Medical Terminology: Pathology and Immunology, Exams of Nursing

Download Medical Terminology: Pathology and Immunology and more Exams Nursing in PDF only on Docsity! 1 PATHOPHYSIOLOGY. GENERAL NOSOLOGY, ETIOLOGY AND PATHOGENESIS Final exam Question and Answers 2024. 1. A 49-year-old man was suffering 12 years ago from rheumatic myocarditis, endocarditis, and insufficiency of mitral valve. Examinations showed the absence of inflammatory process, sufficient minute blood volume. What is it? A. Pathological reaction B. Pathological process C. Typical pathological process D. Compensatory reaction E. Pathological condition 2. The 12-year-old boy took part in sport events in light athletic. Weakness, headache, loss of appetite, and rise in temperature to 37,8oC appeared in him on the next day. What period of disease is it? A. Final period of disease B. Period of manifestation C. Contact period D. Latent period E. Prodromal period 3. Pain in a left half of the chest and dyspnea appear in a patient during walking. This pain increases during respiration. The attack of the pain was stopped by using narcotics. At examination of the patient following data were revealed: severe condition, respiratory rate is 28 per min., respiration is shallow and is dull in left axillary region. Blood pressure is 140/80 mmHg. Patient has sputum with blood. This patient has varicose dilation of veins. In purpose to correct main pathogenetic link it is necessary to use: A. Antibiotics B. Anticoagulants C. Antihistamin preparations D. Spasmolytics E. Coronarilytics 4. A 39-years-old patient has been suffering from gastric ulcer for last 4 years. Pain in epigastric region, heartburn, nausea, and constipation appear mainly in autumn and spring. Name this condition. A. Remission B. Acute period C. Complication D. Pathologic condition E. Relapse 5. Gasping respiration appears in a patient with severe lung pathology. What terminal condition is this characteristic for? A. Agony 2 B. Pre-agony C. Clinical death D. Biological death E. Terminal pause 6. A 10-yeaes-old child endured several rheumatic attacks. At examination of him it was established that he had inflammatory process in his joints and signs of mitral 5 urination developed in him. Which effect of electric current becomes apparent in this case? A. Electrochemical B. Biological C. Heat D. Mechanical E. -- 6. During long hypothermia of the organism phase of decompensation developed. Its feature is: A. Decrease in blood pressure B. Constriction of peripheral vessels C. Rare respiration D. Increase in muscle tone E. Rigor 7. A man took electric wire with high tension by both hands. He died momentary in result of: A. Intracerebral bleeding B. Respiratory standstill C. Cardiac fibrillation D. Burns E. Tearing extremities off 8. The main link in pathogenesis of kinetosis under radial acceleration is: A. Excitation of motor nuclei of vagus nerve B. Irritation of tactile receptors C. Increase in muscular tone D. Irritation of nuclei of vestibular nerve E. Bradycardia 9. A worker, taking part in nuclear power plant breakdown elimination, was exposed to whole-body irradiation. Which organ or which tissue will tumor develop in? A. Lung B. Bone marrow C. Stomach D. Skin E. Bone tissue 10. A worker, taking part in nuclear power plant breakdown elimination, was exposed to ionizing radiation in dose of 6Gr. What changes in the blood will happen after 10 days? A. Agranulocytosis B. Limpocytosis C. Leucocytosis and limphocytopenia D. Basophilia E. Eosiniphilia 11. A man had electric trauma. Current went through the myocardium. What dangerous disorders in heart work needing emergency correction can appear in such situation? A. Fibrillation of ventricles B. Fibrillation of atria C. Bradycardia 6 D. Tachycardia E. Extrasystolia 12. A worker was exposed to ionizing radiation in dose of 5Gr after accident at nuclear power plant. Agranulocytosis was revealed in him in a week. What is the basic pathogenic mechanism in this case? A. Increased outcome of mature leukocytes from bone marrow B. Development of autoimmune processes C. Increase in migration of granulocytes to tissues D. Elevated destruction of leukocytes E. Oppression of leucopoiesis 13. A patient has bone marrow form of radiation diseases. What lineages of hemopoiesis are affected in this case? A. All B. Erythrocytic C. Megakariocytic D. Granulocytic E. Agranulocytic 14. Symptoms of hemorrhage syndrome appeared in a patient with radiation sickness. Which mechanism is leading one in pathogenesis of this syndrome? A. Thrombocytopenia B. Lymphopenia C. Erythropenia D. Eosinopenia E. Neutropenia 15. A doctor revealed in a patient affected by electric current respiratory arrest and disturbances of heart functions. What pathway did electric current go in this case? A. Right hand - head B. Left leg - right leg C. Right leg - right hand D. Left leg - right hand E. Abdomen - right leg 16. Diver, working at depth of 60 m, was raised very quickly on surface after an accident. After a time pain in the joints, skin itching appeared in him. What happened to diver? A. Decompression diseases B. High altitude diseases C. Hyperbaric oxygenation D. Lowering of reactivity E. Compensatory adaptation 17. A galvanizer addressed to a doctor because of appearing of pink itching spots and vesicles on his arms skin. He worked a lot with nickel compounds recently. What is the mechanism of these lesions development? A. Modification of skin proteins due to action of nickel ions with immunopathological reaction development B. Irritant action of nickel compounds on skin C. Vegetative disorders related to nickel compounds received by respiratory tract D. Infection of skin due to microtraumas E. Nickel is a complete antigen 7 18. In consequence of accident in laboratory man was exposed to radiation in dose of 6Gr. Which symptom is the most typical for latent period of acute radiation diseases? A. Leukocytopenia B. Headache C. Depression D. Vomiting E. Diarrhea 19. A patient was admitted to the hospital with extensive burns of the body surface. Which pathogenic factor of burn disease has to be liquidated in the first turn? A. Intoxication of decay products B. Plasma loss C. Pain D. Infection through the injured skin E. Autoallergy 20. During running parallel experiments rats were exposed to prolonged direct solar radiation in open chambers and in ones covered by glass. Tumor development at hair uncovered places of skin was marked in animals residing in open chambers. Which factor influence does this phenomena connected to? A. Sun heat B. Ultraviolet radiation C. Biologic carcinogens D. Exogenous chemical carcinogens E. Infrared radiation 21. In consequence of accident at nuclear power plant radio-active products escape occurred. Peoples, who were in zone of increased radiation, got dose of radiation about 250 – 300 Gr. What symptom would be the leading one in these people? A. Lymphocytosis B. Anemia C. Thrombocytopenia D. Neutropenia E. Leukocytosis 22. A man was admitted to the hospital after exposure to radiation in dose of 3Gr. Which physiological system develops changes in the first turn in this patient? A. Blood system B. Cardiovascular system C. Immune system D. Alimentary system E. Endocrine system 23. Headache, pain in ears, nasal hemorrhages appeared in the passengers during flight by balloon. What serves the pathogenic base for these changes development? A. Explosive decompression syndrome B. Decompression syndrome C. Hypoxia D. Gas embolism E. Toxic influence of gases dissolved in the blood 24. What is the reason for pneumonia development in children after cooling? A. Microorganisms B. General cooling 10 B. Hydrolysis of lipids C. Decarboxylation of amino acids D. Peroxidation of lipids E. Oxidation of carbohydrates 3. Increase in levels of Alanine Aminotransferase (AlAT) and Aspartate Aminotransferase (AsAT) was found during examination of patient’s blood serum. What changes in organism at cellular level lead to this situation? A. Disturbances of intercellular interactions B. Disorders of enzyme systems of cells C. Impairment of energy supply of cells D. Destruction of cells E. Damage of genetic apparatus of cells 4. Increase in activity of Lactate Dehydrogenase was found during examination of patient’s blood serum. What changes at cellular level lead to such disturbances? A. Damage of plasmatic membranes B. Disorders of energy supply C. Disturbances of intercellular interactions D. Damage of genetic apparatus of cells E. Inhibition of enzyme systems 5. Cell of an experimental animal was exposed to X-rays. Protein fragments were formed in cytoplasm as a result. What cellular organelles participate in their utilization? A. Lysosomes B. Glogi apparatus C. Ribosomes D. Endoplasmatic reticulum E. Cell center 6. Activity of Alanine Aminotransferase (AlAT) and Aspartate Aminotransferase (AsAT) sharply increases in blood plasma at hepatitis and myocardial infarction. What are the reasons for increase in their activity in blood? A. Damage of cell membranes and release of enzymes to the blood B. Augmentation of enzyme activity by hormones C. Pyridoxine deficiency D. Increase in rate of amino acids synthesis in tissues E. Increase in rate of amino acids decay in tissues 7. Tissue culture was exposed to radiation. Nucleoli in cell nuclei were damaged. What organelles resumption becomes problematic in cell cytoplasm? A. Endoplasmatic reticulum B. Ribosomes C. Lysosomes D. Golgi apparatus E. Microtubules 8. Activation of universal membrane structure injuring mechanism occurs at reperfusion syndrome. This mechanism is referred to as A. Beta-oxidation of lipids B. Oxidation of cytochromes C. Microsomal oxidation D. Knoop-Lienen cycle 11 E. Peroxidation of lipids 9. It was established that pneumonia was caused by viruses in a 5-year-old child. What is the leading mechanism of cell injury in this pathology? A. Protein B. Electrolyte-osmotic C. Nucleic D. Lipid E. Calcic 10. Destruction of cartilage cells and disorder of their functions are observed in a patient with rheumatism. Which of cellular organelles takes active part in this pathological process? A. Ribosomes B. Microtubules C. Lysosomes D. Golgi apparatus E. Cellular center 11. Which ions accumulation in cytoplasm of muscular cells accounts for stable constriction of myofibrils? A. Calcium B. Sodium C. Potassium D. Magnesium E. Hydrogen 12. What is the direct reason for disorders of calcium-ions extraction from cytoplasm during cell injury? A. ATP deficiency B. Acidosis C. Increase of osmotic pressure in cytoplasma D. Increase of permeability of cell membranes E. Denaturation of proteins 13. At the phase, preceding diastolic relaxation of myocardium, concentration of calcium ions sharply increases in sarcoplasm, and uncombined calcium is virtually absent from sarcoplasm at diastole. Which of following structures participates in accumulation of calcium? A. Mitochondrions B. Lysosomes C. Ribosomes D. Golgi apparatus E. Nucleoli 14. During study of cell structure by students the question appears “What are biological membranes by their structure?” A. Bimolecular lipid layer with protein constituents B. Bimolecular lipid layer C. Monomolecular lipid layer D. Bimolecular protein layer E. Bimolecular protein layer with lipid constituents 12 TOPIC 4. ROLE OF REACTIVITY IN PATHOLOGY. IMMUNOLOGIC REACTIVITY. RESISTANCE. 1. There are no reactions of delayed type hypersensitivity in mice without hairs (nude mice). The most possible reason for this pathology is: A. Defect of phagocytosis B. Disorders of hematopoiesis C. Absence of thymus D. Deficiency of components of complement system E. Absence of gamma globulins in blood 2. Transplantation of skin was performed in a patient with wide spread burns. Graft swelled and changed its color at 8th day and was rejected at 11th. What cells participate in this process? A. Erythrocytes B. Basophils C. Eosinophils D. B-lymphocytes E. T-lymphocytes 3. Deficient content of immunoglobulins was revealed in a patient. What cells of immune system produce immmunoglobulins? A. Plasma cells B. T-killers C. B-lymphocytes D. T-helpers E. T-suppressors 4. Three times immunization of population was carried out by pertussis- diphtheriatetanus vaccine when the number of diphtheria cases rose. The levels of anybodies increased in the blood of immunized people as a consequence of immunization. What cells produce these proteins? A. Acidophilic granulocytes B. Neutrophilic granulocytes C. Macrophages D. Monocytes E. Plasmocytes 5. It is known that plasma cells produce specific antibodies against the given antigen. Number of plasma cells increases after introduction of antigen. What cells of peripheral blood serve as precursors of plasma cells? A. Neutrophils B. B-lymphocytes C. Basophils D. T-lymphocytes E. Eosinophils 6. Formation of T-helpers is held up in thymus. What processes of immunogenesis in connective tissue will be violated at first? A. Phagocytosis of antigens by macrophages B. Opsonization C. Conversion of B-lymphocytes to plasma cells D. Phagocytosis of foreign entities 15 D. T-helpers E. NK-cells 19. A 12-year-old boy with hereditary disease has eczema, 4 cases of pneumonia in his anamnesis, bleedings. Low level of T-lymphocytes, decreased levels of IgM, normal levels of IgA was found in his blood. What disease does the boy have? A. Wiskott-Aldrich syndrome B. Luis-Barr syndrome C. Bruton’s disease D. Late hypogammaglobulinemia E. Early hypogammaglobulinemia 20. A newborn has recurring respiratory tract diseases, pustule affections of the skin, severe clinical course of herpes infection and recurring candidiasis (thrush). Inoculation against smallpox and BCG-vaccination was accompanied by severe complication in him. All classes of immunoglobulins were decreased in his immunological test. Delayed-type hypersensitivity reactions were absent in him. What cells insufficiency underlies this immunodeficiency syndrome? A. Neutrophiles B. T- and B-lymphocytes C. Macrophages D. Fibroblasts E. T-suppressors 21. Father has rhesus-positive erythrocytes and mother’s blood is rhesus-negative. Severe hemolytic anemia has developed just after birth in their second child. What is the mechanism of massive hemolysis at newborn’s organism? A. Toxemia of pregnancy B. Antenatal intoxication C. Antenatal infection D. Genetic deficit of erythrocytes E. Immune hemolysis 22. A 1-year-old boy becomes very often ill with respiratory and pustular skin diseases. Even little damages become complicated by long-time purulent inflammation. All classes of immunoglobulins are nearly absent from the child’s blood. Contents of all leukocyte types and reactions of delayed-type hypersensitivity are normal. What cells inherited decrease in functional activity underlies this syndrome? A. T-lymphocytes B. B-lymphocytes C. Neutrophils D. Eosinophils E. Endoteliocytes 23. Decrease in levels of IgG and particularly IgA, IgM was found during examination of immune status in 5-year-old boy. B-lymphocytes and plasma cells are absent from his blood and lymph nodes. Reactions of T-lymphocytes are normal. This is inherited sex-linked disease. What diagnosis is more possible? A. Bruton’s disease B. Luis-Barr syndrome C. Wiskott-Aldrich syndrome D. Swiss type of immunodeficiency 16 E. Early hypogammaglobulinemia 24. The reasons for disturbances of phagocytosis may be qualitative disorders of phagocytes. What changes of intracellular structures are more typical for “lazy leucocytes” syndrome? A. Chemotaxin and opsonin receptors B. Microfilaments C. Specific membrane glycoprotein (GP 110) D. Microtubules E. Bactericidal system 25. A 9-year-old girl was getting breast feeding during the first year of life. She suffered prolonged severe pneumonia in the end of the first year. She started walking late. Her gait was unsteady and her movements were discoordinated. Telangiectasia appeared in her skin and conjunctivas. IgA is absent from and levels of T-lymphocytes is decreased in her blood. What immunodeficiency disease does the girl have? A. Luis-Barr syndrome B. Wiskott-Aldrich syndrome C. Chediak-Higashi syndrome D. Swiss type of immunodeficiency E. Di George syndrome 26. Immune system is depressed in a patient with HIV-infection. What cells damage contributes more to immunodeficiency at this patient? A. T-suppressors B. Macrophages C. T-helpers D. B-lymphocytes E. T-killers 27. A 2-year-old patient suffering from chronic pneumonia has decrease in quantity of B-lymphocytes, IgM and IgG. What microorganisms can cause development of this disease? A. Candidas B. Mycobacterium tuberculosis C. Herpes virus D. Adenovirus E. Staphylococcus 28. Disorder of cellular immunity was revealed during investigation of immune system in the patient with chronic fungus affection of the skin. What indexes decrease more typically in this case? A. IgG B. IgE C. T-lymphocytes D. B-lymphocytes E. Plasma cells 29. Mantoux test was made to sick child on suspicion of tuberculosis. Swelling, hyperemia and painfulness occur in the allergen injection place in 24 hours. What components determinate this reaction of organism? A. Mononuclear cells, T-lymphocytes and lymphokines B. B-lymphocytes and IgM 17 C. Plasma cells, T-lymphocytes and lymphokines D. Granulocytes, T-lymphocytes and IgG E. Macrophages, B-lymphocytes and monocytes 30. A patient was suffering from chronic renal insufficiency. He has renal transplantation from donor, who died in motorcar accident. Donor had blood group same as recipient. Renal insufficiency occurs in patient again after a time. Which system incompatibility takes part in transplant rejection? A. ABO B. RH C. MNS D. HLA E. Kel-Chelano 31. HIV-infection was suspected at a patient of dental clinics. What cells are damaged at first in patient with AIDS? A. T-helpers B. T-suppressors C. T-killers D. B-lymphocytes E. Macrophages 32. A 48-year-old patient suffers from frequent mycotic lesions and pyoderma at surface of trunk for a long time. He has alcohol abuse in his anamnesis. What promotes realization of disease reason in this case? A. Damage of the blood-brain barrier B. Primary immunodeficiency C. Decreased barrier function of the liver D. Allergy E. Chronic pneumonia 33. A 10-year-old girl suffers from viral and mycotic diseases very often. She has congenital heart disease and insufficiency of thyroid gland. T-lymphocytes is absent from her immunological test. What disorder of immune system takes place in this case? A. Bruton’s hypogammaglobulinemia B. Mixed immunodeficiency C. Terner’s syndrome D. Hypoplasia of thymus E. Inherited defect of complement system 34. Pneumonias and pyodermas very often occur in 5-year-old boy, as well as in his grandfather. B-lymphocytes are absent from their immunological test. What disorder of immune system takes place in this case? A. Bruton’s hypogammaglobulinemia B. Hypoplasia of thymus C. Mixed immunodeficiency D. Terner’s syndrome E. Inherited defect of complement system 35. Viral and bacterial infections, eczema often occur in a 12-year-old boy. Decreased quantity of T-lymphocytes and IgM and normal levels of IgG and IgA are found in him at examination. What kind of immune pathology is observed in this case? A. Hypoplasia of thymus 20 A. Angiospastic ischemia B. Ischemic stasis C. Compressive ischemia D. Venous (passive) hyperemia E. Obstructive ischemia 6. Edema and cyanosis of low extremities appear in a food shop assistant at the end of workday. What is the main factor of edema development in this patient? A. Dilatation of resistant vessels B. Orthostatic increase of venous pressure C. Increase of number of functional capillaries D. Increase of collateral blood flow E. Increase of tissue drainage 7. Redness and increase in volume of affected place of tissue, and increase in local temperature are observed in a patient with burn of thigh. What pathologic process do indicated symptoms correspond to? A. Arterial hyperemia B. Venous hyperemia C. Thrombosis D. Ischemia E. Stasis 8. A 23-year-old woman had intense psycho-emotional excitement. Hyperemia of face skin, tachycardia and increase in BP were observed in her. What is the mechanism of redness of her face skin? A. Congestive venous hyperemia B. Neuroparalytic arterial hyperemia C. Post-ischemic arterial hyperemia D. Neurotonic arterial hyperemia E. Stasis 9. Dyspnea, sharp pain in the chest, cyanosis, and jugular venous distention suddenly develop in a patient with thrombophlebitis of lower extremities. What is the most possible disorder of blood circulation developed in the patient? A. Thromboembolism of coronary vessels B. Thromboembolism of mesenteric vessels C. Thromboembolism of cerebral vessels D. Thromboembolism of portal vein E. Thromboembolism of pulmonary artery 10. Burning in the mouth appears after taking of food with pungent dressings. At examination mucosa of oral cavity is edematous, hyperemic, and bright red. What major reasons underlie disorders of microcirculation? A. Congestion B. Neuroparalitic arterial hyperemia C. Postischemic arterial hyperemia D. Atonic hyperemia E. Degranulation of tissue basophiles 11. A woman experienced a strong psycho-emotional excitement during dentist’s reception. Redness of her face skin and profuse salivation were noticed at that time. What is the mechanism of these phenomena? A. Manifestation of sympathetonic effect 21 B. Stagnant venous hyperemia C. Neuroparalitic arterial hyperemia D. Postischemic arterial hyperemia E. Neurotonic arterial hyperemia 12. Patient’s arm was put in plaster cast on account of simple fracture of humeral bone. Swelling, cyanosis, and decrease in temperature of the traumatized arm appear next day. What disorder of peripheral blood flow do these symptoms testify to? A. Thrombosis B. Venous hyperemia C. Ischemia D. Embolism E. Arterial hyperemia 13. Injury of sympathetic fibers of the sciatic nerve developed in a patient due to trauma. What kind of peripheral blood flow disorder takes place in the patient? A. Neurotonic arterial hyperemia B. Venous hyperemia C. Angiospastic ischemia D. Neuroparalitic arterial hyperemia E. Obturative ischemia 14. A 42-year-old woman, shop assistant by profession, complains of edema of the lower extremities at the end of a workday. Her legs are cyanotic, their temperature is decreased. Venous hyperemia of lower extremities was established, which is due to constitutional weakness of the elastic apparatus of veins and the occupation. What is the major pathogenic factor causing local changes in venous hyperemia? A. Disorders of metabolism B. Hypoxia C. Atrophy D. Dystrophy E. Sclerosis 15. Puncture of abdominal cavity for the extraction of fluid was performed to a 45- year-old patient with diagnosis “cirrhosis of liver, ascites”. State of unconsciousness suddenly developed in the patient as a result of decrease in blood pressure after extraction of 5L of fluid. That was considered as a manifestation of brain blood circulation insufficiency. Which disorder of microcirculation occurs in this case? A. Ischemia B. Arterial hyperemia C. Venous hyperemia D. Thrombosis E. Embolism 16. Signs of disorders of microcirculation in form of venous hyperemia were observed in a patient with gingivitis. This condition manifested by cyanosis and edema of mucosa and decrease in local temperature. What is the major mechanism of congestion development? A. Blood factors B. Perivascular changes C. Disturbances of lymph outflow D. Exudation from vessels E. Increased permeability of vessel wall 22 17. C. Bernard observed increase in secretion of submandibular salivary gland and development of arterial hyperemia irritating chorda tympani (branch of nervus facialis) in an experiment. What sort of arterial hyperemia it is according to mechanism of its development? A. Neuroparalytic B. Neurotonic C. Metabolic D. Reactive E. Working 18. Thrombosis of coronary artery results in myocardial infarction. Which mechanisms will be dominating ones in this disease? A. Electrolytic-osmotic B. Acidosis C. Protein-dependent D. Lipid-dependent E. Calcium-dependent 19. One of the most dangerous points in myocardial infarction pathogenesis is enlargement of the zone of necrosis, dystrophy, and ischemia. Increase in myocardial oxygen consumption plays important role in development of indicated processes. What substances contribute to this process? A. Chlorine ion B. Cholesterol C. Catecholamines D. Acetylcholine E. Adenosine 20. High level of arterial blood pressure is observed in a patient with renal disease accompanied by ischemia of renal parenchyma. What is the leading factor of increase in arterial blood pressure in this patient? A. Excess of angiotensin II B. Excess of antidiuretic hormone C. Augmentation of cardiac output D. Increase in tonus of sympathetic nervous system E. Hypercatecholaminemia 21. Patient has acute retrosternal pain irradiating into left arm, which cannot be controlled by the nitroglycerine for 30 minutes. What kind of changes develop in the patient’s heart? A. Myocardial ischemia B. Pathological hypertrophy of myocardium C. Sharp increase in coronary blood flow D. Mitral valve insufficiency E. Inflammation of pericardium 22. Severe stress was induced in an experimental animal. Under this condition, necrotic changes of myocardium developed in the animal. What is the leading reason for pathogenesis of this injury? A. Increase in calcium content in cardiomyocytes B. Decrease in mitochondrial ATP synthesis C. Affection of Na-K pump functions D. Coronary blood flow insufficiency 25 35. Convulsions and loss of consciousness develop in a diver during the emergency raising from the depth. What is the major pathogenic mechanism in these disorders development? A. Gas embolism B. Hypoxia C. Toxic action of oxygen D. Toxic action of nitrogen E. Hypercapnia 36. Destruction of endothelial layer of vessel leads to vasoconstriction. Decreased secretion of endothelial-derived factor plays the leading role in this phenomena development. What is this factor? A. Nitric oxide B. Adenosine C. Histamine D. Bradykinin E. Adenosine monophosphate 37. What changes develop in human organism in case of depressurization of airplane cabin at altitude of 19 km? A. Gas embolism B. Compensatory augmentation of biologic oxidation in tissues C. Increase in body temperature D. Compensatory augmentation of heart work E. Disorders of muscular coordination TOPIC 7. PATHOPHYSIOLOGY OF INFLAMMATION. 1. A 7-year-old child fell ill sharply. Hi has catarrh, cough, lacrimation and large-spot rash on skin; his temperature is increased up to 38oC. Mucous membrane of patient’s pharynx is edematous and red; buccal mucous membrane has whitish spots. What is the character of inflammation underlying changes of buccal mucous membrane? A. Hemorrhagic B. Serous C. Purulent D. Catarrhal E. Fibrinous 2. Painfulness of tooth and edema of lower part of face at the side of ill tooth are present in a patient with acute pulpitis. What is leading mechanism of edema development in this case? A. Increase in production of aldosterone B. Disturbances of trophic function of nervous system C. Disorder of neural regulation of water-salt metabolism D. Disorders of microcirculation at the focus of injury E. Hypoproteinemia 26 3. A 63-year-old woman has signs of rheumatic arthritis. Which of below enumerated indices of blood test will be most significant for diagnosis verification? A. R-glycosidase B. Lipoproteins C. Acid Phosphatase D. Summary glycosaminoglycans E. General cholesterol 4. A 5-year-old girl has high temperature and sore throat. At the examination of this patient the following was revealed: edema of soft palate, gray films on tonsils, which were removed difficulty and left after themselves deep hemorrhagic defects of tissue. Which disease of bellow enumerated is the most possible? A. Lacunar tonsillitis B. Simanovsky-Vincent’s tonsillitis C. Necrotic tonsillitis D. Diphtheria of pharynx E. Infectious mononucleosis 5. A cook burnt his arm with steam. What substance increased and led to development of redness, edema and painfulness of affected area of skin? A. Lysine B. Histamine C. Thiamine D. Galactosamine E. Glutamine 6. A child with asphyxia was taken to the hospital. On examination of the child whitish and difficulty separating films were revealed in his larynx. What type of inflammation is observed in this case? A. Croupous inflammation B. Diphtheritic inflammation C. Purulent inflammation D. Catarrhal inflammation E. Serous inflammation 7. Enlargement and deformation of joints were revealed in a patient with rheumatism. What type of inflammation underlies these changes? A. Alterative B. Proliferative C. Exudative D. Fibrinous E. Hemorrhagic 8. A painful blisters full of opaque fluid has formed in patient after thermal burn. What type of inflammation has appeared? A. Granulomatous B. Croup C. Serous D. Proliferative E. Diphtheritic 9. Prevalence of proliferative processes was revealed in a patient with chronic inflammation of skin and subcutaneous adipose tissue. Which hormone deficiency can lead to this situation? 27 A. Cortisol B. Aldosterone C. Insulin D. Growth hormone E. Thyroxin 10. A patient complains of a pain in joints. Edema and redness are visible above joints. Which enzyme activity has to be analyzed for establishing the diagnosis? A. Hyaluronidase B. Creatine kinase C. Alkaline phosphatase D. Acid phosphatase E. Urease 11. Indicate inflammatory mediators which have to be inhibited for decrease in exudation: A. Catecholamines B. Histamine C. Heparine D. Thromboxan E. Interleukine-1 12. Condition of biological active substances (BAS) prevalence over there inhibitors usually occurs in inflammation. Indicate correct correspondence of BAS to their inhibitor A. Histamine - carboxypeptidase B. Catecholamines - cholinesterase C. Kinins - monoaminooxidase D. Leukotriens - arylsulfatase E. Serotonin-protease inhibitor 13. Edema has developed as a result of oncotic pressure elevation in the site of inflammation. What is the main reason of hyperoncia? A. Activation of endotheliocytes B. Protein catabolism C. Drainage disorders D. Macromolecules accumulation E. Gluconeogenesis intensification 14. What factor promotes proliferation in focus of chronic inflammation? A. Phospholipase activation B. Hyperosmia C. Protein catabolism D. Hypoxia E. Prostacyclin synthesis 15. A patient has high body temperature, redness, edema, painfulness on her right forearm. What biological active substances intensify inflammatory reaction? A. Vasopressin B. Prostacyclins C. Phospholipase D D. Proteolysis inhibitors E. Kinins 30 28. In female patient, 28, abscess opening was performed and fast wound reparation was observed. Reparation was preceded without score formation. What cells play the main role in proliferation? A. Eosinophils B. Neutrophils C. Fibroblasts D. Lymphocytes E. Monocytes 29. In examination of abscess punctate under a microscope different blood cells were revealed. Which of them appears the first in inflammatory focus? A. Monocytes B. Mast cells C. Eosinophils D. Neutrophils E. Lymphocytes 30. What is the main factor of pain formation in pulpitis? A. BAS action B. Hydrostatic pressure increasing C. Excess of pain receptors excitability D. Ischemia E. Excess of brain centers sensitivity 31. What is the main factor of edema formation in pulpitis? A. Capillaries permeability increasing B. Hypoproteinemia C. Tissue hyperosmia D. Blood hyperosmia E. Capillaries hydrostatic pressure increasing 32. Which of following inflammatory mediators are formatted under the influence of lypooxygenases? A. Leukotriens B. Prostaglandins E1, E2 C. Prostacyclins D. Thromboxans E. Thrombocytes activation factor 33. Patient has a caries complicated with pulpitis. This condition is accompanied by unbearable pain. What is the main reason of pain? A. Ischemia B. Emigration C. Primary alteration D. Exudation E. Proliferation 34. It is known, that inflammatory mediators play the main role in inflammation pathogenesis. What is the histamine action on inflammation? A. Chemotaxis B. Blood vessel permeability increasing C. Thrombocytes aggregation D. Blood vessels constriction E. Blood coagulation 31 35. Female patient, 19, complains of pain in gums, gingival hemorrhage. These symptoms have appeared 3 days after sulphamide drugs taking. Objectively: gingival papilli and gum margin are reddened and swollen; there is a hemorrhage appeared in response of touching. What type of inflammation is observed in patient? A. Acute cattharal inflammation B. Hemorrhagic inflammation C. Fibrinous inflammation D. Pus inflammation E. Chronic cattharal inflammation 36. A patient 6 years old was admitted to the hospital with asphyxia. The membranous coats on mucosa of fauces were revealed. The coats can be removed easy. What type of inflammation is in patient? A. Fibrinous B. Necrotic C. Pus D. Cattharal E. Hemorrhagic 37. In child patient there are following symptoms of inflammation over the skin scratch: pain, swallowing, redness. These sings are symptoms of immediate hypersensitivity. What blood cells lead to such changings? A. Lymphocytes B. Eosinophils C. Basophiles D. Monocytes E. Neutrophils 38. In a girl patient, 5, there are intense throat pain and fever. Objectively were revealed edema and membranous coats on mucosa of fauces. The coats cannot be removed easy. What of the followings are more probably? A. Simanovsky - Vensann tonsillitis B. Infectious mononucleosis C. Diphtheria of fauces D. Necrotic tonsillitis E. Lacunar tonsillitis 39. Patient has a caries complicated with pulpitis. This condition is accompanied by unbearable pain. What is the main factor of pain appearing? A. High pressure of fluid in inflammatory area B. Bradykinin C. Prostaglandins D. Histamine E. Serotonin 40. There are lots of neutrophils in abdominal pus exudates in a patient with peritonitis. What is the main function of neutrophils in inflammatory area? A. Phagocytosis B. Prostaglandins secretion C. Degranulation D. Histamine liberation E. Local blood flow regulation 32 41. Keloid cicatrix has formatted in a place of abscess. Name the stage of inflammation, which caused scar appearing. A. Proliferation B. Exudation C. Primary alteration D. Secondary alteration E. Emigration 42. A male patient, 16, was admitted to the hospital with acute appendicitis. What typical pathological process is the basis of this disease? A. Inflammation B. Hypoxia C. Fever D. Tumor E. Allergy 43. Eyeball inflammation resulted pus in the anterior chamber of the eye (hypopyon). What stage of inflammation was it? A. Exudation B. Proliferation C. Primary alteration D. Secondary alteration E. Emigration 44. In a patient with skin pathological process which has 5 typical symptoms: tumor, rubor, calor, dolor, functio laesa. The development of such process includes 3 stages: Alteration, ............. , proliferation. What is the second one? A. Exudation B. Regeneration C. Reparation D. Fibrosis E. Petrification 45. The secondary alteration is caused by: A. Lysosomal enzymes B. Kinins C. Lympokynes D. Prostaglandins E. Complement components C3a and C5a 46. In proliferation cells multiplying and defect compensation take place. What is the reason of cells growth in specific clones? A. Keylones B. Platelet-derived grow factor C. Interleukins D. Somatomedine E. Lymphocytes peptide 47. There are following components in pleural effusion: proteis-62g/l, abundance of neutrophils. What is the type of inflammation in this case? A. Serous B. Suppuratuve C. Fibrinous D. Hemorrhagic E. Putrefactive 35 sweating, decrease of arterial pressure, and loss of consciousness in him. Which medicine is the pathogenetic remedy? A. Vasoconstrictors B. Antibiotics C. Antipyretics D. Pyrogenal E. Sulfanilamide 10. After being in the room with air temperature 40 0C and humidity 80% a patient has been brought to hospital in grave condition. He was unconscious; he had tachypnea, tachycardia, and body temperature 41 0C. Reanimation was failed. The patient has died. What is the most possible direct reason of death in this case? A. Paralysis of the breath center B. Collapse C. Coagulation of blood and decrease of volume of circulating blood D. Dehydration E. Heart failure 11. Fever of the patients with relapsing fever is characterized by several periods of pyretic temperature per day and several periods of normal temperature. Such type of temperature curve is called: A. Febris hectica B. Febris intermittens C. Febris continua D. Febris recurrens E. Febris atypica 12. Sharp increase of the temperature to 38.7 0C was marked in a patient with acute purulent periodontitis. His body temperature has decreased to normal level after opening the pulp cavity. Which type of fever was in the patient? A. Efemeral B. Septic C. Recurrent D. Remittent E. Continua 13. A patient suffers from osteomyelitis of maxilla. His body temperature increases to 40 0C and then sharply decreases to 35.6 0C every day. Which type of fever curve is characterized by these changes? A. Continua B. Intermittent C. Reccurens D. Atypica E. Hectica 14. Pallor of the skin, “goose flesh” and increase of oxygen consumption appeared in the patient’s skin after injection of pyrogenal. Which stage of fever is characterized by these changes? A. Stadium incrementi B. Stadium fastigii C. The stage of falling temperature by crisis D. The stage of falling temperature by lysis 36 15. Acute increase of body temperature, dyspnea, tachycardia, nausea, convulsions, and loss of conciousness developed in a worker, working in the thick uniform in summer. What was the most possible reason of development of those symptoms? A. Equilibration between heat loss and heat production B. Decrease of heat production C. Decrease of heat loss D. Increase of heat production E. Increase of heat loss 16. A man in light clothes is staying in a room with air temperature +14 0C. Windows and doors are closed. Which way of heat loss is the most considerable in this case? A. Evaporation B. Perspiration C. Conduction D. Radiation E. Convection 17. Experimental mice were kept in a lodge with air temperature 4 0C. Which adaptive reaction supplies its thermal homeostasis? A. Limitation of heat loss B. Decrease of oxygen consumption C. Anabiosis D. Increase of blood consumption E. Decrease of oxidation enzyme activity 18. Inclination of the set point of thermoregulation to higher level due to action of IL- 1 is in a patient. What is the name of this typical pathological process? A. Fever B. Hyperthermia C. Hypothermia D. Inflammation E. Hypoxia 19. The body temperature of a patient with crupous pneumonia is 39 0C. The difference between the morning and evening temperature of his body didn’t exceed 1 0C during 9 days. Which type of the fever curves was that? A. Continua B. Hectica C. Intermittent D. Hyperpyretic E. Reccurens 20. A patient has fever with following stages: incrementi, fastigii, decrementi. Which disease these features can characterize? A. Acute pneumonia B. Acromegaly C. Diabetes mellitus D. Hyperaldosteronism E. Myocardial hypertrophy 21. Body temperature of patient is pyretic; his skin is hot and red. What was the correlation between processes of heat production and heat loss in described stage of fever? A. Heat loss is equal heat production 37 B. Heat loss is more then heat production C. Heat production is more then heat loss D. Heat loss is less then heat production E. Heat production is less then heat loss 22. The body temperature of a patient with pneumonia was keeping on the level 38.3- 38.5 0C all the first week of disease. Such fever is called: A. Febrile B. Hyperpyretic C. Pyretic D. Subfebrile 23. Increase of “acute phase” proteins level in blood such as ceruloplasmin, fibrinogen, C-reactive protein is typical for development of fever. Indicate the possible mechanism of this phenomenon. A. Stimulative influence of IL-1 on hepatocytes B. Destructive action of elevated temperature to the cells of the organism C. Proliferate action of IL-2 to T-lymphocytes D. Adaptive reaction of the organism to pyrogen E. Degranulation of mast cells 24. Most infectious diseases are characterized by development of fever. It can be explained: A. Formation of IL-1 during phagocytosis of microorganisms B. Intoxication of the organism C. Degranulation of mast cells D. Activation of T- and B-lymphocytes E. Processes of exudation 25. Attacks of fever in a patient occur periodically. During the attack the body temperature sharply increases, keeps pyretic level nearly 2 hours and then decreases to normal level. This type of fever is typical for: A. Tertian fever B. Sepsis C. Brucellosis D. Relapsing fever E. Epidemic typhus 26. Body temperature of a patient is 39 0C for several hours (stadium fastigii). Indicate which changes of physiological functions are the most typical for this stage of fever. A. Bradycardia B. Ingibition of phagocytosis C. Increase of heat production D. Increase of heat production E. Heat production is equal heat loss 27. In a patient with pneumonia the increased body temperature was revealed. What sort of biological active substances play the most important role in development of fever? A. Interleukin-1 B. Leukotriens C. Serotonin D. Histamine E. Bradykinin 40 A. Interaction of T-lymphocytes with mediators B. Interaction of antigen with IgM C. Interaction of macrophages with antigens D. Interaction of antigen with IgE E. Interaction of T-lymphocytes with tissue basophils 4. In a 27-years-old man tuberculin test was carried out. Following was observed 24 hours later: infiltration with size of 40x35 mm at the site of injection and hyperemia of skin above it. What group of biologic active substances causes development of allergic inflammation in this patient? A. Lymphokines B. Biogenic amines C. Prostaglandins D. Leukotriens E. Kinins 5. Purulent endometritis developed in a woman after delivery. Treating with antibiotics - inhibitors of murein synthesis was ineffective. Wide spectrum bactericidal antibiotic was administered to her. 6 hours later temperature rapidly increased up to 40oC with shivering, pains in muscles appeared, BP dropped down to 70/40 mmHg, and oligura developed in this woman. What is the main reason for this condition development? A. Endotoxic shock B. Toxic effect of preparation C. Internal bleeding D. Anaphylactic shock E. Bacteremia 6. A 24-years-old patient has edema of face and increase in BP, which appeared 1.5 weeks later severe streptococcus tonsillitis. The patient has hematuria and proteinuria of 1.2 g/L. 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. Descendent tubules D. Loop of Henle E. Pyramids 7. Nausea, fatigue, stomachache, palpitation, difficult respiration, and skin blisters developed in a patient 25 minutes later injection of antibiotics. What stage of allergic reaction is observed in this patient? A. Pathochemical B. Biochemical C. Pathophysiological D. Immunological E. Sensibilization 8. Skin tuberculin test was carried out in a patient with chronic lung tuberculosis. Local hyperemia and edema appeared in the site of inracutaneous introduction of tuberculin preparation within 24-48 hours. What cells are primary effectors in mechanism of this reaction? A. Neutrophils 41 B. T-lymphocytes C. B-lymphocytes D. Endotheliocytes E. Smooth muscle cells of microvessels 9. Hyperemia, swelling and then necrosis of tissue, their rejection and ulcer (Arthus phenomenon) develop at the rabbit in the place of secondary intracutaneus injection of a substance with strongly pronounced antigenic properties (for example horse serum). What factors play the main role in pathogenesis of this phenomenon? A. Antibodies presented by IgE B. Antibodies presented by IgD C. Antibodies presented by IgA D. Antibodies presented by IgG and/or IgM E. Specific T-lymphocytes-effectors 10. Skin rash, itching, swelling and pain in joints, increase in body temperature, and proteinuria appeared in a patient in 5-8 days after use lots of medical serum. Serum sickness was diagnosed. What is the main factor in pathogenesis of this syndrome? A. Primary systemic accumulation of circulating immune complexes in the blood B. Primary systemic degranulation of mast cells in the organism C. Primary systemic activation of T-killers D. Primary systemic activation of endoteliocytes E. Primary systemic cytolysis of blood cells 11. Allergic diagnostic tests are used for the diagnosis of many infectious diseases (tuberculosis, brucelosis, tularemia etc). Diagnosis is confirmed if papula and redness appear in the place of the allergen injection. Antigens interaction reaction is conditioned by: A. IgE and lymphokines B. IgM and macrophages C. T-lymphocytes and lymphokines D. IgE and T-lymphocytes E. IgM and tissue basophiles 12. Catarrhal inflammation of bulbar conjunctiva and nose mucous membrane develop in patient every year in spring and early summer, when trees and flowers are in blossom. Production of specific antibodies to pollen underlies this syndrome. What cells activate and develop exocytosis in this syndrome? A. Neutrophils B. Macrophages C. Lymphocytes D. Mast cells E. Throbocytes 13. An 18-year-old man with shoulder phlegmon got intramuscular injection of penicillin. Tachycardia, thread-like pulse; decrease in BP down to 80/60 mmHg occur after that. What kind of pharmacologic reaction develops? A. Potentiation B. Reflex action C. Central action D. Anaphylaxis E. Peripheral action 42 14. Patient has been wearing removable dental prosthesis for 7 days. Soreness, swelling and hyperemia of prosthesis bed appear in the patient after that. Inflammation subsides after prosthesis taking off and develops again after prosthesis putting on. What process underlies the inflammation development? A. Mechanical irritation B. Hypersalivation C. Hyposalivation D. Resorption E. Secretion 15. Thyrotoxicosis was diagnosed in a patient. Antithyroid antibodies were found in his blood. Which type of allergic reaction is observed at development of this disease? A. Immune complex-mediated B. Stimulating C. Anaphylactic D. Cytotoxic E. Delayed type hypersensitivity 16. Hives, itching of the skin, swelling of the skin and mucous membranes, swelling of lymphatic nodes develop in the patient in 9 days after injection of medicinal serum. What disease develops? A. Pollinosis B. Serum sickness C. Shwartzman’s phenomenon D. Overy phenomenon E. Quincke’s edema 17. Dressler’s syndrome was diagnosed at the patient 1.5 month later myocardium infarction. It is characterized by pericarditis, pleurisy, and pneumonia. What is the reason for this syndrome? A. Sensitization of the organism by myocardium antigens B. Decrease in resistance to microorganisms C. Activation of saprophytic microflora D. Intoxication of organism by products of necrosis E. Release of myocardial enzymes to the blood 18. It is known that bronchial asthma develops by mechanism of immediate hypersensitivity, which includes 3 sequential stages: A. Immunological, pathochemical, pathophisiological B. Pathochemical, pathophisiological, immunological C. Pathochemical, immunological, pathophisiological D. Pathophisiological, immunological, pathochemical E. Pathophisiological, pathochemical, immunological 19. A 20-year-old man has injury of the right testicle. What danger does it brings for the left (healthy) testicle? A. Mimicry of antigens and development of antibody-mediated damage B. Development of infectious process C. Development of atrophy D. Development of hypertrophy E. No danger 20. Guinea-pig’s nephrocytotoxic serum was injected to the rabbit under the experiment. What human disease is modeled in this case? 45 B. Urticaria C. Quincke’s edema D. Attack of asthma E. Pulmonary thromboembolism 32. 0.1 ml of horse serum was injected to the guinea-pig for sensitization. What are external signs of sensitization? A. No external signs B. Skin rashes C. Joints swelling D. Increase in body temperature E. Pain 33. A 15-year-old girl is suffering from bronchial asthma. Severe attack of expiratory dyspnea develops in her during the spring blossoming period. What biological active substance causes spasm of bronchial smooth muscle in this case? A. Leukotriene B. Thromboxane A2 C. Prostacyclin D. Bradykinin E. Serotonin 34. Patient addressed to a doctor with complaints of headache, rhinitis, weakness, and increase in body temperature developing every spring in blossoming period. What type of allergic reaction by Gell and Cumbs underlies this disease? A. Anaphylactic B. Cytotoxic C. Antibody-dependent cell-mediated cytotoxicity D. Immune complex-mediated E. Delayed type hypersensitivity 35. Weakness, itching of skin, acute spasmodic pain in the abdomen, hyperemia and rash on skin, tachycardia, and decrease in BP down to 70/40 mm Hg suddenly developed in a patient few minutes later Novocain injection by the dentist. Which type of allergic reactions does this pathology belong to? A. Anaphylactic B. Cytotoxic C. Stimulating D. Cell-mediated E. Immune complex-mediated 36. Contact dermatitis of upper extremities developed in the nurse, who has been working in manipulation room for 20 years. Which type of allergic reactions does this pathology belong to? A. Delayed-type hypersensitivity B. Primary immunodeficiency C. Immediate type hypersensitivity D. B-cells immunodeficiency E. T-cells immunodeficiency 37. Pain in the joints and loins, hemorrhagic eruptions on the skin, and increase in body temperature occur in the patient with toxemic stage of burn disease in 2 hours after allogenic plasma transfusion. What allergic reaction takes place in this case? A. Serum sickness 46 B. Urticaria C. Quincke’s edema D. Anaphylactic E. Autoimmune vasculitis 38. Hyperergic inflammation form of upper respiratory tract (larynx, trachea, bronchi) develops at 6-year-old child. Threat of respiratory impairment develops and then necessity of using anti-inflammatory hormones occurs. Which hormone has anti- inflammatory property? A. Cortisol B. Adrenaline C. Growth hormone D. Testosterone E. Insulin 39. Swelling, increased BP, proteinuria, hematuria, decreased urine excretion were revealed in the patient, which suffered severe tonsillitis before. These symptoms are typical of acute glomerulonephritis, resulting from damage of glomerular basement membrane. What is mechanism of this disease? A. Anaphylactic allergic reactions B. Cytotoxic allergic reactions C. Immune complex-mediated allergic reaction D. Delayed-type hypersensitivity E. Stimulating allergic reaction 40. An 18-year-old patient has insulin- dependent diabetes mellitus I type. What type of allergic reactions underlies beta cells damage? A. II type, cytotoxic B. I type, anaphylactic C. III type, immune complex-mediated D. IV type, delayed-type hypersensitivity E. Pseudoallergic reaction TOPIC 11. PATHOPHYSIOLOGY OF TISSUE GROWTH. TUMORS. 1. Rate of appearance of tumors is increased in elderly people. One of the main reasons for this is: A. Increase in activity of cellular immunity B. Decrease in activity of cellular immunity C. Rise of disorders of mitoses D. Decrease of intensity of antibody production E. Increase of intensity of antibody production 2. In a patient with metastases of lung carcinoma introduction of cytostatics led to suspension of metastases growth at first but later metastases resumed spread. What is the most possible mechanism of secondary growth of metastases? A. Absence of contact braking B. Absence of Heiflik’s limit C. Rise of genetic heterogeneity of tumor cells D. Increased glucose consumption by tumour E. Increased amino acids consumption by tumour 47 3. A 56-years-old patient, who had contact with diethylnitrozamine at his work place, complains of pain in right subcostal area, weakness, loss of appetite, and decreased workability. At examination of this patient: surface of his liver is rough, splenomegaly and ascites are present in him; his body temperature is 37.2oC; in his blood analysis ESR is 25 mm/hour, besides neutrophilic leukocytosis, and hypochromic anemia were found. What disease developed in the patient’s organism? A. Cancer of liver B. Hepatitis C. Cirrhosis of liver D. Gallstone disease E. Dyskinesia of bile ducts 4. Approximately 60% of tryptophan is oxidized through serotonin pathway in case of malignant intestine carcinoma. What vitamin demand is increased for a patient with malignant carcinoma of intestine? A. Nicotinic acid B. Pantothenic acid C. Folic acid D. Pyridoxine E. Riboflavin 5. Malignant tumor of lung was diagnosed in a patient. What feature of tumour growth testifies its malignancy? A. Infiltrative growth B. Unregulated growth C. Unlimited growth D. Expansive growth E. Appearance from one cell 6. Tumor has developed in a patient with innate immunodeficiency. What factor of non-specific immunity participates in anti-tumor defense? A. Lysozyme B. Interleukin-1 C. Lactoferrine D. Arylsulfatase E. Properdine 7. The woman complained to the doctor for changing of voice, appearance of hair on the face, and reduction of breast. Where would a tumor develop that could lead to these symptoms? A. Tumor of zona reticulata of adrenal glands B. Tumor of ovaries C. Tumor of anterior lobe of pituitary gland D. Tumor of zona glomerulata of adrenal glands E. Tumor of zona fasciculata of adrenal glands 8. Gamma-interferon was used for treatment of the patient, suffering from tumor. What property of this substance was used for treatment of this tumor disease? A. Activation of synthesis of Ig B. Activation of B-lymphocytes C. Activation of killer effect D. Activation of complement system E. Activation of macrophages 50 C. Aerobic glucolysis D. High aminoacides metabolism E. Organospecificity absence in aminoacides consumption 23. A patient with urinary bladder cancer was working in coke factory. What substance was the most probable reason of this pathological condition? A. Naphtylamine B. Dichlorethane C. Vinegar acid D. Alcohol E. Pethroleynic aether 24. It is established that tumor tissue receives in 20-25 times less of glucose that intact tissue in equal glucose amount. What metabolic changings lead to such event? A. Aerobic glycolysis enhancement B. Oxydation improvement C. Normal interaction of these processes D. Tissue respiration improvement E. Decreasing of anaerobic glycolysis 25. They got nitrogenous nitrite to experimental animals. A tumor was developed in 80% of animals. What was the group of cancerogens? A. Nitrosamines B. Aminoasosubstances C. Polycyclic carbohydrates D. Simple chemical substances E. Hormones 26. After Chernobyl disaster morbidity of tumors has been increasing. What action of the radiation has been appearing? A. Oncogenic B. Thermal C. Mutagenic D. Cytostatics E. Immunostimulative TOPIC 12-13. PATHOPHYSIOLOGY OF THE PROTEIN AND CARBOHYDRATE METABOLISM. DIABETES MELLITUS. 1. A patient was admitted to the hospital in comatose state. Accompanying people said that hi lost consciousness at training while he was finishing the Marathon distance. What sort of coma is the most possible in this patient? A. Hyperglycemic B. Hypoglycemic C. Hypothyroid D. Hepatic E. Diabetic ketoacidosis 2. Patient has hyperglycemia, glucosuria, polydipsia, polyphagia, and polyuria. What hormone hyposecretion do these changes develop due to? A. Antidiuretic hormone 51 B. Atriopeptide C. Glucagon D. Insulin E. Cortisone 3. A patient, aged 80, complains of increased appetite, thirst, elevated urination, and worsening of general condition after the taking some sweet food. What disease is it? A. Hypercortisolism B. Hyperthyroidism C. Hypothyroidism D. Diabetes insipidus E. Diabetes mellitus 4. A man, aged 38, is under the course of treatment for schizophrenia at in-patient department. Contents of glucose, ketone bodies, and urea in his blood are normal. Shock therapy with regular injections of insulin has led to development of insular coma, and after that state of patient becomes better. What is the most possible reason for insular coma? A. Glucosuria B. Dehydration of tissues C. Hypoglycemia D. Metabolic acidosis E. Ketonemia 5. In worker at polar station, who has been working there for a long time, hemorrhage form gums occur, his teeth sway and pull out. What vitamin deficiency leads to these changes? A. Tocopherol B. Ergocalciferol C. Ascorbic acid D. Folic acid E. Nicotinic acid 6. A patient, aged 50, complains of increased appetite, thirst, and loss of body weight, weakness. At laboratory examination rise of amount of glucose in his blood revealed. What type of cells is injured in case of this disease development? A. Lipotropocytes B. Thyrocytes C. B-cells of Langerhans islets D. A-cells of Langerhans islets E. Pancreatocytes. 7. In 18-years-old patient, while laboratory examining presence of glucose in urine and normal concentration of glucose in blood plasma were revealed. What disorder is the most possible cause of these changes? A. Disorders of glomerular filtration B. Disorders of tubular secretion C. Disorders of glucocorticoids secretion D. Disorders of insulin secretion E. Disorders of tubular reabsorption 8. Dyspepsia and vomiting are observed in a newborn after feeding with milk. These phenomena disappear after feeding with glucose solution. What enzyme that takes part in carbohydrate digestion is deficient in case of these changes development? 52 A. Amylase B. Lactase C. Maltase D. Isomaltase E. Saccharase 9. In patient painfulness along large nervous trunks and increase of pyruvate in blood are revealed. What vitamin deficiency may lead to these changes? A. Pantothenic acid B. Nicotinic acid (PP) C. Biotin D. Riboflavin (B2) E. Thiamin (B1) 10. A newborn was admitted to the emergency department with following symptoms: vomiting, diarrhea, disorders of growth and development, cataract, and mental retardation. Galactosemia was diagnosed. What enzyme deficiency takes place in this case? A. Glucose-1-phosphate uridiltransferase B. Glucokinase C. Glucose-6-phosphate dehydrogenase D. UDP glucose pyrophosphorilase E. UDP glucose-4-epimerase 11. Flatulence, bowel spasms, abdominal pain and diarrhea often develop in some people after taking milk. These symptoms arise in 1 - 4 hours after intake only one glass of milk. What component of milk these symptoms develop due to? A. Galactose B. Lactose C. Maltose D. Saccharose E. Fructose 12. Newborn has been refusing food, having vomiting and diarrhea, and some time later its crystalline lens become opaque. At examination of newborn: glucose in blood – 8.5 mmol/L and in urine – 1%. What is the most possible diagnosis? A. Galactosemia B. Phenylketonuria C. Tyrosinosis D. Cystinuria E. Alkaptonuria 13. In woman, aged 45, without symptoms of diabetes mellitus, content of glucose in blood on an empty stomach reaches 7.5 mmol/L. What test is necessary to be performed? A. Determination of residual nitrogen in blood B. Determination of glucose in blood on an empty stomach C. Determination of tolerance to glucose D. Determination of ketone bodies in urine E. Determination of glycosylated hemoglobin 14. In man, aged 60, who is 170 cm tall and 110 kg weight, content of glucose in blood is 6.8–7.0 mmol/L. Content of insulin in his blood is normal. Tolerance to glucose is 55 25. During the experiment rat was injected with 5% alloxan solution in dose 200 mg per kg of rat weight. What kind of pathology arises in this case? A. Arterial hypertension B. Acute renal failure C. Diabetes insipidus D. Diabetes mellitus E. Hepatic failure 26 One-year infant lags in mental development from infants of the same age. The infant has vomiting, cramps, and loss of consciousness in the mornings. What enzyme deficiency these changes are connected to? A. Phosphorylase B. Arginase C. Glycogen syntase D. Saccharase E. Lactase 27. In patient with constant hypoglycemia blood analysis does not change after injection of adrenalin. A doctor supposes hepatic disorder. What function disorder it is? A. Cholesterol formation B. Excretion C. Glycolysis D. Ketogenesis E. Glycogen deposition 28. A woman, aged 58, was admitted to the hospital in severe condition. She has confused consciousness; dry skin, hollow eyes, cyanosis, and scent of rotten apples from her mouth. At laboratory examination of her: glucose in blood – 15.1 mmol/L, glucose in urine – 3.5%. What is the most possible reason for this condition? A. Hypoglycemic coma B. Hyperglycemic coma C. Hypovolemic coma D. Uremic coma E. Anaphylactic shock 29. A doctor reveals in child symmetric roughness on cheeks, diarrhea, and disorders of neural activity. What nutrition factors deficit underlies this condition? A. Methionine, lipoic acid B. Lysine, ascorbic acid C. Nicotinic acid, tryptophan D. Threonine, pantothenic acid E. Phenylalanine, pangamic acid 30. The most of participants of Magellan expedition to America died of avitaminosis. This disease displays as general malaise, subcutaneous hemorrhage, pulling teeth out, hemorrhage from gums. What is the name for this avitaminosis? A. Scurvy B. Pellagra C. Addison-Birmer’s anaemia D. Polyneuritis (beriberi) E. Rachitis 56 31. In a woman, of 52 years old and of 125 kg weight, diabetes mellitus develops. It happens due to: A. Decrease of number of insulin receptors B. High-affinity binding insulin to synalbumin C. Reduced cell susceptibility to insulin D. Increase activity of insulinase E. Broken insulin synthesis 32. Unconscious patient was admitted to the hospital. He has Kussmaul respiration, blood pressure 80/50 mmHg, and acetone scent from his mouth. What substances accumulation in organism may lead to these disturbances? A. Complex carbohydrates B. Carbonic acid C. Lactic acid D. Modified lipoproteins E. Ketone bodies 33. In patient suffered from diabetes mellitus metabolic acidosis develops due to accumulation of ketone bodies (beta-oxybutyric acid and acetoacetic acid). At this condition pH of arterial blood is: A. 7.40 B. 7.48 C. 7.56 D. 7.32 E. 7.66 34. A patient, 56 years old woman, who have been suffering from diabetes mellitus for 6 years, complains of compressing pain behind her sternum. What mechanism of heart affection is the most possible in this case? A. Myocardial dystrophy B. Microangiopathy of myocardial vessels C. Macroangiopathy of coronary vessels D. Myocarditis E. Vegetative neuropathy of heart 35. Content of glucose in patient’s blood is: on an empty stomach – 4.52 mmol/l, in one hour after taking sugar – 6.23 mmol/l, and in two hours after taking sugar – 2.56 mmol/l. These signs are characteristic for: A. Healthy person B. Person suffered from insulinoma C. Person suffered from hidden diabetes mellitus D. Person suffered from insulin-dependent diabetes mellitus E. Person suffered from thyrotoxicosis 36. What complication may develop when treating diabetic ketoacidosis with large doses of insulin? A. Arterial hypertension B. Leukocytosis C. Arterial hypotension D. Hypoglycemia E. Hyperkalemia 57 37. A female patient, aged 24, complains of dryness in her mouth, loss of weight despite good appetite. Her height is 157 cm her weight is 72 kg. What analysis we have to perform at fist in this patient? A. Urinalysis by Zemnitsky B. Determination of glucose content in 24-hour urine quantity C. General urinalysis D. Determination of protein fractions in blood serum E. Coagulogram 38. A patient D., 40-years-old woman, was admitted to the hospital with complaints of weakness, giddiness, hunger, cold sweat, and cramps. At examination of the patient: distension of pupils of the eyes, weakening of respiration, and BP is 90/50 mmHg. Biochemical analysis of her blood shows: general bilirubin is 16.0 mcmol/L, urea is 4.7 mmol/L, creatinine is 98 mcmol/L, and glucose is 2.0 mmol/L. What kind of coma may develop in this patient? A. Hyperglycemic B. Hepatic C. Renal D. Hypoglycemic E. At adrenal glands deficiency 39. The woman B., aged 45, was admitted to the emergency department from a street. At examination of patient following symptoms was revealed: loss of consciousness, loss of reflexes, absence of reflexes from pupil of the eye and sclera, Kussmaul respiration, BP is 70/40 mmHg, and body temperature is 35oC. Biochemical analysis of patient’s blood displays: general bilirubin is 16.0 mcmol/L, urea is 3.6 mmol/L, creatinine is 108 mcmol/L, and glucose is 22 mmol/L. What kind of coma has developed in this patient? A. Hypoglycemic B. Hepatic C. Renal D. At adrenal glands deficiency E. Hyperglycemic 40. Diabetes mellitus develops in animals after injection to them some alloxan. What is the main mechanism of this type of diabetes mellitus? A. Selective damage of lambda-cells of pancreatic islets B. Damage of beta- and lambda-cells of pancreatic islets C. Formation of antibodies to insulin D. Selective damage of beta-cells of pancreatic islets E. Gluconeogenesis activation 41. A patient address to a doctor with complaints of constant thirst. Hyperglycemia, polyuria and increased content of 17-ketosteroids in urine were revealed. What is the most probable disease in this case? A. Addison’s disease B. Myxedema C. Glycogenosis of I type D. Insulin dependent diabetes mellitus E. Steroid diabetes 60 TOPIC 14. PATHOPHYSIOLOGY OF ACID-BASE BALANCE 1. At examination of patient following were found: hyperglycemia, ketonuria, polyuria, hyperstenuria, and glucosuria. What kind of acid-base balance disturbances occurs in this case? A. Gas alkalosis B. Non-gas alkalosis C. Metabolic alkalosis D. Metabolic acidosis E. Gas alkalosis 2. Acidosis develops in case of severe form of diabetes mellitus. What buffer system components change at first? A. Bicarbonate B. Phosphate C. Hemoglobin D. Oxihemoglobin E. Protein 3. Prolonged convulsions occur in patient suffered from epilepsy. After that following data of laboratory analysis of this patient were received: pH – 7.14, pCO2 – 45 mmHg, HCO3- – 14 mmol/l, Na+ - 140 mmol/l, Cl- - 98 mmol/l. What kind of acid- base balance disturbances occurs in this patient? A. Metabolic ketoacidosis B. Metabolic lactoacidosis C. Respiratory alkalosis D. Metabolic alkalosis E. There are no disorders of acid-base balance 4. While ascending to mountain in alpinist excitation developed that was replaced with headache, giddiness, breathlessness, and after that apnea occurred. What kind of acidbase balance disturbances occurs in this case? A. Non-gas acidosis B. Excretory acidosis C. Gas alkalosis D. Non-gas alkalosis E. Gas acidosis 5. A patient suffered from chronic glomerulonephritis has increasing general malaise, tachycardia with recurrent arrhythmia, confusion, and sleepiness. What kind of acidbase balance disturbance accompanies uremic coma? A. Non-gas excretory acidosis B. Non-gas excretory alkalosis C. Gas acidosis D. Gas alkalosis E. Respiratory alkalosis 61 6. Pregnant woman has toxicosis accompanied by vomiting of 24 hours duration. After that tetany cramps and dehydration develop. What kind of shift of acid-base balance leads to described changes? A. Gas alkalosis B. Gas acidosis C. Non-gas metabolic acidosis D. Non-gas metabolic alkalosis E. Non-gas excretory alkalosis 7. A patient suffered from diabetes mellitus was admitted to the hospital because of worsening of his condition. He has general malaise, polyuria, lethargy, and sleepiness. Kussmaul respiration, heart arrhythmia, and acetone scent in expired air are noticed in this patient. What kind of shift of acid-base balance contributes these symptoms? A. Gas alkalosis B. Gas acidosis C. Non-gas metabolic alkalosis D. Non-gas metabolic acidosis E. Non-gas excretory alkalosis 8. A group of alpinists was undergone blood analysis in mountains at height 3000 meters. Following was revealed: decrease of HCO3 - down to 15 mmol/l (norm is 22- 26 mmol/l). What is the mechanism of decrease of HCO3- in the blood? A. Decrease of reabsorption of bicarbonate in kidneys B. Hyperventilation C. Intensification of acidogenesis D. Hypoventilation E. Reduction of ammoniogenesis 9. pH of blood of patient suffered from diabetes mellitus sets to 7.3. What component of buffer system determination is used to diagnose disorders of acid-base balance? A. Bicarbonate B. Oxihemoglobin C. Phosphate D. Hemoglobin E. Protein 10. Buffer capacity of blood decreases in worker as a result of exhausting muscle work. What acid substance income to the blood this may be explained? A. Alpha-ketoglutaric acid B. 3-phosphoglycerate C. Lactic acid D. Pyruvate E. 1,3-biphosphoglycerate 11. Repeated vomiting occurs in patient suffered from pylorostenosis which is accompanied by loss of chloride ions from the organism and development of non-gas alkalosis. What conditions these changes of acid-base balance may result from? A. Hyperchloridemia B. Hyponatremia C. Hypokalemia D. Hypernatremia E. Hyperhposphatemia 62 12. 48-years-old patient with diabetes mellitus was admitted to the hospital in severe pre-coma state. When examining of acid-base balance metabolic acidosis was revealed. Patient was treated with complex therapy including insulin intramuscular injections and sodium bicarbonate solution intravenous infusion. What is the main possible mechanism of found changes development? A. Disorders of O2 using in cells B. Disorders of buffer systems of blood C. Decrease of CO2 removing D. Excretion of alkali elements with urine E. Formation of products of incomplete oxidation 13. Patient has disturbances of airways passage at the level of small and medium bronchi. What kind of acid-base disorders may develop in this patient? A. Respiratory alkalosis B. Metabolic alkalosis C. Respiratory acidosis D. Metabolic acidosis E. Acid-base balance does not change 14. In patient suffered from diabetes mellitus coma has developed due to disorders of acid-base balance. What kind of acid-base disorders develops in this case? A. Exogenous acidosis B. Respiratory acidosis C. Metabolic acidosis D. Gas alkalosis E. Non-gas alkalosis 15. A woman has distinct hypersalivation syndrome. Patient has to remove saliva from her mouth with napkin because of hard pain when she is swallowing. What kind of acid-base disorders may develop in this patient in some time? A. Non-gas excretory acidosis B. Gas alkalosis C. Metabolic acidosis D. Non-gas excretory alkalosis E. Gas acidosis 16. During bronchial asthma attack patient developed gas acidosis (hypercapnia). What buffer system of blood plays the main role in compensation of this condition? A. Bicarbonate B. Hemoglobin C. Phosphate D. Protein E. Ammoniogenesis 17. At examination of a patient hyperglycemia, ketonuria, polyuria, hyperstenuria, and glucosuria were revealed. What type of acid-base balance disorder takes place in this case? A. Metabolic acidosis B. Gas acidosis C. Metabolic alkalosis D. Non-gas alkalosis E. Gas alkalosis 65 7. A patient has increased osmolarity of urine and decreased urination due to intensive sweating and dehydration. What hormone secretion changes provide compensatory retention of water at first? A. Antidiuretic hormone B. Aldosterone C. Corticosterone D. Thyroxin E. Insulin 8. Content of sodium in patient’s blood serum is 100 mmol/l. What does this condition may manifest in? A. Edemas B. Arrhythmias C. Dehydration D. Heart arrest E. Tachycardia 9. In a patient, aged 44, thirst develops after burns. What receptors generate impulses that underlie thirst development in this case? A. Osmoreceptors B. Pain receptors C. Thermal receptors D. Tactile receptors E. Chemoreceptors 10. Isoosmolar hypohydration has been formed in a patient due to severe diarrhea. What symptoms are characteristic for this disturbance of water exchange? A. Edematous syndrome B. Decrease of content of water inside cells C. Hypovolemic shock D. Polyuria E. Arterial hypertension 11. In patient with affection of kidneys hypoosmolar hyperhydration (water poisoning) has developed. What is the main pathogenic factor of this syndrome? A. Anuria B. Hypoaldosteronism C. Polyuria D. Hypoproteinemia E. Increase of microvessel permeability 12. Hyperosmolar hypohydration has been formed while prolonged water starvation. Which of following manifestations are typical for this condition? A. Arterial hypertension B. Hypoisostenuria C. Hypothermia D. Increased salivation E. Cramps and hallucinations 13. In patient suffered from severe chronic glomerulonephritis retention of isoosmolar fluid in organism and distinct edematous syndrome occur. What is the major factor of edema development in case of glomerulonephritis? A. Hyperproteinemia B. Secondary aldoseronism 66 C. Hypoproteinemia D. Hypoaldosteronism E. Arterial hypertension 14. In patients with myeloma content of proteins in blood plasma is increased up to 200 g/l. This leads to redistribution of water between intracellular, interstitial, and intravascular spaces. What direction does water mainly move at in this case? A. From interstitium to blood vessels B. From cells to interstitium C. From interstitium to cells D. From blood vessels to interstitium E. From lymphatic vessels to interstitium 15. A patient of 18 years old and of 60 kg weight was admitted to the hospital with signs of hemic hypoxia resulting from poisoning by nitric compounds. Examination of water exchange of this patient displays: general water – 64% of body weight, extracellular fluid – 18%, intravascular fluid – 5%, and intracellular fluid – 46%; osmotic pressure of blood plasma is 250 mosm/l; urination is 0.8 L per 24 hours. Define the type of dyshydration? A. There is no dyshydration B. Isoosmolar hyperhydration C. Isoosmolar hypohydration D. Hypoosmolar hyperhydration E. Hypoosmolar hypohydration 16. Edemas at lower extremities occur in a patient suffered from severe heart failure. What is the leading mechanism of edema development in this case? A. Centralization of blood circulation B. Lowering of hydrostatic pressure C. Secondary hyperaldosteronism D. Orthostatic increase of venous pressure E. Hypoproteinemia 17. What is the initial link in formation of heart edemas? A. Increase of vascular permeability B. Decrease of minute heart volume C. Activation of renin-angiotensin system D. Increase of content of aldosteron in blood E. Increase of secretion of antidiuretic hormone 18. What is the leading factor of edema development in case of nephrotic syndrome? A. Increase of hydrostatic pressure in capillaries B. Increase of vascular permeability C. Hypoalbuminemia D. Dynamic lymphatic insufficiency E. Increase of blood volume 19. Patient suffered from cirrhosis of liver was given with 500 ml of 5% glucose solution with medicines. What disturbances of water-salt balance may appear in this patient? A. Hypoosmolar hyperhydration B. Hyperosmolar hyperhydration C. Isoosmolar hyperhydration D. Hypoosmolar hypohydration 67 E. There is no dyshydrotation 20. Patient has edema of right lower part of face and pulsing pain in tooth, which intensifies when taking some hot food. Dentist has diagnosed acute pulpitis. What is the leading mechanism of edema development in this case? A. Disorders of microcirculation in the focus of inflammation B. Disorders of trophic function of nervous system C. Hypoproteinemia D. Hyperosmia E. Lymphocytosis 21. Toxic lung edema was modeled in rat using solution of ammonium chloride. What is the leading mechanism of edema development in this case? A. Reducing of colloid-osmotic pressure B. Rising of venous pressure C. Increase of vascular permeability D. Disorders of neural and humoral regulation E. Intensification of lymphatic drainage 22. A rat was intravenously injected by 10 ml of 40% glucose solution. In 60 min coma develops due to hyperosmolar dehydration in this rat. What is the mechanism of edema development in this case? A. Loss of water and salts B. Reduction of vasopessin synthesis C. Increase of oncotic pressure of extracellular fluid D. Increase of osmotic pressure of extracellular fluid E. Disturbance of acid-base balance 23. Patient has extracellular edema of tissues (dimensions of soft tissues of extremities, liver, and others are enlarged). What parameter of homeostasis decrease do these changes result from? A. Viscosity B. pH C. Hematocrite D. Oncotic pressure of blood plasma E. Osmotic pressure of blood plasma 24. At complete starvation (with taking water) generalized edemas develop. What is the leading pathogenic factor in this case? A. Increase of oncotic pressure of interstitial fluid B. Decrease of osmotic pressure of blood plasma C. Decrease of oncotic pressure of blood plasma D. Increase of osmotic pressure of interstitial fluid E. Decrease of hydrostatic pressure of interstitial fluid 25. When treating for dehydration by means of salt-poor fluids at the background of sharply reduced excretory renal function resulted from tubular necrosis the worsening of general condition, confused consciousness, convulsive readiness, and brain edema with vomiting develop. What kind of water-salt exchange disturbances takes place in this case? A. Hypoosmolar hyperhydration B. Isoosmolar hyperhydration C. Hyperoosmolar hyperohydration