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Cerebro-vascular disease.Heart diseases. # A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. On microscopic examination his renal artery branches have concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage of the renal parenchyma. An elevation in which of the following substances in his blood is most likely to be associated with these findings? @Cholesterol Renin Troponin I Triglyceride C-reactive protein # A 66-year-old woman has the sudden loss of movement on part of the left side of her body. She has smoked a pack of cigarettes a day for the past 45 years. She has vital signs including T 37.1 C, P 80/minute, R 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery. Laboratory findings include a hemoglobin A1C of 9%. Which of the following components of blood lipids is most important in contributing to her disease? Chylomicron Lipoprotein C lipase VLDL @HDL cholesterol # A 50 year-old patient had hemorrhage of the brain and was taken to the hospital. The place of hemorrhage was revealed on the lateral hemispheres surfaces during the medical examination. What artety was injured? @The middle cerebral artery The posterior cerebral artery The anterior cerebral artery The posterior communicating artery The anterior communicating artery # The majority of cases of subarachnoid hemorrhage result from Transaction of a branch of the middle meningeal artery Bleeding from torn bridging veins @Rupture of a preexisting aneurysm Rupture of an arteriovenous malformation Cortical bleeding occurring opposite the point of a traumatic injury # Subdural hematomas occur most frequently in the Supracerebellar region Infracerebellar region Cerebellopontine angle Pituitary region @Cerebral hemisphere convexities # Which of the following conditions is the most frequent cause of intracerebral hemorrhage? Ruptured aneurysm Trauma Blood dyscrasias Angoimas @Hypertensive vascular disease # A 68-year-old woman can not move her upper and lower right extremities after stroke. Muscle tone of these extremities and reflexes are increased. There are pathological reflexes. What form of the paralysis is it? Monoplegia Paraplegia Dissociation Tetraplegia @Hemiplegia # A patient after hypertension stroke does not have voluntary movements in his right arm and leg with the increased muscle tone in these extremites. What type of disfunction of nervous system is it? Reflex paresis Peripheral paresis Central paresis @Central paralysis Peripheral paralysis # Cerebral embolism occurs frequently in association with all the following conditions EXCEPT Cardiac mural thrombi Left-sided endocarditis @Right-sided endocarditis Cardiac catheterization Prosthetic cardiac valves IBS # The patient has come to the hospital from the smelting workshop in the condition of hyperthermia. What is the direct cause of loss of consciousness at the heat stroke? @Decreased brain blood supply Arterial pressure drop Increased water loss through sweating Dilatation of peripheral vessels Decrease of heart output # A big pallid focus of a softened gray substance of pappy consistence was revealed in the right temporal lobe at the autopsy of a 58-year-old man. Numerous whity-yellow nodes of intima that constricted the lumen were detected in the arteries of the cerebral basis. What is your diagnosis? Abscess of the cerebrum @Ischemic insult Haemorrhage Haemorrhagic infarction Edema of the cerebrum # Autopsy of a 56 y.o. man revealed in the right temporal part of brain a big focus of softened grey matter that was semi-liquid and light grey. Arteries of cerebral tela contain multiple whitish-yellow thickenings of intima that abruptly narrow the lumen. What is your diagnosis? Brain edema Hemorrhagic infarction @Ischemic stroke Brain abscess Hemorrhage # During the section of a dead man, who had atherosclerosis, a thrombosis of a branch of internal carotid was revealed. There was also a gray focus of humid softening of the brain tissue. What pathological process is diagnosed in the cerebrum? Encephalitis Haemorrhagic infiltration Haematoma @Ischemic infarction Braingrowth (the tumour of the brain) # At autopsy of 63-year-old male revealed an atherosclerosis of the brain's arteries and a thrombosis of the internal carotid artery's branch. Gross investigation showed a focus of moist softening in his brain's tissue. Define the pathological process in the.brain. @Ischemic infarction Hemorrhagic infiltration Hematoma Encephalitis Tumour of the brain. # Unexpected sudden cardiac death is a very rare complication of Severe coronary artery disease Myocarditis Cardiac tamponade @Mitral valve prolapsed Dilated or hypertrophic cirdiomyopathy # A 32-year-old man suddenly died during the emotionally strained work. An autopsy revealed uneven myocardium blood supply. Histochemical investigation detected a decrease of the amount of glycogen. Electron-microscopical study showed a destruction of mitochondria, the contractures of myofibrils. What is the most likely disorder of a blood circulation? @Acute ischemia Chronic ischemia Vacating arterial hyperemia Acute vein hyperemia Angioneurotic arterial hyperemia # A 48-year-old patient after severe psychoemotional exertion suddenly began feeling sharp pain in the heart region, irradiating into left arm. Nitroglycerin releaved pain 10 minutes later. What pathogenetic mechanism is responsible for the development of pain in this case? Compression of coronary vessels @ Spasm of coronary vessels Dilation of peripheral vessels Occlusion of coronary vessels Increase of myocardial needs in oxygen # The appearance of coronary artery thrombosis in a 49-year-old man with sudden onset of chest pain is LEAST likely to be associated with: A long history of diabetes mellitus Hypercholesterolemia Acute myocardial infarction @Recurrent pneumonia A history of smoking # A 61-year-old man has the sudden onset of severe chest pain. Vital signs include T 37°C, P 101/minute, R 20/minute, and BP 80/40 mm Hg. An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. He is given thrombolytic therapy with tissue plasminogen activator (tPA). However his serum creatinine kinase is found to be 450 U/L 3 hours after this therapy. Which of the following cellular events has most likely occurred? Cellular regeneration Drug-induced necrosis @Reperfusion injury Increased synthesis of creatine kinase Myofiber atrophy # A 52-year-old man has the sudden onset of chest pain. He is found to have a serum troponin I of 5 ng/mL. A year later he has reduced exercise tolerance. An echocardiogram reveals an akinetic segment of left ventricle, and he has reduced cardiac output, with an ejection fraction of 25%. He then experiences a transient ischemic attack (TIA). His serum troponin I is now <0.5 ng/mL. Thrombosis involving which of the following locations is most likely to have put him at greatest risk for the TIA? Saphenous vein Vertebral artery Superior vena cava Left ventricle @Coronary artery # Severe coronary atherosclerosis leads to an acute myocardial infarction in a 55 year old woman. Which of the following factors is LEAST likely to have contributed to this: Endothelial injury occurred in the first 3 cm of the coronary artery frorn turbulent flow Platelets were adherent to a damaged intima following appearance of a lipid streak Disruption of an intimal plaqua led to thrombus formation in the left anterior descending artery Macrophages released growth factors that led to smooth muscle migration and proliferation @A reduced amount of low density lipoproteins with LDL cholesterol were present in the blood # 12 hours after an accute attack of retrosternal pain a patient presented a jump of aspartate aminotransferase activity in blood serum. What pathology is this deviation typical for? Collagenosis Viral hepatitis @Myocardium infarction Diabetes mellitus Diabetes insipidus # Marked increase of activity of ĚÂ-forms of CPK (creatinephosphokinase) and LDH-1 were revealed on the examination of the patient's blood. What is the most likely pathology? @Miocardial infarction Pancreatitis Rheumatism Cholecystitis Hepatitis # A patient developed substernal pains in the 7 o'clock in the morning. He presented at the Emergency Department in 8 o'clock in the morning, where electrocardiograph investigation revealed a myocardial infarction. Ten minutes later he died. What most reliable morphological sign of myocardium infarction would be found at histological investigation after the autopsy? @Disappearance of glycogen in myocardial cells Vacuolar dystrophy of myocardial cells Fatty infiltration of myocardial cells Necrosis of myocardial cells Weakening of myofibril of myocardial cells # A 58-year-old male, with a history of hypertensive disease, developed a long attack of substernal pain. The infarction of myocardium was diagnosed. A patient died soon. An autopsy revealed flabby myocardium with uneven blood filling. Histological and histochemical examinations showed disappearance of glycogen granules and decreased activity of oxidizing enzymes. What stage of myocardial infarction presented in that case? @Ischemic stage Necrotic stage. Organization Recurrent myocardial infarction Acute relapsing myocardial infarction # A patient has myocardial infarction in the region ofanterior wall of the left ventricle. What artery basin has the circulatory impairment occured in? Atrioventricular branch of left coronal artery Circumflex branch of left coronal artery Left marginal branch of left coronal artery @ Anterior interventricular branch of left coronal artery Anterior ventricular branches of right coronal artery # The pathology evident in the photomicrograph below usually first appears after which of the following lengths of time following a myocardial infarction? 12 h @3 days 7 days 14 days 28 days # A patient died from acute cardiac insufficiency. The histological examination of his heart revealed in myocardium of the left ventricle the necrotized section, which was separated from undamaged tissue by the zone of hyperimic vessels, small hemorrhages and leukocytic infiltration. What is the most likely diagnosis? @ Myocardial infarction Productive myocarditis Myocardial ischemic dystrophy Focal exudate myocarditis Diffuse exudate myocarditis # An autopsy of a 62-year-old male, with a history of ischemic heart disease, revealed an atherosclerosis of coronal arteries and signs of hypertensive disease. On a cut of the heart, in the area of the apex and left ventricle's frontal and lateral walls, there was a well defined yellowish focus, surrounded by hemorrhages. What is the most likely pathological process in the cardiac muscle? @Myocardium infarction Postinfarction cardiosclerosis Diffuse cardiosclerosis Myocarditis Fatty dystrophy of myocardium # During the section of a man who died of pulmonary edema was revealed a big yellow-gray focus in the myocardium. There was also a fresh clot in the coronary artery. Specify the diagnosis. Myocarditis Cardiosclerosis @Myocardial infarction Amyloidosis Cardiomyopathy # An autopsy of a 49-year-old patient, who died from lungs edema, revealed in myocardium a yellow- grey, large focus and a fresh blood clot in a coronal artery. What is the most likely diagnosis? @Myocardium infarction Cardiosclerosis Myocarditis Amyloidosis Cardiomyopathy # An autopsy of a 56-year-old male, with a history of ischemic heart disease, revealed the edema of lungs. What pathological changes could cause a pulmonary disorder? @Acute insufficiency of left ventricle Acute general anemia Acute insufficiency of right ventricle Ischemia of small circle Blood stasis # 33 A patient aged 59 was hospitalised to cardiological department in a sever state, with diagnosis of acute myocardial infarction of the posterior wall of the left ventricle and septum, and primary pulmonary edema. What is the primary mechanism, which causes the development of pulmonary edema in the patient? * Left ventricular failure Pulmonary arterial hypertension Pulmonary venous hypertension Hypoxemia Decrease of alveolocapillary diffusion of oxygen # Histologic sections (routine H&E stain) of lung reveal the alveoli to be filled with pale, nongranular pink fluid. Neither leukocytes nor erythrocytes are present within this fluid. Which of the following is the most common cause of this abnormality? Bacterial pneumonia @Congestive heart failure Lymphatic obstruction by tumor Pulmonary embolus Viral pneumonia # A 66-year-old patient presented in the hospital with the acute recurrent myocardial infarction of front-lateral wall of the left ventricle. On the 4th day of disease, an acute, marked difficulty in breathing, a cough with considerable quantity of a foamy sputum discharge and facial cyanosis developed. A patient died from progressive cardiac insufficiency. An autopsy revealed enlarged grey- pink color lungs. A foamy liquid flowed down from the cut surface. What pathological process in lungs caused a death? @Edema of the lungs Lungs infarction Hydrothorax Pneumonia Pneumosclerosis # A 55-year-old woman has been treated in the hospital for pancreatitis for the past three weeks. She is examined one morning on rounds and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is most likely to be the result of which of the following vascular complications? Venous thrombosis Septic embolization @Congestive heart failure Cellulitis - # Laminar necrosis and watershed infarcts are most suggestive of @Shock Hypertension Fat emboli Vascular thrombosis Verous sinus thrombosis # The mortality from myocardial infarction is most closely related to the occurrence of A pericardial effusion Pulmonary edema Coronary artery thrombosis @An arrhythmia Systemic hypotension # Several days following a myocardial infarction, a 51-year-old man develops the sudden onset of a new pansystolic murmur along with diastolic flow murmur. Work-up reveal increased left atrial pressure that develops late in systole and extends into diastole. Which of the following is the most likely cause of the abnormalities present is this individual? Aneurysmal dilation of the left ventricle Obstruction of the aortic valve Rupture of the left ventricle wall @Rupture of a papillary muscle Thrombosis of the left atrial cavity # A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of the left anterior descending artery. Which of the following vascular complications is most likely to occur in this patient? A systemic artery embolus from thrombosis in a peripheral vein. A systemic artery embolus from a left atrial mural thrombus. Pulmonary embolism from a left ventricular mural thrombus. @A systemic artery embolus from a left ventricular mural thrombus. Pulmonary embolism from thrombosis in a peripheral vein. # A 56-year-old patient presented to the hospital with symptoms of acute myocardial infarction. A diagnosis was confirmed by the EKG and laboratory tests. For 5th days the condition acutely worsened. A progressive cardiac insufficiency resulted in patient's death. A dissection confirmed the diagnosis of myocardial infarction, complicated by the heart's wall rupture and tamponade of pericardium. What process developed in the area of myocardial infarction? @Aseptic autolysis Organization Encapsulation Septic disintegration Petrification # A 48-year-old man, with a history of transmural heart infarction of the left ventricle's myocardium, died from the veritable rupture of heart (the heart tamponade). What process in an infarct zone could promote a heart's wall rupture? @Autolysis with melting of myocardium tissue (myomalacia) Substitution of connective tissue in area of infarction (organization) Rising of blood pressure in the small circulatory circle Scar formation with thinning of wall of the left ventricle # Following development of an acute myocardial infarction (MI), the LEAST likely complication is Cardiac arrhythmia Cardiogenic shock Sudden cardiac death @Cardiac rupture Thromboembolism # A 49-year-old man seven days being admitted to the hospital for an inferior wall, transmural myocardial infarction suddenly becomes short of death. Physical examination reveal hypotension, elevated jugular venous pressure, and muffled heart sounds. His systemic blood pressure drops 13 mmHg with inspiration. Which one of the following pathologic processes produced these clinical findings? Acute inflammation of the pericardium due to an autoimmune reaction Acute mitral regurgitation due to rupture of a papillary muscle Acute suppurative inflammation of the pericardium due to bacterial infection @Blood accumulation in the pericardial cavity due to rupture of the ventricular wall Serous fluid accumulation in the pericardial cavity due to congestive heart failure # In 45-year-old patient died from sudden cardiac death the symmetrical type of adipose heart of third degree; the rupture of right ventricle’s wall with hemopericardium and redundant accumulation of fat under epicardium were found out in autopsy. Microscopically: the adipose tissue grows from epicardium into myocardium with atrophy of fibers of muscle. What process is more probable? @Acute myocardial infarction Ischemic heart disease Fatty degeneration of myocardium Adipose heart Hypertensive disease # Arrange the following numbered statement in the correct order of the expected sequence of events that normally occur during healing of a myocardial infarction. 1 = Collagen is deposited, forming a fibrous scar; 2 = Flocculent densities form within mitochondria; 3 = Granulation tissue begins to form; 4 = Macrophages begin to arrive at the area of coagulative necrosis; 5 = Neutrophils begin to arrive at the area of coagulative necrosis. 2, then 3, then 4, then 5, then 1 2, then 4, then 5, then 3, then 1 @2, then 5, then 4, then 3, then 1 4, then 5, then 3, then 2, then 1 5, then 4, then 3, then 2, then 1 # A 72-year-old man suffered a myocardial infarction involving half the left ventricular free wall 3 months ago. He now has has increasing dyspnea and orthopnea. On examination he has poor capillary filling in hands and feet. A chest x-ray shows pulmonary edema. Which morphological changes most likely to be found in the heart? Cougulative necrosis Colliquative necrosis Diffuse inflammation @Connective tissue scar Hyperplasia of cardiomiocytes # A patient, with a history of myocardial infarction, develops symptoms of blood circulation insufficiency after physical exercises. There is marked cyanosis and edema of subcutaneous tissue of his lower extremities. What changes have developed on a place of a myocardial infarction at the recovered person? @Cardiosclerosis Intracellular regeneration Myocarditis Atrophy of myocardium - # An autopsy of a 58-year-old female revealed in myocardium a large, dense, grey focus, which histologically consisted of the rough connective tissue fibers. It was surrounded by the hypertrophied muscular fibers. What changes arose up in a heart? @Postinfarction cardiosclerosis Ischemic stage of myocardial infarction Necrotic stage of myocardial infarction Diffuse cardiosclerosis Myocarditis # A 52-year-old male, after repeated intramural heart infarction of myocardium, gradually returned to health and further supervision of a district internist. In 2 years he died in a motor-car accident. Define a pathological process in myocardium, which wound be revealed at the autopsy? @Focal cardiosclerosis Diffuse cardiosclerosis. Atrophy. Necrosis. Hyperplasia # A 64-year-old patient, with long history of atherosclerosis and myocardial infarction, developed the attack of substernal pain. A patient was hospitalized in 3 days and died soon from progressive cardiovascular insufficiency. An autopsy revealed in the back wall of the left ventricle and interventricular septum of heart a white color focus, about 3 cm in a diameter. It was fibred, falling back, with a clear boundary. Give the name for these changes: @Focal cardiosclerosis Myocardial ischemia Myocardial infarction Myocarditis Dystrophy of myocardium # 66-year-old man took medical aid because of the sharp pain in the heart with irradiation to the left upper extremity and short-wind. The arterial tension – 100/50 mm of Hg, pulse – 90 per 1 min; electrocardiographically: the hypoxia of myocardium of the front wall of the left ventricle was found. He has died in 2 hours after taking medical aid. In autopsy, the congestion (venous hyperemia) of the internal organs was found. There was also dilatation of the heart’s ventricle. In the fore wall of left ventricle the myocardium was parti-colored with yellowish dim areas of 3,5 to 4 sm. Coronary arteries had atherosclerotic plaques and narrow lumen. In aortic intima, many yellowish-whitish plaques were found out also. The lungs had pasty consistence. @Multifocal (postinfarctional) cardiosclerosis Smallfocal (atherosclerotic) cardiosclerosis Acute myocardial infarction Fatty degeneration of myocardium Myocarditis # Examination of coronary arteries revealed atherosclerotic calcific plaques that close vessel lumen by 1/3. The muscle has multiple whitish layers of connective tissue. What process was revealed in myocardium? Myocardium infarction @Diffuse cardiosclerosis Myocarditis Tiger heart Postinfarction cardiosclerosis # A 57-year-old man, with a long history of an alcohol abuse, died at the increasing phenomena of chronic heart failure. An autopsy revealed the weight of a heart 580 grams; a languid, clay color myocardium, with intensive diffuse interstitial fibrosis. Coronal arteries were intact. A microscopical study of myocardium showed a combination of hydropic and fatty dystrophy of cells; atrophy and hypertrophy of cardiomyocites. There were also some foci of a cells lysis, accompanied with sclerosis. What kind of cardiomyopathy described in that case? @Alcoholic Hypertrophic Dilatative Restrictive Metabolic # A 59-year-old patient receiving chemotherapy with the anthracycline Adriamycin develops severe heart failure. Sections from an endocardial biopsy specimen reveal vacuolization of the endoplasmic reticulum of the myocites. Adriamycin therapy most frequently causes what type of cardiomyopathy? @Dilated cardiomiopathy Hyperplastic cardiomyopathy Hyperthrophic cardiomyopathy Obliterative cardiomyopathy Restrictive cardiomyopathy # A 3-month-old girl is being evaluated for feeding difficulty and failure to thrive. Physical examination finds pallor, peripheral cyanosis, tachypnea, and fine expiratory wheezing. Chest x-ray shows cardiac enlargement. She is admitted to the hospital, quickly develops severe cardiac failure, and dies 3 days after admission. At the time of autopsy the endocardium is found to have a “cream cheese” gross appearance. Histologic sections from this area reveal thickening of the endocardium due to a proliferation of fibrous and elastic tissue. Which of the following is the most likely diagnosis? Dilated cardiomyopathy Hypertrophic cardiomyopathy Infective endocarditis Libman-Sachs endocarditis @Restrictive cardiomyopathy # A synonym for nonbacterial thrombotic endocarditis is Atypical verrucous endocarditis @Marantic endocarditis Limban-Sacks ebdocarditis Viridians endocarditis Rheumatic endocarditis # A 23-year-old woman develops the sudden onset of congestive heart failure. Her condition rapidly deteriorates and she dies in heart failure. At autopsy, patchy interstitial infiltrates composed mainly of lymphocytes are found, some of which surround individual myocytes. The most likely cause of this patient’s heart failure is @Viral myocarditis Bacterial myocarditis Giant cell myocarditis Hypersensitivity myocarditis Beriberi # A 23-year-old woman develops the sudden onset of congestive heart failure. Her condition rapidly deteriorates and she dies in heart failure. At autopsy, patchy interstitial infiltrates composed mainly of lymphocytes are found, some of which surround individual myocytes. Which of the following is the most likely cause of this patient’s heart failure? Autoimmune reaction (to group A β-hemolytic streptococci) Bacterial myocarditis (due to S. aureus infection) Hypersensitivity myocarditis (due to an allergic reaction) Nutritional deficiency (due to thiamine deficiency) @Viral myocarditis (due to coxsakievirus infection) # A patient died from progressive cardiac insufficiency. An autopsy revealed a flaccid, dilated in diameter heart. A cut surface investigation showed the irregular blood filling of a myocardium, resulted in the patchy pattern of its tissue. A histological study determined a hyperemia of myocardium and stromal accumulations of small mononuclear cells. The described morphological changes present: @Nonpurulent interstitial myocarditis Vein plethora Fatty dystrophy of myocardium Cardiosclerosis Myocardial infarction # An autopsy of a child, who died of a heart failure, revealed the dilated heart chambers. Microscopic investigations showed the hyperemia of the myocardial stroma, edema, and diffuse interstitial infiltrates consists of hystiocytes, lymphocytes, some scattered neutrophils and eosinophils. What is the most likely diagnosis? @"Diffuse interstitial exudative myocarditis Focal interstitial exudative myocarditis Nodular productive myocarditis Interstitial productive myocarditis Alternative myocarditis # Autopsy of a man who died from influenza revealed that his heart was slightly enlarged, pastous, myocardium was dull and had specks. Microscopical examination of myocardium revealed signs of parenchymatous adipose and hydropic dystrophy; stroma was edematic with poor macrophagal and lymphocytic infiltration, vessels were plethoric; perivascular analysis revealed petechial hemorrhages. What type of myocarditis was developed in this case? Granulomatous Purulent Interstitial proliferative @Serous diffuse Serous focal # Severe mitral stenosis is frequently accompanied by all the following EXCEPT Aortic valve disease Antecedent rheumatic fever Left arterial enlargement with atrial fibrillation @Pulmonary valvular stenosis Chronic passive pulmonary congestion # Which one of the following is the most common congenital heart defect to cause an initial left-to-right shunt? Tetralogy of Fallor Coarctation of the aorta @Ventricular septal defect Atrial septal defect Paten ductus arteriosus # Bacterial myocarditis constitutes the greatest to patients who have which of the following forms of congenital heart disease? Atrial septal defect @Ventricular septal defect Pulmonic stenosis Tetralogy of Fallot Patent ductus arteriosus # Which one of the following statements correctly describes the flow of blood in an individual with an atrial septal defect who develops Eisenmenger’s syndrome? Aorta to pulmonary artery to lungs to left atrium to left ventricle to aorta Left atrium to right atrium to right ventricle to lungs to left atrium Left ventricle to right ventricle to lungs to left atrium to right ventricle @Right atrium to left atrium to left ventricle to aorta to right atrium Right ventricle to left ventricle to aorta to right atrium to right ventricle # A 2-year-old girl is being evaluated for growth and developmental delay. She has had several past episodes when she would suddenly have trouble breathing, become blue, and then assume a squatting position to catch her breath. Work-up finds a defect in the wall of the ventricular septum, increased thickness of the right ventricle, and dextroposition of the aorta. Which of the following cardiovascular abnormalities is most likely to be present in this child? Coarctation of the aorta Incompetence of the mitral valve Patency of the foramen ovale Persistence of the AV canal @Stenosis of the pulmonic valve # A 2-month-old girl is being examined for a routine check-up. She was born at term, and there were no problems or complications during the pregnancy. The baby appeared normal at birth and has been asymptomatic. Physical examination at this time finds a soft systolic murmur with a systolic thrill. No cyanosis is present, and her peripheral pulses are thought to be within normal limits. An electrocardiogram reveals slight left ventricular hypertrophy. Which of the following is the most likely diagnosis? Coarctation of the aorta Patient ductus arteriosus Persistent truncus arteriosus Tetralogy of Fallot Ventricular septal defect # Konec: #end A 60-year-old patient was diagnosed with hypothalamic lateral nuclei stroke. What changes in patient’s behavior may be expected? Thirst Aggressive behaviour Unsatisfied hunger @The rejection of food Depression #
Rheumatic diseases # What organism causes a rheumatic fever? @Streptococcus Staphylococcus Gonococcus Pneumococcus Clebsiella # A 38 year old patient suffers from rheumatism in its active phas E. What laboratory characteristic of blood serum is of diagnostic importance in case of this pathology? @C-reactive protein Creatinine Urea Transferrin Uric acid # What from the following clinico-morphological features does not typical for rheumatic fever? @The presence of focus of chronic infection Generalized vasculitis Disturbance of immune homeostasis Systemic progressive disorganization of connective tissue Acute flow # Manifestations of rheumatic fever that are of major diagnostic value include all the following EXCEPT Sudcutaneous nodules Migratory arthritis of large joints @Fever Erythema marginatum Chorea minor # A 7-year-old boy presents with the acute onset of fever, pain in several joints, and a skin rash. Physical examination finds an enlarged heart, several sudcutaneous nodules, and a skin rash on his back with a raised, erythematous margin. Laboratory tests find an elevated erythrocyte sedimentation rate and elevated anti-streptolysin O titers. Within the past month, this boy most likely had which one of the following infection? Pseudomonas aeruginosa infection of the aorta Streptococcus pneumonia infection of the lungs α-hemolytic streptococci infection of the oral cavity @β-hemolytic streptococci infection of the pharynx Staphylococcus aureus infection of the skin # A 63-year-old man presents with signs of congestive heart failure, including shortness of death, cough, and paroxysmal nocturnal dyspnea. Physical examination reveals a hyperdynamic, bounding, “water-hammer” pulse and a decrescendo diastolic murmur. His hyperdynamic pulse causes “bobbing” of his head. Which of the following is the most frequent cause of the cardiac vascular abnormality present in this individual? Aortic dissection Infective endocarditis Latent syphilis Marfan syndrome @Rheumatic fever # The most characteristic feature of chronic rheumatic heart disease is Endocarditis Myocarditis Pericarditis @Mitral valvulitis Pulmonic valvulitis # Autopsy of a 58 y.o. man revealed that bicuspid valve was deformed, thickened and unclosed. Microscopically: foci of collagen fibrilla are eosinophilic, react positively to fibrin. The most probably it is: Amyloidosis Fibrinous inflammation Hyalinosis Mucoid swelling @Fibrinoid swelling # A 30-year-old woman was hospitalized with symptoms of active rheumatic fever. She has died because of the increasing cardio-vascular insufficiency. The signs of decompensative chronic cardiac insufficiency were found during autopsy. Small foci of diffuse cardisclerosis were found in myocardium. The leafs of mitral valve were thickened and sclerotic with presence of thrombotic masses looked like warties. What type of endocarditis was @Diffuse Acute wart-like (verrucous) Fibroplastic Recurrent wartilike Polipous-ulcerative # A histology investigation of a mitral valve sample of a patient who died from complications of rheumatism revealed a mucoid swelling, a damage of the endothelial cells and also thrombi at the valve closure line. Name the type of the rheumatic endocarditis? @Acute warty endocarditis Diffuse endocarditis Fibroplastic endocarditis Relapsing warty endocarditis Polyps-ulcerated endocarditis # At the histological exam of the mitral valve were revealed: the mucoid edema, the damage of the endothelium and the formation of fibrin thrombi on the covering margin. What form of the rheumatic endocarditis is observed? @Acute verrucous endocarditis Diffuse endocarditis Fibroplastic endocarditis Recurrent-verrucous endocarditis Polypous-ulcerative endocarditis # Histological investigation of the mitral valves of the heart revealed the focal desquamation of endothelial cells replaced by thrombi. The connective tissue had mucoid swelling areas and also zones of sclerosis and revascularization. Name the type of valve's endocarditis? @Relapsing warty endocarditis Diffuse endocarditis Acute warty endocarditis Fibroplastic endocarditis Polyps-ulcerated endocarditis # A 56-year old male with a long history of a rheumatic heart insufficiency died with symptoms of hemiplegia shortly before death. Histological examination of his mitral; valve revealed severe sclerosis, nodular collection of inflammatory cells and vegetations composed mainly of platelets and fibrin. Name the most likely type of endocarditis? @Relapsing warty endocarditis Acute warty endocarditis Diffuse endocarditis Fibroplastic endocarditis Polyps-ulcerated endocarditis # Physical examination of an asymptomatic 29-year-old woman with a history of rheumatic fever during childhood finds an early diastolic opening snap with a rumbling late diastolic murmur. Which of the following is the most likely diagnosis? Aortic regurgitation Aortic stenosis Mitral regurgitation @Mitral stenosis Pulmonic stenosis # A 32-year-old female with a long history of rheumatic valve's defect presented at the hospital with tachypnea and dyspnea, leg's edema, ascites and hepatomegaly. She died from the chronic heart insufficiency. An autopsy revealed a mitral stenosis. What was the most likely factor of the mitral stenosis morphogenesis? @Leaves union between itself Sclerosis and bulge of leaves Sclerosis and shortening of leaves Shortening of tendon filaments Presence of small blood thromboses on the surface of valve # In 46-year-old patient with rheumatic heart disease (mitral stenosis) the short-wind in low physical loading, tachycardia, cyanosis of lips, wet crepitation in the lower parts of lung and edema of legs have appeared. What histological changes are characteristic in the liver? @Necrosis of hepatocytes in the center of lobule; fatty degeneration in outlying districts Necrosis of hepatocytes in the center of lobule; hyaline degeneration in the outlying districts Fatty degeneration of hepatocytes in the center of lobule; necrosis in the outlying districts Hydropic degeneration of hepatocytes in the center of lobule, necrosis in the outlying districts Necrosis of hepatocytes in the center of lobule; hydropic degeneration in the outlying districts # The most frequent cause of aortic valve incompetence and regurgitation is Latent syphilis Infective endocarditis @Rheumatic fever Aortic dissection Congenital # During the section of a child, who died of heart failure, the dilatated ventricular cavities of the heart were revealed. Microscopically there were plethora, edema, and diffuse infiltrates of histiocytes, lymphocytes, neutrophiles and eosinophiles in the myocardial stroma. What is the most possible diagnosis? Focal intermediate exudative myocarditis @Diffuse intermediate exudative myocarditis Nodular productive myocarditis Intermediate productive myocarditis Alternative myocarditis # Death of the patients in early stages of rheumatic fever because of acute cardiac insufficiency is connected with one of the following manifestations of the rheumatic fever: @Myocarditis Pericarditis Endocarditis Septic endocarditis Cardiosclerosis # At the pathomorphologic exam of a man who died of heart insufficiency the following facts were revealed: mitral valves were deformed, thickened, with knitted margins; connective tissue is filled with diffuse nodules that consist of the areas of fibrinoid necrosis. Macrophagocytes that look like giant multinuclear cells aggregate around these areas. Lymphocytes and single plasmatic cells surround similar focuses. What granuloma was defined? Actinomycotic Tuberculous @Rheumatic Syphilitic Lepromatous # At the section of a dead woman were detected the morphological manifestations of stenosis of the left atrioventricular aperture and the mitral valve insufficiency. Histologically: there were presented a focal cardiosclerosis and Ashof-Talalaev granulomas. What is the most possible diagnosis? Systemic lupus erythematous Scleroderma Dermatomyositis Nodular periarteritis @Rheumatism # Microscopic investigation of the heart auricle from a patient with a history of mitral stenosis revealed the Achoff- Talalayev's bodies (granulomas). What was the most likely cause of the heart insufficiency supported by the histology results? @Rheumatic Atherosclerotic Syphilitic Innate Septic # An autopsy of 48-year-old female revealed a mitral stenosis with valve's incompetence. Histological investigation showed the post- inflammatory cardiosclerosis and Aschoff-Talalayev nodes (granulomas). What is the most likely diagnosis? @Rheumatism Systemic scleroderma Dermatomyositis Nodular periarteritis Lupus erythematosus # Ashoff-Talalaev’s granulomas, which are foci of fibrinoid necrosis that are surrounded by macrophages, are found out in perivascular tissue of myocardium in the result of autopsy of 30 year woman who had the diagnosis: rheumatic fever and who died of heart insufficiency. What type of granuloma is found? @Blooming granuloma Withered granuloma Cicatrized granuloma Epitheliod granuloma Giant cell granuloma # Ashoff-Talalaev and fibroblasts granulomas, which are focuses of fibrinoid necrosis that are surrounded by macrophages, are found in perivascular tissue of myocardium in the result of autopsy of 30 year woman who had the diagnosis: rheumatic fever and who died of heart insufficiency. What type of granuloma is found? Blooming granuloma @Withered granuloma Cicatrized granuloma Epitheliod granuloma Giant cell granuloma # An autopsy of a 34year-old patient with a long history of rheumatism, revealed the epicardial surface of the heart with shaggy exudate formed by grey strands which easily separate from underlying tissues and described as 'bread-and-butter' pericarditis ('hairy heart'). What is the most likely diagnosis? @Fibrinous pericarditis Purulent pericarditis Hemorrhagic pericarditis Proliferated pericarditis Catarrhal pericarditis # A 9-year-old boy presented with painless, firm 1-2 mm nodules at the skin around ulnar and knee joints (at extensor's area). Biopsy investigation revealed a central area of fibrinoid necrosis of the connective tissue surrounded by lymphocytes and macrophages. What disease these nodules are characteristic for? @Rheumatism. Rheumatoid arthritis. Systemic scleroderma. Nodular periarteritis. Lupus erythematosus. # In a patient with vasculitis, the finding of serum antineutrophil cytoplasmic autoantibodies that react by immunofluorescence staining in a perinuclear pattern is most suggestive of Giant cell arteritis @Classic polyarteritis nodosa Wegener’s granulomatosis Churg-Strauss syndrome Microscopic polyangiitis # The necrotizing inflammation of the small gastrointestinal artery shown in the photomicrograph below is most likely due to Myasthenia gravis @Polyarteritis nodosa Atherosclerosis Dissection aneurysm Suphilis # Microscopical investigation of arterioles showed plasmatic saturation, mucoid and fibrinoid swelling, fibrinoid necrosis of walls, diffuse infiltration by lymphocytes, plasmocytes and monocytes. In addition, the focal proliferation of hystiocytes, endotheliocytes and pericytes were determined. The final diagnosis was the "periarteritis nodosa". What type of inflammation took place in arterioles? @ Acute immune inflammation Acute not immune inflammation Focal exudative inflammation Diffusive exudative inflammation Fibrinous inflammation # A 33-year old female died from chronic kidney failure. A post-mortem revealed multiple scars and infarcts in kidneys and spleen. Histological investigation showed alteration of small and medium sized arteries presented with sclerosis and mild endothelial proliferation. A severe lymphocytes and histiocytes infiltrates were also recognized at the perivascular tissues. What is the most likely disease caused these alterations? @Nodular periarteritis Atherosclerosis Hypertonic disease Morphine's Disease Visceral syphilis # A 45-year-old woman has episodes of pain with swelling and warmth of her hands and feet that make it difficult for her to walk or to prepare meals. She develops painful subcutaneous nodules on the extensor surfaces other elbows. Over the years, her hands become deformed so that it is difficult to perform tasks as simple as opening a dooror buttoning her blouse. Which of the following laboratory test findings is she most likely to have? HLA B27 ANA positive at 1:256 @Elevated rheumatoidfactor Markedly decreased serum complement Hypogammaglobulinemia # 33 A 30-year-old woman is suffering from chronic inflammation of the hand joints. If the doctor suggests rheumatoid arthritis, what will be the most probable pathogenesis of the disease? @It is caused by immune complexes of IgM antibody against human IgG It is caused by release of histamine by mast cells, bound with IgE It is caused by CD4 T cells and macrophages invading the joints It is caused by the activity of superantigens that activate both humoral and cellular immune responses It is caused by the primary immune response to hepatitis B surface antigen # A 30 y.o. woman had been ill for a year when she felt pain in the area of joints for the first time, they got swollen and skin above them became reddened. Provisional diagnosis is rheumatoid arthritis. One of the most probable causes of this disease is a structure alteration of a connective tissue protein: Troponin Ovoalbumin Mucin Myosin @Collagen # A 63-year-old woman developed symptoms of rheumatoid arthritis. Their increase of which blood values indicators could be the most significant in proving the diagnosis? R-glycosidase Acid phosphatase Lipoproteids General cholesterol @Additive glycosaminoglycans # After the undercooling of the patient, the deformation of the joints, painfulness, contraction of movements in the fingers of limbs has developed. Little solid nodules appeared around the joints. At the biopsy there were revealed the focuses of fibrinoid necrosis in the nodules that were surrounded by histiocytes. What is your diagnosis? @Rheumatoid arthritis Dermatomyositis Rheumatism Podagra Deforming arthrosis # A 48-year-old female after exposure to cold presents to her physician with painful deformed fingers joints, which bones were restricted in their movements. Physical examination revealed small firm nodules near the joints. Histological investigation of the nodules biopsy showed the centrally located core of fibrinoid necrosis with surrounding rim of macrophages and hystiocytes. What is the most likely diagnosis? @Rheumatoid arthritis. Dermatomyositis. Rheumatism. Gout. Deformed arthrosis. # A 62-year-old woman presents to her physician with considerable deformation of metacarpal phalangeal and feet joints. Histological examination of the soft tissues adjacent to the joints revealed a mucoid swelling of the connective tissue, areas of a fibrinoid necrosis surrounded by palisading epithelioid macrophages and sclerosis. Few 'rice bodies' were found within a synovial cavity. What is the most likely diagnosis? @Rheumatoid arthritis Rheumatism Behterev's Disease Hematogenic tuberculosis Gout # A 43-year-old woman presents to her physician with pain and immobility of the bones in metacarpal phalangeal and feet joints. Similar complains in symmetric pattern were about ulnar and knee joints, though not so severe. Physical examination revealed pastous skin over the joints, a partial ankylosis of metacarpal phalangeal and feet joints, and also ulnar deviation of the hands and flexion- hypertension ('swan neck"or"walrus flipper") deformities of the fingers. In addition, movable firm, rubbery and tender 1cm hypodermic nodules were found in the phalangeal joints area. An aspirate of joint fluid showed increased turbidity and presence of white "grains" ("rice bodies"). Immunofluorescence also revealed the rhematoid factor. What is the most likely diagnosis? @Rheumatoid poliartritis Systemic disease of connective tissue Gout Osteoartrosis - # A 44-year-old woman presents to her physician ulnar deviation of the hands and flexion- hypertension ('swan neck" or "walrus flipper") deformities of the fingers. Her metacarpal phalangeal joints are easily exposed to a dislocation and a subluxation. Microscopical examination revealed nodular proliferations of synovium, cartilage destruction and "pannus" formation. What is the most likely diagnosis? @Rheumatoid arthritis Rheumatic arthritis Osteoarthritis. Lupus erythematosus. - # A 36-year-old woman present because of increasing pain in her hands and knees, which, she says, is worse in the morning. Physical examination finds her fingers to be swollen and stiff, and there is ulnar deviation of her metacarpophalangeal joints. A biopsy from her knee would likely show areas where hystiocytes were palisading around irregular areas of necrosis, as seen in the picture below. The biopsy would also likely show proliferation and hyperplasia of the synovium with destruction of the articular cartilage. Which one of the following terms best describes these pathologic changes? Eburnation Gumma @Pannus Spondylosis Tophus # An autopsy of 61-year-old male with a history of rheumatoid arthritis revealed enlarged dense kidneys, which had yellowish-whitish color and waxy appearance. Grossly, foci of scars were recognized at kidneys surface. Microscopically, at the slides stained by Congo red, homogeneous pink masses at capillaries of glomeruli tufts, arterioles walls and arteries, basal membranes of tubuli and instroma were found. Name the described complication of rheumatoid arthritis? @Secondary amyloidosis of kidneys. Postinfective glomerulonephritis. Quickly progressive glomerulonephritis. Acute necrotic nephrosis. Fibroplastic glomerulonephritis. # True statsments about SLE include allof the following except one: Lupus is associated with autoantibodies to many nuclear components Supressor T cells dysfunction is believed to plat a role in pathogenesis An association with complement component dificiency (C2 and C4) has been shown @Organ damage in lupus is predominantly mediated by natural killer cells - # A 38-year-old man has myalgias, erythematous skin rashes over his face, and arthralgias without evidence for joint deformities. He has a positive antinuclear antibody test with a speckled pattern. Additionally, he has high liters of autoantibodies to ribonucleoprotein (KNP antibodies). A serum creatine kinase is 661 U/L. He has no evidence of renal disease. Which of the following conditions is he most likely to have: Mixed connective tissue disease CREST syndrome Dennatomyositis Polymyositis @Systemic lupus erythematosus # A post-mortem of a 19-year old female revealed multiple furuncles on her skin, a warty endocarditis of the heart valves (Libman-Sacks endocarditis), a focal hemorrhage under the endocardium, ulcerative stomatitis, esophagus ulcers, pneumonia, nephritis, and a spleen hyperplasia with a perivascular sclerosis. Morphological investigation of her brain showed areas of necrosis and signs of vasculitis within thalamus. What is the most likely diagnosis? @Lupus erythematosus Rheumatism. Septic endocarditis. Ischemic heart diseas Hypertensive disease. # At the section of a 19-year-old woman, there were revealed the verrucous endocarditis of all valves, focal subendocardial hemorrhages, ulcerous stomatitis and esophagitis, pneumonia, nephritis, hyperplasia of the spleen with perivascular sclerosis, vasculitis, a necrosis in the area of the optic tuber and numerous furuncles. What is the most possible disease? Septic endocarditis Rheumatism @Systemic lupus erythematous Ischemic heart disease Hypertensive disease # A post-mortem of a 25-year old woman who died from chronic kidney failure revealed a reddish malar rash ('butterfly rash') and small (up to 0,2 cm) pale tan spreading vegetations over the mitral valve surface. Histological investigation of kidneys showed foci of fibrinoid necrosis, eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft and karyorrhexis. What is the most likely diagnosis? @Lupus erythematosus. Nodular periarteritis. Rheumatism. Rheumatic arthritis. - # Red-brownish stains are found on the symmetrical parts of both cheeks in the result of autopsy of 45 year dead woman. Heart is increased, leaflets of aortic valve are condensed and thickened, have thrombotic masses on its surface. Kidneys are increased. Medulla is duck red, cortex is gray-brownish with red half-transparent points. Histologically: “hemothoxilin bodies” are found in the nucleus of ductal epithelium; thickening of basal membranes of glomerular capillaries, which look like “wire-loops”, several places in capillaries have hyaline thrombus and focuses of fibrinoid necrosis. Which diagnosis is more possible? @Systemic lupus erythematosus Rheumatic heart disease Septic endocarditis Glomerulonephritis Atherosclerosis # A post-mortem of 40-year old female who died from uremia revealed enlarged kidneys, which had a patchy pattern of their surface. Histological investigation of kidneys showed eosinophilic deposits (hematoxylin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis. Besides these, Libman-Sacks endorcarditis was also determined. What is the most likely pathology in kidneys? @Lupus erythematosus nephritis. Rheumatoid glomerulonephritis. Choleric glomerulonephritis. Sclerotic kidney. Terminal glomerulonephritis # At the section of a 40-year-old woman, who died of uremia, there were detected enlarged, mottled kidneys with thickened capillary membranes of glomeruli that looked like wire stitches, focuses of fibrinoid necrosis of its walls and hyaline thrombi in the lumens. Nuclei had haematoxylin corpuscles. The heart was affected by Libman-Sacks endocarditis. What is the most possible renal affection? Sclerotic kidney Rheumatic glomerulonephritis Choleric glomerulonephritis @Lupoid nephritis Terminal glomerulonephritis # At the section of a 25-year-old woman, who died of uremia, were detected enlarged, mottled kidneys with the focuses of haemorrhages. Pathohistologically there were revealed haematoxylin corpuscles, capillary membranes of glomeruli that looked like wire stitches, hyaline thrombi, focuses of fibrinoid necrosis and bulbous sclerosis in the renal vessels. What is the most possible diagnosis? Nodular periarteritis Systemic scleroderma Rheumatoid arthritis Rheumatic arthritis @Systemic lupus erythematous # A 28-year old female died from uremia. A post-mortem revealed an enlarged kidneys, which had a patchy pattern with hemorrhages on there surface. Histological investigation showed eosinophilic deposits (hematoxilin bodies), "wire loop" lesions in the basement membrane of the glomerular tuft, hyaline thrombi and foci of fibrinoid necrosis and also 'onion skin' sclerosis at the spleen's vessels. What is the most likely diagnosis? @Lupus erythematosus. Rheumatism. Systemic scleroderma. Rheumatoid arthritis. Nodular periarteritis. # At the patient with suspicion on a systemic disease a biopsy from a site of the skin tightening and restricted motility was taken. A histology investigation revealed all kinds of disorganization of connective tissue fibers with mild cellular reaction and also transition in excessive sclerosis and a hyalinosis. What is the most likely diagnosis? @Scleroderma Nodular periarteritis Lupus erythematosus Psoriasis Dermatomyositis # The woman of 45 years within several years has difficulties at swallowing. She also notes the limitation of fingers movements at printing on the computer keyboard, though joints are not painful. Physical investigation revealed her "stony face" (no wrinkles) owing to tightening of the facial skin and restricted motion of the mouth. The skin biopsy showed a widespread fibrosis of a derma without inflammatory infiltration. Diagnose disease on the listed clinical and morphological data. @Scleroderma Lupus erythematosus Dermatomyositis Amyloidosis Rheumatic arthritis # An 8-year-old boy presents with weakness and pain over several of his proximal muscle groups. Physical examination reveals periorbital edema along with a lilac discoloration around his eyes and erythema over his knuckles. A muscle biopsy reveals atrophic fibers located primarily at the periphery of muscle fiber fascicles. Laboratory tests find the presence of antibodies directed against the microvasculature of skeletal muscle. Which of the following is the most likely diagnosis? Ataxia-telangiectasia Becker muscular dystrophy Charcot-Marie-Tooth disease @Dermatomyositis McCardle’s disease # A 35- year- old female presented her physician intermittent episodes of ischemia of her fingers, marked by pallor, paresthesias and pain, accompanied by tightening and thickening of the skin and poliarthralgia. Histological investigation of the skin biopsy from affected areas revealed mild epidermal atrophy, hyalinosis of collagen fibers within derma, scattered perivascular lymphocytes' infiltrates. Underlying skeletal muscles expressed interstitial edema, loss of cross-section striation, nidal necroses followed with petrification. What is the most likely diagnosis? @Dermatomyositis Systemic scleroderma Lupus erythematosus Nodular periarteritis Rheumatism # A perivascular inflammatory infiltrate in skeletal muscle is likely to be seen in all the following EXCEPT Hypersensitivity angiitis Polymiositis Polyarteritis nodosa @Cystic medial necrosis Systemic sclerosis # A post-mortem of the patient who died from uremia revealed deformation of a spine column with severe restriction of its mobility. Articular cartilages of spine joints were destructed with persistent chronic inflammation in tissues of joints. The joints cavities filled with connective tissue, in some places leading to ossification and ankylosis formation. In an aorta, heart, lungs a chronic inflammation and a focal sclerosis were discovered. In kidneys an amyloidosis was recognized. What diagnosis in this case is most probable? @Ankiloid spondiloartritis (the Behterev's disease) The Pedget's disease (deforming ostosis) Rheumatoid arthritis. Parathyroid osteodystrophy. Osteopetrosis (marble disease). # Konec: #end
Date: 2016-03-03; view: 2409
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