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
PHARMACEUTICAL FACULTY STUDENTS
Module N 1
GENERAL PATHOLOGY
Practical training N 2 TYPICAL PATHOLOGICAL
PROCESSES
VINNITSIA - 2011
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
The manual is recommended for the foreign students of pharmaceutical faculty
(3 course).
rd
2
Thematic plan
Specialization: “Pharmacy”
Lesson 9. Injury of the cell.
Lesson 10. Local disorders of blood circulation (hyperemia, ischemia, stasis,
thrombosis, embolism).
Lesson 11. Inflammation.
Lesson 12. Disorder of heat exchange.
Lesson 13. Neoplasia.
Lesson 14. Practical training: “Typical pathological processes.”
Specialization: “Clinical pharmacy”
Lesson 12. Injury of the cell.
Lesson 13. Local disorders of blood circulation (hyperemia, ischemia, stasis,
thrombosis, embolism).
Lesson 14. Inflammation (vascular reactions).
Lesson 15. Inflammation (pus enzymes).
Lesson 16. Disorder of heat exchange.
Lesson 17. Neoplasia.
Lesson 18. Practical training: “Typical pathological processes.”
3
Theme: «CELL INJURY»
Actuality of theme.
Violations of intracellular homeostasis, which constitute the essence of cell
injury, may develop as a result of direct action of pathogenic agent on the cell, or
indirectly as a result of internal environment constancy violations.
Cell injury – is a typical pathological process, that is based on changes of
intracellular homeostasis, which lead to disorder of the structural integrity of cells
and its functional features.
General purpose of the lesson. To become familiar with the reasons of the
main forms of the cells injury and their pathogenic significance.
For this it is necessary to know (the concrete purposes):
1. To treat concepts: cell injury.
2. To analyze the mechanisms of pathomorphological manifestations and
consequences of cell damage.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Cells structure (Biology Department).
2. Functional significance of subcellular structures (cytoplasmic membrane,
lysosome, mitochondrion, nuclei, endoplasmic reticulum) (Biology
Department).
1.
2.
3.
4.
The checking of primary level of knowledges.
Reasons that lead to cell damage.
Specific manifestations of the cell damage.
Nonspecific manifestations of the cell damage.
Pathogenic significance of different subcellular structures damage.
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Concept about the cell damage.
2. Exogenous and endogenous causes of the cell damage.
3. Types of the cell damage.
4. Direct and indirect effects of cell damaging agent.
5. Basic mechanisms of cell damage: lipid, calcium, electrolyte, osmotic, acidotic,
protein, nucleic.
6. Role of free radicals in the development of cell damage.
7. Concept about the antioxidant defense system.
8. Manifestations of the cell damage - structural and functional.
9. Concept about dystrophy (parenchymal, mesenchymal, mixed).
10.Concept about "necrosis" and "apoptosis." Role of apoptosis in the
development of disease.
4
11.Morphological characteristics of necrosis and apoptosis.
12.Principles of cytoprotective therapy.
Literature.
1. Handbook of general and Clinical Pathophysiology/ Edited by
prof.A.V.Kubyshkin, CSMU, 2005. p.87-96
2. Pathophysiology/ Edited by prof.Zaporozan, OSMU, 2005. p.30-41
3. General and clinical pathophysiology/ Edited by Anatoliy V/ Kubyshkin –
Vinnytsia: Nova Knuha Publishers – 2011. p.135-165
Topic for the abstract (for the independent student work):
1. Apoptosis.
5
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):
1. To know the concept about local disorders of blood circulation.
2. To analyze specific signs of different disorders of local blood circulation.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Division of vessels on the functional departments (Normal Physiology
Department).
2. Structural and functional organization of the circulatory system (Normal
Physiology Department).
3. Concept about central and peripheral circulation (Normal Physiology
Department)
4. Concept about microcirculation (Normal Physiology Department).
5. Mechanisms of blood flow regulation in arteries, capillaries and venules
(Normal Physiology Department).
6. Structure and function of endothelial cells, basal membrane, pericyte
(Histology Department).
7. Concept about the hemostasis system (Normal Physiology Department)
6
8. The concept of the fibrinolytic system (Normal Physiology Department)
9. Platelet function (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:
1) Physiological (after intensive work of organ, reactive)
2) Pathological (neurogenic, metabolic)
5. Venous hyperemia – it is increased blood supply through the organ or part of
tissue against of decreased blood outflow from the veins.
6. 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).
7
7. 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.
8. Stasis – it is slowing-down and stoppage of blood flow in the capillaries, small
arteries and veins.
9. Basic types of ischemia:
1) Compressive
2) Obturative
3) Angiospastic.
10.Basic variants of stasis:
1) Ischemic
2) Venous
3) True (capillary).
11.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.
12.1) 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.
13.Cellular and plasma.
14.Necrosis (infarcnion), aseptic and septic meltdown, tromboembolism,
disseminated intravascular clotting (DIC).
15.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.
16.Exogenous and endogenous.
17.By localization: embolism of greater circulation, embolism of lesser circulation
and embolism of portal vein system.
18.Exogenous types of embolisms: air, gas, bacterial, parasite, embolism by
foreign bodies.
19.Endogenous types of embolisms: thromboembolism, fatty, tissue, embolism by
amniotic fluid.
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
8
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. 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
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
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?
10
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
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
11
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
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
12
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
Correct answers
3 E 4 C 5 A
10 D 11 C 12 E
17 C 18 B 19 B
24 D 25 C 26 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. Main forms of peripheral circulatory disorders.
2. Concept about arterial and venous hyperemia, ischemia, stasis, their types, causes
and mechanism of the manifestations development.
3. Main pathomorphological equivalents of circulatory disorders (hemorrhage,
infarction, brown induration of lungs).
4. Thrombosis, causes and mechanisms of clot formation, types of blood clots.
5. Consequences of thrombosis (lysis, organization, thromboembolism).
6. Embolism, causes, types and consequences of embolism.
7. Principles of prevention and treatment of thrombosis and thromboembolic
conditions.
13
Literature.
1. 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.
Testing according system “Krok-I”
Tests of an open database (2010)
1. A patient is 54 year old. After intense emotional stress he felt strong pain
behind his breastbone irradiating to his left arm and left part of his neck. He felt
also death anxiety and broke into a cold sweat. Nitroglycerine relieved pain.
Name a disturbamce of local blood circulation in heart that has developed in this
case:
A Ischemia
B Thrombosis
C Embolism
D Arterial hyperemia
E Venous hyperemia
2. A child got burn on his hand caused by hot water. Burn skin is bright red.
What disturbance of local blood circulation is it?
A Arterial hyperemia
B Venous hyperemia
C Stasis
D Thrombosis
E Embolism
3. A female patient consulted a doctor about leg pain that arises usually toward
the evening; feet and shins edemata. Objectively: leg skin is cyanotic, cold to the
touch. What type of peripheral circulation disorder does the patient present
with?
A Venous hyperaemia
B Arterial hyperaemia
C Ischaemia
D Stasis
E Thrombosis
4. Examination of the lower limbs of a 40-year-old patient with coronary artery
disease and vascular disease of lower limbs (obliterating endarteritis) revealed
skin pallor and dystrophy, local temperature decrease, sense shock, pain. The
patient is likely to have the following disorder of the peripheral blood
circulation:
14
A Obstruction ischemia
B Compression ischemia
C Angiospastic ischemia
D Venous hyperaemia
E Arterial hyperaemia
(2006-2009)
5. What disorder of local blood flow is characterized by pallor, decrease of local
temperature, pain, local disorder of sensitivity, decrease of the volume of the
organ?
A.Ischemia
B.Venous hyperemia
C.Thrombosis
D.Embolism
E.Arterial hyperemia
6. A patient with portal cirrhosis was made the punction of the abdominal cavity
liver for ascites and 8 litres of liquid was received, that resulted in dizziness and
loss of consciousness. What is the mechanism of the development of this
complication?
A.Ischemia as a result of redistribution of blood
B.Angiospastic ischemia
C.Embolism of cerebral arteries
D.Thrombosis of cerebral arteries
E.Acute venous hyperemia of brain
7. A patient, aged 54, who complains of the pain, pallor and sensation of cooling
of lower extremities. A doctor diagnosed obliterating endarteritis. What
disorder of peripheral blood flow is the main cause of above mentioned
symptoms?
A.Оbturation ischemia
B.Neuroparalytic arterial hyperemia
C.Neurotonic arterial hyperemia
D.Venous hyperemia
E.Venous stasis
8. What disorder of local blood flow is characterized by cyanosis, inlargement of
the volume of an organ or tissue area, lowering of local temperature?
A.Venous hyperemia
B.Arterial hyperemia
C.Thrombosis
D.Embolism
E.Ischemia
15
9. A woman, aged 25, developed the signs of dilated veins of the lower
extremities feet edema on the 8th month of pregnancy. What is the most probable
cause of venous hyperemia of lower extremities at pregnancy?
A.Compression of veins by a pregnant uterus
B.Increase of arterial blood inflow
C.Decrease of venous walls elasticity
D.Decrease of tonus of muscular apparatus of veins
E.Disorder of neuroreflectoric regulation of venous walls tonus
10. A patient with acute left ventricular failure developed lung edema. What
disorder of peripheral blood flow in the lungs was the cause of this disorder?
A.Venous hyperemia
B.Arterial hyperemia of neurotonic type
C.Arterial hyperemia of neuroparalytic type
D.Thrombosis of pulmonary artery
E.Ischemia
11. A woman consulted a doctor with complains of a pain in the legs that
appeared in the evening swelling of feet and shins. Objective signs: the skin of
the leg was cyanotic and cold to the touch. What type of disorder of peripheral
blood flow had the patient?
A.Venous hyperemia
B.Arterial hyperemia
C.Ischemia
D.Stasis
E.Thrombosis
12. What disorder of local blood flow is characterized by hyperemia, small
arteries pulsation, increase of local temperature, increase of tissue turgor?
A.Arterial hyperemia
B.Venous hyperemia
C.Thrombosis
D.Embolism
E.Ischemia
13. During the play volleyball a sportsmen after jump landed on the outer edge
of the foot. Acute pain in talocrural joint appeared. Active movements are
limited in it. They are passive in a full volume but painfull. Then swelling
developed. The skin was hyperemic and wormer to the touch. What type of
disorder of peripheral blood flow developed in this case?
A.Arterial hyperemia
B.Ischemia
C.Fat embolism
D.Venous hyperemia
E. Thrombosis
16
14. A child got burn on his hand caused by hot water. Burn skin is bright red.
What disturbance of local blood circulation is it?
A. Arterial hyperemia
B. Stasis
C. Venous hyperemia
D. Thrombosis
E. Embolism
15. A patient, aged 40, ill with ischemic cardiac disease and with the disease of
feet vessels (obliteric endarteritis) of the low extremities was found to have
pailness and dystrophic changes of the skin, decrease of the local temperature,
sensitivity disorder and pain were revealed during the examination. What
peripheral blood flow disorder has the patient?
A.Arterial hyperemia
B. Obturative ischemia
C.Venous hyperemia
D.Compressive ischemia
E.Angiospastic ischemia
16. For what local blood disorder are painless, decrease of local temperature,
pain, local sensitivity disorder, decrease of the organ volume characteristic?
А.Thrombosis
В.Ishemia
С.Embolism
D.Venous hyperemia
E.Arterial hyperemia
17. What do we call the type of embolism at which due to the attraction
embolus moves against blood flow?
A.Retrograde
B.Paradoxical
C.Gas
D.Air
E.Thromboembolism
18. Femoral bones of an elderly man were crushed due to automobile accident.
In some time the man died from embolism of pulmonary vessels. What type of
embolism is the most probable in this case?
A.Fatty
B.Tissue
C.Gas
D.Air
E.Thromboembolism
17
19. What type of embolism is developed in a diver at his rapid getting up to the
surface?
A.Gas
B.Air
C.Thromboembolism
D.Fatty
E.Embolism tissues derivates
20. A woman that undervent operation (extirpation for fibromioma of uterus),
developed thromboembolism of the pulmonary artery during the postoperative
period. What vessels are the source of thrombi in this case?
A.Deep veins of lower extremities
B.Upper mesenteric vein
C.Portal vein
D.Sinuses of dura mater encephali
E.Pulmonary veins
21. In elderly patient has the fracture of the femoral bone. During the addmition
to the hospital the patient's state became worse the blood pressure sharply
decreased. The signs of lung artery embolism developed. Indicate the most
probable cause of this complication?
A.Gas embolism
B.Fat embolism
C.Obturation ischemia
D.Venous hyperemia
E.Air embolism
1 A
8 A
15 B
2 A
9 A
16 B
Correct answers
3 A 4 A 5 A
10 A 11 A 12 A
17 B 18 A 19 A
6 A
13 A
20 A
7 A
14 A
21 B
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.___________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
18
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?
____________________________________________________________________
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?
19
____________________________________________________________________
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 vessels.
1) What violation of circulation of blood arised up?
____________________________________________________________________
2) What is the mechanism of skin paleness development?
____________________________________________________________________
____________________________________________________________________
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 crosscountry 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 hou, 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.
20
1) What is happened with a diver?
____________________________________________________________________
2) What mechanisms of described violations development?
____________________________________________________________________
____________________________________________________________________
3) What should surrounding to do in this case?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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?
____________________________________________________________________
____________________________________________________________________
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.
21
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
Venous hyperemia
Ischemia
22
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___________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
_________________________________________________________________
23
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. Concept about inflammation.
2. To find out pathological and adaptative-compensative changes at the area of
inflammation.
3. To explain the pathogenesis of local and general manifestations at inflammation.
4. To analyze the pathomorphological signs of inflammation.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Dividing of vessels on functional parts ( Normal Physiology department).
2. Concept about the microcirculation (Normal Physiology department).
3. Mechanisms of blood supply through the veins and capillaries regulation (Normal
Physiology department)
4. Concept about the connective tissue cells, their structure, main functions
(Hystology department).
5. Concept about the products of arachidonic acid cascade, kallikrein-kinin system of
blood plasma, 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?
4. What are the kinds of alteration?
5. What is mediator of inflammation?
6. What mediators of inflammation do you know?
1) name cellular mediators;
2) name plasma mediators;
24
3) what mediators refer to cytokines?
4) what mediators refer to arachidonic acid cascade?
7. Vascular reactions which take place in the area of inflammation. Who
described them first?
Test control is for 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
25
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
26
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
1
8
D
B
2
9
D
E
Correct answers
3 E 4 B 5 B
10 E 11 D 12 C
6 E
13 A
7
A
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Inflammation: definition, classification.
2. Etiology of inflammation.
3. Components of inflammation.
4. Primary and secondary inflammation.
5. Biochemical and physical-chemical disorders at the area of inflammation.
6. Mediators of inflammation, their classification.
7. Role of mediators at the inflammation development.
Literature.
1. 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
27
Testing according system “Krok-I”
Tests of an open database (2010)
1. A patient suffering from pleuritis underwent pleural puncture. There was
obtained a transparent odourless liquid. What type of exudate was obtained?
A Serous
B Haemorrhagic
C Purulent
D Fibrinous
E Putrefactive
2. A child has got a burn. Burnt skin is hyperemic, there are small vesicles full of
transparent fluid. What type of fluid is it?
A Serous exudate
B Hemorrhagic exudate
C Purulent exudate
D Transsudate
E Putrid exudate
(2006-2009)
3. What of processes starts the development of inflammatory reaction?
A.Alteration
B.Arterial hypotension
C.Stasis
D.Venous hyperemia
E.Exit of liquid from vessels in tissues
4. What typical pathological process develops as the response to the injury?
A.Inflammation.
B.Hypoxia
C.Allergy
D.Fever.
E.Tumor growth.
5. A patient due to initial getting to the skin of unknown substance developed
pathological process with the symptoms of hyperemia, swelling, pain, local
increase of temperature. How do we call this process?
A.Inflammation
B.Allergy
C.Hypertrophy
D.Dystrophy
E.Atrophy
28
6. What organ is more frequent responsible for alterative inflammation ?
A.Myocardium
B.Brain
C.Kidneys
D.Spleen
E.Lymphatic nodes
7. An experimental mouse was injected the lethal dose of tetanus toxin into the
abscess cavity that is induced by turpentine. But the experimental animal did
not perished. Indicate the most probable reasons of nonlethal result of the
experiment?
A.Formation of barrier
B.Activation of antibodies synthesis
C.Stimulation of leukopoiesis at inflammation
D.Increased vascularization of the inflammation area
E.Activation of desintoxication function of phagocytes
8. Antiinflammatory effect of some drugs depends on the inchibited release of
arachidonic acid. This acid is precursor of:
А. Urine
В. Heme
С. Prostaglandins
D. Urea acid
E. Cholesterol
1
A 2
A 3
Correct answers
A 4 A 5 A 6
A
7
A 8
C
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?
____________________________________________________________________
____________________________________________________________________
29
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.
____________________________________________________________________
____________________________________________________________________
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.
30
Vessel lumen
1-
margination;
2 - passing of leucocytes through a vascular wall;
3 - accumulation of leucocytes in the hearth of inflammation
Conclusion:__________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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.
31
1 - coagulation necrosis;
2- reflex spasm of arterioles;
3- arterial hyperemia;
4- venous hyperemia;
5- stasis;
6- normal blood circulation.
Conclusion:__________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
32
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):
1. Concept about inflammation.
2. To find out pathological and adaptative-compensative changes at the area of
inflammation.
3. To explain the pathogenesis of local and general manifestations at inflammation.
4. To analyze the pathomorphological signs of inflammation.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Building of the vascular wall (Histology department).
2. Phagocytes. Kind. (Histology department).
3. Mechanisms of phagocytosis (Biochemistry department).
4. Cells of connective tissue, their function (Histology department).
The checking of primary level of knowledges.
Give an answer to the followings questions:
1. Exudation, definition.
2. What form of cells first emigrate into the area of inflammation?
3. What is exudate?
4. What is transsudate?
5. What is emigration of leucocytes?
6. What types of exudate do you know?
7. Proliferation, definition.
8. Local manifestations of inflammation.
9. General manifestations of inflammation:
33
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
34
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
35
Correct answers
1 E 2 B 3 C 4 D 5 C 6 A 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. Disorders of microcirculation at the area of inflammation.
2. Exudation and emigration of the leukocytes, their mechanisms.
3. Kind of exudate. Morphological characteristic of different kind of exudative
inflammation.
4. Mechanisms of proliferation.
5. Concept about interstitial inflammation, granulematous inflammation with the
polyps formation.
6. Morphological characteristic and consequences of proliferative inflammation.
7. Local signs of inflammation, mechanisms of their development.
8. Connection between local general signs of inflammation.
9. Principles of anti-inflammatory treatment.
Literature.
1. 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
Testing according system “Krok-I”
Tests of an open database (2010)
1. A patient with acute pneumonia has an edema and hardening of pulmonary
tissue. What cells are the first to infiltrate the inflammation zone and provide
the effective protection from the bacterial infection?
A Neutrophils
B Monocytes
C Thrombocytes
D Eosinophils
E Basophils
2. A patient diagnosed with acute abdomen was delivered to the hospital. A
doctor suspected acute appendicitis and ordered urgent blood test. What factor
would be the evidence of acute inflammation in this patient?
A Leukocytosis
B Leukopenia
C Eosinophilia
D Erythrocytosis
E Erythropenia
36
3. The leukocytes that are the first to appear in a focus of inflammation are
called:
A Neutrophils
B Monocytes
C Eosinophils
D Lymphocytes
E Basophils
(2006-2009)
4. A patient with pleurisy was found liquid with a putrified odor, that contained
biogenic amines, cellular detritus in the pleural cavity. What type of
inflammation did the patient develop in this case?
A.Putrified
B.Alterative
C.Catarrhal
D.Purulent
E.Fibrinous
5. The skin area that was subjected which was exposed to the action of high
temperature became hyperemic. Give the type of local blood circulation disorder
in the focus of acute inflammation that causes such symptom, as “rubor”.
A.Arterial hyperemia
B.Venous hyperemia
C.Ischemia
D.Stasis
E.Thrombosis
6. What principle of classification of inflammation is in the basis of fibrinous
pericarditis («hairy heart»)?
A.According the character of exudate
B.According reactivity
C.According prevalence of the component
D.According course of the disease
E.According severity
7. What local sign of inflammation is responsible for the irritation and
compression of nervous endings?
A.Pain
B.Edema
C.Rubor
D.Increase of temperature
E.Disorder of function
37
8. A patient on the 2-nd day after the development of acute inflammation of
knee-joint the increase of the joint in sizes and edema of skin were observed.
What components that take a place at inflammation is this symptom associated
with?
A.Exudation
B.Alteration
C.Proliferation
D.Regeneration
E.Sclerosis
9. The first cells that appear in the focus of inflammation are
A.Neutrophils
B.Monocytes
C.Eosinophils
D.Lymphocytes
E.Basophils
10. In exudate, received from the abdominal cavity of a patient contains a small
amount of protein and many cells (more than 5 thousands in 1mcl). What
inflammation is it?
A.Purulent
B. Fibrinous
C. Hemorrhagic
D. Serous
E. Mixed
11. What of pathogenic factors of edema is a leading one in its development in
the focus of inflammation?
A.Increase of osmotic pressure in the focus of inflammation
B.Decrease of оncotic pressure in the blood plasma
C.Increase of hydrostatic pressure in the capillaries
D.Increase of оncotic pressure in the cell of inflammation
E.Decrease of hydrostatic pressure into the tissues
12. A child, ill with diphtheria, developed severe of the external breathing as a
result of trachea obstruction with film. What form of exudative inflammation
takes place in this case?
A.Fibrinous
B.Purulent
C.Serous
D.Hemorrhagic
E.Catarrhal
38
13. A patient ill with tracheitis expectoration with physical properties that
testify to the presence of mucus is observed. What type of inflammation takes
place in this case?
A.Catarrhal
B.Purulent
C.Putrified
D.Hemorrhagic
E.Fibrinous
14. Transparent without odor liquid was received from the patient with a
pleuritis at pleura punction. What type of exudate was received at punction?
A.Serous
B.Hemorrhagic
C.Purulent
D.Fibrinous
E.Putrified
15. Yellowish nontransparent liquid with unpleasent odor was received from the
patient's abscess of gluteusl. What type of exudate was received in this case?
A.Purulent
B.Hemorrhagic
C.Serous
D.Fibrinous
E.Putrified
1
9
Correct answers
A 2 A 3 A 4 A 5 A 6 A
A 10 A 11 A 12 A 13 A 14 A
7 A 8
15 A
A
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 pleura cavity.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
3) Expose the positive and negative value of exudate.
____________________________________________________________________
____________________________________________________________________
39
____________________________________________________________________
____________________________________________________________________
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?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________________________________________________
40
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 8 th 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:__________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
41
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. Fever, definition.
2. To find out pathological and adaptative-compensative changes at the fever.
3. To analyze the pathomorphological signs of fever.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. To know the building of the thermoregulatory center and its functions (Normal
Physiology Department).
2. To explain the mechanisms of heat exchange in norm (Normal Physiology
Department).
3. To explain the mechanisms of heat production and heat loss (Normal Physiology
Department).
The checking of primary level of knowledges.
Give the answers at following questions:
1. Localization of heat-regulating center.
2. What groups of neurons does heat-regulating center consist of?
3. Basic types of thermal homeostasis violations.
4. Factors which cause a fever.
5. Types of pyrogens according to origin.
42
6. Types of pyrogens according to the mechanism of development.
7. Primary pyrogens.
8. Secondary pyrogens.
9. Stages of fever.
10.What correlation of heat production and heat loss processes is at the 1st 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 3rd stages of fever named?
14.How is the slow decrease of temperature in 3rd stages of fever named?
15.How is the graphic image of day temperature fluctuations in 2nd 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;
43
b) TNF;
c) -interferon;
9. a) increase of temperature;
b) standing of temperature at one level;
c) decrease of temperature;
10.А
11.C
12.B
13.critical;
14.lytic (lysis);
15.temperature curve;
16.graphic image of day temperature fluctuations;
17.febris continua, febris remittens, febris intermittens, febris recurrens, febris
hectica, febris undulans, febris atypica, febris inversa, febris ephemera;
18.D.
Theoretical questions at the base of which the execution of purpose types of
activity is possible.
1. Fever, definition.
2. Etiology of fever. Pyrogens. Classification.
3. Stages of fever, their classification.
4. Classic type of hyperthermal reactions.
5. Difference between fever and hyperthermia.
6. Changes of the organism functions at fever.
7. Protective significance of fever and negative effects of fever.
8. Principles of fever treatment.
9. Concept about pyrotherapy.
Literature.
1. 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
44
Testing according system “Krok-I”
Tests of an open database (2010)
1. A patient suffering from the bone marrow form of radiation sickness was
found to have the following changes in his hemogram: leukocytes – 2*109l,
lymphopenia, erythrocytes
- 3,0*1012l, Hb- 52 g/l, thrombocytes – 105*109l,
reduced blood coagulation. These changes are typical for the following stage of
the radiation sickness:
A Fastigium
B Latent period
C Prodromal period
D Solution
E Relapse
2. A warmly dressed child has spent a considerably long time out of doors. This
resulted in body temperature elevation and general weakness development.
What form of thermoregulation disorder is observed in this case?
A Exogenous hyperthermia
B Endogenous hyperthermia
C Fever
D Heat shock
E Centrogenous hyperthermia
(2006-2009)
3. During a day a patient's temperature increases to more than 1°C that changes
for the normal one. What is the type of the temperature curve?
A. Atypica
B. Hectic
C. Inversa
D. Continua
E. Remittent
4. A man, aged 38, body temperature increase up to 390C. What type of
leukocytes most probably produce a substance that increase the body
temperature?
A.Monocytes
B.Eosinophils
C.Basophils
D.Neutrophils
E.Lymphocytes
45
5. A woman complains of weakness, pain in a throat, increase of body t°С up to
38°C. Hyperemia is observed from the side of tonsils. What of above mentioned
substances may be exogenous pyrogens, that caused fever in a patient?
A. Lipopolysaccharides
B. Nonsaturated fat acids
C. Saturated fat acids
D. Nucleic acids
E. Phospholipids
6. A patient is ill with pneumonia. While taking the body temperature during a
day its indices were fluctuating within 39-41°C. Such type of temperature
increasing is called:
A. High
B. Hyperpyretic
C. Moderate
D. Subfebrile
E. Normal
7. It is known that in fever the temperature increase is under the influenсe of
pyrogens. What blood cells form the secondary pyrogens?
A.Basophils
B.Monocytes-macrophages
C.Erythrocytes
D.Plasmatic cells
E.Thrombocytes
8. At the physical examination heat formation is increased at the expense of
increased heat production first of all, in:
А. Hepar
В. Lungs
С. Skeletal muscles
D. Heart
E. Brain
9. During the operation on the heart with the use of hypothermia a patient was
introduced the drug that injures the system of thermoregulation. What is it for?
A. In order that the mechanisms of thermoregulation do not «interfere» with
cooling of organism.
B. By mistake
C. To reduce the body temperature
D. To increase a temperature after the operation
E. To reduce perspiration
1
A 2
A 3
Correct answers
D 4 D 5 A 6 A 7
46
B 8 C 9 A
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 39,50С 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.
47
1) What violation of thermoregulation developed at this patient?
____________________________________________________________________
2) Name the differences of this thermoregulatory violation from other existent
violations.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
________________________________________________________________
48
Algorithm of practical skills: "Differentiation of temperature curves"
Types of fever according to the temperature curves:
1.Constant type
5.Reverse type
2.Aperient type
6.Relapsing type
3.Intermittent type
7.Undulating type
4.Hectic 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.
49
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.
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.
50
№
Temperature Temperature
of water, °C of frog, °C
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.
Ringer's solution temperature, °C
Heart biting rate, in min.
Conclusion:__________________________________________________________
____________________________________________________________________
51
EXPERIMENT 4. The students study available records of respiration of different
animals: guinea - pigs, rabbits, cats
Conclusion:__________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
°
52
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.
For this it is necessary to know (the concrete purposes):
1. Neoplasia, definition.
2. Pathological and adaptative-compensatory processes at the development of
typical pathological processes.
3. Analyze of pathomorphological features of tissue growth disorders.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. To know the morphology of the cells (Histology Department).
2. To know the mechanisms of cells deviation (Biology Department, Hystology
department).
3. To know the principles of metabolism (protein, carbohydrate, lipid)
(Biochemistry Department).
4. Concept about DNA- and RNA-viruses (Microbiology Department).
5. Concept about structure, function and regulation of a gen (Biology Department).
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)?
53
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).
6. Anaplasia, metaplasia, displasia, invasive growth, metastasis.
7. Initiation, promotion, progression.
8. 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.
54
9. Immortalisation - is the phenomenon, when cells can be divided long time
without signs of senescence.
10.Apoptosis - is programed self-destruction of cells which is characterized by
activating of anlyzosomal endogenous endonucleas, which divides nuclear
DNA on little fragments.
11.Mechanisms of transformation - mutational, epigenomic.
12.Protoonkogenes - are normal cellular genes which are able at violation of their
structure to induce tumour growth.
13.Dediferentiation or anaplasia - is getting by the tumours cells of properties
characteristic for the embryo stage of organism development.
14.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).
15.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. General description of the main types of violations of tissues growth.
2. Concept of hypo- and hyperbiotic processes: atrophy, hyperthrophy,
hyperplasia, regeneration, metaplasia, dysplasia, neoplasia.
3. Definition of the concepts of "tumor" and "neoplastic process". Modern views
about etiology of tumors.
4. Role of ionizing radiation, ultraviolet rays and mechanical factors in
cancerogenesis.
5. Chemical carcinogens exo- and endogenous origin, direct and indirect actions.
6. Role of viruses in the development of tumors.
7. Carcinogenesis: the basic stages (transformation, promotion, progression), the
mechanisms (mutative and epìgenomic).
8. Physical, chemical, biological features of the cancerogenesis.
9. Functional, morphological, biochemical, physico-chemical, antigenous features
of the tumors.
10.Principles of tumors classification. The concept of benign and malignant
tumors.
11.Methods to experimental reproduction of tumors.
12.Patophysiological basics of prevention and treatment of tumors.
Literature.
1. 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
55
Testing according system “Krok-I”
Tests of an open database (2010)
1. A 57-year-old worker at an asphalt plant complains of weakness, cough with
blood-streaked sputum, chest pain. He has been diagnosed with lung cancer.
What is the first stage of carcinogenesis?
A Transformation
B Promotion
C Activization
D Progression
E Induction
2. A 56-year-old female patient complains about a fast growing hard neoplasm
in the mammary gland that appeared a month ago. Objectively: the formation is
fused with the surrounding tissues, it is uneven, slightly painful. What are the
peculiarities favouring the infiltrative growth of a malignant tumour?
A Lack of contact inhibition
B Intensified chalone formation
C Intensified contact inhibition
D Intensified formation of tight contacts
E Rise of embryonal antigens
3. What pathology of tissue growth is characterized by cellular and tissue atypia
from the point of histomorphology?
A Malignant tumour
B Dystrophy
C Degeneration
D Benign tumour
E Regeneration
4. A patient suffering from gastric ulcer for a long time has dramatic
emaciation, skin pallor, appetite loss, aversion to meat products. Biopsy of
mucous membrane of stomach revealed cellular atypia. What pathology are
these symptoms typical for?
A Malignant tumour of stomach
B Benign tumour of stomach
C Polyposis
D Hypertrophic gastritis
E Helminthic invasion
(2006-2009)
5. Indicate which of below mentioned factors in not cancerogenous
56
A. Rh- ionizing
B. Helmints
C. Aminoazocompounds
D. Virus
E. Aromatic carbohydrates compouds
6. In 1915 the Japan scientists Ishikava and Jamagiva for the first time caused
the tumor in the experiment painting rabbit's ear skin with coal-tar resin. What
experimental method of causing tumors was used?
A. Explantation
B. Induction of chemical substances
C. Transplantation
D. Induction oof outcells filtrates
E. Induction of radioactive isotops
6. A woman, aged 56, complains of some induration in the mammary gland,
wich appeared a month ago and increases quickly in size. Objectively: the
formation is connected with nearby tissues formation, it is undulating and
sluggish. Call the paculiarities contributing to infiltrative growth of the
malignant tumor:
А. Lack of contact inhibition
В. Appearance of embrional antigens
С. Increasing of contact inhibition
D. Increase formation of keilons
E. Increase formation of contacts
7 A 56-years-old patient, who had contact with diethylnitrozamine at his work
place, complains of pain in right subcostal area, weakness, loss of appetite, and
decreased workability. At examination of this patient: surface of his liver is
rough, splenomegaly and ascites are present in him; his body temperature is
37.2oC; in his blood analysis ESR is 25 mm/hour, besides neutrophilic
leukocytosis, and hypochromic anemia were found. What disease developed in
the patient’s organism?
A. Cancer of liver
B. Hepatitis
C. Cirrhosis of liver
D. Gallstone disease
E. Dyskinesia of bile ducts
8. A male, aged 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?
57
A. Alimentary cachexy
B. Myasthenia
C. Addison’s disease
D.Cancer cachexy
E. Brown induration
9. What biological process augmentation is typical for tumor cells?
A. Anaerobic glycolysis
B. Decarboxilation
C. Tissue respiration
D. Lipolysis
E. Gluconeogenesis
10. What cell structure is a «target» for chemical cancerogens?
A. Nuclear DNA
B. Lysosomes
C. Mitochondria
D. Cytoplasmic membrane
E. Ribosomes
11. 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
12. 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
13. 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
58
1
8
A
D
2
9
A
A
Correct answers
3 A 4 A 5 B
10 A 11 A 12 A
6 A
13 A
7 A
14 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 neutrophiles61%, 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.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
59
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.
____________________________________________________________________
____________________________________________________________________
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.
____________________________________________________________________
____________________________________________________________________
60
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 starvation 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.
For this it is necessary to know (the concrete purposes):
1. Starvation, definition.
2. Pathological and adaptative-compensatory processes at the development of
typical pathological processes.
3. Analyze of pathomorphological features of organism disorders at starvation.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills:
1. Indexes of basal and energy metabolism of the organism (Biochemistry
Department).
2. Significance of the food components (proteins, lipids, carbohydrates, vitamins)
for normal vital activity of the organism (Biochemistry Department).
3. Mechanisms of neuro-humoral regulation of metabolism (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?
61
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. External and internal reasons of starvation.
2. Physiologycal and pathological starvation, complete and incomplete, qualitative,
absolute.
3. Periods of complete starvation.
4. Consequences of starvation.
5. Pathomorphological equivalents – dystrophy, hypotrophy, cachexy.
6. Medical starvation.
Literature.
1. 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
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
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.
62
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
1
A
Correct answers
2 B 3 A 4
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:
erythrocytes-3,1x1012/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?
____________________________________________________________________
2) What is the period of starvation?
____________________________________________________________________
3) Characteristic of this period of starvation.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
63
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:
erythrocytes-3,1x1012/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.
____________________________________________________________________
____________________________________________________________________
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?
64
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
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?
____________________________________________________________________
____________________________________________________________________
65