THE MINISTRY OF PUBLIC HEALTH OF UKRAINE
VINNITSIA NATIONAL MEDICAL UNIVERSITY
named after M.I.PIROGOV
EDUCATIONAL-METHODICAL RECOMMENDATION
FROM PATHOPHYSIOLOGY
FOR THE 3RD YEAR
MEDICAL FACULTY STUDENTS
Module N 1
GENERAL PATHOLOGY
Practical training N 2
TYPICAL PATHOLOGICAL
PROCESSES
VINNITSIA - 2012
1
The manual from Pathophysiology is approved and confirmed for the
introduction into the educational process at Pathophysiology department
meeting.
Protocol N 1
Сompilers:
from 30.08.2011
Head of Department
N.A. Rikalo
as. A.S. Grytsenko
as. O.Y. Guminska
as. S.G.Polinkevich
The manual is recommended for the foreign students of medical
faculty (3rd course).
2
Thematic plan
Medical faculty
Lesson 9. Local disorders of blood circulation (hyperemia, ischemia, stasis, thrombosis,
embolism).
Lesson 10. Inflammation (vascular reactions).
Lesson 11. Inflammation (pus enzymes).
Lesson 12. Disorder of heat exchange.
Lesson 13. Neoplasia.
Lesson 14. Hypoxia. Starvation.
Lesson 15. Practical training: “Typical pathological processes.”
3
Theme: “LOCAL DISORDERS OF BLOOD CIRCULATION”.
Actuality of theme.
Prevalence of local violations of circulation of blood, such as arterial and venous
hyperemia, ischemia and stasis is very important. Their development is predefined
violation of the neurohumoral regulation of local blood circulation. Disorders of local
blood circulation need the detailed study, as they are the main link of pathogenesis of
many pathological processes. Knowledges about general mechanisms of their
development are needed for successful treatment and prophylaxis of the proper violations.
It is known that the system of blood circulation takes leading place in support of
vital functions of an organism as the whole system.
Providing of necessary blood stream is a difficult process which depends on the
adequate functioning of heart, integrity of vascular wall and balance between coagulative
and anticoagulative systems of blood.
All known diseases are accompanied with disorders of blood stream.
Local disorders of blood circulation, such as thrombosis and embolism is one of
the most frequent reasons of death (thromboembolism of cerebrum vessels, pulmonary
artery). That is why knowledge of reasons, mechanisms of development and consequences
of thromboembolism has a large significance for a practical doctor.
General purpose of the lesson.
To learn the reasons of arterial and venous hyperemia, ischemia, stasis origin,
mechanisms of their development, manifestations, significance for an organism. To learn
reasons, mechanisms of development, manifestations, significance of thrombosis and
embolism for the organism.
For this it is necessary to know (the concrete purposes):
To know the arterial and venous hyperemia, ischemia, stasis definitions.
To know the reasons of origin and mechanisms of peripheral blood circulation
disorders development.
3. To describe the basic manifestations of different of, explain the mechanisms of
their development.
4. To explain the value of local blood circulation disorders for an organism.
5. To be able to make the arterial and venous hyperemia, ischemia at experiment.
6. To give determination of conceptions: "thrombosis", "embolism".
7. To be able to explain principal reasons of origin, mechanisms of thrombosis
development.
8. To explain the consequences of thrombosis.
9. To be able to classify embolism by origin and localization.
10. To explain the mechanisms of different kind of embolisms development.
11. To explain the significance of thrombosis and embolism for the organism.
1.
2.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
4
1.
2.
3.
4.
5.
6.
7.
8.
9.
Dividing of bloodstream into the functional parts (Normal Physiology
Department).
The conception about the vessels of microcirculation (Normal Physiology
Department).
Mechanisms of bloodstream regulation (Normal Physiology Department).
Structure and functions of endotelial cells, basal membrane (Histology
department).
Structural and functional organization of the blood circulation system (Normal
Physiology and Histology Departments).
View about central and peripheral blood circulation (Normal Physiology
Department)
Conception about the hemostasis system (Normal Physiology Department)
Concept about the fibrinolytic system (Normal Physiology Department)
Thrombocytes functions (Normal Physiology Department)
The checking of primary level of knowledges.
Give the answers to the following questions:
1. Basic forms of local blood circulation disorders.
2. Arterial hyperemia, definition.
3. What are the reasons of arterial hyperemia development?
4. Types of arterial hyperemia.
5. Venous hyperemia, definition.
6. Reasons of venous hyperemia development.
7. Ischemia, definition.
8. Stasis, definition.
9. Types of ischemia?
10. Types of stasis?
11. Thrombosis, definition.
12. Basic factors which are promote thrombus formation (Virchow’s triad).
13. What are the phases of thrombus formation process?
14. Consequences of thrombosis? From what does it depend?
15. Embolism, definition.
16. Types of embolisms according to origin.
17. Types of embolisms according to localization.
18. Types of exogenous embolisms.
19. Types of endogenous embolisms.
Standards of answers at the theoretical questions of initial level of
knowledges:
1. Arterial and venous hyperemia, ischemia, stasis, thrombosis, embolism.
2. Arterial hyperemia – it is increased blood supply through the organ or part of
tissue against of increased blood inflow from the arteries.
3. Influence of physical, chemical and biological factors of external environment,
multiplying loading on an organ or area of tissue, psychogenic influencing.
4. Types of arterial hyperemia:
5
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
1)
Physiological (after intensive work of organ, reactive)
2)
Pathological (neurogenic, metabolic)
Venous hyperemia – it is increased blood supply through the organ or part of
tissue against of decreased blood outflow from the veins.
Reasons of venous hyperemia:
1)
intravascular (obturation of veins by a thrombus or embolus);
2)
extravascular (compression of veins by a tumour, scar, tourniquet, by the
enlarged organ (for example, by a pregnant uterus) by an edema);
3)
constitutional weakness of elastic apparatus of veins, reduced tone of
muscle elements of their walls;
4)
disorders of general hemodynamics (cardiac failure, diminishing of
suction ability of thorax).
Ischemia - it is decreased blood supply through the organ or part of tissue against
of decreasing or complete stoppage of blood inflow from the arteries.
Stasis – it is slowing-down and stoppage of blood flow in the capillaries, small
arteries and veins.
Basic types of ischemia:
1)
Compressive
2)
Obturative
3)
Angiospastic.
Basic variants of stasis:
1)
Ischemic
2)
Venous
3)
True (capillary).
Thrombosis - is the vital formation on the internal surface of vessel wall blood
clots which consist of its elements. These clots got the name thrombus.
1) Damage of vascular wall; 2) Violation of coagulative and anticoagulative
blood system (increase of coagulative system activity or decline of
anticoagulative system activity; 3) Deceleration of blood flow.
Cellular and plasma.
Necrosis (infarcnion), aseptic and septic meltdown, tromboembolism,
disseminated intravascular clotting (DIC).
Embolism – is transfer of foreign bodies which do not meet there in a norm by
the blood or lymph current with the next complete or partial vessel obturation.
Exogenous and endogenous.
By localization: embolism of greater circulation, embolism of lesser circulation
and embolism of portal vein system.
Exogenous types of embolisms: air, gas, bacterial, parasite, embolism by foreign
bodies.
Endogenous types of embolisms: thromboembolism, fatty, tissue, embolism by
amniotic fluid.
6
Test control is for verification of primary level of knowledges:
1. What substance from recital can result arterial hyperemia development?
А. Noradrenaline
B. Thyroxin
C. Aldosterone
D. Somatotropin
E. Acetylcholine
2. What manifestations are not characteristic for arterial hyperemia?
A. Acceleration of blood stream
B. Deceleration of blood stream
C. Increase of local temperature
D. Multiplying the amount of functional capillaries
E. Redness
3. What manifestations are characteristic for venous hyperemia?
А. Increasing of organ blood supply
В. Cyanosis
С. Deceleration of blood stream
D. Hypoxia
Е. All answers are correct
4. Name possible reasons of physiological arterial hyperemia development?
А. Action of angiotensin-ІІ on the vessels of microcirculation
В. Endothelium injuries
С. Increased loading on an organ
D. Compression of the vessels by the enlarged organ or tumour
Е. Obturation of arteries by the atherosclerotic plaque
5. Name possible reasons of venous hyperemia development?
А. Obturation of vein by a thrombus or embolus
В. Obturation of arteries by the atherosclerotic plaque, blood clot, embolus
С. Spasm of arterioles
D. Action of angiotensin-ІІ on the vessels of microcirculation
Е. Increased loading on an organ
6. Hyperproduction of what matters by endothelium can be the reason of arterial
hyperemia development?
А. Prostaglandins
В. Nitrogen oxide
С. Endothelins
D. Villebrand factor
Е. All answers are correct
7
7. What are credible consequences of venous hyperemia?
А. Edema of tissues
В. Hypoxia
С. Enlargement of connecting tissue
D. Liver cirrhosis
Е. All answers are correct
8. What are possible consequences of arterial hyperemia?
А. Hypoxia
В. Hemorrhage in tissues
С. Enlargement of connecting tissue
D. Atrophy of the organ
Е. All answers are correct
9. What biologically active substances which operate on intact vascular wall can be
the reason of angiospastic ischemia development?
А. Angiotensin-ІІ
В. Acetylcholine
С. Atrial natriuretic hormone
D. Prostaglandins
Е. Nitrogen oxide
10. The obturative ischemia is the result of А. Arteriole spasm
В. Particulate or complete obturation of veins
С. Compression of arteries
D. Partial or complete obturation of arteries
Е. All answers are correct
11. The compressive ischemia is the result of А. Particulate or complete obturation of arteries
В. Particulate or complete obturation of veins
С. Compression of arteries
D. Increased loading on an organ
Е. All answers are correct
12. Rubbing by ointment on the basis of snake venom was done to a patient with
lumbar radiculitis. Apparent redness arised at the place of rubbing after completion
of procedure. What type of local blood circulation disorders took place in this case?
А. Thrombosis
В. Venous hyperemia
С. Stasis
D. Ischemia
Е. Arterial hyperemia
8
13. Cyanosis of back surface of leg in the middle and overhead third is observed at
the patient with thrombophlebitis of lower limb veins. What type of local blood
circulation disorders take place in this case?
A. Stasis
В. Arterial hyperemia
C. Ischemia
D. Venous hyperemia
E. Thrombosis
14. Paleness of skin of foot and leg is observed at the patient with endarteritis. The
skin is cold by touch. What disorder of local blood circulation took place in this case?
А. Arterial hyperemia
В. Stasis
С. Ischemia
D. Venous hyperemia
E. Embolism.
15. The vessel wall is formed by endothelium, basal membrane and pericytes. This
vessel is:
А. Arteriole
В. Venule
С. Hemocapillary
D. Lymphocapillary
Е. Artery with middle caliber
16. Specify factors which promote thrombosis development:
А. Increase of thrombocytes amounts in the unit of blood volume
В. Decrease of red corpuscles amounts in the unit of blood volume
С. Disorders of the acidic - basic state
D. Damage of vascular wall endothelium
Е. Гіпокальціємія
17. What form of embolism from the indicated can develop at transition from the
area of the increased barometric pressure to normal?
А. Fatty
В. Thromboembolism
С. Gas
D. Retrograde
Е. Tissue
18. Name the vessels at the damage of which most probable is an origin of air
embolism:
А. Femoral vein
В. Jugular vein
С. Ulnar vein
D. Hepatic vein
Е. Portal vein
9
19. What is the amount of thrombocytes in a norm?
A 60 – 80x109/l
B. 200 – 400x109/l
C. 450 – 500x109/l
D. 30 – 40x109/l
E. 1 – 5x109/l
20. Name the basic factors of thrombosis (Virchow’s triad) (3):
А. Thrombocytes damage
В. Disorders of coagulative and anticoagulative blood systems
С. Deceleration of the blood stream
D. Multiplying speed of blood stream
Е. Damage of vascular wall endothelium
21. What is the main point of physical and chemical content of thrombosis cellular
phase?
А. Change of vascular wall electric charge
В. Change of thrombocytes electric charge
С. Stability of vascular wall electric potential
D. Stability of thrombocytes electric potential
Е. All answers are right.
22. Name the basic consequences of thrombosis:
А. Necrosis (infarction)
В. Gangrene (extremities)
С. Aseptic or septic meltdown
D. Ischemia
E. All answers are right
23. The neck is injured at man as a result of accident. What is the most probable type
of embolism will develop?
А. Fatty
В. Gas
С. Air
D. Tissue
Е. Thromboembolism
24. A woman got the opened fracture of right femur bone as a result of accident.
What is the most probable type of embolism will develop?
А. Bacterial
В. Gas
С. Air
D. Fatty
Е. All answers are right
10
25. Damage of venous sinus of durae matris was diagnosed at a patient as a result of
trauma. What is the most probable type of embolism will develop?
А. Gas
В. Fatty
С. Air
D. Bacterial
Е. Tissue
26. What type of embolism can arise up at a patient as a result of lungs trauma?
А. Gas
В. Air
С. Bacterial
D. Fatty
Е. Parasitogenic
27. What type of embolism can arise up at a diver who was quickly come up from the
depth?
А. Gas
В. Air
С. Tissue
D. Fatty
Е. Bacterial
28. What type of embolism can arise up at a pilot as a result of dehermetization of
airplane?
А. Parasitogenic
В. Air
С. Fatty
D. Tissue
Е. Gas
1
8
15
22
E
B
C
E
2
9
16
23
B
A
D
C
3
10
17
24
E
D
C
D
Correct answers
4
C
5
11
C
12
18
B
19
25
C
26
A
E
B
B
6
13
20
27
B
D
B,C,E
A
7
14
21
28
E
C
A
E
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Classification of peripheral blood circulation disorders.
2. Arterial hyperemia, determination of conception. Kinds. Reasons, basic
mechanisms of development. Manifestations. Significance for an organism.
3. Venous hyperemia, determination of conception. Reasons, basic mechanisms of
development. Manifestations. Significance for an organism.
4. Ischemia, determination of conception. Kinds. Reasons. Mechanisms of
development. Manifestations. Significance for an organism.
11
5.
6.
7.
8.
9.
Stasis, determination of concept. Kinds. Reasons, mechanisms of development.
Significance for an organism.
Thrombosis, determination of conception. Value of Virchow’s triad in the
mechanism of thrombosis development.
Modern views about thrombosis pathogenesis.
Consequences of thrombosis.
Embolism, determination of conception. Types of embolisms. Reasons of their
origin and mechanisms of development. Value for an organism.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 54-66, 68-71
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.60-68
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. – p. 105-121.
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. Increase of blood viscosity, - impression of microvessels walls at capillaroscopy
were founded in a patient with chronic heart failure. What of these violations is
possible in this case?
A. Sludge-phenomenon
B. Thrombosis
C. Embolism
D. Arterial hyperemia
E. Venous hyperemia
2. While playing volleyball a sportsman jumped and then landed across the external
edge of his foot. This caused acute pain in the talocrural articulation, active
movements became limited, passive movements remained unlimited but painful. In
the region of the external ankle a swelling appeared, the skin turned red and became
warmer to the touch. What type of peripheral circulation disorder has developed in
this case?
A. Embolism
B. Venous hyperaemia
C. Arterial hyperaemia
D. Thrombosis
E. Stasis
3. Postganglionic sympathectomy was made at a patient with obliterating
endarteritis. What type of arterial hyperemia will arise up as a result of the
conducted operation?
A. Neuroparalitic
В. Neurotonic
С. Metabolic
D. Working
Е. Reactive
12
4. Woman, 42 age old, with trigeminal nerve neuralgia complain of periodic redness
of face and neck right half, sensation of hot flushes and increase of the skin
sensitiveness. Development of what kind of arterial hyperemia is able to explain these
phenomena?
A. Neuroparalitic
B. Neurotonic
С. Metabolic
D. Working
Е. Reactive
5. Nerve which innervate the rabbit right ear was cut. Measuring of ears skin
temperature conducted after operation. Temperature of rabbit ear skin at the side of
denervation higher than at the opposite intact side on 1,50С. What form of peripheral
blood circulation disorders was developed at rabbit?
A. Neuroparalitic arterial hyperemia
B. Neurotonic arterial hyperemia
C. Physiological arterial hyperemia
D. Reactive arterial hyperemia
E. Metabolic arterial hyperemia
6. Student wasn’t able to give the right answer on exam. Redness of skin, feeling of
heat and uncertainty of behavior developed at the student. What type of arterial
hyperemia will arise up in this case?
A. Neurotonic
B. Neuroparalitic
C. Metabolic
D. Pathological
E. Reactive
7. Desympathisation of the femoral artery in the area of the femoral triangle was
made in a patient with atherosclerosis. What type of arterial hyperemia will arise up
as a result of the conducted operation?
A. Neuroparalitic
В. Neurotonic
С. Metabolic
D. Working
Е. Reactive
8. Puncture of abdominal cavity for the extraction of fluid was performed to a 45year-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
13
9. Course of atherosclerosis at a patient, 70 years old, was complicated by thrombosis
of lower extremities, a gangrenous fingers of the left foot. Beginning of thrombosis
development is associated with:
A. Transformation of fibrinogen into fibrin
B. Activation prothromboplastin
C. Transformation of prothrombin into thrombin
D. Adhesion, aggregation and agglutination of platelets
E. Reduced synthesis of heparin
10. Thrombocytopenia, reduction of fibrinogen in the blood, appearance of fibrin
degradation products, appearance of petechial hemorrhages are marked at a
patients, 43 years, on the base ofseptic. Specify the cause of these changes:
A. DIC-syndrome
B. Autoimmune thrombocytopenia
C. Hemorrhagic diathesis
D. Violation of platelet formation
E. Exogenous intoxication
(2006-2009)
11. 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
12. At which from processes does arterial hyperemia take place?
А. Arterial hypertension
В. Tumor growth
С. Inflammation
D. Necrosis
E. Arterial hypotension
13. What disorders of peripheral blood circulation will be observed after cutting of
sympathetic (adrenergic) fibres?
А. Ischemia
В. Venous hyperemia
С. Arterioly spasm
D. Arterial hyperemia
Е. Stasis
14
14. At the design of inflammation on mesentery of frog looked after arterial vessels
dilation, acceleration of blood stream under a microscope. What type of hyperemia arised
up here?
A. Working
В. Postischemic
С. Venous
D. Reactive
Е. Metabolic arterial
15. At the design of inflammation on mesentery of frog looked after arterial hyperemia.
What is the main factor of this disorder of blood circulation pathogenesis?
А. Biologically active substances elimination
В. Accumulation of potassium at the area of inflammation
С. Decreasing of potassium amount at the area of inflammation
D. Increasing of β- adrenergic nerves tone
Е. Vasodilators paralysis
16. A patient, 54 age old, entered to the surgical department with complaints of pain in
lower extremities, which increases at the walking. Objectively: the skin of lower
extremities is pale, cold, the pulsation is weak, the sensitiveness is reduced. Obliterating
endarteritis was diagnosed and postganglionic sympathectomy was planned. What type of
arterial hyperemia will arise up as a result of the conducted operation?
A. Neuroparalitic
В. Neurotonic
С. Metabolic
D. Working
Е. Reactive
17. 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
18. 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
15
19. 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. Venous hyperemia
20. 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. Increase of venous pressure
C. Increase of number of functional capillaries
D. Increase of collateral blood flow
E. Increase of tissue drainage
21. 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
22. 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
23. 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
16
24. The patient which injured the left hand a few days before appealed to the doctor.
He complaint of the pain in the site of damage, limitation of movement of fingers.
Objectively: increase of hand volume, hyperemia of the skin, increase of local skin
temperature. What pathological process these signs testify?
A. Thrombosis
B. Tumour
C. Inflammation
D. Embolism
E. Lymphostasis
25. At patient with the ancle joint fracture after the removal of plaster bandage an
edema of foot, cyanosis, decrease of local temperature, increase of organ volume were
developed. What type of blood circulation disorders is observed here?
A. Working hyperemia
B. Arterial hyperemia
C. Venous hyperemia
D. Reactive hyperemia
E. Ischemia
26. 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
27. 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
28. 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. --
17
29. 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
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. 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
32. Dyspnea, acute 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
33. A pilot experienced aircraft decompression on the altitude 14000 m. What type of
embolism could develop?
A. Gas
B. Tissue
C. Thromboembolia
D. Air
E. Fat
18
34. The state of a patient, 27 years old, with polytrauma (thorax closed injury, closed
fracture of the femoral bone) in two hours after conducting of skeletal extraction was
sharply deteriorated. Death came on the base of acute pulmonary-cardiac
insufficiency. The drops of orange color, which obturate the vessels lumen, were
founded at histological research of lungs and cerebrum blood vessels, coloring by
sudan ІІІ. What polytrauma complication developed?
A. Thromboembolism
B. Air embolism
C. Bacterial embolism
D. Fatty embolism
E. Gas embolism
1
10
19
28
A
A
E
A
2
11
20
29
C
D
B
A
3
12
21
30
A
C
D
A
4
13
22
31
Correct answers
B 5
A 6
D 14 E 15
A 23 B 24
A 32 E 33
A
A
C
A
7
16
25
34
A
A
C
D
8
17
26
B
B
A
9
18
27
D
C
A
Situate task:
1. Patient complains of the pain at extremities, numbness of hands fingers, which
frequently arises up on a cold. Sharp paleness of hand and fingers skin, decrease of
skin temperature and disorders of sensitiveness present in it.
1) What disorder of local blood circulation is the reason of founded clinical
symptoms? _____________________________________________________
2) Explain its pathogenesis.____________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
2. Cyanosis, edema of lower extremities, decrease of extremities skin temperature
were founded at a patient with stenosis of the left atrioventricular foramen.
1) What disorder of peripheral blood circulation was developed?
_____________________________________________________________________
2) Explain its etiology and pathogenesis
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
3. Superior cervical ganglion of rabbit sympathetic trunk was cut in an experiment.
The redness and increase of skin temperature were developed on the side of cutting.
1) Explain, what disorder of peripheral blood circulation developed a t a rabbit?
_____________________________________________________________________
19
2) Reasons, mechanism of development of this violation.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
3) Who reproduced this type of local violation of blood circulation first?
_____________________________________________________________________
4) Explain the mechanisms of basic signs development.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
4. Girl, 5 years old, delivered in a clinic with the burn of right upper extremity.
Objectively: skin of hand in the place of burn of red color, the local increase of
temperature, painfullness are marked.
1) What violation of circulation of blood arised up?
_____________________________________________________________________
2) Explain the mechanism of increase of local temperature ?
________________________________________________________________________
______________________________________________________________________
3) What is the mechanism of skin redness development?
________________________________________________________________________
______________________________________________________________________
5. Plaster bandage was imposed to the patient with the right humeral bone fracture.
Next day the soft-tissue swelling appeared, extremity became cyanotic, the
temperature of the injured hand skin decraesed.
1) What violation of circulation of blood arised up?
______________________________________________________________________
2) Explain the mechanisms of development of the soft-tissues swelling.
________________________________________________________________________
______________________________________________________________________
3) What is the mechanism of skin cyanosis?
________________________________________________________________________
______________________________________________________________________
6. Decrease of skin temperature and its paleness, decrease of the artery pulsation on
the dorsal foot surface, painfulness during a walk were marked at a patient K., 60
years old with the atherosclerotic defeat of lower extremities vesselsl.
1) What violation of circulation of blood arised up?
______________________________________________________________________
2) What is the mechanism of skin paleness development?
________________________________________________________________________
______________________________________________________________________
20
7. The collective farmer sensed the pain in a right eye during the work. Lacrimation
appeared. At the review by the medical assistant the foreign body was discovered in
the corner of eye. Palpebral conjunctiva of red color, vessels dilated. The conjunctiva
of the second eye is also injured but less than opposite.
1) What violation of circulation of blood arised up?
______________________________________________________________________
2) How to explain the red color of conjunctiva?
________________________________________________________________________
______________________________________________________________________
3) Explain the mechanism of vascular changes in the conjunctiva of left and right
eyes?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
8. Group of 2nd course students was inspected by a doctor after autumn cross-country
race. Hyperemia of face skin paid attention at all inspected. A skin had bright red
color, was moisture and hot by touch. Frequency of pulse for all students - 110-150
beats per minute. Breathing frequency -40-60 per minute.
1) What violation of circulation of blood arised up?
______________________________________________________________________
2) Explain the mechanisms of development of this violation.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
9. The diver was dipped on a depth 20 m for implementation of caissons works,
where he was during one hour, and then he was quickly lifted up. In a half of hour
muscles pain was marked, which increased, head pain, syncope, numbness of hands
and feet fingers, disorders of hearing.
1) What is happened with a diver?
______________________________________________________________________
2) What mechanisms of described violations development?
________________________________________________________________________
______________________________________________________________________
3) What should surrounding to do in this case?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
21
10. Alpinists slowly rose on the slope of mountain during 6 hours. With every step,
getting up was given all more heavy. A general weakness, palpitation, shortness of
breath, syncope, head pain, decrease of appetite, meteorism ware marked.
1) What was the direct reason of these disorders at alpinists?
______________________________________________________________________
2) How is this simptom-complex named?
______________________________________________________________________
3) Explain the mechanism of violations development.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
4) At what height were alpinists on approximately?
______________________________________________________________________
5) What value has tachicardia and tachipnoe at this situation, what are the
mechanisms of their development?
________________________________________________________________________
______________________________________________________________________
11. Patient V. was in a surgical clinic with thrombophlebitis of right lower extremity.
After a careless movement the expressed shortness of breath, pain in a thorax,
cyanosis arose up.
1) Are these violations resulted by thrombophlebitis of lower extremity?
______________________________________________________________________
2) In what cases are such consequences of thrombophlebitis possible?
________________________________________________________________________
______________________________________________________________________
3) What did arise up at the patient?
______________________________________________________________________
4) Is localization of complications at this patient casual? Explain.
________________________________________________________________________
________________________________________________________________________
5) Is development of complications of thrombophlebitis possible from the side of
other organs - brain, kidney, spleen?
________________________________________________________________________
_____________________________________________________________________
22
Practical work: “LOCAL DISORDERS OF BLOOD CIRCULATION”
Object of work: to show development of venous and arterial hyperemia and ischemia at
animals (experiment on frogs and rabbit).
Description of experiment: arterial post-anaemic hyperemia is demonstrated at a rabbit
after gripe of central artery of ear and venous hyperemia is demonstrated after gripe of
regional vein of ear.
EXPERIMENT 1. Every brigade of students (2-3 students) narcotize a frog. Stretch a
tongue above opening of small plank and examine under a microscope. Then ligate both
regional veins of tongue and mark under a microscope deceleration of blood stream,
pendular movements of blood and stasis. Sketch macro- and microscopic picture of
preparation.
EXPERIMENT 2. Choose a place in the tongue of frog with few capillaries, veins,
arteries and sketch it. Inflict the drop of warmed-up physiological solution at this place.
Look after the acceleration of blood stream in all vessels, expansion of vessels and
increase of number of capillaries. Sketch the changes of vascular net.
EXPERIMENT 3. Immobilize a frog by destruction of spinal cord. Fix a tongue of frog
above opening of small plank. Examine a normal vascular net under a microscope. Then
inflict the drop of adrenalin solution (1:1000) by a Pasteur’s pipette on a tongue. Look
after the picture of local ischemia, expressed in the vasoconstriction, deceleration of blood
stream and growing pale of tongue. Sketch this picture.
Blood supply at norm
Arterial hyperemia
23
Venous hyperemia
Ischemia
EXPERIMENT 4. The spinal cord of the frog is broken with the probe-needle. The thoracic cavity
is cut. The heart is separated from the pericardium. 0,2ml of lypocodium suspension is carefully
injected in the ventricle. The mesentery of the frog and then the lungs are stretched over the opening
in the board.
Look after the blood stream in the vessels. Observe the changes of the blood movement
and movement of the emboli in the vessels, occlusion of the vessels with the emboli of lypocodium.
EXPERIMENT 5. Another frog is injected 0,2ml of fatty emulsion and air into the cardiac cavity.
The mesentery of the frog and then the lungs are stretched over the opening in the board.
Look after the blood stream in the vessels. Observe the changes of the blood movement
and movement of the emboli in the vessels, occlusion of the vessels with the emboli of fatty
emulsion and air.
Embolism
1 – shots of lycopodium
2 – blebs of air
3 – drops of fat
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
24
Theme: “INFLAMMATION (vascular reactions)”.
Actuality of theme.
Inflammation (infammatio – from Latin) - it is organo-tissue reaction is formatted
in the process of evolution and is developed under the injured action which is
characterized by three components: alteration, exudation and proliferation.
The inflammatory reaction, as a typical pathological process, lies in base of many
diseases of infectious and uninfectious nature.
Knowledges of principal reasons of origin, mechanisms of development,
consequences and external manifestations of inflammatory reaction are needed for timely
and correct diagnostics of diseases of inflammatory character, conducting of rational
pathogenic therapy at different stages of inflammatory process development.
General purpose of the lesson.
To have a clear picture of etiology and pathogenesis of inflammation. To define
the role of mediators in inflammatory reaction development.
For this it is necessary to know (the concrete purposes):
1. To give determination of conception «inflammation».
2. To define reasons which cause an inflammatory reactions.
3. To give description of alteration as inflammatory component.
4. Describe vascular reactions at inflammation, to explain their significance in
inflammatory reaction development.
5. To be able to explain the features of vascular reactions and their value at
inflammation in the neonatal period and early postnatal period for children.
6. To give description of mediators of inflammation, explain their value in
inflammation development.
7. To give description of proliferation, explain its significance in inflammation
development.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Functional parts of bloodstream (Normal Physiology Department).
2. Conception about the microcirculation (Normal Physiology Department).
3. Mechanisms of regulation of blood circulation in capillaries and venules (Normal
Physiology Department)
4. Conception about the role of connecting tissue cells, their structure, main
functions (Histology Department).
5. Concept is about the products of arachidonic acid cascade, kalikrein-kinin system
of blood, complement system (Biochemistry Department).
The checking of primary level of knowledges.
Give the answer to the followings questions:
1. Inflammation, definition.
2. What components is process of inflammation consist of?
3. What is alteration?
25
4.
5.
6.
7.
What are the kinds of alteration?
What is mediator of inflammation?
What mediators of inflammation do you know?
1) name cellular mediators;
2) name plasma mediators;
3) what mediators refer to cytokines?
4) what mediators refer to arachidonic acid cascade?
Vascular reactions which take place in the area of inflammation. Who described
them first?
Test control for the verification of primary level of knowledges:
1. Inflammation – is the reaction on .......?
A. BAS action
B. Pyrogens action
C. Allergens action
D. Damage
E. All answers are right
2. What components is inflammatory process consist of?
A. Exudation, proliferation
B. Damage, renewal
C. Alteration, proliferation
D. Alteration,exudation, proliferation
E. Alteration, necrosis
3. Alteration – is…:
A. An exit of leucocytes from the vessels into the tissues
B. An exit of liquid from the vessels into the tissues
C. Regeneration
D. Fibroplasia
E. Damage
4. Types of alteration:
A. Initial, eventual
B. Primary, secondary
C. Exogenous, endogenous
D. Hereditary, acquired
E. Inherited, purchased
5. Exudation – is…:
A. Damage
B. An exit of liquid, albumens and elements of blood from the vessels into the
tissues
C. Proliferation of cells
D. Fibroplasia
E. Release of biologically active substances
26
6. What mediator from enumerated is the strongest mediator of pain?
A. Interleukin-6
B. Serotonin
C. Prostaglandin E
D. Interleukin- 1
E. Bradikinin
7. Proliferation – is…:
A. Proliferation of cells
B. Damage of cells
S. An exit of cells at the area of inflammation
D. Change of cells
8. What BAS from enumerated refer to biogenic amins:
A. Bradikinin, kalidin
B. Histamin, serotonin
C. Prostaglands, leukotriens
D. Cation proteins
E. Interleukin
9. A man after supercooling had a general weakness, general sweating, increase of
general temperature. In a blood test: leukocytosis, increase of ESR; in the serum of
blood: increase of level of alanine aminotransferase (ALT) and aspartate
aminotransferase (AST). What pathological process at a patient?
A. Hyperthermal syndrome
B. Supercooling
C. Fever
D. Allergy
E. Inflammation
10. During the second component of inflammation takes place:
A. Emigration of leucocytes
B. Damage of cells
C. Release of BAS
D. Proliferation of cells
E. An exit of water, albumens and blood cells into the area of inflammation
11. What substances from the enumerated refer to mediators of inflammation?
A. Keilons
B. Nucleic acids
C. К+, Н+
D. Prostaglandins, kinins
E. Glucocorticoids, somathomedins
27
12. A patient, 16 years old, entered to the surgical department with a diagnosis:
«acute appendicitis». What typical pathological process is at the base of this disease?
А. Fever
В. Hypoxia
С. Inflammation
D. Tumour
Е. Allergy
13. 5 signs of inflammation, which got the name of Celsius - Galen pentalogy
readable declared at a patient with an eczema. Specify, what manifestation from the
enumerated refer to them:
А. Redness
В. Cyanosis
С. Jaundice
D. Pigmentation
Е. Albinism
D
B
1
8
2
9
D
E
3
10
E
E
Correct answers
B
4
5
D
11
12
B
C
6
13
E
A
7
A
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Determination of conception «inflammation».
2. Reasons of inflammation.
3. Basic components of inflammation, their determination.
4. Alteration, kinds, description. Significance for an organism.
5. Role of mediators in inflammatory reaction development.
6. Vascular reactions at inflammation, mechanisms of their development.
Significance for an organism.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 97-106
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.68-70
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011/ - p. 184-197
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. 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
28
(2006-2009)
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 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
4. 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
5. 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
6. Indicate inflammatory mediators which have to be inhibited for decrease in
exudation:
A. Catecholamines
B. Histamine
C. Heparine
D. Thromboxan
E. Interleukine-1
29
7. 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
8. 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
9. 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
10. What inflammatory mediator is formed due to limited proteolysis of plasma
globulins?
A. Histamine
B. Leukotriens
C. Bradykinin
D. Prostaglandins
E. Lymphokines
11. 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
30
12. 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
13. 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
14. The secondary alteration is caused by:
A. Lysosomal enzymes
B. Kinins
C. Lympokynes
D. Prostaglandins
E. Complement components C3a and C5a
15. 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
16. 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
1
9
A
C
2
10
D
C
3
11
B
B
Correct answers
4
B
5
A
12 A
13 A
31
6
14
B
A
7
15
D
E
8
16
E
A
Situate task:
1. Plaster bandage was imposed to the patient with the right humeral bone fracture.
Next day the soft-tissue swelling appeared, extremity became cyanotic, the
temperature of the injured hand skin decraesed.
1) What violation of circulation of blood arised up?
_____________________________________________________________________
2) Explain the mechanisms of development of the soft-tissues swelling.
________________________________________________________________________
______________________________________________________________________
3) Explain the decreasing of temperature of the injured hand skin?
________________________________________________________________________
______________________________________________________________________
4) What is the mechanism of cyanosis development?
________________________________________________________________________
______________________________________________________________________
2. Redness of damaged area, local disorder of temperature, feelings of pain appeared
as a result of burn of lower extremity at a woman.
1) What disorder of blood circulation arised up at a patient?
______________________________________________________________________
2) Explain the mechanism of redness of extremity.
________________________________________________________________________
______________________________________________________________________
3) Explain the mechanism of temperature increasing.
________________________________________________________________________
______________________________________________________________________
3. Necrosis focus arised at the area of hyperemia and edema of skin at a patient in a
few hours after a burn.
1) What is the leading mechanism provides strengthening of the destructive
phenomena in the area of inflammation?
______________________________________________________________________
2) Explain the mechanisms of necrosis origin.
________________________________________________________________________
______________________________________________________________________
3) Explain the mechanisms of edema origin.
________________________________________________________________________
______________________________________________________________________
32
Practical work: “THE INFLAMMATION (vascular reactions)”
Object of work: to demonstrate die development of some phases of vascular reactions in
inflammation.
EXPERIMENT 1. Kongeim’s test.
Break the frog's spinal cord and fix the frog on the cork board. Make a small skin
lateral incision of the frogs abdomen, cut the abdominal cavity, pull the loop of the small
intestine, straiten the mesentery over the opening in the board and fix the loop with the
pins. The stretching and drying of the mesentery are the factors causing the
inflammation. Increase the inflammation put a crystal of NaCl on the mesentery.
Study under the microscope the development of the main vascular reactions in
the inflammation (change in the blood stream rate, change of the vascular lumen, lateral
arrangement of the leucocytes and their emigration). Draw the vascular reaction.
Vessel lumen
1 - margination;
2 - passing of leucocytes through a vascular wall;
3 - accumulation of leucocytes in the hearth of inflammation
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
33
EXPERIMENT 2. Break the frog's spinal cord, fix the frog on the board with its belly
down. Stretch its tongue, touch it with a crystal of azitro-aeid argentum and study it under
the microscope
The damaged site is in the state of coagulation necrosis. Around it one can see
the field of vessels with complete stasis and in some places with the diapedesis of the
erythrocytes. Far from the necrotic focus one can see the field of the dilated vessels with
slow-blood stream, lateral stasis and emigration of leucocytes. Farther from the necrotic
site one can observe the belt of vessels in the stage of active hyperemia and normal blood
stream. The vascular belts may be arranged in other succession.
Draw the microscopic picture. Write down the results of the experiment.
1 - coagulation necrosis;
2- reflex spasm of arterioles;
3- arterial hyperemia;
4- venous hyperemia;
5- stasis;
6- normal blood circulation.
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
34
Theme: INFLAMMATION (PUS ENZYMES).
Actuality of theme.
Processes of exudation and emigration of leucocytes, phagocytic function of
leucocytes are key moments in inflammatory reaction development, that determine its
biological maintenance and value as the evolutional produced standard reaction of
organism on a damage.
Ability to estimate character of exudate, its cellular composition, physical and
chemical and biological properties helps to a doctor not only to decide a question about
etiology of this process, but also correctly to appoint the treatment, assume possible
consequences. The study of fermental activity of exudate gives the ability to conclude the
state of nonspecific mechanisms of organism reactivity, in particular, cellular immunity.
General purpose of the lesson.
To have a knowledge about the mechanisms of exudation and proliferation us
components of inflammation.
For this it is necessary to know (the concrete purposes):
To give determination of conception "exudation".
To expose the basic mechanisms of exudation, explain the value of this
component of inflammation.
3. To define the types of exudates.
4. To explain the change of metabolism, physical and chemical violations at the area
of inflammation.
5. To describe proliferation, to define the value of this component of inflammation
for an organism.
1.
2.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Structure of capillary wall (Histology Department).
2. Phagocytes. Kinds (Histology Department).
3. Mechanisms of phagocytosis (Biology Department).
4. Cells of connecting tissue, their basic functions (Histology Department).
1.
2.
3.
4.
5.
6.
7.
8.
9.
The checking of primary level of knowledges.
Give an answer to the followings questions:
Exudation, definition.
What form of cells first emigrate into the area of inflammation?
What is exudate?
What is transsudate?
What is emigration of leucocytes?
What types of exudate do you know?
Proliferation, definition.
Local manifestations of inflammation.
General manifestations of inflammation:
35
Standards of answers at the theoretical questions of initial level of
knowledges:
1. Exudation- it is an exit of liquid and components of blood plasma dissolved in it
from the vessels of bloods into the area of inflammation.
2. Neutrophils
3. Exudate - is the inflammatory irritant fluid.
4. Transsudate – is the uninflammatory irritant fluid
5. Emigration - it is an exit of leucocytes from the vessels into the area of
inflammation.
6. Serous, catarrhal, fibrinous (croupous and diphtheritic), purulent, hemorrhagic,
saprogenic.
7. Proliferation – is the proliferation of cells.
8. Redness (rubor), increase of temperature (calor), swelling (tumor), pain (dolor),
disorders of function (functio laesa).
9. Fever, leukocytosis, changes of leukocytic formula, increase of «albumens of
acute phase of inflammation» in the blood, acceleration of ESR, intoxication.
Test control is for verification of primary level of knowledges:
1. What signs testify the presence of inflammatory process in an organism?
A. Hyperproteinemia
B. Thrombosis, ↑ ESR, fever
C. Erythrocytosis, ↑ ESR
D. Fever, leukopenia, ↓ ESR
E. Leukocytosis, ↑ ESR, fever
2. Exudation - is:
A. Damage of cells
B. An exit of liquid and components of blood plasma dissolved in it from the
vessels into the area of inflammation
C. Regeneration of cells
D. Transition of liquid from the tissues into the vessels
E. Reproduction of cells
3. To the molecules of intercellular adhesion belong:
A. Leukotrienes
B. Interleukin-1, 6, TNF
C. Selektines, integrines
D. IgA, IgE, IgM
E. Lysosomal enzymes
4. Proliferation - is… :
A. Destruction of cells
B. Damage of cells
C. Exit of cells into the area of inflammation
D. Reproduction of cells
E. Accumulation of exudate
36
5. Specify, in what sequence is emigration of leucocytes into the area of
inflammation:
A. Monocytes, neutrophiles, lymphocytes
B. Lymphocytes, monocytes, neutrophiles
C. Neutrophiles, monocytes, lymphocytes
D. Neutrophiles, eosinophil, lymphocytes
E. 6. During the second component of inflammation takes place:
A. Exit of water, albumens and blood cells into the area of inflammation
B. Damage of cells
C. Release of BAS
D. Reproduction of cells
E. Emigration of leukocytes
7. Name the common manifestations of inflammation:
A. General weakness, fatigue ability
B. Tumor, rubor, calor, dolor, functio laesa.
C. Cyanosis, swelling, edema
D. Leukocytosis, fever, ↑ of C-reactive protein in the blood
E. 8. What is the base of the local manifestation of inflammation - rubor?
A. Alteration
B. Exudation
C. Proliferation
D. Arterial hyperemia
E. Venous hyperemia
9. What is the base of the local manifestation of inflammation - tumor?
A. Alteration
B. Exudation
C. Proliferation
D. Formation of tumour
E. All answers are right
10. Exudate of next composition: albumen 4%(in a norm to 1,5%), a lot of cells,
neutrophiles prevail – was got from a pleura cavity at a patient. Name the type of
exudate.
A. Purulent
B. Hemorrhagic
S. Serous
D. Fibrinous
E. Catarrhal
37
1
E
2
B
3
C
4
D
Correct answers
C 6
A
5
7
D
8
D
9
B
10
A
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Exudation, determination of conception.
2. Mechanisms of exudation.
3. Types of exudate. Difference of exudate from transsudate.
4. Changes of metabolism, physical and chemical violations at the area of
inflammation.
5. Significance of exudation for an organism.
6. Proliferation, determination of conception. Mechanisms of proliferation.
Significance for an organism
7. Significance of inflammatory reactions for an organism.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 106-112
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.70-78
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p. 197-208
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. 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
2. Gout is often associated with increasing and deformation of the joints. What type
of inflammation is at the base of these changes?
A. Proliferative
B. Alternative
C. Exudative
D. Fibrinous
E. Mixed
38
3. Youth, 17 years old, became ill sharply. The body temperature rose to 38,5 0С, the
cough, nasal catarrh, lacrimation, nasal effluent appeared. What kind of
inflammation developed at the youth?
A. Purulent
B. Catarrhal
C. Hemorragic
D. Fibrinous
E. Serous
4. The growing of "acute phase" proteins is characteristic for the inflammatory
processes. What substances are the stimulants of their synthesis?
A. Angiotensin II
B. Immunoglobulins
C. Interferons
D. Biogenic amines
E. Interleukin 1
(2006-2009)
5. A patient with inflammation of a forefinger has acute pain, edema, enlargement of
local lymph nodes, temperature rising to 38,5 oC. 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
6. 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
7. An 8-year-old child was admitted to the infectious department with fever (up
to 38°C) and punctuate bright-red skin rash. The child was diagnosed as having
scarlet fever. Objectively: mucous membrane of pharynx is apparently hyperaemic
and edematic, the tonsils are enlarged and have dull yellowish-grey foci with some
black areas. What inflammation is the reason for the pharynx alterations?
A. Haemorrhagic
B. Serous
C. Purulent necrotic
D. Catarrhal
E. Fibrinous
39
8. 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
9. 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
10. 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
11. 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
12. 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
40
13. 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
14. 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
15. 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, .......... , proliferation. What is the second one?
A. Exudation
B. Regeneration
C. Reparation
D. Fibrosis
E. Petrification
16. The woman, 30 years old, is ill about year, when pain soft-tissues swelling,
redness of skin appeared in the area of joints first time. Previous diagnosis is
rheumatoid arthritis. Changing of what component of connecting tissue protein
structure is one of reasons of this disease?
A. Collagen
B. Ovoalbumin
C. Mucin
D. Myosin
E. Troponin
18. At patient, 38 years old, rheumatism is in an active phase. Determination of what
blood serum laboratory index has a diagnostic value at this pathology?
A. Urea
B. Transferrin
C. C-reactive protein
D. Uric acid
E. Creatinine
1
10
D
B
2
11
A
A
3
12
B
A
4
13
Correct answers
E 5
E 6
A 14 A 15
41
D
A
7
16
C
A
8
17
C
C
9
D
Situate task:
1. Puncture of pleural cavity was done to a patient. Exudate of the following
composition: protein - 4,8%, leucocytes - 6200/mcl, mainly neutrophiles, a lot of
damaged and un damaged cells, pH - 5,4 – was got.
1) Name the type of exudate.
______________________________________________________________________
2) Explain the mechanisms of its development in a pleural cavity.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
3) Expose the positive and negative value of exudate.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4) What is the difference of exudate from transsudate?
________________________________________________________________________
_____________________________________________________________________
5) What value has research of its composition?
______________________________________________________________________
2. Patient A, 36 years old, suffers of maxillary sinus mucus inflammation more than a
year. The common state was worsened during the last two weeks. The body
temperature range of 37,5 - 38,50С, headache increased, breathing through a nose
became todiscomfort. Nasal mucus was red and swollen. From the side of blood:
neutrophile leukotsitosis and acceleration of ESR.
1) What type of inflammation developed at the patient?
_____________________________________________________________________
2) What are the mechanisms of common manifestation of inflammation
development?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
5. Boy Y.,13 years old, applied to the doctor concerning a furuncle of right cheek. He
suffered of pain at mastication, headache, increase of temperature. Infiltration was
palpated by the size of a hazelnut at the center of cheek. The skin at the periphery of
infiltration is red and cyanotic at the center.
1) What type of inflammation developed at a patient?
______________________________________________________________________
2) How to explain the different colouring of skin at the staggered area?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
42
Practical work: “THE INFLAMMATION (pus enzyme)”.
Object of work: to acquaint the students with the methodic of determination of the
subtitles of amylolytic enzymes of pus.
Summary; to determine the enzymic special features of pus the serum of pus is prepared.
For this purpose the pus exudate is centrifuged, the upper layer is
aspirated, and diluted with the physiological solution in 10 times.
The amylolytic adaptability of the pus is determined by the following way: prepare several
test - tubes (8) with the main solution of pus serum. Pour 1 ml of the physiologic solution
into each test - tube except the first one
Pour 1 ml of pus serum into the first test - tube. Pour 1 ml of pus serum into the
second one and mix it with 1ml of the physiologic solution; pour 1 ml of mixture from the
second test - tube into the third-one, from the third one into the fourth one and so on to
the end. Pour 1 ml of mixture out of the 8th test - tube. In such a way we get a number of
dilutions of the serum of the pus 1:10,1:20, 1:40 and so on. Add to each dilution 5 ml of
starch 1:1000 and put the test - tube rack into the thermostat for 30 min. The stark is
decomposed under the influence of the amylolytic enzymes passing the stages of the
formation of erythro - and achrodextrins. Lughole’s iodine solution is an indicator of stark
decomposition. The latter acts with not decomposed stark -a blue staining, with
erythrodextrin - a red one and with achrodextrin - a yellow staining.
For example, if a red staining is obtained in the 6th test-tube it means that the
enzyme titer is 1.320 as 1 ml of serum in the dilution 1 : 320 decomposes 5 ml of stark in
the dilution 1:1000 for 30 min before erythrodextrins.
1:10
1:20
1:40
1:80
1:160
1:320
1:640
1:1280
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
43
Theme: «DISORDERS OF THERMAL HOMEOSTASIS. FEVER».
Actuality of theme.
Disorders of thermal homeostasis often enough meet in everyday life of man. For
example, a fever accompanies the different diseases of infectious and uninfectious nature.
A study of etiology and pathogenesis of this typical pathological process is necessary and
important for the doctor of any profession.
Knowledge of reasons and mechanisms of fever development will allow to develop
rational approaches to pathogenetic treatment of fever. Extraordinarily important in doctor
practice is using of pyrotherapy.
A study in an experiment with the poikilotherm and homoitherm animals of
thermal homeostasis violations allows to understand the difference for them thermal
exchange, and mechanism of fever development for at homoitherm animals and human.
Except for a fever, take place and other violations of thermal homeostasis, such as
an overheat (physical hyperthermia), hyperthermal syndrome. Knowledge of reasons and
mechanisms of their development will allow correctly to conduct differential diagnostics
between the different types of thermal homeostasis violations, which will allow to choose
faithful medical tactic.
General purpose of the lesson.
Students must know etiology, mechanisms of development of such violations of
heat exchange as fever, overheat, hyperthermal syndrome.
For this it is necessary to know (the concrete purposes):
1. To define the conception of basic heat exchange violations.
2. To define a difference between an overheat, fever and hyperthermal syndrome.
3. To expose the changes of metabolism and functions of organism at a fever.
4. Base the value of heat exchange violations.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. To know the structure of heat-regulating center and its functioning (Normal
Physiology Department);
2. To expose the mechanisms of heat exchange in a norm (Normal Physiology
Department);
3. To explain the mechanisms of heat production and ways of heat loss (Normal
Physiology Department).
1.
2.
3.
4.
5.
6.
The checking of primary level of knowledges.
Give the answers at following questions:
Localization of heat-regulating center.
What groups of neurons does heat-regulating center consist of?
Basic types of thermal homeostasis violations.
Factors which cause a fever.
Types of pyrogens according to origin.
Types of pyrogens according to the mechanism of development.
44
7.
8.
9.
10.
Primary pyrogens.
Secondary pyrogens.
Stages of fever.
What correlation of heat production and heat loss processes is at the 1 st stage of
fever:
A) heat production high than heat loss
B) heat production less than heat loss
C) heat production equal to heat loss
11. What correlation of heat production and heat loss processes is at the 2nd stage of
fever:
А) heat production high than heat loss
B) heat production less than heat loss
C) heat production equal to heat loss
12. What correlation of heat production and heat loss processes is at the 3 rd stage of
fever:
А) heat production high than heat loss
B) heat production less than heat loss
C) heat production equal to heat loss
13. How is the rapid decrease of temperature in 3 rd stages of fever named?
14. How is the slow decrease of temperature in 3 rd stages of fever named?
15. How is the graphic image of day temperature fluctuations in 2 nd stages of fever
named?
16. What is the base of temperature curve?
17. Types of temperature curves.
18. Organ at human which makes the highest heat production is:
A. Brain
В. Heart
С. Kidney
D. Liver
Е. Splien
Standards of answers at the theoretical questions of initial level of
knowledges:
1. medulla oblongata;
2. central, peripheral, standard neurons;
3. a) fever;
b) overheat (physical hyperthermia);
c) hyperthermal syndrome;
d) supercooling;
4. pyrogens;
5. a) exogenous
b) endogenous
6. a) primary
b) secondary
7. exo- and endogenous pyrogens by origin
8. a) interleukini-1, 6;
b) TNF;
45
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
c) -interferon;
a) increase of temperature;
b) standing of temperature at one level;
c) decrease of temperature;
А
C
B
critical;
lytic (lysis);
temperature curve;
graphic image of day temperature fluctuations;
febris continua, febris remittens, febris intermittens, febris recurrens, febris
hectica, febris undulans, febris atypica, febris inversa, febris ephemera;
D.
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Classification of thermal exchange violations.
2. Fever, determination of conception.
3. Etiology of fever. Description of pyrogens.
4. Mechanisms of fever development.
5. Metabolic and functions disturbance of different organs at the fever.
6. Significance of fever is for an organism. Using of pyrogens in the medical
practice.
7. Overheat of organism. Reasons and mechanisms of development. Difference
from fever. Heat stroke.
8. Hyperthermal syndrome, determination of conception. Reasons, mechanisms of
development. Description.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 122-129
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.78-90
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p. 257-280
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. At the patients with relapsing fever occurs fever that is characterized by periods of
several days of high temperatures, alternating with periods of normal temperature.
This temperature curve is called:
A. Febris recurrens
B. Febris hectica
C. Febris intermittens
D. Febris continua
E. Febris atypica
46
2. Body temperature at the patient with an infection disease was increased to a day
39,5-40,50C and has been kept at this altitude about an hour and then returned to
baseline. What type of temperature curve described in this case?
A. Remittent
B. Constant
C. Intermittens
D. Hectica
E. Atypical
3. Body temperature at the patient with an infection disease was increased to a day
39,5-40,50C and has been kept at this altitude about an hour and then returned to
baseline. At which disease does this type of temperature curve occur?
A. Malaria
B. Tuberculosis
C. Influenza
D Peritonitis
E. Brutselosis
4. Woman came to hospital with a diagnosis of acute pneumonia. She is ill during last
2 days when the body temperature rised up to 39 0C and she fell the weakness, dry
cough. Which of the mediators of inflammation has the properties of endogenous
pyrogens?
A. Interleukin 1
B. Thromboxane A2
C. Histamine
D. Serotonin
E. Bradykinin
5. A patient with the pneumonia lungs has an increase of body temperature. What
biologically active substance plays the main role in the origin of this manifestation?
A. Interleukin -І
B. Serotonin
C. Bradykinin
D. Histamine
E. leukotriene
6. 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
47
7. After transfusion of 200 ml of blood a patient presented with body temperature
rise up to 37,9°C. Which of the following substances is the most likely cause of
temperature rise?
A. Intcrleukin-4
B. Interleukin-2
C. Tumour necrosis factor
D. Interleukin-3
E. Interleukin-l
8. The body temperature of the patient suddenly rose up to 39 ⁰C in the afternoon
and after 6 hours returned to normal. On the second day attack doubled:
temperature climbed to 41⁰C and period apyrexia stepped after 8 hours. Name the
type of temperature curve.
A. Intermitting
B. Recurent
C. Hectic
D. Septic
E. Constant
9. The body temperature of a patient rose up to 390C after long finding the sun with
high humidity of air. What pathological process does observe in this case?
A. Hyperthermia.
B. Infectious fever.
C. Hypothermia.
D. Noninfectious fever.
E. Burn disease.
(2006-2009)
10. 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%
11. 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
48
12. 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
13. 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
14. 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
15. 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
16. 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
49
17. Inclination of the set point of thermoregulation to higher level due to action of IL1 is in a patient. What is the name of this typical pathological process?
A. Fever
B. Hyperthermia
C. Hypothermia
D. Inflammation
E. Hypoxia
18. 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
0
C during 9 days. Which type of the fever curves was that?
A. Continua
B. Hectica
C. Intermittent
D. Hyperpyretic
E. Reccurens
19. 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
20. The body temperature of a patient with pneumonia was keeping on the level 38.338.5 0C all the first week of disease. Such fever is called:
A. Febrile
B. Hyperpyretic
C. Pyretic
D. Subfebrile
21. Increase of “acute phase” proteins level in blood such as ceruloplasmin,
fibrinogen, C-reactive 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
50
22. 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 loss
D. Increase of heat production
E. Heat production is equal heat loss
23. 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
24. 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
25. After blood trasfusion patient complaints feeling of heat, rigor, increase of body
temperature to +400C. It’s 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
26. 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
51
27. 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
28. 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
29. 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
30. The temperature of the ambient environment is 38°C and relative air humidity is
50%. What ways of heat emission provide maintaining a constant temperature of the
human body?
A. Convection
B. Radiation
C. Evaporation
D. Convection and conduction
E. Heat conduction
1
11
21
A
C
A
2
12
22
A
A
D
3
13
23
A
B
E
4
14
24
A
E
C
Correct answers
5
A 6
B
15 A 16 C
25 E 26 A
52
7
17
27
E
A
B
8
18
28
A
A
B
9
19
29
A
A
E
10
20
30
E
A
C
Situate task:
1. The pale, dry skin, chill, gooseflesh arised at patient after introduction of
pyrogenal.
1) Name the period of fever.
______________________________________________________________________
2) How to explain the mechanisms of thermoregulatory center alteration in this
stage.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Increase of temperature of body to 39,5 0С arised at patient with pneumonia. Red
moist skin arised after conducting of febrifuge therapy.
1) Name the period of fever.
______________________________________________________________________
2) How to explain the mechanisms of thermoregulatory center alteration in this
stage.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. Patient S., 48 years old, was hospitalized in a surgical department concerning
planned cholecystectomy. Anaesthetist marked expressed tachycardia to - 200 bit per
minute during conducting of inhalation anesthesia with myorelaxants,. Temperature
of body - 43,10 C.
1) What violation of thermoregulation developed at this patient?
______________________________________________________________________
2) Name the reasons, mechanisms of development and consequences.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
4. Patient K., 25 years old, hospitalized in a surgical department concerning acute
appendicitis. Anaesthetist marked expressed tachycardia to - 200 bit per minute
during conducting of inhalation anesthesia with myorelaxants. Temperature of body
- 43,20 C.
1) What violation of thermoregulation developed at this patient?
______________________________________________________________________
2) Name the differences of this thermoregulatory violation from other existent
violations.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
53
5. Anaesthetist marked expressed tachycardia to - 200 bit per minute during
conducting of inhalation anesthesia with myorelaxants at operation concerning
strangulated hernia. Temperature of body - 43,30 C.
1) What violation of thermoregulation developed at this patient?
_________________________________________________________________
2) Name the reasons, mechanisms of development and consequences of this
violation of thermoregulation.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Algorithm of practical skills: "Differentiation of temperature curves"
Types of fever according to the temperature curves:
1. Constant type
4. Hectic type
2. Aperient type
5. Reverse type
3. Intermittent type
6. Relapsing type
54
7. Undulating type
8. Irregular type
I. Features of the temperature curve.
1. Febris continua: the difference between morning and evening body temperature
ranges between 0,5-1,0 º C.
2. Febris remitens: the difference between morning and evening body temperature
ranges between 1,0-2,0 º C, morning body temperature falls below 38 º C, but not
reduced to normal levels.
3. Febris intermittens: there is a periodic, approximately at regular intervals (1 to 3
days) acute increasing of body temperature (usually in the afternoon, sometimes
at night) for several hours with next its decline to normal levels.
4. Febris hectica: continued fever with daily fluctuations of temperature 4,0-5,0 º C,
with fever to 40,0-41,0 º C at night and its drop to subfebrile and normal values at
morning.
5. Febris inversa: the maximal temperature is observed in the morning, at night it drops
to normal or subfebrile values.
6. Febris recurrent: several days of alternating periods with next several days of
apyretic (apyrexia).
7. Febris undulans: there is a gradual increase of body temperature with next litical
decline of it and more or less long apyretic period.
8. Febris atypica: there is an uncertain duration of the wrong variety and daily
fluctuations of body temperature as a constant, hectic, intermittent, recurrent, and
other curves and combinations of it.
II. Type of temperature curve in English and Latin.
1. Constant (continuous) type: febris continua
2. Aperient (remittent) type: febris remittens
3. Intermittent type: febris intermittens
4. Hectic type: febris hectica
5. Reverse (inverted) type: febris inversa
6. Relapsing (recurrent) type: febris recurrens
7. Undulating type: febris undulans
8. Irregular (atypical) type: febris atipica
III. What disease this type of temperature curve is characteristic for?
1. Febris continua: membranous pneumonia, rheumatism.
2. Febris remitens: purulent inflammation, focal pneumonia.
3. Febris intermittens: malaria.
4. Febris hectica: sepsis, active pulmonary tuberculosis with disintegration of lung
tissue.
5. Febris inversa: sepsis, severe pulmonary tuberculosis.
6. Febris reccurent: relapsing fever.
7. Febris undulans: lymphogranulomatosis, brucellosis.
8. Febris atypica: chronic bronchitis, cholecystitis.
55
Practical work: “HEAT EXCHANGE DISODERS”.
Object of work: to study the thermoregulation and common reaction of the coldblooded and warm-blooded animals at overheating; To take
the temperature in the oral cavity of a frog and to compare it
to the temperature of the air and water.
EXPERIMENT 1. Put a frog into the glass and place it on a water-bath. Take the t°C
of the water in the glass pot gradually rising it up to 40°C. Note the stage of the
excitement and the pose at hyperthermia.
Take the frog out of the glass pot and again to take the temperature in the oral
cavity. Study the common behavior of the frog. Count the respiratory rate before the
overheating and at the movement of the overheating up to 40°C. Then gradually cool
the frog. Write down the results of the experiment. Make the conclusions.
№
Temperature of Temperature
water, °C
frog, °C
of Behavior of the frog
1
2
3
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EXPERIMENT 2. Take the temperature in the floor of the auricle of a rabbit. Put
the rabbit in to the thermostat and rise up the temperature to 42°C. Study the changes
of the temperature of the rabbit's body and its common reaction at the overheating.
Initial level of temperature - ______°C.
Initial respiratory rate - ______in min.
Temperature of the rabbit after the overheating - ______°C.
Respiratory rate after the overheating - _______in min.
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EXPERIMENT 3 Brake the frog's spinal cord. Fix the frog on the board, cut the thoracic
cavity. Grasp the apex of the heart with a cerfine connected with the myograph. Record
with the kymograph the curve of the heart contractions at the effect (under the influence)
of Ringer's solution of different t° 25, 30, 40, 50, 60, 70, 80 and so on up to the heart
failure.
56
Ringer's solution temperature, °C
Heart biting rate, in min.
Conclusion:_____________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
EXPERIMENT 4. The students study available records of respiration of different
animals: guinea - pigs, rabbits, cats
Conclusion:______________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
57
Theme: «PATHOLOGY OF TISSUE GROWTH. TUMOURS».
Actuality of theme.
By the prognoses of Worldwide health protection organization morbidity and
death rate from oncologic diseases in the whole world will grow in 2 times for period
from 1999 year for 2020: from 10 to the 20 million new cases and from 6 to the 12
million registered deaths.
Taking into account that in the developed countries there is a tendency to
deceleration of growth of morbidity and death rate from malignant tumours (due to the
prophylaxis and due to the improvement of early diagnostics and treatment), clearly, that a
basic increase will be at developing countries (countries of former USSR). That is why
doctors have to expect serious increase of morbidity and death rate from oncopathology.
From data of Committee of cancer prophylaxis 90% tumours are related to
influencing of external factors, and 10% - depend on genetic factors.
That is why it is necessary for future specialist to know etiological factors and «
risk factors» of tumours origin. Taking into account that tumours appear at the different
age, race, sex people understanding of carcinogenesis and metastasis mechanisms and
differences of innocent tumours from malignant are necessary for the doctor of any
profession.
General purpose of the lesson.
To learn reasons, mechanisms of development, biological features of tumour
growth.
1.
2.
3.
4.
5.
For this it is necessary to know (the concrete purposes):
To know determination of conceptions " hypertrophy", " hyperplasia ",
"regeneration", "atrophy", "dystrophy", "tumour".
To know the features of innocent and malignant tumours growth.
To describe principal reasons of tumour growth.
To be able to explain the mechanisms of transformation of normal cell in a
tumour one.
To know general principles of patients treatment with malignant tumours.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. To know the structure of cell (Histology Department).
2. To know the mechanisms of cell division (Biology and Hystology Departments).
3. To know principles of metabolism (albumen, carbohydrate, fatty) (Biochemestry
Department).
4. To have imagination about DNA- and RNA-contained viruses (Microbiology
department).
5. Conception about structure, functions and gene regulation (Biology department).
58
The checking of primary level of knowledges.
Give answers to the followings questions:
1. Tumour, definition.
2. What carcinogenic substances do you know?
3. What carcinogens refer to the physical (make examples)?
4. What carcinogens refer to the chemical (make examples)?
5. What carcinogens refer to the biological (make examples)?
6. What characteristic of tumours properties do you know (transfer).
7. Stages of tumours development.
8. What is Heyflik’s limit (barrier)?
9. What is immortalisation?
10. What is apoptosis?
11. What the transformation mechanisms do you do know (transfer)?
12. What is proto-oncogene?
13. What is dedifferentiation?
14. What is antigen simplification?
15. What is the Pasteur’s negative effect?
Standards of answers at the theoretical questions of initial level of
knowledges:
1. Tumour - is the typical pathological process, which is characterized by
unregulated limitless cells and tissues growth which is unconnected with a
general structure and function of the damaged organ.
2. Physical, chemical, biological carcinogens, endogenous
3. Physical carcinogens (ionizing radiation, ultraviolet, infra-red radiation,
mechanical influence).
4. Chemical carcinogens:
exogenous - organic (multiring hydrocarbon - benzyl, 3,4- benzpyrene,
methylholantren), aromatic amine and amide (b-naphtylamine, benzidine,
dimethylaminoazobenzene), nitrosamines, which appear in a stomach from
nitrites and amines in the presence of HCl (diethylnitrosamine,
dimethylnitrosurea, threemethylnitrosurea), aflatoxinы from Aspergillus flavum
and sterigmatoсistin from Aspergsllus nidulans, other - uretan, CCl4, epoxideы,
plastics, peroxides) and inorganic (chrome, arsenic, cobalt, nickel, beryllium,
lead, cadmium);
endogenous (follicle-stimulating hormone, sexl hormones; phenylalanine
tryptophan, tyrosine, indole derivatives; free radicals and peroxides, bile acids,
cholesterol, vit.В12, nicotine acid).
5. Biological carcinogens: RNA- (viruses of mouse and chickens leukemia, Rous
sarcoma, Bittner's virus, and others; for a human - the retrovirus was selected
from the leukemia cells - HTLV (Human T- Lymphoma Virus), that causes Тcellular), DNA - contained viruses (papova - viruses, adenoviruses, viruses (the
of Epstein - Barr virus which result of Burkett’s lymphoma development) of
herpes, hepadnavirus - is a virus of hepatitis causes the cancer of liver), human
papilloma virus (neck of uterus cancer).
59
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Anaplasia, metaplasia, displasia, invasive growth, metastasis.
Initiation, promotion, progression.
Heyflik’s limit - it the maximal amount of cell divisions, which is genetically
programmed. It is different for every cells type. For fibroblasts, for example, it is
divisions.
Immortalisation - is the phenomenon, when cells can be divided long time
without signs of senescence.
Apoptosis - is programed self-destruction of cells which is characterized by
activating of anlyzosomal endogenous endonucleas, which divides nuclear DNA
on little fragments.
Mechanisms of transformation - mutational, epigenomic.
Protoonkogenes - are normal cellular genes which are able at violation of their
structure to induce tumour growth.
Dediferentiation or anaplasia - is getting by the tumours cells of properties
characteristic for the embryo stage of organism development.
Antigen simplification is a loss of own antigens (declines of organo-specifity,
individualities) and appearance of new tumour-embryos antigens (returning to the
embryo state).
Pasteur’s negative effect - is disintegration of carbohydrates to pyruvate and
transformation of it on lactic acid in aerobic conditions.
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Tumour, determination. Morphological, biochemical and physiological features
of of tumours cells.
2. Reasons of tumours origin.
3. Basic mechanisms of carcinogenesis.
4. Description of tumour progression.
5. Ways and terms of tumour cells metastasis.
6. Co-operation of tumour and organism. Mechanisms of cancer cachexy.
7. Experimental study of tumours etiology and pathogenesis.
8. Pathophysiological bases of tumours prophylaxis and treatment.
9. Tumours at children.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 130-138
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.105-114
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p. 166-183
1.
60
Testing according system “Krok-I”
Tests of an open database (2010)
1. Lung cancer developed at the patient who smoked tobacco for a long time. What of
the carcinogens contained in tobacco smoke and concern to PAH?
A. Benzpiren
B. Dymethylaminoazobenzol
C. β - naphthylamin
D. Diethylnitrozamin
E. Ortoaminoazotoluol
2. 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
3. Patient, 62 years old, a fireman, complains of general weakness, sudden weight
loss, husky voice, shortness of breathing, dry cough. Laryngeal tumor that germinates
vocal cords and epiglottis was discovered at laryngoscopy. Name the most likely
cause of the tumor in this patient:
A. Polycyclic aromatic hydrocarbons
B. Nitrosamines
C. Aromatic amine and amides
D. Retrovirus
E. Ionizing radiation
(2006-2009)
4. 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
61
5. 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 37.2 oC; 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
6. 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
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. 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
9. 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
62
10. 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
11. What biological process augmentation is typical for tumor cells?
A. Anaerobic glycolysis
B. Decarboxilation
C. Tissue respiration
D. Lipolysis
E. Gluconeogenesis
12. Erlich’s tumor was transplanted to animal. What is the evidence of tumor
progression?
A. Unlimited growth
B. Resistance to cytostatics
C. Anaplasia
D. Infiltration
E. Tumor weight increasing
13. 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
14. 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
15. What cell structure is a «target» for chemical cancerogens?
A. Nuclear DNA
B. Lysosomes
C. Mitochondria
D. Cytoplasmic membrane
E. Ribosomes
63
16. 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
17. 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
18. 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
19. 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
20. 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
1
11
A
A
2
12
A
B
3
13
A
D
4
14
C
C
Correct answers
5
A 6
A
15 A 16 A
64
7
17
A
A
8
18
B
A
9
19
D
A
10
20
A
A
Situate task:
1. Man, 65 years old, who were smoking during 35, signs the decrease of appetite,
weight loss, dry cough, shortness of breath, decrease of capacity during last few
months. At an inspection: anaemia, leucocytes - 10,5x10 9 /l, methamielocytes-3%,
stab neutrophiles -9%, segmentonuclear neutrophiles-61%, lymphocytes-17%,
monocytes -10%, ESR - 21 mm/hour. The orbed darkening in the area of right
bronchial tube with the diameter of 2sm was discovered at X-ray examination.
1) What kind of pathology was diagnosed at patient?
_____________________________________________________________________
2) Possible etiologic factors of this pathology.
________________________________________________________________________
_____________________________________________________________________
2. Man, 49 years old, was on a clinical account concerning ulcerous illness of stomach
during 25 years. Tumular formation of small curvature of stomach was founded at
the duty fibrogastroscopy review. Cancer of stomach was diagnosed after cytological
examination.
1) Tumor, definition.
________________________________________________________________________
_____________________________________________________________________
2) What is the mechanism of this tumour development?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
3. Woman, 53 years old, complain of the periodic uterine bleeding and general
weakness at the gynecologist reception. Fibromyoma of uterus was diagnosed after
careful inspection.
1) Tumor, definition.
________________________________________________________________________
______________________________________________________________________
2) Basic differences of benigh tumour from malignant.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. Man, 57 years old, complain of acute weight loss on 15 kg during last 8 months,
general weakness, decrease of appetite. Cancer of stomach was diagnosed after
careful inspection.
1) Tumor, definition.
________________________________________________________________________
_____________________________________________________________________
65
2) Basic mechanisms of cancer cachexy development.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
_____________________________________________________________________
5. Patient K., 50 years old, was operated concerning the cancer of thyroid gland.
Adjacent lymph nodes were removed also by a doctor during operation.
1) Why the lymph nods were remote?
_____________________________________________________________________
2) Mechanisms of malignant tumours metastasis?
________________________________________________________________________
_____________________________________________________________________
3) Possible ways of metastasis.
________________________________________________________________________
_____________________________________________________________________
66
Theme: HYPOXIA.
Actuality of theme.
The study of hypoxia takes important place in the system of preparation of future
specialist, because almost there is not such illness of human which would not be
accompanied with hypoxia. The division of this typical pathological process on different
kinds removes the wide circle of diseases in motion of which it arises up.
In addition, some types of professional activity of human also connected with
hypoxia development.
Study of reasons, pathogenesis of hypoxia, protective - adaptive mechanisms of
pathological changes is important for the construction of patogenetic therapy of the
different hypoxic states.
General purpose of the lesson.
To learn the reasons, mechanisms of development and manifestations of different
hypoxia types.
For this it is necessary to know (the concrete purposes):
1. To give the definition of conception “hypoxia”. Classification of the hypoxic
states.
2. To define the reasons and mechanisms of different types of hypoxia development.
3. To describe the mechanisms of urgent and of prolonget duration adaptation of
organism to the hypoxia and disorders of functions at hypoxia.
4. Base the principles of prophylaxis and therapy different types of hypoxia.
5. To explain the age-old sensitiveness of organism to hypoxia.
6. To design the different types of hypoxia.
7. To explain the role of hypoxia at diseases development.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Structure of haemoglobin, mechanisms of oxygen transfer by haemoglobin
(Normal Physiology Department)
2. Enzymes of respiratory chain, mechanism of electrons transfer at the a respiratory
chain (Biochemistry Department).
1.
2.
3.
4.
5.
6.
7.
The checking of primary level of knowledges.
Give an answer to the followings questions:
What is hypoxia?
Classification of the hypoxic states.
What factors cause displacement of haemoglobin dissociation curve to the left?
What factors cause displacement of haemoglobin dissociation curve to the right?
What is Bor’s effect?
What changes of gas indexes of composition of blood are characteristic for
tsirkulyatornoy gipoksii?
What changes of gas composition of blood indexes of are characteristic for hemic
hypoxia?
67
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
What factors cause methemoglobin formation?
What changes of gas composition of blood indexes of are characteristic for
hypoxic hypoxia?
What changes of gas composition of blood indexes of are characteristic for
respiratiry hypoxia?
What changes of gas composition of blood indexes of are characteristic for tissue
hypoxia?
Reasons of respiratory hypoxia development.
Reasons of circulatory hypoxia development.
Reasons of hemic hypoxia development.
Pathological forms of haemoglobin.
Reasons of tissues hypoxia development.
Pathogenic factors of mountain illness development.
Mechanisms of hypoxia compensation.
What refer to respiratory mechanisms of compensation?
What refer to hemodinamic mechanisms of compensation?
What refer to hemic mechanisms of compensation?
What refer to tissues mechanisms of compensation?
What organ is the most sensible to hypoxia?
What is the coefficient of oxygen utilization? What is it equal?
Index of oxygen consumption per minute.
Blood gas composition in a norm.
Standards of answers at the theoretical questions of initial level of
knowledges:
1. It is a typical pathological process which arises up as a result of low supply of
tissues by oxygen or as a result of disorders of its utilization de ctlls.
2. Exogenous (hypobaric, normobaric), endogenous [respiratory, circulatory, hemic,
tissue, mixed].
3. Decrease of temperature, alkalosis, hypocapnia, poisoning by carbon monoxide,
appearance of the pathological forms of haemoglobin, which are inherited
conditioned, diminishing of 2,3- diphosphoglycerate in the red corpuscles.
4. Increase of temperature, acidosis, hypercapnia, multiplying maintenance of 2,3diphosphoglycerate in the red corpuscles.
5. Influence of acidosis and hypercapnia on oxyhemoglobin dissociation.
6. Multiplying of arteriovenous difference of oxygen due to more complete
exception it from arterial blood.
7. Diminishing of blood oxygen capacity
8. Methemoglobin generating (nitrocompound, aminocompound, oxidants, redox
dyes, medicinec - nitrites, nitrates, aniline, phenilhidrasine, sulfanilamides,
barbiturates and others), insufficiency of the antioxidant systems of the red
corpuscles which reduced haemoglobin (the defect of NADF-dependent
methemoglobinreduktase, which is hereditary conditioned).
9. Diminishing of рО2 and рСО2 of arterial blood, development of gas alkalosis.
68
10. Diminishing of рО2 and multiplying рСО2 of arterial blood, development of gas
acidosis.
11. Diminishing of arteriovenous difference of oxygen and multiplying рО2 of
venous blood.
12. А) related to violation of respiratory center functions (poisonings, infectious
processes, impression of medulla oblongata);
B) related to the lungs pathological processes (violation of patency of airways,
violation of elastic properties of pulmonary tissues, diminishing of amount of
functioning alveolis).
13. А) violation of system blood circulation - insufficiency of heart and vessels
(shock, collapse), pathogenic action on a vascular-motive center;
B) violation of local blood circulation (ischemia, thrombosis, embolism).
14. A) anaemias;
B) haemoglobin inaktivation.
15. Carboxyhemoglobin, methemoglobin, sulfhemoglobin
16. A) poisoning (for example, by senile acid);
B) avitaminosises;
C) some types of hormonal insufficiency (deficience of steroid hormones).
17. Diminishing of partial pressure of oxygen in the air, physical overload, decline of
enviroment temperature, ionization of air, influencing of ultraviolet rays.
18. Respiratory, hemodinamic, hemic, tissues.
19. А) reactions of the external breathing (multiplying a depth and breathing
frequency, mobilization of alveolis reserves);
B) reactions of blood circulation system (multiplying the minute volume of blood
due to multiplying force and frequency of heartbeat, increase of arterial pressure,
redistribution of blood);
C) reactions of the system of blood (exit of red corpuscles from a depot,
activating of erythropoiesis, change of the oxyhemoglobin dissociation curve to
the right).
20. Increase of minute volume of heart as a result of multiplying a stroke volume and
tachicardia, increase of vessels tone, redistribution of blood in the vessels.
21. Erythrocytosis, ability of haemoglobin to link normal amount of oxygen,
multiplying oxyhemoglobin dissociation.
22. Change of metabolism, by the predominance of anaerobic glicolisis a display
what and more active absorption of oxygen by tissues from the blood.
23. Cerebrum
24. 0,3-0,4 in a state of rest, 0,5-0,6 - at loading
25. 250-300 ml of О2 per minute
26. О2 in an artery - 90-100 mm Hg., in a vein - 40-46 mm Hg., I
СО2 in an artery - 40 mm Hg.,
in a vein - 46 mm Hg.
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Hypoxya, determination of conception. Classification of hypoxia.
69
2.
3.
4.
5.
6.
7.
8.
9.
Hypoxic hypoxia. Kinds. Reasons of origin. Compensation and disorders of
functions.
Hemic hypoxia. Kinds. Reasons of origin. Compensation and disorders of
functions.
Respiratory hypoxia. Reasons, mechanisms of development. Compensation and
disorders of functions.
Circulatory hypoxia. Reasons, mechanisms of development. Compensation and
disorders of functions.
Tissue hypoxia. Principal reasons and mechanisms of development.
Compensation and disorders of functions.
Description of hypoxia of loading.
Mechanisms of urgent and of long duration adaptation of organism to hypoxia. A
contribution of М.М.Sirotinin to the study of mechanisms of adaptation.
Hypoxia of fetus and new-born. Age-old sensitiveness of organism to hypoxia.
Value of hypoxia in development of child's age pathology.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 72-80
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.115-122
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p. 121-133
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. 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
2. There are the decrease of blood erythrocytes, hemoglobin, color index, the
concentration of serum iron, mikroanizocytosis, poykilocytosis at the patient blood.
These changes were accompanied by development of hypoxia. What type of hypoxia
observed in this case?
A. Hemic
B. Hypoxic
C. Circulatory
D. Tissues
E. Respiratory
70
3. The doctor-researcher within the mountaineering expedition climbed to the base
camp situated at an altitude of 5000 meters. On the 3 rd day he complains of
breathlessness, palpitation, headache, dizziness, and ringing in his. What type of
hypoxia occurs in this case?
A. Hypoxic
B. Hemic
C. Circulatory
D. Tissues
E. Mixed
4. Woman, 56 years, suffered from thyrotoxicosis for a long time. What type of
hypoxia could occur in this instance?
A. Tissues
B. Hemic
C. Circulatory
D. Respiratory
E. Mixed
(2006-2009)
5. 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
6. 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
7. 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
71
8. 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
9. 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
10. 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
11. 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
12. 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
72
13. 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
14. 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
15. 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
16. 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
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
73
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. 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
20. 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
21. 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
22. 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
74
23. 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
24. 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
25. 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
26. 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
27. 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 of oxygen in inspired air
28. 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
75
29. 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
30. 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
31. 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
32. 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
33. 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
76
34. 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
35. 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
36. 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
37. Patient, 56 years old, suffering from thyrotoxicosis for a long time. What type of
hypoxia can develop at this disease?
A. Tissue
B. Respiratory
C. Hemic
D. Mixed
E. Circulatory
38. Senile acid and cyanides cover to the strongest poisons. Depending on a dose
death comes after a few seconds or minutes. Is oppressing activity of what enzyme is
reason of death?
A. Cytochrome-c-oxidase
B. Catalase
C. Acetylcholinesterase
D. ATP - synthetase
E. Methemoglobinreductase
77
39. A woman lost about 800 ml of blood during delivery. Tachycardia, tachipnoe 28
per minute, BP-100/70 mm Hg are marked. What type of Hypoxia initially developed
at such clinical situation?
A. Mixed
B. Respiratory
C. Hemic
D. Cardiovascular
E. Tissue
1
11
21
31
B
B
A
A
2
12
22
32
A
B
B
A
3
13
23
33
A
C
D
A
4
14
24
34
A
D
A
A
Correct answers
5
A 6
B
15 B 16 A
25 A 26 A
35 A 36 A
7
17
27
37
D
D
E
A
8
18
28
38
B
A
A
A
9
19
29
39
C
B
A
C
10
20
30
B
C
A
Situate task:
1. A patient is hospitalized in a surgical department with stomach bleeding. A skin is
pale. A pulse and breathing are accelerated. Amount of red corpuscles-3,12x1012/l,
haemoglobin - 90 g/l.
1) Is there hypoxia at a patient? Explain your answer.
________________________________________________________________________
______________________________________________________________________
2) If there is hypoxia, what is the type of it?
______________________________________________________________________
3) Will pСО2 and maintenance of oxyhemoglobin be changed in arterial blood? If
it’ll changed, how?
________________________________________________________________________
______________________________________________________________________
4) Is the development of hypoxia of this type possible without diminishing of red
corpuscles and haemoglobin in the blood? Explain your answer.
________________________________________________________________________
______________________________________________________________________
5) Name the reasons this type of hypoxia development.
________________________________________________________________________
______________________________________________________________________
6) What will you do for a treatment of hypoxia?
________________________________________________________________________
______________________________________________________________________
78
Theme: ALIMENTARY STARVATION
Actuality of theme.
Alimentary starvation is a pathological process which can arise up not only at the
action of external factors but can conduct a lot of diseases (oral cavity, esophagus,
stomach, intestine, liver and other). Alimentary starvation can be at certain terms and the
treatment factor. That is why a study of reasons, mechanisms of development of different
forms of starvation, study of metabolic disturbance at stervation is important in the system
of doctor preparation.
General purpose of the lesson.
To know principal reasons, mechanisms of starvation development and metabolic
disturbance in it.
1.
2.
3.
4.
5.
6.
For this it is necessary to know (the concrete purposes):
To explain external and internal reasons of starvation.
To adopt the conceptions of energetic, basic exchange.
To describe factors which influence on the level of energetic exchange.
To expose the changes of metabolism in different periods of starvation.
To be able to explain changes at starvation at children.
To describe etiology and pathogenesis of rachitis at children. To know principles
of prophylaxis and therapy of rachitis.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Indexes of metabolism and energy exchange in an organism (Biochemistry
Department).
2. Value of meal components (albumens, lipids, carbohydrates, vitamins and other)
for the normal vital functions of organism (Biochemistry Department).
3. Mechanisms of the neurohumoral regulation of metabolism and energy exchange
(Normal Physiology Department).
The checking of primary level of knowledges.
Give an answer to the followings questions:
1. What is the basic metabolism?
2. External reasons of starvation.
3. Internal reasons of starvation.
4. Classification of starvation.
5. What periods of complete starvation with water do you know?
6. What is respiratory coefficient (RC)? What is it equal at norm?
7. How RC changes at the I period of complete starvation with water?
8. How RC changes at the II period of complete starvation with water?
9. How RC changes at the III period of complete starvation with water?
10. What is physiological starvation? Make examples.
11. What life-span at complete absolute starvation?
12. What life-span at complete starvation with water?
13. What does incomplete starvation mean? Make examples.
14. What does partial starvation mean? What kinds of it do you know?
79
15. What type of starvation is the base pathology which got the name „kwashiorkor”?
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Alimentary starvation, determination.
2. Reasons of starvation.
3. Pathophysiological description of complete starvation periods. Contribution of
V.Pashutin to development of studies about starvation.
4. Pprotein-calorie deficiency. Reasons. Mechanisms of basic manifestations
development.
5. Starvation at children. Reasons of origin. Features of development.
6. Kwashiorkor. Reasons of development. Description.
7. Factors which influence on resistance of an organism to starvation.
8. Conception about starvation diet.
9. Etiology and pathogenesis of rachitis. ypervitaminosis D at children. Principles of
prophylaxis and therapy of rachitis.
Literature.
Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. – p. 143-145
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005 – p.127-133
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p. 288-294
1.
Testing according system “Krok-I”
Tests of an open database (2010)
1. There is only one source of water for the body at absolute starvation - a process of
organic compounds oxidation. Which of the following substances in these conditions
is the main source of endogenous water?
A. Fats
B. Proteins
C. Carbohydrates
D.Glycoproteins
E. Lipoproteins
2. Negative nitrogen balance, hypoproteinemia, violation of water-solt metabolism
combined with normal function of digestive system were founded at the vegetarians.
Name the reason of this state.
A. Monotonous protein diet
B. Monotonous carbohydrate diet
C. Lack of unsaturated fatty acids
D. Deficiency of phospholipids in the food
E. Lack of vitamin E in the food
80
3. At 10th day of medical starvation the patient suffers from excitation, deep, noisy
breathing, blood pressure dropped to 90/60 mmHg, oligouria, urine with a smell of
acetone. Name the reason of this state.
A. Ketosis
B. Non-gas alkalosis
C. Hyperglicemia
D. Hypoglycemia
E. Gas acidosis
4. Esophagus stenosis developed at a patient after a chemical burn. Sharp weight loss
arised. In the blood: erythrocyte.-3,0х1012/l, Hb-106 g/l, whole [crude] protein - 57 g/l.
What type of starvation developed at a patient?
A. Absolute
B. Albumen
C. Water
D. Incomplete
E. Complete
(2006-2009)
5. When is duration of starvation multiplied?
А. At multiplying the body surface
В. At increasing of basic methabolism
С. At action of low temperature
D. At hyperfunktion of thyroid gland
Е. At decreasing of basic metabolism
6. Basic metabolism is increase at starvation. The energy demand of the organism are
provided due to the carbohydrates of reserves. RC=1. Synthesis of albumen is
limited. The biosynthesis of amino acids from ketonic acid and ammonia is reduced.
What is the period of starvation?
А. Indifference
В. Oppression
С. Paralysis
D. Terminal
Е. Excitation
7. Patient, 28 years, middle fatness starves 48 hours. What substances are used by
muscular tissues as an energy source in this case?
A. Glucose
B. Amino acid
C. Keton bodies and fat acids
D. Laktate
E. Piruvate
81
8. At the long starvation hungry edema appear at people. What changes in an
organism results it?
A. Decline of onkotic pressure of blood
B. Decline of osmotic pressure of blood
C. Increase of secretion of ADG
D. Decline of secretion of ADG
E. Increase of onkotic pressure of blood
9. At the inspection of woman 50 years, who long time was on a vegetable diet,
hypothermia, low blood pressure, muscular weakness, negative nitrous balance were
founded. What factor caused such state of patient?
A. Increased amount of carbohydrates in a ration
B. An insufficient amount of carbohydrates in a ration
C. Increased using of liquid
D. An insufficient amount of fats in a ration
E. An insufficient amount of albumens in a ration
10. In an experiment in the conditions of absolute starvation water insufficiency is
partly compensated by formation of endogenous water. What from the resulted
matters at oxidization give the most account of water?
A. Glucose
B. Fats
C. Glycerin
D. Glikogen
E. Protein
11. A patient presents with twilight vision impairment. Which of the following
vitamins should be administered?
A. Retinol acetate
B. Cyanocobalamin
C. Pyridoxine hydrochloride
D. Nicotinic acid
E. Ascorbic acid
12. After a disease a 16-year-old boy is presenting with decreased function of protein
synthesis in the liver as a result of vitamin K deficiency. This may cause disorder of:
A. Blood coagulation
B. Osmotic blood pressure
C. Erythrocyte sedimentation rate
D. Anticoagulant production
E. Erythropoіetin production
82
13. In patients with the biliary tract obstruction the blood coagulation is inhibited;
the patients have frequent haemorrhages caused by the subnormal assimilation of the
following vitamin:
A. A
B. K
C. E
D. D
E. C
14. While determining power inputs of a patient's organism it was established that the
respiratory coefficient equaled 1.0. This means that in the cells of the patient the
following substances are mainly oxidized:
A. Proteins and carbohydrates
B. Carbohydrates and fats
C. Proteins
D. Carbohydrates
E. Fats
1
8
A
A
2
9
B
E
3
10
A
A
Correct answers
4
D
5
11
A
12
E
A
6
13
E
B
7
14
A
D
Situate task:
1. Esophagus stenosis, which obstruct food intake developed at a patient after a
chemical burn. Acute weight loss developed, mass of body diminished on 16%. At
laboratory research of blood the following changes were found out: erythrocytes3,1x1012/l, haemoglobin-113g/l, glucose-4,7 of mmol/l, protein-57g/l.
1) What is the type of starvation at a patient?
______________________________________________________________________
2) What are the possible consequences of hypoproteinemia?
________________________________________________________________________
______________________________________________________________________
3) What are the reasons of this type of starvation?
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
2. A man, 45 years, passes in a clinic the course of medical starvation concerning
obesity. On 4th day from the beginning of starvation, feeling of hunger is saved, a
general weakness, oppressing a psyche, some weight loss are marked. The level of
glucose in blood makes 2,8 mmol/l, a selection nitrogen with urine makes 10 g per
day. Respiratory coefficient 0,9.
1) What is the type of starvation at a patient?
_____________________________________________________________________
83
2) What is the period of starvation?
________________________________________________________________________
3) Characteristic of this period of starvation.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. The weight loss of a 45% of rats body is marked at the 7th days from the beginning
of complete starvation with water. A respiratory coefficient is 0,8. At some animals
there are areas of skin necrosis. What is the period of starvation?
1) What is the type of starvation at a patient?
________________________________________________________________________
2) What is the period of starvation?
________________________________________________________________________
3) Characteristic of this period of starvation.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
4. For a patient with stenosis of pyloric part of stomach, the labored reception of
meal takes place, there are weight loss, muscular weakness, edema of lower
extremities.
1) What is the type of starvation at a patient?
________________________________________________________________________
2) What are the reasons of this type of starvation?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Esophagus stenosis, which obstruct food intake developed at a patient after a
chemical burn. Acute weight loss developed, mass of body diminished on 16%. At
laboratory research of blood the following changes were found out: erythrocytes3,1x1012/l, haemoglobin-113g/l, glucose-4,7 of mmol/l, protein-57g/l.
1) What is the type of starvation at a patient?
_____________________________________________________________________
2) How to explain the decrease of blood cells and haemoglobin in the blood?
________________________________________________________________________
______________________________________________________________________
3) Will resistance of organism to the infectious agents change in this case? Explain
the answer.
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
84
6. A child, 2 years old, was delivered to the clinic in grave condition. The family lives
in one of the poorest countries in Asia, conditions of life and nutrition are not
satisfactory. Breastfeeding is terminated early. Objectively: child is weakened,
flaccid, there is a lack of weight and stunting, muscles hypotonia and dystrophy,
thinning of hair, generalized edema, hyper-pigmentation and desquamation of a skin
in the places of clothes friction.
1) What pathology developed at a child?
______________________________________________________________________
2) What are the causes and mechanisms of this pathology development?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
7. During the earthquake, the scientists, who investigated the mountain caves, were
caught under the blockage without supplies of food and water.
1) What kind of a starvation will develop at people?
______________________________________________________________________
2) That is the duration of this type of starvation?
______________________________________________________________________
3) That is the difference of this type of starvation from incomplete?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________________________________________________
85
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86