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Necrosis. Postmortem changes.
MINISTRY OF PUBLIC HEALTH OF UKRAINE
Case studies in Pathomorphology.
Self assessment textbook.
KROK – 1 (STEP – 1)
Part - І
The methodical manual discussed and accepted at session of the academic Council of Lugansk State Medical University 05.10.07, report N 10
Рекомендовано Центральним методичним кабінетом з вищої медичної освіти МОЗ України як навчальний посібник для студентів вищих медичних навчальних закладів ІІІ-ІV рівня акредитації (протокол № 2 від 19.03.2010)
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Pathology of cell. Parenchymal dystrophy.
1. During an autopsy a parenchymal fatty dystrophy of the myocardium was diagnosed. What is the common or descriptive name of the heart due to this dystrophy?
A. *’Tabby cat’ heart (‘Tiger’s’ heart)
B. Bovine heart
C. ‘Hairy’ heart
D. Solder plaque (bony heart)
E. Cor pulmonale
2. A patient with leukemia died from severe chronic anemia. An autopsy revealed an enlarged heart, with flabby myocardium. It had a dim pale-grey color, yellow spots and bars. Which pathological process was found in the heart at post-mortem?
A. * Parenchymal fatty dystrophy
B. Vacuolar dystrophy.
C. Hydropic dystrophy.
D. Mesenchymal fatty dystrophy.
E. Mixed dystrophy.
3. A 53 year old patient died with symptoms of liver insufficiency. A post-mortem examination revealed the enlarged, flabby, yellow-brown liver. Gross examination of the liver’s section showed drops of fat. Microscopically: hepatocytes on the peripheries of the hepatic lobules contained masses of small drops within the cytoplasm. Which process most likely took place in the liver?
A. *Fatty dystrophy of the liver
B. Glucosylceramide lipidosis (Gaucher’s disease)
C. Sphingolopidosis (Niemann-Pick disease)
D. Gangliosidosis (Тay-Sachs disease)
E. Systemic lipoidoses
4. A patient died from chronic cardiovascular insufficiency. At the post-mortem a ’tabby cat’ heart was found. From the side of the endocardium, a yellow-white striped pattern was noticeable. The myocardium was a dim with gray-yellow color. Which process is most likely diagnosed?
A. * Fatty parenchymal dystrophy.
B. Carbohydrate dystrophy
C. Hydropic dystrophy.
D. Fatty mesenchymal dystrophy.
E. Amyloidosis.
5. A seven-year-old child presented with diphtheria of the pharynx. He subsequently died from acute cardiac insufficiency. Post-mortem examination of the heart revealed that the cavities of the heart were extended horizontally. Muscle of the heart were dim and flabby. Gross section showed motley appearance, with yellow areas. Microscopically in the cytoplasm of some myocardial cells small vacuoles were determined. The frozen sections showed vacuoles within cells stained with sudan-III in orange color. Which type of dystrophy was found in myocardial cells?
A. *Fatty dystrophy
B. Carbohydrate dystrophy
C. Vacuolar dystrophy
D. Hyaline dystrophy
E. Hydropic dystrophy
6. A man died due to cardiac insufficiency. At autopsy revealed the heart increased volume and flabby. A myocardium was a clay-yellow color and dim. From the side of the endocardium a yellow-white striped pattern was visible (‘tabby cat’). Under the microscope the groups of myocardial cells lost their normal structure, their cytoplasm contained shallow drops which were black when stained with sudan-IV. Which one of the following is the correct diagnosis?
A. *Fatty dystrophy of myocardium
B. Cardiosclerosis
C. Rheumatic myocarditis
D. Obesity of the heart
E. Myomalacia
7. A 66-year-old male died from cardiac insufficiency. During the dissection an increase volume heart was found. Observation of the heart revealed a flabby consistency with stretched chambers. The myocardium section had a dim, clay-yellowish color. From the side of the endocardium a yellow-white striped pattern was present, which was especially noted in the papillary muscles. Which pathological process is the most credible?
A. *Fatty dystrophy of the myocardium
B. Obesity of the heart
C. Dilatation cardiomyopathy
D. Myomalacia
E. Cardiosclerosis
8. A patient died from pulmonary-cardiac insufficiency. During the dissection a significantly enlarged anemic liver, with yellow doughy consistencies was found. A liver specimen stained with hematoxylin and eosin exposed various sizes of vacuoles in the cytoplasm of the hepatocytes. Which one of the following dystrophies occurred?
A. *Parenchymal fatty
B. Parenchymal carbohydrate
C. Hyaline
D. Mesenchymal fatty
E. Hydropic
9. A 38-year-old patient, suffering from chronic alcoholism and cirrhosis of the liver, developed profuse bleeding due to varicose veins of the esophagus which resulted in death. During the autopsy a liver was noted to be diminished in size with micronodular tuberosity. The organ was dense and rather yellow in color. A histological evaluation of the cryostat specimens of the liver, stained with hematoxylin and eosin, revealed hepatocytes with large, optically empty vacuoles. These vacuoles were black when stained with osmium acid. These optically empty vacuoles hepatocytes indicate:
A. *Fatty dystrophy
B. Inclusions of hyaline.
C. Alcoholic hyaline (Mallory bodies)
D. Vacuolar dystrophy.
E. Carbohydrates dystrophy.
10. A 16-year-old girl presents with the symptoms of sharp pain during swallowing, lymph node enlargement of the neck, and the body temperature of 38°C. The mucous membrane of the tonsils revealed grayish membranes with yellow tapes with were not easily separated from the defect. The patient’s state progressively worsened which death occurring on the 8th day of the disease due to cardiac insufficiency. Which of following histological changes in the myocardial cells will be the most likely finding?
A. *Fatty dystrophy
B. Hydropic dystrophy
C. Hyaline dystrophy
D. Ballooning dystrophy
E. Mucous dystrophy
11. A 44-year-old woman died from chronic alcoholic intoxication. During the autopsy a significantly enlarged liver of doughy consistency and rather yellowish color was found. Microscopically, after staining with hematoxylin and eosin, cytoplasm of the hepatocytes contained optically empty vacuoles. Which type of dystrophy has taken place?
A. *Parenchymal fatty dystrophy
B. Carbohydrate parenchymal dystrophy
C. Hyaline dystrophy
D. Mesenchymal fatty dystrophy
E. Hydropic dystrophy
12. A patient has died from toxic sepsis. During dissection a ‘tabby cat’ (‘tiger’s heart’) was found. Microscopically, lipids were detected in the cytoplasm of the myocardial cells. What is the primary morphological mechanism for development for this dystrophy?
A. *Decomposition
B. Infiltration
C. Transformation
D. Pathological synthesis.
E. Neoplastic alterations.
13. Ultrastructural investigation of a liver biopsy, revealed that between the mitochondria there were numerous flat cisterns and bubbles with secretory granules circumscribed with membrane. Name a cell structure with the hyperplasic constituents?
A. * Golgi apparatus
B. Pinocytosis bubbles
C. Endoplasmic reticulum
D. Lysosoms
E. Microtubes
14. A 42-year-old female became ill with diphtheria and died from acute cardiac insufficiency. During dissection it was noted that the heart cavities were extended and that the muscle of the heart was dim, motley and on a cut surface had yellow areas. Which process was exposed in the myocardial cells?
A. *Fatty dystrophy
B. Carbohydrate dystrophy
C. Ballooning dystrophy
D. Hyaline dystrophy
E. Hydropic dystrophy
15. During the examination of a newborn, some apparent skin differences are noted. The skin is dry, with an uneven surface and with the presence of grey plates which can be removed layer by layer. These changes are related to which type of dystrophy?
A. *Horny dystrophy
B. Hydropic dystrophy
C. Hyaline dystrophy
D. Fibrinoid swelling
E. Mucoid swelling
16. A male patient had a prosthetic appliance on the lower jaw. The ventral surface of tongue revealed a dense, gray plaque with a clear boundary. Histology revealed the thickened of the stratified squamous epithelium due granular and to basal layers thickening, hyperkeratosis, acanthosis, lymphocyte’s infiltration of connective tissue. Make a diagnosis.
A. *Leukoplakia
B. Erythroplakia
C. Papilloma
D. Cancer in sity (intra-epithelial neoplasia)
E. Condyloma
17. During the preventive examination of a worker employed in the coal resins production the areas of thickening and keratinization of the mucous membrane in the oral cavity were found. This occured mainly on the cheeks areas, showing a whitish color with a rough surface. They were not painful. Which pathology is this related to?
A. * Leukoplakia
B. Papillomatosis
C. Glossitis
D. Stomatitis
E. Calcification
18. A 45-year old male is found to have a severe intoxication. A diagnosis of sepsis is made. Several days later he dies. At autopsy, his myocardium grossly had a ‘tiger heart’ pattern. . Microscopically, lipids were detected in the cytoplasm of cardiac hystiocytes. What morphogenetic mechanism prevails in the development of this dystrophy?
A. *Decomposition..
B. Infiltration.
C. Transformation
D. Abnormal synthesis.
E. Colliquation.
19. A 3-month- old infant dies and autopsy is requested. Electron microscopic examination of liver tissue revealed a great amount of flat cisterns and vesicles with secretory granules, surrounded by membrane, scattered among numerous mitochondria. Which of the following cell ultra structures has been shown to be hyperplastic?
A. *Golgi complex.
B. Pinocytic vesicles.
C. Endoplasmic reticulum.
D. Lysosomes.
E. Filaments.
20. A 36-year-old female develops liver failure followed with lethal outcome. Autopsy has shown an enlarged liver of yellow-brown color and soft consistence. Drops of fat are noticed on the liver cut surface and on the scalpel. Microscopically: hepatocytes at peripheral zone of a liver lobules contain small drops that fill cytoplasm and push the nucleus to the periphery. What process in the liver do the following changes testify to?
A. *Fatty degeneration of liver.
B. Cerebrosidelipidosis (Gaucher's disease).
C. Sphingomyelinlipidosis (Niemann — Pick disease).
D. Gangliosidelipidosis (Tay —Sachs disease).
E. Generalized gangliosidosis (Norman—Landing disease).
21. Autopsy of a menopausal woman with a ling history of a chronic ischemic heart disease revealed soft and enlarged heart. Its chambers were extended; the myocardium sectional view was lack-luster with grey- yellowish coloring. An endocardium presented with yellow-white banding, most evident in papillary muscles. What is the most likely pathological process in woman’s heart?
A. *Fatty degeneration of myocardium.
B. Fatty heart.
C. Dilated cardiomyopathy.
D. Myomalation.
E. Cardiosclerosis.
22. A 77-year-old male with a dental prosthesis on his upper jaw is seen by his dentist because of a solid gray patch on his tongue. A lesion has irregular contour, uneven surface, and clear borders. Microscopic investigation of its biopsy revealed the thickening of stratified squamous epithelium, its hyperkeratosis, and acanthosis accompanied with lymphocytes and macrophages infiltration of subjacent connective tissue. What is the most likely diagnosis?
A. *Leukoplakia.
B. Erythroplakia.
C. Papilloma.
D. Cancer in situ.
E. Condyloma.
23. An autopsy of a patient, who died of progressive anemia due to leukemia, revealed enlarged and flabby heart. The cut surface the myocardium was dim, pale-gray with subendocardial yellow spots and streaks. Which of the following pathologic processes had developed in the heart?
A. *Parenchymal fatty dystrophy.
B. Vacuolar dystrophy.
C. Hyaline-drop dystrophy.
D. Mesenchymal fatty dystrophy.
E. Workload hypertrophy
Connective tissue’s (mesenchymal) dystrophy
1. A 56 year old female has been ill with chronic fibrocavernous tuberculosis of the lungs for the past 20 years. She entered the nephrology department with an uremia syndrome. A test for the presence of amyloid in kidneys was positive. Which form of amyloid is indicated in this case?
A. *Secondary
B. Primary
C. Localized
D. Familial congenital
E. Senile
2. The dissection of a 49 year old male reveals a deformed mitral valve, which is thickened and does not completely close. Microscopically the foci of the collagen fibers are eosinophilic and give a positive reaction on a fibrin test? The most credible explanation is:
A. *Fibrinoid swelling
B. Fibrinoid inflammation
C. Mucoid swelling
D. Hyalinosis
E. Amyloidosis
3. A 56 year old patient with a six year history of peritonitis has died. During dissection the capsule of the liver and the spleen was markedly thickened in places and was noted as being dense and semi-lucent. The most credible explanation for this is:
A. *Hyalinosis
B. Necrosis
C. Mucoid swelling
D. Fibrinoid swelling
E. Amyloidosis
4. The dissection of a 48 year old patient who suffered with rheumatoid arthritis reveals an enlarged, dense spleen. A spleen’s section demonstrates its brown-reddish color with enlarged follicles which have the appearance of semi-lucent, grayish-white corns. What is the name of these lesions in the spleen?
A. * Sago-like spleen.
B. Glazed spleen.
C. Sebaceous spleen.
D. Hyalinosis of spleen.
E. Porphyry spleen.
5. During the post-mortem performed on a 72 year old man there are noted some diminished areas of the spleen with a pinkish color. Microscopic examination revealed that the follicles are diminished in volume and the walls of the arterioles and trabeculas are thickened as well as containing homogeneous eosinophilic, PAS-positive masses. Staining with picrofuksin dye reveals the masses to be a red color. These changes indicate the presence of:
A. *Hyalinosis
B. Amyloidosis
C. Mucoid swelling
D. Fibrinoid swelling
E. Sclerosis
6. A 52 year old male died from a heart attack. At the time of dissection a symmetric type of severe obesity discovered. The rupture of the right ventriculum wall resulted in hemopericardium. Under epicardium an excessive fat tissue formation discovered. A microscopy of the sample showed the excecive growth of fatty tissue accompanied with atrophy of myocardial fibers. Which pathological process is most likely responsible for the patient’s death?
A. * Simple obesity of the heart.
B. Fatty dystrophy of myocardium.
C. Ischemic heart disease.
D. Hypertension
E. Acute myocardium infarct
7. During dissection of a 65 year old patient, who suffered from a fibrous-cavernous tuberculosis, an enlarged, dense spleen was found. Spleen section grossly had brown-pinkish color, smooth, waxy-like surface. Which pathological process listed below is the most credible?
A. * Sebaceous spleen.
B. Glazed spleen.
C. Porphyry spleen.
D. Sago spleen.
E. Cyanotic induration
8. A post mortem performed on a 50 year old male who died of a heart attack indicated a symmetric type of obesity of the III degree with rupture of the walls of the right ventricle and hemopericardium. Under the epicardium surplus deposits of fat were found. Microscopically, fatty tissue from the epicardium was dispersed in the myocardium with an atrophy of the muscle fibers. Which process listed below is the most reliable?
A. *Obesity the heart.
B. Fatty dystrophy of myocardium.
C. Acute infarct of myocardium.
D. Ischemic heart disease.
E. Hypertension.
9. An autopsy of a 45-year-old female revealed the kidneys were dense, yellow in color and appear to have a greasy brilliance. Which pathological process is most likely?
A. *Amyloidosis
B. Hyalinosis
C. Fatty dystrophy
D. Mucoid swelling
E. Hemochromatosis
10. Macroscopic examination of a stomach delivered from surgery, revealed a round lesion 1.5cm in diameter which extended by the muscle layer at the antral zone of a small curvature. A semilucent dense area on the bottom of the defect was also determined. It resembled hyaline cartilage. Which process developed in the bottom of the stomach lesion?
A. *Localized hyalinosis
B. Amyloidosis
C. Mucoid swelling
D. Fibrinoid changes
E. Generalized hyalinosis
11. A skin biopsy of a patient with allergic vasculitis was submitted for examination. It is discovered that the vessel walls were thickened and homogeneous. Picrofuxin stained a tissues a yellow color. They were Shiff-positive. Which pathological process developed in the walls of the vessels?
A. *Fibrinoid swelling
B. Amyloidosis
C. Mucoid swelling
D. Hyalinosis
E. Lipidosis
12. The post-mortem of a patient revealed feature of chronic kidney insufficiency. Grossly, kidneys were enlarged, dense, wax-like, with foci of irregular depressed scars on their surface. Microscopically, the mesangeal areas were expanded and the glomerular capillaries obstructed by Congo red stain-positive amorphous acellular material. In some sections the deposits took on nodular appearance. Which of the following diagnoses is most reliable?
A. *Amyloidosis of the kidneys (Amyloid nephropathy)
B. Acute glomerulonephritis
C. Chronic glomerulonephritis
D. Subacute glomerulonephritis
E. Lipoid nephrosis
13. At autopsy a 76-year-old male, with a history of peritonitis 10 years ago, is found to have thickened and dense both liver and spleen capsules. They were translucent on a sectional view. What is the most likely pathology of the described organs capsules?
A. *Hyalinosis.
B. Necrosis.
C. Mucoid swelling.
D. Fibrinoid swelling.
E. Amyloidosis.
14. A 55-year-old female, with a long history of rheumatoid arthritis, develops renal failure and dies. An autopsy revealed an enlarged solid spleen. On the sectional view, its tissue had brown-reddish coloring with enlarged follicles that look like translucent grayish-white grains. What is the most likely pathological process?
A. *Sago spleen.
B. Frosted spleen.
C. Lardaceous spleen.
D. Spleen hyalinosis.
E. Porphyry spleen.
15. A 66-year-old female, with a long history of post-traumatic osteomyelitis, is admitted to the hospital for treatment of nephrotic syndrome. On the night pf admission she suddenly dies. Autopsy revealed dense, white kidneys with scars in the cortical layer; they had a sebaceous glow on the cut surface. What is the most likely kidneys pathology?
A. *Secondary amyloidosis.
B. Primary amyloidosis.
С. Idiopathic amyloidosis.
D. Chronic glomerulonephritis.
E. Chronic pyelonephritis.
16. A 55-year-old man, with a long history of a symmetrical type of severe obesity, developed acute heart insufficiency followed with lethal outcome. An autopsy revealed right ventricle wall burst with hemopericardium and excessive amount of fatty tissue under epicardium. Microscopically: adipose tissue from epicardium penetrates myocardium with muscle fibers atrophy. Name the pathological process?
A. *Simple fatty heart.
B. Fatty degeneration of myocardium.
C. Ischemic disease.
D. Essential hypertension.
E. Acute myocardial infarction.
17. An autopsy of a 56-year-old man with cavernous tuberculosis of the lungs revealed enlarged dense spleen. The cut surface of the spleen tissue had brown-red, smooth, and wax-like appearance. Which of the following is the most likely pathology in the spleen?
A. * Lardaceous spleen. .
B. Glaze spleen.
C. Porphyric spleen.
D. Sago spleen.
E. Cyanotic induration.
18. A patient had been suffering from bronchoectases for a long time and died of uremia. Autopsy revealed enlarged, dense kidneys with greasy cut surfaces. Which of the following was the most likely disease?
A. *Renal amyloidosis.
B. Glomerulonephritis.
C. Acute tubular necrosis.
D. Pyelonephritis.
E. Nephosclerosis
Mixed dystrophy
1. The necrotic Peyer’s patches of the ileum from the patient with typhoid fever are stained in a yellow-brown color. Which pigment impregnates the necrotic tissue?
A. * Bilirubin
B. Hemoglobin
C. Lipofuscin
D. Indol
E. Melanin
2. During post-mortem of a patient arrived from a tropical country, it is discovered that there is a hemomelanosis of a liver, spleen and elements of the reticuloendothelial stroma. These changes are characteristic for which disease?
A. *Malaria
B. Dysentery
C. Diabetes mellitus
D. Exanthematic typhus
E. Grippe
3. A patient who suffered from cancer of the stomach died from cachexia. During the post-mortem the characteristic alteration in the heart were found. How would this condition be termed in the heart?
A. *’Brown’ atrophy
B. ‘Hairy’ heart
C. Solder plaque (bony heart)
D. Tiger’s heart (‘tabby cat’)
E. Bovine heart
4. A man with insufficiency of the mitral valve complained of a cough and sputum with a brownish colouring. Which pigment results in this color of the sputum?
A. *Hemosiderin
B. Melanin
С. Hemoglobin
D. Hemomelanin
E. Iron sulfate
5. The post-mortem of a man who presented in the hospital with a history of a snakebite reveals expressed intravessels hemolysis. During dissection it is noted that the spleen, bone marrow and lymphatic nodes had a brown colouring. Microscopic examination showed that the cytoplasm of macrophages got a brown pigment. Which pigment accumulated in the tissues?
A. * Hemosiderin
B. Hematoidin
C. Hematin
D. Lipofuscin
E. Bilirubin.
6. The dissection of a patient who suffered from rheumatism and chronic rheumatic valvulitis revealed that mitral valve leaflet was thickened with rough stony deposits. Name the pathology presented with stony appearance of the valves?
A. * Dystrophy calcification
B. Metastatic calcification
C. Metabolic calcification.
D. Fibrinoid
E. Amyloidosis.
7. An endoscopy was performed on a patient with a chronic stomach ulcer complicated with hemorrhage. This procedure revealed a brownish (coffee-like) liquid in the stomach. Which pigment results in the color of the stomach contents?
A. * Hematin hydrochloride
B. Hemosiderin
C. Bilirubin
D. Ferritin
E. Porphyrin
8. A 46-year-old man has an acute stomach ulcer complicated by gastric bleeding and vomiting. Gastric masses had a brown color and “coffee-like” appearance. Which pigment created such colouring?
A. * Hematin hydrochloride
B. Hemoglobin
C. Bilirubin
D. Hemomelanin
E. Iron sulfide
9. A 66-year-old patient complained of pain in the hands and feet joints. Physical examination revealed a deformation and painful of the joints. Laboratory tests showed the increased level of uric acid salts in the blood and urine. Which one of following is not being fully metabolized?
A. *Nucleoprotein.
B. Calcium.
C. Chromoprotein.
D. Lipoprotein.
E. Potassium.
10. A man died from chronic sepsis. A post-mortem revealed an atrophy of the skeletal muscles and brown atrophy of both myocardium and liver. Which one of the following pigments accumulated in tissues?
A. *Lipofuscin
B. Lipochrome
С. Hemosiderin
D. Hemomelanin
E. Melanin
11. A 58-year-old male has been ill for many years with leukemia. A post-mortem exposed a brown color in the marrow, spleen, liver, and lymphatic nodes. The Perls’ histochemical reaction was conducted. It was determined that the reticular, the endothelial cells and histiocytes of these organs contained granules of a dark blue color. Which pigment is responsible for the colouring?
A. *Hemosiderin
B. Bilirubin
C. Hematoidin
D. Hemomelanin
E. Hematoporphyrin
12. The post-mortem of a patient who suffered from malaria revealed jaundiced skin, sclera and mucous membranes. Also, the spleen was enlarged and had dark-grey color. This colour of the spleen is due to the presence of:
A. *Hemomelanin
B. Hemosiderin
C. Lipofuscin
D. Melanin
E. Hemoporphyrin
13. A 56 year old patient died from chronic cardiac insufficiency as a result of rheumatic heart-disease. A post-mortem revealed that lungs were enlarged, dense with red-brownish coloring. What is the most likely diagnosis?
A. *Brown induration lungs
B. Acute bronchitis
C. Honey-comb lungs
D. Chronic bronchitis
E. Chronic emphysema
14. A patient with mitral valve insufficiency presents in his sputum cells, filled with brown pigment. The Perls’ reaction is positive. Name this pigment.
A. *Hemosiderin
B. Hematoidin
C. Melanin
D. Porphyrin
E. Bilirubin
15. A 66-year-old male, with a history of hematogenic tuberculosis was examined. This revealed hyperpigmentation of skin and mucous membranes, cachexia and insufficiency of the cardio-vascular system. Which disease caused such changes?
A. *Addison’s disease
B. Phaeochromocytoma
C. Simmond’s disease
D. Cushing disease
E. Greves’ disease
16. A 52-year-old male with a history of sub-acute septic endocarditis is examined by a physician. A doctor revealed marked general pallor with icteric skin, sclera and visible mucous membranes. Blood test showed accumulation of indirect reacting bilirubin (unconjugated bilirubin). The yellow staining of the skin, sclera and mucous membranes indicates which one of the following?
A. *Prehepatic jaundice
B. Fatty dystrophy
C. Hemosiderosis
D. Hepatic jaundice
E. Posthepatic jaundice
17. A 62-year-old female with a history of stomach cancer with plural metastases died from a cachexia. Select the characteristic changes of the heart expected to be revealed on dissection.
A. *Brown atrophy of myocardium.
B. Amyloid cardiomegaly.
C. Dilatation cardiomyopathy.
D. Hypertrophy cardiomyopathy.
E. “Tabby cat” ("Tiger’s heart").
18. A patient developed a cyst in the cerebrum following a hemorrhagic stroke. Two years later the patient died from pneumonia due to a complication of influenza. During examination of the brain cyst it is noted that the walls have a rusty tint. Perls’ reaction is positive. Name the process occurring in the wall of the cyst?
A. *Localized hemosiderosis
B. General hemosiderosis
C. Local hemomelanosis
D. Infiltration of bilirubin
E. Primary haemochromatosis
19. A patient with a long history of tuberculosis was examined at the hospital. Physical examination revealed a grayish-brown skin color, lowered arterial pressure, hypodynamia and a decline of the level of 17-oxycorticosteroids in the urine and blood plasma. A problem with the metabolism of which pigment is indicated by the clinical signs of this patient?
A. *Melanin
B. Bilirubin
C. Lipofuscin
D. Lipochrome
E. Hemosiderin
20. A fragment of skin (1х2 centimeters) delivered for histological research. Grossly a small (0,5 cm in diameter) slightly elevated brown lesion, sharply demarcated from the surrounding normal skin, was recognized. Microscopically, a lesion presented with nevus cells nests, rich with brown pigment. This pigment had negative Perls’ reaction. Name the pigment.
A. *Melanin
B. Hematoidin
C. Hemosiderin
D. Bilirubin
E. Hemomelanin
21. A 55-year-old male with a history of bronchiectasis, pneumosclerosis and cachexia died. During the post-mortem examination the heart was found to be diminished in size, flabby, with thinned walls. A section revealed brownish color of the heart’s tissue. Which pigment was indicated in the myocardium?
A. * Lipofuscin
B. Hemosiderin
C. Hematoidin
D. Melanin
E. Lipochrome
22. A post-mortem of a 44-year-old patient with a history of mitral stenosis reveals dense lungs that are a brown color. Which pathological process is most likely in the lungs?
A. *Hemosiderosis
B. Hemochromatosis
C. Icterus
D. Hemomelanosis
E. Lipofuscinosis
23. A post-mortem was performed on a 55-year-old male, who over last eight years suffered from chronic form of malaria. At the dissection both grey matter of the cerebrum and a spleen had the ash-grey color. Which pigment is responsible for this discoloration?
A. *Hemomelanin
B. Lipofuscin
C. Hematoporphyrin
D. Melanin
E. Hemosiderin
24. A 62-year-old male who has been ill with diabetes mellitus for 15 years died from a cerebral hemorrhage. Post-mortem revealed kidneys diminished in size with a fine-grained surface. The epithelium of the canaliculi of distal nephron’s segment was high, with a light foamy cytoplasm. The Best’s carmine staining demonstrated a bright red coloring of the cytoplasm’s accumulations. These changes in the epithelium resulted from the accumulation of:
A. *Glycogen
B. Lipids
C. Hyaline
D. Proteins
E. Amyloid
25. At autopsy 68-year-old male is found to have cancer of the esophagus, accompanied with cachexia. Grossly, fatty tissue disappeared, both a liver and a heart were atrophic. Microscopy revealed brown-yellowish corn-like deposited next to nuclei of myocardial cells. These accumulations had negative Perls’ reaction. Name the material of accumulations.
A. *Lipofuscin
B. Melanin
C. Hemosiderin
D. Ferritin
E. Hemomelanin
26. A 55-year-old patient with a bilateral adrenal glands lesions presented with dark brown colouring of the skin. During histochemical examination of the skin the Perls’ reaction was negative. Which pigment is responsible for this discoloration of the skin?
A. *Melanin
B. Hemosiderin
C. Porphyrin
D. Lipofuscin
E. Biliverdin
27. A 58-year-old female with a long history of chronic dysentery died. At autopsy, the stroma and parenchyma of the myocardium, kidneys, the mucous membrane of the stomach, and the connective tissue of lungs revealed violet color amorphous masses, which had positive Koss’ reaction. Which pathological process developed in the patient’s organs?
A. *Metastatic calcification
B. Dystrophy calcification
C. Metabolic calcification
D. Amyloidosis
E. Hyalinosis
28. A 45-year-old male, with a long history of rheumatism and mitral valve insufficiency, develops a chronic cough with rusty expectoration. What pigment colored sputum?
A. *Hemosiderin.
B. Melanin.
C Hemoglobin.
D. Malarial pigment.
E. Iron sulfide.
29. A 67-year-old male, with a long history of mitral valve’s insufficiency, has been experiencing a cough with red-brownish coloring of a sputum. Cells with brown pigmentation and positive Perls' test were detected in the sputum. Which pigment responsible for the septum coloring?
A. *Hemosiderin.
B. Hematoidin.
C. Melanin.
D. Porphyrin.
E. Bilirubin.
30. A 38-year-old female with chronic stomach ulcer complicated with bleeding examined endoscopically. Stomach masses had coffee ground coloring. Which pigment responsible for this coloring?
A. *Hematin chloride.
B Hemosiderin.
C. Bilirubin.
D. Ferritin.
E. Porphyrin.
31. A 47-year-old male, with a history of secondary syphilis, has noticed foci of the skin depigmentation at his neck. Name the pathological process of the skin.
A. *Leukoderma.
B. Metaplasia.
C. Leukoplakia.
D. Dysplasia.
E. Parakeratosis.
32. a 38-year old female is found to have bilateral adrenal adenopathy resulted in brownish coloring of her skin. Perls' test of her skin’s biopsy was negative. What pigment altered the color of the skin?
A. *Melanin.
B. Hemosiderin.
C. Porphyrin.
D. Lipofuscin.
E. Biliverdin.
33. A 70-year-old man has noticed recent swelling of joints of his hands and feet. Joints are painful and stiff. Laboratory tests revealed an increased level of urates in blood and urine. What is the most likely substance caused described pathology?
A. *Nucleoproteins.
B. Calcium.
C. Chromoproteids.
D. Lipoproteins.
E. Potassium.
34. A 70 year-old male with a history of chronic shigellosis died. At post-mortem tissue samples were collected for histopoly. Microscopic investigation of hematoxylyn and eosin slides revealed amorphous violet deposits in stroma of the heart, kidneys, lungs and stomach mucosa. Koss' reaction was positive. What is the most likely pathological developed?
A. *Metastatic calcification.
B. Dystrophic calcification.
C. Metabolic calcification.
D. Amyloidosis.
E. Hyalinosis.
35. A woman presented to intensive care department with symptoms of severe hemolysis due to a snake bite. An autopsy revealed brown coloration of the spleen, bone marrow, and lymph nodes. Microscopic examination showed the accumulation of brown pigment in cytoplasm of macrophages of tissue sampler. Which of the following is the pigment that was accumulated in the tissues?
A. *Hemosiderin
B. Hematoidin.
C. Hematin
D. Lipofuscin.
E. Bilirubin.
36. A patient with prolonged esophageal carcinoma died of cachexy. An autopsy revealed atrophy of his heart and liver, marked reduction of subcutaneous and retroperitoneal fatty tissue. Microscopical examination revealed accumulations of the golden-brown granules and clumps with negative Prussian blue reaction within the myocardial fibers. Which of the following pigments accumulated in myocardial fibers?
A. *Lipofuscin.
B. Melanin.
C. Hematoidin.
D. Ferritin.
E. Hemomelanin.
Necrosis. Postmortem changes.
1. A male had a surgery due to “acute abdomen”. During the operation it was noted that the peritoneum was dull and in the lumen of the mesenteric artery superior a thrombus was detected. About 80 centimeters of the ileac intestine had a black colouring. Which process was diagnosed in the intestine?
А. *Gangrene
B. Decubitus ulcer
C. White infarct
D. White infarct with a hemorrhagic crown
E. Coagulative necrosis
2. A patient with diabetes mellitus presents to his physician with an acute pain in the right foot. At inspection the toe of foot had a black colour, the tissues of foot were edematous, with bed smell. Which form of necrosis was likely to be diagnosed?
А. * Moist (wet) gangrene
B. Decubitus ulcer
C. Sequester
D. Dry gangrene
E. Infarct
3. A 63-year-old male died of an endemic typhus. During the post-mortem it was revealed that the muscles of the abdominal wall and legs were dense with whitish-yellowish colouring. They resemble a candle. Name the pathological process?
А. *Waxy necrosis (Zenker’s necrosis)
B. Apoptosis
C. Fibrinoid necrosis
D. Colliquative necrosis
E. Caseous necrosis
4. A 72-year-old-male had an infarct of the dextral hemisphere of the brain. One year later a computer tomography of the right hemisphere of the brain reveals a cavity with smooth walls and filled with liquid. Which pathological process is he most likely to have?
А. *Post-infarct cyst
B. Hydrocephalus
C. Grey softening of a brain
D. Infarct of a brain
E. Hematoma
5. A post-mortem revealed a thrombus in the left artery mesencephalicae and a large locus of grey softening in the tissues of the left hemisphere of a brain. Which pathological process is most likely to be present in the brain?
А. * Ischemic infarct
B. Coagulative necrosis
C. Abscess
D. Moist gangrene
E. Sequestrum
6. At a post-mortem of the 46-year-old male a large yellow - grey lesion was found in the left ventricle of the heart. A fresh thrombus was found in the coronary artery. What disease is he most likely to have?
А. *Infarct of the myocardium
B. Cardiosclerosis
C. Myocarditis
D. Amyloidosis
E. Cardiomyopathy
7. At autopsy a 60-year-old male is found to have ischemic heart disease and atherosclerosis of the coronary arteries of heart. A section of the myocardium showed a white-yellowish focus, surrounded by the zone of hemorrhages in the apex, anterior and lateral walls areas of a left ventricle. Which is the most likely diagnosis?
А. *Infarct of the myocardium
B. Post-infarction cardiosclerosis
C. Diffuse cardiosclerosis
D. Myocarditis
E. Fatty dystrophy of the myocardium
8. After a long staying in the bed a patient with circulatory deficiency got the skin and soft tissue darening above the sacrums. These tissues became swallowed. Sloughing off the epidermis in this area resulted in ulceration. Which complication is most likely?
А. *Decubitus ulcer
B. Dry gangrene
C. Phlegmon
D. Infarct
E. Abscess
9. Histological investigation of liver’s biopsy revealed that some cells burn on small pieces with separate organellas and nuclei fragments surrounded by a membrane. The inflammatory reaction was missing. Select pathological process, the described changes are characteristic for:
А. *Apoptosis
B. Necrosis
C. Karyorrhexis
D. Plasmolysis
E. Plasmorrhexis
10. A male who had a long history of the intermittent claudication demonstrates the tissue of the foot fingers as being dry with a black colour, resembling a mummy. On small interval from this place the dichromatic line (red colour is next to unchanged tissues, and white - yellow colour close to a tered tissues). Which type of a necrosis occurred?
А. *Gangrene.
B. Infarct.
C. Sequester.
D. Decubitus ulcer.
E. Maceration.
11. A 62-year-old male got a surgery due to the inguinal hernia. Macroscopic examination reveals that the wall of the intestine was a cyanotic, inflated, swallowed and coated with threads of a fibrin. Peristalsis was not heard. Which pathological process occurred in the wall of the intestine?
А. * Moist gangrene.
B. Dry gangrene.
C. Coagulate necrosis
D. Colliquative necrosis
E. Decubitus ulcer
12. A postmortem of a man, who died from typhoid revealed muscles on the abdominal wall and legs were dense, fragile, whitish-yellowish colour, resembling a candle. Which term best characterizes the muscles changes?
А. *Zenker’s necrosis
B. Fibrinoid necrosis
C. Caseous necrosis
D. Colliquative necrosis
E. Apoptosis
13. A 48-year-old male, who had a history of hypertension for 12 years, present acute disturbance of the cerebral circulation. He developed a headache and alteration of the motion in the right extremity. Following right-handed hemiplegia resulted in fatal outcome. A postmortem revealed a systemic hyalinosis of the small arteries, thrombosis in the left arteria cerebri media. In the left parietal-temporal area a lesion was found, which is called:
А. *Ischemic infarct
B. Hemorrhage
C. Abscess of a brain
D. Hemorrhagic infarct
E. Edema of the brain
14. A 45-year-old male suddenly died with the following findings revealed during the postmortem. In the back wall of the left ventricle of the heart a myocardial infarction was found. Which of the following microscopic changes in the myocardiocytes can be seen in the locus of an infarct?
А. *Karyolysis
B. Fatty dystrophy
C. Carbohydrate dystrophy
D. Calcification
E. Protein dystrophy
15. A postmortem of on a previously ill 48-year-old patient found an obturation of the lumen of the middle cerebral artery due to a thrombus. In the parietal-temporal area of the left hemisphere of the brain a locus of grey colour tissue with soft texture is found. Which tern best characterizes the brain tissue changes?
А. *Infarct
B. Sequester
C. Gangrene
D. Caseous necrosis
E. Fibrinoid necrosis
16. A postmortem on the upper lobe of the right lung reveals the large triangle-like locus of the dark red dense tissue. Histological examination indicates necrosis of the walls of the alveolus’s and the lumens filled with erythrocytes. Which is the most likely associated finding?
А. *Hemorrhagic infarct
B. Carnification
C. Lung’s gangrene
D. Hemorrhage
E. Atelectasis
17. A postmortem on an elderly male with atherosclerosis reveals a thrombus in a branch of the internal carotid artery as well as a grey locus of a moist softening of the brain’s tissue. Which pathological process was found in the brain?
А. *Ischemic infarct
B. Hemorrhagic infiltration
C. Hematoma
D. Encephalitis
E. Tumor of a brain
18. A surgery on a patient, with a history of syphilis revealed a locus of flabby tissue. Grossly, this locus was yellowish, dry, structures and gummy. The most likely diagnoses is:
А. *Caseous necrosis
B. Infarct
C. Waxy necrosis
D. Fibrinoid a necrosis
E. Steatonecrosis
19. The investigation of the liver’s biopsy revealed that some separately arranged cells burn on small-sized pieces surrounded by a membrane. In some of them there were organelles, other had the fragments of dissolved nuclei. The inflammatory reaction around these cells missed. Name these changes:
А. *Apoptosis
B. Atrophy
C. Necrosis
D. Hypoplasia
E. Dystrophy
20. An ill elderly patient with a atherosclerosis, develops pain in the left foot. Grossly was found the foot enlargement, its tissues were black, flabby and macerated. The demarcation zone was not expressed. Which term best characterized the foot tissues changes?
А. * Moist (wet) gangrene.
B. Mummification.
C. Coagulate necrosis.
D. Dry gangrene.
E. Sequestrum.
21. A 62-year-old female with atherosclerosis was admitted to the hospitalized. At surgery gross examination revealed purulent peritonitis. During the operation a thrombus in the mesenteric arterias was found. Which was the most likely cause of the peritonitis?
А. *Hemorrhagic infarct.
B. Angiospastic ischemia
C. Ischemic infarct
D. Stasis
E. Compressive ischemia
22. The examination of a child, who had a history of measles, revealed reddish-black, uneven, swollen, slightly fluctuated lesions of cheaks and perineum area. Name the complication of measles?
А. * Moist gangrene (noma)
B. Dry gangrene
C. Gas gangrene
D. Decubitus ulcer
E. Trophic ulcer
23. A postmortem was performed on a female who died due to the cystadenocarcinoma metastases. The postmortem revealed large segments of a necrosis of the skin and soft tissues within cubitus area. Name the form of the necrosis.
А. *Decubitus ulcer
B. Infarct
C. Sequester
D. Caseous necrosis
E. Zenker’s necrosis
24. A 58-year-old female with the history of atherosclerosis dies suddenly due to acute heart failure. Gross inspection of the left ventricle of the heart revealed a whitish-yellowish 6x5 cm, dense lesion with uneven boundaries and hemorrhagic zone next to it. Which is most likely diagnose?
А. *Infarct of the myocardium
B. Postinfarction fibrosis
C. Healed infarct
D. Myocarditis
E. Ischemic cardiomyopathy
25. An ultrastructural examination of a salivary gland revealed within cells pieces of the nuclei surrounded by a membrane. Also condensate fragments of nuclear material and separate organelles were found. An inflammatory reaction around these cells was missing. Which term most correctly defines these alteration?
А. *Apoptosis
B. Karyorrhexis
C. Coagulation necrosis
D. Karyopyknosis
E. Karyolysis
26. A patient with tuberculosis has a kidney biopsy performed. Histological investigation revealed the caseous necrosis of the tissue accompanied by disorderly arranged fine grains of a chromatin. Which term most correctly defines describe lesion?
А. * Karyorrhexis
B. Karyolysis
C. Karyopyknosis
D. Mitotic activity of nuclei
E. Apoptosis
27. A postmortem of a 48-year-old male who had a history of typhoid fever revealed that the rectus abdominis at the wall was dense, a whitish colour, and resembled a candle. Which is the most likely diagnosis?
А. * Waxy necrosis
B. Fibrinoid necrosis
C. Colliquative necrosis
D. Caseous necrosis
E. Apoptosis
28. A 44 year old ill patient died due to the severe chronic heart failure. Pathologist diagnosed rheumatic granulomatous myocarditis. Microscopic evaluation of the myocardium indicated the presence of granulomas which consisted of macrophages with hyperchromatic nuclei and clear cytoplasm. Also necrosis was seen in the center of a lesion. Which is the most likely type of necrosis in the center of the lesion?
А. * Fibrinoid necrosis.
B. Waxy necrosis.
C. Caseous necrosis.
D. Colliquative necrosis.
E. Fatty dystrophy.
29. A 57-year-old patient has a long history of the type II diabetes mellitus. Physical examination revealed the alteration of the right foot tissues. They are dense, black with precise boundaries from normal tissues. Which term most correctly describe the lesion?
А. *Dry gangrene.
B. Wet (moist) gangrene.
C. Gas gangrene.
D. Decubitus.
E. Trophic ulcer.
30. A postmortem examination of a dead body revealed a cloudy corneas, dry skin with yellowish - brown lesion. Which term most correctly identifies describes a post-mortem alterations?
А. *Cadaver desiccation
B. Clotting of blood
C. Livor mortis
D. Rigor mortis
E. Algor mortis
31. The postmortem of a 48-year-old male reveals in the right temporal lobe of the brain a large grey lesion with a softening, porridge-like texture. The basal arteries of the brain had numerous white - yellow thickenings of an intima which significantly decreased lumen. Which is the most likely diagnosis?
А. *Ischemic infarct
B. Abscess of a brain
C. Hematoma
D. Hemorrhagic infarct
E. Edema of the brain
32. At post-mortem, a 60-years-old man, with a history of typhoid fever, is found to have rectus muscles of the anterior abdominal wall dense, whitish, and look like a stearic candle. What is the most likely diagnose?
A. *Zenker's necrosis.
B. Fibrinoid necrosis.
C. Colliquative necrosis.
D. Caseous necrosis.
E. Apoptosis.
33. A 65-year-old female, with a long history of diabetes mellitus, presented her black, edematous and painful thumb of the right foot. Gross inspection revealed a focal epidermal detachment and malodorous discharge. What is the most likely clinicopathologic form of necrosis?
A. *Moist (wet) gangrene.
B. Decubitus ulcer.
C. Sequester.
D. Dry gangrene.
E. Infarction.
34. A 5-year-old boy with measles presents to his pediatrician with necrotic changes of his cheeks. Gross inspection revealed that the cheeks soft tissues were edematous with reddish black fluctuated indistinctly outlined foci. What is the most likely complication of a measles?
A. *Moist gangrene.
B. Dry gangrene.
CGas gangrene.
D. Decubitus ulcer.
E. Trophic ulcer.
35.A physical examination of 67-year old lady, with a history of femoral bone fracture, revealed a sequester formation accompanied with chronic inflammation of a bone marrow and adjacent tissues. What is the most likely disease caused such lesions?
A. *Osteomyelitis.
B. Reticulosarcoma.
C. Multiple myeloma.
D. Osteoclastoma.
E. Periostitis.
36. An elderly woman with a history of a stroke one year ago complains of a left limbs immobility. A computer tomography examination revealed a cavity filled with liquor, at right hemisphere of her brain. What is the most likely diagnose?
A. *Postinfarction cyst.
B. Hydrocephaly.
C. Grey encephalomalacia.
D. Cerebral infarction.
E. Hematoma.
37. A section of the left lung was found to have an area of dense red tissue. The area was cone-shaped, stood out distinctly from the healthy tissue, with its base directed to the pleura. The dissected tissue was granular, dark-red. What is the most likely diagnosis?
A. *Haemorrhagic infarction
B. Lung gangrene
C. Lung abscess
D. Croupous pneumonia
E. Primary tuberculous affection
38. An autopsy of a dead patient with typhoid fever revealed firm, fragile, whitish-yellow, and waxy muscles of the anterior abdominal wall and thighs. What is the most likely pathology of muscles?
A. *Zenker necrosis.
B. Fibrinoid necrosis.
C. Caseous necrosis.
D. Colliquative necrosis.
E. Apoptosis.
39. A 55-year-old patient with 12 years history of hypertensive disease presented to a hospital with disturbances of cerebral blood circulation resulted in right-side hemiplegia. He died shortly after arrival. A postmortem revealed systemic hyalinosis of small blood vessels and thrombosis of medial cerebral artery. There was also a focus of a structureless grayish tissue in the temporal lode of left hemisphere. The focus was interpreted as:
A. *Ischemic infarction
B. Hemorrhage
C. Abscess
D. Hemorrhagic infarction
E. Edema
40. A 59-year-old patient with transmural myocardial infarction died of cardiac tamponade due to ruptured myocardial infarct. Which process resulted in a heart’s wall rupture?
A. *Autolytic process leading to myocardial softening (myomalacia)
B. Replacement of infracted areas by connective tissue (organization)
C. Increasing of blood pressure in pulmonary circulation
D. Myocarditis
E. Chronic aneurism
41. A 58-years-old smoker with a 5-year history of angina pectoris died during the heart attack. An autopsy revealed atherosclerosis of the coronary arteries with thrombosis, uneven color of anterior wall of the left ventricle and flabbiness of the myocardium. What is the most likely diagnosis?
A. Myocardial infarction
B. Angina pectoris
C. Myocarditis
D. Postinfarction cardiosclerosis
E. Myocardial aneurysm
42. A 74-year-old patient with a history of hypertensive syndrome developed collapse and died of increased disturbances of respiration and heart activity. An autopsy revealed a dark-red 2x1x5 cm bloody focus in the trunk of the brain. Vessels of the brain base were considerably thickened, whitish-yellow, with narrowed lumen. What is the most likely diagnosis?
A. Hemorrhagic infarct
B. Cyst of the brain
C. Gumma of brain
D. Ischemic infarct
E. Meningioma
Blood and lymph circulation disorders.
1. The postmortem of a 48-year-old male, with a long history of a chronic heart failure, revealed an enlarged liver. Grossly, a liver had a motley pattern. Macroscopically, the sectional view looked like a nutmeg on incision. Which term most correctly defines these alteration?
А. * General venous plethora
B. General arterial plethora
C. Anemia
D. Hemorrhage
E. Bleeding
2. 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?
А. * Thromboembolism of pulmonary artery.
B. Fat embolism of pulmonary artery.
C. Tissue embolism of pulmonary artery.
D. Foreign bodies embolism of pulmonary artery.
E. Gas embolism.
3. 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 thromboembolies?
А. *Lungs artery
B. Portal vein
C. Left ventricle of heart
D. Brain
E. Veins of the lower extremity
4. The histological investigation of a liver detects venous plethora of center lobules, dystrophy and atrophy of hepatocytes in the venous plethora’s area, fatty a dystrophy of hepatocytes on the periphery of a lobe. The replacement fibrosis in places of an atrophy of the hepatocytes was also revealed. Which pathological process does this refer to?
А. * ‘Nutmeg’ liver with precirrhotic phenomena.
B. Biliary hepatic cirrhosis.
C Fatty hepatosis.
D. Hepatitis.
E. Toxic dystrophy of a liver.
5. 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?
А. *Clotting of a blood.
B. Hemolysis of erythrocytes and compensatory induction of a hemogenesis
C. General arterial plethora
D. Polycythemia
E. Hyperchromatic anemia
6. A male with a history of myocardial infarct died of cardiovascular failure. A post-mortem revealed a replacement fibrosis, hypertrophy of the myocardium and dilatation of the cavities, especially the right ventricle. The liver was enlarged. Its surface was smooth. Grossly, a motley pattern with dark red dots on the grey a background was revealed. Histologically, central zones of the lobules were hyperemic. On the periphery, around of periportal tracts hepatocytes demonstrated fatty dystrophy. Name these liver changes.
А. *”Nutmeg” liver (chronic venous plethora)
B. Pseudo ‘nut-meg’ liver
C. Amyloidosis
D. Cirrhosis of a liver
E. Steatosis of a liver
7. 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:
А. *Air embolism
B. Gas embolism
C. Fat embolism
D. Thromboembolism
E. Foreign bodies embolism
8. A 52-year-old male with long history of rheumatic heart disease died of chronic heart failure. A post-mortem revealed brown colour, enlarged dense lungs. Name the changes in lungs.
А. *Brown induration of lungs
B. Acute bronchitis
C. Horny-comb lungs
D. Chronic bronchitis
E. Chronic emphysema
9. A patient, who had fast elimination of 10 liters of an ascitic liquid from abdomen, suddenly lost his consciousness. What was the cause of this phenomenon?
А. *Anemia of the brain
B. Thrombosis of the cerebral arteries
C. Brain hemorrhage
D. Arterial hyperemia
E. Thrombosis of the cerebral veins
10. A young male with a history of rheumatic heart disease since childhood, gradually develops mitral stenosis, accompanied with episodes of heart failure. He presents to a hospital complaining of coughing with a reddish-brown sputum. Name probable changes at patient’s lungs.
А. *Brown induration of lungs
B. Emphysema of lungs
C. Atelectasis of lungs
D. Pneumosclerosis
E. Bronchiectasis
11. At autopsy an elderly female is found to have a blood clot in the femoral artery, which grossly had a striped pattern. Microscopy revealed a congestions of fibrin fibers and broken down red and white cells. Which is the most likely type of thrombus ?
А. *Mixed thrombus
B. Postmortem convolutions of a blood
C. Thromboemboli
D. Hyaline thrombus
E. Red thrombus
12. 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.
А. *Thromboembolism of branches of pulmonary artery
B. Thromboembolism of vessels of a brain with development of a grey softening of the brain
C. Thromboembolism of vessels of a retina of an eye and development of blindness
D. Thromboembolism of coronary arteries
E. Local anemia
13. 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?
A. *Fat embolism.
B. Gaseous embolism.
C. Medicamentous embolism.
D. Microbial embolism.
E. Thromboembolism.
14. 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?
А. *Thrombosis of veins of the lower extremity
B. Thrombosis of a portal vein
C. Thrombosis of mesenteric arteries
D. Thrombosis in a left ventricle of heart
E. Ball-shaped thrombus of an auricle
15. A male with a fracture of the shoulder bone carried on overlapped plaster bandage. Suddenly, an arm and the visible part of the forearm became cyanotic, cold, and edematous. Which of the following is most likely happened?
А. *Local venous plethora
B. Local arterial plethora
C. Local anemia
D. Stasis
E. Thrombosis
16. An elderly female develops acute disorder of the cerebral blood circulation, followed with coma, resulted in fatal outcome. A post-mortem revealed in the right hemisphere of the brain a large cavity, filled with blood. Which pathological process took place in the brain?
А. *Hematoma
B. Hemorrhagic infiltration
C. Infarct of the brain
D. Diapedesis
E. Edema of the brain
17. 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?
А. *Air embolism
B. Bacterial embolism
C. Hemorrhage
D. Tissue embolism
E. Fat embolism
18. 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 6х5х3 cm. Which one is most likely to cause the death of the patient?
А. *Gas embolism.
B. Fat embolism.
C. Thrombosis.
D. Thromboembolism.
E. Atherosclerosis of the vessels.
19. A post-mortem of an elderly man with a long history of the ischemic heart disease and heart failure revealed a nutmeg liver, brown induration of lungs, cyanotic induration of kidney and spleen. Indicate, what type of the blood circulation disorder is most likely?
А. * Chronic general venous plethora.
B. Arterial hyperemia.
C. Acute general venous plethora.
D. Acute anemia.
E. Chronic anemia.
20. A 50-year-old male with a myocardial infarction died from the heart failure. A post-mortem revealed the edema of the lungs and petechial hemorrhages at serous and mucus membranes. Microscopic examination indicated marked dystrophic alterations of the nephron’s epithelium at proximal canaliculi of kidneys. Also, the centrolobular hemorrhage and necrotic zones were found in the liver. Name the type of the blood circulation disorder.
А. * Acute general venous plethora.
B. Arterial hyperemia.
C. Chronic general venous plethora.
D. Acute anemia.
E. Chronic anemia.
21. 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?
А. * Septic autolysis.
B. Aseptic autolysis.
C. Organization and vascularization of the thrombus.
D. Thromboembolism.
E. Calcification of a thrombus.
22. 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 likel