THE MINISTRY OF PUBLIC HEALTH OF UKRAINE
VINNITSIA NATIONAL MEDICAL UNIVERSITY
named after M.I.PIROGOV
METHODICAL RECOMMENDATION
FOR MEDICAL FACULTY STUDENTS
FROM PATHOPHYSIOLOGY
Module N 1
GENERAL PATHOLOGY
Practical training N 1
GENERAL NOSOLOGY
VINNITSIA - 2011
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
N.A. Rikalo
A.S. Grytsenko
O.Y. Guminska
The manual is recommended for the foreign students
of medical faculty (3rd course).
2
THEMATIC PLAN OF PRACTICAL LESSONS:
Lesson 1 «Subject and tasks of pathophysiology. Methods of pathophysiological
investigations. Hystorical aspects of pathophysiology formation».
Lesson 2 «General nosology: general study about disease, etiology, pathogenesis»
Lesson 3 «Reactivity. Resistance. Immunological reactivity. Their role in
pathology»
Lesson 4 «Role of constitution and heredity in pathology»
Lesson 5 «Pathogenic action of external environment factors (mechanical factor,
physical factors: ionizing radiation, electric current, high and barometric pressure)»
Lesson 6 «Pathogenic action of external environment factors (chemical, biological,
psychical and social factors).»
Lesson 7 «Allergy.»
Lesson 8 Practical training: “General nosology. Pathogenic action of external
environment factors. Role of internal factors in pathology. Allergy.”
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Theme 1: "SUBJECT AND TASKS OF PAHOPHYSIOLOGY. METHODS
OF PATHOPHYSIOLOGICAL INVESTIGATIONS. MAIN
STAGES OF PATHOPHYSIOLOGY AS A SCIENCE
DEVELOPMENT".
Actuality of the theme.
The question of regulation of function at diseased organism – it is one of central
questions in the general pathology. It serves the base to study and understanding
the mechanism of disorders of function at different type of pathology. The
knowledge of these mechanisms is of great importance for physician at choice of
the methods of the diagnostics and pathogenic therapy of diseases.
General purpose of the lesson.
Learn the principles of modeling of the pathological processes. Show the regulation
of breathing in condition of pathology.
For this it is necessary to know (the concrete purposes):
1. To master the elementary skills of planning and carrying out the experiments on
laboratory animals.
2. To be able to draw up a protocol of study, analyze, process, summarize
extracted results and make the conclusions.
3. To fall into a, what is the subject of pathophysiology, pathophysiology tasks,
significance of pathophysiology for the future specialist.
4. To know, what is the physiological regulation of functions, what are the
mechanisms of it.
5. To estimate the significance of modern methods of investigations (experimental
and clonocal) for pathophysiology.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. To know the methods of the empirical cognition: scientific observation,
scientific experiment, empirical modeling (the department of the social sciences
- discipline - philosophy).
2. To have a notion about the main rules of bioethics (the department of the social
sciences - discipline - philosophy).
3. To reveal the mechanisms of neuro-reflector regulation of the external breathing
(the department of normal physiology).
4. To explain at concrete examples the mechanisms of humoral regulation of
external breathing (the department of normal physiology).
5. To reveal the mechanisms neurohumoral regulation of external breathing (the
department of normal physiology).
6. To reveal the role a reflexes from the receptors of the mucous shell of the upper
respiratory ways at regulation of the external breathing (the department of
normal physiology).
4
The checking of primary level of knowledges.
Give the answers to the following questions:
1. How is realized the mechanisms of neuro-reflector regulation of external
breathing?
2. How is realized the mechanisms of humoral regulation of external breathing.
3. How is realized the mechanisms of neuro-humoral regulation of external
breathing.
4. Significance of the reflexes from receptors of the mucous shell of the upper
respiratory ways at regulation of the external breathing.
5. The modern beliefs about respiratory centre.
6. The role of hydrogen at regulation of the external breathing.
7. The role CO2 at regulation of the external breathing.
8. The direct indexes of efficiency of the external breathing.
Theoretical questions, at the base of which the execution of purpose types of
activity is possible.
1. Place of pathophysiology at the system of future doctors preparation.
2. Pathophysiology as a subject, its component parts: general pathology,
pathophysiology of organs and systems.
3. Place of pathophysiology in the system of medical knowledge.
4. Subject of pathophysiology, tasks, objectives. Relationships with other
disciplines.
5. Clinical pathophysiology.
6. The role of the achievements of molecular biology, genetics, biochemistry,
physiology, immunology and other sciences in the development of modern
pathophysiology.
7. Values of pathophysiology for clinical and preventive medicine.
8. Methods of pathophysiology.
9. Experimental modeling of pathological processes (disease) - the main method of
pathophysiology - its possibilities and limitations. Experimental models of disease.
10. Modern methods of the experiment, the rules of work with experimental
animals.
11. Experimental therapy.
12. Methods of clinical pathophysiology.
13. History of pathophysiology. The value of research works of K. Bernard, R.
Virchow, J.Konheyma, Mechnikov, V. Pashutina, H. Selye and other prominent
researchers.
14. Patriotic School of pathophysiology (N.A. Hrzhonschevskyy, V.V.
Pidvisockyy, V.K. Lindemann, O.O. Bogomolets, M.M. Syrotynin, O.V. Reprov,
D.O. Alpern, V.V. Voronin, M.N. Zaikov).
15. Research School of pathophysiology, the main directions of their activities.
16. Regulation of functions in health and pathology.
5
Literature is necessary for studying of the theoretical questions.
1. Handbook of general and Clinical Pathophysiology/ Edited
prof.A.V.Kubyshkin, CSMU, 2005. – P.5-7.
2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.3-10.
by
After adopting the theoretical questions students learn the practical
part of lesson.
Practical work: «REGULATION OF FUNCTIONS IN PATHOLOGICAL
PROCESSES».
Object of work: to show how respiratory regulation occurs in the case of the
stricture of the airways and effect of the chemical irritans.
Description of experiment:The work is of demonstration type with the assistance
of the students.
Each subgroup carries out an acute experiment with a rabit. The rabit is tied to the
bench. The graphic recording of the initial respiration is performed on the tape
measure of the kimograph with the help of the cuff applied to the thoracic cavity
and connected by means of a rubber tube with a capcule of Mareae.
Experiment 1. Cause incomplete asphyxia by partial clamping of the trachea
lumen. The recording of respiration and its analysis are carried out in this
condition.
Conclusion:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
Experiment 2. For 15 sec to allow the rabit to breath with ammonia vapour and
repeat the procedure in some minutes. To record respiration in this condition.
Conclusion:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
6
Experiment 3. Inject 0,5 ml of 0,1n solution of lactic acid into the lateral vein of
the rabbit's ear. To record respiration in this condition. To make the analysis. To
make the conclusions.
Conclusion:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Experiment 4. Cause a full asphyxia claming the trachea. To study the
development of the stages of asphyxia averting the animal from death.
Looked after development of stages of asphyxia:
1. Stage of excitation:
1) inspiratory dyspnea
2) expiratory dyspnea
2. Stage of braking:
3) Gasping-breathing, apnoea
Conclusion:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
Situational task:
The foreign bodey is diagnosed in the larynx of a child. Objectively: the skin is
cyanotic, the puls is rapid. What is the type of breathing that develops at this
pathology?
___________________________________________________________________
7
Theme 2: " GENERAL STUDY ABOUT NOSOLOGY, ETIOLOGY AND
PATHOGENESIS (the SEMINAR)".
Actuality of the theme.
Teaching about disease, or the general nosology (from greek “nosos” - a
disease), belongs to belongs to the most old problem of medicine since. States of
health and disease, as a rule, are interleaved and go one in another often without
observable borders. For physician it is important to have general criteria, which
gave him possibility faultless to distinguish health from disease.
Study about etiology or reason and condition of the development of the
diseases, belongs to the oldest problem of medicine since because the first question,
with which the physician is confronted at examination of sick, concerns its reasons.
Find the reason a disease – it means to find the way to its treatment and preventive
maintenance. However, this question is not from lights often. Special etiology
studies the concrete reasons and condition of the arising the separate diseases.
Thereby, teaching about reason of the origin disease (etiology) is naturalscientific base one of the most important principle of medicine - its preventive
directivity.
Studies about pathogenesis belong to the most actual problems of modern
medicine. In fact only understanding general mechanism of development, motion
and outcomes of diseases, it is possible to consider one a «thinking» doctor.
The sequence of changes is determined in an organism for every disease,
cause-effective relations appear between different structural, metabolic and
functional changes are determined at the same time. In other words factors which
assist subsequent development of illness are determined.
The analysis of pathogenesis requires the clear understanding of role of
etiologic factor in pathogenesis, and also correlation between general and local,
structural and functional. Understanding of cause-effect relations and ability to see
and select the «main link» of pathogenesis will allow the doctor of any profession
to liquidate a pathological process and accelerate the offensive of favorable
consequences of illness.
General purpose of the lesson.
1. To know how to define biological and social essence of disease, the general
regularities of dynamic of its development.
2. To learn the role of the reasons and conditions in development of disease.
3. To learn the general conceptions of pathogenesis, to interpret the mechanisms
of development of pathological processes correctly.
For this it is necessary to know (the concrete purposes):
1. Explain the basic concepts of general nosology: health, disease, pathological
process, typical pathological process, pathological reaction, pathological
condition, etiology, pathogenesis.
2. Explain the basic concepts of etiology: causal factors, risk factors, and conditions
of disease development.
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3. Analyze various options for the cause-effective relationships in pathogenesis.
4. Analyze of pathological phenomena in the pathogenesis: adaptive-compensatory,
general and local, specific and nonspecific, leading to main link of
pathogenesis.
5. Evaluate the importance of modern methods of research (experimental and
clinical) for the pathophysiology.
For realization of purposes of lesson it is necessary to have the base
knowledges-skills.
1. To have a notion about correlation the weltanschauung and philosophy (the
world, its structure, types) (department of the social sciences - discipline –
philosophy).
2. To know philosophy of the Ancient East, China, Greece, Rome, Middle Ages
and Renaissance (department of the social sciences - discipline – philosophy).
3. To be aware of the teaching of dialectical materialism. Have a notion about
dialectics and its alternative (department of the social sciences - discipline –
philosophy).
4. To know the philosophical conception of Z. Freud (department of the social
sciences - discipline – philosophy).
5. To know the main philosophical categories: thing, characteristic, attitude,
reason and effect, single and the general, necessities and casual, reality and
possibility, contents and the form, essence and phenomena, system, element,
structure and function (department of the social sciences - discipline –
philosophy).
6. To have a conception about problem of the person in philosophy (the psyche
and consciousness; biological, social and spiritual at person) (department of the
social sciences - discipline – philosophy).
7. To have a notion about such philosophical conceptions, as: matter, motion,
space and time (department of the social sciences - discipline – philosophy).
8. To have a notion about general-logical methods: abstracting, analysis and
syntheses, induction and deduction, comparison and analogy (department of the
social sciences - discipline – philosophy).
9. To know the methods of the empirical cognition: scientific observation,
scientific experiment, empirical modeling (department of the social sciences discipline – philosophy).
10. To have a conception about relationship of philosophy and medicine (the
theories of the diseases to civilizations, ecological concepts) (department of the
social sciences - discipline – philosophy).
11. To have a notion about philosophical problem of the life and death (department
of the social sciences - discipline – philosophy).
12. To have a notion about the main rule of bioethics (department of the social
sciences - discipline – philosophy).
Information required for renewing the base knowledges it is possible
to find at the following textbook:
9
1. Lectures from the philosophy course.
Check primary level of knowledge.
Give the answers to the following questions:
1. Name the main history directions of development of the teaching about disease.
2. Name the factors, from which the different looks at disease on different stage of
mankind development are depending on.
3. Hippocrates contribution at development of the general teaching about a
disease.
4. Characterize the humoral and the solidary direction.
5. Galen contribution at development of the general teaching about disease.
6. Avicenna contribution at development of the general teaching about disease.
7. Paracelsus contribution at development of the general teaching about disease.
8. Characterize the jatrochemical and the jatrophysical direction.
9. R. Virhov contribution at development of the general teaching about disease.
10. Formulate the main positions of cellular pathology of Virhov.
11. Name positive and negative importance of cellular pathology of Virhov.
12. Give definition of the conception "health".
13. Give definition of the conception "disease".
14. Give the definition of the conception "pathological process" (cite an example).
15. Give the definition of the conception "pathological reaction" (cite an example).
16. Give the definition of the conception "pathological state".
17. Give the definition of the conception "typical pathological process" (cite an
example).
18. Principles of classifications of the diseases (cite an example).
19. Name the periods of disease and give the feature of each period.
20. Name the outcomes of the diseases.
21. Give the definition of the conception "clinical death".
22. Give the definition of the conception "biological death".
23. Give the definition of the conception "social death".
24. Give pathophysiologycal characteristic of the terminal states.
25. Name the factors, from which duration of clinical death depends.
26. Name the pathophysiologycal principles of reanimations
27. Give the definition of conception "etiology".
28. Name the main stages of the development of the teaching about etiology at
pathology.
29. What is the monocausalism? Explain the reasons of origin this direction in
medicine?
30. Significance of monocausalism in the development of the general studying
about etiology.
31. What is the conditionalism?
32. Significance of conditionalism in the development of the general studying about
etiology.
33. What is the constitutionalism?
34. Significance of constitutionalism in the development of the general studying
about etiology.
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35. Give the definition of psychosomatic direction.
36. 1Significance of psychosomatic direction in the development of the general
studying about etiology.
37. What is the philosophical base of general etiology?
38. 1What is a methodological base of general etiology?
39. Name the main positions of dialectics-materialistic determinism.
40. Modern understanding of causality at pathology.
41. Role of the conditions at arising of the diseases. Classification of conditions.
42. Notion about mono- and polyetiologic diseases.
43. Classification of etiological factor.
44. What is the "risk factors"? Cite an example.
45. Significance of "risk factors" at development of the diseases.
46. Significance of the general studying about etiology for theoretical and practical
medicine.
47. Give definition of concept «pathogenesis».
48. Explain the role of etiologic factor in pathogenesis (to make examples).
49. Name the variants of interaction factor with an organism in time.
50. Give description of role of structural and functional changes in pathogenesis.
51. Give description correlation between “general” and “local” in a pathological
process.
52. What is “main link” of pathogenesis?
53. Name the types of cause-effect relations.
54. Give definition of conception «Vicious circle» in pathogenesis.
55. Make an example of direct type of cause-effect relations.
56. Make an example of cause-effect relations on the type of «convergence».
57. Make an example of cause-effect relations on the type of «divergence».
58. Make an example of cause-effect relations on the type of «vicious circle».
59. Significance of common studies about pathogenesis.
Theoretical questions, at the base of which the execution of purpose types of
activity is possible.
1. Basic concepts of nosology: "health", "norm", "disease", "pathologic process",
"pathological condition", "pathological reaction."
2. Disease as a biological, medical and social problem.
3. Abstract and concrete in the concept of "disease".
4. Unity of destructive and protective in the disease.
5. Principles of classification of diseases, the WHO classification.
6. Basic patterns and periods of diseases.
7. Kind of outcomes of diseases. Remission, relapse, complications.
8. The concept of terminal states (preagony, agony, clinical death), and biological
death (definition, features).
9. Pathophysiological basis of reanimation.
10. Main directions of study about the disease: humoral (Hippocrates), solidary
(Democritus), cellular pathology (R. Virkhov).
11. The development of these areas today.
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Theme of reports:
1. Hyperbaric oxygenation, it’s using in medicine.
2. Social death as physician-social problem of mankind.
3. Adaptation, compensation. Mechanisms of immediate and long duration
adaptation.
4. Role of Virchov in development of study about pathogenesis. Positive and
negative value of cellular theory.
5. Adaptation, compensation. Mechanisms of immediate and long duration
adaptation.
6. Role of Virchov in development of study about pathogenesis. Positive and
negative value of cellular theory.
Literature is necessary for studying of the theoretical questions.
1. General nosology. Manuals for the students. – Vinnitsia, 2007.
2. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005.
3. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. – Р.10-12
4. Lecture’s materials.
Checking of the final level of knowleges.
“KROK-1” open database 2010
1. Insufficiency of the mitral valve was founded at man who 12 years ago
suffered from rheumatic myocardites. Investigations have shown that the
inflammatory process is absent, minute volume of circulation is sufficient.
Name the nition of general nosology.
A. Pathological state
B. Pathological reaction
C. Disease process
D. Typical pathological process
E. Compensating reaction
2. Atrophy of bone marked in the patient after the removal of teeth. This is an
example of:
A. Pathological condition
B. Pathological reaction
C. Pathological process
D. Structural adaptation
E. Disease
12
2006-2009
1. A 50-year –old man has a stomach ulcer. After the treatment digestion
become to normal, pain dissapiared, and his mood improved. However, in a
couple of weeks the patient developed pain in epigastric region, heartburn and
acd belching. How this situation might be interpreted?
A. Disease relaps
B. Remission period
C. Terminal status
D. Premonitory period
E. Latent period
2. A 12-year-old boy after coming home from the school began to complaint of
headache, nausea, chill, periodic muscle pain, loss of appetite, and fatigue.
What disease period can show such signs?
A. Prodromal
B. Latent
C. Incybation
D. Height of the disease
E. End of the disease
3. A student fell ill with acute respiratory disease at the end of winter following
long period of mental overloading. What is the cause of the disease?
A. Pathogenic microorganism
B. Irrational diet
C. Mental overloading
D. Supercooling
E. Hypovitaminosis
4. Pain in aleft half of the chest and dyspnea appear in a patient during
walking. This pain increases during respiration. The attack of the pain was
stopped by using narcotics. At examination of the patient following data were
revealed: severe condition, respiratory rate is 28 per min., respiration is
shallow and is dull in the left axillary region. Blood pressure is 140/80 mm Hg.
Patient has sputum with blood. This patient has varicose dilation of veins. In
purpose to correct main pathogenic link it is necessary to use:
A. Anticoagulants
B. Antibiotics
C. Antihistamin preparation
D. Spasmolytics
E. Coronarilytics
5. A 39-years-old patient has been suffering from gastric ulcer for last 4 years.
Pain in epigastric region, heartburn, nausea, and constipation appear mainly
in autumn and spring. Name this condition.
13
A. Remission
B. Acute period
C. Complication
D. Pathologic condition
E. Relapse
6. Gasping respiration appears in a patient with severe lung pathology. What
terminal condition is this characteristic for?
A. Agony
B. Pre-agony
C. Clinical death
D. Biological death
E. Terminal pause
7. A 10-yeaes-old child endured several rheumatic attacks. At examination of
him it was established that he had inflammatory process in his joints and signs
of mitral valve insufficiency. What pathological appearance in this patient
may be attributed
to "disease"?
A. Mitral valve disease
B. Mitral valve insufficiency
C. Rheumatism
D. Inflammation of joints
E. Arthritis
8. Which scientist emphasized senescence of connective tissue cells cytoplasm?
A. Bogomolets
B. Mechnikov
C. Dilman
D. Frolkis
E. Berdichev
9. A 28-year-old patient with symptoms of acute appendicitis was admitted to
the surgical department. Acute pains in his right epigastric area and near the
umbilicus were registered during palpation on examination. SchetkinBlumberg symptom was positive. Which period of disease was observed in that
patient?
A. Period of manifestation
B. Latent period
C. Prodromal period
D. Final period
E. Period of functional disorder
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10. Increase in pulse rate, respiratory rate, and increase of BP were noticed on
the height of 1000 m above the sea in a 25-year-old woman, coming for holydaj
in the mountainous resort. In some time all those symptoms disappeared.
Which process was noticed in a woman?
A. Adaptation
B. Compensation
C. Decompensation
D. Stress
E. Parabiosis
11. A man with the complex of deviation of his health is considered sick. What
is the more typically for disease?
A. Disorder of physiological regulation of functions
B. Decrease of ability to work
C. Disorder of immunity
D. Psychological deviations
E. Decrease of adaptation
Situation tasks:
1. Patient A., 45, arrived in Khmelnik for spa treatment with complaints of
weakness and pain in the muscles of the right leg in time of walking. Five years
ago, on the basis of vascular disease dry gangrene of his left foot developed,
about what it was amputated. The warm hydrogen sulfide bath resort was
recommended to the patient. Soon, however, recommendations was canceled
because painful compression associated with the development of inflammation
in the veins (phlebitis) developed along the subcutaneous veins of the right leg.
In addition, the patient endured the treatment bad: while taking bath his
blood pressure rose and headaches appeared.
1. What pathological reaction, pathological process and pathological condition
developed in a patient?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. Patient S., 18, delivered at the reception department of the hospital in grave
condition. During ski trips he lost in the woods and fell asleep under a tree. He
was founded in a day. Objective: consciousness is lost, rectal temperature
250C, skin and visible mucous membranes are pale, with a cyanotic tint, the
pupils are dilated, blood pressure - systolic 40mm.Hg. (Diastole is not defined).
Pulse 30 beats / min, breathing is unrapid and superficial, reflexes are
decreased, pain sensitivity is absent.
1. Name the terminal condition of the patient?
15
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. Worker P., 42 years old, during an accident at work snatch by hand wire
through which current pass 220 V. As a result of the muscles contractions he
wasn’t able to disconnect by himselve. He quickly lost consciousness. In a few
minutes he was disconnected from the wire by other workers. The doctor
diagnosed the stoping of breathing on the base of intact cardiac activity. There
are small deep wounds of burned with slightly charred edges on the hands and
both feet. Artificial respiration was carried out to the patient during 2.5 hours
(before the appearance of self-breathing).
1. Was the victim in a state of clinical death?
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
4. Patient Z., 27, delivered in a hospital in a grave condition. Skin and mucous
membranes are cyanotic, pulse 146 beats / min, weak content. Blood pressure
90/60 mm Hg, respiration is frequent and shallow, the body temperature 40.50
C. According to the victims, who eliminated the accident within 40 minutes the
patient was working at 700C air and high humidity.
1. Is the state of the patient a terminal staye?
___________________________________________________________________
2. Justify your conclusion.
___________________________________________________________________
___________________________________________________________________
5. Patient A., age 22, entered the clinic with a diagnosis “adhesive bowel
obstruction”. During the operation, carried out under the endotracheal
anesthesia, there was a blockage of mucus endotracheal tube. The patient
stopped to breath, soon the pulse disappeared. After 2 min after the onset of
clinical death the mucus from the trachea was suction and artificial
respiration was started . Simultaneously 300 ml of blood with 1 ml of
adrenaline (1:1000) under the pressure of 220 mm Hg was injected into the
right brachial artery. In the absence of effect the chest was disclosed and
direct cardiac massage started. After 1 min. after the massage were the
contraction of heart and breathing resumed. Postoperative condition is
satisfactory.
1. Can you juistify the ventricular fibrillation of the heart as the cause of ineffective
resuscitation in the first stage?
___________________________________________________________________
16
2. How, without revealing the chest, to diagnose fibrillation of ventricular of the
heart?
___________________________________________________________________
3. What are the basic principles of resuscitation?
___________________________________________________________________
___________________________________________________________________
4. Is it justified the transition from indirect to direct cardiac massage during
ventricular fibrillation without prior defibrillation?
___________________________________________________________________
6. Patient A. came to the clinic with complaints of cough, fever to 38-390C,
general weakness, sweating, headache. Diseases linked to the fact that before
he drove several hours on a motorcycle and was cold. Clinical and radiological
examination allowed diagnosis: pneumonia.
1. What is the direct cause of disease?
___________________________________________________________________
2. What is the role of cooling in this case?
___________________________________________________________________
3. What changes in blood might occur in a patient?
___________________________________________________________________
___________________________________________________________________
7. Patient S., 28 years old, delivered to the resuscitation department
emergency hospital in a grave condition. He was founded on the street with
gunshot wounds of the chest and massive bleeding. Objective: consciousness is
lost, rectal temperature is 250C, skin and visible mucous membranes are pale,
with a cyanotic tint, the pupils are dilated, blood pressure - 0. Pulse is not
defined, breathing and reflexes reduced pain sensitivity is absent.
1. What terminal condition developed at the patient?
___________________________________________________________________
2. What resuscitative measures should be applied?
___________________________________________________________________
___________________________________________________________________
8. Patient S., 37, who suffered as a result of the accident, was taken to the
admission department of the hospital in grave condition. The patient fractured
bones of the pelvis and lower limbs, he has massive bleeding. Objective:
consciousness is lost, rectal temperature 250C, skin and visible mucous
membranes arepale, with a cyanotic tint, the pupils are dilated, blood pressure
- systolic 40mm.rt.st. (Diastolic is not defined). Pulse 30 beats / min, Gaspingbreathing, reflexes are decreased, pain sensitivity is absent.
1. What terminal condition developed at the patient?
___________________________________________________________________
2. What resuscitative measures should be applied?
___________________________________________________________________
___________________________________________________________________
17
Theme
3:
PATHOGENIC EFFECT OF THE ENVIRONMENTAL
FACTORS (mechanical factor, ionizing radiation, barometric
pressure, high and low temperatures)
Actuality of the theme.
Ionizing radiation is radiation, which interaction with the environment
results in ionization with the formation of electric charges with different signs.
Ionization and accompanying it excitement of atoms and molecules is a starting
mechanism of processes that results in the development of the radial damage of
biological structures of cells, tissues, organs, systems of the whole organism.
Mechanical trauma is one of the main reasons of hospitalization and
before the proper time disability. According to the data of the World Organization
of Health 250 thousands of peoples perish from incidents on the roads and more
than 10 millions get injuries every year.
A man feels the influence of diminished barometric pressure at climbing in
mountains or at flight in aircrafts (at decompression of airplane cabin). The
influence of the high barometric pressure at immersion into water.
Thermal factor is of great importance in the development of pathologic
processes. Overheating and super cooling result in changing of thermoregulation,
disorders of different organs and systems of the organism.
Knowledges of the mechanisms of hyper and hypothermia are necessary
for working out the methods of treatment and prophylaxis of these pathological
processes.
Electric current is one of the most dangerous environmental factors that
has a pathogenic influence and results in the development of the extreme states.
The wide use of the latter in industry in everyday life in natural conditions with
diagnostic and therapeutically purpose. The possibility of emergency situations
bring about the necessity of deep study of electric current effect on the organism
General purpose of the studies - to learn the mechanisms of pathogenic
action of mechanical factors and ionizing radiation on the organism, to learn
pathogenic influence of barometric pressure, high and low temperatures on an
organism; to learn the mechanisms of pathogenic action of electric current on the
organism.
For this purpose it is necessary to be able (concrete aims):
1. To analyze the role of environmental factors in causing of disease;
To explain the cause-effective relationships, with separate local and general
changes, pathological and adaptive-compensatory reactions in the pathogenesis of
the manifestations of environmental factors action (overheating, cooling, burns,
freezing, radiation sickness, disease, compression and decompression);
For realization of aims of study base knowledge-abilities are needed.
1. Physical essence of the mechanical force (the department of physics).
2. Physical nature of different types of ionizing radiation (the department of
18
physics).
3. Biological nature of different types of ionizing radiation (the department of
physics).
4. Blood cells and methods of their counting (the department of normal
physiology).
5. Gas composition of the blood and partial pressure of oxygen in the atmospheric
air (normal physiology department).
6 Dependence of degree of hemoglobin saturation with oxygen on its partial
pressure (normal physiology department).
7. Dependence of physic and chemical properties of gases in liquids on barometric
pressure (department of physics).
8. Dependence of physic and chemical properties of proteins on the temperature of
environment (department of physics).
9. Regulation of heat exchange is an organism (normal physiology department).
10. Basic physical parameters of electric current (department of physics).
11. Electric properties of living tissue (physical department).
Information, necessary for addition to base knowledges-abilities on these
questions, can be found in the followings textbooks:
1. Medical Physiology, Arthur C. Guyton, M.D.John E.Hall, Ph.D., W.B.
Saunders company, 1996.
Testing of primary level of knowledge.
Give answers on the followings questions:
1. What structures have the greatest stability to breaking?
2. What tissues are the most stable to compression?
3. The dysfunction of what organs and systems is leading at the “crush”
syndrome?
4. What changes in the picture of blood are characteristic of the first period of
osteo-cerebral form of radiation sickness?
5. What changes in the blood picture are the characteristic of the second period of
osteo-cerebral form of radiation sickness?
6. What changes in the blood picture are the characteristic of the third period of
osteo-cerebral form of radiation sickness?
7. What do we call the first period of osseocranial form of radiation sickness?
8. What do we call the second period of osseocranial form of radiation sickness?
9. What do we call the third period of osseocranial form of radiation sickness?
10. What do we call the 4th period of osseocranial form of radiation sickness?
11. What forms of radiation sickness do you know?
12. Radiation sickness complications.
13. What do the radiation sickness complications depend on?
14. What do the mechanisms of pathogenic action of ionizing radiation consist of?
15. What is radiolysis of water? What is its significance in the mechanisms of
pathogenic action of ionizing radiation?
16. What types of radiation do you know?
19
17. What are radiotoxins? What radiotoxins do you know? What is their
significance in the mechanisms of pathogenic action of ionizing radiation?
18. What system is most sensible to radiation? Motivate you answer.
19. What does the sensitivity of tissues to the action of ionizing radiation depend
on?
20. What are the stages of traumatic shock?
21. Call the main the mechanisms of the pathogenic action of the mechanical
factor?
22. What mechanisms of the pathogenic action of ionizing radiation consist of?
23. When does a man undergo the action of high barometric pressure?
24. When does a man undergo the action of diminished barometric pressure ?
25. What is euphoria?
26. What is saturation?
27. What is desaturation?
28. What changes of gas composition of blood characterize mountain sickness?
29. How does solubility of gases change at the elevation of barometric pressure?
30. How does solubility of gases change at the diminishing of barometric pressure?
31. At what altitude does boiling of biologic liquids at the body temperature take
place?
32. What is explosive decompression?
33. What is gas embolism? How does the change of barometric pressure influence
on its development?
34. What is bleeding from the nose and ears at the diminishing of barometric
pressure associated with?
35. What is hyperoxia? What is the manifestation of toxic action of oxygen?
36. Why in removing of СО2 disturbed at hyperoxia?
37. What is burn disease?
38. Stages of burn disease.
39. When does heat stroke develop?
40. When does sunstroke develop?
41. What conditions are favorable for the pathogenic effect of high temperature of
the environment?
42. What properties does the pathogenic action of electric current depend from (to
enumerate)?
43. What is the significance of pathway of electric current in the organism?
Ground.
44. What is the significance of physiological state of organism at the action of the
electric current?
45. What forms the base of the electrochemical effect of the electric current?
46. What forms the base of the electro thermal effect of the electric current?
47. What does the electromechanical effect of the electric current consist of?
48. What local disorders develop in the tissues at passing of the electric current?
20
Theoretical questions on the basis of which implementation of purpose types of
activity is possible.
1. Classification of pathogenic environmental factors.
2. Pathogenic effect of mechanical factors.
3. Laws of mechanical trauma, crush-syndrome, traumatic shock.
4. Pathogenic effect of ionizing radiation. Types of ionizing radiation. Radiosensitive
tissues.
5. Mechanisms of direct and indirect radiation damage of biological structures.
Radiolysis of water. Radiotoxins.
6. Manifestations of radiation injury at the molecular, cellular, tissue, organ and
systemic levels.
7. Pathogenesis of radiation disease, its basic forms and syndromes.
8. Nearest and long-term consequences of large and small doses of ionizing radiation.
Stochastic and non-stochastic effects.
9. Natural mechanisms of radiation protection. Pathophysiological basis of
radioprotection.
10. Pathogenic effect of thermal factors.
11. Protective, reactions and pathological changes in hyperthermia.
12. Heat- and sunstroke.
13. Burns, burn disease.
14. Hypothermia. Protective, reactions and pathological changes in hypothermia.
15. Mechanisms of long-term adaptation to cold.
16. Artificial hypothermia and its use in medicine.
17. Pathogenic effects of infrared and ultraviolet rays.
18. Photosensitization. Risk of insufficient insulation.
19. Injury caused by electromagnetic radio waves of high frequency.
20. Pathogenic effect of electrical current. Factors that determine the nature of
injuries at that.
21. Effects on the body of high and low atmospheric pressure.
22. Cause-effective relationships in the pathogenesis of compression and
decompression syndromes. Explosive decompression.
23. Effects on the body of space flight factors - acceleration, weightlessness
Literature.
1. Handbook of general and Clinical Pathophysiology/ Edited by prof. A.V.
Kubyshkin, CSMU, 2005.
2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005.
3. Manual of the department “General nosology”, Vinnitsia, 2010.
Themes of reports for individual work of students:
1. Remote results of the ionizing radiation influence.
2. Pathogenic effect of infra-red rays.
3. Pathogenic effect of ultraviolet rays.
4. Medical aspects of consequences of the accident in Chernobyl atomic station..
5. Hypothermia. Its application in medicine.
6. Application of hypothermia in modern medicine.
21
Testing for checking of final level of knowledge
“KROK-1” open database 2010
1. In result of the damage of one of the Atomic Power Plant reactor the runout of radioelements happened. People in the increased radiation zone were
radiated with approximately 250-300 r. They were immediately hospitalized.
What changes in the blood count would be typical?
A Lymphopenia
B Leukopenia
C Anemia
D Thrombopenia
E Neutropenia
2006-2009
1. Liquidator at Chernobyl Atomic Electric Station underwent total
irradiation. In what organ or tissues is most possible development of tumor?
A. Hemopoetic tissue
B. Lungs
C. Stomach
D. Skin
E. Bone tissue
2. A patient suffering of osseo-cerebral form of radiation sickness. What
sprouts of hematogenesis re injured at this disease?
A. All.
B. Erythrocytic.
C. Megacaryocytic
D. Granulocytic.
E. Agranulocytic
3. A man, aged 35 years, in 15 min after a motor-car accident was diagnosed
massive trauma of the lower extremities without profuse external bleeding.
The victim is in the excited state. What component of pathogenesis of
traumatic shock is a leading one and needs immediate correction?
A. Pain.
B. Sharp hepatic insufficiency.
C. Intoxication.
D. Cardiac function disorders.
E. Internal loss of plasma
4. As a the result of the damage of the reactors at AES running out of radioactive products took place. People that were in the area of high radiation got
about 250-300R. They were immediately hospitalized. What main symptom
will the victims have?
22
A.
B.
C.
D.
E.
Lymphopenia
Leucopenia
Anemia
Thrombocytopenia
Neutropenia
5. Accident at Chernobyl AES resulted in development of radiation sikness in
the liquidators. Disorders develops as the result of initial radio-chemical effect
of ionizing radiation mainly on molecules of:
A. Water
B. Albumens
C. Lipids
D. Enzymes
E. Carbonhydrates
6. A patient immediatly after the irradiation (single dose is 80 Gr) instantly
developed such symptoms as: collapse, loss of consciousness, anuria, cramps
and paralysis. What form of radiation sickness in this case?
A. Acute cerebral
B. Osseo-cranial
C. Toxemic
D. Gastrointestinal
E. Chronic radiation sickness
7. Formation of lipids and quinone radiotoxins is one of molecular
mechanisms of indirect action of ionizing irradiation. What is mechanism of
radiotoxin effect on the cells?
A. Depression of synthesis of nucleic acids
B. Activating is POL
C. Stimulation of oxydation of pyrimidine
D. Depression of the activity of atioxydant system
E. Deamination of purine bases
8. As a result of violation of rules of accident prevention the worker of the
radiological department of regional hospital got a single radiation. In 8 days
the ulcero-necrotic changes in the oral cavity were observed. In the blood was:
Er-3,2 x 1012/L, reticulocytes - 0,01% Hb-60g/L, L - 2,3x 109/L, thrombocytes50 G/L What period of radiation sickness is characterizes by such changes?
A.
B.
C.
D.
E.
Period of clinical manifestations
Period of primary reactions
Latent period
Period of imagined safety
Period of outcomes
23
9. Which of nervous tissues features makes it high radio resistance?
A. Lack of mitotic activity in neurons
B. High content of lipids
C. Decrease of permeability of plasmatic membrane of neurons for ionizing
radiation
D. Permanent high functional activity
E. Great intensity of oxygen consumption
10. Pathogenic action of ionizing radiation was studied during the experiment.
Name the symptomocomplex that dosn’t develop at radiation of the organism
by the median doses of ionizing radiation.
A Rough structural changes and death of nervous cells
B. Hemorrhagic syndrome
C. Intestinal autointoxication
D. Nervous-reflex disorders
E. Depression of hemopoesis
11. Victim during an accident on a submarine atomic boat got the dose of
irradiation 6 Gr. It expected essential disorders of functions and structure of
cells:
A. Bone marrow
B. Intestinal epithelium
C. Epithelium of skin
D. Pulp of spleen
E. Thyroid gland
12. A driver was admitted to the resuscitation department. He does not reacts
to the questions, is indifferent to everything, pale, his breathing is superficial,
infrequent. Arterial pressure -75/50 mm. Name the main link of pathogenesis
of abovementioned pathology.
A. Central nervous system inhibition
B. Excitation of CNS
C. Loss of blood
D. Toxemia
E. Redistribution of blood
13. How can one liquidate the main link that appears at traumatic shock?
A. By anesthesia
B. By excitation of vasomotor centre
C. By hypertensive drugs
D. By activating of blood sedimentation
E. By antioxidants
24
14. The worker of AES was admitted to the a clinic after a single radiation
with the complaints of a headache, loss of consciousness, high of temperature,
weakness, vomiting, diarrhea. Blood analyses showed leukocytosis with
lymphopenia. What period of radiation sickness is the most possible in a
patient?
A. Primary reactions
B. Prodromal
C. Lethal
D. Developed clinical picture
E. Period of imagined sufety
15. A patient that is in the clinic for acute radiation sickness complaints of a
headache, insomnia, marked weakness, difficulties of eating. The gums
inflammation, necrotic angina, skin hemorrhagis, blood in urine and fecus
were founded in the physical examination. Damage of what tissue is the main
in pathogenesis of disorders in this case?
A. Hemopoietic
B. Bone tissue
C. Glandular epithelium
D. Nervous
E. Lymphoid
16. On the peak of acute radiation sickness a patient had acute weakness, his
skin was pail, tachycardia, pain in the different parts of the intestine,
vomiting, fecus with the tinge of blood. Arterial pressure – 70/40 mm Hg. Two
weeks before the patient got a radiation dose 30 Gr. What form of radiation
sickness is characterized by such symptoms?
A. Intestinal
B. Toxemic
C. Osseo-cranial
D. Hemorrhagic
E. Cerebral
17. White rat got the X-ray radiation in a dose 10 Gr. Give the most possible
change of the peripheral blood picture that is observed in 0 hours after the
radiation.
A. Neutrophyic leukocytosis
B. Leukopenia, anemia
C. Anemia
D. Anemia, leukopenia, thrombocytopenia
E. Afranulocytosis
18. A rabbit was radiated with a dose 0,5 Gr. In what system are the most
marked disorders observed in 10 hours after radiation?
25
A.
B.
C.
D.
E.
Hemopoietic
Nervous
Cardio-vascular
Sexual
Lymphoid
19. During the work for liquidation of the consequences of AES liquidation of
the consequences a worker got radiation in a dose of 10 Gr. He complains of a
headache, nausea, loss of consciousness. What changes of leukocytes can one
expect in a patient 10 hours after later after radiation?
A. Lymphocytosis
B. Leucopenia
C. Agranulocytosis
D. Neutrophilic leucocytosis
E. Leukemia
20. In a peak period of acute radiation sickness in a patient had leukopenia,
thrombocytopenia, autoinfection, autointoxication, bleeding, high temperature
were observed. What form of radiation sickness is characteristic of such
picture?
A. Intestinal
B. Osseo-cerebral
C. Toxemic
D. Cerebral
E. Hémorragie
21. A 35-year-old man following 30 min after a car incident presented massive
trauma of the low extremities without significant external bleeding. The
patient it agitated. What component of the traumatic shock is prominent in
this case and needs to be corrected immediately.
A. Pain
B. Internal haemorrhage
C. Internal loss of plasma
D. Intoxication
E. Disorder of the internal organs
22. At the height of the acute radiation sickness a patient had leukopenia,
thrombocytopenia, autoinfection, autointoxication, hemorrhagic diathesis, and
fever. What kind of the radiation sickness might be accompanied by these
symptoms?
A. Bone marrow
B. Intestinal
C. Toxemic
D. Cerebral
E. Haemorrhagic
26
23. A primary pathogenic mechanisms of the radiation cell lesion is bound
with:
A. Water radiolosos
B. Activation of the cell membrane phospholipase
C. Accumulation of the Ca++ in the cells
D. Increasing of the Na+ diffusioan in the cell
E. Intracellular acidosis
24. A man was brought to the hospital in 3 days after the influence of ionizing
radiation in a dose # Gr. What physiological system might be primary
involved into the pathological process?
A. Blood
B. Digestive
C. Cardiovascular
D. Immune
E. Endocrine
25. A Chernobil liquidator complaints of fatigue, skin hemorrhages, and
diarrhea. Blood test results: erythrocytes sedimentation rate – 25 mm/h.
erythroxytes – 2,4x1012/l, leukocytes – 2,2x109/l, platelits – 70x109/l. what phase
of radiation sickness takes place?
A. Height of the disease
B. Primary acute reactions
C. Imaginary clinical well-being
D. Restoration
E. Disease outcome
26. A diver that for a long time was on the depth 40 m at decompression
developed in cassion disease. The main of pathogenic link was embolism:
A. Gas
B. Air
C. Fatty
D. Paradoxal
E. Tissue
27. At the decompression of the cabin of airplane at the altitude of 19km the
immediate death of the pilots came. What is its cause?
A. Boiling of blood
B. Cerebral hemorrhages
C. Gas embolism of cardiac vessels
D. Bleeding
E. Paralises of respiratory center
27
28. The state Of passengers of the airplane with partial decompression became
sharply worse. Pain in t he ears, frontal sinus, meteorism, bleeding from the
nose. What peripheral blood disorder caused this bad state?
A. Gas embolism
B. Ischemia
C. Venous hyperemia
D. Thromboembolism
E. Stasis
29. The patient with burns of 40% surface of body burn shock developed.
What is the primary mechanism of its development?
A. Pain
B. Dehydration
C. Disorder of mineral metabolism
D. Autoimmunization
E. Disorder of protein metabolism
30. After the forced quick getting a diver up to the surface from the depth he
developed the signs of caisson disease: pain in joints, itching of the skin,
winkiig in the eyes, loss of consciousness. What type of embolism caused them?
A Gas
B. Air
C. Fatty
D. Tissue
E. Thromboembolism
31. After immersion of a diver on a depth of 60 km he developed the symptoms
of the disorder of the central nervous system - excitement, euphoria, loss of
attention, professional errors. These symptoms are associated with toxic effect
on neurons if:
A. Nitrogen
B. Oxygen
C. Carbon dioxide
D. Ammonia
E. Lactate
32. Decompression of a pilot's cabin happened on height of 14000 m. What
tyje of metabolism did he develop?
A Gas embolism
B. Tissue
C. Thromboembolism
D. Air embolism
E. Fat
28
33. At the emergency getting up from the depth the diver developed cramps
with the loss of consciousness. What pathogenic mechanism is the main one in
the development of this disorder?
A. Gas embolism
B. Hypoxia
C. Toxic effect of oxygen
D. Toxic effect of nitrogen
E. Toxic effect of C02.
34. At the development of mountain sickness subsequently develop below
mentioned changes of indices of the state of vital functions of the organism.
What of them are of pathologic character?
A. Increase of respiratory rate
B. Increase of breathing depth
C. Increase of pulse rate
D. Hypoxemia
E. Hypodynamia and apathy
35. For the first time the character of breathing of the alpinist who was at the
altitude of 5000 m above a see level changed during sleep: after some
respiratory movements there begins respiratory standstill than deep
respiratory movements were restored again and so on. What is the most
possible cause of changes of respiration?
A. Decrease of air temperature
B. Decrease of partial pressure of C02 in air
C. Decrease of partial pressure of 02 in air
D. Increase of blood flow rate
E. Increase of oxygen blood volume
36. An alpinist during climbing the mountain at the altitude of 6 000 m above
a sea level developed euphoria, inadequate estimation of situation,
hallucinations. What IS the main cause of the development of these symptoms
of mountain sickness?
A. Physical overstrain
B. Decrease of atmospheric pressure
C. Snow ophthalmia
D. Decrease of partial pressure of air oxygen
E. Expansion of air in frontal sinus
37. A man lived in high -mountain conditions for a long time. What change in
the system of blood is observed?
A. Increase of the diameter of the blood vessels
B. Decrease of the number of leucocytes
C. Decrease of the number of erythrocytes
D. Increase of the number of erythrocytes
E. Decrease of the number of thrombocytes
29
38. An alpinist was climbing the mountains for several days. At the altitude of
5 000 m tachypnoe, tachycardia, pain in the ears, headache of expansive
character developed. Indicate possible cause of these symptoms.
A. Increase of partial pressure of air oxygen
B. Insufficient ventilation of lungs
C. Gas embolism
D. Decrease of air temperature
E. Decrease of barometric pressure
39. At the experimental study of the influence of low barometric pressure
effect on white rats in barocamera at the altitude that corresponds to 2 000 m
above the sea level the animals developed tachypnoe, increase of the number of
erythrocytes and hemoglobin concentration. At what altitude above a sea level
the phenomenon of «self boiling of blood» is observed?
A. 14 000 m
B. 7 500 m
C. 8 500 m
D. 19 000 m
E. 10 000 m
40. At climbing the mountains in the group of students there were a
tachypnoe, euphoria, tachycardia, increase of erythrocytes and hemoglobin in
blood. What itate from the side of blood accompanies the above described
symptoms?
A. True erythremia
B. Erythrocytisis
C. Megaloblastic anaemia
D. Leucopenia
E. Thrombocytopenia
41. The member of high -mountain expedition at the height of 6 km devebped
dizziness, weakness. He lost his consciousness. This was respiration standstill.
These disorders developed due to:
A. Insufficient content of 02 in the organism
B. Excessive removing of C02 from the organism
C. Insufficient formation of C02 in tissues
D. Insufficient utilization of 02 by tissues
E. Insufficient liberation of 02 by hemoglobin
42. Acute general disorders are observed at long-term action of environmental
high temperature on the organism. What is the base of this phenomenon?
A. Cardiac insufficiency
B. Increase of body temperature
C. Dehydration
D. Intoxication
E. Hypoxia
30
43. A patient due to along-term work in the apartament in the condition of hot
microclimate the body temperature rose considerably. The state became wors
till evening: temperature of body 40°C, there was stupor, pallor of the skin,
bleeding from the nose. Arterial pressure was 80/50 mmHg. What extremal
state is observed in a patient?
A. Thermal shock
B. Hemorrhagic shock
C. Hyperthermal coma
D. Cardiogenoc shock
E. Hyperthermal collaps
44. After a long-term staing on the sun a patient had the temperature up the
41°C. on the background of the intensive therapy with salicylates the body
temperature became to 36,6°C. in this case fall in body temperature to the
normal indices is:
A. Active process, regulated by jatrogenic antipyretics
B. Active signal of hypothalamus to the end of the program of the fever
C. Passive process due to the exhaustion exo- and endogenous pyrogens
D. Active process, regulated by the natural pyrogenes
E. Pathological reaction to salycilates
45. On admitting to the hospital the man with the closed craniocerebral
trauma had a headache, nausea, vomiting, high t°C. Pathology from the side of
inner organs was not revealed. What form of thermoregulation disorder is
observed in a patient?
A. Exogenic hyperthermia
B. Fever
C. Endogenic hyperthermia
D. Centrogenic hyperthermia
E. All answers are correct
46. A man that had suffered from the explosion in the mine was admitted to
the reception department of the hospital. His general state was satisfactory. He
was conscious. There were areas of hyperemia of skin with blisters on the face,
hands and trunk. What factor mainly had the effect on the miner?
A. Chemical
B. Thermal
C.
Airwave
D.
Psychological
E. Toxic
47. A diver after submergence in depth of 60 m presented symptoms of central
nervous system dysfunction - excitement, euphoria, decreasing of attention,
professional mistakes. These symptoms take place due to influence on neurons
of
31
A. Nitrogen
B. Oxygen
C. Carbonic acid
D. Ammonia
E. Lactate
48. At what directions of passing of the electric current through the organism
there is the greatest threat to the life of the patient?
A. Back of the head -lower jaw.
B. Left leg -right leg.
C. Right leg - right hand.
D. Left leg-left hand.
E. back-abdomen
49. During a rain storm a ragged electric wire fell down on the head of the
victim whereupon he perished. Death occurred as a result of:
A. Paralysis of respiratory center
B. Disorders of cerebral blood circulation
C. Oppression of the cortex
D. Paralysis of the motor -vascular center
E. Irritation of nuclei of vagus nerve
50. An electrician working with the violation of rules of accident preventioi by
chance touched bare electric wire with both hands and perished. Death was at
the result of:
A. Fibrillation of auricles and ventricles
B. Complete atrio-ventricular block
C. Oppression of automatism of sinoarterial node
D. Decrease of myocardial contractive ability
E. Disorder of the vagus cardiac regulation
51. Electric current with the voltage of 1000 V was passed through the brain
of an experimental animal. The animal perished. The skin was cyanotic.
Determine the course of death:
A. Respiration standstill
B. Cardiac arrest
C. Collapse
D. Psychogenic shock
E. Cardiogenic shock
52. As a the result of a contact with the bare electric wire a small damage of
grayish color by sizes appeared 2 x 1,5 s-m appeared on the skin. It was
separated Irom healthy tissues by the demarcation line. There was no exudate
and erythema. Define the described damage:
A. Electric burn of II degree
32
B.
C.
D.
E.
Electric burn of a I degree
Inflammation
Necrosis
All answers are correct
53. In 2 weeks after electric trauma necrosis of the skin and surrounding
tissues developed in the peace of a contact with the electric wire. Define the
leading factor of the necrosis development in this case:
A. Discharge of a greatest amount of heat
B. Coagulation of proteins
C. Polarization of cell membranes
D. Damage of blood vessels
E. Injury of the skin and muscles with the products of POL
54. A direct electric current passed through the organism of a man that was in
the state of easy alcoholic intoxication (I = 20 ma, U = 220 V, t = 0,03 sec) at
the position of electrodes «head - leg» whereupon the paralysis of respiratory
center was observed. What factor contribute to the above mentioned
complication?
A CNS disorder
B. The pass way of electric current
C. State of alcohol intoxication
D. Types of electric current
E. The time of current action
55. A man who ignored the rules of accident prevention got an electric trauma
with electric current passing through the cardiac muscle. What dangerous
disorder in the work of the heart requires immediate interference may develop
in this situation?
A Tachycardia
B. Extrasystolia
C. Fibrillation
D. Arrhythmia
E. Bradycardia
56. The doctor of the first-aid station determined respiratory standstill with
the signs of the work of the heart in the victim from the influence of electric
current. What was the most possible pass way of the electric current passing in
this case?
A. A right hand - head
B. A left leg - right hand
C. A right leg - right hand
D. A left leg - right hand
E. Abdomen - right leg
33
57. A man had an electric trauma with the electric current passing through
ihmuscle of the heat. What dangerous disorders in the work of the heart that
require immediate interference may develop in this situation?
A. Bradycardia
B. Extrasystolia
C. Fibrillation of die auricle
D. Fibrillation of ventricles
E. Tachycardia
58. An electrician, working with violation of safety measures, touched an
electrical cable and died. He died due to
A. Atrial and ventricular fibrillation
B. Complete atrioventricular heart block
C. Depression of the sinoatrial automatism
D. Decreasing of contractive capacity of the heart muscle
E. Disorder of the vagal heart regulation
59. As a result of a trauma a patient has developed traumatic shock that led to
the following disorders: AP is 140/90 mm Hg, Ps is 120 bpm. The patient is
fussy, talkative, psie. Such state relates to the following shock phase:
A. Terminal
B. Latent period
C. Erectile
D. Torpid
E.-Desorder of the vagal heart regulation
Situational tasks:
1. As a result of damage of container of one of the blocks of Power-plant
reactor there took place leackage of radio-active products. In the area of
higher radiation the workers got 8 Gr. They were admitted to the clinik
immedeatly.
1. What complications can one expaect at the patients?
________________________________________________________________
2. Explain the mechanisms of pathogenic action of the ionizing radiation.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
3. What investigations are necessary for diagnosis of severity of the disease?
__________________________________________________________________4
4. What is radiation disease?What forms do you know?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
34
5. Give the characteristic of stages of osseo-cranial form of radiation disease.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
6. What is hemorrhagic syndrome? Mechanisms of its development at radiation
disease.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
7. What form of radiation disease developed at the victims?
________________________________________________________________
2. A man was engaged in the repairing of the TV-set that was switched on the
electric system. The loss of consciousness was sudden.
1. What is lead to the loss of the consciousness?
________________________________________________________________
2. What physical parameters of the electric current have the affecting influence?
___________________________________________________________________
________________________________________________________________
3. What directions of the electric current is the most dangerous one?
___________________________________________________________________
________________________________________________________________
4. What does the first aid consist of?
___________________________________________________________________
________________________________________________________________
5. What does the pathogenic action of electric current consist of?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
6. What local and general disorders take place at the actionof electric current?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
7. What rules of accident prevention were violated?
___________________________________________________________________
________________________________________________________________
3. Mountaineers slowly climbed on the slope of Everest (6 hours of liftare
behind). Felt: general weakness, palpitations, dizziness, headache, meteorism,
difficult to breathe.
1. What is the reason of the state of the mountaineers?
35
_________________________________________________________________
2. On the what height the alpinists are situated?
_________________________________________________________________
3. What is the significance of the tachycardia and tachypnea in this situation?
___________________________________________________________________
___________________________________________________________________
4. Explain the mechanisms of tachycardia and tachypnea in this situation.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
3. To perform the caisson works diver dipped to a depth of 20 m. There, he
was an hour and then it quickly brought to the surface. After 15 min. he began
to feel pain in the muscles, joints, began to hear badly, headache, dizziness
appeared.
1. What is happened with the diver?
___________________________________________________________________
__________________________________________________________________
2. What is the reason of the described disorders?
___________________________________________________________________
___________________________________________________________________
3. How to name the complex of the symptoms that arose up at the patient?
___________________________________________________________________
___________________________________________________________________
4. Give the characteristic of this complex of the symptoms.
___________________________________________________________________
___________________________________________________________________
5. What should be the actions of others? Explain your opinion
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
36
Theme 4: PATHOGENIC EFFECT OF THE ENVIRONMENTAL
FACTORS (chemical, biological, social and psyhical).
Among the pathological environment factors chemical substances take one
of leading places. Constant decreasing of their number is observed. Now more than
five million different chemical substances have been registered in the world and
about two thousand new ones are synthesized every year. A man widely enough
contacts with 60 – 70 thousand chemical substances. Scientific and technical
progress is associated with steady decrease of mass of chemical substances that get
in an environment.
In basis of mechanisms of pathogenic effect of chemical factors there lies their
ability to react with normal components of the organism and change their structure,
and, consequently, and functional properties.
General purpose of the studies to learn the mechanisms of pathogenic
action of chemical, biological, psychical and social factors on the organism.
For this purpose it is necessary to be able (concrete aims):
1. To analyze the role of environmental factors in causing of disease includes
social, psychical factors.
2. To analyze general laws of the pathogenic mechanisms of environmental factors
on the organism.
3. To explain pathogenic mechanisms of physical, chemical and biological
environmental factors.
4. Give the characteristic of the effects of chemicals actions.
5. Alcogolism. Narcomania. Toxicomania.
For realization of aims of study base knowledge-abilities are needed.
1. Types of reactions of chemical factors with the most important biological
substances (biochemistry department ).
2. Products of ethanol oxidization (biochemistry department).
Information, necessary for addition to base knowledges-abilities on these
questions, can be found in the followings textbooks:
1. Medical Physiology, Arthur C. Guyton, M.D.John E.Hall, Ph.D., W.B. Saunders
company, 1996.
Testing of primary level of knowledge.
Give answers on the followings questions:
1. What is teratogenic effect? What environment factors is it inherent to?
2. What does mutagenous effect of chemical factors consist of?
3. What is „ the effect of adaptation”? What environmental factors is it inherent
to?
4. Mention the biological effects that appear due to the action of chemical
environmental factors.
37
5.
6.
7.
8.
What is a psychical effect?
What pathology may develop under the influence of the psychical factors?
What are social factors?
What are jatrogenic diseases?
Abstinence (Lat. abstinentia - retention) is the state that develops when some
substances that cause narcotic dependence stop getting into the organism.
Abstinence is characterized by the vegetosomatic, psychical, neurological
disorders.
Theoretical questions on the basis of which implementation of purpose types of
activity is possible.
1. Chemical pathogenic factors as a problem of ecology and medicine.
2. The concept of toxicity, carcinogenicity and teratogenicity of chemical
compounds.
3. Exo-and endointoxications.
4. General laws of poisons, specific and nonspecific mechanisms of intoxication.
5. Natural mechanisms of protection against toxins and poisons.
6. Pathophysiological aspects of alcoholism, drug addiction, substance abuse.
7. Infectious process, the general patterns of development.
8. Classification of infectious agents.
9. Protective barriers against infection, the conditions to overcome them.
10. Distribution and dissemination of infectious agents in the body.
11. Sepsis.
12. The role of pathogen properties and reactivity in the development of infectious
diseases.
Testing for checking of final level of knowledge
“KROK-1” open database 2010
1. A woman who was infected with toxoplasmosis during the pregnancy has a
child with multiple congenital defects.This is a result of:
A Teratogenesis
B Cancerogenesis
C Biological mutogenesis
D Chemical mutogenesis
E Recombination
38
2006-2009
1. A galvanizer addressed to a doctor because of appearing of pink itching
spots and vesicles on his arms skin. He worked a lot with nickel compounds
recently. What is themechanism of these lesions development?
A. Modification of skin proteins due to action of nickel ions with
immunopathological reaction development
B. Irritant action of nickel compounds on skin
C. Vegetative disorders related to nickel compounds received by respiratory
tract
D. Infection of skin due to microtraumas
E. Nickel is a complete antigen
2. What is the reason for pneumonia development in children after cooling?
A. Microorganisms
B. General cooling
C. Decrease in reactivity due to previous diseases
D. Insufficiency of nutrition
E. All these factors
3. A patient very often has diseases of nasopharynx, which appear under the
influence of different factors and in the most cases manifest by inflammation.
Which of listed factors is the most probable reason for these diseases?
A. Microorganisms
B. General cooling of organism
C. Overstrain
D. Immunodeficiency
E. Insufficiency of nutrition
Practical work:
“Pathogenic action of chemical factors”
Object of work: to study the pathogenic action of chemical factors on the
organism of animals.
EXPERIMENT № 1. Induction of coagulative necrosis.
Inflict the drop of phenol by a glass stick on the area of membrane. Examine and
sketch the picture of coagulative necrosis. Make the conclusions.
EXPERIMENT № 2. Induction of colliquative [liquefactive] necrosis.
Inflict the drop of the concentrated alkali (caustic potash solution).
Examine and sketch the picture of colliquative necrosis.
39
Blood stream in norm
necrosis
Coagulative necrosis
Colliquative
Conclusions:________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
Literature.
1. Pathogenic action of the environmental factors. Manuals for the students. Vinnitsia, 2007.
1.
2.
3.
Themes of reports:
Teratogenic action of the drugs.
Medicosocial aspects of the alcoholism problem.
Medicosocial aspects of the narcomania.
40
Theme 5: ROLE OF REACTIVITY, RESÍSTANSE AND SMPh IN
DEVELOPMENT OF PATHOLOGY. IMMUNOLOGICAL
REACTIVITY.
Actuality of the theme
Notion of reactivity firmly entered in practical medicine, helping objectively
to estimate being of patient. Reactivity of an organism is one of important factors
of pathogenesis of disease, as pathological reactivity is characterized by the
decrease of adaptation properties of an organism.
Any pathological process changes reactivity of an organism. At the same
time the change of reactivity, that exceeded physiological borders, can become the
basis of development of disease. Therefore the study of reactivity and its
mechanisms has the important value for understanding of pathogenesis of diseases
and purposeful medical treatment.
Immunological reactivity is the issue of the day of modern medicine.
Study of immunity, as firmness to the infectious diseases, beginning is
fixed to L. Paster, I.I. Mechnicov, drove to our time to opening of mechanisms of
immunological reactivity that is carried out by competent immune tissue. Support
of antigen homeostasis in an organism both to infectious is the basic function of it
and to the uninfectious antigens.
The cellular and humoral immunological reactions are, from one side, by
the basis of protective mechanisms at a different pathology, and from the second by the basis of allergy. Different pathological processes develop in the case of
insufficiency or discoordinated functions of the immune system.
Therefore study of structure and functions of cells, which take part in the
immune answer, finding out of type of inheriting of immunodeficiency syndromes,
mechanisms of their development, conducting of adequate treatment has big value
in the system of preparation of future doctor.
General purpose of the lesson - to learn the main types of reactivity of an
organism at pathological processes; to expose a role of the system of mononuclear
phagocytes (SMPh) in the mechanisms of reactivity; to learn the mechanisms of
development of immunodeficiency and methods of their correction
For this purpose it is necessary to be able (concrete aims):
1. To learn concept of reactivity, to understand its role in support of homeostasis
and development of pathological process.
2. To know kinds and main mechanisms of reactivity.
3. To know the character of reactivity of child's organism.
4. To be able to explain of definition "resistance of an organism" and expose the
main mechanisms of specific and unspecific resistance.
5. To be able to describe the value of SMPh in the mechanisms of reactivity.
6. To analyze mechanisms of immunological reactivity.
7. To analyze features of forming of immunological reactivity in child's age.
8. To explain violations, which lead to insufficiency of the immune system.
41
9. To explain methods of correction of insufficiency of a different immunological
states.
For realization of aims studies base knowledge-abilities (practical
knowledge) are needed:
1. Nervous, endocrine and humoral mechanisms of reactions of an organism on
action of external environmental factors (normal physiology).
2. Reactions from the cardiovascular system on the physical loading (normal
physiology).
3. Reactions from the thermoregulatory system on action of thermal and cold
factors (normal physiology).
4. Reactions from the external breathing system on the change of barometric
pressure of oxygen in air (normal physiology).
5. Structure SMPh (department of histology).
6. Cells, which behave to macro- and microphages (department of histology).
7. Concept about phagocytosis. Role of I.I. Mechnicov in the study of
phagocytosis (department of microbiology).
8. Common properties of antigens (department of microbiology)
9. Kinds of immunoglobulins, their structure, functions (department of
microbiology)
10. Immunity, its mechanisms (department of microbiology)
Information, necessary for addition to base knowledges-abilities on
these questions, can be found in the followings textbooks:
1. Histology.
2. Normal physiology.
3. Medical biology.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Testing of the primary level of knowledge.
Give an answer for the followings questions:
Definition of concept „reactivity".
What types of reactivity do you know?
Name factors which affect on reactivity of human organism?
Definition of consept „ resistance".
What types of resistance do you know?
What is phagocytosis?
What cells are phagocytes?
Name functions of phagocytes.
Name stages of phagocytosis.
Name violations of phagocytosis.
What is SMPh? Give characteristic.
What is biological barriers? Name kinds.
What is the main function of the immune system?
What are antigens?
What arc antibodies?
42
16. Name kinds of antigens.
17. Name kinds of immunoglobulins.
18. What arc the central organs of the immune system?
19. What are the peripheral organs of the immune system?
20. Classification of immunodeficiency.
21. Name kinds of B-cell immunodeficiency.
22. Name kinds of T-cell immunodeficiency
13 Name combined kinds of T- and B-cell immunodeficiency.
24. What cells take part in realization of immune answer?
25. Na me kinds of immune answer?
26. Name kinds of primary (inborn) B-cell immunodeficiency.
27. Name kinds of primary (inborn) T-cell immunodeficiency.
28. Name reasons of the secondary (acquired) immunological insufficiency.
29. What is immunological tolerance?
Theoretical problems on the basis of which implementation of purpose types of
activity is possible:
1. Reactivity, definition of concept. Types of reactivity. Value of nervous,
endocrine and other systems in forming of reactivity. Influence of the gender and
age in forming of reactivity.
2. Resistance, definition of concept. Kinds. Unspecific resistance. Consept about
internal and external barriers, their role in reactivity of an organism.
3. Biological barriers. Kinds. Main functions. Their role in the origin of
pathological processes.
4. Phagocytosis, definition. Role of I.I. Mechnicov in the study of phagocytosis.
Violation of phagocytosis - kinds, reasons, mechanisms, consequences.
5. Role of SMPh in reactivity of an organism.
6. Mechanisms, which provide immunological reactivity.
7. Palhogenetical classification of the immunodeficiency.
8. Reasons of origin of primary (inborn) immunodeficiency.
9. Classification of primary (inborn) immunodeficiency.
10. Secondary immunodeficiency. Reasons of origin.
11. Syndrome of the acquired immunodeficiency (AIDS). Reasons, pathogenesis.
12. Concept about immunological tolerance.
13. Antigens of main complex of histocompatibility.
14. Antigen associated diseases.
15. Methods of increase of activity of the immune system. Methods of
immunosupression.
Literature is necessary for studying of the theoretical questions.
Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. - P. 35-45.
2.
Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. - P.
3.
Lecture's materials.
1.
43
Themes of reports:
1. Inborn and acquired violations of phagocytosis.
2. Biological barriers. Value in resistance of an organism.
3. AIDS - pathophysiologycal characteristic.
Testing according "Krok-I"
Open database 2010
1. Macrophages surrounded with alien erythrocytes were found at microscopic
examination of smear of exudation took from Wat suffering from aseptic
peritonitis with addition of bird erythrocytes. What stage of phagocytosis does
this occurrence correspond to?
A. Incomplete phagocytosis
B. Adhesion
C. Hemotaxis
D. Engulfment
E. Intracellular digestion
2. After 4 th subcutaneous introduction of horse serum in rabbits sharp
inflammation type Arthus phenomenon developed. Which type of altered
reactivity concerns such pathology?
A. Hyperergia
B. Positive hypoergia
C. Negative hypoergia
D. Disergia
E. Anergia
3. A 10-year-old girl suffers from viral and mycotic diseases very often. She
has congenital heart disease and insufficiency of thyroid gland. T-lymphocytes
is absent from her immunological test What disorder of immune system takes
place in this case?
A. Bruton's hypogammaglobulinemia
B. Mixed immunodeficiency
C. Terner's syndrome
D. Hypoplasia of thymus
E. Inherited defect of complement system
4 Decrease in levels of IgG and particularly IgA, IgM was found during
examination of immune status in 5-year-old boy. B-lymphocyfes_and plasma
cejteare absent from his blood and lymph nodes. Reactions of T-lymphocytes
are normal. This is inherited sex-linked disease. What diagnosis is more
possible?
44
A.
B.
C.
D.
E.
Bruton's disease
Luis-Barr syndrome\
Wiskott-Aldrich syndrome
Swiss type of immunodeficiency
Early hypogammaglobulinemia
2006-2009
1. A child had recurrent candidosis (mycotic stomatitis). Injury has a severe
course that is due to herpes virus, complications at the vaccination of BCG
and vaccine against a pox. Lymphocytopenia is in blood. The numbers of other
leukocytes is within the norm. Immunoglobulins are a little lower below the
norm. Reaction of HDT is absent The decrease of functioning of what cells is
the base of the syndrome?
A. T-lympocytes
B. Neutrophils
C. Macrophage
D. B- lympocytes
E. Endotheliocytes
2. A boy, aged 1,5, is ill with chronic pyodermia and three times was ill with
pneumonia. The number of immunoglobulins G and A is decreased in blood.
What type of immunodeficiency has a child?
A. Bruton's hypogammaglobulinemia
B. Swiss type
C. Hypoplasia of gland
D. Wiskott-Oldrich syndrome
E. Luis-Barr syndrome
3. The diagnosis of thymus hyperplasia was made in a child of two years old.
What indices of the state of the immune system is the most characteristic for
this immunodeficiency?
A. Decrease of T-lymphocytes
B. Decrease of B- lymphocytes
C. Deficiency of T and B - lymphocytes
D. Absence of plasmatic cells
E. Decrease of immunoglobulins M
4. A girl was born in term. Up to 1 year old was breast fed. At the end of the
first year of life she suffered from lingering pneumonia. A girl lately began to
walk; the gait was unstable, with the disorder of movement coordination.
There was teleangiectasia on the skin and conjunctiva. Decreases of T-cell
level (32%), absence of Ig; were revealed at examination. What syndrome
developed in a child?
45
A.
B.
C.
D.
E.
Luis-Barr syndrome
Di George syndrome
Bmlon's disease
Chcdiak-Higashi syndrome
I mmunodeficiency of Swiss type
5. Decrease of IgG and especially IgA and IgM was revealed in a boy 5 months
aged the examination of immune status B-lymphocytes and plasmatic cells
were absent in Mood and lymphatic nodes. Reactions of T-cell are preserved.
The disease is Inhered as inoculated with sex. What diagnosis is the most
possible?
A. Bruton's disease
B. Luis-Barr syndrome
C. Wiskott-Aldrich syndrome
D. Swiss type of immune deficiency
E. Early hypogammaglobulinemia
6. Sharp decrease of number of B- lymphocytes and immunoglobulins M and
G is observed in a boy aged 2 with chronic pneumonia. What microorganisms
can cause development of this disease?
A. Staphylococcus
B. Adenovirus
C. Herpesvirus
D. Mycobacterium of tuberculosis
E. Candidas
7. Disorder of cell immunity system was revealed at the examination of patient
immune system state with the chronic candidosis of skin. Decrease of what
indices is the most characteristic of this case?
A. T-lymphocytes
B. Immunoglobulins G
C. Immunoglobulins E
D. B-lymphocytes
E. Plasmocytes
8. The decrease of immune system activity is observed in AIDS-infected
patient. Injury of what cells is the most responsible for the state of
immunodeficiency in this patient?
A. T-helpers
B. T-suppressors
C. macrophages
D. B-lymphocytes
E. Neutrophils
46
9. Vomiting, diarrhea with steatorrhea, hepatosplenomegalia were observed
in a child in the first weeks after birth. It is diagnosed the inherited autosomalrecession sickness of Volman's What was the cause of this state?
A. Absence of acid lipase
B. Absence of glycocerebrolidase
C. Absence of sphingomielinase
D. Deficiency of glucose-6 -phosphate
E. Deficiency of amilo-1,6 glucosidase
10.Pneumonias and purulent injuries of the skin are often in a boy aged 5, as
well as in his grand-dad. The absence of B -lymphocytes is revealed at
immunological examination. What immune system disorder is observed in
this case?
A. Hypogammaglobulinemia of Bruton
B. Hypoplasia of thymus
C. Combined immunodeficiency
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
11. Movement coordination disorder, injury of small vessels of skin
(teleangiectasia), decreased of immunological reactivity are observed in a child
aged 10 that was admitted to the clinic in a severe state. What type of
immunodeficiency may this state is associated with?
A. Luis-Barr syndrome
B. Di George syndrome
C. Agammaglobulinemia of Bruton's
D. Disorders in B-lymphocytes system
E. Wiskott-Aldrich syndrome
12. Thymus hyperplasia was revealed in a new-born child with cramp
syndrome and defect of inter-ventricular septum of the heart at the X-rays
examination of the chest What immunodeficiency may be supposed in this
patient?
A. Di George syndrome
B. Bruton syndrome
C. Wiskott-Aldrich syndrome
D. Syndrome of Guda
E. Luis-Barr syndrome
13. Mice without hairs and eel! reactions of slow type were brought to the
laboratory. I 01 this pathology the most possible is?
A. Absence thymus gland
B. Absence of gamma globulins in blood
C. Disorder of hemopoiesis
D. Disorder of phagocytosis
E. Insufficiency of complement factors
47
14. At immunodeficiency according the system of B-lymphocytes diseases
develop. The main role in pathogenesis of witch belongs to:
A. Disorder of synthesis of antibodies
B. The disorder of immunological reactions of cellular type
C. To the loss of ability to rejection of transplant
D. To the decrease of slow hypersensitivity
E. To the decrease of antitumor immunity
15. Viral and bacterial infections, eczematous injuries of the skin often
develop in a boy, aged 12. Decrease of T~lymphocytes and IgM at normal
content of IgE and IgG were revealed at the examination. What type of
pathology of the immune system is observed in a boy?
A. Combined immunodeficiency
B. Hypoplasia of thymus
C. Hypogammaglobulinemia of Bruton
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
16. There are often fungi and viral diseases in a girl aged 20 who suffer
intestinal poliposis. The lack of what link of the immune system is the most
possible in this case?
A. T-Iymphocytes
B. B-lymphocytes
C. Natural killers
D. Complements
E. Phagocytes
17. Viral and fungi diseases are often in a girl aged 10 with hereditary defects
of the heart and thyroid. Absence of T-cell is revealed at the immunological
analysis. What disorder of the immune system is observed in this case?
A. Hypoplasia of thymus
B. Hypogammaglobulinemia of Bruton
C. Combined immunodeficiency
D. Syndrome of Shereshevskii-Turner
E. Inherited deficiency of the complement system
18. Bruton's disease is diagnosed in a child aged 5. It consist of severe course of
bacterial infections, absence of B- lymphocytes and plasmatic cells. What
changes of immunoglobulin content will be observed in blood serum in this
child?
A. Decrease number of IgD, IgE
B. Increase number of IgD, IgE
C. Decrease number of IgA, IgM
D. Increase number of IgA, IgM
E. Without change
48
19. The number and functional T and B -lymphocytes activity is not changed
in a patient with clinical signs of immunodeficiency. The defect of function of
antigen presenting of immunocompetent cells takes place. Defect of what cells
is most possible?
A. Fibroblasts, B- lymphocytes, T- lymphocytes
B. B- lymphocytes, T- lymphocytes
C. Macrophages, monocytes
D. NK-cells
E. 0- lymphocytes
20. What is syndrome of Di- George?
A. Immunodepression after the spleen removal
B. Insufficiency of the IgM
C. Insufficiency of the plasmatic cells
D. Hypoplasia of thymus gland
E. Inherited insufficiency of C4
21. The patient was made transplantation of donors heart. What conditions
must one follow to prevent regection of organ transplantate?
A. Transplantation of bone marrow
B. Transfusion of donors blood
C. Choosing the donor after the antigens of HLA
D. removal of spleen
E. Administration of immunomodulators
22. A boy aged 3 years is ill with chronic pneumonia. He has the low indices of
B - lymphocytes system. The diagnosis is hypogammaglobulinemia of Bruton.
Indicate the complication of B -lymphocytes system insufficiency.
A. Decreased resistance of organism to the viruses
B. Decreased resistance of organism to the mycotic and tubercular infection
C. Decreased resistance of organism to the pyrogenic cocci flora
D. Absence of reaction of transplant regection
E. Increased of risk of development of tumors in an organism
23. A child with inherited heat defect face defect absence of thyroid and
thymus inland and blood T-lymphocytes was admitted to the children hospital.
What inherited pathology is it associated with?
A Luis-Barr syndrome
B. Syndrom of Terner
C. Bruton's disease
D. Down's disease
E. Di George syndrome
49
24. An HIV-positive man experienced immunodeficiency. What type of
immune cells is involved in the immunodeficiency developing?
A. T-helpers
B. T-suppressors
C. Macrophages
D. B-lymphocytes
E. T-killers
25. In the conditions of getting up in mountains a man had the tachypnoe,
tachycardia, euphoria. Changes that are observed are the result of reactivity:
A. Specific
B. Nonspecific
C. Group
D. Disergic
E. Hyperergic
26. The patient with radiculitis was made a novocaine blockade after which he
grew dark in eyes, his arterial pressure decreased to 90/50 mmHg, breathing
became more frequent up to 24 per minute. The state of patient is the result of
reactivity:
A. Physiology
B. Hypoergic
C. Normoergic
D. Nonspecific
E. Hyperergic
27. After the trauma of one eye patient the sight of the second eye began
gradually to rail. What mechanism can one explains this phenomenon?
A. By the decrease of organism resistance
B. By an infection
C. By the damage of histohematic barrier
D. By immunodeficiency
E. By immune depression
28. It is known that at some pathological processes reactivity of organism
changes oppositely to the change of its resistance. At what pathological
processes or diseases such situation is possible?
A. Shock
B. Fever
C. Inflammation
D. Posthaemorragic anemia
E. Arterial hypertension
50
29. Nonspecific protective factors of the oral cavity from penetrating of
pathogenic microorganisms play an important role in the general system of
physiology resistance of the organism. Which of abovementioned components
in the oral cavity is the most important factor of nonspecific protection?
A. Complement
B. Phagocytosis
C. B-lysin
D. Properdine
E. Lysocime
30. What is the basic difference of pathological reactivity from physiological
one?
A. Participation of immunological mechanisms
B. Change of permeability of histohaematic barriers
C. Change of nervous regulation
D. Change of the endocrine regulation
E. Restriction of adaptation possibilities
31. What is correlation between reactivity and resistance during hibernation?
A. Decreased reactivity and resistance
B. Decreased resistance and increased reactivity
C. Decreased reactivity and increased resistance
D. Increased reactivity and resistance
E. Reactivity and resistance does not change
32. The example of nonspecific reactivity is:
A. General adaptation syndrome;
B. Transplantation immunity;
C. Allergic reactions of immediate type;
D. Allergic reactions of slow type;
E. Immunodeficiency state;
33. Quite often the cause of secondary immunodeficiency is an infection
involvement, when the causative agents propagate directly in the cells of
immune system and destroy it the following diseases are characterized by:
A. Infectious mononucleosis, AIDS
B. Poliomyelitis, type A hepatitis
C. Q-febris. epidemic typhus
D. Dysentery, cholera
E.T uberculosis, mycobacteriosis
Situational tasks:
1. A patient with the infectious disease has an decreased phagocytosis.
51
1. What reasons resulted in decreased phagocytosis and how it can be associated
with the development of infection? What is primary one?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. What disorders of phagocytosis do you know.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
2. A newborn was diagnosed hypoplasia of thymus gland.
1. What complications does it result in?
___________________________________________________________________
2. What are their mechanisms of the development?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
3. In the conditions of getting up in mountains a man had the dyspnoe,
tachycardia, euphoria.
1. What type of reactivity do the changes that are observed in a man belong to?
___________________________________________________________________
___________________________________________________________________
2. Give the description of this type of reactivity.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
4. Patient P. Was admitted to the clinical hospital with a trauma of right eye.
A patient complained of gradual loss of sight of left eye.
1. What mechanism explains this phenomenon?
___________________________________________________________________
2. What is biobarriers?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
3. What histobarriers do you know?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
52
Practical work: „REACTIVITY OF THE ORGANISM. FUNCTIONS OF
SYSTEM OF MONONUCLEAR PHAGOCYTES (SMPh) IN
CONDITIONS OF PATHOLOGY."
Object of work: to show the electoral adsorbtivity of cells of SMP at introduction
of colloid paints and creation of pathological products of exchange of matters in an
organism. To show phagocytal ability of leucocytes at animals at introduction of
foreign matters at the organism.
EXPERIMENT № 1. For days to work in the abdominal region of rabbit through a
fistula 0,5 ml of dredge of Indian ink is entered with one drop of turpentine. From
the fistula of abdominal region by a pipette get an exsudate from which prepare
smears. Fix them on the fire of gas-ring and dye during 5 minutes by methylene
blue. Then wash off paint by water, smears dry out and examine preparation under
a microscope. Sketch a microscopic picture, look after the presence of particles of
Indian ink in separate cells. Make the conclusions.
I stage - approaching
III stage - absorption
II stage - adhesion
IV stage - digestion
53
Conclusion:_______________________________________________________
___________________________________________________________________
_________________________________________________________________
EXPERIMENT № 2. To the frog destroy a spinal cord, cut a thorax, release a
heart from a pericardium and enter in the cavity of ventricle 0,2 ml of the Indian
ink diluted 1:2. Through 1 hour 10 minutes blood from a heart frogs collect by a
pipette with the thinly drawn aside edge.
Smears prepare, fix them by mixture of Nikiforov, dye during 10 minutes
by methylene blue, wash off paint, dry out smears.
1 – erythrocytes of a frog
2 – leukocytes with the elements of
Indian ink
Theme 6: ROLE OF HEREDITY, CONSTITUTION AND AGE FACTORS
IN DEVELOPMENT OF PATHOLOGY.
Actuality of theme.
Recently, the disease occurrence in which genetic factors play an
important role, causing an increased interest in communication because of the fact
that the structure of morbidity, they acquire a large share. Scientific basis in the
ratio becomes hereditary and acquired human pathology.
Constantly expanding amount of information about the mutagenicity of
environmental factors.
Great importance of the disease, in which the matter of genetic
predisposition (peptic ulcer, hypertension, atherosclerosis, diabetes, allergies and
many others). Treatment and prevention of them will be based on the role of
heredity.
Noteworthy diseases that arise during fetal development under the
influence of pathogenic factors on pregnant women.
All this testifies to the importance of studying the mechanisms of heredity,
diagnosis and correction of genetic disease.
General purpose of the lesson – to study the pathogenesis of hereditary
forms of pathology and types of inheritance.
For this purpose it is necessary to be able (concrete aims):
1. To find out and analyze the role of anomalies in the constitution, fetal
development and heredity, the importance of age changes and disturbances of
reactivity in the development of diseases.
2. To characterize an etiological factors and the development of hereditary diseases
and disorders of fetal development.
For realization of aims studies base knowledge-abilities (practical
knowledge) are needed:
1. Mutations, kind (biology department)
2. Notions about genes, chromosoms (biology department)
3.Types of inheritans of hereditary signs (biology department)
Information, necessary for addition to base knowledges-abilities on
these questions, can be found in the followings textbooks:
1. Histology
2. Physiology
3. Medical biology
Testing of the primary level of knowledge.
Give an answer for the followings questions:
55
1. Name mutagenic factors of external environment.
2.Name types of mutations.
3. What is chromosomal aberration?
4. What is a mutation? Classification of mutations after the reasons for origin.
5. Classification of mutations after their value for an organism.
6. Reasons for origin of mutations.
7. Name the types of inheriting.
8. Name the examples of the inherited diseases, which are passed after a autosomicrecessive type.
9. Name die examples of the inherited diseases, which are passed after an
autosomic-dominant type.
10. Name the examples of the inherited diseases, which are passed with a sex
chromosom.
11 What are the chromosomal diseases?
12. Name examples of syndromes which related with change of amount of somatic
chromosomes.
13. Name examples of syndromes which related with change of amount of sex
chromosomes.
14. Name the kinds of chromosomal aberration?
15. Name classifications of constitutional types of a human. Give their
characteristic.
Theoretical problems on the basis of which implementation of purpose
types of activity is possible:
1. Main reasons and general mechanisms of origin of the inherited forms of
pathology.
2 . Mutations, definition. Reasons for mutations. Principles of classification.
3. Gene mutations. Signs of gene mutations at different level.
4. Chromosomal diseases.
5. Main methods of study of the inherited diseases.
6. Hereditary propensity to diseases.
7. Methods of corrections of genetic defects. Prospects of the gene engineering.
Principles Of warning of the inherited diseases.
8. Constitution, definition. Classification of constitutional types of a human.
9. Characteristic of constitutional types of a human.
10. Value of scientific works of O.O.Bogomolets in definition of constitution
pathology of a human.
Literature is necessary for studying of the theoretical questions.
1. Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005.
2. Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. - P..
56
T he me s o f re po rt s:
1. Gene engineering and inherited diseases.
2. Value of heredity in pathology.
3. Inherited enzymopaty, characteristic. Principles of classification and medical
treatment.
4. Inherited propensity to diseases.
A gene is the unit of chromosome. Genes are linearly located in chromosomes.
A place which rank a gene in a chromosome is named locus.
Genotype is - aggregate (total) genes of an organism.
Alleles are genes, which rank the same locus in the homologous chromosomes,
hut they causedphenotypic differences.
Phenotype is the aggregate of the properties of organism, both inherited
conditioned and conditioned by influencing of external emnronment.
Phenocopy is changes which arose up under action of external environment,
and lo o k like w ith the changes concerned with any genotypic factor.
I n the nuclei of cells of woman's organism, unlike masculine there is sex
chromatin (as lum p under the membrane of nucleus). Number of the lumps of
sex chromatin is equal amountsX-chromosome minus 1.
Analogue of sex chromatin is Barr's body (on the nucleus of neutrophil as a
drumstick).
Constitution it is the complex of morphological, functional and psychical
features of an organism that determine his reactivity and are formed on the
inherited basis under at i of external environmental factors.
Testing according "Krok-I"
Open database 2010
1. A child is pale, pastose, muscular tissue is bad developed, lymph nodes are
enlarged. He often suffers from angina and pharyngitis, blood has signs of
lymphocytosis. The child is also predisposed to autoallergic diseases. What
type of diathesis can be presumed in this case?
A Lymphohypoplastic
B Exudative
C Gouty
D Asthenic
E Hemorrhagic
2. Examination of a 12 year old boy with developmental lag revealed
achondroplasia: disproportional constitution with evident shortening of upper
and lower limbs as a result of growth disorder of epiphyseal cartilages of long
tubal bones. This disease is:
A Inherited, dominant
B Inherited, recessive
57
C Inherited, sex-linked
D Congenital
E Acquired
3. A couple had a child with Down's disease. Mother is 42 years old. This
disease is most probably caused by the following impairment of prenatal
development:
A Gametopathy
B Blastopathy
C Embryopathy
D Non-specific fetopathy
E Specific fetopathy
4. A married couple came to the genetic counseling. The husband suffers from
the insulin-dependant diabetes, the wife is healthy. What is the probability
that this couple will have an insulin-dependant child?
A Higher than throughout the population
B The same as throughout the population
C Lower than throughout the population
D 100%
E 50%
5. Daltonism was diagnosed in a 7-year-old boy while prophylactic medical
examination. Parents are healthy, color vision is normal. Grandfather from
the mother's side has the same disorder. What is the type of inheriting of this
anomaly?
A Recessive, connected with sex
B Dominant, connected with sex
C Incomplete domination
D Autosomal-recessive
E Autosomal-dominant
6. A 32 y.o. man is tall, he has gynecomastia, adult woman pattern of hair
distribution, high voice, mental deficiency, sterility. Provisional diagnosis is
Klinefelter's syndrome. In order to specify diagnosis it is necessary to analize:
A Caryotype
B Leukogram
C Spermatogenesis
D Blood group
E Genealogy
7. During a prophylactic medical examination a 7-year-old boy was diagnosed
with daltonism. His parents are healthy and have normal colour vision, but his
grandfather on his mother’s side has the same abnormality. What is the type
of the abnormality inheritance?
58
A
B
C
D
E
Recessive, sex-linked
Dominant, sex-linked
Semidominance
Autosomal recessive
Autosomal dominant
8. A woman who was sick with rubella during the pregnancy gave birth to a
deaf child with hare lip and cleft palate. This congenital defect is an example
of:
A Phenocopy
B Edward’s syndrome
C Genocopy
D Patau’s syndrome
E Down’s syndrome
9. A couple came for medical genetic counseling. The man has hemophilia, the
woman is healthy and there were no cases of hemophilia in her family. What is
the risk of having a sick child in this family?
A 0%
B 100%
C 75%
D 50%
E 25%
10. A healthy woman has three sons affected by color blindness who were born
after her two marriages. Children both of her husbands are healthy. What is
the most possible pattern of inheritance of this disease?
A X-linked recessive
B Y-linked
C Autosomal recessive
D Autosomal dominant
E X-linked dominant
2006-2009
1. The father of pregnant woman suffers from hemeralopia, that is inherited
by i recession sign coupled with X-chromosome. Among the relatives of
husband this disease there was no such disease. What possibility that a born
child will suffer by a in mei alopia if it is known that fetus is mail sex?
A. 50%
B 0%
C. 25%
D. 75%
E. 100%
59
2. Syndrome of Down is characterized by:
A. Trisomy for 21 chromosome
B. Trisomy for X chromosome
C. Deficiency for 15 chromosome
D. Pathology coupled with X -chromosome
E. High growth of patients with this pathology
3. Neutrophilic leukocytes with a 1 "drumstick" were revealed in sick boy's
blood at examination in medico-genetic consultation. The presence of what
syndrome is possible in a boy?
A. Klinefelter's syndrome
B. Down' s syndrome
C. Syndrome of Shereshevskii-Turner
D. Edward's syndrome
E. Trisomy X-syndrome
4. Ataxia, coordination disorder, teleangiectasia of skin and conjunctiva,
adrenal and sevual glands, disorders mental deficiency, recurrent
sinuspulmonic infections, thymus hypoplasia, lack of Ig and Ig E were
revealed in a girl aged 5. In future lymphosarcoma developed and child died.
What type of inheritance is characteristic Of this illness?
A. Autosomal-recessive
B. Partial dominance
C. Dominant
D. Coupled with a sexl chromosome
E. Polygenic
5. omiting and diarrhea, general dystrophy, hepato- and splenomegaly are
observed in a new-born. Brest feeding at stopping and the symptoms decrease.
What basic Inherited defect will be observed in pathogenesis?
A. Galactose exchange disorder
B. Hypersecretion of external secretion glands
C. Tyrozine exchange disorder
D. Fenilalanine exchange disorder
E. Insufficiency of glucose - 6-phosphatedegidrogenase
6. At amniocentesis three lumps of sexual chromatine were found in nuclei of
cells of It-mail sex. What kariotype does this disorder correspond to?
A. 49,XXXXY
B. 47, XXX
C. 48,XXXY
D. 47,XXY
E. 48,XXXX
60
7. Heterozygous mother carrier passed a mutant gene to the half of sons
(which were ill) and a half of daughters which that were phenotypical health,
but are the carries and may pass a recession gene with X-chromosome to the
next generation. The genes of what abovementioned diseases may be passed to
daughters?
A. Polygraphic
B. Thalassemia
C. Phenylketonuria
D. Hemophilia
E. Hypertrichosis
8. Mother and one of daughters have arterial hypertension. Mother and
daughter that is ill work on conveyor. Another daughter also sometimes has
high arterial pressure. What group of genetic diseases does arterial
hypertension belong to in this family?
A. Monogenes
B. Chromosomal
C. Multifactorial
D. Genomic
E. Acquare
9. A girl, aged 16, has some deviations from norm: her hight is lower than in
children of the same age, signs of the sexual maturety are absent, she has a
short neck) wide shoulders. Intellect is in a norm. What of abovementioned
syndromes may be supposed?
A. Patau's syndrome
B. Down's syndrome
C. Edward's syndrome
D, Klinefelter's syndrome
E. Syndrome of Shereshevskii-Turner
10. A women has deviation from norm in physical and sexual development. At
the microscopical examination of mucos cell of oral cavity sexual chromatin
was not found. What diagnosis is the most possible?
A. Syndrome of Shereshevskii-Turner
B. Klinefelter's syndrome
C. Down's syndrome
D. Rcclingauzen's disease
E. Trisomy for X chromosome
11. An elderly man has high sensitivity to infections, especially activation of
chronic Hral infection disease of vessels, particular of atherosclerotic type,
pernicious inemia. Changes in what system of organism aging are
accompanied by abovementioned phenomenon?
A. Endocrine
61
B.
C.
D.
E.
Nervous
Immune
Connecting tissue
Circulation of blood
12. A man has a high stature, astenic structure of body, gynecomastia, mental
insufficiency. At the microscopic examination of mucus cells of the oral cavity
there was found in 30% cells sexual chromatine (one Barras body). What the
most possible diagnosis in this case?
A. Icenko-Cushing syndrome
B. Reclingauzen's disease
C. Syndrome Di George
D. Down's syndrome
E. Klinefelter's syndrome
13. A patient aged 60 consulted a doctor. She complained of pain in the small
joints of legs and hands. Joints are inlarged, look like as bulged nods. There is
increased content of urates in the blood serum. The disorder of what
metabolism caused the development of this state?
A. Metadiazines
B. Amino acid
C. Purine
D. Lipids
E. Carbohydrates
14. A man aged 65 consulted a doctor. He complained of acute pain in a large
toys of the leg. He likes and often drinks beer. Gout was suspectide. Content of
what of bellow mentioned substances is it necessary to determine in blood to
confirm a diagnose?
A Urinary acid
B. Bilirubin
C. Ketonic bodies
D. Urina
E. Lactate
15. A child aged 6 months is observed has deceleration of motor and psychical
development, pallor of skin iris of eye, positive test of Felling (with a 5%
solution of trichloracetate iron). What of abovementioned inherited diseases is
diagnosed in a child?
A. Urine acid
B. Alkaptonuria
C. Down’s disease
D. Albinism
E. Phenylketonuria
62
16. Hemolytic crisis and development of sicle-shape anaemia are observed in a
patient who is a carrier of sicle-shape anomaly of erhytrocytes due to the
development of atalectase of the lungs. What is the mechanism of the
development of this form of anaemia?
A. Neurohumoral
B. Ncuro-reflectory
C. Humoral
D. Corticovisceral
E. Genetic
17. A child was born in a mother who suffers from alcoholism. The signs of
mental and physical deficiency in the process of growth and development were
observed. Of what character is this pathology?
A. Inherited
B. Chromosomal
C. Acquired
D. Inborn
E. Prenatal
18. The physical examination of a patient revealed thin stature, large skull,
strongly developed frontal part of face, short extremities. What stature type is
it characteristic of?
A. Respirator
B. Muscle
C. Digestive
D. Cerebral
E. Mixed
19. What diseases is a man with astenic type of stature according Crechmer's
classification more often ill with?
A. Acute respiratory infections
B. Tuberculosis of lungs
C. Hypoacidic gastritis
D. Hysteria
E. Schizophrenia
20. What is diathesis?
A. Diseases of an early child's age
B. Anomaly intrauterine development
C. Anomalic stature with the inadequate reaction of organism to
irritation
D. Inherited enzymopathy
E. Tendency of the people to definite diseases
63
21. Physical examination of the a patient revealed: thin stature, large skull,
strongly developed frontal part of face, short extremities. What constitutional
type is it characteristic of?
A. Mixed
B. Digestive
C. Muscles
D. Cerebral
E. Respiratory
22. Karyotype 47 XXY was revealed in a young 20-year-old tall asthenic man
with signs of hypogonadism, gynecomastia and decreased sperm production
(azoospermia). What hereditary syndrome might be diagnosed in this case?
A. Klinefelter'
B. Wiskott-Aldrich
C. Turner's syndrome
D. Louis-Bar
E. Down's
23. Three lumps of sexual chromatin were revealed in the cell nuclei of the woman
fetus. What karyotype would be appropriate in this case?
A. XXXXY
B. XXX
C. XXXY
D. XXY
E. XY
24. A 28-ycar-old female patient consulted a gynecologist about sterility.
Examination revealed underdeveloped ovaries and uterus, irregular menstrual
cycle. Analysis of the sex chromatin revealed 2 Barr's bodies in most somatic
cells. What chromosome disease is most likely?
A. Klinefeltier's syndrome
B. Turner's syndrome
C. Patau's syndrome
D. Triple X syndrome
E. Edwards' syndrome
Ситуаційні задачі:
1. Pregnant M. asked the doctor advice in the genetic consultation. It is known
from anamnesis, that her brother from the side of mother (fathers are
different) is ill with phenylketonuria. Her daughter from the first marriage is
healthy. It is also known that in family of her second husband H. there were
marriages between relatives, but nobody was ill with phenylketonuria. The
physical examination of the woman and her husband did not revealed the
deviations in their state of health.
64
1. What type of inheritance of phenylketonuria? What is it characterized by?
___________________________________________________________________
___________________________________________________________________
________________________________________________________________
2. What is the probability of development of phenylketonuria at woman's sons and
daughters?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
4. What are the symptoms of phenylketonuria?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
4. What protein (enzyme, structural protein, receptor, and membrane carrier) is
encoded by an abnormal gene at tiiis form of pathology?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
5. How is this pathology diagnosed in the new-born?
___________________________________________________________________
________________________________________________________________
6. How can we prevent the development of this pathology at child?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
2. At a child aged 5 who often is ill with respirators diseases is observed
eczematous symptoms after eating of some food and tendency to chronical
course of inflammatory processes. Parents observe the increased excitement of
the nervous system (tearfulness, frequent changes of mood) during the last
time. Objective: the skin is pale, pastosic, high temperature and hyperemia of
skin in the area of knee-joints are observed . At X-ray examination the
deformation of knee-joints is seen.
1. What type of diathesis can one expect in this case?
___________________________________________________________________
2. What type of diathesis do you know?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
65
Theme 7: ALLERGIC REACTIVITY
Actuality of the theme.
Last years the frequency of development of allergic diseases rose considerably
due to increasing of the variety of surrounding a man chemical agents. Knowledge
of reasons and mechanisms of development of allergic reactions is the first step in
the prophylaxis of these states and their complications.
General purposes of the lesson.
To learn the reasons and mechanisms of allergic reactions, main principles
of their prophylaxis.
For this it is necessary to know (the concrete purposes):
1. To give the determination of conception «allergy».
2. To describe the principal reasons of allergic reactions origin.
3. To explain the mechanisms of development of different types of allergic
reactions.
4. To design the allergic reactions of different types.
For realization of purposes of lesson it is necessary to have the base
knowleges-skills:
1. To know the conception about the central organs of immunity and immunecompetent cells (the department of normal physiology, the department of
histology).
2. To be able to explain the mechanisms of realization of immune answer (the
department of microbiology).
3. To have a notion about antigens, gaptens (the department of microbiology).
4. To have a notion about the basic classes of immunoglobulins, their structure and
function (the department of microbiology, the department of normal
physiology).
Check the primary level of knowledges.
Give the answers to the following questions:
1. What is "allergy"?
2. Name the stages of allergy.
3. Classification of allergens by the origin.
4. Classification of allergens by the structure.
5. Name the exogenous allergens.
6. Name the endogenous allergens.
7. What is "sensibilization"?
8. Name the types of sensibilization:
9. Classification of allergic reactions by the time of their development:
10. Classification of allergic reactions by the pathogenesis (due to Gell and Cumbs
classification):
11. What biologically active substances are the mediators of early phase of allergy?
66
12. What biologically active substances are the mediators of late phase of allergy?
13. What biological effects of histamine at the action on Hrhistaminoreceptors do
you know?
14. What biological effects of histamine at the action on H2-histaminoreceptors do
you know?
15. What groups of mediators are the lipid mediators?
16. Name the leukotriens at the «slow reactive substance»?
17. What reactions are the hypersensitiveness of immediate type?
18. What reactions are the hypersensitiveness of slow type?
19. What allergic reactions of anaphylaxic type do you know?
20. What allergic reactions of cytotoxic type do you know?
21. What allergic reactions of immunocomplex type do you know?
22. What allergic reactions of cellular-mediated type do you know?
23. Name the process of decline of sensitiveness of organism to the action of
allergens.
24. Name the types of hyposensibilization:
Standards of answers:
1. It is the increased sensitiveness of organism to the repeated introduction of
allergen, at the base of which are immune mechanisms.
2. A) Immune reactions
B) Pathochemical
C) Pathophysiological
3. A) Exogenous
B) Endogenous
4. A) Complete
B) Incomplete
5. A) Infectious
B) Uninfectious: domestic, epidermal, pollens, medicinal, food, industrial
6. A) Primary
B) Secondary: infectious, uninfectious
7. It is the state of the promoted sensitiveness of organism to the certain antigen, at
the base of which are the processes of antibodies or sensibilizated lymphocytes
formation.
8. A) Active
B) Passive
9. A) Hypersensitiveness of immediate type
B) Hypersensitiveness of slow type
10. A) I type, anaphylaxic
B) II type, cytotoxic
C) III type, immunocomplex
D) IV type, cellular-mediated
11. A) Biogenic amines: histamine, serotonin
B) Lipid: prostaglandins, leukotriens
C) Factor of thrombocytes activation
67
D) Polypeptide: khemaza, treptaza
12. A) Histaminase
B) Prostaglandins E1, E2
C) Arhylsulfatase
D) Phospholipase B and D
E) Polysaccharides: heparin, heparan sulfate
13. At the action on Hr histaminoreceptors: results an itch, pain, expansion of
arterioles, multiplying formation of mucus in overhead respiratory tracts,
increase of permeability of vascular wall, reduction of muscular fibers of
bronchial tubes, uterus, intestine.
14. At the action on H2- histaminoreceptors: results reduce of anaphylaxic reactions
by braking of basophiles degranulation in tissues, oppressing of lymphocytes
activity, T-supressors activation.
15. Prostaglandins, leukotriens.
16. Leukotriens C4, D4, E4.
17. Anaphylaxic shock, bronchial asthma, pollenosis, hives.
18. Reaction of tearing away of transplant, contact dermatitis, bacterial
allergy, autoallergy.
19. Anaphylaxic shock, bronchial asthma, pollenosis, hives.
20. Medians allergy, hemolytic disease of new-born, hemotransfusion
reactions, autoallergic reactions.
21. Glomerulonefritis, Vaskulitis, dermatitis.
22. Reaction of tearing away of transplant, contact dermatitis, bacterial allergy,
autoallergy.
23. Hyposensibilization.
24. Specific, nonspecific.
Theoretical questions, at the base of which the execution of purpose
types of activity is possible.
1. Actuality of problem of allergic diseases.
2. Allergy, determination of concept.
3. Classification of allergens, allergic reactions.
4. Mechanisms of development of different types of allergic reactions.
5. Main mediators of allergic reactions, their short description.
6. Main forms of allergy at human, their description.
7. Mechanisms of development of autoallergy.
8. Desensibilization, determination of concept. Kinds.
9. Actuality of problem of allergy for children. Features of development of allergic
reactions at children.
10. Allergoid reactions, determination. Reasons, mechanisms of development.
Differentiation with allergic reactions.
68
Literature is necessary for studying of the theoretical questions.
1.
Handbook of general and Clinical Pathophysiology/ Edited by prof.
A.V.Kubyshkin, CSMU, 2005. - P. 49-53.
2.
Pathophysiology/ Edited by prof. Zaporozan, OSMU, 2005. - P..
3.
Lecture's materials.
Testing according "Krok-I"
Open database 2010
1. A 27 y.o. patient put eye drops that contain penicillin. After a few minutes
she felt itching and burning of her body, there appeared lip and eye-lid
edemata; arterial pressure began to drop. What immunoglobulins took part in
the development of this allergic reaction?
A lgE and lgG
B IgM and IgG
C IgA and IgM
D IgM and IgD
E IgG and IgD
2. A 27- year-old woman has dropped penicillin containing eye drops. In few
minutes there appeared feeling of itching, burning of the skin, lips and eyelids
edema, whistling cough, decreasing of BP. What antibodies take part in the
development of this allergic reaction?
A IgE and IgG
B IgM and IgG
C IgA and IgM
D IgM and IgD
E IgG and IgD
3. A woman has been applying a new cosmetic preparation for a week that
resulted in eye-lid inflammation accompanied by hyperemia, infiltration and
painfulness. What type of allergic reaction was developed?
A ІV
B I
C II
D III
E V
2006 - 2009
1. Pain in the heart and joints and pneumonia appeared in a patient three
weeks later acute myocardial infarction. What is the main mechanism of
development of post infarction Dressler's syndrome?
69
A. Ischemia of myocardium
B. Resorption of enzymes from necrotized area of myocardium
C. Secondary infection
D. Thrombosis of vessels
E. Autoimmune inflammation
2. A patient addressed to a dentist with complaints of redness and edema of
mucous membrane of his mouth a month later dental prosthesis. Allergic
stomatitis was diagnosed in this patient. What type of allergic reaction by Gell
and Cumbs underlies this disease?
A. Cytotoxic
B. Delayed-type hypersensitivity
C. Immune complex-mediated
D. Anaphylactic
E. Stimulating
3. Anaphylactic shock developed in a patient with botulism after second
injection of antitoxic antibotulinus serum mixture. What is the main
mechanism of anaphylaxis.'
A. Interaction of T-lymphocytes with mediators
B. Interaction of antigen with IgM
C. Interaction of macrophages with antigens
D. Interaction of antigen with IgE
E. Interaction of T-lymphocytes with tissue basophils
4. In a 27-years-oId man tuberculin test was carried out. Following was
observed 24 hours later: infiltration with size of 40x35 mm at the site of
injection and hyperemia of skin above it. What group of biologic active
substances causes develop men I ol allergic inflammation in this patient?
A. Lymphokines
B. Biogenic amines
C. Prostaglandins
D. Leukotriens
E. Kinins
5. A 24-years-old patient has edema of face and increase in BP, which
appeared 1.5 weeks later severe streptococcus tonsillitis. The patient has
hematuria and proteinuria of 1.2 g/L. Anti-streptococcus antibodies and
decrease in content of compliment system components were revealed in
patient's blood. Which microvessels do deposits of immune complexes localize
in and cause nephropathy?
A Proximal tubules
B. Glomerule
C. Dcscendent tubules
D. Loop of Henle
E. Pyramids
70
6. Nausea, fatigue, stomachache, palpitation, difficult respiration, and skin
blisters developed in a patient 25 minutes later injection of antibiotics. What
stage of allergic reaction is observed in this patient?
A. Pathochemical
B. Biochemical
C. Pathophysiological
D. Immunological
E. Sensibilization
7. Skin tuberculin test was carried out in a patient with chronic lung
tuberculosis. Local hyperemia and edema appeared in the site of
inracutaneous introduction of tuberculin preparation within 24-48 hours.
What cells are primary effectors in mechanism of this reaction?
A. Neutrophils
B. T-lymphocytes
C. B-lymphocytes
D. Endotheliocytes
E. Smooth muscle cells of microvessels
8. Hyperemia, swelling and then necrosis of tissue, their rejection and ulcer
(Arthus phenomenon) develop at the rabbit in the place of secondary
intracutaneus injection of a substance with strongly pronounced antigenic
properties (for example horse serum). What factors play the main role in
pathogenesis of this phenomenon?
A. Antibodies presented by IgE
B. Antibodies presented by IgD
C. Antibodies presented by IgA
D. Antibodies presented by IgG and/or IgM
E. Specific T-lymphocytes-effectors
9. Skin rash, itching, swelling and pain in joints, increase in body temperature,
and proteinuria appeared in a patient in 5-8 days after use lots of medical
serum. Serum sickness was diagnosed. What is the main factor in pathogenesis
of this syndrome?
A. Primary systemic accumulation of circulating immune complexes in
the blood
B. Primary systemic degranulation of mast cells in the organism
C. Primary systemic activation of T-killers
D. Primary systemic activation of endoteliocytes
E. Primary systemic cytolysis of blood cells
10. Allergic diagnostic tests are used for the diagnosis of many infectious
diseases (tuberculosis, brucelosis, tularemia etc). Diagnosis is confirmed if
papula and redness appear in the place of the allergen injection. Antigens
interaction reaction is conditioned by:
71
A. IgE and lymphokines
B. IgM and macrophages
C. T-lymphocytes and lymphokines
D. IgE and T-lymphocytes
E. IgM and tissue basophiles
11. An 18-year-old man with shoulder phlegmon got intramuscular injection
of penicillin. Tachycardia, thread-like pulse; decrease in BP down to 80/60
mmHg occur alter that What kind of pharmacologic reaction develops?
A. Potentiation
B. Reflex action
C. Central action
D. Anaphylaxis
E. Peripheral action
12. Thyrotoxicosis was diagnosed in a patient. Antithyroid antibodies were
found in his blood. Which type of allergic reaction is observed at development
of this disease?
A. Immune complex-mediated
B. Stimulating
C. Anaphylactic
D. Cytotoxic
E. Delayed type hypersensitivity
13. Hives, itching of the skin, swelling of the skin and mucous membranes,
swelling of lymphatic nodes develop in the patient in 9 days after injection of
medicinal serum. What disease develops?
A. Pollinosis
B. Serum sickness
C. Shwartzman's phenomenon
D. Overy phenomenon
E. Quincke's edema
14. Dressler's syndrome was diagnosed at the patient 1.5 month later
myocardium infarction. It is characterized by pericarditis, pleurisy, and
pneumonia. What is the reason for this syndrome?
A. Sensitization of the organism by myocardium antigens
B. Decrease in resistance to microorganisms
C. Activation of saprophytic microflora
D. Intoxication of organism by products of necrosis
E. Release of myocardial enzymes to the blood
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15. A 20-year-old man has injury of the right testicle. What danger does it
brings for the left (healthy) testicle?
A. Mimicry of antigens and development of antibody-mediated damage
B. Development of infectious process
C' Development of atrophy
D. Development of hypertrophy
E. No danger
16. Guinea-pig's nephrocytotoxic serum was injected to the rabbit under the
experiment. What human disease is modeled in this case?
A. Nephrotic syndrome
B. Acute pyelonephritis
C. Chronic renal insufficiency
D. Acute diffuse glomerulonephritis
E. Chronic pyelonephritis
17. Acute glomerulonephritis appeared in the patient 2 weeks later purulent
tonsillitis. Antibodies against microorganism antigens were found at the
patient. Which microorganism are these antibodies against?
A. Hemolytic streptococcus
B. Staphylococcus
C. Pneumococcus
D. Mycobacterium tuberculosis
E. Meningococcus
18. Severe edema of soft tissues of upper and lower jaws, rash on the skin of
face, redness, and itching appear in the patient in response to using anesthetic
drag at tooth extraction. Which pathological process underlies the reaction to
anesthetic?
A. Inflammation
B. Drag toxic action
C. Allergy
D. Insufficiency of blood circulation
E. Disorder of lymph outflow
19. Novocain was injected by dentist for anesthesia at tooth extraction.
Symptoms of phvlactic shock appeared at the patient few minutes later.
Patient has drop of BP, dyspnea, loss of consciousness and convulsions. What
type of reaction is it?
A. Immediate type hypersensitivity
B. Cytolytic or cytotoxic reactions
C. Arthus phenomenon reactions
D. Delayed type hypersensitivity
E. Stimulating allergic reaction
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20. Man with the caries is subjected to constant sensitization by streptococcus
antigen. What disease can appear due to this etiological factor?
A. Glomerulonephritis
B. Pancreatitis
C. Myocarditis
D. Pulpits
E. Periodontitis
21. Antitoxic diphtheria serum was introduced to a child suffering from
diphtheria. Skin eruption accompanied by itching, increase in body
temperature to 38°C, and pain in joints occurred in patient 10 days later.
What is the reason for these symptoms?
A. Contact allergy
B. Serum sickness
C. Atopy
D. Anaphylactic reaction
E. Delayed type hypersensitivity
22. A dentist injected ultracain to a patient before tooth extraction for the
purpose of anesthesia. Sensitivity test was not made. Anaphylactic shook
developed in the patient in few minutes after drag injection. What cells
produce reagins, which take part in development of anaphylactic reaction?
A. Plasma cells
B. B-lymphocytes
C. T-lymphocytes
D. Mast cells
E. Eozinophiles
23. Tooth was extracted in a teenager under Novocain anesthesia. Paleness of
skin, dyspnea and hypotension occurred in the patient 10 minutes later. What
type of allergic reaction is it?
A. Anaphylactic
B. Cytotoxic
C. Arthus phenomenon type
D. Delayed type hypersensitivity
E. Stimulating
24. Tooth was extracted in a teenager under Novocain anesthesia. Paleness of
skin, dyspnea and hypotension occurred in the patient 10 minutes later. What
substance does allergen react with on the surface of mast cells?
A. IgE
B. T-lymphocytes
C IgA
D. IgD
E. IgM
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25. A 43-year-old woman is suffering from pneumonia. She began complaining
of weakness, face and arms burning pain in 10 minutes after ampicillinum
injection. Cough, dyspnea, pain in the chest developed in her. At clinical
examination patient has cyanosis, eyelids swelling, face red rashes, heart rate 120 per minute, BP – 120 mm Hg». muffled heart sounds, hypopnoe and
tachypnea, respiration with different moist rales. What is the reason for
worsening of patient's condition?
A. Anaphylactic shook
B. Urticaria
C. Quincke's edema
D. Attack of asthma
E. Pulmonary thromboembolism
26. 0.1 ml of horse serum was injected to the guinea-pig for sensitization.
What are external signs of sensitization?
A. No external signs
B. Skin rashes
C. Joints swelling
D. Increase in body temperature
E. Pain
27. A 15-year-old girl is suffering from bronchial asthma. Severe attack of
expiratory dyspnea develops in her during the spring blossoming period.
What biological active substance causes spasm of bronchial smooth muscle in
this case?
A. Leukotriene
B. Thromboxane A2
C. Prostacyclin
D. Bradykinin
E. Serotonin
28. Patient addressed to a doctor with complaints of headache, rhinitis,
weakness, and increase in body temperature developing every spring in
blossoming period. What type of allergic reaction by Gell and Cumbs
underlies this disease?
A. Anaphylactic
B. Cytotoxic
C. Antibody-dependent cell-mediated cytotoxicity
D. Immune complex-mediated
E. Delayed type hypersensitivity
29. Weakness, itching of skin, acute spasmodic pain in the abdomen,
hyperemia and rush on skin, tachycardia, and decrease in BP down to 70/40
mm Hg suddenly develloped in a patient few minutes later Novocain injection
by the dentist. Which type of allergic reactions does this pathology belong to?
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A. Anaphylactic
B. Cytotoxic
C. Stimulating
D. Cell-mediated
E. Immune complex-mediated
30. Contact dermatitis of upper extremities developed in the nurse, who has
been working in manipulation room for 20 years. Which type of allergic
reactions docs this pathology belong to?
A. Delayed-type hypersensitivity
B. Primary immunodeficiency
C. Immediate type hypersensitivity
D. B-cells immunodeficiency
E. T-cells immunodeficiency
31. Pain in the joints and loins, hemorrhagic eruptions on the skin, and
increase in body temperature occur in the patient with toxemic stage of burn
disease in 2 hours after allogenic plasma transfusion. What allergic reaction
takes place in this case?
A. Serum sickness
B. Urticaria
C. Quincke's edema
D. Anaphylactic
E. Autoimmune vasculitis
32. Hyperergic inflammation form of upper respiratory tract (larynx, trachea,
bronchi) develops at 6-year-old child. Threat of respiratory impairment
develops and then necessity of using anti-inflammatory hormones occurs.
Which hormone has anti-inflammatory property?
A. Cortisol
B. Adrenaline
C. Growth hormone
D. Testosterone
E. Insulin
33. Swelling, increased BP, proteinuria, hematuria, decreased urine excretion
were revealed in the patient, which suffered severe tonsillitis before. These
symptoms are typical of acute glomerulonephritis, resulting from damage of
glomerular basement membrane. What is mechanism of this disease?
A. Anaphylactic allergic reactions
B. Cytotoxic allergic reactions
C. Immune complex-mediated allergic reaction
D. Delayed-type hypersensitivity
E. Stimulating allergic reaction
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34. An 18-year-old patient has insulin-dependent diabetes mellitus I type.
What type of allergic reactions underlies beta cells damage?
A. II type, cytotoxic
B. I type, anaphylactic
C. Ill type, immune complex-mediated
D. IV type, delayed-type hypersensitivity
E. Pseudoallergic reaction
35. Which one among mentioned below pathologic processes can be described
as a reaction of immediate type?
A. Polynosis
B. Autoallergy
C. Contact allergy
D. Graft-versus-host reaction
E. Bacterial allergy
36. Intramuscular penicillin was administrated to a patient. Following the
injection the condition of the patient worsened abruptly: breathlessness and
death-damp appeared. Pulse -140 and weak, blood pressure - 90/40. What
complication is the most possible in this case?
A. Anaphylactic shock
B. Pulmonary embolism
C. Cardiogenic shock
D. Infectious toxic shock
E. Infectious allergic shock
37. It was decided to inject antitetanus serum to a patient, but allergic test
appeared to be positive. What is the appropriate way to conduct
desensitization?
A. Injecting of small doses of antitetanus serum
B. Injecting of glucocorticoids
C. Injecting of a full dose of antitetanus serum
D. Prescribing of antihistamine medications
E. Prescribing of immunosuppressants
38. A 10-year old child had the mantoux tuberculin test administered. 48
hours later a papule up to 8 mm in diameter appeared on the site of the
injection. What type of hypersensitivity reaction developed after the
tuberculin injection?
A. Atopic reaction
B. Seroreaction
C. Arthus phenomenon
D. Type IV hypersensitivity reaction
E. Type II hypersensitivity reaction
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39. After the prior sensibilization an experimental animal was given a
subcutaneous injection of an antigen. The place of injection exhibited a
fibrinous inflammation with alteration of the vessel walls, basal substance and
fibrous structures of the connective tissue in form of mucoid and fibrinoid
swelling and necrosis. What immunological reaction is it?
A. Granulomatosis
B. Normergic reaction
C. Reaction of transplantation immunity
D. Delayed-type hypersensitivity
E. Immediate hypersensitivity
Practical work:
“ALLERGIC REACTIVITY”
Object of work : to study the basic mechanisms of allergic reactions development.
EXPERIMENT 1. 20-30 days before the experiment 5ml of horse serum was
ijected subcutaneously to the rabbit 5 times with 5-6 days intervals.
The infiltrate with the next
development of an acute hyperergic
inflammation with necrosis is formed after 5
injections on the site of injections.
1 – necrosis
2 – place of injections
Conclusion:
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EXPERIMENT 2. For 3 days a guinea-pig is injected 0,2ml of horse serum into
the abdominal cavity. In 12-14 days the final dose 2ml (better intravenously or
intracardiac) is inlected and the development of anaphylactic shock is observed.
After the animal’s death the cardio-pulmonary preparation is extracted. Pay
attention to the characteristic changes in the lungs.
Conclusion:
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