony has heartbeat rate increased up to 130 bpm.
Clinical symptoms of organic heart injury were not found in this patient. At pressing on
carotid sinus heart rate decreased, but after returned to previous frequency. What is the
origin of this disorder of heart rhythm?
A. Fluctuations of parasympathetic tonus
B. Inflammatory lesion of myocardium
C. Enhanced influence of sympathetic nervous system
D. Ischemic injury of myocardium
E. Toxic injury of myocardium
96. Thrombosis of anterior intraventricular coronary artery developed after coronarography
in a patient with ischemic heart disease and atherosclerosis of coronary arteries. What
mechanism is the most significant for development of this complication?
A. Slowing of blood flow
B. Injury of endothelium of vessel wall
C. Increase in blood coagulant concentrations
D. Decrease in blood anticoagulant concentrations
E. Reduction of fibrinolytic system activity
97. Under hypertrophy of myocardium mass of heart increases due to:
A. Enlargement of each muscular fiber
B. Growth of connective tissue
C. Increase in number of myocardiocytes
D. Growth of adipose tissue
E. Enhancement of blood supply of heart muscle
98. Changes in ECG was shown at first by lengthening of P-Q interval, after that by falling
out of single QRS complexes, later by increasing in number of fallen out ventricle
complexes, and at last atriums constrict with frequency of 70 bpm and ventricles constrict
with frequency of 35 bpm. Described changes are characteristic for:
A. Intraatrial block
B. Cross-sectional block
C. Intraventricular block
D. Arrhythmia due to disturbances of automatism
E. Arrhythmia due to disturbances of conduction
99. The first link in atherosclerosis development is:
A. Slowing of blood flow
B. Degenerative-proliferative changes of internal layer of arteries
C. Excessive depositions of blood plasma lipoproteins in internal layer of arteries
D. Formation of fibrous plaque on internal layer of arteries
E. Disorders of intactness of arterial wall
100. A patient suddenly lost consciousness and develop cramps. At his ECG followings
were revealed: 2 to 3 P cogs related to 1 QRST complex. What property of heart
conductive system is impaired?
A. Automatism
B. Excitability
C. Conduction
D. Constriction
E. Reproduction of frequency of excitement
ANSWERS: 1.-E. 2.-A. 3.-B. 4.-C. 5.-A. 6.-A. 7.-D. 8.-A. 9.-C. 10.-A. 11.-C. 12.-B. 13.C. 14.-C. 15.-D. 16.-B. 17.-E. 18.-A. 19.-A. 20.-A. 21.-A. 22.-A. 23.-A. 24.-A. 25.-A. 26.A. 27.-A. 28.-C. 29.-D. 30.-D. 31.-C. 32.-E. 33.-C. 34.-A. 35.-C. 36.-D. 37.-A. 38.-E. 39.C. 40.-C. 41.-A. 42.-C. 43.-C. 44.-A. 45.-A. 46.-D. 47.-A. 48.-A. 49.-A. 50.-A. 51.-A. 52.A. 53.-C. 54.-B. 55.-A. 56.-C. 57.-C. 58.-A. 59.-B. 60.-C. 61.-D. 62.-E. 63.-B. 64.-D. 65.A. 66.-D. 67.-C. 68.-D. 69.-E. 70.-A. 71.-A. 72.-C. 73.-D. 74.-C. 75.-D. 76.-A. 77.-B. 78.C. 79.-E. 80.-A. 81.-B. 82.-A. 83.-A. 84.-A. 85.-A. 86.-C. 87.-D. 88.-E. 89.-A. 90.-B. 91.D. 92.-E. 93.-A. 94.-B. 95.-C. 96.-B. 97.-A. 98.-B. 99.-E. 100.-C.
Topic 9. Pathophysiology of respiratory system.
1. A young man with suspicion on narcotic poisoning was admitted into neurological
department. Which of the disorders of external respiration can be expected?
A. Asphyxia
B. Alveolar hyperventilation
C. Kussmal respiration
D. Biot’s Respiration
E. Alveolar hypoventilation
2. In pathogenesis of which types of respiration the main link is the fall of excitability of
respiratory centre to carbon dioxide due to oxygen starvation of this centre?
A. Accelerated and deep breathing
B. Expiratory dyspnoea
C. Periodic respiration
D. Inspiratory dyspnoea
E. Combined dyspnoea
3. As a result of casualty the obturation of the lung trachea occurred. Which stage of
respiration will be impaired first?
A. Tissue respiration
B. Lung ventilation
C. Exchange of gases in the lungs
D. Exchange of gases in tissues
E. Transport of oxygen and carbon dioxide
4. The functional state of respiratory system was examined in a patient with emphysema.
What is more characteristic for this state?
A. Increase of tidal volume
B. Increase of vital volume of the lungs
C. Increase of inspiratory reserve volume
D. Decrease of total volume of the lungs
E. Decrease of inspiratory reserve volume
5. The syndrome of respiratory insufficiency is often observed in premature born children.
What is the main cause of this?
A. Swallowing of amniotic water
B. Immaturity of lung alveoli due to deficiency of surfactant
C. Intrauterine hypercapnia
D. Imperfection of the nervous regulation of the respiratory act
E. Intrauterine asphyxia
6. Paleness of the skin, accelerated superficial respiration is observed in a newborn.
Numerous diffused atelectasis are revealed at X-ray examination. What is the most possible
cause of this condition?
A. Pneumothorax
B. Hydrothorax
C. Tuberculosis
D. Bronchial asthma
E. Surfactant deficiency
7. A patient who was at a resuscitation department with skull injury suddenly developed
convulsions on the background of regaining consciousness, and short arrest of breathing
was changed by solitary sighs with calming down character. What types of respiration
appeared in the patient?
A. Gasping respiration
B. Cheyne-Stokes respiration
C. Biot’s respiration
D. Kussmaul respiration
E. Apnoeystic respiration
8. During meal a child breathe in a seed. What respiratory changes will develop in the
child?
A. First expiratory dyspnoea, then inspiratory one
B. At first inspiratory dyspnoea, then expiratory one
C. At first arrest of breathing, then expiratory dyspnoea
D. Expiratory dyspnoea, then Cheyne-Stokes respiration
E. Inspiratory dyspnoea, then Biot’s respiration
9. A partial respiratory insufficiency developed in a patient due to a chronic impairment of
the organs of respiratory system. What is a characteristic sign of partial respiratory
insufficiency?
A. Hypoxemia and hypercapnia
B. Hypoxemia and decrease of alveolar ventilation
C. Decrease of alveolar ventilation and hypercapnia
D. Hypoxemia and gas acidosis
E. Hypoxemia without hyperapnia
10. When developing of pulmonary emphysema in a patient the following is notified:
A. Increase of functional “dead space”.
B. Inspiratory dyspnoea
C. Cardiac insufficiency (left ventricular type)
D. Decrease of resistance to the airflow in the respiratory tract
E. Decrease of functional “dead space”
11. Decrease of the passage at the level of middle and small bronchi is observed in a
patient. What process will be the leading in the development of respiratory insufficiency?
A. Disturbance of diffusion
B. Hyperperfusion
C. Hypoventilation
D. Hypoperfusion
E. Hyperventilation
12. In the decrease of the middle and small bronchial passages in a patient the following is
observed:
A. Development of gas alkalosis
B. Decrease of pressure in pulmonary circulation
C. Development of inspiratory dyspnoea
D. Hypocapnia
E. Decrease of pO2 and increase of pCO2 in the alveolar air
13. In obstructive type of respiratory disturbances in a patient it will be determined
A. Increase in forced vital volume of the lungs
B. Expiratory dyspnoea
C. Increase in vital volume of the lungs
D. Decrease of the tidal volume
E. Decrease of the total volume of the lungs
14. In restrictive type of respiratory disturbances in a patient the following is revealed
A. Decrease of rate and increase of depth of respiration
B. Expiratory dyspnoea
C. Increase of vital capacity of the lungs
D. Increase of tidal volume of the lungs
E. Decrease of tidal volume of the lungs
15. Gas alkolosis is revealed in the patient is blood. What process impairment is connected
with this development?
A. Impairment of diffusion
B. Hyperventilation
C. Hyperperfusion
D. Hypoventilation
E. Hypoperfusion
16. The application of oxygen did not eliminate hypoxemia in a patient with partial
respiratory insufficiency. What is the mechanism of respiratory insufficiency?
A. Disturbance of diffusion
B. Hyperperfusion (functional shunt)
C. Hypoventilation
D. Hyperperfusion (anatomical shunt)
E. Hyperventilation
17. Patient aged 62 was admitted into neurological department due to cerebral
haemorrhage. Grave condition. Increase of depth and rate of respiration and then its
decrease and apnoea is observed. After that the cycle of respiratory movements start again.
What type of respiration appeared in the patient?
A. Apneustic respiration
B. Kussmaul respiration
C. Gasping respiration
D. Cheyne-Stokes respiration
E. Biot’s respiration
18. After Typhno’s test index decreased to 30% in the patient. The development of what
pathological process in the organs of respiratory systems does it indicate?
A. Lobular pneumonia
B. Pneumothorax
C. Obstructive bronchitis
D. Tuberculous pleurisy
E. Pneumosclerosis
19. A patient has developed athelectasis, which was accompanied by alveolar collapse.
What contributes to this?
A. Hyperventilation
B. Spasm of lung vessels
C. Arterial hypertension
D. Surfactant deficiency
E. Respiratory acidosis
20. A patient has the pathology of the lung with the disturbance of external respiration and
development of hypercapnia and hypoxia. How many times is the ability of CO 2 to
diffusion through alveolar-capillary membrane higher than the same one of oxygen?
A. 5
B. 10
C. 15
D. 20
E. 25
21. Patient’s respiratory rate is 10 per min, respiratory volume - 1.1 l whistling rals are
heard over the lungs on auscultation. Which of pathogenetic forms of external respiratory
disturbance has this patient:
A. Diffuse-pneumonia
B. Diffuse-restrictive
C. Ventilative-restrictive
D. Primary-dyskinetic
E. Obstructive
22. Which of the pathogenetic forms of external respiratory disturbance may develop in
traumatic costal fracture?
A. Primary-dyskinetic
B. Ventilative-restrictive.
C. Obstructive
D. Diffuse-restrictive
E. Diffuse pneumonia
23. Which of pathogenetic forms of external respiratory disturbance may appear in
cerebrospinal trauma of the level of cervico-thoracic part of the spine?
A. Obstructive
B. Primary-dyskinetic
C. Ventilative-restrictive
D. Diffuse-restrictive
E. Diffuse pneumonic
24. In which of pathologic processes does obstructive form of disturbance of external
respiration appear?
A. Pulmonary edema
B. Pneumonia
C. Pleurisy
D. Bronchial asthma
E. Open pneumothorax
25. In which of pathologic processes does ventilative-restrictive form of external
respiratory disturbance develop?
A. Pulmonary edema
B. Bronchial asthma
C. Poliomyelitis
D. Syringomyelitis
E. Bronchitis
26. In what form of dyspnea develops in insufficiency of surfactant system of the lungs?
A. Rare shallow respiration
B. Fast deep respiration
C. Fast shallow respiration
D. Expiratory dyspnea
E. Rare deep respiration
27. Which of pathogenetic forms of external respiratory disturbance may develop in
craniocerebral trauma?
A. Diffuse-pneumonic
B. Diffuse-restrictive
C. Ventilative-restrictive
D. Primary dyskinetic
E. Obstructive
28. A patient aged 23 was admitted to the hospital with a craniocerebral injury in a poor
condition. Respiration is characterised by spasmatic effort of inspiration which does not
stop and sometimes is broken by expiration. What type of respiration is this typical for?
A. Apneustic respiration
B. Gasping respiration
C. Kussmal’s respiration
D. Cheyne-Stokes’ respiration
E. Biot’s respiration
29. A patient aged 64 was admitted to the hospital with complaints of cough with sputum,
marred dyspnea. Objectively forced position, respiratory rate - 32 per min: additional
muscles take part in the act of respiration. X-ray examination: the lungs have increased
transparency. What is the main link in the pathogenesis of respiratory insufficiency of this
patient?
A. Decrease of elastic abilities of the lungs
B. Accumulation of sputum in the lungs
C. Thin mucus membranes of bronchi
D. Impairment of surfactant system of the lung
E. Pneumosclerosis
30. Both vagus nerves were cut during experiment on animal. How may vagus respiration
be characterized?
A. Frequent and deep
B. Very rare and deep
C. Rare and shallow
D. Frequent and shallow
E. Periodic
31. A child with diphtheria developed larynx edema. What type of respiration is observed?
A. Gasping respiration
B. Apneustic respiration
C. Kussmal’s respiration
D. Dyspnea
E. Biot’s respiration
32. A female patient was admitted to the hospital with exertion of chronic bronchitis.
Antibiotic treatment was administered. On the fourth day general condition became worse:
the temperature persisted, dyspnea and cough increased, itching eruptions appeared on the
skin, diffused dry whistles were heard on auscultation. There is eosinophilia (10%) in the
blood. Aggregation of symptoms of the patient is caused by the development of:
A. Asthmatic bronchitis
B. Bronchial asthma
C. Bronchopneumonia
D. Allergic reaction
E. Drug allergic reaction
33. The deficiency of alpha-1-antitrypsine was determined in a patient with pulmonary
emphysema. What is the leading mechanism of the development of emphysema in this
patient?
A. Excessive discharge of elastase by lymphocytes
B. Increase of histamine discharge
C. Dilation of bronchioles
D. Activation of elastolysis
E. Decrease of elastase discharge by neutrophilic granulocytes
34. A patient with bronchial asthma has developed acute respiratory insufficiency. What
type of respiratory insufficiency appears in this case?
A. Disregulative disorder of alveolar ventilation
B. Diffuse
C. Perfuse
D. Restrictive disturbance of alveolar ventilation
E. Obstructive disturbance of alveolar ventilation
35. 0.5 ml of air was introduced into a rat’s pleural cavity. What type of respiratory
insufficiency appears in this case?
A. Restrictive disturbance of alveolar respiration
B. Obstructive disturbance of alveolar ventilation
C. Perfuse
D. Diffuse
E. Disregulative disturbance of alveolar ventilation
36. Acute respiratory insufficiency appeared in a patient with tetanus. What type of
respiratory insufficiency develops in this case?
A. Restrictive disturbance of alveolar respiration
B. Disregulative disturbance of alveolar ventilation
C. Obstructive disturbance of alveolar ventilation
D. Perfuse
E. Diffuse
37. Increased content of carbon dioxide is in a room. How does respiration change (its
depth and rate) in a man entered this room?
A. Depth of respiration increases
B. Rate of respiration increases
C. Depth and rate of respiration increase
D. Depth of respiration decreases
E. Rate of respiration decreases
38. When eating a child aspired some food. Strong cough, cyanosis of skin and mucous
membranes, increase in pulse rate, rare respiration, and lengthening of inspiration
developed in him. What kind of disorder of external respiration developed in this child?
A. Stenotic respiration
B. Expiratory dyspnea stage in asphyxia
C. Inpiratory dyspnea stage in asphyxia
D. Biot’s respiration
E. Alternative respiration
39. A 56-year-old patient, who is fitter by occupation, has been suffering form fibrouscavernous tuberculosis of lungs for 10 years. During later 3 weeks cough and weakness
intensify, amount of purulent-mucous phlegm with blood increases in him. What is the
reason for developed ventilation insufficiency in this case?
A. Decrease in number of functioning alveoli
B. Disturbances of functions of respiratory center
C. Disturbances of functions of neuro-muscular apparatus
D. Disturbances of agility of the thorax
E. Disturbances of airways passage
40. A 50-year-old unconscious patient was admitted to the endocrinology department. It is
known that patient has been suffering from diabetes mellitus for many years. What kind of
disorders of external respiration will be present in this patient?
A. Kussmaul’s respiration
B. Asphyxia
C. Biot’s respiration
D. Stenotic respiration
E. Chain-Stocks respiration
41. Attack of suffocation developed in a 45-year-old woman suffered from bronchial
asthma for a long time. What pathogenetic mechanism does this phenomenon have?
A. Expiratory narrowing of small bronchi
B. Loose of elasticity of lung tissue
C. Decrease in sensitivity of respiratory center
D. Disorders of agility of the thorax
E. Impairment of perfusion of lung tissue
42. Edema of larynx developed in a child on the background of allergic reaction. What kind
of respiratory failure has developed in this case?
A. Obstructive
B Restrictive
C. Disregulative
D. Parenchimatous
E. 43. A patient with both-sided lung edema was in the emergency department. What kind of
dyspnea is observed in this case?
A Shallow frequent respiration
B. Deep frequent respiration
C. Shallow rare respiration
D. Shallow respiration
E. Asphyxic respiration
44. Lung fibrosis with disorders of alveolar ventilation developed in a miner. What is the
leading mechanism in this disorder development?
A. Restriction of respiratory surface of lungs
B. Narrowing of upper airways
C. Disorders of neural regulation of respiration
D. Restriction of agility of the thorax
E. Spasm of bronchi
45. A 60-year-old male patient in severe condition was admitted to the hospital. The patient
has been suffering from diabetes mellitus for 10 years. At second day of his stay at the inpatient department his condition sharply worsened: coma developed, noisy respiration
appeared, which was accompanied by deep inspirations with forced expirations and
participation of expiratory muscles. What kind of disorders of respiration is observed in the
patient?
A. Kussmaul’s respiration
B. Stenotic respiration
C. Tachipnea
D. Chain-Stocks’ respiration
E. Biot’s respiration
46. A patient with craniocerebral trauma has respiration, which is characterized by
respiratory movements becoming deeper and then becoming shallower and after that short
pause in respiration occurs. What periodical respiration is this type characteristic for?
A. Chain-Stocks’ respiration
B. Biot’s respiration
C. Kussmaul’s respiration
D. Gasping respiration
E. Apneastic respiration
47. A female patient N., aged 16, with asphyxia was admitted to the emergency
department. She has expiratory dyspnea with respiration rate of 8 per minute, BP of 80/50
mmHg, heartbeat rate of 40 bpm, and narrowed pupils. What phase of asphyxia does this
patient have?
A. II phase
B. I phase
C. II phase
D. IV phase
E. 48. A boy was admitted to resuscitation department. He has inspiratory dyspnea, general
excitation, widened pupils, tachycardia, and BP of 160/100 mmHg. What phase of
asphyxia does this patient have?
A. I phase
B. II phase
C. III phase
D. IV phase
E. 49. A 15-year-old girl has been suffering from bronchial asthma for 5 years. What kind of
hypoxia does this patient have?
A. Respiratory
B. Circulatory
C. Hemic
D. Tissue
E. Mixed
Topic 10. Hypoxia
1. A man constantly lives in mountains. What changes of blood test indices can found in
him?
A. Increased red blood cells number
B. Decreased reticulocytes count
C. Decreased color index
D. Appearance of erythroblasts in blood
E. Decreased hemoglobin content
2. After autopsy a forensic medical expert established that death of 20-year-old woman
resulted from cyanide poisoning. What process disorder caused the death?
A. Oxygen transport by hemoglobin
B. Tissue respiration
C. Hemoglobin synthesis
D. Urea synthesis
E. Oxidative phosphorilation
3. Increased number of erythrocytes in blood test was revealed in people residing in village,
which is situated in mountains at the altitude of 3000 m. What is the reason for changes in
their blood?
A. Increased vitamin B12 synthesis
B. Blood clotting
C. Change of spleen function
D. Increased erythropoietin production
E. Increased circulating blood volume
4. The group of patients from sanatorium went to the mountains for excursion. Tachycardia
and breathlessness developed in part of them in two hours after beginning of excursion.
Which type of hypoxia do those disturbances result from?
A. Hemic
B. Hypoxic
C. Respiratory
D. Tissue
E. Circulatory
5. A driver slept in garage in a car with working engine. When he woke he had headache
and later vomiting began in him. What compound formation in blood caused this state?
A. Carbhemoglobin
B. Methemoglobin
C. Carboxyhemoglobin
D. Desoxihemoglobin
E. Oxihemoglobin
6. Which sportsman will have highest content of lactic acid in the blood?
A. Weight-lifter
B. Who just had run 100 m
C. Who just had run 5000 m
D. Who put the shot
E. Jumper with pole
7. A 40-years-old man took cyanic potassium by mistake. He died instantly. What
mitochondrial enzymes do cyanides block?
A. NAD-dependent Dehydrogenases
B. Cytochrome Oxydase
C. Cytochrome B
D. Cytochrome C
E. FAD-dependent enzymes
8. Pain in muscles appears after physical exertion in people, who move a little (have
hypodynamia) for a long time. What is the possible reason for this?
A. Decreased content of lipids in muscles
B. Increased content of ATP in muscles
C. Accumulation of creatinin in muscles
D. Accumulation of lactic acid in muscles
E. Enhanced decay of muscle proteins
9. The number of erythrocytes in alpinist’s blood before going to mountains is 4,5x1012/L.
What changes of erythrocytes number can develop at the altitude of 2500 m above sea
level?
A. Absolute erythropenia
B. Absolute erythrocytosis
C. Relative erythropenia
D. Relative erythrocytosis
E. There won’t be any changes
10. Dyspnea, increased heart beat rate, weaken of attention, foolishness occurred in
sportsmen without acclimatization during the ascent to the altitude of 3000 m. Then
weakness and disturbance of muscular coordination occurred. What was the reason for that
condition?
A. Circulatory hypoxia
B. Hypoxic hypoxia
C. Respiratory hypoxia
D. Hemic hypoxia
E. Hypercapnia
11. Environmental pollution by nitric compounds occurs after accident at a chemical
factory. People, who live at this region, have sharp weakness, headache, breathlessness,
and giddiness. What does hypoxia result from?
A. Cytochrome Oxidase inactivation
B. Dehydrogenases suppression
D. Carboxyhemoglobin formation
E. Decreased function of FAD-dependent enzymes
C. Methemoglobin formation
12. Total respiratory insufficiency was noticed on examination of blood gases partial
pressure in a patient with bronchial asthma. What is the reason of respiratory hypoxia in
this case?
A. Increased perfusion
B. Decreased diffusion
C. Increased ventilation
D. Decreased ventilation
E. Increased diffusion
13. Total respiratory insufficiency developed in a patient with lung disease. It manifested
by decreased pO2 and increased pCO2 in patient’s blood. What caused development of
respiratory hypoxia and pronounced respiratory insufficiency?
A. Excessive hyperventilation
B. Frequent shallow respiration
C. Oxygen deficit in inspired air
D. Uneven ventilation of the lungs
E. Functional blood shunting in the lungs
14. Disorders of oxyhemoglobin formation have led to development of hemic hypoxia.
What are the reasons for hemic hypoxia development?
A. Methemoglobin formation
B. Inhibition of dehydrogenases
C. Pronounced polycytemia
D. Activation of Glutation Peroxidase
E. Deficiency of riboflavinum
15. Which factors increase hypoxic injury of a cell under hypoxic conditions?
A. Chinon derivations
B. Inhibitors of proteolysis
C. Glucocorticoids
D. Catecholamines
E. Glutation-peroxidase
16. Symptoms of poisoning such as sharp weakness, dizziness, headache, vomiting,
dyspnea, tachycardia, cyanosis of lips, ears, distal phalanges of fingers occurred in one
child from group of children, who had eaten sweet juicy watermelon. Laboratory test of
watermelon showed high level of nitrates. What is leading mechanism in pathogenesis of
only one child poisoning?
A. Superoxide dismutase deficiency
B. Cytochrome oxidase blockade
C. Glutathione peroxidase deficiency
D. Methemoglobin reductase deficiency
E. Catalase deficiency
17. A man has been living high in mountains for a long time. What changes in his blood
would develop?
A. Increase in number of leukocytes
B. Increase in diameter of blood vessels
C. Decrease in number of leukocytes
D. Increase in quantity of hemoglobin
E. Rare pulse
18. Tachypnea and hypopnoe developed in tourists, which had climbed to the altitude of
3000 m. These changes are consequence of stimulation of
A. Chemoreceptors of carotid sinus
B. Mechanoreceptors of pulmonary alveoli
C. Baroreceptors of arch of aorta
D. Neurons of the cerebral cortex
E. Motoneurons of spinal cord
19. Cyanosis, swelling of lower extremities, dyspnea occurred in a 60-year-old patient
suffering from heart failure. Long-term adaptation of organism to hypoxia, occurring in
that condition, can be supplied by
A. Blood outlet from the depots
B. Increased hemopoietic activity
C. Opening of non-functioning capillaries
D. Tachycardia
E. Increased blood oxygenation
20. A dog has poisoning by unknown substance that caused its immediate death because of
oxidation of cytochromes. What is that substance?
A. Potassium chloride
B. Potassium cyanide
C. Potassium sulfate
D. Potassium orotate
E. Potassium permanganate
21. Gas alkalosis developed in a group of alpinists due to rise to the Everest’s top. So,
carbon dioxide partial pressure in their arterial blood makes up
A. 40 mmHg
B. 50 mmHg
C. 30 mmHg
D. 60 mmHg
E. 70 mmHg
22. Hemic hypoxia occurred in a patient. It is accompanied by methemoglobin
accumulation and development of metabolic acidosis. Which substance accumulation leads
to disturbance of acid-base balance?
A. Sulfates
B. Lactates
C. Phosphates
D. Hydrocarbonates
E. Hydroxybutirates
23. During keeping salvage operations, several miners were taken out from the mine. They
were unconscious but without any visible damages. Air in mine had considerable amounts
of methane. Which type of hypoxia developed in those people?
A. Hypoxic
B. Hemic
C. Circulatory
D. Tissue
E. Respiratory
24. A 29-year-old patient with carbon monoxide poisoning was admitted to the hospital. He
had signs of severe hypoxia: pronounced dyspnea, cyanosis and tachycardia. Which
changes of hemoglobin take place during carbon monoxide poisoning?
A. Methemoglobin formation
B. Carboxyhemoglobin formation
C. Carbhemoglobin formation
D. Sulfhemoglobin formation
E. Oxyhemoglobin inactivation
25. A 54-year-old patient was admitted to hospital in hypoxic state, developed due to
aspiration of vomit mass. Blood test was taken after the treatment of patient. Does
erythrocytes number in peripheral blood change in the initial phase of hypoxia?
A. Increase due to outlet of the blood from depots
B. No change in initial phase
C. Decrease due to hemolysis of erythrocytes
D. Decrease due to depot of blood
E. Increase due to increase of hemopoiesis
26. A patient had course of dosing hypoxic trainings as a part of treatment of hypertensive
disease. The most considerable cellular adaptative mechanism that begins working under
such treatment is
A. Cellular hypertrophy
B. Defense of cell membrane
C. Correction of ions transport
D. Mobilization of plastic reserve
E. Decrease in functional activity of cells
27. A patient came to a dentist with complaints of prolonged bleeding from his gums,
reclining of teeth. Paradontosis was diagnosed. Which type of hypoxia developed in the
patient?
A. Hemic
B. Circulatory
C. Respiratory
D. Tissue
E. Hypoxic
28. Dyspnea, cyanosis of mucous membranes of the lips, moderate tachycardia (pulse rate
of 80 beats per minute) suddenly occurred in a patient during the treatment of carious tooth.
Which type of hypoxia developed in this patient?
A. Tissue
B. Hemic
C. Circulatory
D. Respiratory
E. Hypoxic
29. Sensitivity of different tissues to oxygen deficit depends on their metabolic rate, power
of glycolytic system, reserve of ATP and ADP, potential possibility of genetic apparatus to
provide the plastic consolidation of hyperdeduction. Which system is in the worst
conditions from these points of view?
A. Nervous system
B. Cardiovascular system
C. Respiratory system
D. Gastrointestinal system
E. Urinary system
30. A patient addressed to the doctor with complaints of the attack of breathlessness and
dizziness. It was revealed that he worked at the chemical factory, producing senile acid.
Those signs can be explained by disturbance of enzyme
A. Succinate dehydrogenase
B. Cytochrome oxydase
C. Catalase
D. Lactate dehydrogenase
E. Pyruvate dehydrogenase
31. Decrease in adenylic nucleotides ATP/ADP ratio leads to the increase in glycolysis in
tissues under hypoxic conditions. Which reaction get active in this situation?
A. Triozophosphate isomerase-depended
B. Lactate dehydrogenase-depended
C. Aldolase-depended
D. Endolase-depended
E. Phosphofructokinase-depended
32. A child has been brought to the admissions office. He had nitrates poisoning symptoms
such as cyanosis, dyspnea, and cramps. What is the mechanism of those symptoms
development?
A. Oxyhemoglobin formation
B. Reduce hemoglobin formation
C. Carbhemoglobin formation
D. Methemoglobin formation
E. Carboxyhemoglobin formation
33. Sense of muscular weakness, dyspnea, and tachycardia appeared in a tourist at the
altitude of 5200 m. What was the reason for appearance of these symptoms?
A. Decrease in oxygen partial pressure in expired air
B. Decrease in atmospheric pressure
C. Increase in carbon dioxide partial pressure in patient’s blood
D. Gas embolism
E. Air embolism
34. A fireman with signs of carbon monoxide poisoning has been brought from the place of
accident. Which type of hypoxia is more possible in that situation?
A. Hemic hypoxia
B. Ischemic hypoxia
C. Stagnant type of circulatory hypoxia
D. Hypoxic hypoxia
E. Respiratory hypoxia
35. A 60-year-old man was admitted to the hospital with carbon monoxide poisoning. What
is mechanism of disturbances that man has?
A. Inactivation of hemoglobin respiratory function
B. Insufficiency of lungs ventilation
C. Disturbance of blood circulation in the organs and tissues
D. Decrease in partial pressure of oxygen in alveoli
E. Increase in adrenaline secretion
36. Patient has microanizocytosis and poikilocytosis, decreased erythrocytes number,
hemoglobin levels, color index, concentration of iron in serum. These changes were
accompanied by development of hypoxia. It name is:
A. Hemic
B. Hypoxic
C. Circulatory
D. Tissue
E. Respiratory
37. Which reason can lead to hypoxia of exogenous type?
A. Acute bleeding
B. Air embolism
C. Gas embolism
D. Insufficiency of ventilation
E. Decreased partial pressure in inspired air
38. A patient has been suffering from disease of cardiovascular system for a long time.
Chronic blood circulation insufficiency developed in him eventually. Which mechanism of
long-term adaptation to hypoxia takes place in this patient?
A. Activation of hemopoiesis
B. Tachypnea
C. Tachycardia
D. Mobilization of blood from depots
E. Interorganic redistribution of blood circulation
39. A patient has been taken to resuscitation department. Considerable content of
sulfhemoglobin was revealed in his blood. Which type of hypoxia does patient have?
A. Hemic
B. Respiratory
C. Circulatory
D. Tissue
E. Exogenous
40. Alpinists started complaining of breathlessness, palpitation, headache, dizziness, and
ringing in their ears during climbing to mountain at the altitude of 5000 m. Which
pathologic factor caused these symptoms?
A. Hypoxemia
B. Hypokaliemia
C. Increased oxygen capacity of blood
D. Lactacidemia
E. Hypothermia
41. Depressurizing of an airplane cabin happened due to emergency conditions at the
altitude of 5000 m. What is the main mechanism of damages inflicted on the people that
were in the airplane?
A. Hypoxic hypoxia
B. Gas embolism
C. Tissue embolism
D. Respiratory hypoxia
E. Circulatory hypoxia
42. Symptoms of hypoxia appeared in a patient after the course of treatment with
amidopirin and sulfanilamides. What is the reason for development of this type of hypoxia?
A. Formation of methemoglobin
B. Formation of carboxyhemoglobin
C. Formation of nitroxyhemoglobin
D. Formation of carbhemoglobin
E. Formation of oxyhemoglobin
43. After an accident in a coalmine, miners were complaining of headache, dizziness,
tiredness, glimmer in front of their eyes, tachycardia. Which type of hypoxia did they
have?
A. Hypoxic
B. Circulatory
C. Respiratory
D. Tissue
E. Hemic
44. Signs of hypoxia such as dyspnea, tachycardia, and cyanosis of visible mucous
membranes appeared in a patient with myocardial infarction. Development of hypoxia
connected with
A. Decrease in velocity of blood flow
B. Decrease in erythrocytes number
C. Decrease in content of hemoglobin
D. Insufficiency of blood oxygenation
E. Difficult oxyhemoglobin dissociation
45. A man has been brought in hospital by ambulance. He was unconscious because of
carbon monoxide poisoning. What substance accumulation in the blood underlies this
condition?
A. Carboxyhemoglobin
B. Oxyhemoglobin
C. Desoxyhemoglobin
D. Methemoglobin
E. Carbhemoglobin
46. A 65-year-old patient suffers from aortic valve stenosis. She has symptoms of heart
failure such as dyspnea, cyanosis, and edema that appeared after viral infection. She was
admitted to the therapeutic department. Which type of hypoxia is in the patient?
A. Circulatory
B. Hemic
C. Hypoxic
D. Respiratory
E. Tissue
47. A 70-year-old patient underwent medical treatment for ischemic heart disease, heart
failure in cardiological department. Which type of hypoxia was in the patient?
A. Circulatory
B. Hemic
C. Respiratory
D. Tissue
E. Mixed
48. A 13-year-old girl undergoes treatment for iron-deficiency anemia in hematological
department. Which type of hypoxia does this patient have?
A. Hemic
B. Circulatory
C. Tissue
D. Respiratory
E. Mixed
49. A 56-year-old woman suffers from thyrotoxicosis for a long time. Which type of
hypoxia can develop in this patient?
A. Tissue
B. Hemic
C. Circulatory
D. Respiratory
E. Mixed
50. Group of tourists ascended to the altitude of 4200 m. Three alpinists complained of
headache, pain in their ears and frontal sinuses, somnolence, considerable muscular
weakness, irritability during the ascent. The possible reason for appearance of these
symptoms was
A. Altitude sickness
B. Hyperbaric oxygenetion
C. Caisson disease
D. Gas saturation in blood
E. Altitude decompression
ANSWERS:
1-A, 2-B, 3-D, 4-B, 5-C, 6-C, 7-B, 8-D, 9-B, 10-B, 11-C, 12-D, 13-B, 14-A, 15-D, 16-D,
17-D, 18-A, 19-B, 20-B, 21-C, 22-B, 23-A, 24-B, 25-A, 26-A, 27-D, 28-C, 29-A, 30-B, 31B, 32-D, 33-A, 34-A, 35-A, 36-A, 37-E, 38-A, 39-A, 40-A, 41-A, 42-A, 43-A, 44-A, 45-A,
46-A, 47-A, 48-A, 49-A, 50-A
Topic 12. Pathophysiology of digestive system.
1. After taking a fatty food a patient feels nausea, flaccidity, later the sign of steathorrhea
has appeared, cholesterol in the blood 9,2ml/c. The cause of this state is the deficiency of:
A. Chylomicrones.
B. Triglyceroides.
C. Bile acids.
D. Fatty acids.
E. Phopholipids.
2. A patient aged 45 had the diagnosis ulcer of the stomach. On examination of secretory
function of the stomach it was determined that the amount of basal secretion was
100mole/hr, acidity of basal secretion -60mml/hr. What factors action contributes to the
hypersecretion in the stomach?
A. Gastrine.
B. Pancreatic polypeptide.
C. Somatostatin.
D. Glucagon.
E. Betaendorphin.
3. On laboratory examination increased amount of diastase in the urine and also a large
amount of undigested fat in stool were revealed in a patient female with complain of
circular character pain in epigastric area. What form of gastrointestinal tract pathology are
described signs typical for?
A. Inflammation of large intestine.
B. Acute appendicitis.
C. Infectious gastritis.
D. Ulcerous disease of the stomach.
E. Acute pancreatitis.
4. A part of patient pancreas was resected. What kinds of product must be limited in his
diet?
A. Sour milk product
B. Fruits.
C. Not fatty boiled meat.
D. Fatty and fried meal.
E. Vegetables.
5. What enzyme deficiency is the cause of maldigestion of fats in the gastrointestinal tract
and increase of neutral fats in the stool?
A. Gastric lipase
B. Intestinal lipase.
C. Hepatic lipase,
D. Enterokinase.
E. Pancreatic juice.
6. Decrease of synthesis and secretion of trypsin is observed in chronic pancreatitis. The
splitting of what substances is broken?
A. Proteins.
B. Nucleic acids
C. Polysaccharides.
D. Lipids.
E. Liposoluble vitamins.
7. In coprologic investigation it is determined that stool is discoloured, there are drops of
neutral fat in it. The most possible cause of this is the impairment of?
A. Secretion of intestinal juice.
B. Process of absorption in the intestine.
C. Entering of bile into the intestine.
D. Acidity of gastric juice.
E. Secretion of pancreatic juice.
8. A patient had been taking antibiotics of a wide spectrum of action for a long period of
time that caused decrease of appetite, nausea, and diarrhea with saprogenic smell. What is
the side effect of treatment?
A. Hepatotoxic action.
B. Allergic reaction.
C. Dysbacteriosis.
D. Nephrotoxic action.
E. Direct irritative action
9. On examination of a patient suffering from acute pancreatitis increased amount of
chylomicrons was determined in the blood. What enzyme activity is sharply decreased in
this pathology?
A. Lipoprotienelipase.
B. Pancreatic lipase.
C. Pancreatic phospholipase.
D. Tissue triglyceride lipase.
E. Tissue diglyceride lipase.
10. The analysis of gastric juice of an elderly man who complained of unmotivated
weakness, sickness, absence of appetite showed achylia, achlorhydrea, and presence of
lactic acids and coagulated blood, decreased of pepsin secretion. What disease causes such
clinical-laboratory symptoms?
A. Cancer of the stomach.
B. Chronic gastritis.
C. Chronic pancreatitis.
D. Cavitary Maldigestion.
E. Acute gastritias.
11. A man with chronic hepatitis has dyspeptic disorders: decrease of appetite, nausea,
unstable stool, and steatorrhea. What is the mechanism of dyspeptic disorders in hepatic
pathology?
A. Intoxication
B. Hypoglycemia
C. Cholalemia
D. Hypocholea
E. Hyperbilirubemia
12. Spasmodic pains in the abdomen and repeated diarrhoea with mucus appeared in a
healthy person 3-5 hours later after taking meals. This was preceded by nausea and
momentaneous vomiting, general weakness, loss of appetite. What is the most possible
cause of the desired symptoms?
A. Chronic pancreatitis
B. Food intoxication
C. Enterocolitis
D. Hyperacid state of the stomach
E. Chronic gastritis
13. A man who works at a storage battery plants complains of constant feeling of weight
and periodical spasmodic pains in the abdomen, constant retention of stool (not more often
than one time per three day). This is accompanied by frequent headaches, flaccidity,
absence of appetite, and bad taste in the mouth. What are the causes of these disorders?
A. Hyper acid state of the stomach
B. Hypoacid state of the stomach
C. Spastic lead colie with constipation
D. Chronic pancreatitis
E. Parietal maldigestion
14. Due to chronic gastritis a man has the impaired structure of the mucous membrane,
decreased indices of acid formation function of the stomach. The most essential negative
result of this will be the impairment of
A. Excretion of secretum
B. Pancreatic juice secretion
C. Secretory function of small intestine
D. Evacuation of chyme into duodenum
E. Protien digestion
15. On laboratory examination increased amount of diastase in the urine and also a large
amount of undigested fat in stool were revealed in a patient with complains of circular
character pains in epigastric area. What form of gastrointestinal tract pathology are the
described signs typical for?
A. Inflammation of the large intestine
B. Acute appendicitis
C. Infectious hepatitis
D. Ulcerous disease of the stomch
E. Acute pancreatitis
16. A patient aged 35 with ulcerous disease had a rejection of antral portion of the stomch.
What gastrointestinal hormone secretion will be impaired due to operation?
A. Gastrin
B. Secritin
C. Neurotensin
D. Histamine
E. Cholecystokinin
17. A patient aged 57 was admitted to a gastrointestinal department with suspicious on
Zolliger-Ellison syndrome, which was proved by sharp increase of gastrin level in the
blood serum. What impairment of secretory gastric function is the most possible?
A. Hyperacid hyposecretion
B. Hyperacid hypersecretion
C. Hypoacid hypersecretion
D. Achylia
E. Hypoacid hyposecretion
18. A patient with signs of encephalopathy was hospitalised in neurological in- patients
department and co relation between increase of encephalopathy and substances passing
from intestine into systemic blood circulation was determined. What compounds formed in
the intestine may cause endotoximia?
A. Acetoacetat
B. Biotin
C. Indole
D. Ornitin
E. Buthirat
19. 150 ml of meat broth were introduced into the stomach cavity of experimental dog to a
probe the content of what substance will increase quickly in the animal’s blood?
A. Insulin
B. Vasointestinal peptide
C. Neurotensin
D. Somatostatin
E. Gastrin
20. A patient age 37 was admitted into a surgical department with the signs of acute
pancreatitis; vomiting, diarrhea, bradycardia, hypotension wearness, dehydration of the
organism. What preparation must be used first of all?
A. Ephedrine
B. No-spa
C. Pephenazine
D. Contrical
E. Platyphyllin
21. A patient has a stone in the common bile duct, which has stopped passing bile into the
intestines. The impairment of what digestive process is observed in this case?
A. Digestion of carbohydrates
B. Absorption of carbohydrates
C. Digestion of fats
D. Absorption of proteins
E. Digestion of proteins
22. On fibroscopy of the stomach ulcer was revealed in antrum portion, which was
associated with dissemination of mucosa by Helicobacter pylori. The role of this agent in
the formation of ulcer results in:
A. Damage of mucous barrier
B. Inhibition of mucosa regeneration
C. Impairment of microcirculation in mucous
D. Stimulation of HCL secretion
E. Stimulation of pepsin secretion
23. A patient with ulcer of stomach has impairment of equilibrium between the factors of
aggression and defense. What factor contributes to the development of gastric ulcer?
A. Mucin
B. Helicobacter pylori
C. Bicarbonate
D. Prostaglandin E2
E. Prostacyclin
24. After resection of duodenum a patient has developed a syndrome of duodenal in
sufficiency due to the impairment of its endocrine function with signs of cell insufficiency
of APUD system. What hormone is produced by A-cells of this portion of intestine?
A. Histamine
B. Insulin
C. Seratonin
D. Secrtin
E. Glucagon
25. A patient complains of nausea, which often ends with vomiting. These dyspeptic
phenomena become more laborious with time. What stomach function is infringed in this
patient?
A. Evacuation
B. Motility
C. Reservoir
D. Incretory
E. Secretory
26 A patient aged 42 was admitted to the hospital with gastric hemorrhage (ulcerous
disease was excluded by a patient). Ulcer and hyperplasia of gastric mucose were revealed.
What investigation is it necessary to carry out to confirm the diagnosis of Zollinger-Ellison
syndrome in this patient?
A. Definition of gastrin level in the blood.
B. Tomography of pancreas
C. Definition of secretin level in the blood
D. Definition of activity level of pancreatic enzymes
E. Investigation of activity level of pancreatic secretion
27 The amount of protein in the blood was examined in a patient after resection of sizeable
part of small intestine. What change of protein amount may be expected in this patient?
A. Hyperproteinemia
B. Hypoproteinemia
C. Paraproteinemia
D. Hypergammaglobulinemia
E. Dysproteinemia
28 Ulcerous disease of the stomach is revealed in a woman aged 52, who has been ill with
contact dermatitis. On examination it is determined that the patient had been taking
corticosteroid preparations for a long period of time, but acidity of gastric juice was
increased. What mechanism caused the increase of gastric secretion?
A. Decrease of prostaglandin content
B. Increase of secretin secretion
C. Gastrin hyposecretion
D. Increase of histamine content
E. Increase of gastrin excretion
29 A patient complains of vomiting, eructation, pain in epigastric area, constipation, and
emaciation. On examination a basal secretion of HCL is 6mml/gr; maximal one is
60mml/gr. What state has acid-forming function of this patient?
A. Hypoacid
B. Anacid
C. Hyperacid
D. Hypersecretory
E. Normacid
30 A patient aged 42 complains of pains in epigastric area, vomiting; vomitory masses
have color of “coffee grounds”, melena. In anamnesis there is ulcerous disease of the
stomach. On examination: skin is pale, heart rate-110 beats per minute; AP-90/50mm.hg.
Blood analyses: erythrocytes-2.8 x 1012/l; leucocytes-8x109/l; hemoglobin-90gr/l. What is
the possible complication that developed in the patient?
A. Penetration
B. Perforation
C. Hemorrhage
D. Cancerous degeneration
E. Pylorostenosis
31 The investigation of pancreatic function was carried out in experimental animal by
radioisotopic method. The percentage of excreted with stool 1131- albumin is 53%. This is
the evidence of.
A. Increase of exocrine function
B. Increase of incretory function
C. Inhibition of incretory function
D. Inhibition of exocrin function
E. Normal function
32 Malabsorption syndrome is:
A. Syndrome of membraous maldigestion
B. Syndrome of gastric malabsorption
C. Syndrome of malabsorption in small intestine
D. Syndrome of intestinal malabsorption
E. Malabsorption of proteins
33. A patient complains of dyspeptic disorders, melaena, hemorrhoidal bleedings. While
examination of the patient enlargement of veins at the anterior surface of abdomen and
increased abdomen dimensions were revealed. What pathology of GIT may manifest by
such symptoms?
A. Colitis
B. Portal hypertension
C. Intestinal autointoxication
D. Peptic ulcer
E. Enteritis
34. A 67-year-old woman, who has cholecystitis for a long time, suddenly developed sharp
pain in the upper part of abdomen, nausea, and vomiting after food intake. Acute
pancreatitis was diagnosed in this patient. What is the main link in pathogenesis of this
disease?
A. Preliminary activation of pancreatic enzymes
B. Decrease in enzyme levels in pancreatic juice
C. Intensification of enzyme activation in duodenum
D. Reduction of pancreatic polypeptide secretion
E. Increased level of cholecystokinin
35. A patient has increased gastric secretion in response to both mechanical and chemical
stimuli. He has high acidity of gastric juice with pH equals 2.0 on an empty stomach. After
the breakfast pH restores to normal in 12 minutes and is continuously dropping during
following 2 hours. What type of stomach secretion is being observed in this patient?
A. Excitable
B. Brakable
C. Inert
D. Asthenic
E. Normal
36. Frequent liquid stool, signs of intoxication, and dehydration developed in a newborn at
5-6 day. After this newborn was fed by acid-milk mixtures indicated symptoms
disappeared. The conclusion of innate lactose deficiency was made. What process was
broken in this newborn?
A. Membrane digestion
B. Cavital digestion
C. Excretory function of intestine
D. Secretory function of pancreas
E. Secretion of gastric juice
37. Ulcers of stomach were found out in a patient, who was treated with glucocorticoids for
a long time. What is the main mechanism of ulcer development in this case?
A. Increase in secretion and acidity of gastric juice
B. Decrease in histamine concentration in stomach wall
C. Increased tonus of sympathetic nervous system
D. Increased production of prostaglandins E
E. Decreased tonus of parasympathetic nervous system
ANSWERS:
1.-C.2.-A.3.-E.4.-D.5.-E.6.-A.7.-C.8.-C.9.-A.10.-A.11.-D.12.-B.13.-C.14.E.15.-E.16.-A.17.-B.18.-C.19.-E.20.-D.21.-C.22.-A.23.-B.24.-E.25.-A.26.-A.27.-B.28.A.29.-C.30.-C.31.-D.32.-D. 33.-B. 34.-A. 35.-A. 36.-A. 37.-A.
Topic 13.Pathophysiology of the liver.
1.Flabby contraction of gall bladder was revealed in a woman aged 55 after introducing
some of vegetable oil into duodenum. What hormone insufficiency with such state?
A. Gastrin
B. Enterogastrin
C. VIP
D. Pancreozymin
E. Cholecystokinin
2A patient aged 25 has a diagnosis of chronic hepatitis. A patient has lost 10 kg of his body
weight for 2 months. Objectively: the skin is dry, desquamative, and pale with yellowish
color, small punctate hemorrhages on the skin, stomatorrhagia. The impairment of what
hepatic function do petechial hemorrhage and stomatorrhagia prove?
A. Glycogen synthetic
B. ekromogenic
C. Detoxicative
D. Depositing
E. Albumin synthetic
3.On examination bile congestion in the liver and cholelitiasis were revealed in a patient.
Point out the main component of cholelitiasis in this state:
A. Calcium bilirubinate
B. Triglycerides
C. Protein
D. Cholesterol
E. Mineral salts
4.What kind of jaundice is characterized by increased amount of direct bilirubin in the
blood, appearance of bilirubin in urine, acholic stool?
A. Hemolytic
B. Obstructive
C. Parenchymatous
D. E. 5.Residual nitrogen and urea were determined in the patient’s blood analysis. The amount
of urea in the residual nitrogen is considerably reduced. The disease of what organ is
characterized by this analysis?
A. Intestine
B. Kidneys
C. Stomach
D. Heart
E. Liver
6.A patient complains of general weakness, boring pain in the abdomen, bad appetite,
suspicion on jaundice. Blood serum contains 77.3 mcml/L of total bilirubin and 70.76
mcml/L of conjugative bilirubin. What is the most possible type of jaundice?
A. Mechanical jaundice
B. Acute hepatitis
C. Hepatic cirrhosis
D. Parenchymatous jaundice
E. Hemolytic jaundice
7.In 70’s the scientists determined that the cause of severe jaundice in newborns was the
impairment of connection of bilirubin in hepatocytes. What substance is used for the
formation of conjugate?
A. Glucoronic acid
B. Pyruvic acid
C. Uric acid
D. Sulphuric acid
E. Lactic acid
8.A man aged 38 with ecteric skin has anemia,enlarged spleen, hyperbilirubinemia,
urobilinuria, hypercholic stool. What condition are these changes typical for?
A. Suprahepatogenous jaundice
B. Subhepatogenous jaundice
C. Cellular-hepatogenous jaundice
D. Gilbert’s syndrome
E. Syndrome of hepatic insufficiency
9.It’s determined that a patient with jaundice has increased amount of total bilirubin instead
of indirect one (free) in blood plasma,high content of stercolbilin in stool and urine,the
level of direct (connected) bilirubin in blood plasma is normal.what kind of jaundice is it?
A. Mechanical
B. Icterus of new borns
C. Parenchymatous (hepatic)
D. Hemolytic
E. Gilbert’s disease
10.In inflammatory process colloidal properties of bile are impaired in gall bladder and this
results in the formation of gall stones. What substance crystallization is the main cause of
the formation?
A. Cholesterol
B. Urate
C. Chloride
D. Oxalate
E. Phosphate
11.After an accident a completely crashed man’s liver was removed.what disorders do of
hepatic absence may cause death during the first hours after operation?
A. Hypoglycemia
B. Intoxication
C. Fall of AP
D. Sharp ascites
E. Hemophilia and hemorrhage
12.rked isoosmotic hyperhydration has developed in a patient with hepatocirrhosis. What is
the leading mechanism of dyshydria development?
A. Cardio-vascular insufficiency
B. Growth of wall capillary permeability
C. Rushyer-petrovsky reflex
D. Secondary aldosteronism
E. Hypoproteinemia
13.On the background of pain in the right hypochondrium and yellowness ‘a patient with
hepatic cirrhosis has constant dyspeptic disorders in a kind of bitter taste in the mouth,
feeling of heaviness in epigatric area, nausea, unstable stool, steatorrhea. What is the main
cause of the described disorders?
A. Hypoglycemia
B. Hypocholia and intoxication
C. Increase of stercobilin
D. Hyperbilirubinemia
E. Hypoproteinemia
14.In a severe course of viral hepatitis, a patient has developed adynamia, sleepiness at day
time and insomnia at night, inadequate behavior (delirated ideas). There is fetor hepaticus,
Kussmaul’s respiration. What kind of metabolism impairment causes these symptoms?
A. Carbohydrate metabolism and hypoglycemia
B. Water and salt metabolism and hyperhydration
C. Fat metabolism
D. Pigmental metabolism and hyperbilirubinemia
E. Nitrogenous metabolism
15.There is increase of indole amount and decrease of indican 1 in the patient’s urine. This
indicate the impairment of
A. Filtering function of kidneys
B. Detoxication function of liver
C. Reabsorptive funtion of kidney
D. Albumin synthetic function of liver
E. Secretory function of pancreas
16.Increase of direct and indirect bilirubin is determined in blood of a patient with marked
yellowness of sclerae and skin. There is great amount of bilirubin and urobilin in the urine,
traces of stercobilin, decrease of stercobilin in stool. Define pathogenic type of jaundice in
a patient.
A. Parenchymatous
B. Hemolytic
C. Mechanical
D. By-pass
E. Transmissible
17.A patient admitted to the hospital has clearly marked widened subcutaneous veins in the
area of umbilicus (“the head of medusa”). Which of the large venous vessels has the
impaired passage?
A. V. renalis
B. V. porta
C. V. iliaca inferior
D. V. mesenterica superior
E. V. mesenterica inferion
18.In coprologic investigation it is determined that stool is colorless; there are drops of
neutral fat in it. The most possible case of this is impairment of:
A. Entering the bile into intestine
B. Secretion of intestine juice
C. Acidity of gastric juice
D. Processes of absorption in the intestine
E. Secretion of pancreatic juice
19.A patient had nausea and malaise after taking fatty foodstuffs. Sings of steatorrhea
developed in this patient some time later. Content of cholesterol in patient’s blood is 9.2
mmol/L. This condition results from deficiency of:
A. Chylomicrones
B. Triglycerids
C. Bile acids
D. Phospholipids
E. Lipase
20.Low level of albumins and fibrinogen were revealed in the patient’s blood. The
decreased activity of what hepatocyte organells cause this phenomenon?
A. Agranular endoplasmic network
B. Mitochondria
C. Granular endoplasmic network
D. Goldgi’s complex
E. Lysosoms.
21.A patient was admitted into a clinic with signs of acute alcohol poisoning. What
changes of carbohydrate metabolism are typical for this condition?
A. Gluconeogenesis increases in the liver
B. Glycogen decomposition increases in the liver
C. Aerobic decomposition of glucose increases in the muscles
D. Anaerobic decomposition of glucose predominates in the muscles.
E. The rate of gluconeogenesis decreases in the liver.
22A man aged 54 was admitted into the clinic with complaints of pains in the right
hypochondrium vomiting with blood. Objectively: enlargement of hepatic size, varicose of
esophagus and stomach, bleeding from them. The functional disorder of what vessel took
place?
A. Vena hepatica
B. Vena cave superior
C. Vena porta
D. Aorta abdominalis
E. Vena cava inferior
23.The development of acute pancreatitis in a patient is accompanied by the impairment of
permeability of common bile duct. What pathologic process may this result in?
A. Hemolytic jaundice
B. Parenchymatous jaundice
C. Hepatic coma
D. Mechanical jaundice
E. Portal hypertension.
24.Which of the factors plays the leading role in the development of encephalopathy in
hepatic insufficiency?
A. Increase of concentration of toxic substances in the blood
B. Hyperaldosteronism
C. Hyperbilirubinemia
D. Hypofibrinogenia
E. Hypoproteinemia
25.A patient has a diagnosis of ascites. There are no edemas in the other parts of the body.
There are large vessels of cyanotic color on the abdomen. What pathology has this patient?
A. Essential hypertension
B. Hypertension of pulmonary circulation
C. Portal hypertension
D. Chronic circulatory insufficiency
E. Hepatic hypertension
26.Arterial hypertension may develop in a case of hepatic insufficiency. Which of these
factors causes the increase of arterial pressure in such cases?
A. Aldosteron
B. Adrenaline
C. Renin
D. Noradrenalin
E. Angiotensin II
27.A patient aged 25 is ill with jaundice, his skin has got yellow and green color, there’s
skin itch, hypocholic stool throbbing gall bladder. What is the origin of jaundice?
A. Serum hepatitis
B. Obturative genesis
C. Hepatic cirrhosis
D. Leptospirosis
E. Post-transfusion
28.A patient complains of general weakness, breathlessness. Decrease of AP, ascites,
widening of superficial veins of anterior abdominal wall, splenomegaly were established in
this patient. What impairment of hemodynamic has this patient?
A. Portal hypertension syndrome
B. Left ventricular failure
C. Right ventricular failure
D. Collapse
E. Arterial hypotension.
29.A patient with jaundice complains of erythrism, headache, and insomnia. Objectively:
pulse-54 beats/min. AP- 90/60 mmHg. Coagulation of blood decreases. There are traces
scratching on skin. The action of what component causes these symptoms?
A. Bilirubin
B. Cholesterol
C. Bile pigment
D. Bile acid
E. Fatty acid
30.A patient was admitted to the hospital with complaints of dyspeptic disorders, melena,
hemorrhoidal bleeding. Extensions of the vessels on the anterior abdominal wall in
combination with the enlargement of size of the abdomen were revealed on examination of
this patient. What pathology of gastrointestinal tract shows these symptoms?
A. Ulcerous disease
B. Intestinal autointoxication
C. Portal hypertension
D. Colitis
E. Enteritis.
31.Yellow color of the skin and the sclera, dark urine appeared in a patient after fungus
poisoning. What pigment causes the color of urine in the patient with hemolytic jaundice?
A. Biliverdin
B. Verdoglobin
C. Unconjugated bilirubin
D. Monoglucoronide bilirubin
E. Stercobilin
32A female patient with chronic hepatitis complains of increase sensitivity to barbiturates
which she used previously without any symptoms of intoxication. The disorder of what
hepatic jaundice is responsible for this state?
A. Bile formation
B. Hemodynamic
C. Metabolic
D. Hemopoetic
E. Phagocytotic
33.Marked jaundice appeared in a patient 3 months later after the operation on his upper
jaw. What pathological process may this patient have?
A. Suprahepatic jaundice
B. Hereditary hemolytic jaundice
C. Hepatic jaundice
D. Subhapetic jaundice
E. Cholecystitis
34.A female patient aged 45 was admitted to a hospital with complains of sudden pain in
the abdominal cavity, increase of temperature, and leukocytosis. Which of factors caused
these changes in the woman’s condition?
A. Gall stones
B. Bacteria
C. Mechanical energy
D. Acids
E. Viruses
35. In a 38-year-old patient, who endued viral hepatitis C and is abusing alcohol, symptoms
of hepatic cirrhosis with ascites and edemas on lower extremities developed. What changes
in blood composition underlies edema development?
A. Hypoglycemia
B. Hypoalbuminemia
C. Hypoglobulinemia
D. Hypokalemia
E. Hypocholesterolemia
ANSWERS:
1.-E.2.-E.3.-D.4.-B.5.-E.6.-A.7.-A.8.-A.9.-D.10.-A.11.-A.12.-D.13.-B.14.E.15.-B.16.-A.17.-B.18.-A.19.-C.20.-C.21.-E.22.-C.23.-D.24.-A.25.-C.26.-A.27.-B.28.A.29.-D.30.-C.31.-E.32.-C.33.-C.34.-A. 35.-В
Topic 14. Renal pathophysiology
1.A patient has severe nephropathy with a massive edematous syndrome, which
complicated bronchiectatic diseases. Laboratory investigations show massive proteinuria,
cylindruria, considerable decrease of protein content in the blood serum, hyperlipidemia,
hypokalemia and other deviations. What is the main link in the pathogenesis of the
patient’s edemas?
A. Decrease of oncotic blood pressure.
B. Increase of extracellular fluid pressure.
C. Increase of hydrostatic blood pressure.
D. Blockade of lymph drainage.
E. Hyperpermeability of microvessels
2.A patient with renal insufficiency has a disorder of hemopoietin synthesis produced in the
kidneys. What formed blood elements development is impaired?
A. Erythrocytes
B. Granulocytes
C. Thrombocytes
D. B-lymphocytes
E. T-lymphocytes
3.The narrowing of afferent glomerular renal arteriole caused the decrease of urination. The
cause of this is a decrease of:
A. Reabsorption of glucose
B. Reabsorption of ions
C. Reabsorption of urea
D. Reabsorption of water
E. Effective filtration pressure
4.A man aged 32 has been ill with chronic glomerulonephritis for 4 years. He was
hospitalized with the signs of anasarca. AP-185/105 mm. Hg. Blood analysis shows: Hb110gm/l; erythrocytes-2.6x1012/l; leucocytes-9.5x109/l; residual nitrogen-32 mmol/l; total
protein-50 gm/l. What change points to glomerulonephritis with nephrotic syndrome?
A. Anemia
B. Arterial hupertension
C. Hyperzotemia
D. Hypoproteinemia
E. Leukocytosis
5.Sharp decrease in sodium content in the blood serum was revealed in a patient with renal
insufficiency. There are pale crumby edemas of the face manifesting in the morning. What
substance composing intercellular matrix comes from blood bed?
A. Collagen
B. Elastin
C. Procollegen
D. Hyaluronic acid
E. Fibronectin
6.Edemas appeared in a patient after Streptococcus infection. The urinalysis was made and
allowed to make a diagnosis of acute glomerulonephritis. What pathologic changes in urine
confirm the diagnosis?
A. Fresh erythrocytes
B. Protein with high molecular mass and lixiviated erythrocytes
C. Protein only with low molecular weight (up to 40000.
D. Increased excretion of sodium
E. Leukocyturia
7.After poisoning by salts of heavy metals a patient has developed nongaseous acidosis,
urine pH=6.0, glucosuria without hyperglycemia, polyuria, natriuresis. Which of the
structures is damaged?
A. B-cells of Lanhergans islets
B. Nephron glomeruli
C. Nephron tubules
D. Nuclei of hypothalamus
E. Adrenal cortex
8.A patient age 48 with fibro-cavernous tuberculosis complains of general weakness
decrease of diurnal urination, edemas of the trauma and extremities, increase of AP up to
180/90 mm. Hg Urinalysis shows increase of protein, hyaline and granular cylinder,
erythrocytes. A month later he died from renal insufficiency. Enlargement of the heart and
large “fatty kidneys” were revealed at autopsy (weight of kidneys is 240.0 gm-260.0 gm).
What disease was fibro-cavernous tuberculosis of the lungs complicated by?
A. Glomerulonephritis
B. Nephrotic syndrome
C. Amyloidosis
D. Pyelonephritis
E. Nephrosclerosis
9.A patient with chronic glomerulonephritis has edemas, AP-210/100 mmHg, and the rate
of heart beats-85 per minute. The borders of the heart are dilated. What is the leading
mechanism in the development of arterial hypertension?
A. Increase of sympathetic-adrenal system activity
B. Hyperfunction of the heart
C. Activation of renin- angiotensin -aldosteron system
D. Increase of circulatory blood volume
E. Increase of vasopresin discharge
10.The presence of glucose in the urine in its normal concentration in the blood serum was
determined in a patient aged 18 on laboratory examination. The most possible cause of this
is the impairment of
A. Tubular reabsorption
B. Glomerular filtration
C. Tubular secretion
D. Secretion of the glucocorticoids
E. Insulin secretion
11.In a week and a half after a severe streptococcal tonsillitis a patient aged 24 developed
edematous face, increased arterial pressure, hematuria, and proteinuria of 1.2 g/L .His
blood analysis shows antistreptococcal antibodies and decrease of complement
components. In the microvessels of what structures is the most possible localization of
immune complex deposits which caused the development of nephropathy.
A. Proximal tubules
B. Gomeruli
C. Descendent tubules
D. Henle’s loop
E. Pyramids
12.Increased amount of proteins in the urine was revealed in a patient with acute
glomerulonephritis. The impaired function of what nephron structures is the presence of
protein in the urine connected to?
A. Basal membrane of glomerulus capillaries
B. Epithelium of parietal layer of glomerulus capsule
C. Epithelium of thin tubules
D. Epithelium of distal tubules
E. Epithelium of Henle”s loop
13.Proteinuria (5 g/l) due to low molecular weight proteins and hematuria with lixiviated
erythrocytes were revealed in patient’s urinalysis. What renal function disorder do these
findings point out?
A. Increase in glomerular permeability
B. Increase in tubular secretion
C. Increase in tubular excretion
D. Decrease in tubular reabsorption
E. Extrarenal disorders
14.A patient with chronic glomerulonephritis has symptoms of anemia. What causes these
symptoms?
A. Decrease in erythropoietin synthesis
B. Loss of erythrocytes in urine
C. Increased destruction of normal erythrocytes
D. Erythrocytes hemolysis
E. Iron deficiency for hemoglobin synthesis
15.A patient with chronic renal disease is edematous, pale, and his BP is increased.
Laboratory examination shows protein and erythrocytes in patient’s urine. Protein content
in the blood is the normal. What is the main link in the pathogenesis of edematous
syndrome?
A. Arterial hypertension
B. Hyperazotomia
C. Secondary aldosteronism
D. Hematuria
E. Poteinemia
16.A patient with chronic renal disease is edematous, pale, and his BP is increased.
Laboratory examination revealed protein and erythrocytes in his urine, hyperazotemia, and
decrease in erythrocytes and hemoglobin in his blood. What is the main link in
pathogenesis of arterial hypertension of this patient?
A. Activation of renin-angiotensin system
B. Anemia
C. Hyperazotemia
D. Increase of circulatory blood volume
E. Proteinuria
17.A patient with diabetes mellitus has developed chronic renal failure with the
development of uremia and the rate of glomerular filtration of 8 ml/min. What is the mainly
possible mechanism of decrease in glomerular filtration rate and the development of
chronic renal failure in this patient?
A. Spasm of afferent glomerular arteriole
B. Occlusion of tubular lumen of nephron by hyaline cylinders
C. Increase of osmotic blood pressure
D. Decrease of systemic BP
E. Decrease of the number of working nephron
18.Severe poisoning by mercury salts has lead to decrease and then to ceasing of patient’s
urination. There are headache, nausea, and vomiting in this patient. Laboratory
investigation reveals quickly increasing azotemia. The established diagnosis is the acute
renal failure, stage of oligouria-anuria. What disorders of aqueous and osmotic homeostatic
does this patient have at this stage of the disease?
A. Hypoosmolar hypohydration
B. Hyperosmolar hypohydration
C. Isoosmolar hypohydration
D. Hypoosmolar hyperhydration
E. Hyperosmolar hyperhydration
19.A patient with chronic renal disease is edematous, pale, his AP is increased, and he has
vomiting and diarrhea with ammoniac smell. Laboratory investigation reveals protein and
erythrocytes in his urine, hyperazotemia, decrease of erythrocytes and hemoglobin in his
blood. What is the main link pathogenesis of anemia which complicated renal disease?
A. Loss of erythrocytes with urine
B. Toxic influence of urea on bone marrow
C. Deficiency of erythropoietin
D. Impaired of iron absorption due to diarrhea
E. Impaired of regulation of erythropoiesis by endocrine glands
20.A man suffering from gout complains of pains in the area of kidneys. Ultra sound
examination reveals the presence of renal calculi. What substance increased concentration
causes the formation of calculi in this case?
A. Bilirubin
B. Uric acid
C. Urea
D. Cystine
E. Cholesterol
21.What hormone increased secretion is caused by activation of renin-angiotensin system
in renal hypoxia?
A. Hydrocortisone
B. Thyroxin
C. Aldosteron
D. Insulin
E. Parathormone
22.A man has decreased urination, hypernatremia, hypokalemia. What hormone
hypersecretion is the cause of such changes?
A. Vasopressin
B. Atrial natriuuretic factor
C. Parathormone
D. Aldosterone
E. Adrenalin
23.A patient with acute renal insufficiency developed anuria (diurnal urination - 50 ml).
Which of the bellow-mentioned mechanisms is the main one in its development?
A. Decrease of glomerular filtration
B. Impairment of renal blood circulation
C. Increase of water reabsorption
D. Increase of sodium reabsorption
E. Difficulty of urine outflow
24.A patient with chronic glomerulonephritis has vegetation of collagenic fibers in
interstitium near tubules in which reabsorption of sodium ions decreases. What underlies
these changes in reabsorption of sodium ions in tubules?
A. Inhibition of energy metabolism
B. Activation of glycolysis
C. Inhibition of lipid peroxidation
D. Stabilization of lysosomal membranes
E. Increase of antioxidative activity
25.The damage of proximal portion of nephron with decrease of sodium ion reabsorption
was observed in a patient after poisoning by corrosive sublimate. How much maximally
may sodium ions be reabsorbed in this part of nephron?
A. 65 %
B. 80 %
C. 50 %
D. 35 %
E. 20 %
26.The damage of proximal portion of nephron was held in a patient in 24 hours later after
the poisoning by corrosive sublimate. What electrolyte reabsorption is impaired in this
pathology?
A. Ions of potassium
B. Ions of chloride
C. Ions of sodium
D. Ions of calcium
E. Ions of magnesium
27.A patient aged 35 complains of pain in the lumbar area, edema under eyes, and
increased fatigability in usual physical loads. Protein was revealed in patient’s urine
(0.99gr/l). Patient’s BP is -160/110 mmHg. What pathology has the patient?
A. Pyelitis
B. Nephritic syndrome
C. Cystitis
D. Acute renal failure
E. Nephrotic syndrome
28.What pathological process is non-selective, non-massive proteinuria is characteristic
for?
A. Nephritic syndrome
B. Urethritis
C. Chronic renal failure
D. Acute renal failure
E. Nephrotic syndrome
29.What origin of protein is the most possible in selective proteinuria with intensity 12
gr/day?
A. Suprarenal
B. Tubular
C. Glomurular
D. Urethra
E. From urinary bladder
30.What pathological process is characterized by combination of massive proteinuria
(25gr/day) with generalized edema?
A. Urethritis
B. Chronic renal failure
C. Nephrotic syndrome
D. Cystitis
E. Nephritic syndrome
31.What pathological process may be complicated by acute renal failure?
A. Chronic lung abscess
B. Viral hepatitis
C. Polycystitic kidneys
D. Extensive burn
E. Hypertensive disease
32.Acute pylonephritis was diagnosed in a patient with complains of increased
temperature, pain in the lumbar area, and frequent and painful urination .Which of the
infectious agents is a cause of the disease?
A. Staphylococci
B. Streptococci
C. Escherichia coli
D. Brucella
D. Anaerobic flora
33.A patient suddenly has developed colicky pains in the are of kidney with irradiation to
grain, nausea, and vomiting; the discharge of urine for 24 hours is 90 ml. Determine
mechanism of anuria
A. Impairment of filtration
B. Increase of reabsorption
C. Blocking of a work of a part of nephrons
D. Reflex anuria
E. Obturation of ureters
34.A man of aged 72 is ill with chronic glomerulonephritis. On examination following was
determined: absence of appetite, vomiting, diarrhea, skin itching, anemia, the content of
residual nitrogen in the blood is 45mm/l. The indicated signs are caused by:
A. Increase of glomerular membrane permeability
B. Disturbance of nephron function
C. Autoimmune damage of nephrone function
D. Renal ischemia
E. Disturbance of concentrating mechanism
35.A patient of age 32 with acute glomerulonephritis, who did not follow regime of NaCl
and water limitation, suddenly has lost his consciousness and convulsions appeared in him.
His BP is 220/120 mmHg, he has mydriatic pupils and bradycardia. What complication has
appeared in this patient?
A. Acute heart failure
B. Hypertensive crisis
C. Renal coma
D. Epilepsy
E. Eclampsy
36.A woman aged 25 with frequent prolonged tonsillitis in her anamnesis came to а doctor
with complaints of periodical headaches, undue fatigability, periorbital edemas. Cliniclaboratory investigations show moderate arterial hypertension, proteinuria,
hypoproteinemia, hyperlipidemia. Bilateral disturbance with insignificant increase of
echogenity of renal parenchyma was diagnosed by ultrasound examination of kidneys.
What disease is the mast possible in this case?
A. Chronic pyelonephritis
B. Acute glomerulonephritis
C. Lipoid nephrosis
D. Chronic glomerulonephritis
E. Acute renal failure
37.Protein, which level didn’t exceed 1g/L, was revealed in the urine of physically healthy
young military men after a hard physical exertion during one day foot match (50 km). What
kind of proteinuria takes place first of all?
A. False proteinuria
B. Organic proteinuria
C. Alimentary proteinuria
D. Dehydrated proteinuria
E. Cyclic proteinuria
38.After a severe trauma a patient developed shock with signs of acute renal failure. What
is the leading mechanism in the development of acute renal failure in this case?
A. Decrease of oncotic blood pressure
B. Increase of pressure in renal arteries
C. Increase of pressure in glomerular capsule
D. Damage of outflow of urine
E. Fall of arterial pressure.
39.Decrease in insulin clearance down to 60 ml/min was determined in a patient with
chronic renal failure. What renal function impairment is this connected with?
A. Glomerular filtration
B. Tubular secretion
C. Reabsorption in proximal part of nephron
D. Reabsorption in distal part of nephron
E. Reabsorption in collecting renal tubules.
40.A patient with chronic renal insufficiency has developed anorexia, dyspepsia,
impairment of cardiac rhythm, skin itching. What is the main mechanism of the
development of these impairments?
A. Disturbance of lipid metabolism
B. Accumulation of products of nitrogen metabolism in the blood
C. Changes of carbohydrate metabolism
D. Renal acidosis
E. Disturbance of water and electrolyte metabolism.
41.A patient who has been suffering from osteomyelitis of the mandible for many years has
extensive edemas; marked massive proteinuria is revealed in his urine. Which form of
complications in the course of osteomyelitis has this patient?
A. Pyelitis
B. Nephrotic syndrome
C. Nephritic syndrome
D. Chronic renal failure
E. Renal calculi disease
42.After automobile accident a patient’s BP is 70/40 mm Hg. The patient is unconscious.
His diurnal urination is about 500 ml. There are periodical convulsions, Kussmaul’s
respiration in him. What is the cause of the disorder of urination?
A. Considerable acute hypotension
B. Increase of glomerular filtration
C. Decrease of tubular reabsorption
D. Increase of tubular reabsorption
E. Intoxication by metabolites of nitric exchange
43.In a man rate of glomerular filtration rises in 20% as a result of prolonged starvation.
What is the most possible reason for changes of filtration under indicated conditions?
A. Increased permeability of renal filter
B. Increase in filtration coefficient
C. Increased systemic arterial pressure
D. Decreased oncotic pressure of blood plasma
E. Increase in renal blood flow
44.Under experiment morphological impairment of epithelial cells of distal part of nephron
was induced in rats. What functional processes in kidneys are weakened in this case?
A. Filtration
B. Reabsorption of sodium and glucose
C. Reabsorption of glucose
D. Reabsorption of water and salts
E. Reabsorption of proteins
45.Glucosuria and aminoaciduria were found out in a patient with nephritis. What
mechanism of reabsorption of glucose and amino acids is impaired in this case?
A. Pinocytosis
B. Primary active transport
C. Simple diffusion
D. Secondary Na-dependent transport
E. Phagocytosis
46.Following changes were observed in a patient after poisoning with salts of heavy
metals: increased level of residual nitrogen, hyperphosphatemia, hypersulfatemia,
hyperacidemia, and decreased alkaline reserve. What structures impairment has led to
described changes?
A. Glomerulus of nephron
B. Langerhgans’ islets
C. Hepatocytes
D. Cortex of adrenal glands
E. Tubules of nephron
47.A 48-year-old man was admitted to the hospital with aggravation of chronic
glomerulonephritis. Examination of this patient found out a presence of chronic renal
failure in him. What does azotemia in chronic renal failure results from?
A. Decreased glomerular filtration
B. Decreased tubular reabsorption
C. Decreased tubular excretion
D. Disorders of protein metabolism
E. Disorders of water-salt balance
48.A patient was admitted to the hospital with complaints of absence of urination during 24
hours and pains in lumbar area. Catheterization of patient’s urinary bladder does not relief
the patient. What pathology may be cause of anuria in this patient?
A. Bilateral renal calculi
B. Heart failure
C. Bleeding
D. Vomiting
E. Severe intoxication
49.Inhibitor of phosphorilation in cells of nephron tubules – floridzine, was introduced to
an animal in experiment. What substances reabsorption impairment may develop in this
case?
A. Disorders of reabsorption of glucose
B. Disorders of reabsorption of non-organic phosphate and calcium
C. Disorders of reabsorption of amino acids
D. Disorders of reabsorption of proteins
E. Disorders of reabsorption of sodium ions and water
50.What pathological changes are characteristic for glomerulonephritis?
A. Presence of high molecular weight proteins (70,000 D) in urine
B. Presence of fresh erythrocytes in urine
C. Presence of low molecular weight proteins (about 40,000 D) in urine
D. Increased excretion of sodium and hyaline cylinders in urine
E. Leukocyturia without hematuri
ANSWERS:
1.-A.2.-A.3.-E.4.-D.5.-D.6.-A.7.-C.8.-C.9.-C.10.-A.11.-B.12.-A.13.-A.14.-A.15.-C.16.A.17.-E.18.-D.19.-C.20.-B.21.-C.22.-D.23.-A.24.-A.25.-B.26.-C.27.-B.28.-A.29.-B.30.C.31.-D.32.-C.33.-D.34.-B.35.-E.36.-D.37.-E.38.-E.39.-A.40.-B.41.-B.42.-A.43.-D.44.-D.
45.-D. 46.-A. 47.-A. 48.-A. 49.-A. 50.-A.
Topic15.Pathophysiology of endocrine system.
1. The height of an adult is 100cm, in proportional constitution and normal mental
development. What hormone insufficiency do the indicated signs characterize?
A. Growth hormone
B. Thyroxin
C. Antidiuretic
D. Mineralocorticoids
E. Gonadotropic hormone.
2. Under the influence of harmful ecological factors the normal formation of lysosomes is
inhibited in thyrocytes. What stage of hormone production of thyroid gland will be
impaired?
A. Synthesis of colloid
B. Iodinisation of colloid
C. Synthesis of thyroglobulin
D. Reabsorption of colloid
E. Proteolysis of phagocytosed colloid from follicles.
3. Diabetes insipidus appeared in a patient after cerebral infarction with impairment of
hypothalamus nuclei. What is the cause for increased urination in this patient?
A. Decrease of reabsorption of sodium
B. Acceleration of glomerular filtration
C. Decrease of water reabsorption
D. Decrease of arterial pressure
E. Hyperglycemia
4. What hormone stimulates inclusion of calcium in osteoblasts of bone tissue in tooth?
A. Insulin
B. Thyroxin
C. Parathormone
D. Hydrocortisone
E. Calcitonin
5. A 10-year-old child has a height of 178 cm and weight of 64 kg. What endocrine gland
disorder does this connected with?
A. Sexual glands
B. Adrenal glands
C. Parathyroid glands
D. Pituitary gland
E. Thyroid gland.
6. A patient with thyrotoxicosis has hyperthermia, bulimia, and loss of weight. What kind
of impairment does this connected to?
A. Reaction of fat synthesis
B. Lyses of adenosintriposphoric acid
C. Conjunction oxidation and phosphorylation
D. Reaction of citric acid cycle
E. Reaction of beta-oxidation of fatty acid.
7. During an experiment on animals the nervous tracts leading to the crus of hypophysis
were broken. That impaired the entrance of the fallowing hormones into the blood.
A. Hypophysis hormones
B. Vasopressin and oxytocin
C. Adenohypophysis hormone
D. Thyrotropic hormone
E. Adenocorticotropic hormone
8. A careless student suddenly meets his dean. What hormone concentration will be
increased in student’s blood more rapidly?
A. Somatotropin
B. Hydrocortisone
C. Corticotropin
D. Thyroliberine
E. Adrenalin
9. A women aged 44 complains of general malaise, pain in the heart area, and considerable
increase of body weight. At examination of this patient following symptoms are revealed:
lunar face, hirsutism, BP 165/100 mmHg, height is 164 cm, weight is 103kg, the adipose
deposits mainly on the neck, shoulders, abdomen. What is the main pathogenic mechanism
of the woman’s obesity?
A. Decrease of thyroid hormone production
B. Decrease of glycogen production
C. Increase of glucocorticoid production
D. Increase of insulin production
E. Increase of minerelocorticoid production.
10. A child has a time disturbance of teeth eruption, enamel anomalies, and its lips and
tongue are enlarged. What hormone deficiency causes these changes?
A. Thyroxin
B. Parathormone
C. Thyrocalcitonin
D. Insulin
E. Somatotropin
11. At clinical examination of a woman it was determined increase of basal metabolism
rate by 40%, increased perspiration, tachycardia, and leanness. What endocrine gland
functions are impaired and what direction in?
A. Sexual glands, hypofunction
B. Cortical substance of adrenal glands, hyperfunction
C. Medulla of adrenal glands, hyperfunction
D. Thyroid gland, hyperfunction
E. Pancreatic gland, hyperfunction
12. A young man aged 17 has the signs of retention of sexual development; his height is
184 cm; he is asthenic; his secondary sexual characters are weakly developed. Sex
chromatin is absent in this patient’s cells. At the age of 4 he endured epidemic parotitis.
What was the cause of hypogonodism?
A. Deficiency of gonadoliberine
B. Deficiency of gonadotropin
C. Cryptorchism
D. Orchitis
E. Chromosomal anomalies (XXY)
13. A patient aged 20 complains of polydipsia and abundant urination (up to 10 liters for 24
hrs); concentration of glucose in his blood is normal; in his urine glucose is absent. What
hormone absence may cause such clinical picture?
A. Oxytocin
B. Vasopressin
C. Insulin
D. Hydrocortisone
E. Triiodothyronine
14. A woman with primary hyperparathyroidism has periodically repeated attacks of renal
colic. Ultrasound examination shows presence of small stones in her kidneys. What is the
cause of the formation of these stones?
A. Hypercholesterolemia
B. Hyperuricemia
C. Hyperkalemia
D. Hyperphosphatemia
E. Hypercalcemia
15. Substances which imitate morphine effects but which are produced in CNS may be
used for analgesia. Indicate them:
A. Somatotropin
B. Oxytocin
C. Beta-endorphin
D. Vasopressin
E. Calcitonin
16. Dilated pupils, dryness of mucous membranes, accelerated heart rate, constipation, and
tremor are observed in some people during emotional exertion. What system activation will
lead to such changes in the organism?
A. Pituitary-adrenal system
B. Sympathetic nervous system
C. Sympathoadrenal system
D. Somatic nervous system
E. Parasympathetic nervous system
17. In ancient India those people who were suspected in committing crimes were given
swallow a handful of dry rice. Criminals couldn’t swallow rice due to decreased salivation
(oligosalivation) caused by:
A. Decrease of blood supply of salivary glands
B. Activation of sympathoadrenal system
C. Activation of parasympathetic nucleus of glossopharyngeal nerve
D. Inhibition of sympathoadrenal system
E. Activation of parasympathetic nucleus of facial nerve
18. A patient aged 23 complains of headache, changes of his appearance (increase of size
of feet, fingers, features of the face), hoarseness of the voice, worsening of the memory.
The disease has begun 3 years ago without any causes. Increase of superciliarry arches,
nose, and tongue were found during physical examination of this patient; the blood sugar
was normal; the urinalysis is out of changes. What is the cause of such condition?
A. Excessive production of corticosteroids
B. Excessive production of somatotropin
C. Insufficiency of aldosterone
D. Insufficiency of glucagon
E. Insufficiency of thyroxin
19. Adrenalin is used to prolong Novocain action in infiltration anesthesia. What adrenalin
action is this effect connected with?
A. Potentiation of Novocain action at the level of CNS
B. Inhibition of function of nerve ending and conductors
C. Dilatation of vessels
D. Constriction of vessels
E. Inhibition of tissue esterases
20. A patient aged 80 complains of increased appetite, thirst, excretion of large amount of
urine, and worsening of general condition after taking sweet food. What disease is it?
A. Hypercorticoidism
B. Hyperthyroidism
C. Hypothyroidism
D. Diabetes insipidus
E. Diabetes mellitus
21. Persistent hyperglycemia developed in a patient with Cushing’s syndrome under the
influence of excessive amount of glucocorticoids. What is the mechanism of
hyperglycemia in this case?
A. Activation of glycogenolysis at the liver
B. Activation of gluconeogenesis
C. Activation of insulinaze of the liver
D. Decrease of hexokinase activation
E. Increase of absorption of glucose in intestine
22. A man aged 38 is in stress state due to industrial conflict. Which of below mentioned
hormones participate in starting stress reaction of the organism?
A. Adrenalin
B. ACTH
C. Glucagon
D. Hydrocortisone
E. Thyroxin
23. A woman aged 28 addressed to a doctor a month later after delivery with complaints of
decreased breast milk formation. What hormone insufficiency caused this condition?
A. ACTH
B. Glucagon
C. Insulin
D. Prolactin
E. GH
24. While examining a patient a doctor suspected Cushing’s syndrome. What substance
determination in patient’s blood will prove doctor’s supposition?
A. Tocopherol
B. Adrenalin
C. Cholesterol
D. Retinol
E. Cortisol
25. The attacks of convulsions appeared in a patient after resection of thyroid gland. What
preparation must be administered in this case?
A. Somatotropin
B. Insulin
C. Thyroxin
D. Prednisolon
E. Parathyroidin
26. A dog with endocrine pathology had decreased oxygen usage in the state of rest,
decreased body temperature, and decrease of glucose tolerance. What hormone
insufficiency may explain the discovered changes?
A. Growth hormone
B. Thyroxin
C. Gonadotropin
D. Adrenocorticotropic hormone
E. Insulin
27. A patient aged 50 complains of thirst, he drinks much water, has marked polyuria. His
blood glucose - 4.8 mmol/L, glucose and acetone bodies are absent in the urine; urine is
colourless, its specific gravity - 1.002-1.004. What is the cause of polyuria?
A. Insufficiency of ADH
B. Hypothyrosis
C. Insulin insufficiency
D. Aldosteonism
E. Thyrotoxicosis
28. A patient aged 40 was hospitalized with complaints of general malaise, convulsions of
upper and lower extremities, his BP - 160/100 mm Hg. The results of laboratory
examination of him: blood glucose - 6.5 mmol/L, calcium - 2 mmol/L, phosphates - 1
mmol/L, sodium-160 mmol/L. Urination-700 ml for 24 hours. What pathology causes such
state?
A. Hyperaldosteronism
B. Hypoaldosteronism
C. Hyperparathyroidism
D. Thyrotoxycosis
E. Rickets
29. Pilosis by male type and increase of muscular mass began appearing in a boy of 5 years
old who had developed previously without declination from the age norms. At examination
of the patient marked secondary male sexual signs were revealed, but the size of his testes
corresponds to his age. What is the cause of precocious puberty?
A. Androgen producing adrenal tumor
B. Hormone producing testis tumor
C. Increase of gonadotropin production
D. Increase of adrenocorticotropin production
E. Increase of gonadoliberin production
30. Why must a patient, who has taken prednisolone for rheumatoid arthritis for a long
time, avoid contacts with infectious patients?
A. Because of the development of secondary immunodeficiency
B. Because of risk of exacerbation of arthritis
C. Because of risk of thromboembolic complications development
D. Because of the development of lymphopenia
E. Because of the blockade of interferon formation
31. Liquidator of an accident at Chernobilskaya AES began complaining of increased
excitability, nervousness, heartbeat, decrease of body weight, constant weakness, body
tremor, feeling of fever, bad heat endurance. What gland hyperfunction may be the cause
of such state?
A. Thyroid gland
B. Adenohypophysis
C. Adrenal gland
D. Medulla of adrenal gland
E. Parathyroid gland
32. Muscular weakness, adynamia, decrease of body temperature, hypoglycemia,
developed in a dog after two-sided resection of adrenal gland. What other manifestation of
adrenal insufficiency may be noted?
A. Lymphopenia
B. Arterial hypotension
C. Increase of glycogen synthesis
D. Hypernatriemia
E. Hypokalemia
33. A woman complains of increased irritability, perspiration, weakness, loss of body
weight, tremor of extremities, increased heartbeat rate, and exophthalmia. What metabolic
impairment in the organism accompanies this disease?
A. Increase of adenosine triphosphoric acid synthesis
B. Decrease of organism sensitivity to hypoxia
C. Weakening of phospholipase activation
D. Increase of basal metabolism
E. Decrease of cholesterol lysis
34. A patient who suffered from severe thyrotoxicosis had been operated on for
strumectomy after that weakness, sensitivity to cold, increase of body weight, paleness and
dryness of skin developed. What are the other manifestations of hypothyrosis?
A. Inhibition of CNS activity
B. Tachycardia
C. Increase of basal metabolism
D. Increase of intestinal peristalsis
E. Decrease of tolerance to carbohydrates
35. In case of hypercortisolism – Cushing’s disease – the following changes in the
organism take place:
A. Development of cachexia
B. Impoverishment of the liver with glycogen
C. Hyperglycemia
D. Hypotension
E. Lymphocytosis
36. A patient was admitted to the hospital with complaints of loss of weight, quick
fatigability, darkening of skin. His heart sounds are dull. What are the other manifestations
of adrenal insufficiency?
A. Lymphopenia
B. Adynamia
C. Arterial hypertension
D. Increase of minute blood volume
E. Increased appetite
37. A patient admitted to the hospital complains of quick fatigability, loss of weight,
hyperpigmentation of the skin. Her heart sounds are dull. She has pulse rate - 96 beats per
minute and BP - 90/50 Hg. What metabolic impairments are observed in hypocortisolism?
A. Hyperkalemia
B. Increase of glycogen synthesis
C. Hypernatremia
D. Hyperhydration
E. Hypoglycemia
38. The manifestations of hypoparathyrosis developed in a patient after strumectomy. What
changes in the organism are observed in this case?
A. Hypophosphatemia
B. Resorption of bone tissue
C. Acidosis
D. Hypocalcaemia
E. Decrease of neuromuscular excitability
39. Small height, disproportional development of the body, and insufficient mental
development were found in a boy of 10 during examination. What hormone deficiency
caused these changes?
A. Thyroxin
B. Parathormone
C. Thyrocalcitonin
D. Adenocorticotropic hormone
E. Oxytocin
40. With the help of indirect calorimetrical measurement it was determined that the basal
metabolism of the patient was 40% lower than the proper one. What endocrine gland
hypofunction is the cause of described changes?
A. Adrenal glands
B. Thyroid gland
C. Epiphysis
D. Thymus
E. Pancreas
41. After suffered sepsis a bronze color of the skin typical for Addison’s disease appeared
in a woman aged 27. Hyperpigmentation occurs due to the increased secretion of:
A. Melanocytstimulating hormone
B. Growth hormone
C. Adrenocorticotropic hormone
D. B-lipotropic hormone
E. Thyrotropic hormone
42. A patient with rheumatic arthritis was given hydrocortisone for a long period of time.
He developed hyperglycemia, polyuria, glycosuria, and thirst. These complications after
treatment develop due to the activation of the process of:
A. Gluconeogenesis
B. Glycogenolysis
C. Glycogenesis
D. Glycolysis
E. Lipolysis
43. Fibrillary muscular tics of arms, legs and face appeared in a woman aged 46 after the
operation on thyroid gland. These disorders may be eliminated by injection of:
A. Parathyroidin
B. Triiodthyronine
C. Thyrotropin
D. Thyroxin
E. Calcitonin.
44. Atrophy of the testis developed in an athlete who systemically used androgen
hormones. This phenomenon is due to the inhibition of secretion of:
A. Gonadotropic hormone
B. Corticoliberine
C. Prolactoliberin
D. Gonadoliberine
E. Testosterone.
45. During the examination of the patient a doctor found out Cushing’s disease that is
characterized by obesity. It is connected with:
A. Excessive use of fats with meal
B. Impairment of ventromedial nuclei of hypothalamus
C. Inhibition of adrenalin synthesis by adrenal glands
D. Production of excessive amount of glycocoticoids
E. Hereditary tendency to hyperlipemia.
46. A patient with diffuse toxic goiter has marked exophthalmia. The appearance of
exophthalmia is explained in this pathology by:
A. Antibody circulation against thyroglobulin
B. Presence of immunoglobulins in the blood
C. Production of exophthalmia factor by hypophysis
D. Increase of adrenorecpetor sensitivity to catecholamines
E. Pathogenic action of thyroid prostaglandins.
47. A patient with myxedema came to a doctor. Her face was puffy with poor facial
expression; she had thickened nose and lips. These signs can be explained by:
A. Free filtration of sodium in glomeruli
B. Accumulation of hydrophilic mucous substances
C. Impairment of sensitivity of volumo- and osmoreceptor
D. Increase of sodium reapsorption in tubules (canaliculi)
E. Increased permeability of capillary walls.
48. After physic exertion a patient with pheochromocytoma complains of tachycardia,
increased arterial pressure, and sharp pain in epigastric area. These attacks may be
explained by:
A. Massive release of catecholamines by adrenal glands
B. Release of norepinephrine by sympathetic nerves
C. Activation of hypothalamus vegetative nuclei
D. Increase of thyroid hormone secretion
E. Increased synthesis of adrenocorticotrophic hormone
49. Excessive secretion of a certain hormone was observed in a patient with
pheochromocytoma -a tumor, which appears from the medulla of adrenal glands. How is
this hormone called?
A. Glucagon
B. Insulin
C. Thyroxin
D. Adrenalin
E. Somatotropin
50. Adenoma, which grows from the cells of glomerular zone of adrenal cortex and is the
source of excessive formation of aldosterone was found in a patient. This resulted in a
development of primary hyperaldosteronism or Conn’s disease. What electrolyte exchange
does this hormone influence?
A. Ferric ion
B. Calcium ion
C. Magnesium ion
D. Chlorine ion
E. Sodium ion
51. Weakness, thirst, sharp increase of neuromuscular excitability with the development of
parathyroid tetany were observed in a dog 1-2 days later after resection of thyroid glands.
What disturbance of electrolyte exchange takes place in this condition?
A. Hypercalcaemia
B. Hypocalcaemia
C. Hypomagnemia
D. Hypermagnemia
E. Hyponatremia
52. Removal of cancer tumor of the testis in a patient before the period of sexual maturity
resulted in the development of eunochoidism and was accompanied by the deficiency of
the production of:
A. Androgens
B. Estrogens
C. Kinines
D. Prostaglandins
E. Cytokines
53. Male patient aged 55 had an increase of pituitary gland dimensions and hyperplasia of
adrenal cortex. At examination of the patient: BP-190/90 mm Hg, content of blood glucose
is 20 mmol/L; there are glucosuria, obesity, and histurism. What pathology are these
changes typical for?
A. Barraker-Simmond disease
B. Adipose-genital dystrophy
C. Cushing’s syndrome
D. Addison’s disease
E. Cushing’s disease
54. A patient aged 29 had acute massive blood loss during delivery. Then the following
changes developed: acute loss of weight, atrophy of skeletal muscles, thinning of skin,
decrease of body temperature, hypotension, and hypoglycemia. What pathology of pituitary
gland is the most possible in this case?
A. Sheehan’s disease
B. Parhon’s syndrome
C. Diabetes insipidus
D. Adipose-genital dystrophy
E. Pituitary dwarfism
55. A 28-years-old patient complains of flaccidity, quick mental and physical fatigue, and
dyspeptic disorders. During the examination following was found out: positive TB tests,
hypoglycemia, BP - 90/60 mm Hg, hyponatremia, skin pigmentation. What disease of
adrenal glands underlies observed symptoms?
A. Cushing’s syndrome
B. Addison’s disease
C. Acute insufficiency of adrenal cortex
D. Hypofunction of medullar layer of adrenal glands
E. Conn’s syndrome
56. Which of the signs that develops in hyperthyrosis is the most important for making
diagnosis?
A. Tachycardia
B. Subfebrile temperature
C. Increase of basal metabolism
D. Increase excitability
E. Disorder of sleep
57. A patient aged 41 complains of weakness, sweating, fever, tremor of hands, BP-160/90
mm Hg. Diffuse toxic goiter was diagnosed (Basedow’s diseas). What is the main
mechanism of impairment of the function of cardio-vascular system in this disease?
A. Decrease of tonus of sympathetic nervous system tonus
B. Increase of tonus of sympathetic nervous system tonus
C. Auto immune reactions
D. Increase of catabolism
E. Hyperthermia
58. A girl aged 5 had the symptoms of premature sexual development, menses, growth of
mammary gland, adipose deposits in the field of pelvis and femur. The most possible cause
of premature sexual development is:
A. Adrenal adenoma
B. Hypopituitarism
C. Polycystic ovary syndrome
D. Hyperplasia of adrenal glands
E. Hormone- active tumor of ovaries
59. Conn’s syndrome was diagnosed in a patient who complained of muscular weakness,
increased urination (at night), and increased arterial blood pressure. What is typical for this
syndrome?
A. Increase of renin, increase of aldosterone, and increase of potassium
B. Decrease of renin, increase of aldosterone, and increase of potassium
C. Decrease of renin, increase of aldosterone, and decrease of potassium
D. Decrease of renin, decrease of aldosterone, and decrease of potassium
E. Increase of renin, decrease of aldosterone, and increase of potassium
60. A female patient aged 44 complains of general malaise, large increase of body weight,
growth of hair on the face, arrest of menses, BP-165/100 mm Hg. What diagnostic test will
help to differentiate Cushing’s disease from Cushing’s syndrome?
A. Level of ACTH in blood plasma
B. Level of cortisol in plasma
C. Excretion of 17-oxyketosteroids with urine
D. X-ray of the skull
E. Number of eosinophils in blood
61. A patient aged 42 complains of sharp loss of body weight, weakness, appearance of
pigmental spots on the skin and mucus membranes. Addison’s disease was diagnosed in
this patient. Which of the following tests is the most important for diagnostics of Addison’s
disease?
A. Content of 17-oxyketosteroids in urine
B. Level of potassium and sodium in blood plasma
C. Tests with injection of ACTH
D. Level of cortisol in plasma
E. Content of blood glucose
62. A 55-years-old man had an attack of angina pectoris which w as accompanied by a
severe pain behind the breastbone and resulted in anuria. What mechanism influenced on
the appearance of anuria?
A. Excessive somatotropin secretion
B. Excessive vasopressin secretion
C. Decrease of corticotropin secretion
D. Vasopressin deficiency
E. Somatotropin deficiency
63. Enlargement of thyroid gland, aloofness, increased basal metabolism, tachycardia,
tremor of fingers were found out in a women aged 52. Psychic excitability was increased in
her. The leading part of pathogenesis of this state is:
A. Increase of mitochondrial membrane permeability
B. Negative nitrogen balance
C. Hypocholesteremia
D. Decrease of protein synthesis
E. Hyperglycemia
64. Thyrotoxicosis was produced in an animal experimentally. For confirming this state it
is necessary to determine the level of metabolism according to food taking and physical
load. What experimental method must be used in this case?
A. Determination of iodine content in the thyroid gland
B. Determination of concentration of organic iodine in blood
C. Direct calorimetry
D. Determination of oxygen tension in the blood
E. Determination of the content of the gland hormone in the blood
65. Three months later after delivery female patient C., aged 30, began to complain of
increase of body weight, excessive adipose deposits, mainly in the area of the neck and
face, growth of hair on the upper lip. The increase of size of cella turcica was determined
by X-ray examination. What pathogenic mechanism underlies determined pathology?
A. Hypersecretion of glucocorticoids
B. Increase of food taking
C. Hyposecretion of thyroxin
D. Development of diabetes mellitus
E. Birth of a child
66. A boy of 14 years old visited endocrinologist. His mother complains of his being
behind in physical development and growth. The boy has proportional constitution, his is
104 cm tall, and his secondary sexual characters are not marked. The cause of this
pathology is hyposecretion of:
A. Gonadotropic hormone
B. Growth hormone
C. All hormones of adenohypophysis
D. ACTH
E. Thyroid stimulating hormone
67. Patient female aged 47 was admitted to the hospital with complaints on increased
nervous excitability disorder of sleep, heartbeat, pain in the heart area, and muscular
weakness. Objectively: the patient is thin, has exophthalmia, tremor of hands, increase of
reflexes. She has body temperature - 37.5oC, heartbeat - 150 beats per minute; at her ECG
sinus tachycardia was revealed. Thyroid gland is increased. Arrhythmia in this patient
develops is due to:
A. Increase of tonus of sympathetic nervous system
B. Decrease of tonus of vagus nerve
C. Intoxication
D. Metabolic increase in myocardium
E. Increase of catchecolamine level
68. A 51-years-old male patient has been suffering from tuberculosis for 10 years. He is
abusing alcohol. At last time, complaints of irritability, fast fatigability, syncope, muscular
weakness, and loss of weight appear in him. At examination of the patient:
hyperpigmentation of his skin; his BP is 90/60 mmHg. What is the most possible reason for
disease development in this patient?
A. Chronic alcohol intoxication
B. Impairment of adrenal gland due to tuberculosis
C. Alcoholic injury of the liver
D. Hypothalamic tumor
E. Thyroid gland impairment
69. A woman aged 40 complains of general malaise, pain in the heart area, increase of
body weight. At examination of the patient: she is 164 cm height and 104 kg weight; she
has predominant deposits of fat at face, neck, shoulders, and abdomen; her BP – 165/100
mmHg; content of glucose in her blood – 7.8 mmol/L. What endocrine gland function is
infringed and what direction at?
A. Pituitary gland, basophilic adenoma, hyperfunction
B. Pituitary gland, eosinophilic adenoma, hyperfunction
C. Sexual glands, hypofunction
D. Cortex of adrenal glands, hypofunction
E. Thyroid gland, hypofunction
70. In a patient aged 23 BP rapidly drops down to 70/40 mmHg after surgical removal of
left adrenal gland. Patient has rapid, weak pulse, vomiting, and cramps; he is covered by
cold sweat.What is the most possible cause for this condition?
A. Hypertrophy of the right adrenal gland
B. Hypofunction of adenohypophisis
C. Atrophy of the right adrenal gland
D. Hyperfunction of adenohypophisis
E. Hypofunction of neurohypophisis
71. A 17-years-old female patient, who has been ill for 6 months, complains of appearance
of mustache and beard, roughness of voice, and absence of menses. At examination of the
patient hirsutism and undeveloped mammal glands and sexual organs were revealed. What
glands impairment has lead to this pathology?
A. Adrenal glands
B. Thyroid gland
C. Neurohypohpisis
D. Adenohypophisis
E. Sexual glands
72. A child aged 4 lags behind at physical development, sleeps badly, and has increased
irritability, thirst, and polyuria. Glucose is absent in patient’s urine. Patient has negative
reaction to vasopressin injection. What is the mechanism of revealed disorders? A.
Disturbance of realization of hormone biological activity
B. Impairment of neural regulation of endocrine glands
C. Disorders of biosynthesis and secretion of hormones
D. Disorders of neuroendocrine regulation
E. Disorders of feedback mechanisms
73. Loss of body weight, fatigue, pulling teeth out, and coming hairs out began in a patient
in several months after delivery. She often became ill. At examination of the patient:
subcutaneous adipose tissue is virtually absent; BP – 90/55 mmHg; body temperature –
36.0 oC. Biochemical analysis of patient’s blood: glucose content – 3.0 mmol/L. There is
increased level of growth hormone and adrenocorticotropic hormone in her blood. What
kind of pituitary functions is impaired in this patient?
A. Pituitary dwarfism
B. Panhypopituitarism
C. Acromegaly
D. Cushing’s disease
E. Diabetes insipidus
74. Hans Sallie, author of doctrine of stress, showed that different stimuli (heat, cold, pain)
always evoke standard non-specific reaction: 1) involution in thymico-lymphatic system; 2)
hemorrhage acute ulcers of stomach and duodenum. Name the third compound of classical
triad.
A. Hypertrophy of adrenal cortex
B. Hypertrophy of beta cells of Langerhans’ islets
C. Myocardial infarction
D. Parodontitis
E. Cerebral hemorrhage
75. Polyuria and polydipsia developed in a 40-years-old patient accordingly to impairment
of hypothalamic-pituitary connective way. What hormone deficiency evokes this changes?
A. Oxytocin
B. Antidiuretic hormone
C. Adrenocorticotropic hormone
D. Growth hormone
E. Thyroid stimulating hormone
76. In a patient excessive development of bones and soft tissues of his face, enlargement of
his tongue, and widened interspaces between teeth in enlarged teeth arch were found out.
What changes of hormone secretion are the most possible in this patient?A. Elevated
secretion of insulin
B. Increased secretion of thyroxin
C. Increased secretion of growth hormone
D. Reduced secretion of growth hormone
E. Elevated secretion of vasopressin
77. A boy aged 9 is in endocrinology department because of increase bone fragility. What
endocrine organ is impaired?
A. Adrenal glands
B. Thymus
C. Thyroid gland
D. Parathyroid gland
E. Epiphysis
78. A child has infringements of teeth enamel and dentin formation because of reduced
content of calcium in his blood. What hormone deficiency may evoke these changes?
A. Growth hormone
B. Triiodthyronin
C. Parathormone
D. Thyroxin
E. Thyrocalcitonin
79. By X-ray examination of scull bones enlargement of cella turcica, thinned anterior
inclined appendices, and destruction of different places of cella turcica were revealed.
What endocrine gland tumor may lead to such bone destruction?
A. Thyroid gland
B. Epiphysis
C. Adrenal gland
D. Thymus
E. Pituitary gland
80. After the operation on thyroid gland tetany developed in a patient that manifested in
convulsions of striped muscles. What does this complication may be connected to?
A. Mistaken removal of parathyroid glands
B. Insufficient removal of thyroid tissue
C. Hyperfunction of adrenal glands
D. Hypofunction of adrenal glands
E. Elevated blood content of thyroid-stimulating hormone
81. A female patient with hyperthyroidism has increased body temperature. What is the
mechanism of body temperature elevation?
A. Separation of oxidation and oxidative phosphorilation
B. Increase utilization of glucose by tissues
C. Intensification of glycogenolysis
D. Intensification of protein catabolism
E. Elevation of oxidation of fat in liver
82. A woman has fatigue, sleepiness, apathy, worsening of memory, and edemas. These
symptoms appeared in several years after change of dwelling. “Endemic goiter” is
diagnosed in this patient. What substance deficit in water and food may lead to this
disease?
A. Iodine
B. Fluoride
C. Iron
D. Calcium
E. Magnesium
83. A 38-years-old patient complains of thirst (he drinks 8 liters of water daily), polyuria,
loss of weight, and general malaise. He has been sick for 6 months. Urinalysis of the
patient shows: special gravity – 1.001, leukocytes – 1 to 2 in field of vision, protein – trace
amount. What reason evokes the constant polyuria in this patient?
A. Reduction of ADH production
B. Injury of renal glomerules
C. Injury of renal tubules
D. Elevation of osmotic pressure of urine
E. Increase of oncotic pressure of urine
84. When stomatological examining the patient aged 18 the following symptoms were
revealed: woman features of his face, anomalies of form of crowns in some teeth, catarrhal
gingivitis, and resorption of interdental junctures. Cytological examination of mucous
membrane epithelium discovers that cells contain 1 Barr’s body. What endocrine pathology
are these manifestations the most probably connected to?
A. Hypogonadism
B. Hypergonadism
C. Cretinism
D. Thyrotoxicosis
E. Chronic hypoparathyroidism
85. A 20-years-old patient has hypoplasia of enamel and impaired formation of dentin in
his teeth after surgical removal of thyroid gland. What hormone deficiency became the
reason for indicated pathology?
A. Parathormone
B. Thyroxin
C. Thyroid-stimulating hormone
D. Thyroid-stimulating hormone-releasing factor
E. Thyrocalcitonin
86. A patient, who lives in mountain region, was admitted to the hospital with diagnosis of
endemic goiter. What is characteristic for this disease?
A. Decreasing of thyroxin and triiodthyronin synthesis
B. Increase of thyroid hormone production
C. Toxic action of thyroxin and triiodthyronin
D. Chronic hypoparathyroidism
87. A child aged 2.5 has retardation in physical development, absence of appetite, thirst,
and polyuria; he sleeps badly. Sugar was not found in the patient’ urine. Which of
endocrine pathologies is the reason for disorders of water-salt metabolism?
A. Hyposecretion of antidiuretic hormone
B. Hypersecretion of antidiuretic hormone
C. Secondary hyperaldosteronism
D. Hyposecretion of growth hormone
E. Hyposecretion of adrenocorticotropic hormone
88. What pathological conditions the tumor growing from reticular zone of adrenal gland
may lead to?
A. Virilization of female organism
B. Elevation in content of glucocorticoids in blood
C. Tachycardia
D. Elevation of content of mineralocorticoids in blood
89. What changes result from separation in oxidation and oxidative phosphorilation?
A. Elevation in heat production
B. Decrease of free oxidation part
C. Decrease in heat production
D. Enhancement of functional activity of organs
E. Increase in ATP production
90. What changes in adult organism may be evoked by hypersecretion of growth hormone?
A. Development of diabetes mellitus
B. Intensification of lipolysis
C. Intensification of urea production
D. Reduction of transport of amino acids to the cell
E. Increase in content of calcium in blood
91. A 40-years-old patient complains of decreased capability of working, sleepiness,
sensitivity to cold, fragility and coming out of hairs, dryness of skin, and edema of face and
extremities. There is no formation of pit under the pressing at the anterior surface of
patient’s calves. Patient has slow tendon reflexes and bradicardia. What infringement do
these changes result from?
A. Hypothyroidism
B. Adrenal insufficiency
C. Hypoparathyroidism
D. Vitamin C deficiency
E. Iron deficiency
92. Influence of unfavorable psycho-emotional factor upon a patient results in development
of non-specific pathological process, which course consists of 3 stages: 1) anxiety reaction;
2) stage of resistance; 3) stage of exhaustion. This process involves system hypothalamus –
pituitary – adrenal cortex. What is the name for this process?
A. Stress
B. Parabiosis
C. Adaptation
D. Compensation
E. Dominance
93. A doctor suspects the hypothyroid goiter in a patient with enlarged thyroid gland. What
sign has a decisive importance for establishing the diagnosis?
A. Decrease of basal metabolism
B. Bradicardia
C. Edemas
D. Arterial hypotension
E. Hypodynamism
94. Arterial hypotension, muscular weakness, and periodic convulsions appear in the
patient with hepatic cirrhosis. Content of sodium is increased and content of potassium is
decreased in patient’s blood. What kind of endocrine disorders underlies this symptoms?
A. Secondary hyperaldosteronism
B. Hypopituitarism
C. Primary hyperaldosteronism
D. Hyperpituitarism
E. Hypoaldosteronism
95. Prolonged intake of mineralocorticoids led to development of muscular weakness in a
patient. What gives rise to these symptoms?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hyponatremia
E. Hypervolemia
96. What hormone increased secretion causes becoming thin at the period of enhanced
growth?
A. Growth hormone
B. Prolactin
C. Glucagon
D. Progesterone
E. Insulin
97. What kind of endocrine disorders lead to obesity?
A. Hypercortisolism
B. Hypofunction of adrenal glands
C. Hyperparathyroidism
D. Hypergonadism
E. Hyperaldosteronism
98. A 50-years-old female patient, who was operated on thyroid gland for diffuse toxic
goiter, begins complaining that she is spiritless and slow, has fast fatigability, increased
working ability, sleepiness, worsening of memory, and increasing of body weight. At
examination the patient has dry skin, edematous face, and striped nails with broken edges.
What is your assumable diagnosis?
A. Myxedema
B. Cushing’s disease
C. Acromegaly
D. Obesity
E. Thyrotoxicosis
99. A 25-years-old male patient, who endured influenza, complains of increased thirst (he
drinks 5 to 6 liters of water daily), frequent abundant urination, and loss of body weight.
Patient has dry mucous membranes and dry skin with reduced turgor. Urinalysis of this
patient displays: urine is colorless, its special gravity – 1.000-1.004, leucocytes and
erythrocytes – 1 to 2 in field of vision. What pathology does this patient suffers from?
A. Diabetes insipidus
B. Diabetes mellitus
C. Conn’s disease
D. Pheochromocytoma
E. Secondary hyperaldosteronism
100. When prophylactic examining of the first-year pupils in two of them lag in their height
by 2-3 sigma deviations was indicated. No another disorders were revealed. What hormone
deficiency could lead to this pathology?
A. Growth hormone
B. Sexual hormones
C. Insulin
D. Thyroid hormones
E. Glucocorticoid
16. 1.-A2.-E3.-C4.-E5.-D6.-C7.-B8.-E9.C10.-A11.-D12.-D13.-B14.-E15.-C16.-C17.-B18.B19.-D20.-E21.-B22.-A23.-D24.-E25.-E26.-B27.-A28.-A29.-A30.-A31.-A32.-B33.-D34.A35.-C36.-B37.-E38.-D39.-A40.-B41.-A42.-A43.-A44.-A45.-D46.-D47.-B48.-A49.-D50.E51.-B52.-A53.-E54.-A55.-B56.-C57.-B58.-E59.-C60.-A61.-C62.-B63.-A64.-C65.-A66.A67.-A68.-B69.-A70.-C71.-A72.-A73.-B74.-A75.-76.-C77.-D78.-C79.-E80.-A81.-A82.A83.-A84.-A85.-A86.-A87.-A88.-A89.-A90.-A91.-A92.-A93.-A94.-A95.-A96.-A97.A98.-A99.-A100.-A
Topic 17. Pathophysiology of the nervous system
1. A 38-year-old man is going undertreatment in a hospital for schizophrenia. Blood
contents of glucose, ketone bodies, and urea in him are norm. Shock therapy with regular
injections of insulin was led to the development of insulin coma, after that the patient’s
condition improved. What was the most possible reason for development of insulin coma?
A. Glucosuria
B. Dehydratation of tissues
C. Hypoglycemia
D. Metabolic acidosis
E. Ketonemia
2. Smell of apples is felt from the patient in comatose state. The content of glucose is 18
mmol/L. Which coma is more possible in this case?
A. Hypoglycemic
B. Toxic
C. Hyperosmolar
D. Ketoacidotic
E. Lactatacidotic
3. A patient is drowsy, with cloudiness of consciousness, his reaction to the strong stimuli
is slow. His skin is pale and dry. He has edemas, muscular fibrillar tremor, midriasis,
Cheyne-Stokes respiration with ammonium smell. Pericardial rub was revealed during
auscultation. Which type of coma has been developed in this patient?
A. Ketoacidotic
B. Renal
C. Hyperosmolar
D. Hepatic
E. Apoplectic
4. Increase of blood pressure and rapid pulse are noticed in a sportsman at the start before
competitions. Influence of which part of the CNS can above-mentioned changes be
explained?
A. Cortex of hemispheares
B. Medulla oblongata
C. Mesencephalon
D. Diencephalons
E. Hypothalamus
5. The close clinical examination of the patient, admitted to the reanimation department in
unconscious condition allowed to make a conclusion that the patient was in uremic
comatose state. Which symptom is more characteristic for this type of coma?
A. Hyperglycemic
B. Acetone smell from his mouth
C. Polyuria
D. Hypernitremia
E. Non-gas alkalosis
6. The close clinical examination of the patient, admitted to the reanimation department in
unconscious condition allowed to make a conclusion that the patient was in state of diabetic
coma. Which symptom is more characteristic for this type of coma?
A. Hyperglycemia
B. Smell of ammonium from the mouth
C. Anuria
D. Metabolic alkalosis
E. Decrease of content of nonprotein nitrogen in serum
7. Ptyalism, bradycardia (heart rate 45 beats per minute), miosis are observed in a man.
What is the most possible reason for such changes?
A. Increase of sympathetic influence
B. Increase of parasympathetic influence
C. Decrease of sympathetic influence
D. Decrease of parasympathetic influence
E. Decrease of vegetative influence
8. The reactions, typical for stimulation of parasympathetic nerves, appeared after irritation
of throphogenic zone of hypothalamus, including preoptic nucleas and anterior
hypothalamic area. What appears in this case?
A. Tachycardia
B. Mydriasis
C. Exophthalmus
D. Decrease of BP
E. Hyperglycemia
9. After amputating the upper extremity a patient had a bad pain in it. Which mechanism of
the pain feeling formation is more possible in this case?
A. Phantom
B. Reflex
C. Hyposecretion of endorphin
D. Hypersecretion of endorphin
E. Hyposecretion of encephalin
10. A patient had hemiplegia after insult. What disorder is observed in this case?
A.
B.
C.
D.
E.
Taste
Balance
Movement
Vision
Hearing
ANSWERS:
1.-C. 2.-D. 3.-B. 4.-A. 5.-D. 6.-A. 7.-B. 8.-D. 9.-A. 10.-C.
Topic 18. PATHOPHYSIOLOGY OF EXTREME CONDITIONS.SHOCK.
1. A patient in comatose state has smell of acetone from his mouth. Content of glucose in
his blood plasma is of 18 mmol/L. What kind of coma is the most possible one in this case?
A. Hyperosmolar
B. Ketoacidemic
C. Hypoglycemic
D. Toxic
E. Lactatacidemic
2. A patient with crushed muscular tissue was admitted to the traumatological department.
Which biochemical index of urine is increased in this case?
A. Glucose
B. Mineral salts
C. Uric acid
D. General lipids
E. Creatinin
3. A patient is drowsy, his conscious is depressed, and his reactions to irritants are
suspended. He has a pale dry and edematous skin, muscular fibrillations, mydriasis, and
Cheyne-Stocks’ respiration with ammonium scent from his mouth. Pericardial friction
sound was found at auscultation of the patient’s heart. What kind of coma has developed in
this patient?
A. Ketoacidotic
B. Renal
C. Hyprosmolar
D. Hepatic
E. Apoplectic
4. A 35-year-old man has massive trauma of lower extremities without considerable
external bleeding. The victim is in exited condition. What component of pathogenesis of
traumatic shock is leading and needs immediate correction?
A. Pain
B. Internal bleeding
C. Intoxication
D. Disorder of organ functions
E. Internal loss of plasma
5. A patient with burn of 30% of body surface has decrease in BP to 75/20 mm Hg,
frequent, filiform pulse (110/min). What is the main factor of decrease in BP in burn
shock?
A. Intoxication by decay products
B. Plasmarrhea
C. Activation of sympathetic nervous system
D. Hypoproteinemia
E. Activation of parasympathetic nervous system
6. Spasm of resistant vessels develops in zones with alpha-adrenoreceptors in erectile phase
of shock. What hemodynamic changes will be observed in this case?
A. Systemic decrease of peripheral blood flow
B. Centralization of blood flow
C. Bradycardia
D. Decrease of venous return
E. Decrease of blood flow speed
7. A victim of the earthquake felt well just after he was extracted from under ruins, but
soon abrupt worsening of his condition developed. He lost consciousness, his BP was of
70/35 mmHg, and his pulse was of 90 per min; edema of previously ischemic tissues
increased quickly. Which is the main cause of patient’s condition worsening?
A. Increase in tonus of sympathetic nervous system
B. Thrombosis of subcutaneous venous vessels
C. Dehydration
D. Systemic activation of proteolytic processes and PLO
E. Disorders of renal functions
8. A patient was admitted to the hospital in severe state. He does not answer the questions
and does not react to pain stimuli. Patient’s BP is 50/10 mmHg, his pulse is 50 per min.
What are the reasons for disorders of system hemodynamics at torpid phase of shock?
A. Total decrease in peripheral vascular resistance
B. Elevation of venous return of blood
C. Increase of CBV
D. Rise of tonicity of sympathetic nervous system
E. Decrease in permeability of exchange vessels
9. Intravenous infusion of blood and blood substitutes does not lead to the stabilization of
BP in a patient with torpid phase of shock. After cessation of infusion patient’s blood
pressure decreases again. What does inefficacy of medical treatment in torpid phase of
shock connected to?
A. Spasm of resistant vessels
B. Hemodilution
C. Increase in velocity of blood flow
D. Tachycardia
E. Systemic increase in vessel permeability
10. Levels of plasma proteins are sharply increasing, and the number of alveolar
macrophages and lymphocytes is decreasing in bronchoalveorlar contents of a patient with
shock. What is the mechanism of these phenomena appearance?
A. Increase in permeability of lung capillaries
B. Spasm of resistant vessels of the lungs
C. Increase in inhibitor systems of the lungs
D. Increase in pulmonary blood flow
E. Hyperventilation
11. A patient with torn away finger was admitted to the traumatological department. He is
fussy, verbose, and pale. His pulse is 120 beats per minute, BP 140/90 mmHg. What are
the peculiarities of disorders of microcirculation and systemic hemodynamics in erectile
phase of shock?
A. Systemic spasm of volume vessels
B. Increase in systemic peripheral resistance
C. Decrease in venous return and volume of blood circulation
D. Increase in peripheral resistance in the brain, heart and lungs vessels
E. Hypoxia in zones with beta-adrenoreceptors
12. Hemodialysis was utilized for treatment for acute renal failure developed in a patient as
a result of traumatic shock. While carrying out the hemodialysis patient’s condition became
worse, aggregation of erythrocytes, leukocytes, and platelets occurred in microvessels, and
blood viscosity increased. What kind of disorders of microcirculation developed in the
patient?
A. Sludge syndrome
B. Disorders of vascular permeability
C. Extravascular disorders
D. Capillary-trophic insufficiency
E. Lymphatic system insufficiency
13. Tourniquet was applied to upper third of hip of wounded driver just at place of car
accident. The patient was admitted to a surgical department in satisfactory condition 3
hours later. Marked edema of hip tissues, frequent pulse, cold perspiration, and expressed
hypotension develop in the patient after removal of tourniquet. Which pathological process
develops in the patient?
A. Toxic shock
B. Anaphylactic shock
C. Collapse
D. Cardiogenic shock
E. Hemorrhagic shock
14. Daily diuresis amounts to 250 ml in a patient with anaphylactic shock. The patient has
moist rales in his lungs; his consciousness is intact. In patient’s blood acidosis reveals with
base deficiency of 14.5 mmol/L; plasma contents of potassium is 8.8 mmol/L and urea is
48 mmol/L. How is this disorder of kidney called?
A. Uremic coma
B. Acute diffuse glomerulonephritis
C. Acute renal failure
D. Chronic renal failure
E. Chronic glomerulonephritis
15. Sharp weakness, paleness of skin, lost of consciousness appeared in a patient the next
day after resection of his stomach. The patient’s BP is 70/40 mmHg; pulse is 160 beats per
minute. In the patient’s blood test Hb is 70 g/L, erythrocytes are 2.3x1012/L. What
pathology appeared in a patient?
A. Orthostatic collapse
B. Pain shock
C. Traumatic shock
D. Hemorrhagic collapse
E. Cardiogenic collapse
16. Sharp decrease of systolic BP down to 60 mmHg, tachycardia of 140 beats per minute,
dyspnea, and loss of consciousness developed in a patient on the second day after
myocardial infarction. What pathways have the most important significance in
pathogenesis of this shock?
A. Increase in excitability of the myocardium by products of necrotic decay
B. Decrease in blood volume
C. Development of paroxysmal tachycardia
D. Decrease in stroke volume
E. Development of anaphylactic reaction to myocardial proteins
17. A driver was admitted to an emergency department after a car accident. He does not
react to questions; he is indifferent to everything, pale; he has shallow and infrequent
respiration and BP of 75/50 mmHg. Name the principal link in pathogenesis of this
pathology.
A. Excitement of CNS
B. Inhibition of CNS
C. Loss of blood
D. Toxemia
E. Redistribution of blood
18. To compensate considerable loss of blood resulting from knife wounding of liver, a 30yer-old patient with blood of IV (AB) Rh (-) group was transfused with blood of IV(AB)
Rh (+) group. Requirement in repeated blood transfusion appears in several days. What
kind of blood is it possible to use for transfusion?
A. IV(AB) Rh (-)
B. I(O) Rh (+)
C. II(A) Rh (-)
D. IV(AB) Rh (+)
E. III(B) Rh (-)
19. A patient was admitted to a hospital with acute high bowel obstruction. He had
prolonged vomiting and blood pressure decreased down to 60/40 mmHg. Which
mechanism of shock development is principal one in this case?
A. Exhaustion of arteriolar alpha-adrenoreactivity
B. Hypovolemia
C. Acidotic dilation of metarteriols
D. Loss of chlorides
E. Increase in tonus of vagus nerve
20. Novocain solution was injected to a patient for anesthetization at extraction of a carious
tooth. Drop of BP, loss of consciousness, dyspnea, and convulsions develop in the patient
in a few minutes. What is the reason for anaphylactic shock development?
A. Desensitization of the organism
B. Toxic action of Novocain
C. Sensitization to Novocain
D. Autoallergic state
E. Para-allergy
21. Severe burn shock has developed in a patient with 40% of body surface burnt. What is
the cause of shock development?
A. Dehydration of the organism
B. Mineral metabolism disturbances
C. Autoimmunization of the organism
D. Protein metabolism disturbances
E. Pain
22. A teeth was extracted in a teenager with Novocain utilization. Paleness of skin,
dyspnea, and hypotension developed in the teenager 10 minutes later. What kind of allergic
reactions developed in the teenager?
A. Immune complex
B. Stimulating
C. Anaphylactic
D. Cytotoxic
E. Cell-mediated
23. After a car accident a patient has BP of 70/40 mmHg; he is unconscious; his daily
diuresis is about 300 ml. What is the mechanism of urinopoiesis disturbances in this case?
A. Augmentation of glomerular filtration
B. Reduction of tubular reabsorption
C. Decrease in glomerular filtration
D. Augmentation of tubular reabsorption
E. Reduction of tubular secretion
24. A 45-year-old victim with severe craniocerebral trauma was admitted to the hospital by
emergency team. Shockogenic trauma was diagnosed: loss of consciousness, paleness of
skin, decrease in body temperature down to 350С, decrease in muscular tonus, absence of
reflexes, frequent and weak pulse, and decrease in BP down to 50/30 mmHg appeared in
the patient. Which clinic stage of traumatic shock is the patient in?
A. Terminal
B. Erectile
C. Excitation
D. Inhibition
E. Torpid
25. A doctor established shock condition in a patient who fell from high altitude. What is
the most important in traumatic shock development?
A. Disturbances of the neurohumoral regulation
B. Toxemia
C. Disorders of regulation of the hemodynamics
D. Hypovolemia
E. Disturbances of renal functions
26. A patient developed anaphylactic shock in a dental room after injection of Lidocain
solution. Which immunoglobulins underlie anaphylactic shock development?
A. Ig E
B. Ig М
C. Ig А
D. Ig G
E. Ig D
27. Traumatic shock developed in a patient as a result of severe trauma. Neuroendocrine,
hemodynamic, and metabolic disorders took place during the shock development.
Clinically, after erectile stage of shock, another stage developed, which is referred to as:
A. Torpid
B. Septic
C. Chronic
D. Neurocirculatory
E. Ischemic
28. Anaphylactic shock developed in a patient after injection of local anesthetic drug.
Which mechanism of blood circulation disorders is the leading one in this condition?
A. Decrease in tonus of vessels
B. Hypovolemia
C. Pain
D. Activation of sympathetic-adrenal system
E. Reduction of contractile function of the heart
29. Hypovolemic shock and signs of severe hypoxia developed in a victim of aircraft crash
due to severe hemorrhage. In this situation the most severe disorders for the organism
develop in:
A. Heart
B. Kidneys
C. Lungs
D. Liver
E. Spleen
ANSWERS:
1.-B, 2.-E, 3.-B, 4.-A, 5.-B, 6.-E, 7.-D, 8.-A, 9.-E, 10.-A, 11.-B, 12.-А, 13.-А, 14.-С, 15.-D,
16.-D, 17.-В, 18.-А, 19.-В, 20.-С, 21.-Е, 22.-С, 23.-С, 24.-А, 25.-А, 26.-А, 27.-А, 28.-А,
29.-А.