Circulatory disturbance №2.

#

A 35-year-old patient complains of repeated vomiting, diarrhea, decreased arterial pressure and tachycardia. He supposes this condition related to the food poisoning. Laboratory tests detected Salmonella's infection. Hematological examination revealed an increased number of erythrocytes per unit volume. Which circulatory disturbance took place to create this pathology?

@Clotting of a blood.

Hemolysis of erythrocytes and compensatory induction of a hemogenesis

General arterial plethora

Polycythemia

Hyperchromatic anemia

#

Examination of a patient who has recently had a hepatic disease revealed low concentration of prothrombin in blood. First of all this will cause disturbance of:

Vasculothrombocytic haemostasis

First phase of coagulation haemostasis

Fibrinolysis

Anticoagulative blood properties

@Second phase of coagulation haemostasis

#

During the autopsy of a 46-year-old man who died when the motorcycle he was riding was hit by a truck, a 1.2-cm red mass is found within a branch of the left pulmonary artery. Grossly this mass is rubbery, gelatinous, and has a “chicken fat” appearance. Histologic sections reveal that this mass is not attached to the wall of the pulmonary artery, and alternating lines of Zahn are not seen. Which of the following statements best describes this intravascular mass?

@Postmortem blood clot

Postmortem hematoma

Premorten embolic blood

Premorten non-embolic thrombus

Premorten non-thrombotic embolus

#

All following factors predispose to thrombosis EXCEPT one:

Injury of ultima

Turbulence blood flow

Stasis of blood

Hypercoagulability

@Fibrinolysis

#

What of the vascular wall components is a highly thrombogenic surface and plays a sufficient Jole in thrombogenesis?

Endothelium

@Subendothelium collagen

Muscular layer (media)

Adventitia

Elastic membranes

#

All following conditions contributeto theprocess of thrombosis EXCEPTone:

Stasis

Turbulence blood flow

Hypercoaculability states

Injury of vascular wall

@Hemodilution

#

At autopsy an elderly female is found to have a blood clot in the femoral artery, which grossly had a striped pattern. Microscopy revealed congestions of fibrin fibers and broken down red and white cells. Which is the most likely type of thrombus?

@Mixed thrombus

Postmortem convolutions of a blood

Thromboemboli

Hyaline thrombus

Red thrombus

#

A 62-year-old man has experienced substemal chest pain upon exertion with increasing frequency over the past 6 months. At the moment he hospitalised with acute substemal pain with irradiation to left arm. An electrocardiogram shows features of acute myocardium infarction. LDH level is increased. By angiography, there is complete occlusion of the left anterior descending artery. Which of the following events is most likely to occur in this patient:

A systemic artery embolus from thrombosis in a peripheral vein.

A systemic artery embolus froma left atrial mural thrombus.

Pulmonary embolism from a left ventricular mural thrombus.

@Obstructive thrombosis of coronary artery superimposed to atherosclerotic plaque

Pulmonary embolism from thrombosis in a peripheral vein.

#

A neonate died of intoxication. A microscopic examination of an umbilical vein revealed a diffuse inflammatory infiltration of the vessel's wall. Also, its lumen was filled with thrombus, rich with leucocytes and bacterial colonies. Karyorrhexis was detected in many leucocytes. Which is most likely outcome of a thrombus in that case?

@Septic autolysis.

Aseptic autolysis.

Organization and vascularization of the thrombus.

Thromboembolism.

Calcification of a thrombus.

#

A 43-year-old patient has thrombopenia, reduction of fibrinogen, products of degradation of fibrin presented in the blood, petechial haemorrhage along with septic shock. What is the most likely cause of the changes?

Autoimmune thrombocytopenia

@DIC-syndrom

Exogenous intoxication

Disorder of thrombocytes production

Haemorrhagic diathesis

#

A patient was ill with burn disease that was complicated by DIC syndrome. What stage of DIC syndrome can be suspected if it is known that the patient's blood coagulates in less than 3 minutes?

Hypercoagulation

@Transition phase

Fibrinolysis

Terminal

Hypocoagulation

#

A patient underwent a surgery for excision of a cyst on pancreas. After this he developed haemorrhagic syndrome with apparent disorder of blood coagulation. Development of this complication can be explained by:

Reduced number of thrombocytes

Activation of Christmas factor

Insufficient fibrin production

@Activation of fibrinolytic system

Activation of anticoagulation system

#

A 68-year-old female is admitted to the hospital for treatment of deep vein thromboses. The next day she suddenly died. At autopsy a large plug of laminated blood clot is found to occlude the main pulmonary artery. Which is likely to be found in her lungs?

@Thromboembolism

Thrombosis

Tissue embolism

Foreign body’s embolism

Fat embolism

#

A post-mortem of a 43-year-old female revealed multiple, hemorrhagic infarcts in lungs. Some lungs' vessels had reddish-brown dense masses within lumens, which were not attached to the vessel walls. Varicose phlebectasia of the legs with thromboses of some veins were also determined. Which pathological process occurred in this case?

@Thromboembolism of pulmonary artery.

Fat embolism of pulmonary artery.

Tissue embolism of pulmonary artery.

Foreign bodies embolism of pulmonary artery.

Gas embolism.

#

The gross appearance of thrombophlebities ofcatheterised subclavian vein is associatedwith:

Multiple lung infarction

@Systemic embolism

Isolated brain infarction

Myocardium infarction

Aneurysm formation

#

A 65-years-old patient suffered by thrombophlebitis of the deep veins of both legs has died suddenly. Autopsy was showed free lying dry friable red masses with a dull crimped surface within the truncus pulmonalis and bifurcation of the lung artery. What process within the vessels did pathologist find?

@Thromboembolism

Thrombosis

Tissue embolism

Postmortem clot

Hemangioma

#

Patient suffering from trombophlebitis of the deep veins suddenly died. Autopsy has shown freely lying red friable masses with dim crimped surface in the trunk and bifurcation of the pulmonary artery. What pathologic process was revealed by morbid anatomist?

Fat embolism

Thrombosis

Embolism with foreign body

@Tromboembolism

Tissue embolism

#

A patient suffering from trombophlebitis of deep veins suddenly died. The autopsy has shown freely lying red friable masses with dim crimped surface in the trunk and bifurcation of the pulmonary artery. What pathologic process was revealed by the morbid anatomist?

Thrombosis

Embolism with foreign body

@Tromboembolism

Fat embolism

Tissue embolism

#

A patient ill with thrombophlebitis of his lower limbs had chest pain, blood spitting, progressing respiratory insufficiency that led to his death. Autopsy diagnosed multiple lung infarctions. What is the most probable cause of their development?

@Thromboembolism of pulmonary artery branches

Thrombosis of pulmonary veins

Thrombosis of bronchial arteries

Thrombosis of pulmonary artery branches

Thromboembolism of bronchial arteries

#

A patient with thrombophlebitis of lower extremities had got chest pains, blood spitting, growing respiratory failure that caused his death. Autopsy revealed multiple pulmonary infarctions. What is the most probable reason of their development?

@Pulmonary artery embolism

Pulmonary venous thrombosis

Bronchial artery thrombosis

Pulmonary artery thrombosis

Bronchial artery embolism

#

Following a fall down some stairs at work, a 64-year-old woman suffers a right hip fracture for which she is hospitalized. She undergoes surgery for placement of a hip prosthesis. She is recuperating from the surgery when she suddenly develops dyspnea and expires in only a few minutes despite resuscitative measures. Autopsy reveals a saddle pulmonary embolus. A 1-cm infiltrating ductal carcinoma is found in the right breast, but there are no metastases. Which of the following statements regarding death certification is most accurate in this case:

@The immediate cause of death is cardiopulmonary arrest

This is a therapeutic misadventure

The mode (manner) of death is accident

Breast carcinoma is a contributing cause of death

E. Pulmonary embolism is the underlying cause of death

#

A 62-year-old patient had a surgery due to acute appendicitis. She had been placed in a bed for 5 days. After she decided to get out of bed she experienced a shortage of air, her face became cyanotic and she lost her consciousness. After unsuccessful resuscitation the patient died. A post-mortem revealed a thromboembolism of the pulmonary artery. Which of the following is most likely source of thromboembolism?

@Thrombosis of veins of the lower extremity

Thrombosis of a portal vein

Thrombosis of mesenteric arteries

Thrombosis in a left ventricle of heart

Ball-shaped thrombus of an auricle

#

A male patient died after a abdominal surgery. During the postmortem numerous thrombuses were found in the veins of the pelvis. Thromboembolic syndrome was diagnosed. Where it is necessary to search for thromboembolics?

@Lungs artery

Portal vein

Left ventricle of heart

Brain

Veins of the lower extremity

#

A 72 year old man has congestive heart failure with decreased cardiac output due to chronic left ventricle aneurysm with large mural thrombosis. All following statements concerning this state are true EXCEPT one:

This state may complicated by systemic embolism

The possible fatal result may associated with pulmonary embolism

@The possible fatal result may associated with brain infarction

The underlying cause of thrombosis is alteration of blood flow

#

During post mortem examination of the corpse 26 year old woman who died from infectious endocarditis of aortic valve have been noted: multiple thrombotic vegetation on the semilunar aortic valves, infarction of the brain, spleen, kidney and gangrene of the right foot. In the both lung there are prominent infarction with abscess (focal suppurative inflammation) formation. Blood culture revealed Staphylococcus aureus. What condition is underlies all these complications:

Systemic embolism

@Systemic thrombobacterial embolism

Pulmonary embolism

Bacterial embolism

#

All following statements are associated with pulmonary embolism EXCEPT one.

The ultimate result depends on the calibre of Ihromboembolus

The possible cause of thrombosis is phlebothrombosis of deep veins

Prolonged thromboembolismleads topulmonary hypertension

@The manifestation of thromboembolism oftruncus pulmonale are multiple infarction of lung

The tromboembolus obstruction of small branches of pulmonary artery results in haemorrhage infarctions

#

A patient has a purulent otitis and thrombosis of a sigmoid sinus of a dura mater. Name the complication if thrombus breaks down and fragments circulate to distal vessels.

@Thromboembolism of branches of pulmonary artery

Thromboembolism of vessels of a brain with development of a grey softening of the brain

Thromboembolism of vessels of a retina of an eye and development of blindness

Thromboembolism of coronary arteries

Local anemia

#

A young male fractures his pelvis and femur in a motor vehicle accident. On the third day he dies after respiratory distress and cerebral dysfunction. A histological examination revealed Sudan-positive orange globules scattered within cerebral cortex, kidneys and lung microcirculatory vessels. Which are most likely diagnoses?

@Fat embolism

Gas embolism

Tissue embolism

Microbial embolism

Thromboembolism

#

A 43-year-old male, with a history of traffic accident and poly trauma, including multiple bone fractures, presented to the hospital. On the second day after the trauma, he complained of a pain in the right half of the chest, heavy breathing. At night, he died due to progressive heart and respiratory failure. Microscopic investigation revealed Sudan-positive orange drops in pulmonary and cerebral vessels that completely occlude the lumens of microcirculatory vessels. What is the most likely complication led to a patient's death?

@Fat embolism.

Gaseous embolism.

Medicamentous embolism.

Microbial embolism.

Thromboembolism.

#

The pulmonalis embolism has suddenly developed in a 40 year-old patient with opened fracture of the hip. Choose the possible kind of embolism.

@Fat

Air

Thrombus-embolus

Tissue

Foreign body

#

A saddle- rider in a rodeo who was first crushed into the gate, then thrown from the horse, then stepped on and kicked by the horse, then dropped from the stretcher by the paramedics carrying him out of the arena, sustained right femoral and left humeral fractures. Two days later he developed respiratory difficulty, most likely due to:

Vasculitis

Pulmonary thromboembolism

Aspiration of gastric contents

@Fat embolism

Pulmonary contusion

#

A 19-year-old offensive tackle for a major university football team fractures his right femur during the first game of the season. He is admitted to the hospital and over the next several days develops progressive respiratory problems. Despite extensive medical intervention, he dies three days later. At the time of autopsy oil red O-positive material is seen in the small blood vessels of the lungs and brain. Which of the following is the most likely diagnosis?

Air emboli

Amniotic fluid emboli

@Fat emboli

Paradoxical emboli

Saddle emboli

#

A 29-year-old man, who had a comminuted fracture of a right femur, presented on the third day after the event with complains of a pain in his chest, hard breathing. In a day he died because of progressive heart insufficiency. Histological examination showed sudanophylic orange drops that closed lumens of microcirculatory vessels in lungs and cerebrum. What complication is associated with the death of the man?

@Fat embolism

Gaseous embolism

Medicine embolism

Bacillary embolism

Thromboembolism

#

2 hours after a skeletal extension was performed to a 27 year old patient with multiple traumas (closed injury of chest, closed fracture of right thigh) his condition abruptly became worse and the patient died from acute cardiopulmonary decompensation. Histological examination of pulmonary and cerebral vessels stained with Sudan III revealed orange drops occluding the vessel lumen. What complication of polytrauma was developed?

@Fat embolism

Thromboembolism

Gaseous embolism

Microbal embolism

Air embolism

#

A patient with severe fracture of both femoral bones has died in a 4 hours after trauma. What additional staining of microscopic sections is it necessary to make for exacter diagnosis of the cause of death?

@The lungs and brain by Sudan III

The lungs and kidney by Congo-red

The lungs and liver by Perl’s reaction

The brain and kidney by Congo-red

The kidney and heart by toluidin-blue

#

A male patient involved in the traffic accident received a wound in the neck due to broken glass. The bleeding was small, but a short time after the accident he died of acute dyspnea. A post-mortem of the heart revealed bubbles excretion when pericardium filled with water. Indicate which pathological process took place:

@Air embolism

Gas embolism

Fat embolism

Thromboembolism

Foreign body’s embolism

#

A male suddenly died after an open fracture of the clavicle. A post-mortem revealed in the right ventricle of the heart and pulmonary arteries the foamy blood. Which one was the cause of death?

@Air embolism

Bacterial embolism

Hemorrhage

Tissue embolism

Fat embolism

#

A cosmonaut died due to the air-tightless of the space-shuttle cabin. Microscopic examination of the vessels of the internal organs revealed multiple bubbles. Liver cells developed fatty dystrophy. In the brain and spinal cord multiple small, grey, soft lesions were discovered. Indicate the most probable cause of such alterations.

@Gas embolism

Air embolism

Fat embolism

Thromboembolism

Tissue embolism

#

During a histological examination of a pilot, who died after depressurization of a plane’s cabin, a great amount of vesicles were detected in the vessels of internal organs. There were also dystrophia adiposa hepatis and multiple, small, ischemic, gray, softened focuses in cerebrum and spinal cord. Select the most possible reason of such changes.

Fat embolism

Aeroembolism

@Gaseous embolism

Thromboembolism

Tissue embolism

#

A pilot has died because of depressurization of the cabin of the airplane. In autopsy it was found out a gross marked rigor mortis, emphysema of subcutaneous tissue of the body and face. There were also edema and perivascular hemorrhages within the lungs. There was a foamy and fluid blood within the veins. The histological examination was showed a lot of bubbles within the vessels of all inner organs, a fat dystrophy of the liver and a quantity of small gray softening areas in the brain. Call the more probable cause of those changes.

@Gas embolism

Air embolism

Tissue embolism

Thromboembolism

Fat embolism

#

A diver who has been staying at the depth of 40 m for a long time fell ill with caisson disease as a result of decompression. The main pathogenetic factor is the following embolism:

Paradoxical

@Gaseous

Tissue

Air

Fat

#

On a trip to the Caribbean, a 29-year-old male takes a scuba diving course. He goes on a wreck dive to a depth of 50 meters (170 feet). His diving partner signals to him that it is time to ascend, but he continues to explore the wreck, noticing some time later than he is running low on air. He panics and ascends to the surface quickly- Within a couple of hours he then develops a headache, tightness in his chest with difficulty breathing, and generalized pain in all extremities. The mechanism for these findings is the result of:

Disseminated intravascular coagulopathy

Hypothermia

Free radical cellular injury

Apoptosis

@Nitrogen bubble formation

#

A male with a history of the decompression sickness developed symptoms of acute cerebral circulation disorder and died soon. A post-mortem revealed in the left hemisphere of the brain the locus of a grey softening of the brain, which was 6x5x3 cm. Which one is most likely to cause the death of the patient?

@Gas embolism.

Fat embolism.

Thrombosis.

Thromboembolism.

Atherosclerosis of the vessels.

#

An inexperienced scuba diver ascends from a depth of 55 meters to the surface in about 5 minutes. Shortly after surfacing he complains of severe muscle contraction and intense abdominal pain. What is most likely diagnosed?

@Gas embolism

Air embolism

Fat embolism

Thromboembolism

#

23-year old female during the course of labour suddenly feels chills, nausea, and vomiting and profound respiratory difficulty. Medical examination revealed deep cyanosis and signs of cardiovascular shock. Few hours later the lung edemas with respiratory failure have been developed. The hypercoagulability state was diagnosed. Later they follows by hypocoagulability with massive bleeding from uterus.What are the name of this potentially fatal labour complication:

Pulmonary embolism due to thrombosis of parametric veins

Fat embolism due to damage of birth canal

@Amniotic fluid embolism due to tear of the placental membranes

Acute myocardial infarction due to systemic embolism

#

The pregnancy for a 27-year-old woman was uncomplicated, with an ultrasound at 19 weeks gestation demonstrating no abnormalities. She goes into labour and 6 hours later has a routine vaginal delivery of a term male. An intact placenta is delivered a few minutes later. However, within a few minutes she develops severe dyspnea and cyanosis, followed by seizures and coma. The most likely explanation for this series of events is:

Disseminated intravascular coagulation

Metastatic choriocarcinoma

Cerebral infarction

@Amniotic fluid embolism

Pulmonary infarction

#

A 29 years old patient has obtained multifragmental thigh bone fracture. Three days after he gained itching in right part of thorax and difficult breathing. One day after he died in the background of progressive cardio-respiratory failure. Histological research revealed sudanophilic drops of orange colour, that clotted the lumen of microcirculatory vessels. What complication caused death of the patient?

@Oil embolism

Gaseous embolism

Medicine embolism

Bacterial embolism

Thromboembolism

#

Inflammation is characterised by increasing penetration of vessels of microcirculation stream, increasing of their fluid dynamic blood pressure. Increasing of the osmotic concentration and dispersity of protein structures present in the intercellular fluid. What kind of oedema will appear in this case?

Hydrodynamic

Lymphogenic

Membranogenic

Colloid-osmotic

@Mixed

#

The concentration of albumins in human blood sample is lower than normal. This leads to edema of tissues. What blood function is damaged?

Maintaining the body temperature

@Maintaining the oncotic blood pressure

Maintaining the blood sedimentation system

Maintaining the Ph level

All answers are correct

#

Laboratory rats that have been fed only with carbohydrate food for a long time display water accumulation in the tissues. What pathogenetic mechanism is the main cause of edema in this case?

Disregulatory

@Hypooncotic

Hyperosmolar

Lymphogenic

Membranogenic

#

Chronic glomerulonephritis was diagnosed in a 34-year-old patient 3 years ago. Edema has developed in the last 6 monthes. What caused it?

Hyperaldosteronism

Hyperproduction of vasopressin

Hyperosmolarity of plasma

Disorder of albuminous kidneys function

@Proteinuria

#

A 9-year-old boy suddenly develops severe testicular pain. He is taken to the emergency room, where he is evaluated and immediately taken to surgery. There his left testis is found to be markedly hemorrhagic due to testicular torsion. Which of the following mechanisms is primarily involver in producing this type of testicular infarction?

Arterial occlusion

Septic implantation

Decreased collateral blood flow

Increased dual blood flow

@Venous occlusion

#

Toxic pulmonary edema was reproduced on a laboratory rat by means of ammonium chloride solution. What is the leading pathogenetic factor of this edema?

Decrease of colloid osmotic pressure

Increase of lymph outflow

Disorder of neural and humoral regulation

Increase of venous outflow

@Increased permeability of capillars

#

A patient was stung by a bee. Examination results: his left hand is hot, pink and edematic, there is a big blister on the spot of the sting. What is the leading mechanism of edema development?

Reduced blood filling of vessels

Vascular damage caused by the sting

@Increased vascular permeability

Reduction of osmotic pressure of tissue

Reduction of oncotic pressure of tissue

#

A 56-year-old patient with cardiac failure notices edematous feet and shins, the skin in the place of edema is pale and cold. What is the leading pathogenesis of this patient's edema?

@ Increased hydrostatic pressure in venulaes

Reduced oncotic pressure in capillaries

Lymph outflow impairment

Increased capillary penetration

Positive water balance

#

Which of the following changes best describes the pathophysiology involved in the production of pulmonary edema in patients with congestive heart failure?

Decreased plasma oncotic pressure

Widespread endothelial damage

@Increased hydrostatic pressure

Increased vascular permeability

Acute lymphatic obstruction

#

The patient with acute miocardial infarction was given intravenously different solutions during 8 hours with medical dropper 1500ml and oxygen intranasally. He died because of pulmonary edema. What caused the pulmonary edema?

Inhalation of the oxygen

Decreased oncotic pressure due to hemodilution

Neurogenic reaction

Allergic reaction

@Volume overload of the left ventricular

#

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INFLAMMATION

Date: 2016-03-03; view: 3774